Rains Expose Poor Sanitation

by Pilirani Semu-Banda
LILONGWE, Jan 23 (IPS) - Zimbabwe - where cholera has claimed more than 2,700 lives so far according to the Red Cross - is not the only southern African country facing increased disease as rains set in across the region. Malawi is also battling a cholera outbreak which has killed 19 people since the onset of the rainy season, an unusually high death toll.

Up to 485 cases of the epidemic have since been registered and treated. World Health Organisation records from the 2007/2008 rainy season indicate not even a single cholera case was registered in the country's capital, Lilongwe, last year, although up to 20 deaths and 1,022 cases were documented in nine of Malawi's 27 districts.

Apart from the current outbreak in Lilongwe, one other cholera case was treated in the country's commercial capital, Blantyre, two weeks ago, but this was imported from Zimbabwe, according to Malawi's principal secretary for health Chris Kang'ombe.

"Queen Elizabeth Central Hospital in Blantyre treated a Zimbabwean truck driver who had cholera. He recovered and has since returned to Zimbabwe," said Kang'ombe.

There is a lot of cross-border trade and movement between Malawi and neighbouring Zimbabwe and Malawi health authorities have been on alert and intensifying civic education on cholera to ensure that the serious Zimbabwe cholera situation does not spread into the country, according to Kang'ombe.

But cholera is not primarily spread directly from person to person. The country's health experts have attributed the problem to lack of safe water combined with poor sanitation and poor hygiene.

The outbreak has hit Lilongwe, and surrounding communities hardest. Kang'ombe said all the people that have died were resident in Malawi's fastest-growing city which has large populations living in slums with little access to safe water. Cholera is transmitted through contaminated water or food.

"We encounter cholera outbreaks almost every rainy season when people who have little or no access to safe water resort to using untreated water from swamps," Kang'ombe told IPS.

The Banda clan, living on the outskirts of Lilongwe city, has lost two family members to the disease within a period of two weeks. Another member of the family was also infected but has recovered after treatment.

A clan member, Jabu Banda, said his aunt got ill with cholera two weeks ago and was admitted to one of the tents erected in Likuni, one of Lilongwe's high density areas, by the ministry of health specially to care for cholera victims. "She died two days after being taken to the health centre," said Banda.

He said his niece also started showing signs of cholera a week after the death in the family. "We took her to the health centre but she also died a day later," Banda said.

Banda said his cousin who played the role of guardian for the two victims was also diagnosed with cholera last week.

"She has just been discharged from the clinic but she is yet to recover fully. She is very weak," Banda told IPS.

In managing the outbreak, Malawi's Ministry of Health has erected special tents near local hospitals and within areas that have been highly affected by the cholera outbreak.

"The idea is to avoid mixing cholera patients with others admitted to hospitals for other less contagious illnesses," said Kang'ombe.

He said the outbreak would have been quickly contained if people had improved on their hygiene. Kang'ombe said a lot of people in townships and surrounding areas eat fresh foods such as fruits without washing them. Fruits such as mangos, bananas and pineapples are in abundance during the rainy season in Malawi.

"We are providing chlorine to households for them to be able treat their water. We are also stopping communities from preparing food at gatherings such as funerals and to avoid buying cooked food from streets to avoid contamination," he said.

The ministry has also cautioned people who handle corpses of cholera cases to be extra careful. Culturally, most communities in Malawi administer a bath to the dead just before burial.

Meanwhile, there are more fears of cholera outbreaks in other parts of Malawi – health officials are vigilant in the flood-prone areas of the country which include southern districts of Chikwawa and Nsanje, the lowest-lying areas of Malawi, which experience floods annually and where cholera epidemics are most common during the rainy season.

Floods have already affected 2,100 households in 21 villages in Nsanje district and 1,573 other families in Chikwawa district since the beginning of the New Year, according to government statistics from district commissioners' offices.

A task force comprising the Ministry of Health, United Nations Children's Fund – (UNICEF), World Health Organisation (WHO) and United Kingdom's Department For International Development (DFID) is currently working to promote civic education on hygiene and chlorination of water sources in the country to control further cholera outbreaks.

Malawi's rainy season runs from November to May and the country still has five more months to contend with cholera.