Health workers fight to keep vaccination alive

 Early this year, village head Dyson Chamizi and his brother were taken ill at Nathenje Health Centre outside Lilongwe City. Both had cholera, a disease which kills within hours if not treated on time.

Three days earlier, the pair had attended the funeral of a person who died of cholera. The burial was reportedly conducted without following safety measures to avert the spread of the disease.

“We did not have enough information on the risks that come with handling the body of a cholera patient or conducting a big funeral,” says Chamizi.

The defiance to public health measures was reportedly fuelled by a widespread rumour that health workers were harvesting patients’ body parts, sparking fear and anger among communities over burial rituals.

As such, they collected the deceased body from the hospital and carried out the burial according to custom.

The misinformation intensified at the height of the year-long cholera outbreak that has claimed about 1 700 from more than 57 000 patients since its onset in March 2022.

However, enhanced outbreak control measures have helped curb the outbreak, with the country reporting a downward trend in cholera cases and deaths since February.

Misleading information on cholera poses a real threat to outbreaks control. Mistrust in health workers, fuelled by misinformation, has even sparked physical aggression towards doctors and nurses in cholera-affected areas, undermining outbreak response efforts.

Tackling myths

To counter the dangerous rumours, the World Health Organisation (WHO) has collaborated with the Ministry of Health and partners to address the threat.

The United Nations health agency has trained community health workers to debunk rumours and empower communities on cholera prevention.

By mid-March, 820 health surveillance assistants had been trained in Lilongwe, one of Malawi’s worst cholera hotspots. They work with community volunteers in an effort that has seen 658 018 households provide information about cholera, 10 150 community meetings, 617 sessions held in schools, along with 985 gatherings in marketplaces to share accurate messages.

“Misinformation can be deadly as it fuels the spread of preventable diseases like cholera. We are engaging local leaders and influencers because they are the point of contact with communities,” says Tiyamike Chitete, one of the new health surveillance assistants.

For her, it is important to ensure that people receive the right information they can use to make informed decisions.

“When people are aware of how the disease is transmitted, it helps reduce the occurrence of cholera infections and deaths in communities,” says Chitete.

She thanks WHO’s intervention for broadening the country’s community engagement approaches and concepts.

“We are now being strategic in our approach to build resilient communities to prevent outbreaks,” says Chitete.

In early February, Malawi launched the End Cholera (Tithetse Kolera) campaign to intensify the response at community level.

With support from WHO and partners, community health workers are conducting meetings with local leaders and community influencers to address cholera misinformation and mistrust in health authorities.

The aim is to avert a situation where misinformation and mistrust contribute to patients failing to seek timely treatment, raising their risk for rapid onset of severe dehydration, and even death. Left untreated, cholera can cause death within hours.

Says Aminata Kobie, WHO risk communication technical officer in the African region’s emergency team: “Through community dialogues, we are assessing the public’s knowledge and perception of cholera, tailoring our messages to address any misinformation or misconceptions.

“This approach allows local leaders and community influencers to understand the risk factors for cholera in their respective areas and facilitates the dissemination of expert health advice.”

As a result of these efforts, local leaders such as village head Chamizi have started engaging their communities to be proactive in the fight against cholera.

“We now have by-laws to ensure everyone is being responsible and is following the recommended precautions to stop the spread of cholera, and limit deaths in our village,” he says.

Knowledge is power

Meanwhile, WHO has deployed risk communication and community engagement emergency experts in high-burden districts. It also supported advocacy and dialogues with over 1 075 local leaders in Lilongwe.

These include traditional, religious and political leaders from various hotspot areas. During the sessions, leaders discuss local solutions to ending cholera in their communities, including making a commitment to the creation of enabling environments.

In his village, Chamizi is fully committed to keeping his community on high alert.

“I don’t want my people to die from a treatable and preventable disease like cholera. I believe knowledge is power and I am using every opportunity, at any community gathering, to address any misinformation and sensitise my people on cholera prevention and control measures. I will not stop until we kick cholera out,” he says.—Who