Malawi: Winning TB Fight in Malawi Through Global Fund

12 January 2020

When he picked his job as Laboratory Technician at Mzuzu Central Hospital few years ago, Ian Kambwani's celebratory mood for picking the new job was short-lived.

Dr Mirriam Nyenje_We have digital machines that give instant results, Pic by Mphasto Nkuonera -Mana People queue for TB testing at Mtambo Village in Mangochi, Pic by Mphatso Nkuonera -Mana One of the sputum collection centres, Pic by Mphatso Nkuonera -Mana One of the mobile clinic vans, Pic by Mphatso Nkuonera -Mana Dr James Mpunga

He realised that he had to work in risky conditions that exposed him to airborne diseases like tuberculosis (TB). The room he operated from did not have any scientific protective measures despite TB being airborne.

But now he feels safe following expansion of the offices and installation of ultraviolet germicidal (UVG) lights used to kill or inactivate microorganisms, thanks to Global Fund.

"Now we are safe. The offices are spacious and complete with UGV lights which kill bacteria that cause TB making the working premises free from TB transmission," he says.

Kambwani recalls that before the restoration it was also difficult to work in a tiny room filled with machines and cartons of various medical materials.

Kambwani adds that in the past years he used to test very few sputum spacemen.

But now the numbers have swelled up because Global Fund also assisted with Genexperts 002 modern machines that facilitate rapid tests.

Ministry of Health spokesperson Joshua Malango says Global Fund has from 2003 assisted with four mobile vans, medical items, drugs to fight TB, malaria, HIV and AIDS and drug storage facilities national wide.

"We have four mobile vans to help in mobility and bring clinical services to the rural masses living in hard to reach areas," Malango says.

Mzimba (North) District Health Social Services Officer Dr Emily Gama says the mobile clinic vans have led to increase in number of people that demand for TB tests.

"More men are now coming for TB testing than before because the mobile clinic vans get closer to them in their areas," she says.

Gama says there is a direct connection between the presence of the mobile clinic vans and the number of people to be screened for TB and also patients on treatment.

"Since the coming in of the mobile vans here we have seen that number of people screened per day and those put on treatment has increased positively.

"The presence of mobile clinic vans gives us the opportunity to take early assessments of TB signs from their homes through special sputum collecting points in various communities," Dr Gama says.

Mzimba North alone received 3000 people between March 2018 and June 2019 and 74 of them were found with TB.

"We now have improved TB notification rate. In addition, patients are able to follow treatment well because these mobile vans regularly visit the sputum collections points to administer drugs to patients while continuing testing others.

"We are excited because no health worker is infected with TB from patients unlike in the past when many workers contracted the disease. Commendably UVG lights have reduced transmission rate by 70 percent," she says.

Gama, however, says there is need for more clinical officers to be trained in TB diagnosis and more microscopic centres to be opened to help in the speedy testing of people.

Mchinji District Assistant TB Officer Alex Mphalaso says Global Fund trained health workers and donated a motorbike to facilitate mobility from sputum collection points to the hospital.

"From 2009, mobility was the biggest challenge and TB treatment defaulting was very high. Now, the motorbike has led to early detection of TB cases and patients are put on treatment on time.

"For example, in 2018, we detected 266 cases while by September 2019, we had 395 cases; the figures are likely to increase," Mphatso explains.

Similarly, Mangochi District Hospital mobile van coordinator Esnart Chikhawo says more men come to test for TB than women.

"Men come in large numbers to get tested for TB because they save time and money because they can no longer walk long distance to hospitals.

"I appeal for more mobile vans because the one we have is overstretched and fails to reach more other hard-to-reach areas," Chikhawo says.

She adds that the sputum collection points have also assisted in the early detection of diabetes, BP and cervical cancer.

"We take advantage of our interaction with people to advise them to visit hospitals when we notice signs of the other diseases in them," Chikhawo says.

Mangochi based Agness Asida, 60, is one of the people who have benefited from the mobile clinic vans.

"We are very excited to have tests on TB. We wish they started conducting HIV tests as well because the district hospital is far and we find it very hard to raise K1000 for transport," Asida says.

Meanwhile, communities of Mtambo Village in the district have instituted TB fighting groups at village level to help in monitoring those taking drugs and mobilising others to go for TB testing.

Asida says the TB fighting groups are yielding "good results because multitudes throng to the mobile vans for TB screening."

Laboratory Manager at Community Health Science Unit (CHISU) Dr Mirriam Nyenje says TB diagnoses and treatment has improved tremendously because of Global Fund donation of 76 Genexperts machines, microscopes and medication.

"We now have 375 microscopes across the country.

"TB is now manageable unlike in the past when all sputum samples across the country had to be tested here; no wonder it took eight weeks to release results. But now it only takes 42 days," Nyenje says.

National TB Control Programme Manager Dr James Mpunga says through massive decentralisation, diagnostic centres have increased from 74 to 372.

He says Malawi is winning the TB fight as World Health Organisation recommendations are that patients on treatment must be cured at 90 per cent and the country is rated at 88 per cent.

"We have reduced new cases to 131 from every 100 000 people and, as we go towards 2025, we will be very good.

"We have opened 2500 Sputum Collecting Committees across the country where, through volunteers at community level, members are aided by well trained health workers in sensitising people on TB issues," Dr Mpunga says.

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