1.3. Age (In Yrs 1.6. Patient residency 1.7.

Patient
S/N 1.1. Patient Full name 1.2. MRN or Months) 1.4. Sex 1.5. Phone Number Region residency Sub city
1 Hafiza Adem Ahmed 18201 25 Female 960292037 Oromia Other
2 Kassahun Nimane Bereket 354334 28 Male 912385678 Addis Ababa Addis Ketema
3 Azmera Atsbeha Abay 43712 65 Female 919399164 Addis Ababa Addis Ketema
4 Demeke Wakene Weda 316386 62 Male 925694476 Addis Ababa Addis Ketema
5 Tewabech Worku Bacha 19587 57 Female 913938115 Addis Ababa Addis Ketema
6 Seyfedin Kemal nur 19588 45 Male 911609124 Addis Ababa Addis Ketema
7 Yimegnushal Taddesse 19567 30 Female 962150529 Addis Ababa Addis Ketema
8 Behailu Hirgate Tekle 277753 49 Male 911957214 Addis Ababa Addis Ketema
9 Sisay Zemecha Gibe 230012 34 Male 916872209 Addis Ababa Addis Ketema
10 Melka Sore Tafi 357460 85 Male 911191015 Addis Ababa Kolfe Keranio
11 Andualem Tegene Agegnew 357243 40 Male 911633307 Addis Ababa Addis Ketema
12 Tigist Tenagn 357443 20 Female 962883418 Addis Ababa Addis Ketema
13 Wodesen Tesfaye Bekele 185997 24 Male 941391382 Addis Ababa Addis Ketema
14 Nebil Seid Mohammed 19660 9 Male 900077122 Addis Ababa Addis Ketema
15 Abush Demise Regasa 19653 19 Male 949127657 Oromia Other
16 Megertu Bute 161229 65 Female 944251272 Addis Ababa Addis Ketema
17 Abay Gete Tesfaye 19709 20 Female 911391528 Addis Ababa Addis Ketema
18 Delil Ahmed ediris 19716 65 Male 933655862 Oromia Other
19 Mekdes Asfaw Tadege 191578 30 Female 913543154 Addis Ababa Addis Ketema
20 Helen Zewde Demeke 341411 45 Female 913982119 Addis Ababa Addis Ketema
21 Birhanu Cherkos Delilew 311995 33 Male 910668595 Addis Ababa Addis Ketema
22 Kebede Shibarhi Benti 252211 59 Male 913653659 Addis Ababa Addis Ketema
23 Bethelhem Guytabe Musem 302510 14 Female 912970782 Oromia
24 Alem Yirga 19772 35 Female 920110138 Addis Ababa Kolfe Keranio
25 Daniel Mamo Degefu 133281 45 Male 913160453 Addis Ababa Kolfe Keranio
26 Kalkidan Kebede Shibeshi 358002 18 Female 907503555 Addis Ababa Addis Ketema
27 Murida Seman Bushira 148493 47 Female 912920191 Addis Ababa Kolfe Keranio
28 Sisay Mare Kezane 10338 28 Male 9967190704 Addis Ababa Kolfe Keranio
29 Sadiya Mohamed 12039 56 Female 922949472 Addis Ababa Kolfe Keranio
30 Hailu Adibib Nurge 19861 25 Male 921704240 Addis Ababa Addis Ketema
31 Jemanesh Haile Sima 358255 40 Female 912069022 Addis Ababa Addis Ketema
32 Teshome Tekle Behlku 198826 46 Male 910180529 Addis Ababa Kolfe Keranio
33 Chewanesh Liga Wodo 19884 36 Female 922085407 Addis Ababa Kolfe Keranio
34
35
36
37
38
39
1.7a. Specify if 1.8. Patient residency 1.9. Patient residency Ketena 1.11. Patient current 1.11a. 1If other, Specify
Other Woreda (specific area) 1.10. House Number Occupation occupation.
Filidoro Filidoro New Unemployed
12 3 New Daily Labourer
13 6 New Unemployed
13 4 1029 Private
12 4 666 Housewife
8 new Marchant
12 4 1183 Private
13 6 New Private
12 4 New Private
10 Mebrathayl New unemployed
12 Chelfo Dildiy 801 Private
14 New Private
14 New Private
11 4 754 Student
Ashewameda Filidoro Bero New Private
11 724 Housewife
11 kibiad village 7059 servant
