Malawi's deadly cholera epidemic hits the poor hardest
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[March 09, 2023]
By Charles Pensulo
BLANTYRE (Thomson Reuters Foundation) - Domestic worker Annita Symon
fears for her children's health after seeing several friends fall
seriously ill due to a cholera outbreak that has killed more than 1,600
people in Malawi over the last year.
Like many low-income families, she and her two children are forced to
get their drinking water supplies from contaminated rivers that are
spreading the disease in a country where about one in three households
lacks access to safe drinking water.
"The water from (communal) taps doesn't come regularly but is also
expensive. So sometimes we fetch from some streams or rivers and dams,"
said Symon, 27, who lives in Malawi's second-largest city Blantyre, one
of the hotspots of the outbreak.
"We have been advised by the health workers to apply chlorine or boiling
water before drinking," she said, adding she does not always treat water
but was using chlorine handed out by health officials to help curb the
current disease outbreak.
Cholera is mainly spread by contaminated food or water and can cause
acute diarrhoea. While many people have mild symptoms, if untreated it
can kill within hours. Children, especially those under age five, are
particularly vulnerable.
![](http://archives.lincolndailynews.com/2023/Mar/09/images/ads/current/debbiesfloral_lda_021023.png)
Poor people are being especially hard hit by Malawi's deadliest ever
outbreak of the disease, which comes amid an "exponential" rise in cases
across Africa this year, according to the World Health Organization
(WHO).
More than 50,000 people have been infected with cholera nationwide and
more than 1,600 have died since March last year, according to health
ministry data.
While the epidemic has brought fresh urgency to calls to improve water
and sanitation access, they remain out of reach for many in Malawi, one
of the world's poorest and least-developed nations.
About a third of households in the country of 18 million lack access to
clean drinking water, according to the United Nations, while almost a
quarter of all water points are not functional. Only 26% of the
population have basic sanitation services.
Households that do not have water piped into their homes usually either
use boreholes or buy supplies from kiosks.
A bucket of water costs just under 10 cents – a high sum for many in the
southeast African nation, where about 70% of the population lives in
extreme poverty, according to the World Bank.
In the southern district of Phalombe, Enifa Ngalawa, a 26-year-old sales
agent, said they drink water from a shared tap fed by untreated water
from a nearby mountain.
Her three-year-old daughter has had diarrhea dozens of times since last
year.
"The water coming out from the tap is very dirty. My daughter has been
having diarrhea almost every week to the extent that she stopped going
to a nursery school last term," she said.
DIRTY WATER
Adamson Muula, a professor of public health and epidemiology at Kamuzu
University of Health Sciences, said the current cholera outbreak was
concentrated in low-income areas.
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"The wealthy do not draw water from shallow wells or in streams where
sewage and water flow," he said.
The government declared the outbreak a public health emergency in
December.
It has rolled out a national response plan in collaboration with the
WHO, including oral vaccination campaigns, water quality tests in
affected areas, and public education on water, sanitation and hygiene.
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![](../images/030923PIX/health71.jpg)
Vendors selling clothes and other
merchandise in the city of Lilongwe, Malawi. Behind them is polluted
water. Poor drainage facilities is one of the problems in the
cities. January 11, 2023. Kondwani Magombo/Thomson Reuters
Foundation
![](http://archives.lincolndailynews.com/2017/Jul/22/images/ads/current/rohlfs_lda_072017.png) Volunteers will help identify
communal water points for water quality testing and decontamination,
provide purification chemicals to households, and support the
construction of new toilets and handwashing facilities, Health
Minister Khumbize Kandodo Chiponda said in a recent statement.
There are also particular challenges in tackling poor hygiene and
disease in slums and other low-income urban areas, where clean water
is sometimes unavailable.
A survey by the Society of Medical Doctors last year found some
water kiosks in such areas had closed down, said its spokesperson
Zaziwe Fatsani Gunda.
"The reason is that (local people) couldn't afford water from the
kiosks, and some were closed because of debts with the water board
and water association users," said Gunda.
"Many have been using untreated water, including from rivers and
wells."
WATER KIOSKS
Many households on the outskirts of urban areas rely on water kiosks
operated by community-based Water User Associations (WUAs) under a
government mandate.
The kiosks are intended to be affordable for low-income households,
and their water supply tariff is heavily subsidised compared to
standard household or commercial rates.
But their running costs - from kiosk operation bills to staff
salaries - push up prices for customers, according to a 2016 Water
Aid report.
"Low-income customers are paying more for water at kiosks than
people with household connections," it said, adding that many of the
poorest families ration water or turn to unsafe water sources.
Associations can also incur debts to the water boards that supply
them if their sales income does not cover the cost of staff
salaries, it said.
![](http://archives.lincolndailynews.com/2023/Mar/09/images/ads/current/xamis_lda_ANIMAL_2023.png)
Poor construction of sanitary facilities and a widespread lack of
awareness of health safety messages are exacerbating infection risks
in poor urban districts, said George Jobe, executive director for
Malawi Health Equity Network.
"Controlling behaviours and practices has proven to be difficult in
high-density areas," he told the Thomson Reuters Foundation.
"For instance, it is not easy to control people when disposing waste
... especially in low income and high density areas where the
facilities are either not available or the people don't follow the
rules."
In Makhetha, a dense township on the outskirts of Blantyre,
30-year-old Flone Yobe frantically pushed herself into the queue of
community members struggling to get water from a kiosk.
She said supplies could be erratic, and the vendor had run dry for
almost the past two weeks.
"It's been difficult to get water and we've ended up going to the
rivers," said Yobe, as water officials distributed extra supplies to
families from a storage tank.
"Here at (this) kiosk, we haven't had water since last month and
we're struggling. I fear for myself and my family."
(Reporting by Charles Pensulo; Editing by Sonia Elks. The Thomson
Reuters Foundation is the charitable arm of Thomson Reuters. Visit
https://www.context.news/)
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