COVID-19 and cholera co-infection and comorbidity in Africa and Asia: a systematic review and meta-analysis

Abstract

# Background Cholera and COVID-19 represent a dual burden on healthcare systems, especially in low-resource settings. Despite their significant impact, data on their co-occurrence and interaction remain unreliable. This is primarily due to limited and fragmented data availability, which affects our understanding of the relationship between these two diseases. This systematic review aims to address these gaps by summarizing the current state of knowledge and identifying specific data deficiencies. # Methods A comprehensive search was conducted on PubMed, Scopus, and Web of Science. The search was limited to studies published from January 2020 to December 2023. Specific search terms included "cholera and COVID-19 co-infection," "cholera outbreaks during COVID-19," and "impact of COVID-19 on cholera." The Studies were selected based on predefined criteria, including relevance to the topic, quality of the data, and geographical scope. The Studies were selected based on predefined criteria, including relevance to the topic, quality of the data, and geographical scope. # Results A total of 18 studies were identified, encompassing a range of geographic locations and study designs. A meta-analysis revealed a strong positive correlation (95% confidence interval, CI=0.80, 0.99) between COVID-19 and cholera coinfection and comorbidity in Africa and Asia. Specifically, the correlation was observed between the frequency of cholera cases and the incidence of COVID-19, highlighting how the pandemic exacerbated cholera outbreaks in certain regions. # Conclusions The findings highlight the essential need for improved data collection and surveillance to better understand and manage the dual burden of cholera and COVID-19. The systematic review also highlights significant publication bias and data limitations, suggesting that future research should focus on addressing these gaps through enhanced data collection methods and rigorous analysis. Recommendations include developing targeted interventions to improve vaccination coverage and water, sanitation, and hygiene (WASH) practices, alongside strategies to counteract misinformation about vaccines. **PROSPERO Registration ID: CRD42023485040**