BackgroundMalawi is a low-income country with high Tuberculosis (TB) burden. TB diagnosis delay and untimely initiation of treatment is still a major problem in Malawi which could increase the risk of tuberculosis transmission in the communities. This study investigated factors related to the diagnostic delay of tuberculosis from TB healthcare providers in the northern region of Malawi.MethodsNine focus group discussions were conducted with 57 participants in total. The participants were healthcare cadres including district TB officers, clinical officers, TB nurses, laboratory technicians and Health Surveillance Assistants (HSAs). NVivo (11.0) software was used for data analysis.ResultsThe factors related to diagnostic delay were categorized into three themes: client factors, institutional factors and healthcare provider related factors. Client’s stigma and fear for HIV test, resource shortage within healthcare institutions and the healthcare workers’ poor attitude against potential patients were among the most influential factors behind the TB diagnostic delay.ConclusionsThe TB control strategies should aim to reduce HIV stigma, improve resource supply and improve TB healthcare workers’ morale in order to achieve timely TB diagnosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0279-1) contains supplementary material, which is available to authorized users.

Establishing a good communication and referral mechanism between different levels of health facilities is crucial to timely TB diagnosis. China's experience on pro-poor interventions could be useful to its Malawian counterpart and other similar settings with high TB burden.

Data on the prevalence of extrapulmonary tuberculosis (EPTB) patients are limited in many African countries including Malawi. We conducted a retrospective review of all histology reports for cancer suspected patients at Mzuzu Central Hospital (MZCH) between 2013 and 2018 to determine the proportion of EPTB cases among cancer suspected patients and characterised them epidemiologically. All reports with inconclusive findings were excluded. In total, 2214 reports were included in the review, 47 of which reported EPTB, representing 2.1% (95% CI 1.6−2.8). The incidence of EPTB was significantly associated with sex, age and HIV status. Men were more than twice (OR 2.1; 95% CI 1.2–3.9) as likely to have EPTB as women while those with HIV were more than six times (OR 6.4; 95% CI 1.7–24.8) as likely to have EPTB compared to those who were HIV-negative. EPTB demonstrated an inverse relationship with age. The highest proportion of EPTB was found from neck lymph nodes (10.3% (5.4–17.2)). A reasonable number of EPTB cases are diagnosed late or missed in Malawi's hospitals. There is a need for concerted efforts to increase EPTB awareness and likely come up with a policy to consider EPTB as a differential diagnosis in cancer suspected patients.

Maternal Mortality Ratio and neonatal mortality rate are alarmingly high in Malawi. The shortage and poor retention of midwives coupled with poor working conditions have been a major challenge affecting the provision of high-quality maternity care for women. Many women are giving birth without skilled attendants, increasing the risk of maternal and neonatal illness and death. The major driving factor in the shortage of health staff is the limited number of existing training slots and hence the minimum output from the training institutions into service delivery units. Midwifery is a key component of sexual, reproductive, maternal, and newborn healthcare. Responding to the crisis, the Malawi Government has made a commitment in strengthening human resources for health, including accelerating training and recruitment of health professionals to fill all the shortage gaps in the health sector. One mechanism implemented by Malawi Government to increase skilled attendance at birth in rural areas is the introduction of Community midwifery assistants (CMA) training. This program of training community midwives is being piloted and targets the general population of pregnant women and their new born babies in rural areas where the CMAs are deployed. However, there is a great need to have this initiative evaluated and gauge its impact in attaining the desired outcomes.