Tuesday, March 24, 2009
by Pilirani Semu-Banda
LILONGWE, Mar 24 (IPS) - Malawi does not have accurate statistics that define the extent of tuberculosis (TB) cases within its borders, and there are fears that only half of those infected with the disease are able to access testing and treatment.
Technical advisor of the country’s National TB Control Programme (NTCP), Dr. Daniel Nyangulu, said TB is one of the top killer diseases in the country, together with malaria and HIV/AIDS. "Every year, [we estimate that] up to 30,000 people are treated for TB, and 8,000 die of the disease. TB is a huge public health problem," said Nyangulu.
In the 1980s, TB infections were much lower, with public health facilities having to treat only 5,000 TB patients per year.
Malawi’s fears that only half of those infected with the disease are accessing treatment are supported by 2008 World Health Organisation (WHO) data, which estimate that there were more than 50,000 new cases of TB in the country last year. Malawi falls short of the WHO recommended treatment success rate of 85 percent by at least 13 percent. But all existing data are estimates.
NTCP has therefore embarked on a campaign to provide universal access to TB testing and treatment. Sputum collection centres have been established in hard-to-reach rural areas that don’t have health facilities. Members of local communities are volunteering to collect sputum from people with TB symptoms. The volunteers then transport the samples to the closest health facility for testing.
According to the United Nations, up to 85 percent of Malawi’s population lives in rural areas where about 60 percent of the people live below the poverty line of $1 per day. It is difficult for them to seek medical care when they need it, especially if public health facilities are far away from their villages and they don’t have the money to pay for transportation.
"We have discovered through surveys that most people in villages are not accessing health services such as TB detection services easily. This is mainly because of the distances they have to travel to get to the nearest health centres and also because of the high poverty levels," explained Nyangulu. Residents of rural areas have to travel an average of five kilometres to reach a clinic or hospital.
Lack of knowledge about TB has also been cited as contributing to the fact that few Malawians get tested, said Nyangulu. He said most people in rural areas have little information about the disease and therefore fail to recognise its symptoms.
Mtsiriza, a rural community on the outskirts of Malawi’s capital Lilongwe, is one area that has benefited from the universal access initiatives launched by NTCP. Now that sputum collection centres have been established in the community, people have been flocking to the centre to be tested in high numbers. NTCP is also encouraging home-based care services, delivered by community volunteers who observe and follow up on treatment for TB patients.
John Chiguduli (48) is one of the patients who has been cured from TB due to the new centre in Mtsiriza. "I have been sick for about a year, and I haven’t been able to work at all. I felt very weak but I could not access testing services because the hospital is far away from here, and I didn’t have money for transport. I only got diagnosed with TB when a medical facility was set up here in my village," Chiguduli told IPS.
He believes the NTCP initiative of bringing health care to the people, instead of expecting people to make their way to health facilities, has saved his life. "I nearly died. The testing service came to my area just in time to save me," said Chiguduli, who is now able to work his fields again.
The community TB initiative also encourages all members of a household with a TB patient, especially children, to be tested.
In addition, NTCP offers ‘active screening’ at its TB testing centres, which means that HIV testing is offered in combination with TB tests. This way, government tries to identify the large number of TB/HIV co-infections, which the national health department estimates to be 77 percent.
NTCP has also established walk-in centres in the country’s main health facilities, such as referral hospitals, to enable people to access TB testing services without having to join the long queues of patients requiring other hospital services.
Hospital waiting times are usually long because Malawi is facing acute shortage of health personnel. The Department of Health indicates that up to 120 registered nurses leave the country per year for better-paying jobs in the developing world. Currently, 50 patients are looked after by only one nurse, while one doctor is responsible for 64,000 patients, according to health department figures.
In addition to bringing TB testing to rural areas as part of its universal access strategy, the NTCP makes special efforts to provide testing services in other TB hot spots, such as prisons. "Most of the prisons in the country are overcrowded and this becomes a breeding ground for TB," said Nyangulu, explaining that prison authorities are now encouraged to offer TB testing to every new prisoner and offer testing services for all prisoners on a regular basis.
Yet, health experts realise that efforts to curb TB will be less effective if Malawi does not have accurate statistics on the TB situation in the country. The health department is therefore planning to embark upon a national prevalence survey later this year. "Right now, we only have estimates, but we need specific figures to be able to treat all cases properly," said Nyangulu.