Malawi is suffering the worst cholera outbreak in decades


Cholera ward in a health center in Blantyre. Malawi has experienced a massive increase in cholera in the past year. Source: Charles Mpaka/IPS
  • by Charles Mpaka (blantyre)
  • Inter Press Service

That one case was a warning of what would become Malawi’s worst cholera outbreak in decades.

For nearly a year, cholera has gripped the country, with cases reported in all 29 districts and rising.

In an unprecedented occurrence, cases surged even during the summer months when cholera is least expected and the country least prepared for it.

As of January 4, 2023, up to 640 people were killed and 19,000 cases were recorded, government data shows. The fatality rate stands at 3.4 percent, higher than the recommended rate of less than one percent.

Maziko Matemba, executive director of the Health and Rights Education Program (HREP), a local civil society organization, says the situation is alarming and keeps the country in a “spiral of health crisis”.

“We entered the year 2022 in hopes of recovering from the devastation of Covid-19. Then Tropical Storm Ana hit us back in January. Cholera hit in March, and it hasn’t left for ten months, and it’s getting worse as time goes by. We haven’t had cholera outbreaks like this for a long time,’ says Matemba.

And fears are growing that the disease could spread further now that the rainy season, which usually breaks out in Malawi, has begun.

Tropical Storm Ana played a major role in this outbreak, experts say. The downpour affected 16 districts, including Machinga, where the first cholera case was reported in March, and Nsanje, a flood-prone district and one of the first areas to report cholera cases during this outbreak.

A final situation report on the impact of the storm by the Department of Disaster Management Affairs found that more than 53,000 latrines collapsed, while 337 boreholes, 206 water taps and eight gravity-fed water systems in those 16 districts were damaged.

The department said this resulted in low sanitation coverage, limited access to safe water and poor hygiene practices, with some sites and communities reporting open defecation and contamination of the few water sources available.

The report said the situation increased the risk of cholera and other communicable diseases.

“As such, safe water supply, sanitation and hygiene services are immediately needed to address water, sanitation and hygiene issues. In addition, there is a need for rehabilitation of toilets to prevent infectious and water-borne diseases,” it said.

But Malawi has not fully recovered from this disaster since then, Matemba says.

“So lack of recovery of water and sanitation destroyed during that time has created good conditions for cholera to thrive. This fits into an existing framework of a weak prevention system. We usually take prevention rather casually,” he says.

Save Kumwenda, an expert on environmental hygiene, says that in addition to the issues with water, sanitation and hygiene, there is also evidence that temperature and precipitation influence cholera outbreaks – with temperature-causing epidemics and rainfall as a spreading mechanism.

“Then there are also socioeconomic conditions that are the main drivers of outbreaks, as they increase exposure to pathogens,” said Kumwenda, an associate professor at the Malawi University of Business and Applied Sciences (MUBAS).

He says the situation could worsen as the rainy season spreads the bacteria by contaminating water bodies and food.

The outbreak has hit Malawi’s two largest cities, Lilongwe, the capital, and Blantyre, the trading city, the hardest hit.

For example, in the 7 days between December 29, 2022 and January 4, 2023, the country recorded 2,773 cases and 137 deaths. Of these, Blantyre and Lilongwe contributed 47 percent of new cases and 53 percent of new deaths.

Kumwenda says this is because the two cities, which struggle with solid waste management and aging sewers, have large peri-urban areas where residents rely on wells, boreholes and river water highly contaminated by faeces from toilets, broken septic tanks, broken sewage pipes and open defecation.

He says most homes in these areas don’t have adequate toilets, and many rely on sharing.

In addition, most of these households cannot afford to pay for water from water boards for both drinking water and domestic use. Therefore, they prioritize safe water for drinking only and unsafe water for other uses, leading to contamination of food and utensils and also contamination of the available safe water.

“The other reason for the high number of cholera cases in these cities is the large number of people who depend on piecework, and these depend on food sold in markets where hygiene and sanitation conditions are compromised,” he says.

In response, the government delayed the opening of schools in the two cities and surrounding areas by two weeks. Malawi opened on January 3 academic year 2022.

Health Minister Khumbize Kandodo Chiponda says in a statement that opening schools in the two cities would affect containment efforts for the outbreak, as cholera is passed from one person to another through contaminated food, water and inadequate sanitation, a hallmark that exists in school settings.

“Pupil convergence, especially in pre-primary, primary and secondary schools, increases the likelihood of the uncontrolled spread of the vibrio bacteria that causes cholera,” she says.

During the two-week delay, the government will conduct a thorough assessment and improve water and sanitation in schools in both cities.

For a national response, the government says it will open more treatment centers in the cholera hotspots, hire more staff in the treatment centers, step up hygiene promotion and carry out water quality assessments in specific areas, among other things.

In November last year, Malawi launched the reactive oral cholera vaccination campaign, targeting 2.9 million people aged one year and older.

Kumwenda says Malawi had to act quickly to stop the outbreak before the start of the rainy season as there was clear evidence of impending emergency due to the surge in cases during the hot months.

But to bring the disease under control in the long term, Malawi needs to invest in research to come up with evidence-based interventions.

“In this way we ensure that we always invest in interventions that yield the maximum. We need to understand the main causes of the epidemic and also identify the reservoirs of the bacteria that cause cholera. The knowledge of the reservoirs will help us easily prevent a recurrence of the outbreak,” said Kumwenda, president of the Malawi Environmental Health Association, a group of environmental health experts.

IPS Report of the UN Office

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© Inter Press Service (2023) — All rights reservedOriginal source: Inter Press Service

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