Predictors of mortality from diarrhea during a cholera outbreak in Haiti’s Artibonite and Centre regions, 2022–2024

Abstract

Background Haiti reported a resurgence of cholera in October 2022, which caused 88,087 suspected cases and 1,324 deaths through December 2024. There is limited data on the predictors of mortality from cholera during this epidemic period. Methodology/Principal Findings We conducted a retrospective cohort analysis of data from 15 cholera treatment centers (CTCs) supported by a non-governmental health organization in Haiti to identify factors associated with suspected cholera deaths. Cases were individuals treated for acute watery diarrhea at CTCs in the Artibonite and Centre departments between October 2022 and December 2024. We described the characteristics of cases, calculated case fatality ratios (CFRs), and used mixed-effects logistic regression to assess predictors of death, accounting for clustering by CTC. Missing data were addressed using multiple imputation chained equations (MICE, m = 50). We analyzed 17,912 suspected cholera cases, including 134 deaths (overall CFR: 0.7%). Nearly 51.0% of cases were male (9,056/17,822), and 32.2% (5,688/17,659) were aged ≤5 years. A quarter (4,490/17,912) of all cases presented with severe dehydration, and 65.1% (8,951/13,759) reported vomiting. After accounting for facility-level clustering, mortality was significantly associated with age ≥ 60 years (adjusted odds ratio [aOR] 6.08, 95%CI 3.56 - 10.38, p < 0.001), severe dehydration (aOR 5.24, 95%CI 2.85 - 9.64, p < 0.001), and vomiting (aOR 2.96, 95%CI 1.33 - 6.56, p = 0.008). Odds of death were lower among cases treated in 2023 (aOR 0.32, 95%CI 0.20 - 0.50, p < 0.001) and 2024 (aOR 0.24, 95%CI 0.07 - 0.79, p = 0.02), compared with 2022. Conclusions/Significance Older age, severe dehydration, and vomiting were significant predictors of cholera-related deaths in the Centre and Artibonite regions during Haiti’s 2022–2024 cholera epidemic. Improving data collection during outbreaks, including information on comorbidities, may enhance our understanding of these associations and inform interventions for further reducing cholera mortality.