INTRODUCTION:
cholera remains a significant public health threat in low-income countries, including ethiopia, where recurrent outbreaks disproportionately affect urban populations. despite the critical role of primary healthcare centers in outbreak response, their level of preparedness and readiness in addis ababa is not well understood. this study assessed the cholera outbreak preparedness of public health centers, identified associated factors, and explored operational barriers.

METHODS:
an institutional-based, cross-sectional mixed-methods study was conducted from august to september 2024 across all 101 public health centers in addis ababa. quantitative data were collected using a standardized 14-point who checklist, and analysis used binary logistic regression. health centers were classified as prepared if they met ≥75% (11/14) of indicators. qualitative data from five key informant interviews and two focus group discussions explored systemic barriers thematically.

RESULTS:
a total of 101 health centers were analyzed. 56 (55.4%) of the health centers were prepared for cholera outbreak response. having an emergency preparedness response plan was significantly associated with preparedness (adjusted odds ratio [aor] equals 6.88, 95% ci equals 1.39-9.89; p less than 0.05). main barriers identified qualitatively were financial barriers, lack of cooperation and multi-sectorial involvement, and low motivation from healthcare workers.

CONCLUSIONS:
cholera outbreak preparedness in public health centers of addis ababa was 55.4%. the presence of an emergency preparedness response plan was significantly associated with improved preparedness. to enhance urban health system resilience, it is crucial to address the identified barriers: financial constraints, limited multi-sectorial cooperation, and low staff motivation.