When a body of a driver was stretchered into Ndirande Health Centre in Blantyre last month, health workers knew cholera was back.
Their worst fears were confirmed by laboratory tests three days later.
The results showed the 47-year-old patient, who had travelled from Lilongwe and died in a lodge in the populous town, succumbed to the fast-killing diarrhoeal disease caused by unsafe water and poor hygiene.
According to health workers deployed to investigate the case, the patient was found dead in a motel room after people broke a door.
Cholera kills within hours if not treated and a single case constitutes an outbreak.
Unsurprisingly, the death of the driver from Mgona, a populous township in Lilongwe which was hit hard by cholera early this year, has sent ripples of fear countrywide.
Just last week, a 55-year-old woman who presented with profuse diarrhoea at Bangwe Health Centre, Blantyre, was isolated and tested for cholera. Two cases were handled in Karonga in a similar fashion.
However, Ministry of Health spokesperson Joshua Malango tells us that all three tested negative.
“When a cholera case is confirmed in an area, all patients with acute diarrhoea are presumed and treated as cholera cases until lab tests prove otherwise. I can confirm that three tested negative,” he explains.
According to Blantyre district health officer Dr Gift Kawalazila, the Bangwe patient was producing watery stools and vomiting profusely when she arrived from Mpingwe.
“A rapid cholera test came up positive, She was isolated and another test showed it was positive. However, results from Queen Elizabeth Central Hospital [Qech], showed negative,” he says.
The district health office reports that she took contaminated water and food.
The woman was discharged yesterday—soon after Qech released the results—six days after she went to Bangwe Health Centre.
This shows delays in reliable cholera diagnosis in the country.
Although there is only one confirmed case countrywide, areas that have experienced cholera scare have deployed teams to prevent further spread of the disease.
“The disease spreads and kills fast,” says Kawalazila. “For this reason, we are cautioning people that there is a cholera outbreak. They should avoid eating any public food as it might be contaminated.”
The outbreak comes just six months after the end of another spate which affected about 1 000 people and killed 33 in 13 districts.
Rapid water tests conducted in Lilongwe, Salima and Karonga by water officials in partnership with United Nations Children’s Fund (Unicef) showed that water sources in nearly all affected communities were contaminated by human waste. This points to poor sanitation, with the majority of Malawians sharing latrines or defeacating in the open.
To Malawi Health Equity Network (Mhen) executive director George Jobe, the country needs to draw lessons from perennial cholera outbreaks and close the gaps to save lives.
He states: “The first lesson is that cholera can happen in urban areas just as in rural areas as we saw last year that Lilongwe City was hit.
“Second lesson is that cholera hits areas where people use water from the lake or shallow-water from wells. This shows cholera is not just a health issue but a hygiene and sanitation issue as well.”
The healthcare activist urges district and city councils to take all preventive measures to avoid the spread of the disease.
He urges Ministry of Health to trace the source of the Ndirande case as the deceased travelled from Lilongwe to Blantyre via Ntcheu and Balaka.
Presently, Blantyre City Council has banned sale of foodstuffs in public to contain the outbreak.
In an interview, Malango said it is possible to prevent and control cholera if people work together with government.
He reckons the Ministry of Health is working with the media to spread messages about cholera, especially causes, risk factors and preventive measures.
Other interventions include strengthening water, sanitation and hygiene services, including open defaecation-free (ODF) activities.
“There are also prompt treatment of cholera patients as government has pre-positioned enough drugs and medical supplies for cholera treatment in readiness for any cholera case,” he said.