Fighting Malawi’s raging cholera outbreak

Malawi is facing the worst cholera outbreak in the country’s history. As of January 31, 2023, the country reported a total of 563 new cases and 25 new deaths. The cumulative confirmed cases and deaths reported since the onset of the outbreak in March 2022 is 34,918 cases and 1,133 deaths across all 29 districts in the country.

The worst cholera outbreak was between October 2001 and April 2002 when 33 546 cases were recorded, leading to 968 deaths.

According to the World Health Organisation (WHO) although cholera outbreaks are endemic in Malawi especially during the wet season, the country has been hit hard this year even during the dry season due to the effects of tropical storm Ana which hit the country in January 2022 and Cyclone Gombe which landed two months later. The two disasters led to flooding which resulted in lack of access to safe water, sanitation and hygiene.

The soaring cases of cholera worried Mwanza district public health promotion officer Dikirani Chadza. The last cholera case was recorded in the district in 2017. So, when the first case was found on 4 September 2022, health officials feared the worst.

“The district has since registered 47 cases and four deaths. If we look at the prevalence rates, Mwanza is one of the districts that have registered the least cases. This, partly, has been due to timely interventions from the Save the Children which responded in time and according to our needs,” he said.

Chadza, who is also the district hospital public relations officer, said apart from a home-to-home chlorinisation campaign, Save the Children also provided information, education and communication materials, and funded community engagement meetings as well as coming up with community-based response plans.

“They helped us train 175 health workers on cholera case management. We also got a mobile van facility to track and treat cases while conducting public awareness meetings to increase hand-washing and proper hygiene practices,” he said.

Chadza added that they have also been working with other sectors, like education, where they have held sensitisation meetings with staff and students about the disease.

“The outbreak is controlled in Mwanza. The cases are minimal and for us that is an achievement,” he said.

Ruth Mkandawire, a health surveillance assistant HSA who benefitted from the training said apart from the pot-to-pot chlorinisation and the use of a locally made water tap called mpondagiya.

“Villagers wash their hands when coming from the toilet using a water from a bottle which is connected to a stick using a string. They step on the stick and water flows from the bottle. This enables them to wash their hands without touching the bottle,” she said.

She added that they also encourage villagers to cover their pit latrines and store water properly.

With seven chiefs under him, Group Village Headman Mulongolola hailed the efforts to prevent cholera spread. The first case was recorded in his village as the victim was drawing water from the Mkulumadzi River.

“Villagers now use chlorine and we encourage them to drink water from the borehole and not the shallow wells on the banks of the river. We have also spread the message of using mpondagiya. We are discouraging villagers from relieving themselves in bushes,” he said.

Zomba district environmental health officer Innocent Mvula said with assistance from SAVE THE CHILDRENand other partners, they are controlling cholera in the district.

“Some partners come with prequalified assistance which at times are not what we need. The supplies and medical equipment we got from Save the Children assisted us a lot in bringing down the cholera cases. After we did a gap analysis, Save the Children was able to assist us in conducting death audits and the orientation of health workers,” he said.

One of the health workers trained on cholera case management, Protazio Chiwaya of Matiya Health Centre in Zomba said the facility has had 14 cases so far.

“We got supplies and cholrine for cholera prevention and treatment. For us to get only 14 cases in an area covering 118 villages and a population of 50,000 is an achievement. Through water committees, some boreholes have been repaired in the area,” said Chiwaya.

But while Mwanza and Zomba are registering advances in cholera management, other districts like Balaka have registered surges. About 1,270 cases have been registered in the district with 39 deaths.

Balaka district hospital senior medical officer Dr Leone Tumizgani Lowole said cholera has been spreading at an alarming rate in the district.

“We had less than 80 cases in December but in January, 700 new cases have been recorded. This is why we thank Save the Children for coming to increase awareness on cholera on its prevention and treatment. The upsurge is mainly due to lack of awareness on cholera and we are going on the ground with community engagements,” she said.

According to her, the hospital is facing several challenges like inadequate supplies like IP fluids, canulars and chlorine. “We also need fuel as we are doing more running around with increased cases. We are meeting at least twice a week with other stakeholders and SAVE THE CHILDRENour main partner,” said Lowole.

During one of the initial community engagements with locals at Utale 2 Health Centres, Group Village Headwoman Wiliki in T/A Nkaya’s area hailed the sensatisations, saying it will array some of the misconceptions people had on cholera.

“Some thought the chlorine that was distributed was for clandestine purposes. They have taught us hown to prevent the disease. We will hold further awareness meetings on proper hygiene and sanitation. This is a disease that borders on proper hygiene,” she said.

According to a health and nutrition specialist at Save the Children Balaka Branch Christina Matias this was one of the engagements they are conducting following the upsurge of cases.

“There have been rumours saying the current cholera outbreak is the result of Satanists. We are trying hard to dispel such rumours, while at the same time encouraging communities,” she said.