Clinical Features and Determinants Linked to Severe Outcomes in 1891 Pediatric Cholera Cases in Lusaka

Overview

A retrospective review of 1891 pediatric cholera cases in Lusaka, Zambia, identified severe acute malnutrition (SAM), HIV infection, and dehydration severity as key factors associated with prolonged hospitalization. Fatal outcomes were rare (1.4%) and not independently linked to specific risk factors in multivariate analysis, though younger age and SAM showed associations in bivariate analysis.

Background

Cholera remains a significant public health threat in Africa, with Zambia experiencing a major outbreak from October 2023 to June 2024. Children under 15 years represent a substantial proportion of cases, but risk factors for mortality and prolonged hospitalization in this group are not well characterized. Management of pediatric cholera requires rapid assessment and appropriate rehydration strategies, with comorbidities such as HIV and malnutrition potentially influencing outcomes. This study aimed to elucidate clinical features and determinants of severe outcomes among pediatric patients treated at two main cholera treatment centers in Lusaka.

Data Highlights

Key Findings

• Severe acute malnutrition (SAM) was strongly associated with prolonged hospitalization (OR 10.8; 95% CI, 2.91–61.1).
• HIV infection increased odds of hospitalization longer than 2 days (OR 6.89; 95% CI, 1.32–71.9).
• Dehydration treatment plans B and C, indicating moderate to severe dehydration, were linked to longer hospital stays (Plan B OR 3.93; Plan C OR 7.54).
• Fatal outcomes were infrequent (1.4%) and not independently associated with measured risk factors in penalized logistic regression.
• Bivariate analysis suggested younger age and SAM were positively associated with mortality risk.
• Patients with comorbidities and those requiring more intensive treatment had longer hospitalizations.

Clinical Implications

Clinicians should prioritize early identification and management of comorbidities such as SAM and HIV in pediatric cholera patients to reduce hospitalization duration. Close monitoring and appropriate dehydration treatment plans tailored to severity are critical. Further research is needed to clarify risk factors for mortality to improve pediatric cholera outcomes.

Conclusion

This study highlights the significant impact of comorbidities and dehydration severity on hospitalization length in pediatric cholera cases in Lusaka. While mortality was low, ongoing investigation into fatality risk factors is warranted to optimize care strategies.

References

1. Zambia Ministry of Health 2024 -- Cholera Outbreak Report
2. Global Task Force on Cholera Control Guidelines
3. World Health Organization 2024 -- Cholera Epidemiology in Africa