How Malawi Is Slowly Winning the War Against TB
The World Health Organisation (WHO) recommends that the tuberculosis (TB) treatment rate in countries around the world must be at 90 percent, and several countries including Malawi are working hard to achieve this.
If the statistics are anything to go by, Malawi is on the right track in the fight against TB as the treatment success rate in the country is at 90 percent.
This success has not been easy to come, according to Programmes Manager for the National TB and Leprosy Elimination Programme Dr James Mpunga. So how is Malawi making strides in the battle against one of the most difficult diseases?
As Chikondi Mphande has been finding out, it remains a laborious battle – a mixed bag.
Tuberculosis (TB) is caused by a bacteria called Mycobacterium tuberculosis that most often affect the lungs. Tuberculosis is curable and preventable, according to the World Health Organisation (WHO). It spreads from person to person through the air when people with it cough, sneeze or spit, which pushes the germs into the air. A person needs to inhale only a few of these germs to become infected.
According to BMJ Global Health, TB remained an important cause of morbidity and mortality worldwide, such that an estimated 10 million cases occurred as of 2020, causing 1.5 million deaths. In Malawi in 2021, the TB death rate was 15 cases per 100,000 people, indicating the seriousness of the respiratory diseases.
Back in the years, Malawi’s TB treatment was below 50 percent. The disease was rated among the lethal killers in Malawian society. Over the years, the trend has been declining, thanks to different interventions being implemented by the health authorities. These include, but not limited to Direct Observation Treatment (DOT), and lately incentives to encourage patients to finish treatment.
DOT is the practice of observing a patient swallow his or her TB medications, and Malawi adopted it following its success in countries such as the United States.
In 2007, Malawi declared TB a national emergency in order to raise awareness and improve TB case detection. This was because it had been noted that the low treatment rate was a result of low detection in the communities.
Programmes Manager for the National TB and Leprosy Elimination Programme Dr James Mpunga says these interventions are now paying off at both national and district level in Malawi.
"We no longer wait for patients to come to the facility but we are conducting door-to-door mass screening. We are using mobile vans to find more TB cases," says Dr Mpunga.
He says these interventions have been successful with good coordination among district TB officers, Health Surveillance Assistants (HSAs) and members of the community in manning sputum collection points.
In Mangochi, for example, District TB Officer Hope Kumwenda says the door-to-door screening approach has been very helpful.
"In 2022, TB the treatment success rate was at 86 percent here in Mangochi compared to 2021 when it was at 82 percent, and the death rate is at 9 percent this year , although last year it was 8 percent," said Kumwenda.
While in Machinga, District Labolatory Officer Khama Saudi says they are using genexpert machines to run tests and these machines are efficient in both TB and HIV positive patients.
TB officer in Machinga Godfrey Makhalira says they have increased the number of sputum collection points from 82 to 107 and are conducting a fast diagnosis strategy in seven health facilities to identify presumptive TB cases.
"Here in Machinga, the TB treatment success rate in 2022 was at 84 percent but in 2021 it was 77 percent. The death rate is at 11 percent this year  and last year it was 19 percent," discloses Makhalira.
He, however, observes that the tendency by some patients to report to hospital very late is a setback in the fight against the disease.
To beat the challenge, the district is conducting community sensitizations, encouraging people to report to hospital the moment they observe signs and symptoms of TB, adding that Machinga now has 107 sputum collection points from which volunteers transport samples to nearest health facilities.
In the workplace, the authorities here are leaving no stone unturned. Machinga District Labour Officer Chrissy Banda says they inspect workplaces to make sure workers are being provided with protective materials, and they also encourage employers to follow labour laws that promote good health among their staff.
Chairperson of Mbando sputum collection point in Machinga Twalosi Makawa says their group started in 2020. It is made up of four men and six men who go door to door conducting TB screening and send the samples to the hospital.
According to Makawa, they follow up on all TB patients to make sure they are taking drugs and following treatment accordingly using the DOT methodology.
"However, lack of training, inadequate bicycles to use in following up patients and the delay to get results after sending sputum [to the hospital] are the challenges that delay people who are TB positive to start taking medication," he observes.
His sentiments are echoed by TB Focal Person at Mposa in Machinga Amon Fabiano, who says a lack of resources, like bicycles for transport, is a challenge in most sputum collection points.
Fabiano says they struggle to deliver sputum to hospitals in good time due to a lack of effective means of transport, whereas the lack of other items like raincoats, umbrellas, bags and boots also provide challenges in their daily work.
Realising the importance of local leaders, Group Village Headman Mbando says he and fellow chiefs conduct sensitization meetings, mainly by focusing on the need for villagers to avoid discrimination against TB patients.
As observed, the lack of proper means of transport to reach out to people with TB messages is a serious challenge, especially in rural areas. This is, however, being dealt with, according to the Deputy Programme Manager for the National TB and Leprosy Elimination Programme Dr Kuzani Nigel Mbendera.
He tells Zodiak that they have procured additional mobile diagnostic vans to help in detecting as many TB cases as possible in the country.
"Our main focus is to find more TB cases. We are using several ways of testing people for TB. The new mobile vans we have procured have a laboratory, a genexpert machine and microscopes, and they can reach the remotest areas in the country," says Dr Mbendela.
He describes 2022 as a year of success in the fight against TB in Malawi as the treatment success rate reached 90 percent. This, he says, has in turn led to a decline in the rate of transmission and the number of people dying from the disease.
Dr Mbendela says there has also been focused treatment among people living with HIV as they are more likely than others to become sick with tuberculosis because HIV weakens the immune system, which makes it harder for the body to fight TB germs.
Further, The National TB and Leprosy Elimination Program says provision of transport money to all the 165 patients currently on multi drug resistant (MDR) TB is helping them not to shun medical treatment.
Coordinator for MDR TB treatment Yusuf Sayidi told Zodiak Online that the patients are no longer missing hospital appointments.
"We conduct monthly clinics on MDR TB to make sure the patients are taking medication and identify any side effects as well as to manage the side effects before their condition worsens.
"So, provision of transport money is helping them to visit health facilities in good time to collect medication and undergo checkup,” said Sayidi.
He said, currently, Malawi has 165 patients:103 males and 62 females on MDR TB treatment.
Psychosocial & Nutrition Support Officer in the ministry of health Chrissy Padoko said they are also providing food items to all MDR TB patients in the country.
"We are providing cooking oil, beans, Likuni phala (nutritional porridge flour), maize flour, sugar and milk to all the 160 MDR TB patients in the country.
"These patients take powerful drugs, hence provision of food items every six month to improve their health," said Padoko.
The gains from these efforts are evident now. In 2021, the incidence of tuberculosis for Malawi was 132 cases per 100,000 people. It has declined slowly from 401 cases per 100,000 people in 2002 to 132 cases per 100,000 people in 2021, surely a positive trend.
Malawi could be making gains in the fight against TB, but surely more needs to be done if the country is to be a real victor is this battle: continued coordination among all the key players - government, the patients and the citizenry at large.
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