Malawi’s cholera outbreak in focus at climate change, health summit

by Noah Wekesa

In the Kigali Convention Center in Rwanda this week, hundreds of delegates from various African countries and overseas gathered and tackled the growing threat of climate change and its impacts on health systems, a clear consensus is now on the need for more action and not mere lip service.

The Africa Health Agenda International Conference (AHAIC) is one of the largest health gatherings on the continent drawing delegates from local and international NGOs, funders, researchers, health campaigners, scientists and even the private sector.

During the 2023 AHAIC, the message was clear that Africa does not need to beg for a fair deal in tackling the health and climate crisis but fight for equity.

“Africa needs to fight for equity to tackle Covid-19 and the climate change impacts on health systems,” says Oyewale Tomori, professor of virology at Nigeria’s Redeemers University.

It was not only Tomori; he was joined in this push by Amref Health Africa’s Group CEO, Githinji Githahi, who observed that the continent is highly vulnerable to the climate crisis, yet it contributes very little to the net carbon emissions.

“Now Africa is tackling rising costs of food, Covid-19 and climate change which is causing a huge health crisis. At the United Nations Conference of Parties (COP28) to be hosted this year in the United Arab Emirates, we must all focus on health and the climate crisis,” stressed Gitahi, whose organization is co-hosting AHAIC 2023 with Rwanda’s Ministry of Health supported by Africa Centers for Disease Control and the African Union.

Malawi’s cholera situation came into the picture. As the country grapples with the worst cholera outbreak in history which has now hit 50,000 confirmed cases based on data from the Public Health Institute of Malawi (PHIM), there was a call at the conference for strengthening health systems and putting in place mechanisms for climate health action.

African Institute for Development Policy (Afidep) Executive Director, Eliya Zulu, whose organisation actively works in Malawi, noted in his presentation the need to enhance the use of evidence in making the health system climate resilient.

“Both climate adaptation and mitigation are vital and we must build capacity in the use of evidence, translation and ensuring that the evidence is used in decision making for effective programs and setting right priorities,” explained Zulu.

He added that many Africans live in slums where health and environmental conditions are dire. At the same time, the continent is experiencing a rapid population growth expected to hit 2.478 billion in 2050 based on population projections.

“There is huge work that needs to be done in climate and health integration,” observed Zulu.

In Malawi, the cholera outbreak was declared on March 3, 2022, by the Ministry of Health, according to World Health Organization (WHO).

People from southern Malawi who were displaced due to torrential rains and floods from late January to February 2022 did not have access to safe drinking water and sanitation services and, therefore, were at an increased risk of diseases such as cholera.

Malawi is still reeling from the aftereffects of cyclone Ana (January 28, 2022) and cyclone Gombe (March 11–13, 2022), which collectively killed 51 people and impacted an estimated one million people.

In an assessment, the Malawi Red Cross Society and technical advisors at IFRC Africa regional office note that Malawi is a hotspot for cholera outbreaks in Africa.

“Communities located along Lake Malawi, Lake Chilwa and in the flood plains of the Shire Valley, as well as urban centres of Lilongwe and Blantyre are regularly affected by cholera.

“Globally, cholera transmission has been linked with seasonal trends in rain, and especially extreme weather events such as abrupt and heavy rainfall,” reads in part of the report co-authored by Tilly Alcayna, Tima Munthali, Vivian Njogu, Mizan Michael and Laura Stewart.

The report also explains that rising temperatures in water increase the growth of vibrio cholerae, the pathogen that causes cholera.

The risk of cholera is therefore linked to both climate variability and extreme weather as disaster events damage water, sanitation and hygiene (Wash) infrastructure, disrupt access to clean water or sanitation and create conditions conducive to faecal–oral transmission of Cholera.

Malawi outlines its climate change and health priorities in the National Adaptation Programme of Action (Napa) and the Nationally Determined Contributions (NDCs). Health is a priority sector and is identified as being vulnerable to climate change under both policy instruments.

The urgency of potential risks caused by recurrent floods and droughts as well as their effects on human well-being and ecologies are highlighted in the country’s adaptation plans.

In a recent article published by Devex, an international publication, Professor Adamson Muula, head of public health at Kamuzu University of Health Sciences (KUHES), is quoted as saying the outbreak has further been exacerbated by the effects of climate change on food security.

“In the wake of climate change, access to food has become a challenge and hungry people have little choice on what to eat,” Muula explained.

“The situation is made worse by contamination of underground water and the low access to safe drinking water by the majority of the population.”

Article first published on

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