Download Tuberculosis in Malawi

Tuberculosis in Malawi
By: Tanya Staton
MPH 583
Tuberculosis (TB):
• Is caused by the bacterium
Mycobacterium tuberculosis
(CDC, 2014).
• The bacteria attacks the lungs,
but can also affect the kidneys,
spine and brain (CDC, 2014).
• If left untreated TB can be fatal.
• The TB bacteria can be
transmitted into the air when a
person with TB disease of the
lungs or throat coughs, sneezes,
speaks (CDC, 2014).
Everyone will not become ill when exposed
to TB, because of this there are two types of
TB-related conditions.
Latent TB Infection
• The body is able to fight the TB
bacterium from multiplying.
• They do not feel sick and do
not have any symptoms.
• People with latent TB infection
are not infectious and cannot
spread TB bacteria to others
(CDC, 2014).
TB Disease
• The body can not stop the
bacteria from multiplying.
• These people are sick and can
spread the bacteria to other
people (CDC, 2014).
• Latent TB can develop into TB
disease weeks or even years
after being exposed (CDC,
2014).
Malawi
• Is a country located in Southern –Central
Africa. It shares borders with Tanzania,
Zambia, and Mozambique (USAID, 2014).
• Population is an estimated 15 million people
(USAID, 2014).
• Like many African countries tuberculosis
remains a public health problem in Malawi.
TB in Malawi
• TB prevalence has increased dramatically the last 30 years, mainly
due to emergence of HIV/AIDS and high levels of poverty (Target
Tuberculosis, 2014).
• 52 percent of Malawians live on less than $1.25 per day (Target Tuberculosis, 2014).
• 63 percent of TB patients are also HIV positive (Target Tuberculosis, 2014).
• TB is a leading cause of death for Malawians, but only half of all TB
cases are detected (Target Tuberculosis, 2014).
• The average life expectancy in Malawi is only 54 years.
Diagnosing TB
• The most important diagnostic test is
to identify the acid-fast bacilli from 3
different sputum samples.
• The Ziehl-Neelsen staining method,
has a reasonable diagnostic yield, and
culturing the bacteria onto media
improves the yield (Nyirenda, n.d).
• Problem is in a resource-poor nation
like Malawi, cultures are only possible
in research labs and in the reference
laboratory in Lilongwe (Nyirenda, n.d).
• Priority is given to relapse cases,
defaulters, treatment failures and any
patient going onto a retreatment
regimen (Nyirenda, n.d).
• Chest x-rays are also commonly used
to screen for TB, and pleural effusions
usually occur in a third of adults
(Nyirenda, n.d).
Diagnosing TB in Children:
• Children rarely cough up sputum,
therefore culturing Mycobacterium
is rare.
• A chest X-ray (CXR), tuberculin skin
test (TST) and a positive history of
close contact with an adult is
usually how children are diagnosed
(Nyirenda, n.d).
• The Mantoux test is the most
reliable in children, and 5mm
induration is considered diagnostic
(Nyirenda, n.d).
• The National TB Control Program
(NTP) in Malawi collects its data on
TB through registries (Nyirenda,
n.d).
• There are 3 registries:
1) A chronic Cough Register where details of
patients who submitted sputa for examination
are recorded.
2) A laboratory TB register where sputum smear
results are recorded.
3) A TB register where diagnosed TB cases are
recorded for commencement of treatment.
• The NTP utilizes passive case
findings. This is an inexpensive way
to manage and control TB within
the community.
• The problem with this data method
is TB can be underreported and
some patients with active TB can
even be misdiagnosed (Nyirenda,
n.d).
Incidence:
• There was a 45 percent increase in prevalence of diagnosed cases
between 1994 and 2003 (Nyirenda, n.d).
• Attack rates were highest between the ages of 25 -44. The age group
of 25 – 34 contributed about 40% of all smear positive TB cases
(Nyirenda, n.d).
• Between the ages of 0 and 24 there are more females with smear
positive TB than males (Nyirenda, n.d).
Directly Observed Treatment Short course
(DOT)
• DOTS has been successful in Malawi.
• The cure rates have increased to 67 percent in
2001 to 75 percent in 2005 due mainly to DOTS
(Planipolis, 2007).
• It is projected that by 2015, that 91 percent of TB
cases will be cured under DOTS (Planipolis, 2007).
What else is being done to prevent TB in
Malawi?
• Organizations like Target TB have
been working in the country to
improve TB outcomes.
• The Sue Ryder Foundation in
Malawi has been working with
target TB since 2005 to improve
the prevention, detection and
treatment of TB (Target
Tuberculosis, 2014).
• The Umodzi TB Project is focused
on improving access to TB
information, diagnosis and
treatment to the people in Bwanje
Valley (Target Tuberculosis, 2014).
Other efforts…..
• Kutukula Umoyo is a new three year project which aims to improve
the health of pregnant mothers and children under-5 through
preventing and treating TB (Targeting Tuberculosis, 2014).
• Over 50,000 pregnant women will have the opportunity to be
screened for TB, and receive education and advice on TB (Targeting
Tuberculosis, 2014).
~ Currently, in Malawi 112 out of 1,000 children die before their
5th birthday.
References:
• Center for Disease Control and Prevention. (2014). Tuberculosis (TB). Retrieved from
http://www.cdc.gov/tb/topic/basics/default.htm
• USAID. (2014). Malawi. Retrieved from http://tbcare2.org/cp-malawi
• Target Tuberculosis. (2014). Malawi. Retrieved from http://www.targettb.org.uk/what-wedo/where-we-work/malawi
• Planipolis (2007). The 2007 Malawi Millennium Development Goal Report. Retrieved from
http://planipolis.iiep.unesco.org/upload/Malawi/Malawi_MDG_report_2007.pdf