Village Health Volunteers in the forefront of integrated door to door cholera outbreak interventions in Malawi

In early February, Malawi launched the End Cholera/Tithetse Kolera campaign, a strategy to intensify the response at community level. With support from WHO and partners, community health workers and volunteers through the Ministry of Health were trained to implement integrated cholera response interventions at community level in areas of water, hygiene and sanitation, surveillance, case management through oral rehydration points and health promotion.

Since January 2023, the country has been registering a decline in new cholera cases and deaths – thanks to robust response efforts from WHO and partners. Despite the downward trend in the outbreak, the country faces a risk of further spread of cholera due to impact of Tropical Cyclone Freddy that hit the country in March, affected fifteen districts of the southern region. With damage of water and sanitation facilities, residents in cyclone affected areas are vulnerable to disease outbreak and the risk of small number of cholera cases propagating rapidly remains substantial. It is for this reason that the WHO is providing technical support to the Ministry of Health and partners to implement Case Area Targeted Interventions (CATI). The strategy focuses on localised response in an area that is reporting cases to curb transmission of the outbreak.

“We have trained community health workers and volunteers to do targeted interventions at household level for rapid response to cholera,” says Dr Nelly Jepkonga Yatichi, WHO Incident Manager for cholera outbreak response in Malawi.
“With the country recording small number of cholera cases, it is important to modify our strategy to spatial targeting of case households and their radius. This practice is efficient in ensuring we stop further transmission of cholera and would potentially get us to zero cases and deaths.”

The frequent visits of community volunteer to households are sustaining uptake of interventions. For instance, Chrissy Dzimkambani, has observed an increase in demand for chlorine in her communities which is a sign that communities are now accepting of cholera preventive measures. The door to door is also helping to identify suspected cases of cholera which are then referred to oral dehydration points, an intervention managed by MOH with support from the World Health Organization. Early detection and referral of cholera cases contributes to high chance of survival of cholera patients. If left untreated, cholera causes severe dehydration and death within a few hours.

Chrissy narrates that at the peak of the outbreak in her area, they recorded over 20 cholera cases. In comparison, only one person has had confirmed cholera in two months since the implementation of door-to-door strategy.

“The targeted door to door strategy is yielding positive impact to the cholera outbreak response in our communities and evidently saving lives,” she says.