Cholera outbreak Investigation: Geospatial case mapping, risks and antibiotic resistance patterns of Vibrio cholerae in Mzimba North -Malawi

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Background: Malawi continues to record recurring Cholera outbreaks in Priotized Areas for Multi-sectoral Interventions (PAMI), owing to a lack of access to clean water and sanitation facilities. In November 2024, a fresh outbreak began in Mzimba North and expanded to a neighboring district. This study sought to determine the geographical distribution of cases, environmental risks and drug susceptibility patterns. Methods: A cross-sectional descriptive study was carried out in two phases. The initial phase involved analysis of laboratory test reports as well as the clinical and social demographic data contained in the line list. Field case mapping of the affected households were subsequently conducted using Geographical Positioning System (GPS) device. Descriptive statistics, statistical t-tests, and geospatial maps were used to explore demographic characteristics, spatial distribution of cases, determination of risks and drug resistance patterns. Results: Out of 75 cholera suspects, 32 (43%) were confirmed positive. The majority of cases were male tenants working in farms (n=22; 68.8%, Median age=26). The epidemic curve indicated a progressive source outbreak, with a significant drop in incidence following implementation of Cholera Area Targeted Interventions (66.7% reduction; p=0.005). Most cases did not appear clustered, reflecting local settlement patterns as well as hydrological networks and population mobility. Environmental risk assessment revealed shallow wells, salty borehole water, and poor housing structures. Most antibiotics showed moderate to high effectiveness. Conclusion: The Cholera outbreak in Mzimba North reflect persistent underlying environmental risks as well as occupation-related exposure among male tenants. Investing in piped-water and sanitation infrastructures is essential for preventing recurring outbreaks.

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