Analytical summary - Tuberculosis
Tuberculosis (TB) is one of the public health problems in Malawi. It is a major cause of morbidity and mortality in the population. In 2011, there were 21 653 reported TB cases in Malawi. Of those, 19 331 (89%) were new; 865 (4%) were previously treated smear-positive pulmonary TB cases; and 1457 (7%) were previously smear-negative and extrapulmonary TB cases.
The national TB response, coordinated by the National TB Control Programme, continued with DOTS, the basic package that underpins the Stop TB Strategy approach. TB case notification has been steadily decreasing from around 29 000 cases in 2005 to around 26 000 in 2009. The treatment success rate for adults was 89% in 2011, surpassing the WHO target of 85%. The case detection rate in DOTS areas was 49%, compared with the target of 70%.
The National TB Control Programme has made contributions to health sector strengthening in a number of ways, including the construction and equipping of laboratories in health centres. Of the 135 targeted health centres, 60 laboratories have been constructed to date. Health workers have been trained in HIV testing and counselling and TB microscopy, and four central hospital laboratories have been upgraded.
The National TB Control Programme is also implementing activities at community level with a view to raising people’s awareness of, and demand for, TB services and to strengthen community participation. Activities include:
- scaling-up the establishment of community sputum collection points to reduce distances that TB suspects travel to health facilities (there are over 1000 community sputum collection points throughout the country);
- providing sputum transportation boxes in 200 sites;
- providing bicycles in 480 sites;
- providing radios to TB community clubs for health education in 480 sites.
Despite these achievements, a number of challenges have been encountered in implementing the National TB Control Programme, including:
- TB/HIV infection is high at 65%, resulting in high case fatality and thus low treatment success and cure rates
- late disbursement of funds from partners
- slow absorption of funds and leadership challenges within the Programme.
Access to HIV testing and counselling is 86%. Access to antiretroviral therapy is 54% due to:
- a time lag of 2 months between starting TB treatment and antiretroviral therapy
- poor access to TB care for the poorest of the poor, especially in rural areas
- fighting the threat of multidrug-resistant TB.
Death rates have greatly reduced from around 20% in 2006 to 8% in 2010. Most TB deaths are due to a high TB/HIV coinfection rate, currently 68%, a reduction from 77% in 2000. The decrease in TB deaths is mainly due to effective HIV interventions. Currently, 90% of TB cases have access to HIV testing and counselling but the proportion on antiretroviral therapy is on the low side. The TB default rate has fallen from 5% in 2006 to 2% in 2009–2010. The target for 2010 was 4%, hence the target has been achieved.
The National TB Control Programme will endeavour to continue ensuring early detection of TB and treatment adherence in TB patients in the quest to curb the incidence of multidrug-resistant TB in Malawi. The implementation of TB intervention has been hampered by late disbursement of funds from the development partners and the slow absorption of these funds and leadership challenges within the Programme.
- ↑ Ministry of Health, 2010