Spatio-temporal patterns of cholera outbreak in rural settings of Ethiopia, 2023.

Objectives: The aim of this study was to assess the spatio-temporal pattern of cholera in rural settings of Ethiopia. Methods: A spatiotemporal analysis of daily cholera cases in 59 Kebeles across 7 districts in the Gedeo zone from April 2 to November 18, 2023, obtained from the Gedeo Zone Health Department, was conducted. The global Moran's I statistic was used for spatial autocorrelation analysis, and the retrospective space-time scan statistic was used to analyze spatiotemporal clusters of cholera. Results: Throughout the outbreak, 792 cholera cases were reported, corresponding to an annual incidence of 169.4 per 100,000 population. The spatial distribution showed strong autocorrelation, with a global Moran's I coefficient of 0.272 (P-value <0.001). Five statistically significant clusters were identified by space-time scan statistics using a discrete Poisson model. These identified clusters overlapped in time and had longer durations with a relatively high risk of cholera in the study areas. Conclusion: The identification of high-risk clusters specific to rural settings forms the basis for rapid public health emergency response and resource allocation by prioritizing the significantly high-risk clusters to control and eventually eliminate cholera. There is room to improve the public health response to cholera outbreaks in the study settings.