Malawi’s worst cholera outbreak on record has left more than 1,000 people dead even as cases have reached 30,621, health minister Khumbize Chiponda has said.
The death toll announced on Tuesday breached a grim milestone and surpassed the largest recorded outbreak, which killed 968 people between 2001 and 2002, according to the World Health Organization (WHO).
Chiponda on Wednesday called on people to take extra care handling the bodies of cholera victims before funerals.
“People who are dying from cholera may be washed by family members who then prepare funeral feasts… outbreaks of cholera commonly follow these feasts,” she said.
Chiponda also urged people to use proper decontamination procedures with chlorine and plastic body bags.
Most of the deaths occurred in the two main cities of Lilongwe and Blantyre where children have recently gone back to class after schools delayed opening to try and contain the spread.
Situation at a glance
Malawi is experiencing a widespread cholera outbreak, with 36 943 cases and 1210 associated deaths reported from all 29 districts since 3 March 2022. This is the deadliest outbreak of cholera in the country’s history.
Cholera has been endemic in Malawi since 1998 with seasonal outbreaks reported during the rainy season (November through May). However, the current outbreak has extended through the dry season, with cases being reported since March 2022.
In light of the ongoing rainy season, wide geographical spread, and a consistently high case fatality rate (CFR) of above 3%, the ongoing cholera outbreak was declared a public health emergency by the Malawi government on 5 December 2022. Currently, the large geographic spread and the high number of reported cases in the country are stretching all capacity to respond to the outbreak, increasing the risk of serious public health impact. The outbreak in Malawi is occurring against a backdrop of a surge in cholera outbreaks globally, which has constrained the availability of vaccines, tests, and treatments.
With a sharp increase of cases seen over the last month, fears are that the outbreak will continue to worsen without strong interventions.
On 3 March 2022, the Ministry of Public Health of Malawi notified WHO of a cholera outbreak after laboratory confirmation of a cholera case in Machinga district hospital on 2 March 2022.
Between 3 March 2022 through 3 February 2023, a total of 36 943 cases, including 1210 deaths, have been reported from all 29 districts in Malawi (overall case fatality rate (CFR) 3.3%) with active transmission ongoing in 27 of 29 districts. There was a 143% increase in the number of cases in January (17 078) compared to December (7017 cases). As of 3 February, Mangochi district bordering Lake Malawi is the most affected area, reporting 6974 cases and 114 deaths (CFR 1.6%).
The current outbreak started in March 2022 from Machinga district following tropical storm Ana (January 2022) and Cyclone Gombe (March 2022) which caused floods leading to the displacement of a population with low pre-existing immunity and had lack of access to safe water, sanitation, and hygiene. The outbreak was mainly limited to the flood-affected areas in the southern region until August 2022 when it spread to the northern and central parts of the country. Since December 2022 cases have spread back towards the south of the country with all regions affected including Blantyre and Lilongwe, the two main cities of the country.
Since the beginning of the outbreak, and as of 3 February 2023, the age group 21 to 30 years is the most affected (27.7% of cases) followed by the 11 to 20 age group (22.8%). Of all the cases,17 943 are males representing 57% of the caseload. Most deaths have been reported among those aged 60 years and above as of 29 January 2023. Most deaths have occurred among males (66%).
From 1998 to date, cholera cases have been reported in the country, especially in the southern region, which is low-lying, flat, and prone to flooding during the rainy season. The highest numbers of cases and deaths were reported in 1998/99 (25 000 cases, 860 deaths, CFR 3.4%), 2001/02 (33 546 cases, 968 deaths, case fatality rate 2.3%), and 2008/09 (5751 cases, 125 deaths, CFR 2.2%).