Clinical Characteristics and Factors Associated With Severe Outcomes of 1891 Pediatric Patients Admitted to the Referral Cholera Treatment Centers in Lusaka, Zambia, December 2023–March 2024

Category	Detail
Condition	Pediatric cholera infection with dehydration and comorbidities
Key Mechanisms	Acute watery diarrhea causing dehydration; severity influenced by comorbidities such as HIV and severe acute malnutrition (SAM)
Target Population	Children aged 0 to 15 years hospitalized with cholera in Lusaka, Zambia
Care Setting	Two main cholera treatment centers (Heroes CTC and Levy CTC) in Lusaka

Among 1891 pediatric patients, 1.4% had fatal outcomes and 47.9% had hospitalization longer than 2 days.
Independent risk factors for prolonged hospitalization (>2 days) included HIV infection, severe acute malnutrition, and dehydration treatment plans B and C.
No independent risk factors for mortality were identified by penalized logistic regression, though younger age and SAM showed positive association in bivariate analysis.

Assess dehydration severity using clinical signs: no dehydration, some dehydration, or severe dehydration.
Classify dehydration severity based on alertness, pulse, thirst, eye appearance, skin pinch, and danger signs.
Screen for comorbidities such as HIV infection and severe acute malnutrition.

Assign treatment plans based on dehydration severity: Plan A (oral rehydration), Plan B (oral rehydration with 75 mL/kg over 4 hours), Plan C (intravenous Ringer lactate).
Modify treatment plans for patients with SAM to include low-osmolarity oral rehydration, reduced infusion rates, and monitoring for hypoglycemia and hypothermia.
Refer patients with comorbidities to specialized care centers (Levy CTC) for intensified management.

Closely monitor hydration status and clinical progression, especially in patients on treatment plans B and C.
Monitor for deterioration requiring escalation of care.
Observe for complications related to comorbidities such as SAM and HIV.

Prolonged hospitalization is associated with HIV infection, severe acute malnutrition, and higher dehydration severity.
Mortality risk factors remain unclear and require further investigation.
Younger age and SAM may increase risk of fatal outcomes based on bivariate analysis.

Pediatric patients aged 0–15 years hospitalized with cholera in Lusaka, Zambia

Treatment plans B and C correlate with longer hospital stays; modified protocols for SAM patients are essential to address comorbidity-related risks.

Early and accurate assessment of dehydration severity to guide appropriate treatment plan assignment.
Screening and management of comorbidities, especially HIV and severe acute malnutrition, to reduce hospitalization duration.
Use of modified rehydration protocols for malnourished children to prevent complications.
Referral of patients with comorbidities to specialized treatment centers for comprehensive care.
Close monitoring of clinical status to detect deterioration and adjust treatment promptly.

Clinical Scorecard: Clinical Features and Determinants Linked to Severe Outcomes in 1891 Pediatric Cases Treated at Cholera Referral Centers in Lusaka, Zambia, December 2023–March 2024