Impact of COVID-19 on tuberculosis notifications in Blantyre Malawi: an interrupted time series analysis and qualitative study with healthcare workers

Abstract

COVID-19 may impact on tuberculosis (TB) diagnosis and care. We analysed a city-wide electronic TB register in Blantyre, Malawi and interviewed TB officers. Malawi had no official 'lockdown' but closed schools and borders on 23-March 2020. In interrupted time series analysis, there was an immediate 35.9% reduction in TB notifications (95% CI 22.0 to 47.3%) in April, which recovered to near pre-pandemic numbers by December 2020, but with 333 (95% CI 291 to 375) fewer cumulative notifications than anticipated. Women and girls were impacted (30.7% fewer cases, 95% CI 28.4 to 33.0%) more than men and boys (20.9% fewer, 95% CI 18.5 to 23.3). Fear of COVID-19 infection, temporary facility closure, inadequate protective equipment and COVID-19 stigma with similar presenting symptoms to TB were mentioned. Public health measures could benefit both TB and COVID-19, but only if diagnostic services remain accessible and are considered safe to attend.

Emerging public health challenges during the COVID‐19 pandemic in Malawi: A review

“…Since confirmation of COVID‐19 in Malawi, there has been an overall reduction in the number of persons presenting with presumptive TB (45.6%), bacteriologically diagnosed positive (2.6%), and those registered for TB treatment (19.1%) [ 37 ]. The reduction in TB notifications was attributed to COVID‐19 infection and COVID‐19 stigma because TB and COVID‐19 share similar symptoms, temporary facility closures, and inadequate PPE [ 40 ]. Despite the real‐time monthly surveillance, these declining trends in HIV and TB case detection were not addressed [ 37 ].…”

Fighting Tuberculosis in Africa: The Current Situation Amidst the COVID-19 Pandemic

“…In Malawi, the emergence of the pandemic has led to a substantial decline in the number of notified TB cases due to several reasons such as general disruption and challenging access to a range of primary health-care services, and delayed or missed TB diagnosis in people with true TB disease. 15 On the other hand, to reduce the displacement of civilians and flatten the COVID-19 curve in Sierra Leone, the government has allowed health facilities to supply patients with sufficient TB medication for weeks. However, such action may lead to a decrease in TB cure rates and the development of drug-resistant TB due to a possible low adherence to treatment, which suggests risks of spread of the disease in the community.…”