Sheger city Melkagefersa 3 276 Employed
10 3 66 Housewife
11 3 690 Church Servant
12 4 New Private
13 4 New Private
Burayu Gujje New Student
10 2 862 Private
10 5 New Private
13 4 663 Student
10 6 New Housewife
10 New butcher
10 New Unemployed
12 3 New Private
12 2 308 Private
10 new Private
10 new Private
 1.16. Date of onset
1.12. Name of Health 1.13. Health facility location 1.13a. Specify if location of 1.15. Date seen at health of disease
facility (Sub city) HF is other 1.14. GPS facility (MM/DD/YYYY) (MM/DD/YYYY)
Dr Jeilan Clinic Addis Ketema May22,2023 May21,2023
Sindemer Clinic Addis Ketema May22,2023 May21,2023
Kolfe H.C Addis Ketema June 7,2023 Jun 7,2023
Kolfe H.C Addis Ketema July 28,2023 July 27,2023
Dr Jeilan Clinic Addis Ketema Jul 28,2023 Jul 27.2023
Dr Jeilan Clinic Addis Ketema Jul 28,2023 Jul 27.2023
Dr Jeilan Clinic Addis Ketema Jul 28,2023 Jul 27.2023
Kolfe H.C Addis Ketema Jul 19,2023 Jul 18,2023
Kolfe H.C Addis Ketema Jul 20,2023 Jul 18,2023
Kolfe H.C Addis Ketema Jul 21,2023 Jul 19,2023
Kolfe H.C Addis Ketema Jul 20,2023 Jul 18,2023
Kolfe H.C Addis Ketema Jul 23,2023 Jul 23,2023
Kolfe H.C Addis Ketema Jul 23,2023 Jul 23,2023
Dr Jeilan Clinic Addis Ketema Jul 31,2023 Jul 30,2023
Dr Jeilan Clinic Addis Ketema Jul 31,2023 Jul 29,2023
Dr Jeilan Clinic Addis Ketema Jul 2,2023 Jul 1,2023
Dr Jeilan Clinic Addis Ketema Jul 2,2023 Jul 1,2023
Dr Jeilan Clinic Addis Ketema Jul 2,2023 Jul 1,2023
Esam Clinic Addis Ketema Jul 3,2023 Jul 2,2023
Kolfe H.C Addis Ketema Aug 3,2023 Aug 1,2023
Kolfe H.C Addis Ketema Aug 4,2023 Aug 3,2023
Kolfe H.C Addis Ketema Aug 4,2023 Aug 3,2023
Kolfe H.C Addis Ketema Aug 5,2023 Aug 5,2023
Dr Jeilan Clinic Addis Ketema Aug 5,2023 Aug 4,2023
Dr Jeilan Clinic Addis Ketema Aug 5,2023 Aug 4,2023
Kolfe H.C Addis Ketema Aug 5,2023 Aug 4,2023
Kolfe H.C Addis Ketema Aug 5,2023 Aug 5,2023
Dr Jeilan Clinic Addis Ketema Aug 7,2023 Aug 5,2023
Dr Jeilan Clinic Addis Ketema Aug 8,2023 Aug 8,2023
Dr Jeilan Clinic Addis Ketema Aug 9,2023 Aug 9,2023
Kolfe H.C Addis Ketema Aug 9,2023 Aug 8,2023
Dr Jeilan Clinic Addis Ketema Aug 10,2023 Aug 9,2023
Dr Jeilan Clinic Addis Ketema Aug 10,2023 Aug 9,2023
 2.1. Presenting clinical
feature/Profuse Watery 2.1. Presenting clinical 2.1. Presenting clinical
2.1. Presenting clinical feature diarrhea feature/Vomiting feature/Nausea
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes No
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes No
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes Yes Yes
Yes No Yes
Yes Yes Yes
Yes Yes Yes
2.1. Presenting clinical 2.1. Presenting clinical 2.1. Presenting clinical 2.2. Dehydration 3.1. Sample taken
feature/Fever feature/Muscle pain feature/Other (specify) status of the patient for the patient?
NO Yes Dry mouth Severe Dehydration Yes
NO Yes Severe Dehydration Yes
NO Yes Severe Dehydration Yes
NO Yes Loss of conciousness Some Dehydration No
NO Yes No dehydration No
No Yes No dehydration No
No Yes Some Dehydration No
NO Yes Some Dehydration Yes
NO Yes Severe Dehydration No
NO Yes Dry mouth Severe Dehydration No
