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In Malawi, community-run Oral Rehydration Points help address cholera deaths

In Malawi, community-run Oral Rehydration Points help address cholera deaths

3 Março 2023 | Malawi
In the small compound that he, his wife and their young child share with five other people, Sainedi Miengo, 24, draws water from the well for domestic use and to brew masese – a local beer – which customers consume on the spot. “We have only one toilet that our customers use. Maybe it is how I got sick,” he says as he recounts the evening when he felt unwell. “I had severe diarrhoea and I vomited a lot. It was terrible.”

Lilongwe – In Area 36, a densely populated neighbourhood of the capital of Malawi, Lilongwe, community volunteers and health workers keep a lifesaving Oral Rehydration Point (ORP) open every day, all day long. Every morning, the small group sweeps the ground and takes out supplies provided by World Health Organization (WHO): an oral rehydration solution and chlorine solutions to mix with water to disinfect cups and surfaces and for hand hygiene.

At this ORP, like the 46 others that WHO has helped establish, community members with cholera symptoms can easily access treatment for rehydration. More severe cases are quickly referred to the nearest cholera treatment centre.

With 48 000 cumulative cases and over 1500 deaths since March 2022, Malawi is experiencing its worst cholera outbreak. The setting up of ORPs helps increase chances of quick recovery and reduces cholera deaths. As of 18 February, Malawi had registered a 15.7% week-on-week decrease in new cases and a 36.4% decrease in deaths.

Miengo sought help from a volunteer working at an Oral Rehydration Point located in his community. There, he received an oral rehydration solution (ORS) and was referred to the hospital where he was treated on time and quickly recovered. “I returned to the ORP where I received more ORS and chlorine to disinfect my house,” he says.

Oral Rehydration Points are run by community volunteers and health workers. “When someone comes here, we give ORS and we ask questions about the symptoms, their frequency and intensity. If the patient is very sick, we send them to the hospital,” says Falesi Nkhoma, who took part in recent polio and cholera vaccination campaigns. “Two of my neighbours had cholera and one died. After that, I thought I should help.”

Whereas cholera treatment units and cholera treatment centres may be too far for people to reach them quickly, ORPs are located within communities and offer easy access to basic screening and rehydration. “The objective is to address the high fatality rates by ensuring people don’t wait too long before being treated,” says Dr Lilian Malino, who works on case management at the Ministry of Health. Cholera is an acute intestinal infection caused when someone consumes food or water contaminated with the bacterium Vibrio cholerae. The disease can kill within hours if untreated.

With WHO and partners’ support, Malawi health authorities established 47 ORPs in 10 of the most affected districts in late January 2023, after the country registered a surge in deaths. This was in response to a high weekly fatality rate of 4.6% in the last week of December 2022. “Our strategy was that each cholera treatment unit or cholera treatment centre must be linked to four ORPs, so that severely ill patients, including pregnant women and children under 5, could start rehydration even before they arrive at the hospital,” says Dr Malino.

In a congested neighbourhood like Area 36, observing basic hygiene measures often proves to be difficult. “So, when people come to see us, we educate them on the use of chlorine and hand washing,” says Jean Richman, a Health Surveillance Assistant who supervises volunteers at the ORP. “When the ORP was established in late January, we saw around 12 patients a day and almost all of them were referred to the hospital. Now we see seven or eight each day and most of them are only mildly sick.”

WHO plans to set up 250 ORPs in total, in addition to the 100 that the International Federation of Red Cross and Red Crescent Societies forecasts to support.

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