Conference Abstract | Volume 9 (ConfPro8): Abstract 76 | Published: 10 Oct 2026
Alex Rodrigues Manuel1,2, &, Liliana Cândida Dengo2, Fabião Edmundo Maússe1,2, Érika Valeska Rossetto1, Áuria Ribeiro Banze1,2
1Mozambique Field Epidemiology Training Program (FETP), Maputo, Mozambique; 2Instituto Nacional de Saúde, Maputo, Mozambique
&Corresponding author: Alex Rodrigues Manuel, Mozambique Field Epidemiology Training Program (FETP); Instituto Nacional de Saúde, Maputo, Mozambique, Email: alex.manuel@ins.gov.mz, ORCID: https://orcid.org/0009-0005-9205-5336
Received: 11 Mar 2026, Accepted: 30 Aug 2026, Published: 10 Oct 2026
Domain: Infectious Disease Epidemiology
Keywords: Cholera, sentinel surveillance, seasons, rural population, Mozambique
©Alex Rodrigues Manuel 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: Alex Rodrigues Manuel et al., Cholera in Nampula Province, Mozambique: Demographic and seasonal drivers of persistent outbreaks and rural-to-urban temporal patterns, 2017–2024. Journal of Interventional Epidemiology and Public Health. 2026;9(ConfPro8):76. https://doi.org/10.37432/JIEPH-CONFPRO8-0076
Observational study with two components: (1) cross-sectional analysis of 1,382 suspected cases tested (culture or rapid diagnostic test) at five sentinel sites in Nampula City, Meconta and Monapo (January 2022–October 2024), using multivariable logistic regression, with positivity weighted to the provincial urban–rural population structure; (2) ecological analysis of weekly cholera series (2017–2023) using cross-correlation, Granger causality, ARIMA/SARIMA and Poisson regression with rainy season as covariate.
Test positivity was 42.3% (95% CI: 39.7–44.9%), similar in urban (42.8%) and rural (40.5%) residents; after population weighting, rural areas accounted for 34.8 of 40.9 percentage points. Compared with children under 5 years, odds of confirmation were higher among those aged 5–14 years (AOR = 2.94; 95% CI: 1.95–4.47) and ≥15 years (AOR = 1.62; 95% CI: 1.14–2.31). Vomiting (AOR = 1.68; 95% CI: 1.27–2.25) and moderate (AOR = 1.57) or severe dehydration (AOR = 1.77) were also associated with confirmation. Most tested individuals (92.2%) did not treat drinking water, and only 0.9% reported prior oral cholera vaccination. Rural incidence predicted urban incidence (p<0.001), but not the reverse (p > 0.99). The rainy season was associated with 41% higher weekly rural incidence (IRR = 1.41; 95% CI: 1.34–1.48), with no significant effect in urban areas (IRR = 0.95; p = 0.096).
Cholera in Nampula affects school-aged children most and is driven by rural, rainy-season transmission that precedes urban surges. Rural-focused WASH investment, oral cholera vaccination prioritizing school-aged children, and seasonally timed early warning linking rural surveillance to urban preparedness could help interrupt recurrent outbreaks.
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