Malawi - High priority areas / Hotspots

SUMMARY OF KEY FINDINGS

Cholera burden and dynamics

• Regularly affected communities were located in Southern Region near Mozambique in the Lake Chilwa area and the Shire River floodplain, urban centers of Lilongwe and Blantyre, and districts along Lake Malawi. 

Since 2010, Lake Chilwa (Machinga, Zomba and Phalombe) accounted for 34.5% of all cases.

Since 2010, the Shire River floodplain (Chikwawa and Nsanje) accounted for 31.5% of all cases.

• Cholera outbreaks in Malawi often occurred following the onset of the rainy seasons (between November and April)
• Cross-border transmission appears to play a major role in cholera outbreaks in Malawi due to porous national borders between Malawi and Mozambique (and likely Tanzania to a lesser degree) and poor water and sanitation conditions in cross-border zones

Localization of cholera priority areas

• Urban districts: Lilongwe and Blantyre
• Shire River floodplain and cross-border area (Mozambique): Chikwawa and Nsanje
• Lake Chilwa and cross-border area (Mozambique): Machinga, Phalombe and Zomba
• Lake Malawi: Karonga (cross-border district with Tanzania), Salima and Nkhata Bay
• Transit district: Balaka District - crossroad between Zomba and Lilongwe as well as Blantyre and Salima

Risk factors

• Limited access to safe drinking water

63% of rural populations and 87% of urban population have access to at least basic drinking water sources

• Lack of borehole maintenance and frequent breakdown of piped water supplies and were noted as contributing factors associated with cholera in Chikwawa District
• Fishermen live in zimboweras or islands at Lake Chilwa defecate in the same lake water they used for drinking
• Boreholes with allegedly salty water forced communities to drinking lake or river water in Nsanje, Chikwawa and Karonga Districts
• Water shortages due to lack of piped water/breakdowns in piped water networks, in dense urban/peri-urban areas in Blantyre and Lilongwe implicated during outbreaks

• Limited access to basic sanitation and hygiene facilities

43% of rural populations and 49% of urban populations had access to at least basic sanitation

17% of rural populations and 7% urban populations have no handwashing facility on premises.

• High-risk practices

Approx. 7% of rural populations and 2% of urban populations resort to open defecation in Malawi

• Fishermen on Lake Chilwa and communities in Karonga defecate directly in the lake used as a main source of drinking water
• Fishermen at Lake Chilwa reportedly believe “that if they stop defecating in the lake, then the fish will not reproduce and will eventually die…. And that drinking water direct from the lake brings them good luck… [to] be successful fishermen”

Certain sociocultural believes have been implicated during cholera outbreaks

• Some affected communities failed to seek healthcare as they believed that cholera does not require medical treatment (in 2011-2012)

• Environmental factors: heavy rains and flooding

Cholera outbreaks in Malawi often occurred following the onset of the rainy seasons (between November and April)

Heavy rain and flooding cause latrines to overflow and contaminate drinking water sources with sewage

• Communities living in the Shire River floodplain, in Chikwawa and Nsanje Districts, are especially at risk to flooding
• Latrine overflow/contamination of water sources – was also implicated in cholera outbreaks in Lilongwe

(WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene: 2015 Estimates)