Malawi: Cholera Response - Emergency Appeal n° MDRMW017

SITUATION OVERVIEW

Malawi is battling the worst cholera outbreak in two decades. Cholera is an acute diarrheal disease spread via contaminated water and food which can cause severe dehydration in children and adults alike. It takes between 12 hours and five days for an infected person to show symptoms after ingesting contaminated food or water and can kill within hours if untreated.

Cholera is not new to Malawi. However, this outbreak is atypical, having continued to propagate from the dry season to the current rainy season, which increases the risk of the disease spreading. The first cases were reported in February 2022 in Machinga district, and an outbreak was declared in March 2022. Initially limited to the southern part of the country, it has now spread throughout Malawi across 29 health districts putting at risk over 10 million people including more than five million children. On 5 December 2022, the president declared the cholera outbreak a “Public Health Emergency”.

In response to the escalation of cases, the Malawi Red Cross Society (MRCS) was able to scale up its response through the support of partners and an initial allocation from the IFRC Disaster Response Emergency Fund of CHF 392,014 in September 2022, which was later increased to CHF 748,286 on 22 December 2022. The Participating National Societies (PNS) in-country also supporting the operation are the Danish Red Cross, Swiss Red Cross, Icelandic Red Cross, Finnish Red Cross, and Italian Red Cross.

On 23 January, the Ministry of Health reported the cumulative confirmed cases and deaths since the onset of the outbreak at 29,995 and 990 respectively, with the case fatality rate at 3.30%, which is above the acceptable threshold set by the WHO of less than 1%. The update also indicated that a total of 27,936 people have recovered while 1,069 are currently in treatment units.

The Red Cross branches report that there is an urgent need to address the risk factors of the outbreak, such as the provision of safe drinking water, especially in the hotspot areas. Several displaced communities in areas that were affected in 2022 by the cyclones Ana and Gombe are still living in precarious hygienic conditions. The drought and associated malnutrition that has affected vast areas of Malawi are making the communities, particularly children, more at risk of mortality due to the increased vulnerability caused by their poor nutritional status.

The main risk driving factors of the cholera outbreak are unsafe water, poor sanitation, and lack of hygiene. Secondly, the existing response system has gaps, such as the inadequate and long distance between the health system and response areas, resulting in delayed access to rehydration treatment. There is also insufficient community awareness about the disease and how to support the affected people with oral rehydration therapy, linked with generalized stigmatisation of those affected.

Due to the high rate of transmission, the disease is now affecting people across multiple geographical areas. Fishing communities along the lake represent some of the most at-risk communities due to the limited availability of safe drinking water, the sandy terrain that increases the risk of latrines collapsing during the rainy season and the widespread utilisation of lake water for drinking purposes. Children, who tend to spend many hours swimming in the lake, are also at higher risk from contaminated water. Transmission routes from the lake have contributed to the spread of the outbreak in other parts of the country, including gatherings at lakeshore fish markets and the movements of urban populations towards the lake for tourism purposes, which could have contributed to the spike in cases. Mozambique shares a border with Malawi through the lake and has already reported some cholera cases. Therefore, it is necessary to extend border coordination between the two countries.

Despite efforts to slow the spread of the diarrhoeal disease, the numbers are rising at an accelerating pace. The capacity of the Ministry has been stretched due to the high number of admissions, lack of human resources to manage the caseload, inadequate cholera treatment units (resulting in the closure of some health facilities which are being used as cholera treatment units), lack of cholera supplies and inadequate disinfection liquids to stop the transmission. There is a disrupted community health care system where primary health care - which is responsible for ensuring that community members are adhering to water, sanitation and hygiene practices - is overwhelmed. Active case finding and surveillance has been challenged, compounded by inadequate or no space for treatment of cholera cases. There is a need to mobilise and train more volunteers to support task shifting from medical personnel to volunteers, as well as support in increasing risk and treatment awareness.

The MRCS continues to work in close coordination with District Health Offices with the main actions including Risk Communication and Community Engagement (RCCE) at the household and community levels; deployment of volunteers to provide support with active case findings; oral cholera vaccination campaigns in high-risk districts; capacity building and training of volunteers, community health workers, and village health committees on cholera prevention and control modules; and the provision of critical non-medical cholera prevention and control supplies to cholera treatment centres. These include WASH household items, including soap, gloves, gumboots, aprons, oral rehydration points, cholera beds, etc.

To date, the MRCS, with the support of partners, has been able to contribute to the government’s response as follows:

• Reached 799,119 households through RCCE actions, promoting early treatment-seeking behaviour for diarrhoea and the usage of latrines.

• Some of the RCCE activities conducted so far are as follows: a community sensitisation campaign on cholera and oral cholera vaccine through cholera cinema programs and van publicity, radio jingles and radio programmes, and community feedback sessions.

• Supported contact tracing.

• Pot-to-pot chlorination for households to assure drinking water sources.

• Supported disinfecting exercises at seven cholera treatment units where volunteers play a key role in cleaning the units with chlorine.

• Supported the set-up of two cholera treatment units for District Health Officers by erecting additional tents to support pregnant women patients.

• Supported the disinfecting of four marketplaces.

Based on the MRCS scenario planning, the scale of the needs has now reached the worst-case scenario. The IFRC has, therefore, been asked to launch this Emergency Appeal for CHF 5.2 million to enable the MRCS to further scale up their response, reaching over two million people.