First Biosafety Level 3 Lab in Malawi Officially Handed over to Ministry of Health
On October 1, 2009, USAID officially handed over the keys to the newly refurbished and upgraded Central Reference Laboratory (CRL) in Lilongwe, Malawi, to the Ministry of Health in a ceremony attended by representatives from USAID, the Government of Malawi, MSH, the Tuberculosis Control Assistance Program (TB CAP), and other collaborating partners.
With the improvements, the CRL is now the first Biosafety Level 3 laboratory based on World Health Organization (WHO) guidelines in Malawi and one of the few laboratories of this level in southern Africa. According to USAID Charge d’ Affaires in Malawi, Kevin Sullivan, “tuberculosis is a major public health threat to Malawi, and the renovation of the Central Reference Laboratory is an important step in stopping this deadly disease.” As the coordinating partner of TB CAP in Malawi, and working in collaboration with the Ministry of Health and Malawi’s National Tuberculosis Control Program (NTP), MSH with funding from USAID oversaw the renovation with long-term technical assistance provided by Liverpool Associates in Tropical Health. Although the CRL will have an essential role in improving tuberculosis (TB) control in Malawi, the lab will also have the potential to monitor other hazard group 3 biological agents, such as those that develop into salmonella and strains of E. Coli.
Improved Worker Safety and TB Case Detection
The CRL renovation included making overall improvements to the facility, adding features to improve worker safety, and the purchase and installation of new equipment to perform culture and drug sensitivity tests for TB and multidrug-resistant tuberculosis (MDR-TB), a strain of TB resistant to standard treatment. MSH and the NTP also put standards and procedures into place to adhere to WHO guidelines for infection prevention among lab staff and to ensure improved quality of test results.
According to Sullivan, the renovated lab and the installation of the new equipment will “greatly improve” the detection of TB in Malawi. The case detection rate in Malawi over the last five years has averaged 41 percent, far below the WHO target of 70 percent. Improved case detection is key to ensuring that patients are properly treated and to prevent further transmission in communities and more deaths. 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. And, by having equipment designed to detect drug sensitivities, the spread in Malawi of MDR could also be contained as patients will be able to be treated as soon as drug resistance is detected.
Ministry of Health Now Able to Determine TB Prevalence in Malawi
With the improved capabilities of the CRL—now also able to handle a larger number of cultures—it will be possible for the Ministry of Health to conduct long-needed Tuberculosis Prevalence and Drug Resistance surveys in Malawi. 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 both TB and MDR-TB will create a baseline for properly planning, budgeting, and allocating resources for TB in the country. MDR-TB in particular is of 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 these other countries into Malawi.
In addition to the CRL renovation, MSH has worked for the last two years in Malawi with the NTP and its TB CAP partners (KNCV Tuberculosis Foundation, Family Health International, and the World Health Organization) to increase case detection and reduce TB morbidity and mortality rates through implementing TB and HIV services at the community, facility, district, and central levels. The project has strengthened TB and HIV integration at the facility level, refurbished facilities, increased the capacity of health workers, procured equipment, and developed laboratory procedures and guidelines.