Malawi: Cholera Outbreak Intensifies as Rainy Season Continues

Malawi 2009 © Benoit Loop/MSF

MSF staff treat a child suffering from cholera in Lilongwe.

A cholera outbreak in Malawi that began in November has escalated considerably, with the number of cases growing by more than 100 percent in January. So far, 1,142 patients have been treated and 39 people have died.

Exacerbated by poor sanitation and floods brought on by the rainy season, the outbreak began in the capital, Lilongwe, on November 17, and quickly spread to two of the capital's densely-populated slums where there is no running water. The disease has now spread to more than 30 percent of the districts in the country, with the highest concentration remaining in and around Lilongwe.

“It’s extremely worrying, as the disease continues to spread and numbers mount. Every day, the rain pounds down and people with no access to safe water resort to drinking untreated water from swamps or from unprotected wells in slums,” said Dr. Moses Massaquoi, Doctors Without Borders/Médecins Sans Frontières (MSF) medical coordinator in Malawi. “As one of the poorest countries in the world, water and sanitation levels are extremely low. On top of this, the floods cause latrines to overflow and sewage then mixes with drinking water.”

MSF teams are helping to set up special isolation units in the most affected areas of Lilongwe, installing latrines, and donating cholera beds and plastic sheeting to help with the response.

Moses continued: “Authorities here are doing their utmost to try to contain the spread, but it is a real struggle. At the best of times, the country has an acute shortage of healthcare workers, so when cholera breaks out it puts an unbearable strain on an already creaking health system and overworked medical staff.”

While cholera is not unusual in Malawi, it has been eight years since the country’s worst outbreak, which killed up to 1,000 people, and much of the memory of how to respond to cholera has been lost. As a result, MSF medical staff are carrying out intensive bedside training and mentoring for national nurses and assisting them in handling cases so as to increase their capacity to respond and contain this outbreak.

“People have forgotten about the disease, so it spreads faster,” said Moses. “Right now, there aren’t enough health staff in Malawi with the training or experience needed to respond to a serious cholera outbreak. Time is life in a cholera outbreak, so it’s essential to act fast, but people are going to clinics too late. Cultural practices are also contributing to the worrying increase in cases, as people continue to wash dead bodies before burial, look after and visit the sick, and eat together during funerals.”

MSF has worked in Malawi since 1986.

Read more about how MSF treats cholera.