Cholera remains one of the most rapidly fatal infectious diseases globally, with untreated cases leading to death within hours due to severe dehydration. Despite being preventable and treatable, it continues to pose a significant public health threat, especially in low and middle-income countries where water, sanitation, and hygiene (WASH) services are inadequate. This study investigates delays between symptom onset, health facility admission, and outcomes among cholera patients in Zambia, with a focus on the 2023–2024 outbreak.

We conducted a retrospective cross-sectional study using national cholera surveillance data from Zambia’s 2023–2024 outbreak to examine delays in care and associated outcomes. All suspected and confirmed cases with complete records on symptom onset, admission, and outcome were included. Key time intervals were calculated and analyzed using descriptive statistics and non-parametric tests, with subgroup comparisons by age, sex, and outcome status. Ethical approval was obtained, all data were anonymized, and analyses were performed using Stata version 14.2. A total of 3,655 cases were analyzed, of whom 52.2% were male and 37.8% were under 15 years. Nearly all patients (99%) were admitted as inpatients, and the overall mortality rate was 4.2%. The median time from symptom onset to death was 3 days, underscoring the rapid progression of the disease. Among the 2,162 patients included in the survival analysis, the death rate was 0.85 per 100 person-days, with higher rates observed among males (1.05) and adults aged 50 years and above (2.71). Confirmed cases experienced the highest mortality, and survival probabilities were significantly lower among males, older adults, and confirmed cholera cases (p < 0.05).

Delays in seeking and receiving care significantly increase the risk of cholera mortality. Strengthening oral rehydration points, improving transportation systems, and addressing social barriers to timely care are essential to reducing cholera deaths. Targeted, evidence-based interventions are urgently needed to close these critical gaps in Zambia’s cholera response strategy.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The University of Zambia Biomedical Research Ethics Committee

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The data that support the findings of this study are available from the Zambia National Public Health Institute (ZNPHI) (https://www.znphi.org.zm) and the Ministry of Health, Lusaka, Zambia (https://www.moh.gov.zm). However, restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data can be accessed upon reasonable request and with permission from the relevant authorities.