Epidemiological evaluation of cholera outbreak dynamics in conflict-affected Central and Northwestern Tigray, northern Ethiopia: evidence from GEE analysis.

Cholera remains a major public health concern in conflict-affected Tigray, Ethiopia, where disrupted water, sanitation, and hygiene (WaSH) services and displacement have increased transmission risk. This study analysed outbreak dynamics, attack rates (AR), and predictors of cholera to inform interventions aligned with Ethiopia's Cholera Elimination Plan (2022-2028). A retrospective analysis was conducted on 802 suspected and confirmed cholera cases reported from 25 July to 4 October 2024 across 25 districts in Central and Northwestern Tigray. Data from the Tigray Health Research Institute line list were analysed using descriptive statistics, Chi-square tests, and Generalized Estimating Equation (GEE) models. Attack rates were highest in Asgede (357.25/100000) and Endabaguna (88.12/100000). Significant associations were observed with age, sex, occupation, water source, travel history, vaccination, latrine access, and contact history. GEE analysis showed strong intra-cluster correlation (α = 0.949). Higher odds of cholera were associated with males, adults aged 16-45 years, and use of unsafe water sources, while vaccination and latrine availability reduced risk. Strengthening WaSH services, vaccination coverage, surveillance, and targeted risk communication is essential to reduce cholera transmission in Tigray.