Cholera is endemic to Malawi and its transmission is evolving. We are observing changes in which cholera transmission dynamics have been reported. As of June 30, 2023, Malawi reported 58,912 cases, 1,763 deaths, and 4 hospitalized cases in all 29 districts of Malawi. Evidence from the World Health Organization (WHO) and the Malawi Ministry of Health has shown that most cases have been reported during the rainy season, with the largest outbreak occurring from October 2001 to April 2002, affecting 26 of the 29 districts, with 33 546 cases and 968 deaths (Case Fatality Rate (CFR) 3%). However, the current outbreak has extended throughout the dry season, with cases being reported since March 2022. The outbreak, which was initially limited to the southern region and flood-affected areas, has now spread to all regions and districts in the country. One aspect contributing to the increased cholera cases in Malawi is climate change, which has caused flooding. Inadequate sanitation and insufficient access to safe drinking water have already impacted cholera transmission dynamics.
A novel computational tool is developed in which all cholera cases are hosted, and all interventions are put in place to provide a better understanding of cholera transmission trends to drive decision-making. Most of these cases are not hosted on interoperable systems such as interactive dashboards for effective communication. This presents an obstacle to better understanding the outbreak and overcoming its devastating effects. A customized dashboard is more than effective communication and has helped shape decision-making processes and provided real-time surveillance data to guide targeted public health interventions. Public health systems are unprepared, and customized tools to visualize the disease burden are utilized to help mobilize the right resources and inform early warning systems. A dashboard is a resource that helps advance the understanding of cholera, inform the public, and brief policymakers to guide responses, improve care, and save lives.

Despite the concurrent incidence of cholera in the country, no one has developed a customized dashboard that reports total trends, cases, deaths, or even the number of vaccines administered at the community level. Most of the reports generated come in pdf format which is not interactive in reporting cases of cholera. A high-quality and fine-scale interactive dashboard was developed to understand which communities and environments are disproportionally affected by surges of cholera transmission so that additional mitigation strategies and limited resources can be appropriately directed by humanitarian agencies and local governments. It is unique to have an interactive cholera dashboard with visual graphics and trends in cholera cases across communities in Blantyre.

Through collaboration with the Serosurveillance of Vaccine-Preventable Diseases in Malawi (Serosurv) project at the Malawi Liverpool Wellcome Programme (MLW), Blantyre District Health Office (BDHO), Public Health Institution of Malawi (PHIM), and Digital Health Information (DHI). We were provided with the cholera line list that contained details about the patient’s name, age, sex, Traditional Authority (TA), date of onset of cholera, date seen at a health facility, village, RDT result, culture result, treatment given, and status whether alive or dead. Our data were summarized in the R programming language, and we obtained all villages from which the patients were reported from. With the help of the Malawi University of Business and Applied Sciences (MUBAS) youth mappers, we geolocated all villages around Blantyre. An Open Data Kit (ODK) was used to collect the coordinates. This spatial aspect was then merged with the cholera data. R Shiny was used to develop and host the dashboard. A cholera hotspot map and graphs were created to convey cholera information by presenting location-based cases using intuitive and interactive data visualization for at-a-glance decision-making.

With the use of ODK, we managed to map all the villages around Blantyre District. The developed dashboard in R Shiny showed hotspots of cholera cases at the community level. The map shows that most cases were centralized in the urban areas, with decreasing cases as we moved to the outskirts of the district. Further, the dashboard visualized that the daily, weekly, and monthly cases came from a village called Bangwe, which is in the urban area of the Blantyre district.

The study has demonstrated the power of using Open Data resources to visualize disease burden to aid in decision-making. The cholera dashboard has enabled real-time data analysis, early detection of outbreaks, spatial mapping, and prediction modelling. Plotting the locations of reported cases on a map provided a clear picture of the affected areas, hotspots, and potential transmission routes. This spatial visualization enhanced our understanding of disease dynamics, helped to identify high-risk regions, and aided in resource allocation for disease control. Further, open mapping has enhanced the visualization of the spread of cholera outbreaks and highlights areas at risk. This has increased public understanding of the disease and encouraged proactive measures such as water and sanitation improvements, hygiene practices, and vaccination campaigns. This has empowered communities to take preventive action and reduce the burden of cholera.