Children face acute risk amid Malawi’s deadliest cholera outbreak

The disease, which has killed 1,500 people since last March, has been aggravated by heavy rains and an overburdened health system

Malawi’s cholera outbreak is the country’s deadliest on record, claiming more than 1,500 lives, according to the UN.

More than 50,000 cases have been detected in the landlocked country in south-east Africa since an outbreak was declared in March last year, triggered by two devastating tropical storms that hit the region. Almost 200 children have died.

Cholera has been endemic in Malawi since the late 1990s, but a phenomenon that is usually seasonal, limited to between November and May, has this time persisted and spread to all of Malawi’s 28 districts.

“Malawi is experiencing the deadliest cholera outbreak in its recorded history. The country is also struggling to respond to a polio outbreak and ongoing Covid-19 cases across the nation,” Rudolf Schwenk, the country representative for the UN children’s fund, Unicef, said in a press briefing this week.

“Resources are limited, the health system is overburdened, and health workers are stretched to their limits,” he added.

This week, the UN World Meteorological Organization said that Malawi could see heavy rains in the south of the country as cyclone Freddy hits the region in the coming days, aggravating the situation.

Cholera, transmitted by taking in contaminated food or water, is often a mild infection, but can kill within hours if left untreated. It can be treated with intravenous fluids and antibiotics in severe cases.

Woman washing utensils outside her home, with child in foreground.
Washing utensils at a public water point in Kaliyeka township in Lilongwe. Contaminated water is a leading cause of cholera. Photograph: Fredrik Lerneryd/AFP/Getty Images

A spokesperson for the Society of Medical Doctors in Malawi, Dr Zaziwe Fatsani Gunda, said unsafe drinking water and poor sanitation were big problems in cities like Lilongwe and Blantyre, both of which have high numbers of cholera cases. The current economic crisis in the country is also a factor. “People would rather opt for cheaper sources of water than using piped water, which comes at a cost,” Gunda said.

On a recent visit to clinics in Blantyre, he said he had observed a drop in the number of admissions, especially among children and older people who are more at risk. He also noted that most patients were coming from areas of the city which had not had running water for some time.

Last month, the World Health Organization said 22 countries are fighting outbreaks of cholera currently, including Syria and Haiti. But the health agency warned that only 37m doses of vaccine were believed to be available this year. In October, the WHO was forced to ration vaccine doses.

On Wednesday, Unicef and the WHO began a vaccination campaign in earthquake-hit areas in north-west Syria, with 1.7m doses expected to be delivered to people above the age of one.

Schwenk said Unicef was “extremely concerned” about worsening conditions in Malawi.

A relative visiting a patient in bed in a cholera centre in Lilongwe, Malawi.
A relative visiting a patient in a cholera centre in Lilongwe in February. The deadliest outbreak in Malawi’s history has killed at least 1,500 people. Photograph: Fredrik Lerneryd/AFP/Getty Images

Half the children are in need of humanitarian aid. Almost a quarter of a million children under five are expected to be acutely malnourished, and more than 60,000 severely malnourished, by the end of the month, Schwenk said.

“As a severely malnourished child is 11 times more likely to die from cholera than a well-nourished child, a bout of cholera may amount to a death sentence for thousands of children in Malawi.”

George Jobe, health rights activist and executive director at Malawi Health Equity Network, praised a campaign launched last month to help curb the outbreak. The initiative aims to increase access to treatment for cholera, increase access to safe water and promote food hygiene and raise awareness of the disease among health workers, traditional and religious leaders. But, he added: “The fight is still on and we need more resources to raise awareness.”


Saeed Kamali Dehghan and Charles Pensulo in Lilongwe

The GuardianTramp

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