Malawi’s cholera outbreak exacerbated by inadequate funding for water and sanitation

Malawi's worsening cholera crisis is the result of long-term neglect of the country's water supplies and water testing urgently needed, specialists say.

Malawi has been dealing with a cholera outbreak since March 2022 with 26,263 confirmed cases in 27 districts and 852 deaths as of this week (16 January), according to an update from the country's Ministry of Health.

Cholera is a water-borne disease caused by a bacterium Vibrio cholerae, which propagates due to poor maintenance of water, sanitation and hygiene (WASH) systems.

It results in watery diarrhea and vomiting, and can lead to severe dehydration, kidney injury or death.

"It is sad to note that WASH has not been prioritized for decades," Willies Mwandira, coordinator of the Water and Environmental Sanitation Network, an umbrella organization of institutions working in the water sector, told SciDev.Net.

"The current challenges in fighting infectious diseases such as cholera and COVID-19 is mainly as a result of the past negligence of the sector," he said.

Water monitoring

The Water and Environmental Sanitation Network recommended that funds are spent urgently to step up activities such as massive awareness campaigns on preventative measures, water quality monitoring, testing and chlorination.

"It is sad to note that WASH has not been prioritized for decades" - Willies Mwandira, Water and Environmental Sanitation Network

Dylo Pemba, a retired professor of biological sciences at the University of Malawi, told SciDev.Net that there was a need to check all the sources of drinking water in order to know which ones are polluted, and enhance sanitation and hygiene in schools and markets, and distribute sanitizers.

"[Studies indicate] fecal material has entered water sources below the ground," Pemba said.

"We need to ensure functional sewage systems in the management of human wastes in growing urban areas and not septic tanks.

"Septic tanks are heavily polluting underground water, leading to outbreaks like cholera when such water is consumed."

City authorities, January 3, closed the Wakawaka vegetable market in the capital Lilongwe after finding it lacked toilets and proper water for handwashing.

The country's taskforce on Coronavirus and Cholera on 6 January issued a statement appealing to the public and private sector and international organizations for support the fight against the nationwide cholera outbreak.

Matthews Ngwale, chairperson of Malawi's Parliamentary Committee on Health, who toured Machinga District Hospital and Ntaja health facilities in southern Malawi to measure the scale of the crisis, said that lack of funding to ensure good sanitation and hygiene has exacerbated the outbreak.

Children

Charles Mwansambo, the principal secretary of the country's Ministry of Health, upon receiving a donation worth US$50,000 of cholera response medicines and supplies from the humanitarian organisation Save the Children last week (11 January), added that one in every three people affected by cholera is a child.

"This donation is timely as we are stepping up our efforts in fighting the outbreak amid [a] shortage of medicines and supplies," Mwansambo explained. "[The] Ministry of Health is overstretched."

In a statement last week (13 January), UNICEF added it received support from the European Civil Protection and Humanitarian Aid Operations to secure supplies for Malawi, including acute watery diarrhoea kits to support health facilities and communities, high-performance tents and some medicines.

"We will continue to support the Ministry of Health to scale-up [the] cholera response," said Rudolf Schwenk, the country representative of UNICEF Malawi.