Weekly IDSR Bulletin

During Week 6, the national completeness of reporting stood at a commendable 97.0% across all districts using the One Health Surveillance Platform. This figure indicates a strong level of engagement from health facility focal persons and data clerks who are consistently uploading surveillance records. While this percentage remains high, there is still a 3% margin of missing data that represents a significant number of health facilities. Sustaining this high level of performance is essential for maintaining the integrity of our national epidemiological database.

To reach the ultimate target of 100% completeness, district surveillance officers must actively follow up with facilities that have failed to report. These gaps are often caused by technical issues, personnel shortages, or administrative oversights at the local level. It is vital that these specific facilities receive the necessary logistical support to resume reporting. Continuous monitoring and immediate feedback loops will ensure that the surveillance system captures every significant health event across the country.

The timeliness of reporting for Epidemiological Week 6 was recorded at 91.0%, which is a decrease compared to previous periods. This decline is particularly concerning because timely data is the backbone of any effective outbreak response strategy. Delay in reporting often means that public health actions are initiated too late to prevent further spread of disease. We have observed that several key facilities, including major central hospitals, are struggling to meet the reporting deadlines consistently.

Specifically, facilities such as Kamuzu Central Hospital and districts like Balaka and Mangochi must investigate the root causes of these reporting delays. The Ministry emphasizes that data must be entered and validated as soon as it is generated at the facility level. Zonal Epidemiology Officers are tasked with providing direct oversight to those districts that have fallen below the 90% threshold this week. Improving timeliness will require a renewed commitment to strict adherence to the surveillance calendar and better internal coordination.

A total of twenty-eight (28) Event-Based Surveillance (EBS) signals were reported during this week, showing a notable increase in signal detection. This increase suggests that community-level surveillance and health worker sensitivity to unusual health events are improving across the districts. EBS is a critical component of our early warning system as it captures signals that might not be detected through routine reporting. The variety of signals reported this week reflects a robust effort to monitor diverse public health threats simultaneously.

However, reporting the signals is only the first step in a larger process of public health verification. District Rapid Response Teams (DRRTs) are now mandated to conduct comprehensive risk assessments for every one of these 28 verified signals. These assessments must be conducted without any further delay to determine the potential for outbreak or emergency. Failure to investigate these signals promptly could lead to missed opportunities for early containment of infectious diseases or other hazards.

Malaria continues to be the leading cause of morbidity in the country with 48,308 cases reported in Week 6 alone. This volume represents a massive burden on the national healthcare infrastructure and requires constant resource allocation. Eight (8) deaths were unfortunately recorded this week, highlighting the ongoing risk of severe malaria among vulnerable populations. While the total case count has seen a slight reduction from previous weeks, the disease remains highly endemic. The majority of these cases are being treated at the primary healthcare level where diagnostic tools are essential.

Efforts to control malaria must focus on both prevention and the quality of clinical management for severe cases. The distribution of insecticide-treated nets and indoor residual spraying must be maintained in high-burden districts to drive down transmission rates. Additionally, health workers are encouraged to strictly follow treatment protocols for complicated malaria to prevent further avoidable deaths. The secretariat will continue to monitor malaria trends closely to identify any unusual spikes that may indicate localized outbreaks or resistance patterns.

A total of 1,072 cases of bloody diarrhoea were reported across the country during Epidemiological Week 6. This figure shows a downward trend from the previous reports, which is a positive sign for the national health system. However, even with the decrease, the presence of over a thousand cases indicates ongoing issues with water and sanitation. Dysentery remains a significant concern in crowded urban settings and rural areas with limited access to clean water. Vigilance must remain high as we are still within the seasonal peak for enteric diseases.

Public health officials are urged to continue promoting handwashing and the use of safe water to prevent the transmission of these pathogens. Districts reporting the highest numbers of bloody diarrhoea should conduct targeted health education campaigns in the most affected communities. Laboratory confirmation of the causative agents is also necessary to rule out potential outbreaks of Shigellosis or other serious conditions. We must not allow the current downward trend to lead to a relaxation of prevention and control measures.

The cholera situation remains a high-priority public health concern with 79 suspected and 11 confirmed cases reported this week. While there were zero deaths recorded in Week 6, the continued occurrence of confirmed cases indicates active transmission within the environment. Each confirmed case serves as a warning that the underlying conditions for a larger outbreak are still present. The health system must remain in a state of high alert to manage any sudden increase in case numbers. Immediate isolation and treatment are critical to preventing secondary transmission among household contacts.

Response teams are focusing on intensive WASH (Water, Sanitation, and Hygiene) interventions in the specific communities where confirmed cases have been identified. It is essential that all partners and government ministries collaborate effectively to ensure that clean water supplies are maintained. Public awareness campaigns should be intensified to educate the population on the symptoms of cholera and the importance of seeking care early. The lack of deaths this week is encouraging, but we must maintain this standard through high-quality clinical care and rapid response.

In Week 6, our surveillance system captured four (4) maternal deaths across different health facilities in the country. Although this is a reduction from the seven deaths reported in Week 4, every single maternal death is considered a sentinel event that requires urgent attention. These deaths represent a profound loss to families and reflect gaps in our maternal health delivery system. The Reproductive Health Department is now responsible for ensuring that each of these cases is thoroughly audited. We must understand the clinical and systemic factors that contributed to these tragic outcomes.

