Health workers launch preemptive attack on cholera
Cholera Response in Malawi
In July 2022, when a businessman from Limbe Town, Blantyre City, was diagnosed with cholera, the health workers at South Lunzu health centre were soon overwhelmed by an influx of patients. The centre was already grappling with a high disease burden from Machinjiri, the city's largest township. "The patient may have consumed contaminated food or water. However, the cases quickly escalated to 15 to 17 a day, leaving us with no time for rest," remarks Susan Muyaya, a senior health surveillance assistant (HSA) at the facility.
Muyaya leads a team of 37 HSAs, collaborating with 24 nurses and 12 clinicians and medical assistants. They worked tirelessly in six-hour day and night shifts to treat the influx of patients while also informing communities where the patients resided or worked.
Since March 2022, cholera has claimed more than 1,750 lives out of about 58,600 reported cases nationwide, following the detection of Malawi's deadliest outbreak. South Lunzu health centre recorded 13 deaths from over 600 cases. The facility serves a sprawling, densely populated settlement with limited access to safe water and sanitation.
"Upon the arrival of the first case, we anticipated more cholera patients as neighbouring health facilities were already overwhelmed. The only way to halt the outbreak was to combat it at the source, in the communities from which the patients were emerging," Muyaya explains.
Their approach led to the implementation of Case Area Targeted Interventions (CATI), which successfully stopped cholera transmission in Machinjiri's Area 5 within three weeks. The local outbreak tragically claimed the lives of two school-going children in the area.
After confirming a case, Muyaya recounts, "We registered 16 additional cases from her neighbourhood. Our rapid response team was informed about the looming crisis. They sanitised the primary case's household with chemicals to eliminate cholera germs and educated her neighbours about the outbreak's dangers and preventive measures."
Financial support from multiple international organizations, including the European Civil Protection and Humanitarian Aid Operations, the United Nations Central Emergency Response Fund, the United States Agency for International Development and Bureau for Humanitarian Assistance, allowed UNICEF to aid the Ministry of Health and Ministry for Water and Sanitation. The assistance trained health workers to implement the new strategy to combat the prolonged cholera outbreak.
Benson Kamwendo, a local resident, expressed his gratitude to the CATI team for rapidly mitigating the outbreak that affected one of his eight children. "When cholera broke out in my community, I was terrified for myself and my five children. But the health workers swiftly intervened. They shared insights about the disease's spread and prevention methods, enabling us to fight it," he says.
In collaboration with the Ministry of Health and the Malawi Red Cross Society, UNICEF supports the rapid response implementation to decrease the risk of cholera infection in households neighbouring infected patients' homes.
Blessius Tauzie, a UNICEF water, sanitation and hygiene specialist, is thrilled that CATI, which proved effective in Haiti and South Sudan, is also making a difference in Malawi. "The rapid response aims to limit cholera transmission in areas with confirmed cases. The results are usually immediate as households near a confirmed case are quickly alerted and provided with essential supplies for cholera prevention," he explains.
Tauzie envisions health workers, as the daily cholera patient counts dwindle, devoting more time to treating everyday illnesses and spending time with their families.
At South Lunzu, Muyaya is relieved that the centre's 29-bed cholera treatment unit has had several days with no patient. "The targeted preemptive interventions allow us to control the outbreak before it spirals out of control. We aim to empower affected communities to comprehend the dangers of cholera, its transmission, and prevention methods," she explains.
The mother of three reflects on the worst cholera outbreak in her 23-year career, "At the outbreak's peak, there was no time to rest, except for desperate naps in a room without window glasses, where mosquito bites tormented us day and night. Now, I feel relieved. I can spend more time with my family and sleep peacefully, without worrying about lives at risk and mosquito bites."
