Impact of Cholera on Children with Malnutrition under 5 Years in Hodeidah , Yemen

Abstract

Background: Cholera and malnutrition synergistically increase mortality in children under five years. This case report evaluates clinical outcomes and management challenges in malnourished children hospitalized during cholera outbreak. 

Objective: To assess the clinical outcomes in malnourished children with cholera, identify the barriers to care, and evaluate the rehydration and nutritional interventions. Methodology: A retrospective study (a case series) of 25 children (1–5 years, median age: 3 years) , confirmed with cholera infection and diagnosed with moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The data included demographics, symptoms, dehydration severity, admission timing, and treatment outcomes.  Results:  25 children, 76% presented with severe dehydration, 100 % with acute watery diarrhea (AWD) and vomiting, and 100% of patients were malnutrition (68% of SAM and 32% of  MAM). Delayed admission (>72 hours) occurred in 56% of cases. All cases received the recommended rehydration (32% IV fluids) of world health organization (WHO) guideline and nutritional support (F75 therapeutic milk, RUTF). Full recovery was achieved in 92%, with 8 % requiring intensive care unit (ICU) care for hypovolemic shock.  Conclusion: Malnutrition exacerbated the severity of cholera, but adherence to WHO-integrated hydration and nutrition protocols had  significantly improved survival rates. Early intervention and addressing systemic delays in care are critical to reducing mortality in cholera-endemic settings.