The Maternal and Perinatal Death Surveillance and Response (MPDSR) audits must be conducted within the stipulated timeframe of 48 to 72 hours. These audits are intended to identify avoidable causes and to formulate actionable recommendations to prevent future occurrences. Health facilities are reminded to prioritize emergency obstetric care and to ensure that referral systems are functioning efficiently. Continuous training for midwives and clinicians on managing obstetric emergencies is also a key recommendation to drive these numbers down to zero.

Severe Acute Respiratory Infections (SARI) have shown a significant increase this week with 125 reported cases and 2 deaths. This sharp rise in morbidity suggests that there is a high circulation of respiratory pathogens in the community. The rainy season often correlates with an increase in viral respiratory illnesses, which can progress to severe pneumonia if not managed. Health facilities must be prepared for an influx of patients presenting with severe respiratory distress. The two deaths recorded indicate that the severity of these infections can be fatal without prompt intervention.

District health offices must ensure that there is an adequate supply of oxygen and essential antibiotics in all treatment centers. Clinicians should be vigilant in screening patients for SARI and following the established clinical guidelines for management. It is also important to maintain robust testing for influenza and other respiratory viruses to understand the local epidemiology. Public health messages should emphasize the importance of early care-seeking behavior for children and the elderly who develop high fever and breathing difficulties.

Surveillance for Adverse Events Following Immunization (AEFI) recorded 49 cases during Epidemiological Week 6. This number is a significant decrease from the 103 cases reported in Week 4, which may reflect a change in the intensity of vaccination activities. AEFI surveillance is essential for maintaining public confidence in national immunization programs and ensuring vaccine safety. Most of the reported cases this week were minor and expected reactions that were successfully managed at the local level. No serious adverse events leading to hospitalization or long-term disability were reported this week.

Health workers are encouraged to continue reporting all AEFI cases, regardless of their perceived severity. Consistent reporting allows the national regulatory authorities to monitor the safety profile of all vaccines being used in the country. It is important to investigate any clusters of AEFI to rule out issues related to vaccine quality or administration errors. Maintaining a sensitive and transparent AEFI surveillance system is key to addressing vaccine hesitancy and promoting high coverage across all districts. Documentation of these events must be accurate and submitted through the established reporting channels.

There were zero (0) new confirmed Mpox cases and zero (0) new alerts generated during Epidemiological Week 6. This lack of activity is a positive development compared to the seven alerts that were investigated in Week 4. It suggests that the immediate risk of transmission may be low at the moment, but we cannot afford to become complacent. The global and regional situation for Mpox remains dynamic, and the risk of importation remains a factor for Malawi. Our surveillance systems at points of entry and in health facilities must remain functional and sensitive.

Health workers should continue to maintain a high index of suspicion for any patients presenting with unexplained rash and fever. Early detection and isolation of suspect cases are the most effective ways to prevent a localized outbreak from occurring. Public health education on the symptoms of Mpox and how it spreads should continue in high-risk areas. We will continue to monitor the situation and provide updates as soon as new information becomes available. The secretariat remains prepared to reactivate full response protocols should any new signals emerge.

Surveillance for Acute Flaccid Paralysis (AFP) recorded ten (10) cases this week, which is a high number that demonstrates the sensitivity of our system. AFP surveillance is the primary method for detecting potential Polio cases and is a major requirement for maintaining Polio-free status. Every single case of AFP must be treated as a potential public health emergency until proven otherwise by laboratory results. We also recorded five (5) cases of suspected meningitis, which requires careful clinical and laboratory investigation. These conditions represent serious threats to child health and require immediate action.

For the ten AFP cases reported, it is mandatory that two adequate stool samples are collected at least 24 hours apart and within 14 days of the onset of paralysis. These samples must be transported under cold chain conditions to the national laboratory for analysis. Surveillance officers are urged to ensure that the 48-hour deadline for sample collection after notification is strictly met. In addition, the suspected meningitis cases should have lumbar punctures performed to confirm the diagnosis and determine the appropriate antibiotic therapy. Strengthening these surveillance activities is essential for national health security.

Typhoid fever surveillance recorded 29 cases in Week 6, continuing a steady but slightly declining trend from previous reporting periods. Typhoid remains a challenge in many districts due to the persistent difficulties in accessing safe drinking water and adequate sanitation. The persistence of these cases highlights the need for integrated environmental health interventions alongside clinical care. Most of these cases are reported from urban and peri-urban centers where population density is high. Laboratory confirmation is often a challenge, so many of these are managed based on clinical suspicion and rapid tests.

The long-term solution for Typhoid fever involves significant investment in water infrastructure and the promotion of food safety practices. We encourage districts to map out hotspots of Typhoid fever and prioritize these areas for hygiene promotion and water testing. Health workers should also be trained on the updated guidelines for Typhoid management to ensure effective treatment and prevent antimicrobial resistance. The introduction of the Typhoid Conjugate Vaccine (TCV) in the national schedule is a critical step that should be supported by high coverage rates. Monitoring trends will help us evaluate the impact of these vaccination efforts over time.