Cholera one year on: gains, drawbacks

It has been a year since the first case of cholera was reported in Malawi and the diarrhoeal disease, which thrives in unhygienic conditions, continues to claim lives in the country. Is Malawi any closer to completely annihilating the disease? The current outbreak, recorded as the worst to ever to visit Malawi, however, extended through the dry season.

By Patience Lunda:

It has been a year since the first case of cholera was reported in Malawi and the diarrhoeal disease, which thrives in unhygienic conditions, continues to claim lives in the country.

Efforts to contain its spread appear to have worked but, still, in both rural and urban locations, cases continue being registered.

Is Malawi any closer to completely annihilating the disease?

Cholera has been endemic in the country since 1998, with seasonal outbreaks reported during the rainy season.

The current outbreak, recorded as the worst to ever to visit Malawi, however, extended through the dry season.

The Ministry of Health indicates that between March 2022 and March 2023, 53,925 cases have been recorded out of which 1,658 have died in all the districts of the country.

In the first months of the outbreak, areas that were affected by floods as a result of cyclones Ana and Gombe that hit the country in January and March 2022, respectively, were affected most before the disease later started to spread across the country.

Society of Medical Doctors (SMD) Public Relations Officer, Zaziwe Gunda, observes that the country has not done well in the fight against the epidemic.

Gunda states that lack of coordination between communities and health workers has resulted in delays in reporting cases.

“Sensitisation was not done well because we saw instances where communities attacked health workers who were assisting cholera patients. All health facilities also need to have medical supplies for assisting patients,” he says.

National Organisation of Nurses and Midwives of Malawi president, Shouts Simeza, argues that health workers have been doing their best despite being overwhelmed with cases.

Simeza wonders why Malawi seems not to have learnt lessons from previous cholera outbreaks, which would help in keeping the current one under control.

“On our part, we have not relented in the fight, despite what we have to handle other cases.

“Authorities need to do more than what they are doing because the health sector is disorganised. We cannot even plan ahead, what is why we still have a preventable disease taking lives,” he says.

Sanitation problems caused by Tropical Cyclone Freddy, which battered the Southern Region recently, are worrying health rights activists who fear the cholera situation might worsen.

“We need to act fast, lest we return to the outbreak’s worst days,” Malawi Health Equity Network Executive Director George Jobe says.

He calls for amplified awareness raising, especially in areas worst knocked by the cyclone recorded as the worst to ever hit the southern hemisphere and the longest-lasting to visit Africa.

Jobe, on the other hand, touts interventions such as ‘Tithetse cholera (Let’s end cholera)’ campaign launched by President Lazarus Chakwera, which he says have contributed to a reduction of cases.

The World Health Organisation (WHO) says the ongoing cholera outbreaks in Africa are being exacerbated by extreme climatic events and conflicts that have increased vulnerabilities as people are forced to flee their homes and grapple with precarious living conditions.

And SMD is worried that the impacts of Cyclone Freddy, which made landfall in Malawi on March 11, could contribute to a rise in cases once again.

But Ministry of Health spokesperson Adrian Chikumbe insists authorities have learnt lessons from the outbreak and that measures to contain it are working.

“We will continue sensitising people so that they improve on sanitation and hygiene principles. We are engaging councils on formulation of bylaws that can help in minimising the spread of cholera,” Chikumbe says.

On the possibility of cholera cases rising again in the wake of Cyclone Freddy, Chikumbe admits that the threat is real.

He appeals with people in the affected areas to be proactive in following preventive measures while the ministry also does its part.

“We have met challenges before such as hesitance among some quarters to take cholera vaccines,” Chikumbe says.

Since the onset of the current outbreak, WHO has supported the country with access to 4.9 million doses of oral cholera vaccines from the International Coordinating Group—the body that manages emergency supplies of vaccines— with funding from Gavi.

In May and June 2022, 1.95 million doses were administered during a campaign in nine of the most affected districts in the Southern Region.

A second batch of 2.9 million doses arrived in October and WHO, together with Unicef, supported a vaccination campaign in 14 more districts.

For both campaigns, only one dose was administered instead of two, due to the global shortage in the vaccines.

With millions yet to get the shots, observers say, attention should be on improved prevention so that the gains made are not eroded by the recent disaster.