Development of a Scorecard to Monitor Progress toward National Cholera Elimination: Its Application in Uganda

Abstract

In 2017, the Global Task Force for Cholera Control (GTFCC) set a goal to eliminate cholera from ≥ 20 countries and to reduce cholera deaths by 90% by 2030. Many countries have included oral cholera vaccine (OCV) in their cholera control plans. We felt that a simple, user-friendly monitoring tool would be useful to guide national progress toward cholera elimination. We reviewed cholera surveillance data of Uganda from 2015 to 2021 by date and district. We defined a district as having eliminated cholera if cholera was not reported in that district for at least 4 years. We prepared maps to show districts with cholera, districts that had eliminated it, and districts that had eliminated it but then "relapsed." These maps were compared with districts where OCV was used and the hotspot map recommended by the GTFCC. Between 2018 and 2021, OCV was administered in 16 districts previously identified as hotspots. In 2018, cholera was reported during at least one of the four previous years from 36 of the 146 districts of Uganda. This number decreased to 18 districts by 2021. Cholera was deemed "eliminated" from four of these 18 districts but then "relapsed." The cholera elimination scorecard effectively demonstrated national progress toward cholera elimination and identified districts where additional resources are needed to achieve elimination by 2030. Identification of the districts that have eliminated cholera and those that have relapsed will assist the national programs to focus on addressing the factors that result in elimination or relapse of cholera.

Figure 1.

Map of Uganda showing cholera hotspots identified using data from 2011 to 2016. The SaTScan method identifies districts with a statistically significant increase in the risk of cholera compared with the country as a whole.

Figure 2.

Map of Uganda showing districts where oral cholera vaccine (OCV) campaigns were conducted, 2018–2021.

Figure 3.

Uganda cholera hotspot map using the Global Task Force for Cholera Control method and using data from the years 2015–2021.

Figure 4.

Uganda maps showing districts deemed to be endemic (shaded districts) and those deemed to have eliminated cholera (non-shaded districts) for (A) 2018, (B) 2019, (C) 2020, and (D) 2021.

Figure 4.

Uganda maps showing districts deemed to be endemic (shaded districts) and those deemed to have eliminated cholera (non-shaded districts) for (A) 2018, (B) 2019, (C) 2020, and (D) 2021.

Figure 5.

Uganda map showing districts that were continuously endemic 2015–2021 and those that had relapsed.