Operational research on tuberculosis control in Malawi

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UvA-DARE (Digital Academic Repository)

Banerjee, A.

Publication date

2003

Link to publication

Citation for published version (APA):

Banerjee, A. (2003). Operational research on tuberculosis control in Malawi.

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2.. Malawi

2.1.2.1. General information

Malawii is located in Central/Southern Africa, landlocked by Mozambique, Tanzania andd Zambia (Figure 1). Twenty percent of the area is occupied by lakes. The climate iss tropical.

Administratively,, the three regions in Malawi (North, Central and South) are divided intoo 25 districts. Paved roads permit easy access to most district capitals and a furtherr network of earth roads allows peripheral areas to be reached most of the yearr round. Main human development indicators for Malawi are found in table 1. Tablee 1. Human Development Indicators for Malawi in 2001 [1]

Area a Districts s

Traditionall Authorities Populationn (Urban)

Populationn below poverty line Populationn Growth

TFR R

Lifee Expectancy at birth IMR R

Underr 5 Mortality MMR R

illiteracyy Total/Male/Female GDPP (per capita)

UNDPP Human Development Index Healthh Expenditure (per capita)

118,4800 sq. kilometres 25 5 202 2 10,346,3822 (15%) 60% % 2.1% % 6.3 3 399 years 102 2 193 3 620 0 39%/25.0%/52.4% % 1.77 billion USD (USD 170) 0.3344 (no. 161)

2.88 % of GDP Public, 3.5% of GDP Private, 6.3%% of GDP total

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Figuree 1. Map of the Republic of Malawi

Tanzania Tanzania

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2.2.2.2. Tuberculosis Control in Malawi

Thee National Tuberculosis Control Programme (NTP) in Malawi was launched in 1964 whenn Malawi became an independent nation. The Ministry of Health has implemented directlyy observed treatment (DOT) in a hospital setting by health care workers for TB patientss since 1983. In 1984, Malawi started receiving technical support and assistancee from the International Union against Tuberculosis and Lung Disease [2]. Thee NTP is organised on three tiers: central, regional and district. Central and regional levelss support the district level where TB activities are fully integrated. The functions of thee Central Unit are:

1.. Planning, coordinating, monitoring and evaluating standard anti-tuberculosis measures s

2.. Training and supervision of personnel involved in TB work

3.. Budgeting, procuring and distribution of supplies, e.g. drugs and laboratory suppliess and equipment

4.. Compilation and analysis of TB data 5.. Carrying out operational research Thee functions of the Regional TB Office are:

1.. Co-ordinating TB control activities in the respective regions while working closely withh the Central Unit staff

2.. Supervision and training of district TB officers and other peripheral workers

3.. Ordering supplies, e.g. drugs, stationary, sputum containers for the region and arrangingg distribution to the districts.

4.. Compilation and analysis of TB data for the region and discussing these with the Regionall Health Office before transmission on to the Central Unit

Thee District TB Officer has the responsibility of implementing the NTP in the district throughh the staff of the district and the peripheral units.

Tuberculosiss is the main cause of hospital admissions (considerable higher than admissionss due to diarrhoea or malaria) and considering only hospital bed-days, this wouldd represent for the year 1995, if all TB patients were hospitalised two months,

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Thee regimens used in Malawi from 1984 onwards were two months of streptomycin, rifampicin,, isoniazid and pyrazinamide followed by 6 months of isoniazid and thiacetazonee (2SRHZ/6HT) for patients with new smear-positive PTB and serious formss of EPTB and one month streptomycin, isoniazid and thiacetazone followed by 111 months of isoniazid and thiacetazone (1SHT/11HT) for patients with smear-negativee PTB and less serious forms of EPTB. Thiacetazone was replaced with ethambutoll (E) in case patients reacted against thiacetazone.

Thee country is badly affected by the HIV/AIDS epidemic [10-15]. Figure 2 shows howw the HIV sero-prevalence rose amongst the urban adult population up to 25 to 30%,, followed by an increase in the rural adult HIV sero-prevalence. The graph also showss that the increase of adult HIV sero-prevalence is accompanied by an increasee in TB incidence.

Figuree 2. Impact of HIV on TB cases in Malawi [8,15]

TBB incidence/ Dynamics of TB and HIV in Malawi

Adult

wvsero-100,0000 prevalence 2500 -, r 35 200 0 150 0 100 0 50 0 —— TB Cases/100,000 -*—— HIV prevalence urban -*—— HPV prevalence rural 1980 0 H—I—h h 1984 4 H—I—I—h h 1988 8 1992 2 H—I—I—h h 1996 6 2000 0

2.3.2.3. Ntcheu district

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hospitall is situated is halfway on the national highway between the two largest cities, Lilongwee and Blantyre.

Thee District Health Officer of the district (author of the thesis) was co-opted as a memberr of the National TB Programme management team and was the principal investigatorr for most of the studies presented. In 1997 the NTP allocated a Deputy Regionall TB Officer for Research to each region, the one for the Central Region beingg based in Ntcheu and taking part in data collection for all studies, whether in Ntcheuu only or part of a larger national sample.

References References

1.. http://www.worldbank.org/data/countrydata/aag/mwi_aag.pdf

2.. Nyangulu DS. The point of view of a high prevalence country: Malawi. Bull Int Union Tubercc Lung Dis 1991; 66:173-4

3.. World Health Organization Task Force on Health Economics. Sawert H. Health Economics.. Cost analysis and cost containment in tuberculosis control programmes. Thee case of Malawi. WHO/TFHE/96.1. Geneva 1996.

4.. World Health Organization. Global Tuberculosis Control. WHO Report 1998, Global Tuberculosiss Programme, WHO/TB/98.237. World Health Organisation, Geneva, 1998. 5.. World Health Organization. Global Tuberculosis Control. WHO Report 1999, Global

Tuberculosiss Programme, WHO/TB/99.259. World Hearth Organisation, Geneva, 1999. 6.. World Health Organization. Global Tuberculosis Control. WHO Report 2000, Global

Tuberculosiss Programme, WHO/CDS/TB/2000.275. World Health Organisation, Geneva,, 2000.

7.. World Health Organization. Global Tuberculosis Control. WHO Report 2001, Global Tuberculosiss Programme, WHO/CDS/TB/2001.287. World Health Organisation, Geneva,, 2001.

10.. Kelly P, Bumham G, Radford C. HIV seropositivity and tuberculosis in a rural Malawi hospital.. Trans R Soc Trop Med Hyg 1990; 84 :725-7

11.. Harries AD, Maher D, Mvula B, Nyangulu D. An audit of HIV testing and HIV serostatuss in tuberculosis patients, Blantyre, Malawi. Tuber Lung Dis 1995; 76:413-7

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Harriess AD, Nyangulu DS, Kangombe C et al. The scourge of HIV-related tuberculosis:: a cohort study in a district general hospital in Malawi. Ann Trap Med Parasitoll 1997; 91 : 771-6

Harriess AD, Nyangulu DS, Kang'ombe C et at. Treatment outcome of an unselected cohortt of tuberculosis patients in relation to human immunodeficiency virus

serostatuss in Zomba Hospital, Malawi. Trans R Soc Trop Med Hyg 1998; 92 :343-7 Kang'ombee C, Harries AD, Banda H et al. High mortality rates in tuberculosis patientss in Zomba Hospital, Malawi, during 32 months of follow-up. Trans R Soc Tropp Med Hyg 2000; 94 : 305-9

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