To think of a period of more than 14 months without any confirmed cholera case in Malawi is a situation which one never thought of but because it is a reality for now, it is an incredible achievement as a nation and worth sharing.
For many decades, Malawi has been struggling with cholera—both in its prevention as well as treatment. Looking at the history of cholera in the last six years, the country registered the highest cholera cases in 2008/2009, where 3 250 cases and 82 deaths were recorded. Since then the trend has been declining.
This good news of not recording any cholera cases for the past two years has not just come out of the blue. It is a result of the investment in knowledge, resources and behaviours that promote zero occurrence to cholera. Knowing that cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium vibrio cholera, the best way to prevent it is to know exactly what causes it.
Every year, there are an estimated three to five million cholera cases and between 100 000–120 000 deaths due to cholera globally. The disease’s short incubation period of two hours to five days enhances the potentially explosive pattern of outbreaks. And the sad part is that cases of cholera are now largely confined to regions of the world with poor sanitation and water hygiene.
While it is sometimes good not to know how certain diseases occur, for cholera, the understanding of the disease is very easy. The vibrio bacteria that causes cholera is always found in feacal matter and obviously, if one suffers from cholera, it means hygiene was very much compromised such that the patient ended up ingesting either food or water contaminated with feacal matter.
Often times, cholera is classified as a subject of the health sector. It is, however, an outcome of multiple factors and featuring high is sanitation and hygiene. Registering a cholera patient in the hospital is an outcome of unavailability of certain supplies and also a product of unhygienic human behaviour. It is apparent that anyone’s fear in an event where water supply is low or is non-existent at all is that waterborne diseases may occur. The unavailability or absence of this resource can potentially breed a situation where cholera will flourish.
In Malawi, the season for cholera begins on the first day of November every year and it is always known as the epidemiological calendar of cholera. This is the period also associated with the onset of rains. This is so because rains bring water as a resource for household use and some communities use water collected from unsafe sources.
In a country where access to safe water and utilisation of sanitary facilities falls short of remarkable benchmarks, achieving a cholera free season for a period of approximately 24 months is a success story. The disease has disappeared for now. We do not know how long it may take to come back should we relax in our comfort zone and not take measures to maintain the status quo.
One thing for sure is that, no one has died of a confirmed cholera case in Malawi since November 2012 and we shall make history again this year if we continue to observe good hygiene practices. The answers are at individual, household and community level. We need to think seriously that any loss of life due to preventable conditions is regrettable. A reminder to all of us is that cholera remains a global threat to public health and a key indicator of lack of social development.
—The author is spokesperson for the Ministry of Health.