Cholera outbreak in Malawi kills over 1,600, poor people hit the hardest

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.

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.

WORST CHOLERA OUTBREAK IN 2 DECADES SWEEPS THROUGH MALAWI, HAS NOW CLAIMED 750 LIVES

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.

"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.

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