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Sokemawu Freeman AY, Ganizani A, Mwale AC, Manda IK, Chitete J, Phiri G, Stambuli B, Chimulambe E, Koslengar M, Kimambo NR, Bita A, Apolot RR, Mponda H, Mungwira RG, Chapotera G, Yur CT, Yatich NJ, Totah T, Mantchombe F, Chamla DD, Olu OO. Analyses of drinking water quality during a protracted cholera epidemic in Malawi - a cross-sectional study of key physicochemical and microbiological parameters. J Water Health 2024; 22:510-521. [PMID: 38557567 DOI: 10.2166/wh.2024.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/25/2024] [Indexed: 04/04/2024]
Abstract
Anecdotal evidence and available literature indicated that contaminated water played a major role in spreading the prolonged cholera epidemic in Malawi from 2022 to 2023. This study assessed drinking water quality in 17 cholera-affected Malawi districts from February to April 2023. Six hundred and thirty-three records were analysed. The median counts/100 ml for thermotolerant coliform was 98 (interquartile range (IQR): 4-100) and that for Escherichia coli was 0 (IQR: 0-9). The drinking water in all (except one) districts was contaminated by thermotolerant coliform, while six districts had their drinking water sources contaminated by E. coli. The percentage of contaminated drinking water sources was significantly higher in shallow unprotected wells (80.0% for E. coli and 95.0% for thermotolerant coliform) and in households (55.8% for E. coli and 86.0% for thermotolerant coliform). Logistic regression showed that household water has three times more risk of being contaminated by E. coli and two and a half times more risk of being contaminated by thermotolerant coliform compared to other water sources. This study demonstrated widespread contamination of drinking water sources during a cholera epidemic in Malawi, which may be the plausible reason for the protracted nature of the epidemic.
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Affiliation(s)
| | | | | | | | | | - Gift Phiri
- Ministry of Water and Sanitation, Lilongwe, Malawi
| | | | | | | | | | - Alisa Bita
- World Health Organization Country Office, Lilongwe, Malawi
| | | | - Hamid Mponda
- World Health Organization Country Office, Lilongwe, Malawi
| | | | | | - Chol Thabo Yur
- World Health Organization Emergency Preparedness and Response Hub, Nairobi, Kenya
| | | | - Terence Totah
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Freddie Mantchombe
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Dick Damas Chamla
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Olushayo Oluseun Olu
- World Health Organization Regional Office for Africa, Brazzaville, Congo E-mail:
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Dulacha D, Ramadan OPC, Guyo AG, Maleghemi S, Wamala JF, Gimba WGW, Wurda TT, Odra W, Yur CT, Loro FB, Joseph JLK, Onak ETT, Aleu SCG, Berta KK, Isindu BA, Olu OO. Use of mobile medical teams to fill critical gaps in health service delivery in complex humanitarian settings, 2017-2020: a case study of South Sudan. Pan Afr Med J 2022; 42:8. [PMID: 36158930 PMCID: PMC9474833 DOI: 10.11604/pamj.supp.2022.42.1.33865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/22/2022] [Indexed: 11/11/2022] Open
Abstract
The vulnerable populations in the protracted humanitarian crisis in South Sudan are faced with constrained access to health services and frequent disease outbreaks. Here, we describe the experiences of emergency mobile medical teams (eMMT) assembled by the World Health Organization (WHO) South Sudan to respond to public health emergencies. Interventions: the eMMTs, multidisciplinary teams based at national, state and county levels, are rapidly deployed to conduct rapid assessments, outbreak investigations, and initiate public health response during acute emergencies. The eMMTs were deployed to locations affected by flooding, conflicts, famine, and disease outbreaks. We reviewed records of deployment reports, outreach and campaign registers, and analyzed the key achievements of the eMMTs for 2017 through 2020. Achievements: the eMMTs investigated disease outbreaks including cholera, measles, Rift Valley fever and coronavirus disease (COVID-19) in 13 counties, conducted mobile outreaches in emergency locations in 38 counties (320,988 consultations conducted), trained 550 healthcare workers including rapid response teams, and supported reactive measles vaccination campaigns in seven counties [148,726, (72-125%) under-5-year-old children vaccinated] and reactive oral cholera vaccination campaigns in four counties (355,790 vaccinated). The eMMT is relevant in humanitarian settings and can reduce excess morbidity and mortality and fill gaps that routine health facilities and health partners could not bridge. However, the scope of the services offered needs to be broadened to include mental and psychosocial care and a strategy for ensuring continuity of vaccination services and management of chronic conditions after the mobile outreach is instituted.
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Affiliation(s)
- Diba Dulacha
- The World Health Organization (WHO), Juba, South Sudan,Corresponding author Diba Dulacha, The World Health Organization (WHO), Juba, South Sudan.
| | | | | | | | | | | | | | - Walla Odra
- The World Health Organization (WHO), Juba, South Sudan
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