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Improving tuberculosis screening in rural Malawi

By Rachel Kachali:

A desire to help make a difference in the fight against tuberculosis (TB) in rural Malawi is what most motivated Chrissie Murray to get trained as a Health Surveillance Assistant (HSA).

But when Murray, who grew up in Traditional Authority (T/A) Malemia in Zomba, first reported for work at Likangala Health Centre in the same T/A over three years ago, she was alarmed by the high staff-to-patient ratio at the hospital, particularly for patients seeking TB and antiretroviral therapy (ART) services.

“I have always known that TB cases are prevalent in rural areas. That is why I wanted to help in the first place. I just did not expect the problem to be that big or the health facilities to have very limited resources,” she says.

Murray says it was hard to assist all the patients seeking TB care at Likangala Health Centre because despite being understaffed, the facility had only one sputum smear microscope which was used to detect the disease.

Sputum smear microscopy has been the primary method for the diagnosis of pulmonary TB in most parts of developing countries. With this type of microscopy, a presumptive TB patient has to give a first sputum sample and another early morning sample which requires the patient to at least visit the facility twice.

Murray says sometimes samples from rural health facilities are sent to district or referral hospitals to be thoroughly diagnosed with improved machinery and people are asked to come at a later date for their results.

“In some cases, our facility used to register high default rates because some of the patients, especially those who live very far from the hospital, did not return to provide another sample or get their results,” says Murray, who fears that those patients could easily contribute to the spread of TB in their community by the time they are diagnosed.

The 2016 World Health Organisation (WHO) report on TB shows that out of 9.6 million people who fell ill with TB in 2014, six million (62.5 percent) were reported to national authorities. This means that more than a third (37.5 percent) of the cases went undiagnosed.

Thus, while highlighting improvements made in TB fight, WHO acknowledges the significant detection and treatment gap reported, particularly in low-income countries.

To bridge this gap, various medical organisations such as Dignitas International (DI), have been scaling up efforts of providing integrated care to fight TB in the country.

DI, with support from USAid, has been providing TB trainings to medical personnel such as lab assistants and HSAs, and supplying TB drugs and other supplies in both government and Christian Health Association of Malawi (Cham) facilities in southern and eastern Malawi.

Murray is one of the beneficiaries of the TB trainings.

“Currently, we have trained over 50 people on TB screening and TB control. These people are already working in various government and Christian Health Association (Cham) hospitals where we operate,” says Mike Liomba, DI’s Laboratory Services Coordinator.

Apart from equipping the medical personnel with the laboratory skills, DI has also provided fluorescent microscopies at district hospitals of Mangochi and Machinga, and the health centres of Namwera in Machinga, Utale in Balaka, Likangala in Zomba and Migowi in Phalombe.

One of the microscopy training facilitators from Ministry of Health, Felix Chanjoka, says the fluorescence microscope is much better than the conventional microscopy because the latter takes longer to examine TB samples.

“Also, studies comparing fluorescent and conventional microscope found that the sensitivity of fluorescent microscopy was higher than that of conventional microscopy, and that it remains high even after concentration of the samples,” he says.

After receiving the training on TB screening and control, Murray corroborates that the fluorescent microscope is doing wonders at Likangala Health Centre.

The skillful Murray, who proudly says she is helping make a difference to end TB, currently assists her facility’s TB specialist with TB screening and treatment.

“Unlike before, we do not have workload because we are now completing work that used to take more hours in less than 30 minutes. Thus, a lot of samples are being diagnosed in a day and patients start treatment earlier,” she ecstatically explains.

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