Multiple countries are currently affected by outbreaks of acute watery diarrhoea (AWD), including cholera. Some of these countries have concurrent high prevalence of acute malnutrition. It is likely that a substantial number of the cholera affected children also suffer from severe acute malnutrition (SAM). In light of this, CDC reviewed multiple treatment protocols and guidance documents on cholera and SAM. They highlight several observations and critical concerns with existing protocols and points of attention for improved guidance. The findings are published in the Lancet.

In response to the review, WHO has identified that the current Ethiopian protocol (2017) is the most appropriate to refer to in the immediate term (based on existing WHO guidelines), whilst recognising research gaps remain.

Programmers are urgently asked to re-examine their current protocols and amend accordingly.

WHO is working with partners on moving the research agenda forward to ensure there is strong evidence to support an updated protocol for the future not only in the area of cholera and SAM but in diarrhoea, dehydration and SAM in general. In the meantime, WHO will issue a guidance pulling together existing WHO recommendations.