Malawi curbs cholera through enhanced outbreak control


Although Malawi continues to record only sporadic cholera cases, with just an average of 10 cases a week as of January 2024 compared with close to 700 cases per week at the peak of the outbreak in January 2023 – infection control measures are being applied rigorously to further curb the disease, save lives and avert a flare-out.

At the heart of the measures being undertaken is the 7-1-7 approach: essentially it entails timely case detection (a target of less than seven days from emergence of infection), notification (a target of less than a day from detection) and completion of seven early response actions (a target of below seven days from notification).

To implement this approach, the Ministry of Health, with support from World Health Organization (WHO), has enhanced early detection through community-based surveillance and strengthening of laboratory surveillance such as by sending cholera rapid diagnostic tests to health units in 29 districts and training of laboratory technicians to detect suspected cases in less than seven days.

Through the work of community health volunteers, active search finding of acute watery diarrhoea cases enables health workers implement targeted measures to prevent infection spread. The community volunteers also work with environmental health officers to conduct health promotion on the important of water chlorination and ensure that communities observe good sanitation and hygiene practices.

Recently in Malawi’s northern Mzimba District, for instance, after 14 cases were detected, WHO worked with the health authorities to quickly manage these cases and ensure timely disease surveillance efforts among over 3000 community members. Through these efforts, the spread of infection was contained within two weeks.

To further enhance timely case detection, notification and response, Malawi is currently rolling out the third edition of the Integrated Disease Surveillance and Response (IDSR) guidelines which were adopted in 2020. The IDSR framework makes surveillance and laboratory data more usable, helping public health managers and decision-makers improve detection and response to outbreaks and other diseases. Prior to the reporting period, WHO provided technical support to eight districts to train health care workers from the districts and facilities in IDSR training and roll out. Surveillance teams are on the ground and are promptly responding to any report that arises.

Chifundo Kamkhwali, Lilongwe District’s IDSR focal person, says that surveillance and detection of cholera has informed the rapid response in the major cities of Lilongwe and Blantyre, which at this time last year had the highest number of cholera cases.

“Being able to contain the numbers in the cities has played a major role in the decrease of cases and impacted on the transmission of cholera cases to other districts surrounding these cities. The main concern that remains are bordering and hotspot districts like Nsanje,” he says.

The government, with support from partners, has intensified cholera prevention interventions by applying best practices learnt from the 2023 cholera outbreak – the worst in the country’s history, says Hon Khumbize Kandodo Chiponda, the Minister of Health. She highlights the launch of the Tipewe Cholera campaign and collaboration with the Presidential Taskforce, WHO and other partners as a milestone in containing cholera.

With the declining cholera cases, the Ministry of Health declared in August 2023 that cholera was no longer a national public health emergency, with no cases in 26 of 29 districts in the country.

“However, we all need to take responsibility by treating water and practicing good hygiene and sanitation from individual level, family level to community level as a core preventative measure,” says Hon Chiponda.

Supporting the community water quality surveillance efforts, in October 2023 WHO donated nine water testing machines enabling timely community testing of water when cases are detected, delivery of two tent units, two oral rehydration point kits, and life-saving intravenous treatment for severe cases, assorted medical supplies and equipment in Lilongwe and Mzimba districts.

“WHO will continue to support Malawi to work on a longer-term, multisectoral strategy to control cholera and ultimately lead to elimination as outlined by the Global Task Force on Cholera roadmap to eliminate cholera by 2030,” says Dr Neema Rusibamayila Kimambo, WHO Representative in Malawi.