Aubrey Timoti is not willing to take chances when it comes to sanitation issues in his community after witnessing his neighbours lose two children to cholera.

Timoti (28) from Kulima village in Malawi’s Chikwawa District in the Southern Region is an advocate for the setting up of Oral Rehydration Points (ORPs) in the community to curb the cholera outbreak that has wreaked havoc in the country for the past two years.

 “I lost two neighbours to cholera. My two children are victims of cholera too. I understand the severity of cholera. I have lived it,” he said.

“It was important to set up an ORP for our community at a central point so everyone could access the services.”

Since the beginning of the year, the World Health Organization (WHO) with funding from Contingency Fund for Emergencies (CFE) has been conducting community sensitization programmes countrywide to identify the drivers of cholera and mitigate its spread.

This has enabled Timoti and his community access to services that are helping to fight the cholera outbreak. 

He spoke at one of the meetings organized by WHO’’s Risk Communication and Community Engagement (RCCE) teams, which highlighted the importance of water sanitation and hygiene (WASH) in the fight against cholera and the central role that ORPs can play.

The meetings were attended by chiefs, community residents, faith leaders, health centre management committees, and ward councilors.

“What is unique is that during the community leader’s engagement meetings, we employed a bottom-up approach where the local leaders convened and discussed context specific community cholera drivers, issues around ORPs functionality focusing on stigma, myths and misconceptions and came up with local solutions including ideal locations to install ORPs in the communities. By so doing, the community became active stakeholders to address cholera in their communities,” says Denford Chuma , WHO RCCE Team Lead for cholera outbreak response in Malawi.

He added. “Some of the found drivers and key issues mentioned by the local leaders includes that most cholera deaths were as a result of delayed health seeking behavior where most communities’ members visited the hospital when they are heavily dehydrated. To this effect, local leaders came up with bylaws to address these issues. Consequently, there has been a significant reduction in number of community deaths in Malawi since this intervention kicked off. Faith leaders began to take active roles to sensitize church members about cholera and supporting cholera patients with transport to go to hospital. ”

ORPs are community level sites that provide rapid access to oral rehydration salts (ORS) solution in communities, and assessment before patients are referred to Cholera Treatment Units.

Kulima is a rural settlement which is situated about 100 kilometres from Blantyre's business district under the Traditional Authority (TA) Ngabu.

This is one among many villages that were hit hard by Cyclone Freddy earlier this year in the Southern Region, which worsened the cholera outbreak.

Before the disaster, cholera was already a public health concern countrywide, but the cyclone, with the enormous amounts of water it brought, worsened the situation.

Cholera is endemic in Malawi. It is highly contagious and occurs in places without safe water and proper sanitation.Cholera causes serious diarrhoea and vomiting, and without treatment can quickly lead to severe dehydration followed by death.

Thokozani Nyirenda, the Health Surveillance Assistant for Ngabu Health Centre which serves Kulima Village, said the WHO interventions such as the ORPs were bearing fruit as cholera cases were on the decline.

"I come here almost every day, and no one has shown signs of diarrhea or cholera, which is a sign of good progress,” Nyirenda said.

“I always advise the community, to comply with advice related to hygiene and sanitation. “They need to stay safe. They have to be free from all those kinds of diseases.”

She added: “We are provided with chlorine, which has gone a long way to help us (fight cholera).

“WHO provided us with buckets in which we store chlorinated water, which is safe for people to drink.

“The ORP is open to serve the community. Anyone passing through can wash their hands.”

In the past weeks, Ngabu Health Centre has only recorded four new cases coming from other surrounding villages and none from Kulima.

Ending cholera in Malawi would require a concerted effort from all partners, but the engagement of local leaders has brought hope to the community of Kulima.

Through continued community engagement, the spread of the disease could be halted, and the community will move towards a healthier and more sustainable future.