No Yes Severe Dehydration Yes
NO No No dehydration No
NO No No dehydration No
NO Yes Easy Fatique Some Dehydration No
NO Yes Headachea&Easy Fatique No dehydration No
NO No Some Dehydration No
NO No Some Dehydration No
NO No Severe Dehydration No
NO Yes Some Dehydration No
NO Yes Severe Dehydration No
yes Yes Dry mouth Some Dehydration No
NO Yes Some Dehydration No
NO Yes Some Dehydration No
NO Yes No dehydration No
NO Yes Dry mouth Severe Dehydration No
NO Yes Dry mouth Severe Dehydration No
NO Yes No dehydration No
NO Yes Some Dehydration No
NO Yes Some Dehydration No
NO Yes Dry mouth Severe Dehydration No
NO No Some Dehydration No
NO Yes Weekness Some Dehydration No
NO No No dehydration No
 4.1. Does the patient has
3.1a. If yes, Date Specimen 3.1b. If yes, RDT test 3.1c. If sample taken, history of travel to cholera
collected (DD/MM/YYYY)? result? Culture test result? 3.2. Patient (case) category? outbreak area?
May22,2023 Negative Not Done Suspected No
May22,2023 Negative Not Done Suspected No
Jun 7,2023 Positive Positive Confirmed No
Suspected No
Suspected No
Suspected No
Suspected No
Jul 20,2023 Positive Not Done Confirmed No
Suspected No
Suspected No
Jul 20,2023 Positive Confirmed No
Suspected No
Suspected No
Suspected No
Suspected Yes
Suspected No
Suspected No
Suspected Yes
Suspected No
Suspected No
Suspected No
Suspected No
Suspected Yes
Suspected No
Suspected No
Suspected No
Suspected No
Suspected No
Suspected No
Suspected No
Suspected No
Suspected No
Suspected No
 4.2. Does the patient has Contact 4.3. Types of food exposure five days before onset of
4.1a. If Yes, Specify the history with Suspected/Confirmed 4.2a. If yes, contact illness (specify the types of food the client take 5 days
area Cholera patient ? address? before onset of illness)?
No Potato chips,pip water,cabbage
No Beyayinet,Raw meat,Egg,Banana
No Cheese,Lentile wet,Porge,Cabbage
No Tea with bread,Tomatto&Cabbage
No Cabbage,Shiro wet
No Tommatto wet,Enjera with lentile wet
No Enjera with wet
No Enjera,Meat&Shiro
No Cabbage&Beyaynet
No Cheese,pasta with vegtable &Enjera
No Cooked meat,Enjera,Rice&Potato
No Enjera with Cabbage&Bread from shoap
No Enjera with Cabbage&Bread from shoap
No Avocado,Pasta&Vegetables
Filidoro No Raw milk,Beyaynet
No Enjera with shiro wet&cooked vegtables
No Cheese&Enjera with wet
oromia filidoro No Enjera with wet
No Raw tomatoes&Enjera with wet
No Tomatoes wet & Enjera with shiro wet
No Potato BREAD,ENJERA WITH SHIRO WET,cabbage
No Enjera with shiro wet&Raw meat
oromia filidoro No Enjera with Butter& Tomatoes sils
No Enjera with cabbage
No Enjera with wet
yes House Hold Enjera with shiro wet&Tea
No Bread from shop&fruit
No Raw Meat &Enjera with wet
No Enjera with shiro wet&Meat
No Dulet&Raw Meat
No Enjera with shiro wet
No Takeaway from piasa,selata,tomatoes &pasta with potato
No Takeaway from piasa,selata,tomatoes &pasta with potato
 4.4a. Specify if other 5.1. Admission 5.2. Date of admission
4.4. Main Water source water source. status (MM/DD/YYYY) 5.3. Date of discharge 5.5. Patient outcome
Pipe water Outpatient Referred
Pipe water Outpatient Referred
