# From evidence to action: identification and strategic application of cholera priority areas for multisectoral interventions (PAMIs) in Sudan (2016–2025)

## TL;DR

This study identifies high-risk areas in Sudan for cholera outbreaks and uses them to guide vaccine planning and policy.

## Contribution

The study introduces a strategic framework for identifying and applying cholera priority areas in Sudan.

## Key findings

- 52 priority areas were identified, covering 80% of cholera cases and 77% of deaths.
- These areas informed Sudan’s first national 3-year OCV plan and updated National Cholera Plan (2025–2030).
- The PAMIs framework proved effective in guiding public health actions in fragile humanitarian settings.

## Abstract

Sudan has a long history of struggling with recurrent cholera outbreaks. The interplay of infrastructure damage, massive displacement, and limited access to safe water and sanitation has increased the risk of cholera transmission. The study aims to identify priority areas for multisectoral interventions (PAMIs) to inform public health policy and ensure evidence-based strategic control of cholera in Sudan.

In this retrospective study, national cholera data from 2016 to 2024 (excluding 2020–2022) were used. The Global Task Force on Cholera Control (GTFCC) tool for identifying PAMIs was applied to the analysis. Key epidemiological indicators, such as incidence, mortality, and persistence of cholera, were used to score each geographical unit and were subsequently summed to generate a priority index (PI). Furthermore, vulnerability factors were evaluated, including water, sanitation, and hygiene (WASH) infrastructure, crowded settings, displacement, inaccessibility, and community awareness. A national stakeholder validation workshop reviewed and contextualized the findings to finalize the list of PAMIs. This study also documents the immediate applications of PAMIs for strategic cholera control.

A priority index threshold of 6 was established through stakeholders’ consensus, which resulted in the identification of 52 PAMIs. These administrative units account for 80% of reported cholera cases and 77% of deaths, encompassing 31.5% of Sudan’s total population. The identified PAMIs were immediately applied to guide preventive oral cholera vaccine (OCV) planning, resulting in the selection of 40 high-risk localities and the development of Sudan’s first national 3-year OCV plan. In addition, they informed the development of the updated National Cholera Plan (NCP; 2025–2030) as a long-term strategy for cholera control.

The study provides strong evidence-based identification of PAMIs in Sudan and supports local, national, regional, and global efforts to control cholera risk. Targeted interventions in these areas are essential to contain outbreaks and build resilient public health systems. The PAMIs identification exercise informed evidence-based prioritization and planning for preventive OCV deployment and catalyzed the establishment of a national committee that developed the updated national cholera plan (2025–2030), reflecting the country’s shift toward proactive and sustainable cholera prevention. Sudan’s experience demonstrates the feasibility and policy relevance of the PAMIs framework, even in highly fragile humanitarian settings.