Rains are yet to start, but the Ministry of Health has already recorded about 46 cholera cases and one death between September 25 and October 22 2023, raising fears of another outbreak in the country.

The new cases have been recorded in Lilongwe, Blantyre and Nsanje districts by the Public Health Institute of Malawi (Phim) and come after Minister of Health Khumbize Kandodo Chiponda and the Presidential Task Force on Covid-19 and Cholera declared on August 16 that the disease was no longer a public health threat. The declaration followed zero new cases and deaths in a protracted epidemic that broke out in March 2022.

Flashback: A cholera patient being assisted at one of the makeshift clinics in Mangochi

In an interview yesterday, Ministry of Health spokesperson Adrian Chikumbe said the government has stepped up efforts to contain cholera.

He said poor access to safe water was a major contributing factor for the cholera spread in most communities, including in Blantyre and Lilongwe cities which are often hard-hit.

Said Chikumbe: “For Nsanje, most of the index cases have been migrants from an area in Mozambique which is endemic to cholera. People go to that area to do illegal mining and there are no sanitary facilities.

“For the rest of the communities, including these ones [the most recent cases], it has been a case of poor compliance to cholera preventive measures.”

He said to contain the further spread of the disease, which has also been recorded in Zimbabwe, government was raising awareness on cholera prevention in districts nationwide and distributing cholera supplies such as chlorine for water treatment as well as oral rehydration solutions (ORS) for use on patients who develop signs of cholera.

“This will reduce the need for hospital referrals of mild cases, and thereby reduce further transmission. We want to sustain the multi-sectoral collaboration that helped a lot in managing the previous outbreak,” said Chikumbe.

Phim director Matthews Kagoli, in a separate interview yesterday, said to contain cholera, Malawi needs improved sanitation, water treatment, increased safe water supply, improved food hygiene and safety as well as improved community-based surveillance, among others.

He said: “All households should have sanitation facilities like pit latrines, hand washing facilities with soap and refuse pits for proper disposal of solid waste. All public places should have sanitation facilities to ensure that people use toilets and wash hands with soap after using toilets.

“Additionally, the Ministry of Water and Sanitation should increase coverage of areas with safe water supply, especially in the urban areas, to ensure people use safe water.”

Kagoli also called for the need for community members to separate raw and cooked food to avoid contaminating cooked foods with germs, and improve on community-based surveillance.

“Community health workers and volunteers should search for people with diarrhoea and encourage them to drink ORS while going to the health facility for further medical care,” he said.

Meanwhile, public health expert Adamson Muula has regretted that the country remains ineffective in dealing with the issues.

He said the government negotiated with the water boards not to raise tariffs and to postpone closing communal water taps, but the opposite happened.

Muula, a professor of public health at the Kamuzu University of Health Sciences, said: “The high tariffs are now back and cities can spend two to four days without water. At the same time, the water sources for our cities remain inadequate. Lilongwe and Blantyre cities are often hit hard by cholera because of lack of potable water.

“The problem is acute in peri-urban areas, also known as slums. Access to clean water in this country is the preserve of the rich. Poor people, especially in urban areas who also have no access to latrines and toilets, are at great risk of catching and spreading cholera.”

Malawi Health Equity Network executive director George Jobe observed that people have relaxed, especially after cholera was declared no longer a public concern.

In an interview, he said: “Now we need a lot of public awareness raising activities that we still have cholera, and remind them of the prevention measures. The Lilongwe City Council and other councils need to manage waste better by guiding residents in waste management and also by ensuring that public places such as markets and streets are clean.

“Last year, we recommended [although not taken] that our councils should be orienting vendors of cooked food items on best ways of handling it. Teachers should also be engaged to help with passing the information to parents through learners in their schools.”

Jobe also said government should increase cholera vaccinations, especially in the hotspots.

Since March 2022 when the first case was recorded in Machinga District, Malawi has recorded over 58 055 cholera cases and 1 769 deaths from the pandemic that affected all 28 districts.

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