BLANTYRE – The worst cholera outbreak in Malawi in two decades has now claimed 750 lives, a government minister said, while the World Health Organization chief described the southeast African country as one of the hardest hit amid ongoing global epidemics that are “widespread and deadly than normal.”
Malawi’s Health Minister Khumbize Kandodo Chiponda on Thursday ordered many shops that lack clean water, toilets and sanitary waste disposal facilities to close and announced restrictions on the sale of pre-cooked food.
“We continue to see an increasing number of cases across the country, despite signs of reduced transmission and deaths in some areas,” Chiponda said in a statement, calling for compliance with sanitation and hygiene measures.
On Wednesday, Chiponda said 17 people had died “in the past 24 hours” from 589 new cases of the waterborne disease. She said the country has registered 22,759 cases since the outbreak began in March last year.
Figures show about 15 people have died every day for the past few days, with 155 deaths recorded over the past 10 days. Nearly 1,000 people were hospitalized as of Wednesday.
This week WHO Director-General Tedros Adhanom Ghebreyesus said 31 countries have reported cholera outbreaks since December, a 50% increase from previous years.
“Although we have had major cholera outbreaks before, we have never seen so many simultaneous outbreaks,” Tedros said, adding that Malawi is among the worst-hit countries, along with Haiti and Syria.
Over the past year, the WHO and its partners switched to a single dose of the standard cholera vaccine instead of the usual two doses due to supply problems.
“Production is currently at maximum capacity and despite this unprecedented decision, stock levels remain very low,” Tedros said, adding that four other countries had requested vaccines in recent weeks.
The WHO has previously blamed complex humanitarian crises in countries with fragile health systems, exacerbated by climate change, for the unprecedented global rise in cholera. Warmer temperatures and increased rainfall make it easier for the bacteria that causes cholera to multiply and spread.
Africa CDC director Ahmed Ogwell Ouma told reporters during a weekly online briefing on Thursday that 14 African countries are reporting cholera cases, many of which have been attributed to flooding across the continent. A significant portion of the continent’s 1.3 billion people lack access to clean water, sanitation and good hygiene.
Ouma said that over the past week in Africa, where Malawi is the epicenter of the outbreak, 393 deaths have been reported out of just over 4,000 new cases.
The country of about 20 million people has recorded 71% of cases and 88% of deaths over the past week, Ouma said.
In the capital, Lilongwe, some people blamed the lack of basic services like clean water and sanitation for the outbreak.
“I ate and drank in the markets without washing my hands. I wasn’t careful, but there’s no water in those places either,” said 24-year-old Kondwani Malizani, a car mechanic from the crowded Ngwenya township in Lilongwe. He said he was hospitalized with cholera last week.
The hardest hit are Lilongwe and the city of Blantyre, an economic center in the south of the country. Many public places like busy markets are without tap water, while people are forced to dig wells at home or get water from unsafe sources like rivers and streams – factors that contribute to cholera outbreaks.
Epidemiologist Adamson Muula told the AP that the outbreak is affecting “the poorest” who lack access to clean water and sanitation.
“People with working water closets, drinking water from faucets in homes, and those who fortify themselves by not eating in questionable places are not fundamentally at risk,” said Muula, an associate professor at Kamuzu University of Health Sciences in Blantyre. He blamed the ruling elites for not investing in infrastructure.
“People who are not supplied by the municipal water supply system. Affected are people who defecate in bushes and other open spaces, drink from open water sources, and those living in communities where the various water companies cannot provide tap water for days,” Muula said. “Such a disease becomes difficult to control as the bourgeois feel at ease.”
Health Secretary Chiponda on Thursday announced a ban on the sale of pre-cooked food on streets, local markets, bus depots and schoolyards. She also ordered the closure of all marketing, transportation and travel, sports, religion and entertainment establishments that lack clean water, functioning toilets and “organized and sanitary” waste disposal facilities.
She also said the government plans to expand the water mains network and deliver water by truck to people living in slums in Lilongwe and Blantyre. Schools in the two areas, whose openings were delayed in early January, are scheduled to reopen on Jan. 17. This comes after the government pledged to provide safe drinking water and reconnect tap water, which had been shut off at some schools in Lilongwe and Blantyre, Chiponda said.
The country solicited donations of cholera beds, tents, buckets of water, rehydration salts, medical supplies and cash this week.
In November, WHO and its partners sent nearly 3 million cholera vaccines to Malawi. Cholera is an acute diarrheal disease transmitted through contaminated water and food that can cause severe dehydration. It is a bacterial disease that affects both children and adults. Left untreated, up to 30% of cholera cases can be fatal and in extreme cases, the disease can be fatal within hours.
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Farai Mutsaka in Harare, Zimbabwe contributed to this report.
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