{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T07:47:09Z","timestamp":1770536829281,"version":"3.49.0"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Malawi experienced its deadliest cholera outbreak in 2022, reporting over 50,000 cases and more than 1,700 deaths. This situation was further exacerbated by the Tropical Cyclone Freddy, which caused widespread damage to health infrastructure and strained Malawi\u2019s limited healthcare resources. Despite the scale of the outbreak, no evaluations were conducted to identify risk factors associated with cholera-related mortality among hospitalized individuals. This study filled that gap by characterizing the clinical and treatment-related factors contributing to cholera mortality in Malawi. A retrospective matched case-control study was conducted in August 2023 across four high-burden cholera districts: Blantyre, Mangochi, Lilongwe, and Nkhatabay. Medical records of 174 laboratory-confirmed cholera patients admitted between March 2022 and September 2023 were reviewed, including 87 matched pairs of deceased (cases) and surviving (controls) patients by age group and district. Data were extracted using a standardized mortality audit tool capturing socio-demographic characteristics, care-seeking behaviour, clinical status, and treatment received. Conditional logistic regression was used to identify factors associated with cholera mortality. Inadequate intravenous fluid management within the first 6 hours of admission was the strongest predictor of mortality (adjusted OR = 45.26, 95% CI: 9.09\u2013225.30, p\u2009&lt;\u20090.001). Other factors such as clinical status on admission showed a trend toward association but did not reach statistical significance. Timely and appropriate intravenous fluid administration within the first 6 hours of care is critical to reducing cholera mortality. We highlight an urgent need to strengthen the early response capacity in cholera treatment units, particularly during climate-related public health emergencies.<\/jats:p>","DOI":"10.1371\/journal.pgph.0004335","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:43:43Z","timestamp":1760031823000},"page":"e0004335","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Determinants of cholera fatalities in Malawi: A case-control study of patient-level and clinical management factors in the 2022\u201323 outbreak"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0231-1721","authenticated-orcid":true,"given":"Ronald","family":"Chitatanga","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2991-5366","authenticated-orcid":true,"given":"Alex","family":"Thawani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3290-2241","authenticated-orcid":true,"given":"Hope","family":"Chadwala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9301-9674","authenticated-orcid":true,"given":"Amon","family":"Chirwa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Collins","family":"Mitambo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"issue":"3","key":"pgph.0004335.ref001","doi-asserted-by":"crossref","first-page":"169","DOI":"10.3390\/tropicalmed8030169","article-title":"Global Patterns of Trends in Cholera Mortality","volume":"8","author":"I Ilic","year":"2023","journal-title":"Trop Med Infect Dis"},{"issue":"28","key":"pgph.0004335.ref002","doi-asserted-by":"crossref","first-page":"34906","DOI":"10.1007\/s11356-020-09992-7","article-title":"How climate change can affect cholera incidence and prevalence? A systematic review","volume":"27","author":"Z Asadgol","year":"2020","journal-title":"Environ Sci Pollut Res Int"},{"key":"pgph.0004335.ref003","article-title":"Practical field epidemiology to investigate a cholera outbreak in a Mozambican refugee camp in Malawi, 1988","author":"A Moren","year":"1991","journal-title":"The Journal of Tropical Medicine and Hygiene"},{"issue":"7","key":"pgph.0004335.ref004","doi-asserted-by":"crossref","first-page":"3761","DOI":"10.1097\/MS9.0000000000000961","article-title":"The devastating effect of cyclone Freddy amidst the deadliest cholera outbreak in Malawi: a double burden for an already weak healthcare system-short communication","volume":"85","author":"L Focus Adriano","year":"2023","journal-title":"Ann Med Surg (Lond)"},{"issue":"7","key":"pgph.0004335.ref005","doi-asserted-by":"crossref","DOI":"10.1016\/S2666-5247(22)00131-8","article-title":"Malawi takes on cholera outbreak amid cyclone devastation","volume":"3","author":"S Bagcchi","year":"2022","journal-title":"Lancet Microbe"},{"issue":"23","key":"pgph.0004335.ref006","doi-asserted-by":"crossref","first-page":"776","DOI":"10.15585\/mmwr.mm7123a3","article-title":"Notes from the Field: Initial Outbreak Response Activity Following Wild Poliovirus Type 1 Detection - Malawi, February 2022","volume":"71","author":"Malawi Ministry of Health, Global Polio Eradication Initiative","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pgph.0004335.ref007","article-title":"First case report of a successfully managed severe COVID-19 infection in Malaw","author":"B Ndaziona Peter","year":"2020","journal-title":"Malawi Med J"},{"key":"pgph.0004335.ref008","unstructured":"WHO. Cholera. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cholera#:~:text=Researchers%20estimate%20that%20there%20are,oral%20rehydration%20solution%20and%20antibiotics"},{"issue":"6","key":"pgph.0004335.ref009","doi-asserted-by":"crossref","first-page":"428","DOI":"10.2471\/BLT.17.207175","article-title":"Oral cholera vaccine in cholera prevention and control, Malawi","volume":"96","author":"M M\u2019bangombe","year":"2018","journal-title":"Bull World Health Organ"},{"key":"pgph.0004335.ref010","unstructured":"Ministry of Health M. Cholera National Information Dashboard 2022. Available from: https:\/\/cholera.health.gov.mw\/surveillance"},{"key":"pgph.0004335.ref011","unstructured":"GPnotebook. World Health Organization (WHO) scale for dehydration. Available from: https:\/\/gpnotebook.com\/pages\/haematology\/world-health-organization-who-scale-for-dehydration. 2025. Accessed 2025."},{"key":"pgph.0004335.ref012","unstructured":"Kobo O. KoboToolbox: Making data collection accessible to everyone, everywhere. Available from: https:\/\/www.kobotoolbox.org\/about-us\/"},{"key":"pgph.0004335.ref013","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2023"},{"issue":"9596","key":"pgph.0004335.ref014","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"E von Elm","year":"2007","journal-title":"Lancet"},{"issue":"5","key":"pgph.0004335.ref015","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1093\/trstmh\/trx041","article-title":"Treatment of severe cholera: a review of strategies to reduce stool output and volumes of rehydration fluid","volume":"111","author":"T Butler","year":"2017","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"8946","key":"pgph.0004335.ref016","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/S0140-6736(95)90344-5","article-title":"Why treatment centres failed to prevent cholera deaths among Rwandan refugees in Goma, Zaire","volume":"345","author":"AK Siddique","year":"1995","journal-title":"Lancet"},{"issue":"9","key":"pgph.0004335.ref017","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-063703","article-title":"Epidemiology, diagnostics and factors associated with mortality during a cholera epidemic in Nigeria, October 2020-October 2021: a retrospective analysis of national surveillance data","volume":"12","author":"K Elimian","year":"2022","journal-title":"BMJ Open"},{"key":"pgph.0004335.ref018","article-title":"Improving access to health services in Malawi","author":"R Msokwa","year":"2023","journal-title":"SEEJPH"},{"key":"pgph.0004335.ref019","article-title":"Identifying and quantifying the factors associated with cholera-related death during the 2018 outbreak in Nigeria","author":"KE Elimian","year":"2020","journal-title":"PAMJ"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004335","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:43:49Z","timestamp":1760031829000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004335"}},"subtitle":[],"editor":[{"given":"Julia","family":"Robinson","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":19,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0004335","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]}}}