Prioritizing areas for multisectoral interventions (PAMIs) for cholera control in Cameroon
Authors: Ngomba Armelle , Esso Linda , Fouda Mbarga Nicole , Kenko Ingrid , Defo Eric , Mandeng Nadia , Tonye Theodore A. , Mendjime Patricia , Bilounga Chanceline , Choupo Loic , Douba Emmanuel , Etoundi Georges A 
Published: January 2025

Introduction

The Global Task Force for Cholera Control (GTFCC) developed a Global Roadmap for Ending Cholera by 2030 emphasizing the need for targeted multisectoral interventions in priority areas. In 2023 for the first time in Cameroon, identification of PAMIs for cholera control was conducted, following the 2023 GTFCC guidelines. We hereby describe experience of PAMI’s identification in a cholera high-burden country.

Methods

In August 2023, a multisectoral technical team was set up, under the leadership of the Ministry of health to conduct identification ofPAMIs.Stakeholders were briefed on GTFCC guidelines. A retrospective (January 2016-September 2023) descriptive study was conducted in all the 10 regions of Cameroon. Data were collected from DHIS-2, national cholera line lists, situation reports, databases from the Centre Pasteur of Cameroon and the National Public Health Laboratory. These datasets were entered in the GTFCC tool for automated analysis. An initial list of PAMIs was identified based on a priority index using four indicators: cholera incidence, mortality, persistence, and positivity. In December 2023, we conducted amultisectoral validation workshop, during which the threshold of 9 was setfor PAMIs’ prioritizationand asecond prioritization done using vulnerability factors.

Results

Overall, 48 health districts (25% of all health districts) were identified as PAMIs, 35 PAMIs using the priority index and 13 based on vulnerability factors. About 11 488 089 people (41% of the country’s population) live in these PAMIs from which 93% of cholera cases were reported over the past 8 years. The Centre, Littoral, South-West, and the Far North regions are home to 66% of PAMIs.

Conclusion

Identification of PAMI’s was successfully conducted in Cameroon and provided scientific evidence for decision-making to level up cholera preparedness and prevention. The ownership and leadership of governmental main stakeholders were critical. Data availability facilitated this exercise.

Key questions

What is already known on this topic

Ending cholera requires implementation of targeted interventions in high-priority areas for maximum impact. Identification of these areas (PAMIs) is the first step towards cholera elimination.

What this study adds

Priority areas for targeted cholera control interventions were identified and categorized in Cameroon for cholera control. PAMIs represent 25% of health districts in Cameroon with a targeted population representing 41% of the whole country. The study describes lessons learnt and challenges of using GTFCC guides for PAMIs identification, which is useful information for other countries.

How this study might affect research, practice or policy

Our findings will inform decision-making for cholera control in Cameroon and in other countries through elaboration, implementation and monitoring and evaluation of a national cholera control budgeted plan with specific key long-term interventions to be conducted where needed.