Malawi is battling a protracted cholera outbreak that begun in March 2022 in districts affected by Tropical storm Anna and Cyclone Gombe in the Southern region of the Country. The current outbreak is unprecedented, spreading to districts in central and northern regions that have not experienced cholera in over a decade. From March up to Mid-August the country had 1000 cholera cases with 10 districts affected. The risk is very high at the national level with accumulated cases of over 3960 and 111 deaths in 22 affected districts as of October 6, 2022. 

The World Health Organization (WHO) together with the Ministry of Health is calling on donors, partners, and all relevant stakeholders to strengthen the cholera outbreak response in Malawi. The country is targeting to contain the cholera outbreak before the rainy season starts which could be in the next in sixty days. The appeal for all stakeholders to contribute to the response was made at a media briefing that was hosted by by the Minister of Health Honorable Khumbize Kandodo Chiponda (MP) and the WHO Representative for Malawi Dr Neema Rusibamayila Kimambo on 4 October 2022 at the Ministry of Health Headquarters in Lilongwe.

The current upsurge in cases is reported in the dry season which is traditionally a low transmission period for Malawi.  The rainy period occurs from November through March which could increase cholera transmission across the region.

“It is one of the worst cholera outbreaks to hit Malawi in over ten years and this calls for all stakeholders within and beyond the health, water and sanitation sectors to contribute to the cholera response. We are calling for support to contain the cholera outbreak before rains hit hence the 60 days target,” said Honorable Chiponda. The funding GAP for the Cholera response plan in 14 million USD.

Malawi is facing multiple public health emergencies namely, COVIDS 19, polio and cholera outbreaks and the government is overwhelmed hence the need for more coordinated response strategy. The Ministry of Health with support from WHO and partners have updated its The Cholera Epidemic Preparedness and Response Plan. The plan is intended to contribute to the implementation of an effective, comprehensive, integrated system of cholera prevention and control in Malawi.

“We are on the verge of having a public health crisis if we do not mobilize great support for Malawi. We urge donors, partners and all stakeholders to work together to support government’s goal to contain the cholera outbreak urgently,” said Dr Kimambo.

Cholera is an acute diarrheal disease caused by infection of the intestine with the bacterium Vibrio cholerae. The disease is characterized by a sudden onset of profuse painless watery diarrhea, occasional vomiting and in severe cases, rapid dehydration leading to death if prompt treatment is not given. Cholera is treated using fluids (oral or intravenous) with or without antibiotics such as doxycycline or azithromycin/erythromycin. Cholera is linked to poor hygiene, poor sanitation and lack of, or limited access to, safe drinking water. It can be prevented by improving access to safe water, sanitation and hygiene (WASH) and the selective use of oral cholera vaccine (OCV).

The UN through WHO and UNICEF have recently secured USD one million from the UN Central Emergency Response Fund (CERF) to support the response.

WHO Support to the Response

5. WHO is assisting Malawi to acquire adequate oral cholera vaccine doses to protect at-risk populations in affected districts (prioritized by burden of Cholera disease in the districts).
5. WHO supported the update of a risk assessment with greater focus on the epidemiological situation, the state of preparedness and response readiness, and identifying the critical needs in affected and at-risk districts.
5. The WHO team is working with the Ministry of Health and partners to strengthen disease surveillance, provide medical treatment for patients, distribute laboratory supplies, monitor water quality, and chlorinate public water supplies, and promote health education and hygiene among affected and at-risk communities.
5. In the ongoing cholera outbreak response, WHO donated to the Ministry of Health assorted cholera investigation, laboratory, and case management kits to facilitate sample collection from suspect cases, onsite rapid diagnostic testing, sample transportation to the laboratory and eventual testing as well as the clinical management of cholera cases at designated cholera treatment centers, units, and oral rehydration points. 
5. WHO trained over 800 health care workers in lifesaving critical care skills nationwide in readiness for such outbreaks.
5. WHO is supporting case management though capacity building, supporting surge additional health workers and support for tents, equipment, medical supplies, lab reagents and medicines for cholera case management.
5. WHO stockpiled cholera supplies in the Ministry of Health central medical stores following a risk assessment on the potential outbreak spread beyond southern Malawi.  

Supplies Provided by WHO

• • WHO procured cholera kits for case management worth $54,600 for different levels of care i.e. (including but not limited to; community, peripheral, central, and laboratory supplies) specialized clinical supplies and consumables. The kits also contained Infection Prevention and Control items such as gloves, gowns, handwashing items have been distributed in all districts reporting cases serving at risk-populations.
  • So far, 48,000 Ringers Lactate with giving sets of different sizes have been distributed to affected districts.
  • Antibiotics (Doxycycline) enough doses to treat 1,200 cholera cases have been distributed to facilities in affected districts.
  • 1,005 litres of fuel for distribution of cholera supplies, allowances for drivers and assistants was supplied to MOH.
  • Twelve tents to set up treatment centers were distributed and erected in selected affected districts.
  • WHO also:
    • supported procurement of Cholera tests which are adequate to test up to 1000 cases and these have been distributed to all facilities in affected districts.
    • Conducted sensitization meeting at Kabwangala, Chiri fishing villages reaching approximately 320 people in around 80 temporary and semi-permanent households.
  • A total of six traditional authorities and area development committees plus 43 fishing villages have been reached along lakeside and 120 local miners in hotspot areas in Nkhata Bay.