Cholera situation in Malawi

Situation Report
Originally published
Over the last five years Malawi has experienced cholera epidemics of varying magnitude. The current season which started on 28 October 2001 is described as the worst that the country has ever faced with 32,968 cases reported and 980 deaths recorded as at 7 April 2002, thus resulting in an unacceptable 2.97 CFR while for WHO this must be below one. (CFR<1)*.

So far, all of the 27 districts have reported at least one case except Rumphi in North. Lilongwe district where the capital city is located leads all other districts in disease burden with 5537 cases and 160 deaths. Weekly incidence data show that districts in the centre and south of the country are more affected by the current epidemic, especially those in close proximity to natural lakes where the epidemics usually start before spreading to other districts. Further analysis of the epidemic by time, person and place will be needed to get more insight into risk factors for high transmission of cholera during this season.

Bacteriological testing has confirmed that Vibrio cholerae 01 Ogawa biotype is responsible for the current cholera epidemic.

In light of increased morbidity and mortality due to cholera, a review of the current response is warranted as a matter of urgency.

As part of the ongoing United Nations Inter-Agency Assessment on Food shortage and related health impact, WHO and health partners, will visit district health management teams, health facilities, and communities in most affected areas to identify strengths and weaknesses of the current response to the cholera epidemic, assess immediate needs for support, and devise a plan (out line) for cholera epidemic preparedness and response for the 2002/2003 season.

Some questions which, should be answered in this review, are:

  • Was the existing surveillance system sufficiently sensitive to pick up the outbreak early, and were surveillance findings translated into response (outbreak control activities)?

  • What are the factors contributing to the unacceptably high case fatality rate (incorrect case management; insufficient availability of drugs, supplies or personnel; co-morbidity effects of malnutrition resulting from the concurrent food shortage, etc.)?

  • Were key partners (Ministry of Health, UN Agencies, NGOs and communities) mobilized and well synchronized/coordinated?
With this information in hand, Malawi should be able to improve the response to the current epidemic and be better prepared for the next season, in terms of training, prepositioning, assigned responsibilities, and good coordination among actors.

WHO main orientations to prevent and control cholera epidemic are:

- Early case detection - Epidemiological Surveillance.

- Information Education of Communities

- Cases management particularly with ORS.

- Multisectoral interventions to identify the source of contamination and solve the problem in a sustainable manner.

* CFR = Crude Fatality Rate = Deaths/ Cases in the same period.

For more information please contact:

WHO Country office:
Phone: 772755/772450
Fax: 772350

TELEPHONE: (265) 772-755 & 772-450
P. O. Box 30390, Lilongwe 3. Malawi. E-mail:
Fax: (265) 772-350