Editorial: Malawi’s Cholera Outbreak-2022

Adamson S. Muula 1,2

1Editor-in-Chief (Malawi Medical Journal); 2 Professor and Head, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi

Address for correspondence: amuula@kuhes.ac.mw

As of 20th December 2022 and barely a few weeks after the rainy season had started, Malawi’s cholera death toll for the year had already exceeded 410 and the cumulative number of cases reported as 13,837.1 Obviously, this was an underestimate as it is not possible for all the cases to be captured by the formal recording system. 2 Some patients may have died without being recorded. Mild cases who are unlikely to go seeking medical attention may also have been missed. Of particular note also was the case fatality of 2.96% (almost 3% in fact) which is about or at least three times that which is expected. Normally, <1% of case fatality is acceptable. By 20th December 2022, the government had declared cholera a Public Health Emergency.

The current outbreak started in fisher or fishing communities in Nkhata Bay in Northern Malawi. The national response was largely oblivious and ceremonial. Each week thereafter, one or more districts were added to those reporting their own outbreaks. Unlike in the past when cholera was a rainy season disease, the present outbreak in fact started in the dry season. Along the fishing communities in Nkhata Bay where the disease started, people had no potable water and they were defecating in the same water they were using for drinking and preparing food with. In short, this community had been neglected. It was just a matter of time before the disease was going to be exported to other communities and the present conflagration resulting.

Unlike Covid-19, cholera affects the very poor. Much of the population, especially those who have access to potable water, toilets or hygienic latrines, access to food prepared and stored in hygienic ways is not at (great) risk of catching cholera. Not all of us are at risk of cholera. People who have functioning water closets, potable water from taps in homes and those who fortify themselves by not eating at questionable places are basically not at risk. Such a disparity in risk has contributed to the spread of the disease. Cholera affects people “without names”. People who are not served by the municipal water supply system. People who defecate in bushes and other open spaces, drink from open water sources (lake, unprotected wells) and those who live in communities where the different water companies can fail to provide tap water for days on end. Such a disease becomes difficult to control as the bourgeois feel unconcerned.

Cholera is a disease of poverty. It is a disease of neglect. It is a disease which people get when their drinking water and/or food is mixed with faeces from infected persons. All the 410 deaths and those more than 13,000 others had in fact drank water which was mixed with human faeces As humanity, we should be ashamed of ourselves really, because if this is not shameful, then what is?  As long as there are the glaring disparities between the “haves” and the “have nots” in accessing safe water and food hygiene, Malawi will never eliminate or eradicate this scourge. Cholera will disappear once we are committed to meeting the most related Sustainable Development Goals, i.e. SDG 3 (Good health and Wellbeing); SDG 6 (Clean water and Sanitation); and SDG 10 (Reduced Inequalities). 3-5

Acknowledgement and Disclaimer

I thank Mr Joe Mlenga of the Malawi University of Business and Applied Sciences (MUBAS) for editing the manuscript of this article. The content in this article is solely the responsibility of the author.


  1. Kandodo-Chiponda K. Cholera Outbreak in the country. Speech by Minister of Health at the Central Office of Information, Government of Malawi, 22nd December, 2022, Lilongwe, Malawi
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