BMJ Open (May 2024)

Acute watery diarrhoea cases during cholera outbreak in Syria: a cohort study

  • Amr Hamza,
  • Ahmad Yamen Arnaout,
  • Yaman Nerabani,
  • Mohamad Nabhan Sawas,
  • Tala Jouma Alhejazi,
  • Mohamad Ali Farho,
  • Khaled Arnaout,
  • Hassan Alshaker,
  • Baraa Shebli,
  • Mostafa Helou,
  • Bashir Badawi Mobaied,
  • Mohamad Bassel Mouti,
  • Fares Kady,
  • Ziad Aljarad,
  • Aalaa Mohammed nedal Al shalabi,
  • Alaa Fawaz Dasouki,
  • Abdulrhman Breij,
  • Ahmad Ryyan Shheibar,
  • Ahmed Alabdullah,
  • Alaa Wais,
  • Abd Alazeez Atli,
  • Amira Fathi Breis,
  • Bakri Roumu Jamal,
  • Baraa Ahmad Abduljalil,
  • Batoul Mohammed Mashhadi,
  • Batoul Shyah,
  • Bayan Zitani,
  • Fatima Breim,
  • Ghina Maarawi,
  • Hala Jafa,
  • Heba Haj Saleh,
  • Hiba Bathish,
  • Ibrahim AL mhawsh,
  • Ibrahim Arnaout,
  • Joud Khalili,
  • Joud Markaby,
  • Joudy Karh Damour,
  • Lama Kanaa,
  • Lana issa Kitan,
  • Leen Jaber,
  • Leen Tfnkjy,
  • Leen Zoheir Amaraya,
  • Maher Moaammar Zeno,
  • Manar Haitham Nayef,
  • Maram Ahmad Mobaid,
  • Mawya Ghassan Alrawi,
  • Maysoon Mohammad Jadid,
  • Mohamad Amin Kreid,
  • Mohamad Nour Martini,
  • Mohamed Alkhalifa,
  • Mohammed Al-mahdi Al-kurdi,
  • Mona Abdulkader Haj Mahmoud,
  • Mona Najib Barakat,
  • Monzer Keblawy,
  • Najlaa Mohammad Rabee Fjleh,
  • Nour Mohammed raed Arab,
  • Ola Hamdan,
  • Ola Fateh Alkhallouf,
  • Raneem Sattout,
  • Rasha Yossef Al Ibrahim,
  • Rasha Abdullah Al aouir,
  • Rima Modabbes,
  • Roua Arian,
  • Saad Haykal,
  • Sabah Faour,
  • Salam Yones Al-wannous,
  • Saleh Bourghol,
  • Salma Alkurayem,
  • Sana Ahmad Masoud,
  • Sedra Mohammad Anas helou,
  • Shahed Ammar Rihawi,
  • shaimaa radwan,
  • Sima Mohannad Sagheer,
  • Toka Adna,
  • Wael Najeb,
  • Wafaa Jawesh,
  • Wesam Hritani,
  • Yahya Dordi,
  • Yamama Alali,
  • Yasmen Saber Toffaha,
  • Zein A Alsayed-Ahmad,
  • Rayan Badawi,
  • Ghina Motaz Ghannam,
  • Mahmoud Mohamad Mohamad Alhasan,
  • Abdullah Mohammed Al-Nabbash,
  • Ayah Kouli,
  • Toula Bayaa,
  • Osama Abd Alhaji,
  • Ibrahim Al Tabbaa,
  • Mary Alakkash,
  • Shamma Alaa Aldeen Alothman,
  • Fatima Abazid,
  • Rima Saad Taleb,
  • Bayan Rokia,
  • Ahmad Saher Aljarad,
  • Dimah Tarabelsi,
  • Ahmad Fadel Karaze,
  • Eman Abdulrahman Ibrahim,
  • Hasan Hamsho,
  • Ola Ramadan,
  • Ola Alzalek,
  • Noor Masri,
  • Abdullah Ahmad Mohammad Mano,
  • Wajeh Kurdi,
  • Arij Assi,
  • Tasnim Zakaria Bathish

DOI
https://doi.org/10.1136/bmjopen-2023-082385
Journal volume & issue
Vol. 14, no. 5

Abstract

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Objectives The aim of this study is a descriptive presentation of cases of acute watery diarrhoea (AWD) that were presented to Aleppo University Hospital (AUH) during the recent cholera outbreak in Syria.Design Prospective, observational, cohort study.Setting and participants A total of 1061 patients with AWD were admitted to AUH during the timeframe of 20 September 2022 to 20 October 2022. The data collection was done through a structured questionnaire. This includes comprehensive clinical observation, laboratory analyses, therapeutic interventions and holistic case evaluations.Results The analysis has revealed notable insights: a predominant proportion of patients (58.6%) were residents from urban areas and 40.3% were residents from rural areas. Intriguingly, a diverse range of potential infection sources emerged from patient data within our hospital, including uncontrolled well water, vegetables and faecal-oral transmission through contaminated street/fast food. At discharge, most patients were in good health (79.7%), followed by moderate health (17.6%) and poor health (2.3%), with a minimal percentage dying before discharge (0.4%). The most common complications reported at admission and during hospitalisation included electrolyte imbalance (28.2%), followed by severe dehydration (16.3%). In the follow-up period, the majority of patients exhibited good health (81.0%). Older patients (>60 years) had poorer outcomes, with 8.4% having poor health and 4.2% death rate.Conclusions The study found results consistent with previous AWD outbreaks in developing countries like Yemen, Nigeria and Lebanon. Preventative measures like improving water sanitation and hygiene practices are essential to prevent future outbreaks and ease the strain on healthcare systems. Therefore, future studies must investigate the risk factors that increase the spread and the severity of the disease and investigate the best management method.