Malawi, Africa | Cholera Response – Emergency Appeal n° MDRMW017 – Operational Strategy

Timeline

February 2022: First cholera suspect case in Machinga district, southern Malawi.

March 2022: First cholera case confirmed, Ministry of Health (MOH) declared outbreak. 3

September 2022: IFRC’s Disaster Response Emergency Fund (DREF) allocates CHF 392,014 for initial response in Karonga, Mzuzu, Nkhatabay and Nkhotakota districts.

November 2022: Danish Red Cross provides emergency funding for Mangochi, Chikwawa and Mwanza townships; Swiss Red Cross provides funding for Blantyre and Rumphi districts, northern Malawi; and Finnish and Icelandic Red Crosses provide additional funding through Danish Red Cross.

December 2022: President declares the outbreak a public health emergency.

December 2022: Public Health in Emergencies Coordinator from the IFRC Regional Office visits Malawi; scale-up of DREF to CHF 748,286 covering five districts, adding Salima district to the original four.

December 2022: The Presidential Task Force on COVID-19 and Cholera makes a public appeal to organisations and private companies to support the Ministry of Health with supplies.

January 2023: IFRC surge begins. Public Health and WASH Engineer, Logistics and Finance delegates, and IFRC Emergency Response Unit (ERU) for Community Case Management for Cholera (CCMC) deployed.

January 2023: IFRC surge begins. Public Health and WASH Engineer, Logistics and Finance delegates, and IFRC Emergency Response Unit (ERU) for Community Case Management for Cholera (CCMC) deployed.

January 2023: IFRC issues Federation-wide emergency appeal for CHF 5.2 million to cover 2.1 million people.

DESCRIPTION OF THE EVENT

Malawi is currently battling its worst cholera outbreak in two decades after the Ministry of Health (MOH) found a case in Machinga district in the southern region of the country, likely in the aftermath of storm Ana and cyclone Gombe. Initially limited to the southern part of the country, the disease has now spread across 29 health districts throughout Malawi, putting at risk over 10 million people including more than 5 million children. On 5 December 2022, the President declared a public health emergency.

Cholera is an extremely virulent disease, spread via contaminated water and food, causing severe acute watery diarrhoea leading to severe dehydration in children and adults alike. It takes between 12 hours and 5 days for an infected person to show symptoms after ingesting contaminated food or water and it can kill within hours if untreated.

The main risk factors of the outbreak are unsafe water, poor sanitation, and lack of hygiene. And due to the high rate of transmission, the disease is now affecting people across multiple geographical areas.

Compounding the crisis, communities experiencing high rates of poverty often have limited access to sanitation and are therefore at increased risk of infection.

Thus, despite efforts to slow the outbreak, the numbers are rising faster, with a case fatality rate of 3.2%.

Facts and figures (IMT surveillance report Week #5)

• Cumulative 34,355 cases, 1,108 deaths

• By Week 4: 4,261 cases, 120 deaths

• 61 per cent of cases among 10-39 age group

• 32 per cent of deaths in people over 50 (case fatality rate [CFR] 7.4 per cent)

• 56 per cent of cases are among males.

• 64% of deaths are male (CFR male 2.7%, female 2%)

In addition to cholera, Malawi is currently affected by COVID-19, polio, and chronic hunger, and the country is just beginning to recover from the effects of tropical storm Ana and Cyclone Gombe, which is straining already limited resources. The rainy season is also exacerbating the growth rate and reduction in doubling time since the rains started in November 2022.

The Ministry of Health is overstretched due to several factors, including:

• the high number of admissions;

• lack of human resources to manage the caseload;

• inadequate cholera treatment units, which necessitates converting some health facilities for the purpose; and

• lack of cholera supplies and inadequate disinfection liquids to stop transmission.

The community health care system has been disrupted as well, and active case finding and surveillance are a challenge, while there is little or no space for the treatment of cholera cases in the community. The general population has also become unsettled by the number of deaths being reported across multiple districts, this compounded by the stress of the rainy season, commonly held myths, misconceptions, and religious beliefs.

Delayed health-seeking behaviours only exacerbate the crisis.

Based on MRCS scenario planning, the scale of the needs has now reached the worst-case scenario and IFRC is launching this Emergency Appeal for CHF 5.2 million to enable them to scale up the response to reach over 2 million people.

Source: International Federation of Red Cross And Red Crescent Societies