Pipe water Outpatient Referred
Pipe water Outpatient Improved
Pipe water Outpatient Ontreatment
Pipe water Outpatient Improved
Pipe water Outpatient Improved
Pipe water Outpatient Ontreatment
Pipe water Inpatient Referred
Pipe water Outpatient Referred
Pipe water Outpatient Referred
Pipe water Outpatient Improved
Pipe water Outpatient Improved
Pipe water Outpatient Improved
Pipe water Outpatient Improved
Pipe water Outpatient Improved
Pipe water Inpatient Jul 2,2023 Jul 3,2023 Improved
Pipe water Inpatient Jul 2,2023 Referred Referred
Pipe water Inpatient Aug 3,2023 AUg 4,2023 Improved
Pipe water Inpatient Aug 3,2023 AUg 4,2023 Improved
Pipe water Inpatient AUg 4,2023 Aug 5,2023 Improved
Pipe water Inpatient AUg 4,2023 Aug 5,2023 Improved
Pipe water Outpatient Improved
Pipe water Outpatient Improved
Pipe water Inpatient AUg 4,2023 Referred
Pipe water Inpatient Aug 5,2023 Ontreatment
Pipe water Outpatient Improved
Pipe water Inpatient Aug 7,2023 Ontreatment
Pipe water Inpatient Aug 8,2023 Improved
Pipe water Inpatient Aug 9,2023 Referred
Pipe water Inpatient Aug 9,2023 Improved
Pipe water Inpatient Aug 9,2023 Improved
Pipe water Outpatient Improved
 5.8. Is there any
5.6. Disinfection status of 5.7. Do the patient has any 5.7a. If yes, specify complications 5.8a. If yes, specify any
the household? other co-morbidity? any co-morbidities secondary to Cholera? complications
Not Disinfected Yes Severe Aneamia Yes Severe Dehydration
Not Disinfected No Yes Severe Dehydration
Disinfected No Yes Severe Dehydration
Diabetes
Not Disinfected No Mellitus&Hyperten No Some Dehydration
Not Disinfected Yes sion No No Dehydration
Not Disinfected No No No Dehydration
Not Disinfected No No No Dehydration
Disinfected No No Some Dehydration
Disinfected Yes RVI Yes Severe Dehydration
Not Disinfected No Yes Severe Dehydration
Disinfected No Yes Severe Dehydration&AKI
Not Disinfected No No No Dehydration
Not Disinfected No No No Dehydration
Not Disinfected No No Some Dehydration
Not Disinfected No No No Dehydration
Not Disinfected No Yes Some Dehydration
Not Disinfected No Yes severe Dehydration
Not Disinfected No Yes Severe Dehydration&AKI
Disinfected No Yes Some Dehydration
disinfected No Yes Severe Dehydration
Disinfected No Yes Some Dehydration
Disinfected No Yes Some Dehydration
Not Disinfected No No Some Dehydration
Not Disinfected No No No Dehydration
Not Disinfected No Yes Severe Dehydration&AKI
Disinfected No Yes severe Dehydration
Not Disinfected Yes HTN&DM No No Dehydration
Not Disinfected No No Some Dehydration
Not Disinfected No No Some Dehydration
Disinfected No No Severe Dehydration&AKI
Disinfected No No Some Dehydration
Not Disinfected No No Some Dehydration
Not Disinfected No No No Dehydration
 5.13. If the source of the patient is
5.9. If the patient is admitted, 5.10. If the patient is 5.11. Date the 5.12. Referral status of the refered from other health facility,
admission site(name of HF) refered , where? patient refered? patient on arrival? specify referring site?
RDDH May22,2023
RDDH May22,2023
Minilik Hospital June 7,2023

