Conference Abstract | Volume 9 (ConfPro8): Abstract 19 | Published: 05 Oct 2026
Rocham Mulumbwe1,2,&, Hellen Kaoma2, Francis Ngosa Mwenya2, Dabwisto Banda2, Nyambe Sinyange2, Hebert Luhanga1,2, Matildah Mubanga2,3, Ishbak Chimfwembe2,3,4, Shadreck Manda2,3
1University of Zambia, School of Public Health, Lusaka, Zambia; 2Zambia National Public Health Institute, Field Epidemiology Training Program, Lusaka, Zambia; 3Levy Mwanawasa Medical University, Department of Public Health and Environmental Sciences, Lusaka, Zambia; 4Ministry of Health, Lusaka Provincial Health Office, Lusaka, Zambia
&Corresponding author: Rocham Mulumbwe, Institution: University of Zambia, School of Public Health, and Zambia National Public Health Institute, Field Epidemiology Training Program, Lusaka, Zambia, Email: mulumbwerocham@gmail.com, ORCID: https://orcid.org/0009-0000-1268-8998
Received: 12 Mar 2026, Accepted: 29 Aug 2026, Published: 05 Oct 2026
Domain: Infectious Disease Epidemiology
Keywords: Cholera, outbreak investigation, case-control study, 7-1-7 framework, WASH
©Rocham Mulumbwe et al. Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Rocham Mulumbwe et al., Cholera outbreak investigation, Lusaka, Zambia, March 2026. Journal of Interventional Epidemiology and Public Health. 2026;9(ConfPro8):19. https://doi.org/10.37432/JIEPH-CONFPRO8-0019
Cholera remains a public health challenge in Zambia, driven by inadequate water, sanitation and hygiene (WASH) infrastructure. With 683 cases recorded in Lusaka amid the ongoing national outbreak, the emergence of two deaths and 17 positive cases within 24 hours in Makeni area warranted urgent investigation of risk factors and response using the 7-1-7 framework.
We conducted a 1:2 case-control study (8-18 March 2026). Cases were residents with acute watery diarrhoea (≥3 episodes/24h); controls were asymptomatic neighbours. Data were collected via structured questionnaires; stool and water samples underwent laboratory testing. Multivariable logistic regression estimated adjusted odds ratios (aOR) and 95% CI. Response milestones were assessed against 7-1-7 targets; facilitating or hindering factors were documented as enablers and bottleneck.
We enrolled 114 participants including 38 cases. Median age 30 years (IQR: 20-39); 61% (23/38) male. The attack rate was 4.2% (38/905), higher in Green zone (10.3%; 36/350) than White zone (0.4%; 2/555); case fatality rate was 5.3% (2/38). Of 16 stool samples cultured, 14 (87.5%) were confirmed; all four water samples were E. coli positive. Symptoms: diarrhoea (100%), vomiting (57.9%), abdominal cramps (39.5%) and general weakness (31.6%). Sewer overflow was the strongest risk factor (aOR=10.53; 95%CI: 3.41-41.7; p<0.001); male sex had increased risk (aOR=2.59; 95%CI: 1.02-6.93; p=0.05). Access to a handwashing facility (aOR=0.16; 95%CI: 0.02-0.82; p=0.043) and secondary education (aOR=0.09; 95%CI: 0.00-0.75; p=0.048) were protective. All 7-1-7 targets were met: detection in 2 days, notification in 1 day, response in 2 days. Enablers: communication channels, multi-sectoral collaboration and Incident Management System; low clinical suspicion and poor health-seeking behaviour were bottlenecks.
This outbreak was driven by sewer overflow and inadequate sanitation infrastructure. Sewerage rehabilitation, WASH strengthening and risk communication are essential to prevent recurrence. Meeting all 7-1-7 targets demonstrates health security capacity for early containment of future outbreaks.
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