Epidemiological Trends of Acute Watery Diarrhoea (AWD) across all Age Groups at Cumilla General Hospital: Retrospective Cross-sectional Insights from AWD Surveillance Data of 2022 to 2024

Objectives Acute Watery Diarrhea (AWD) remains prevalent (16/1000 population) in Bangladesh. Nationwide AWD surveillance has been active since 2014 across 16 sentinel sites. With an estimated over 100,000 cases and approximately 3,500 deaths annually, cholera remains a critical public health concern. This study analysed AWD surveillance data from June 2022 to September 2024. Methods Suspected, RDT for cholera positive, and culture/PCR Positive cholera cases were identified using The U.S. Centers for Disease Control and Prevention (CDC) clinical definitions, Rapid Diagnostic Tests (RDTs), and microbiological culture. Socio-demographic, clinical, and etiological characteristics were examined descriptively. Cases identified using the Cholkit RDT. Results Among 977 cases, 49 (5%) were RDT-positive for cholera. Culture was not conducted in 41/49 (84%) cases. Children under five were predominantly affected (56.1%). Two culture positive cases were RDT-negative. Suspected case surges occurred in November and January. All cases reported drinking untreated water and not using soap after defecation; 67.45% consumed roadside food. Alarmingly, 90% (881/977) of suspected cases had taken antibiotics before hospital admission. Cumilla Adarsha Sadar sub-district bore the highest burden (66.8% of suspected cases). RDT-positive cases showed variation across demographic and clinical characteristics, Conclusions The study indicates a substantial burden of acute watery diarrhea, with a small proportion of cases testing RDT-positive for cholera. Enhancing diagnostic capacity particularly microbiological culture use is essential for accurate detection. Public health efforts must prioritize promotion of safe water and handwashing practices. Themes Communicable Diseases, Epidemiology