WASH deficiencies fueling cholera outbreak

By Charles Mkula

Deficiencies in the provision of Water, Sanitation and Hygiene (WASH) services in Malawi contributes to the increasing cases of infectious diseases, including cholera, Maria Rusca, Hyphen Media Institute Board Member has said.

Rusca raised the concern in the wake of a cholera outbreak in Tukombo area in the country’s northern district of Nkhata Bay.

The Tukombo community traditionally depends on fishing as a major economic activity though recently it has seen a gold rush with hundreds of small-scale miners flocking to the site to mine alluvial gold which has just been discovered in the area.

The Ministry of Health confirmed the Nkhata Bay outbreak on August 7, 2022. Other cases are reported to have occurred in neighboring Nkhotakota district and Mzuzu city.

Genetic analyses of vibrio cholerae strains has shown that the disease is spreading outside traditional hotspot areas including Blantyre, the country’s commercial capital city, which was once crowned Africa’s cleanest city

Currently, Malawi has recorded 1,483 cases and 68 deaths with a case fatality at 3.9 per cent. Further reports indicate that the figures continue to rise.

In 2010, one of the country’s major cholera outbreaks occurred in the fishing communities on and around Lake Chilwa, in Zomba district. A total of 1,171 cholera cases and 21 deaths were reported in the three districts around the lake while other cases were also reported on the Mozambican side of the lake.

“Lack of clean water forces people to consume water from unsafe sources,” said Rusca who pointed at poor hygiene practices such as inconsistent handwashing to be another problem increasing the risk of cholera transmission.

Rusca also observed that the disruption of rural livelihoods due to climate change induced drought is another factor that forces people to migrate away from their rural homes to seek employment in urban areas.

“Rural to urban migration is contributing to the expansion of informal urban settlements,” she said explaining that failure to provide safe water for the population in these settlements lead to the use of unregulated and unprotected wells which are vulnerable to bacterial contamination

She said lasting solutions to the spread of infectious water borne diseases in the country must, apart from the provision of WASH services, include stakeholder support to accelerate the provision of WASH services in rural areas and overcrowded urban informal settlements.

“We have to lobby for increased funding to neglected areas of the service delivery chain,” said Rusca explaining the need for provision of WASH infrastructure as well as sustainable post-construction support and monitoring activities.

Since the declaration of the outbreak in March, the Ministries of Health, Water and Sanitation together with development partners have embarked on a national response that includes strengthening surveillance for early detection, quality case management and provision of water treatment, personal hygiene and water storage facilities at the household level. Community engagement and dissemination of communications around cholera prevention, and positive hygiene practices have also been stepped up.