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CC BY 4.0 · Avicenna J Med 2023; 13(04): 223-229
DOI: 10.1055/s-0043-1776045
Original Article

Geographical Origin, WASH Access, and Clinical Descriptions for Patients Admitted to a Cholera Treatment Center in Northwest Syria between October and December 2022

Ahmad Hmaideh   *
1   Syrian Board of Medical Specialties, Syria
2   Syria Public Health Network, United Kingdom
,
Maia C. Tarnas   *
3   Department of Population Health and Disease Prevention, University of California Irvine, Irvine, California, United States
,
Wasim Zakaria 
1   Syrian Board of Medical Specialties, Syria
,
Ahmad Oussama Rifai 
1   Syrian Board of Medical Specialties, Syria
4   The Virtual Nephrologist, Florida, United States
,
Mosab Ibrahem
1   Syrian Board of Medical Specialties, Syria
,
Yaser Hashoom
1   Syrian Board of Medical Specialties, Syria
,
Nusaima Ghazal
1   Syrian Board of Medical Specialties, Syria
,
Aula Abbara
1   Syrian Board of Medical Specialties, Syria
2   Syria Public Health Network, United Kingdom
5   Department of Infectious Diseases, Imperial College, London, United Kingdom
› Author Affiliations Funding None.
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Abstract

Background On September 10, 2022, a cholera outbreak was declared in Syria for the first time in over a decade of protracted conflict. As of May 20, 2023, 132,782 suspected cases had been reported, primarily in northwest and northeast Syria. We aim to provide a detailed description of water sources and clinical status of a patient cohort seen at a cholera treatment center (CTC) in northwest Syria.

Methods We retrospectively identified patients with confirmed cholera who presented to the CTC in Idlib governorate between October 8 and December 18, 2022. Data were obtained from clinical case records and analyzed in R v4.0.4.

Results Ninety-four patients (55.3% men) were treated at the CTC. Thirty-five patients were severely dehydrated (Plan C treatment), 54 had some dehydration (Plan B), and 5 had no dehydration (Plan A). Most patients were between 11 and 20 years old (n = 25, 26.6%) or 31 and 40 years old (n = 19, 20.2%). Note that 70.2% (n = 66) of patients were seen in November 2022 and most were from Harim district (n = 44, 46.8%). Public wells (n = 46, 48.9%) and water trucking (n = 41, 43.6%) were the most commonly used water sources. Note that 76.6% (n = 72) did not have access to chlorine-treated water. Forty-seven patients (50%) had more than five water, sanitation, and hygiene (WASH)-related cholera risk factors. Following treatment, six patients were transferred to another treatment center, three died (case fatality rate: 3.2%), and the remainder were discharged.

Conclusion Most patients reported WASH-related risk factors for cholera, reflecting the poor state of WASH in northwest Syria after over a decade of conflict. This relates to the direct and indirect impacts of urban and periurban violence as well as the underfunded humanitarian response. Strengthening WASH and health promotion are important components to control the outbreak.

Keywords

cholera - conflict - Syria - outbreaks - WASH - water and sanitation

Previous Presentation

The abstract has previously been presented at the Emergency Environmental Health Forum in May 2023.


Ethics

This study was deemed exempt by the Human Research Protections board at the University of California, Irvine.


Authors' Contributions

A.H., W.Z., A.A. conceptualized the study. M.T. led the data analysis. A.H., M.T., A.A. wrote the first draft of the manuscript. A.H., M.T., W.Z., A.O.R., M.I., Y.H., N.G., A.A. edited, commented on, and revised the manuscript and interpretations. All authors approved the final version.


* Joint first authors




Publication History

Article published online:
30 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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