Determinants of cholera among affected population of Ethiopia: a systematic review and meta-analysis

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BACKGROUND: In Ethiopia, cholera is still a serious public health concern, and outbreaks are frequently caused by a lack of safe drinking water, sanitation, and hygiene (WASH) facilities. Very few nationally representative studies from Ethiopia exist, despite the global determinants of cholera being widely known. Therefore, this study aimed to identify the key determinants of cholera outbreaks across various regions in Ethiopia. METHODS: We conducted a systematic review and meta-analysis following the PRISMA and MOOSE guidelines, and the study was registered on PROSPERO (CRD420251035681). We included English observational studies (both cross-sectional and case-control studies) on the determinants of cholera in Ethiopia, regardless of the publication year. Using MeSH terms and Boolean operators, searches were conducted throughout PubMed, Web of Science, EMBASE, SCOPUS, MEDLINE, CINAHL, and gray literature. The Newcastle-Ottawa Assessment Scale was used to evaluate the quality of each featured article. STATA version 17 and Microsoft Excel 2013 were used for data extraction and analysis, respectively. A random-effects model was used for the meta-analysis, and heterogeneity was assessed using the Cochrane Q statistic and I2 statistic. Furthermore, publication bias was identified using Egger’s test (p < 0.05) and/or visually inspecting the asymmetry of the funnel plot. RESULTS: The search strategy retrieved 1701 articles, leaving 805 after duplicates were removed. After screening, 62 were eligible; however, 53 papers were removed due to the outcome of interest not being reported. For the final analysis, nine studies, eight case-control studies, and one cross-sectional study were examined. Key determinants for cholera in Ethiopia included not using sanitary latrines (AOR: 3.52; 95% CI: 1.40–5.65), drinking untreated water (AOR: 3.03; 95% CI: 1.62–4.45), and proper handwashing practices (AOR: 0.16; 95% CI: 0.01–0.30). CONCLUSION: Access to safe drinking water, the use of sanitary latrines, and proper handwashing practices are key determinants of cholera in Ethiopia. Therefore, strengthening WASH interventions and promoting behavior change are essential strategies for cholera prevention and control. CLINICAL TRIAL NUMBER: Not applicable.

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