Oral rehydration points provide frontline shield in the fight against cholera
Cholera Response in Malawi
Enock Mwenyeidi, one of the eight volunteers operating an Oral Rehydration Point (ORP) in Kauma, Lilongwe, sees a glimmer of light in the fight against cholera. His optimism is fueled by the weekly decrease in confirmed cholera cases at the ORP.
An ORP serves as the primary point of care for cholera in communities recognized as hotspots of infection. Kauma is one such hotspot, identified among seven in the district, according to George Mwinamiwa, Malawi Red Cross Society's (MRCS) project coordinator. He is responsible for an emergency cholera response project supported by UNICEF and funded by the European Civil Protection and Humanitarian Aid Operations, the United Nations Central Emergency Response Fund, the Bill and Melinda Gates Foundation, and the Latter-Day Saints Charities.
Mwinamiwa says, “Anyone who suspects they have cholera rushes to this ORP for oral rehydration. We also distribute chlorine at the same point for people to have safe water and prevent the disease.”
Malawi is grappling with its worst cholera outbreak in its recorded history, having registered 58,616 cases and 1,756 deaths up until May 10, 2023. The World Health Organization (WHO) defines cholera as an acute diarrhoeal infection caused by the bacterium, Vibrio Cholerae, ingested via contaminated food or water. Individuals in areas with poor sanitation and unclean drinking water are most susceptible to this disease, which can be fatal if untreated.
Responding to the escalating cholera cases claiming over 10 lives in the area, the ORP at Kauma initiated operations in March 2023. Since its inception, the ORP has logged 233 suspected cholera incidents, referring 57 cases to the nearest public health facility, Area 18 Health Centre, for advanced treatment.
The mission of the ORPs is to mitigate cholera cases in communities and decrease the number of patients in cholera treatment units. According to Mwinamiwa, the goal of MRCS's emergency cholera response project, supported by UNICEF and other donors, is to eradicate cholera-induced morbidity and mortality in various districts of Malawi reporting high case numbers.
He adds, “We are responding to the six pillars of the Tithetse Kolera (End Cholera) Campaign. We are doing case management, which is early detection of cholera cases so that we can treat them. We are also doing surveillance activities, which is early detection.” Mwinamiwa further mentions that under the project, MRCS coordinates district-level activities, trains health workers and volunteers, and conducts risk communication and community engagement activities.
With Lilongwe identified as a cholera hotspot, MRCS executes preventive activities, including rapid response interventions in the affected communities to prevent disease spread. The ORP at Kauma, run by eight volunteers, operates seven days a week from 6 AM until 6 PM. However, since the volunteers live within the community, they handle emergencies beyond these hours.
Mwenyeidi asserts that the ORPs not only stabilize patients but also alleviate congestion in health facilities since some cases might not require referral to the health centre after being treated with Oral Rehydration Solutions (ORS). He says, “We have been here for about two months. People come here who are vomiting or show signs of diarrhoea. After giving them ORS, we place them in a waiting area to stabilize them and we then provide them with transport to go Area 18 Health Centre for further treatment.”
Although more than 10 people have died in Kauma since the outbreak in 2022, only one death has been registered since the ORP's inception in March 2023. Among the 57 confirmed cholera cases processed by the ORP, four were children under five years of age.
Dickson Makono, one of the community volunteers, emphasizes the crucial role of ORPs and community engagement sessions in managing the cholera situation. He says, “We go around the homes with messages about things such as washing hands, eating hot foods, and not drinking water from untreated sources. People are now paying attention. When we previously went around the community with the same message, few paid any attention, but due to rising cases of cholera, people started to notice.”
While UNICEF's involvement in the project will conclude in August, Mwinamiwa is confident that the impact will persist in the community's fight against cholera. He says, “UNICEF has helped us to train those volunteers. The volunteers have been here because the Red Cross is targeting this area as part of its interventions. Our plan as Red Cross covers the whole year or until we have dealt with cholera.”
