Epidemic cholera during refugee resettlement in Malawi.

BACKGROUND: In June 1988 a cholera epidemic occurred in a Mozambican refugee population resettling in southern Malawi. METHODS: A case-control study was conducted to determine possible risk factors for disease. The characteristics of 48 refugee households with any member(s) hospitalized for suspected cholera were compared to 441 randomly sampled refugee households without hospitalizations. RESULTS: Vibrio cholerae 01 was isolated from 50% (5/10) of case-patient stool cultures. Having any water containers with > or = 10 T capacity was associated with a significantly lower odds of suspected cholera in households (adjusted odds ratio [aOR] = 0.02, 95% confidence interval [CI] : 0.003-0.12), as was having metal cooking pots (aOR = 0.3, 95% CI : 0.12-0.7), after adjusting for length of residence and socioeconomic status (logistic regression model). Households with two or more children < 5 years old were at markedly increased odds of suspected cholera (P < 0.0001). These results suggest that water containers and cooking pots served important preventive functions during this cholera outbreak. Young children may have contributed to cholera transmission, but the reason(s) remains undetermined.

Practical field epidemiology to investigate a cholera outbreak in a Mozambican refugee camp in Malawi; 1988

Of all populations affected by cholera; refugees are at particular risk of infection due to overcrowding and poor sanitation. Between 15 March and 17 May 1988; 951 cases of cholera were registered at the cholera treatment centre in a Mozambican refugee camp in Malawi. The epidemic duration was 65 days. Vibrio cholerae biotype E1 Tor serotype Inaba was isolated. To identify high-risk groups and potential risk of acquiring the disease; an epidemiologic investigation was conducted. The attack rate of recorded cases was 2.6 percent with a range from 0.9 to 5.1 percent for different sections of the camp. The case fatality rate was 3.3 percent and decreased from week 1 to week 6. The epidemic started in the section near the market place and radiated out. A matched-pair case-control study of food and water consumption was performed early in the outbreak. It showed that cases were more likely to use shallow wells (surface wells) instead of boreholes compared to controls (OR = 4.5; CI = 1.0-20.8; P = 0.04) and that cases were more likely to have had contact with the market than controls (OR = 3.5; CI = 0.7-16.8; P = 0.09). None of the food items available at the market was more likely to be preferred by cases than controls. Recommendations included early case finding and treatment; temporary closure of the market; tetracycline prophylaxis of contacts; and water chlorination

Primary health care in Malawi: an introduction

The process of PHC in Malawi has been the establishment of a health delivery infrastucture and community mobilization and involvment in the health development process. The article descibes the organizational structure of PHC in Malawi and suggests standards for measuring the success of the programmes

Report on the evaluation of the Expanded Programme on Immunization in Malawi (Draft)

This study is a follow-up of an earlier WHO collaboration in 1978 when a plan for EPI was prepared for Malawi

Report on food survey in government hospitals: Malawi

The report to investigate the food situation at district and rural hospitals with recommendations to services and menus