Statistics don’t lie, they are hard facts. From an average of 13 new cases a day in February 2018 to around 5 cases a day now is factual evidence that the Government has done and it continues to do all it can, to address the cholera outbreak.
Cholera is an acute diarrhoeal disease that can kill within hours if left untreated.The infection is caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Cholera remains a global threat to public health and an indicator of inequity and lack of social development.The World Health Organisation (WHO) estimates that each year, there are 1.3 million to 4.0 million cases of cholera, and 21 000 to 143 000 deaths worldwide due to cholera.
In Malawi, so far the cases recorded indicate that interventions by Government and its partners are working, despite continued challenges posed by other social considerations.The new cases, regrettable deaths and even at times pointing fingers, indicate that a more multi-sectoral approach is required, to close this rainy season outbreak.
The challenge now remains addressing religious beliefs which see some sectors of society refuse medical attention in hospitals, delays in bringing patients and others using traditional herbal doctors.
The first cholera case was reported from Karonga on 24th November, 2017. At the peak of the outbreak (in February 2018), a total of 13 districts were reporting cholera cases in Malawi. During this period, average of 13 cases was being reported each day from these districts. At the beginning of the outbreak, President Peter Muntharika ordered all sectors- Disaster Management led by the Vice President Rt. Hon Saulos Chilima, Ministry of Health and Population, and the Ministry of Agriculture, Irrigation and Water Development, all at senior levels to find ways and means of mitigating the impact of cholera, and contain it.
The Ministry of Health and Population in collaboration with all its partners intensified implementation of activities and interventions in order to control the cholera situation in the country. The cholera situation has improved since the end of February 2018. Now 5, as opposed to 13, new cases of cholera are being reported each day from the 4 remaining districts that are still reporting cases (Karonga, Lilongwe, Salima and Dedza). Nkhatabay, Likoma, Kasungu, Dowa, Blantyre, Mulanje, Chikwawa and Nsanje have been declared free from the outbreak after surpassing more than 14 days without reporting a new cholera case.
Rumphi has not reported a new cholera case for over a week now and may soon be declared free of the outbreak. Furthermore, data, analysis both national and in those districts that are still reporting cholera cases, shows that the number of new cholera cases, and as such the cholera outbreak, has been on the decline in the last 3 weeks. This is an encouraging indicator that the Ministry of Health and its partners are containing the outbreak.
The historical data indicates that Malawi has been having cholera outbreaks every year from 1998 to 2016 only between November 2012 to October 2014 did the country not register any cholera case. The highest recorded cases were in 2001/2002 when 33,456 cases were recorded that resulted in 973 deaths.
The 2015/2016 rainy season recorded 1805 cases that resulted in 48 deaths. During the current rain season, as of Tuesday 13thMarch, 2018, 768 cases had been recorded. Out of these only 14 patients that have recently (in the last 3 days) been diagnosed of cholera are still in treatment centres. This means that the majority of the reported cases, 729 patients have been successfully treated and have recovered and returned home. Unfortunately, during this outbreak, 25 people have lost their lives. 12 of these 25 died in their community without the deceased reaching a health facility.
These are important facts as cholera remains a public health challenge in Malawi and its short incubation period, between two to five days, means Malawians need to be on alert and rush to public health facilities all of which are well equipped to handle cholera cases.
The secret of effective treatment and containment of cholera lies in reaction from those feeling unwell rushing to hospital, especially during rainy season when cholera outbreak occurs. Cholera is associated mainly with unprotected water sources such as shallow wells, rivers and lakes, poor sanitary facilities and inadequate food hygiene.
In Malawi, health education through community and health centres are continuous. It is mainly the religious and traditional beliefs that continue to challenge effectiveness of interventions as some patients delay to go to health facilities or refuse medication.
The sad cases in Salima where three people died who were Zion faith members opted for prayers. It took the intervention of Police to force the remaining seven to hospital. Such incidents stretch capacity of Government to effectively deal with the outbreak. It is up to religious leaders to help in public education, especially in cases where faith becomes a barrier to proper health care. This is the unfortunate reality facing the Ministry of Health dealing with the outbreak.
The second equally important partner is the need by stakeholders to address traditional beliefs. Some rural communities believe their sickness if from witchcraft. Some have argued, “Cholera is like a wind, it will pass hence you can’t control and others will say it’s “Witchcraft: why me, we all use water from the same source?” Most of them start by going to traditional herbal doctors than hospitals. A considerable number of deaths emanate from this group.
There is political will to contain cholera. There is Government capacity to handle cholera. There are partners such as; Lilongwe Water Board who are helping through provision of safe water to affected areas, Malawi Defence Force (MDF) who gave in their water bowsers for distribution of safe water in affected areas, ONSE (MSH), UNICEF, World Vision, Red Cross, World Vision, United Purpose, Medicines San Frontiers (MSF) and Johns Hopkins University, all of whom are working to stop cholera, not for this year, but forever.
Treatment centres have been established in all affected communities and at central level, Secretary for Health, Dr. Dan Namarika chairs a response team that looks at ensuring resources, public education and provision of adequate health care. District Commissioners are chairing at district level.
Short term interventions include public education, safe water and sanitation provision, surveillance including case investigation and contact tracing, supply of medicines. Since 2015, Oral Cholera Vaccines have been administered with about 600,000 people in Nsanje, Chikwawa, Phalombe, Zomba, Machinga, Salima and Dzaleka Refugee Camp being vaccinated. Oral Cholera Vaccination campaign is underway in Karonga. By 17th March 2018, 108,000 people would have received the vaccine in Karonga.
The Malawi Government has sourced 1 million doses for 500,000 people in Lilongwe for a campaign to start early next month, while Mangochi, Nkhata bay and Rumphi are the next targets of the vaccination campaign.
Government with support from ONSE (MSH) has trained 2105 Clinicians, Nurses, Medical Assistants, Health Surveillance Assistants and Hospital Attendants in cholera case management.
To improve access to safe water, a multibillion kwacha Lake Malawi Water project is on the cards which will see Lilongwe which has recorded 246 cases resulting in 13 deaths and communities along the pipeline in Salima with 91 cases and four deaths, access to clean water.
The commercial city of Blantyre too will benefit from the Likhubula Water Supply project which government through Blantyre Water Board is going to get waters from Mulanje Mountain and is expected to be pumping 20 million liters of safe water to communities in Thyolo, Blantyre and Chiradzulu every day.This will be complemented by new water supply projects such as one in Mzimba and numerous deep and safe boreholes Government is drilling across the country.
Malawi strategy in containing cholera outbreaks indicate that it is effective and capable of ensuring that the cholera does not continue to spread. It is up to our communities, our faith and traditional leaders and indeed every Malawian to preach the anti-cholera message, improve personal hygiene, wash hands before eating and after using toilets, drink safe and boiled water and more importantly- rush to hospital when not feeling well. Only then, not the Malawi Government, but all of us, collectively as a nation, we will completely contain cholera. Government is doing its part.
- Joshua Malango – Principal Public Relations Officer, Ministry of Health and Population