RDDH Jul 20,2023

ALERT Hospital Jul 21,2023
ALERT Hospital Jul 21,2023

ALERT Hospital Jul 2,2023

Dr Jeilan Clinic ALERT Hospital

Kolfe Health Center ALERT Hospital

Dr Jeilan Clinic
Dr Jeilan Clinic
Kolfe Health Center
Dr Jeilan Clinic
 5.15. Living status of the 5.17. MUAC for under 5.18. Oral Cholera
5.14. Mode of arrival? patient (Housing status? 5.16. Nutritional Status five children vaccination status?
Other public/private tra Home Normal Zero dose
Other public/private tra Home Normal Zero dose
Other public/private tra Home Normal Zero dose
Walking but supported bHome Normal Zero dose
other public/private tranHome Normal Zero dose
Walking and stable Home Normal Zero dose
Walking but supported bHome Normal Zero dose
Walking and stable Home Normal Zero dose
Other public/private tra Home Normal Zero dose
Other public/private tra Home Normal Zero dose
Walking but supported bHome Normal Zero dose
Walking and stable Home Normal Zero dose
Walking but supported bHome Normal Zero dose
Walking but supported bHome Normal Zero dose
Walking and stable Home Normal Zero dose
Walking but supported bHome Normal Zero dose
Other public/private tra Home Normal Zero dose
Other public/private tra Home Normal Zero dose
Other public/private tra Home Normal Zero dose
Other public/private tra Home Normal Zero dose
Other public/private tra Home Normal Zero dose
Other public/private tra Home Normal Zero dose
Walking and stable Home Normal Zero dose
Walking but supported bHome Normal Zero dose
Other public/private tra Home Normal Zero dose
Other public/private tra Home Normal Zero dose
Walking but supported bHome Normal Zero dose
Walking but supported bHome Normal Zero dose
Walking but supported bHome Normal Zero dose
Other public/private tra Home Normal Zero dose
Walking and stable Home Normal Zero dose
Ambulance unstable) Home Normal Zero dose
Walking and stable Home Normal Zero dose
5.19. Pregnancy status 5.20. If lab test do not,
if female? done Why? Remark Column1
Not pregnant
Not pregnant
Not pregnant LMHC catchment
Not pregnant No Test Kit MHC Catchment&Chronic drunker
Not pregnant No Test Kit ADK-Woreda 4 catchment
Not pregnant No Test Kit ADK-woreda 8 pt
Pregnant No Test Kit
Not pregnant LMHC catchment
No Test Kit
No Test Kit KK-w-10

Pregnant No Test Kit MHC Catchment

No Test Kit MHC Catchment
No Test Kit Philipos Catchment
No Test Kit Oromia catchment
Not pregnant No Test Kit K.K woreda -10
Not pregnant No Test Kit Philipos Catchment
No Test Kit Oromia catchment
Not pregnant No Test Kit ADK-w-10
Not pregnant No Test Kit Philipos Catchment
No Test Kit
No Test Kit LMHC catchment
Not pregnant No Test Kit Oromia catchment
Not pregnant No Test Kit KK-w-10
No Test Kit KK-w-10
Not pregnant No Test Kit LMHC catchment
NA No Test Kit KK-w-10
No Test Kit KK-w-10
NA No Test Kit KK-w-10
No Test Kit
Not pregnant No Test Kit
No Test Kit KK-w-10 the same exposure
Not pregnant No Test Kit KK-w-10 the same exposure