World Health Organization

WHO Malawi






During the first week of January 2003 heavy rains, an aftermath of the tropical depression Delphina caused extensive flooding in some districts in Central and Southern Malawi. President Bakili Muluzi visited some of the affected areas and relief aid has been dispatched to the districts.

On January 14th 2003 a visit was organised to Salima district in order to assess the effectiveness of the emergency response and to map out the next steps for the near and mid-term vision. The team travelling from Lilongwe comprised Mr G. Bello, member of the Epidemiology Unit at the CHSU (Community Health Sciences Unit) in the Ministry of Health and Population (MoHP) and Dr. T. de la Torre, WHO emergency response.

Upon arrival to Salima District Hospital the Salima District Health Officer (DHO) Dr. Mongoni, Salima District Environmental Health Officer (DEHO) Mr. Mitochi, the deputy DEHO and a representative from the Central Clinical Services joined the team.

Places visited

The main affected areas are the Namanga and the Litchi areas, about 20 km South West of Salima Town along the Linthipe river. They are mostly flat and swampy areas and flooding has happened in the past.

The team went first to Naliomba village, the closest village to an area still inaccessible by land. Three villages are reported in the area, approximately 300 people affected. These people had been able to walk from their villages to Naliomba in order to pick up food from the WFP food distribution and relief items handed out by the District Assembly during the Presidentís visit. It was agreed with the Naliomba villagers that they would send a message to the nearest health post if the people crossed again.

The team then proceeded to Punga village, where a group of approximately 40 households had resettled. We spoke with the village headman who explained that in total 350 households had been initially displaced by the floods in the area. At the present moment quite a lot of people were trying to go back.

In Punga village the resettlers had built grass huts and were now busy digging latrines (quite shallow because the water table is very high). The village has 9 boreholes (8 functional) so the water supply is not a problem at present.

They explained that their worst loss was the fields of maize and rice that had been washed away (somebody talked of thousands of hectares).

They had received food from the WFP food distribution but no other form of relief. The children looked dirty but not malnourished. They reported an increase in the number of diarrhoeal episodes among the community. Most of them intend to go back to their original village once the risk of additional floods is over.

The team visited the home of the Health Surveillance Assistant (HSA) in charge of the area; unfortunately he was not there. We spoke with his wife who showed us the small remaining stock of drugs. HSAs are supposed to have ORS, cotrimoxazol, Fansidar, mebendazol and paracetamol always at their disposal. In discussion with the DHO it was agreed that the HSA would be included immediately in the new cholera training course (about to start next week) if he had not been included in the first round. Additionally the replenishment of the drug stock would be treated as an urgent matter.

At the moment of the visit Salima District had 7 patients under treatment, 5 at the District Hospital and 2 at Chipoka Hospital. None of the cholera patients came from the flood-affected areas. The team visited the cholera treatment centre located at the Salima District Hospital. Up until last week the hospital was seeing 1-2 patients per day, so they were being treated in the isolation rooms at the male and female wards. During the last week the number of cases had increased progressively until the day before our visit when they registered 10 new cases. At that moment the decision was taken to open the treatment centre (a big UNICEF tent). At the time of out visit the tent was erected and the patients were about to be transferred.

All the patients (4 women and 1 man) presented signs and symptoms consistent with cholera; they were all on IV fluid treatment even though none of them was severely dehydrated anymore. Only 2 of the patients had ORS within reach. The DHO explained how difficult it was to change old habits and beliefs not only in the patients but in the nursing staff as well.