{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T14:25:48Z","timestamp":1769005548667,"version":"3.49.0"},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T00:00:00Z","timestamp":1698624000000},"content-version":"vor","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Avicenna J Med"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003On 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.<\/jats:p><jats:p>\n          Methods\u2003We 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.<\/jats:p><jats:p>\n          Results\u2003Ninety-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\u2009=\u200925, 26.6%) or 31 and 40 years old (n\u2009=\u200919, 20.2%). Note that 70.2% (n\u2009=\u200966) of patients were seen in November 2022 and most were from Harim district (n\u2009=\u200944, 46.8%). Public wells (n\u2009=\u200946, 48.9%) and water trucking (n\u2009=\u200941, 43.6%) were the most commonly used water sources. Note that 76.6% (n\u2009=\u200972) 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.<\/jats:p><jats:p>\n          Conclusion\u2003Most 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.<\/jats:p>","DOI":"10.1055\/s-0043-1776045","type":"journal-article","created":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T01:29:53Z","timestamp":1698715793000},"page":"223-229","source":"Crossref","is-referenced-by-count":2,"title":["Geographical Origin, WASH Access, and Clinical Descriptions for Patients Admitted to a Cholera Treatment Center in Northwest Syria between October and December 2022"],"prefix":"10.1055","volume":"13","author":[{"given":"Ahmad","family":"Hmaideh","sequence":"additional","affiliation":[{"name":"Syrian Board of Medical Specialties, Syria"},{"name":"Syria Public Health Network, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maia C.","family":"Tarnas","sequence":"additional","affiliation":[{"name":"Department of Population Health and Disease Prevention, University of California Irvine, Irvine, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3842-6977","authenticated-orcid":false,"given":"Wasim","family":"Zakaria","sequence":"additional","affiliation":[{"name":"Syrian Board of Medical Specialties, Syria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2233-1188","authenticated-orcid":false,"given":"Ahmad Oussama","family":"Rifai","sequence":"additional","affiliation":[{"name":"Syrian Board of Medical Specialties, Syria"},{"name":"The Virtual Nephrologist, Florida, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mosab","family":"Ibrahem","sequence":"additional","affiliation":[{"name":"Syrian Board of Medical Specialties, Syria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaser","family":"Hashoom","sequence":"additional","affiliation":[{"name":"Syrian Board of Medical Specialties, Syria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nusaima","family":"Ghazal","sequence":"additional","affiliation":[{"name":"Syrian Board of Medical Specialties, Syria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aula","family":"Abbara","sequence":"additional","affiliation":[{"name":"Syrian Board of Medical Specialties, Syria"},{"name":"Syria Public Health Network, United Kingdom"},{"name":"Department of Infectious Diseases, Imperial College, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,10,30]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1093\/ia\/iiaa131","article-title":"Water weaponization in the Syrian conflict: strategies of domination and cooperation","volume":"96","author":"M Daoudy","year":"2020","journal-title":"Int Aff"},{"key":"ref2","first-page":"33","volume-title":"Health System Fragmentation and the Syrian Conflict","author":"A Abbara","year":"2021"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"2516","DOI":"10.1016\/S0140-6736(17)30741-9","article-title":"Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet-American University of Beirut Commission on Syria","volume":"390","author":"F M Fouad","year":"2017","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.ijid.2021.05.030","article-title":"Weaponizing water as an instrument of war in Syria: Impact on diarrhoeal disease in Idlib and Aleppo governorates, 2011-2019","volume":"108","author":"A Abbara","year":"2021","journal-title":"Int J Infect Dis"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.ijid.2023.03.042","article-title":"Politicization of water, humanitarian response, and health in Syria as a contributor to the ongoing cholera outbreak","volume":"131","author":"M C Tarnas","year":"2023","journal-title":"Int J Infect Dis"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"100126","DOI":"10.1016\/j.jmh.2022.100126","article-title":"The health of internally displaced people in Syria: are current systems fit for purpose?","volume":"6","author":"A Abbara","year":"2022","journal-title":"J Migr Health"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"100021","DOI":"10.1016\/j.jmh.2020.100021","article-title":"\u201cTen years of war! You expect people to fear a \u2018germ\u2019?\u201d: a qualitative study of initial perceptions and responses to the COVID-19 pandemic among displaced communities in opposition-controlled northwest Syria","volume":"1-2","author":"Y Douedari","year":"2020","journal-title":"J Migr Health"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/1471-2334-5-89","article-title":"The burden of diarrhoea, shigellosis, and cholera in North Jakarta, Indonesia: findings from 24 months surveillance","volume":"5","author":"M D Agtini","year":"2005","journal-title":"BMC Infect Dis"},{"issue":"02","key":"ref15","first-page":"3","article-title":"Cholera outbreak in South Africa: preliminary descriptive epidemiology on laboratory-confirmed cases, 15 November 2008 to 30 April 2009","volume":"7","author":"B Archer","year":"2009","journal-title":"Commun Dis Surveill Bull"},{"issue":"03","key":"ref17","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1093\/ije\/20.3.729","article-title":"Excess female deaths among rural Bangladeshi children: an examination of cause-specific mortality and morbidity","volume":"20","author":"V Fauveau","year":"1991","journal-title":"Int J Epidemiol"},{"issue":"03","key":"ref18","first-page":"151","article-title":"Risk factors and gender differentials for death among children hospitalized with diarrhoea in Bangladesh","volume":"18","author":"A K Mitra","year":"2000","journal-title":"J Health Popul Nutr"},{"issue":"06","key":"ref19","doi-asserted-by":"crossref","first-page":"e499","DOI":"10.1016\/j.ijid.2009.07.021","article-title":"The epidemiology of hospitalization with diarrhea in rural Kenya: the utility of existing health facility data in developing countries","volume":"14","author":"J A Tornheim","year":"2010","journal-title":"Int J Infect Dis"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1186\/s12889-018-6227-6","article-title":"The cholera outbreak in Yemen: lessons learned and way forward","volume":"18","author":"F Federspiel","year":"2018","journal-title":"BMC Public Health"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1186\/s12889-019-7559-6","article-title":"Descriptive epidemiology of cholera outbreak in Nigeria, January-November, 2018: implications for the global roadmap strategy","volume":"19","author":"K O Elimian","year":"2019","journal-title":"BMC Public Health"},{"issue":"25","key":"ref25","doi-asserted-by":"crossref","first-page":"2387","DOI":"10.1056\/NEJMc2213908","article-title":"Reemergence of cholera in Haiti","volume":"387","author":"D HF Rubin","year":"2022","journal-title":"N Engl J Med"}],"container-title":["Avicenna Journal of Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1776045.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T00:01:42Z","timestamp":1703203302000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1776045"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10]]},"references-count":15,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2023,12,21]]},"published-print":{"date-parts":[[2023,10]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1776045","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2231-0770","2249-4464"],"issn-type":[{"value":"2231-0770","type":"print"},{"value":"2249-4464","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10]]}}}