Cholera in Kenya: A scoping review of current research, evidence gaps and future directions

Cholera remains a major public health challenge in Kenya, driven by environmental pollution, poor water, sanitation, and hygiene (WASH) facilities, weak monitoring systems, and climate effects. While there have been improvements in studying the disease, testing, monitoring, and environmental checks, the spread continues, especially in informal settlements, rural areas, and refugee camps. This review looked at 106 peer-reviewed studies published between 1979 and 2024. It aimed to describe the scope, progress, and gaps in cholera research in Kenya. Five databases, including Google Scholar, Web of Science, PubMed, Embase, and Scopus, were searched using the terms "cholera" and "Kenya." Titles and abstracts were reviewed using Rayyan, and data were collected using a standard form that noted study goals, methods, findings, limitations, and geographic coverage. The evidence was analysed thematically, and trends were tracked over time. Among 845 records found, 106 met the criteria for inclusion. The literature consistently connects cholera outbreaks in Kenya to climate events like flooding, drought, and El Niño, with greater vulnerability seen in informal settlements and refugee areas. Surveillance systems are still disconnected, often leading to delays in reporting and limited information at sub-county levels. Assessments of the health system reveal ongoing issues, including a shortage of laboratory resources and necessary tests. Despite innovations such as rapid diagnostic tests, whole-genome sequencing, and spatial modelling that have enhanced outbreak detection and understanding of transmission, their regular use is hindered by cost, infrastructure, and workforce issues. Social and behavioural factors, such as low-risk perception and gaps between knowledge and practice, also contribute to continued transmission. In summary, controlling cholera in Kenya needs a coordinated, multi-faceted approach. This should focus on strengthening surveillance, improving WASH facilities, increasing laboratory and molecular capabilities, expanding vaccine access, and fostering community-led efforts to turn scientific progress into effective public health measures.