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Cholera outbreak in districts around Lake Chilwa, Malawi: Lessons learned


Cholera is endemic in Malawi with seasonal outbreaks during thewet season. People living around Lake Chilwa rely on the lake fortheir water supply. From May 2009 to May 2010, a cholera outbreakoccurred in fishing communities around Lake Chilwa. This paperdescribes the outbreak response and lessons learned for preventionand management of future outbreaks.


Starting in January 2010, Médecins Sans Frontières (MSF) helpedDistrict Health Management Teams (DHMTs) to distributeeducational materials, water disinfectant and hygiene supplies, andoral rehydration solution (ORS) in fishing communities. MSF alsosupported case management by mentoring health workers andproviding equipment and supplies.


A total of 1,171 cholera cases and 21 deaths were reported inthe districts around the lake, with cases also being reported onthe Mozambican side of the lake. The attack rate was highestamong people living on or around the lake, particularly amongfishermen. Samples of lake water had high turbidity conducive tothe propagation of Vibrio cholerae.


A number of practical measures could be taken to prevent futureoutbreaks and to manage outbreaks more effectively. Thesemeasures should address surveillance, environmental management,outbreak preparedness, and case management.