Cholera Surge response and Case Management : A Coordinated Response to Save Lives in Malawi
In 2023, Malawi experienced one of its most devastating cholera outbreaks in recent history, with over 31,000 cases and more than 1,000 deaths recorded since the outbreak began in early 2022. This was exacerbated by the Cyclone Freddy which hit Malawi and especially the southern region. Every district was affected, with case fatality rates soaring as high as 14.2% in some areas and 3% nationally—far above the World Health Organization’s (WHO) recommended threshold of 1%. The outbreak was driven by limited access to clean water, poor sanitation, and stretched health system capacity, making a swift, coordinated response essential.
To confront this crisis, the Centre of Innovation for Public Health and Emergency Response (CIPHER), in collaboration with the Ministry of Health (MoH), Kamuzu University of Health Sciences (KUHeS), UNICEF, WHO, and other partners, launched a Cholera Case Management Initiative. The Ministry of Health led the response, with CIPHER providing technical and operational support across all levels of intervention.
Understanding the Threat and Defining the Response
Cholera spreads rapidly through contaminated food and water, and without timely treatment, can cause severe dehydration and death. In Malawi, many communities rely on untreated water sources, making them highly vulnerable. Recognizing this, the initiative set out three primary goals:
- Reduce the cholera case fatality rate to below 1%
- Improve community-level health practices
- Enhance the capacity of healthcare workers to manage case surges
Strategic Phased Implementation
The intervention followed a three-phase approach over three months:
- Training the KUHeS Emergency Response Team
30 doctors, clinicians and nutritiomists from KUHeS were trained in cholera case management and emergency response, based on national guidelines. These teams were then deployed to the hardest-hit zones to offer immediate support.
- Training Surge Staff
Surge staff supportd by the MOH and UNICEF were trained by KUHeS. Their mission: reinforce care teams in overburdened districts and deliver rapid, quality response.
- Strategic Deployment
Trained response teams were dynamically deployed to high-risk areas based on weekly case trends. This agile approach allowed the initiative to respond swiftly to emerging hotspots, improving patient outcomes and saving lives.
Community Engagement and Preventive Action
A key component of the initiative was community-centered outreach. Health teams worked with local leaders to promote hygiene, safe water practices, and early health-seeking behaviors. Cholera vaccinations were also administered in high-risk areas. Families of patients were educated on safe caregiving to reduce secondary infections.
This grassroots engagement not only helped reduce the number of new cases reaching health facilities, but also built lasting awareness around disease prevention.
Monitoring, Real-Time Support, and Supervision
To ensure the initiative’s effectiveness, a live digital dashboard was introduced to monitor cholera treatment units (CTUs) across districts. Daily updates from frontline teams were used to guide decisions and allocate resources in real-time. Supervisory teams provided on-site support to CTU staff, ensuring high standards in patient care and adherence to case management protocols.
Measuring Success and Deliverables
Key outcomes of the initiative included:
- Reduced Case Fatality Rate: The fatality rate dropped closer to WHO’s acceptable 1% threshold during the intervention.
- Improved Patient Care: With better-trained staff and more resources, facilities reported reduced caregiver infections and improved outcomes.
- Strengthened Community Practices: Community engagement resulted in improved hygiene behaviors and higher vaccination coverage.
- Health System Resilience: The initiative helped build a more agile, coordinated response model for future health emergencies.
A Model for Future Health Crises
The Cholera Case Management Initiative is a powerful example of what coordinated action can achieve. Led by the Ministry of Health and supported by CIPHER, KUHeS, UNICEF, WHO, and others, this intervention not only addressed an urgent crisis—it laid the foundation for long-term public health resilience in Malawi.
By combining rapid deployment, community engagement, clinical training, and real-time monitoring, the initiative demonstrates how innovation, collaboration, and evidence-based strategies can save lives in even the most challenging public health emergencies.
