Pharmacoepidemiology of Cholera in Hodeidah, Yemen: A Randomized Clinical Trial

Abstract

Background: Early diagnosis and rapid management of dehydration are crucial for increasing positive outcomes. Most cholera cases are usually mild to moderate and easily managed with an oral re-hydration solution (ORS) and intravenous (IV) solution for severe cases.

Objectives:  The study aimed to monitor the impact of national guideline on cholera outcome and side effect of medications in Hodeidah , Yemen. Methodology: A randomized clinical trial (RTC) design encompassed , the study included l7,821 patients diagnosed and isolated based on national cholera management guideline, ranging from 1 to 97 years old . All patients were admitted to the Cholera Treatment Center (CTC) in collaboration with  Tropical Medicine and Infectious Diseases Center (CTMID), Al Thawara Public Hospital Authority in Hodeidah, Yemen.  The case management of cholera included five steps : assessment of dehydration status. rehydration therapy, monitoring ,antimicrobial therapy and nutrition status. 10,534 patients (59.1%) were diagnosed with  mild and moderate dehydration  and received oral rehydration solution (ORS) alongside standard care, In addition, 7,287 patients (40.9%) were diagnosed with severe dehydration and underwent intravenous treatments (IV) based on national guideline. Additionally, 250 patients required dialysis therapy. Results: The results showed that the ratio of males to females 44.6% to 55.4 % (0.8:1). The primary symptom reported was acute watery diarrhea. The study highlighted the substantial impact of rehydration therapy on cholera prognosis where the case fatality rate (CFR %) was 39/l7821 (0.21 %), In addition, 250/l7,821 (1.40 %) cases complicated by acute renal failure (ARF) and 1595/l7,821 cases (8.95 %) had shock (hypovolemic). The incidence of pleural effusion was approximately 728/ l7,821 cases (4.08 %) . 150 of mild cases were developed into severe illness and transferred to plan C for  their management . On the other hand, 10 of severe cases (0.06 %)  were developed to pleural effusion because the intravenous fluid overload as the result of therapeutic side effect. Conclusion: Efficient cholera control, notably via rehydration strategies, markedly decreased mortality rates (less than 1 %) and the side  effects was not reported. This emphasizes the critical role of prompt intervention and customized treatment strategies in outbreak situations.