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Cholera epidemic in Malawi

A cholera outbreak has been sweeping through Malawi since March 2022. And it’s not the only country affected. Worldwide there have been 50% more countries affected by outbreaks in 2022 than in previous years. This is according to The World Health Organisation’s Director General, Tedros Adhanom Ghebreyesus. That’s 31 countries and Malawi, Haiti and Syria are among the worst affected. With so many countries needing the vaccine, which is given by mouth, supply cannot keep up with demand. Malawi was given 4.9 million doses by the WHO in 2022 but these have now been used and no more are currently available.


Cholera is spread by the faecal contamination of drinking water or food and causes profuse watery diarrhoea. The good news is that, with proper rehydration, many lives can be saved. If left untreated, between a quarter and a half of affected patients will die. With optimum treatment, the death rate can be as low as 1% but it’s currently 3.3% in Malawi. This is a result of lack of medical supplies and personnel in the hospitals but also as many people arrive too late to be saved. Cholera can kill within hours of the first symptom appearing and getting to hospital quickly is of utmost important – before severe dehydration sets in.


Vibrio cholerae bacteria produce a toxin that causes cholera


It’s particularly sad when Malawi had almost eradicated the disease. There were only two reported cases in 2021. But over 1200 people have died of it in less than a year and the government is taking action to try to limit its spread. In January 2023, the health minister, Khumbize Kandodo Chiponda ordered the closure of businesses that lack access to safe water, safe toilets or hygienic waste facilities. This is important but when businesses can’t trade, it can mean financial ruin for people that are already struggling with poverty. In addition, many schools were ordered to remain closed after the Christmas break – affecting children’s education.


This February, President Lazarus Chakwera launched a further campaign, called “Tithetse Kolera” or “Let’s end cholera”. He stressed the importance of Malawians following following good health practices – also known as WASH -WAter, Sanitation and Hygiene. There is help for those who do not have access to a toilet or latrine to build one, and water kiosks, where people pay a small fee to obtain water, are being repaired. Previously, according to UNICEF, only 77% were functional. Water tankers have been sent into communities that lack a safe water supply. Chlorination facilities and house-to-house chlorination programmes have been set up, some by NGOs such as the Red Cross. However, there is so much more to be done and the cost is enormous.


In Lilongwe, the capital of Malawi, extra hospital tents have been erected to house the sick and the deceased. There are not enough beds for all the patients and some have to lie on the floor. There are not enough staff for them either. Many of the patients are are desperately ill and have had to be carried in by relatives or pushed in wheelchairs. The sickest patients are most likely to survive if given intravenous fluids but a mixture of clean water, salt and sugar (oral rehydration therapy, ORT) saves lives too and is much cheaper. ORT can also be administered without the need for specialist personnel or equipment. The WHO has provided some extra medical supplies but there is still a need for more.


Cholera patients at a hospital in Malawi


Public health experts point to several potential causes of the outbreak. Heavy rains and floods in January and March last year, caused by Tropical Storm Ana and Cyclone Gombe, destroyed latrines and hand-washing facilities in some communities. In addition, the rise in population has caused over-crowding and rapid urbanisation. Another factor could have been waning immunity among Malawians before the epidemic hit. Not only did vaccination efforts slow after the 2017 campaign, but the recent low prevalence of disease may have reduced natural cholera immunity. Disruption due to the coronavirus pandemic has also had an effect.


UNICEF Public Information poster


Although the incidence of cholera is starting to come down in some of Malawi’s districts, the disease prevalence is still high and the epidemic is far from over. Once it is, it will be important that vaccination coverage is maintained and that good hygiene practices continue.

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