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

Abstract

Background: Zambia declared a cholera outbreak on 18 October 2023 and, as of 31 June 2024, had recorded 23 381 cases and 740 deaths. Of the patients seen at the 2 main cholera treatment centers in the capital Lusaka, a third of them were children aged 0 to 15 years. Despite the significant pediatric cholera burden, risk factors for mortality and prolonged hospitalization remain unknown. Methods: A retrospective data review was conducted by examining the clinical characteristics of patients aged 0 to 15 years hospitalized at the 2 cholera treatment centers between 15 October 2023 and 31 March 2024. Descriptive analysis was conducted for patient characteristics, and penalized logistic regression (PLR) was used to analyze risk factors for the outcomes. Results: A total of 1891 patients were identified, among which 1.4% (18/1253) had fatal outcomes and 47.9% (399/833) had hospitalization >2 days. By the PLR, the following factors were independently correlated with hospitalization >2 days: HIV infection (odds ratio [OR], 6.89; 95% CI, 1.32-71.9), severe acute malnutrition (SAM; OR, 10.8; 95% CI, 2.91-61.1), and dehydration treatment plans B (OR, 3.93; 95% CI, 1.80-9.27) and C (OR, 7.54; 95% CI, 2.71-22.9). For the fatal outcome, none of them independently showed any significant correlations by the PLR, although younger age and SAM were positively associated by bivariate analysis. Conclusions: Comorbidities such as SAM and HIV, being on plan B or C, and deteriorating and requiring more intense treatment are associated with longer hospitalization. Risk factors for mortality need to be further investigated.