Controlling the Spread of TB in Malawi by Bringing Services Closer to the Community
In Malawi where a district hospital can be many miles from a village, rural communities and health centers are playing a vital role in preventing the spread of tuberculosis (TB) in the country. Working with Malawi CAP’s National Tuberculosis Programme, MSH and the Tuberculosis Control Assistance Program (TB) are training community volunteers and strengthening health centers to improve the TB case detection rate and support HIV and TB diagnosis and treatment services.
In Mangochi district in southeast Malawi, the number of TB suspects examined at the Chilipa Health Centre has more than doubled in just nine months—from 39 to 93 patients—and the turnaround time for TB examination results has gone down from three to four weeks to 48 to 72 hours. There is also a strengthened referral system between the health center and the community.
In collaboration with the Mangochi District Health Team, MSH and TB CAP worked together to better control TB by improving case detection in the area served by the Chilipa Health Centre through strengthening the capacity of the health center, mobilizing the community, and strengthening the link between the health center and the community.
Chilipa Health Centre now offers full TB and HIV diagnosis and treatment services for the health center’s cachement area and those of the other four health centers in the rest of the zone. There is also a clearly defined referral system between the TB and HIV treatment and diagnostic services at the facility. The health center is also able to offer training in basic TB and HIV concepts and infection prevention and offer infection prevention materials.
In the community, volunteers are disseminating TB and HIV information through awareness campaigns and performances and collecting sputum. Specimens are brought to the Chilipa Health Centre for TB microscopy via bicycles offered by the health center. The volunteers also serve as a referral link between the community and the Chilipa Health Centre.
The Chilipa Health Centre is almost 40 miles from the nearest district hospital and is a hub site for a cluster that includes four other health centers with a total catchment population of more than 75,000. Until two years ago, case detection was passive, limited to people who went to one of the health centers for testing, and all sputum specimens, used to identify TB, were sent to the district hospital for diagnosis. There was also no integration between TB and HIV diagnostic and delivery services.
In Malawi, the case detection rate for TB has averaged 41 percent in the last five years, far below the World Health Organization (WHO) target of 70 percent. A contributing factor is that 80 percent of Malawi’s population lives in rural areas, many with limited access to TB information, diagnosis, and treatment. According to the WHO, of the 51,200 estimated new adult TB cases in Malawi in 2008, 70 percent were estimated to be HIV positive. Improved detection is especially important in the case of those who are co-infected with HIV and TB, as they are more likely to die from TB-related causes.
Malawi Conducts First Multi-drug Resistant Tuberculosis Survey
Malawi’s Ministry of Health, with the support of MSH and TB CAP, is now conducting a long-needed multi-drug resistant tuberculosis (MDR-TB) survey in Malawi. Funded by USAID, the survey started in February 2010 and will end September 2011.
In 2008, WHO estimated that 3.5 percent of adult TB cases in Malawi are MDR-TB. However, without a nationwide survey it has not been possible to assess the true magnitude of the problem. Surveying the prevalence of MDR-TB will create a baseline for properly planning, budgeting, and allocating resources for TB in the country. MDR-TB is of particular concern in Malawi because other countries within the sub-Saharan region, such as South Africa, have reported high levels of MDR-TB, leading to the possibility that MDR-TB may easily spread from other countries into Malawi.
TB CAP in Malawi
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