2016: When cholera, typhoid hit hard

To many Malawians, the year 2016 has not been very good. This was the year when over a thousand were affected by cholera and typhoid fever in some districts.

First to be registered was cholera in two Eastern Region districts of Machinga and Zomba. By January 2016, some cases were also reported in Nkhata Bay.

Typhoid fever outbreak, on the other hand, was first reported early this year at Nsambe in Traditional Authority (T/A) Dambe’s area in Neno District. For the record, the typhoid fever outbreak had, in fact, initially been reported in the area on Augusts 6 2015 after it attacked 130 people.

After months of battling with the two outbreaks, Malawians will be ending the year 2016 on a good note with no cholera or typhoid fever outbreak being addressed in any corner of the country.

A closer look at cholera

The year 2016 started on a bad note with Ministry of Health (MoH) reporting cholera outbreaks in Machinga and Zomba districts.

According to MoH, the cases were from Lake Chilwa area which spreads cross Zomba, Phalombe and Machinga districts.

In 2016, the situation got out of hand, though, as one district after another joined Zomba and Machinga as they also registered the cholera outbreak. First to be in the footsteps was Nkhata Bay followed by Karonga then Lilongwe, Phalombe, Mangochi, Salima, Rumphi, Mchinji and Nsanje.

The outbreak was largely attributed to poor sanitation and hygiene practices, especially in shoreline localities where resident and migrant fishing crews live in congested shacks and zimbowera (temporary shelters constructed on the waters) with no toilets nearby.

Statistics from MoH in September showed that cumulatively 1 786 cases, including 58 deaths, were reported in the 14 affected districts. The statistics indicated that Machinga recorded 829 cases and 18 deaths followed by Zomba with 312 cases and three deaths and third was Karonga with 238 cases and 13 deaths.

MoH spokesperson Adrian Chikumbe said on the situation: “Though Machinga leads in the total number of cases registered, case fatality rate ([FR]—a measure of the severity of a disease—has been highest in Karonga.”

Up close on typhoid fever

In March 2016, there were 10 cases of typhoid in Nsambe.

MoH celebrated winning the battle against this outbreak. However, it was short-lived as come April another outbreak was reported in Mchinji with 18 cases confirmed.

Yet another typhoid outbreak was reported at Malosa in Zomba after Zomba District Health Office (DHO) on July 2 said there was an increase in the number of cases at St. Luke Hospital with typhoid fever symptoms. These include fever, headache, vomiting, abdominal pain and general body weakness.

When the Zomba outbreak was getting contained, a fresh outbreak was confirmed around Zalewa in Neno East where 143 cases were recorded. It was linked to the Malosa, Zomba outbreak.

MoH said investigations—blood culture—in the cases reported, conducted through testing strains from samples, found Salmonella typhi, a similar bacterium that recorded in the Zomba outbreak.

Medics’ perspective, way forward

Last month, one of the Malawi-Liverpool Wellcome Trust (MLW) Clinical Research Programme researchers, Dr. Chisomo Msefula, said investigations into typhoid indicate an increase in outbreaks since 2010.

Msefula, who is also a senior lecturer at the Microbiology Unit at College of Medicine (CoM)—a constituent college of the University of Malawi (Unima), said the trust is doing studies to understand the antibiotic sensitivity as well as diagnostics of the disease.

Blantyre DHO Medson Matchaya also said research has helped Malawi make positive strides in the fight against typhoid as at the moment government is using a lot of research with its partners like MLW to introduce or find a better way of diagnosing typhoid easily as the current method takes longer.

Outlook for 2017

As the year 2016 draws to an end, we hope that Malawians will not experience the two outbreaks in 2017. The outbreaks slowed down economic activity as people attended to ill relations instead of engaging in productive activity. They were also robbed of loved ones.

By following a strict personal hygiene code at household and community level, cholera and typhoid fever are avoidable. n