Malnutrition aids cholera epidemic

Malawi is currently experiencing its worst ever cholera epidemic, and experts believe malnutrition, mismanagement and a lack of capacity have aided the outbreak. The cholera epidemic has already claimed nearly 1,000 lives. It peaked in February and March with about 40,000 reported cases and is on a downward trend in terms of infection rates, said World Health Organisation (WHO) country representative Youcef Chellouche. Malawi is also experiencing a severe food shortage that has left large parts of the population more vulnerable to disease. Chellouche told IRIN on Wednesday that an inter-agency assessment was being conducted to establish what role mismanaged responses to the outbreak had played in abetting the epidemic. The assessment would also interrogate what impact the food crisis and malnutrition has had on the situation. "This is not easy to conclude ... we will compile all the findings [of the assessment] around 17 May and we will have a common analysis of the roles of malnutrition and mismanagement," he said. A key area of concern was also the lack of capacity to deal with the epidemic. "We've seen how ... from time to time, the problem is not mismanagement but that there is just no capacity," Chellouche said. A WHO report on the current cholera situation in the country said: "Over the last five years Malawi has experienced cholera epidemics of varying magnitude. The current season, which started on 28 October 2001, is described as the worst that the country has ever faced." By early April, 980 deaths were recorded and the number may have risen. "So far, all of the 27 districts have reported at least one case except Rumphi in in the north. Lilongwe district where the capital city is located leads all other districts in disease burden with 5,537 cases and 160 deaths," the WHO report said. Districts in the centre and south of the country were more affected by the current epidemic. WHO said districts that were close to natural lakes were especially in danger as this was "where the epidemic usually starts before spreading to other districts". As part of an ongoing UN inter-agency assessment on Malawi's critical food shortage and related health impact, WHO and its health partners were to visit district health management teams, health facilities, and communities in the most affected areas. The assessment would identify strengths and weaknesses of the current response to the cholera epidemic and identify immediate needs for support, and devise a plan for preparation and response for the 2002/03 cholera season. Some of the questions that will be answered by the assessment are whether the outbreak was identified early enough, and whether the response was adequate. Also under scrutiny will be factors that contributed to the high fatality rate and whether the key partners (Ministry of Health, UN agencies, NGO's and communities) were properly coordinated. "With this information in hand, Malawi should be able to improve the response to the current epidemic and be better prepared for the next season," WHO said.