Tuberculosis in Malawi

Clinical description

The National Tuberculosis Control Programme (NTP) was established in 1964 in the Ministry of Health (MoH) to coordinate the national response to the fight against tuberculosis (TB) in Malawi. Within MoH, NTP falls under the Directorate of Preventive Health Services. The day- to-day management of the programme is the responsibility of a Programme Manager who is supported by a Deputy Programme Manager and various programme officers at national, zonal, district and facility levels. TB control activities are fully integrated within Malawi’s decentralized public health system, and private health facilities also provide TB control services under a central government-brokered Public Private Partnership (PPP) framework.

In general, TB services are provided free of direct cost to clients at points of care and TB is among the priority Essential Health Package (EHP) conditions. By the end of the 2015 fiscal year, more than 17,000 new TB patients were notified nationally. Decentralization of TB diagnostic and treatment services to facilities lower than the district hospitals is an ongoing process.

Microscopy (both light and florescent) remains the mainstay for TB diagnosis in Malawi, with radiology as an adjunctive technology where available. As of December, 2015, 302 public and CHAM health facilities across the country had capacity for both TB diagnosis and treatment initiation. Additionally, 284 peripheral laboratories had capacity for TB diagnosis through florescent or light microscopy. Gene Xpert technology has been introduced in the past few years to increase detection of TB, especially in sputum smear negative and HIV positive clients.

The National TB Reference Laboratory (NTRL) provides high level diagnostic services, including solid and liquid culture to confirm TB and drug sensitivity testing on selected specimens from across the country. NTRL is also responsible for quality assurance services to peripheral laboratories.

MoH is the only source of all anti-TB medications and commodities. This ensures quality assured treatment and rational drug use in all public and private health facilities in the country.

The tight drug regulation and management has helped the country to register one of the lowest prevalence rates of drug resistant TB in the region at 0.4% among new and 4.8% among previously treated patient populations.