Taming cholera amidst Covid-19, polio outbreaks

In April this year, 30-year-old Thoko Gawani (not her real name) suffered a bout of diarrhoea.

Since she had to report for work that day, she ignored the illness thinking it was induced by what she ate the previous night.

The mother of two quickly took a bath and was soon on her way to her workplace.

Upon arriving at work at 6am, Thoko went straight into business and forgot about the vomiting and diarrhoea she had experienced when she woke up.

Just as her day was going on smoothly, around 7am, the vomiting and diarrhoea returned, this time with very sharp abdominal pains.

“Although I took some painkillers, within a short period, I became very weak and laid flat on the floor, failing to move or eat. Concerned with my condition, my employer took me to Limbe Health Centre,” she narrates.

At Limbe Health Centre,  she tested positive for cholera. Health workers at the facility quickly put her on an intravenous drip and the vomiting immediately stopped.

But the comfort would not last. The vomiting resumed after she ate some food later that afternoon, prompting health workers to administer two more drips to stabilise her condition.

“I spent a night at the hospital and was discharged the following day because my condition had improved tremendously,” Thoko says.

Now she is back at home. She feels much better and has regained her appetite and strength, grateful to the health workers who saved her life.

The Blantyre-based young lady is just one out of the over 550 cholera cases the country has registered so far following an outbreak that was first recorded in Machinga District and has since spread to four other districts namely Blantyre, Chikwawa, Neno and Nsanje.

A recent World Health Organisation (WHO) report indicates that the age of the cholera cases range between two and 57, with the five to 14 years age group being the most affected.

On the other hand, the United Nations Children’s Fund (Unicef) Malawi floods, polio, cholera Humanitarian Situation report of March 2022, says the multiple burden of floods, Covid-19 pandemic, polio and cholera outbreaks require a unique and urgent response to prevent the current emergencies from having a severe impact on the well-being of children.

Ministry of Health public relations officer Adrian Chikumbe concedes that community health workers are being overwhelmed as they have to provide routine services at health centres  on top of the emergency services created by the  Covid-19, polio outbreaks and now, cholera.

Even so, he says the ministry is working tirelessly to treat all existing cholera cases and trace those who were in contact with the patient as they could be at a high risk of infection.

“We are also promoting health education on safe water for domestic use, hand washing with soap including personal hygiene, food safety and early health seeking behavior,” Chikumbe adds.

He says: “In addition, we have intensified cholera prevention sensitisation campaigns in the affected districts as well as distribution of chlorine to affected populations for treating water.”

However, Chikumbe adds that if available resources permit, the ministry intends to conduct a cholera vaccination campaign in the five affected districts.

“About 1.9 million doses have been procured and received for the campaign; whereby, people will receive two doses of the vaccines two weeks apart,” he says, with a tinge of pride, cautioning on the need to urgently improve access to safe and clean water and coverage on sanitation.

He stresses that to ensure that cholera does not spread out to schools, the Ministry of Health is working in close collaboration with the Ministry of Educations School Health and Nutrition (SHN) coordinators in schools.

Meanwhile, the Ministry of Health rolled out administration of an oral cholera vaccine targeting 1.9 million people targeting adults and children from one year old above in the hot spot districts of Nsanje, Chikwawa, Phalombe, Blantyre, Mulanje, Balaka, Machinga and Mangochi starting from May 23 to May 27.

Concurring with Chikumbe, Ministry of Education Public Relations Officer  Chikondi Chimala said: “Our ministry works closely with the Ministry of Health in implementing various public health interventions in schools.

“Similarly, with cholera, we are undertaking joint awareness activities in schools and usage of other mass communication interventions.”

Chimala says the education sector has also put in place measures to improve the capacity of teachers and other stakeholders to ensure that they can provide proper guidance to students under their care.

The ministry has also set standards for all schools to guide implementation of Water Sanitation and Health services, according to Chimala.

“Through our officers in all education districts in the country, the ministry is implementing school-based health and nutrition services as an integral, sustainable part of the education system so as to build a healthy foundation for all learners,” he says.

Unicef is one of the organisations which has stepped up efforts to curb the spread of cholera. The UN agency has since reached out to 50 230 different hygiene promotion approaches as indicated in their Malawi Humanitarian Situation Report of April 2022. n