Epidemiology of Tuberculosis in Malawi

Abstract

The National TB Control Program (NTP) in Malawi collects its data through registers maintained at district level and kept by District TB Officers . The registers are of 3 types: A chronic Cough Register where details of patients who submitted sputa for examination are recorded a laboratory TB register where sputum smear results are recorded and a TB register where diagnosed TB cases are recorded for commencement of treatment. District TB Officers collate data on a quarterly basis before forwarding it to Regional TB Officers who in turn send regional summaries to the Central Unit of the NTP at the Community Health Sciences Unit. The NTP uses passive case finding i.e. patients present to health facilities for TB diagnosis which is the most inexpensive way of managing and controlling TB in a community. This results in incidence data being based on notified cases. However there is a problem of under-reporting of TB cases with this approach and many patients with active TB are undiagnosed. In Thyolo district where the majority of TB patients are HIV-positive it has been shown that active case finding among household contacts yields up to nine times more TB cases and is an opportunity for reducing TB morbidity and mortality. Since 1985 reported TB cases in Malawi have been on the increase. There has been a 45 % increase in prevalence of notified cases between 1994 and 2003 and a doubling in the number of cases that have relapsed after treatment. (excerpt)