Malawi is a landlocked Southeast African country that borders Zambia, the United Republic of Tanzania and Mozambique. With an estimated population of 21,279,597 in 2023, the country is rife with poverty and has experienced stagnation in progress due to low education completion rates, slow infrastructure reform and the recurrent shocks of drought and flooding. High dependency on low-yield subsistence agriculture has resulted in high rates of food insecurity and limited the country’s potential for economic growth. Furthermore, limited investment in health care infrastructure, especially in isolated rural areas, has increased the population’s vulnerability to disease: in 2011, there were 1.3 hospital beds per 1,000 people and, as of 2020, Malawi’s health expenditure accounted for only 5.4% of its GDP.

Consequently, many in Malawi are at great risk of contracting and suffering from infectious diseases, including food and waterborne illnesses and diseases transmitted by animals. Malaria, typhoid and cholera are three of the most predominant diseases impacting Malawi. Fortunately, there has been ongoing progress in improving health care services in Malawi and reducing the spread of disease.

Malaria in Malawi

A life-threatening tropical disease, Malaria is caused by one of five species of parasites that can be transmitted to humans through infected mosquitos. According to the World Health Organization (WHO), the primary symptoms include fevers and headaches. However, without fast and effective treatment, the disease can lead to more serious symptoms, including anemia, respiratory dysfunction and organ failure, resulting in death.

Difficulty in recognizing the primary symptoms of malaria has contributed to its fast spread. Like other countries in sub-Saharan Africa, Malawi is highly susceptible to malaria outbreaks because much of the population depends on agriculture for income, and farmland and irrigation systems can provide favorable breeding habitats for mosquitos. Climate change is exacerbating the threat of malaria as rising temperatures, rainfall and humidity enable mosquitos to breed in new areas. Additionally, anti-malarial drug resistance, alongside mosquito resistance to insecticides, continues to increase, making it exceedingly difficult to prevent and eradicate the disease.

According to the United Nations Children’s Fund (UNICEF), “in 2021, there were 247 million malaria cases globally that led to 619,000 deaths in total.” Highlighting the inordinate risk that malaria poses in Malawi, the World Bank recorded 219.2 malaria infections per every 1,000 Malawian people in 2021. More recently, the United States Agency for International Development (USAID) clarified, in its 2023 Malaria Operational Plan for Malawi, that the country’s entire population is at risk, with a projected 9,692,000 malaria cases afflicting the country in 2023.

However, there have been growing efforts to tackle the threat. In addition to USAID’s initiatives, scientists from Liverpool School of Tropical Medicine and Lancaster University are collaborating to fight the spread of malaria in Malawi using drones. By collecting aerial data, they are able to identify, predict and reduce mosquito breeding sites, thus reducing the number of malaria infections.

Typhoid Fever in Malawi

Typhoid fever is caused by ingesting the bacterium Salmonella Typhi, which multiplies in the human bloodstream. Easily contracted through contaminated food or water sources, the disease causes symptoms including chronic high fevers, headaches, nausea and diarrhea and, in severe cases, can be fatal. Poor sanitation and lack of access to safe water have made it prevalent in Malawi, recording an estimated 16,000 cases or more of typhoid each year. With children under the age of 15 accounting for about 64% of Malawi’s typhoid infections and 67% of its typhoid deaths as of 2017, increased drug resistance has made typhoid a growing concern in recent years.

A 2021 study found the WHO-prequalified Typbar-TCV vaccine to be not only longer-lasting and more effective than previous vaccines, but also 84% effective and safe for children that are six months and older. Accordingly, in 2022, the Malawian government launched a campaign to distribute the vaccine to all children between nine months and 15 years of age.

Cholera in Malawi

Cholera is another life-threatening disease that is transmitted by contaminated food or water, consequently posing a heightened threat to those who lack access to basic sanitation services and clean water supplies. While most infected people develop no or only mild symptoms, some become severely dehydrated due to vomiting and diarrhea, and this can cause death within hours if left untreated. Between March 3, 2022, and February 3, 2023, Malawi had 36,943 reported cases of cholera, with the outbreak causing a reported 1,210 deaths. Fortunately, oral rehydration solutions are effective for treating the disease, and improved hygiene and vaccinations can significantly reduce its spread. WHO and UNICEF have been supporting Malawi in the fight against cholera by promoting these and other forms of treatment and prevention.

For example, WHO has trained more than 800 health care workers to save lives and worked with Malawi’s Ministry of Health to increase surveillance of the disease, provide medical treatment and chlorinated water and improve community hygiene. UNICEF has provided water, sanitation and hygiene supplies and trained 480 Health Surveillance Assistants and community members to detect and report cases of cholera. Furthermore, the organization has supplied affected areas with cholera treatment kits. These include 25 Acute Watery Diarrhea kits, each of which can help treat over 2,000 cases. Working in conjunction with WHO and UNICEF, the Government of Malawi also initiated a national Oral Cholera Vaccination campaign that, as of August 2022, has helped provide life-saving vaccinations to around 1,136,643 people.

Looking Forward

These and other diseases impacting Malawi are placing pressure on the country’s limited health care services, with a lack of sanitation, clean water supplies and knowledge contributing to the escalation. While the situation urgently calls for further funding and support, WHO, UNICEF, the Malawian government and others are making steady progress in the fight to mitigate the spread of diseases in Malawi and alleviate the suffering of affected people.

– Isla Wright
Photo: Flickr