Finding missing cases in Southern Malawi: A success story
Background
St Martin’s Community Hospital is situated around 25 kms from Mangochi district centre in Southern Malawi. It provides health services, including TB diagnosis and treatment to a population of over 42,000 in 32 communities. In October 2021, Development Aid People to People (DAPP) Malawi started implementing a 3-year project in the districts of Mulanje, Mangochi and Machinga to strengthen the capacity for TB case finding and linkage to treatment. . This project is funded through a Cooperative Agreement with USAID under the TB Local Organization Network-2 and St Martin’s Community Hospital is one of the hospitals benefitting from this project.
Tuberculosis burden
The World Health estimates that 27,000 new TB occurs each year in Malawi. Just 14,380 new TB cases were diagnosed in 2021, representing 53% of the new TB cases. This means that nearly half of the new cases that occurred in 2021 were missed, hence not put on treatment. Finding missing TB cases is essential to achieve the End TB targets by 2035 in Malawi. At the start of the project, DAPP Malawi trained community health workers on the FAST methodology (Find cases Actively, Separate safely & Treat effectively), an administrative approach to infection control that relies on cough surveillance and rapid molecular testing. Four trained FAST promoters (FP) started working at St Martin’s Community Hospital in November 2021.
Project objective: to detect an additional 1,133 TB cases in addition to the baseline in the impact districts.
Picture: FAST promoters and the DAPP Malawi Mangochi District Coordinator at St Martin’s Community Hospital, Malawi
Project Results
As the table below shows, initial results have shown a remarkable increase in the number of additional TB cases being detected at St Martin’s. The project has helped detect 51 cases of TB since it started implementing systematic TB screening activities in October to November 2021. In summary, 39% of all cases in the past four corresponding years have been detected in the one year that the project has been operational.
Methodology utilised
The trained health workers/FAST Promoters (FP) meet every morning and agree on the responsibilities for each department with each one of them assigned to a specific area to cover. The four areas they work in are: the integration ward (where ante-natal care and nutrition care is provided), HIV care Clinic, Outpatients’ department, and the paediatric ward.
The FAST promoters provide information and education on TB to their clients following which they screen them for TB symptoms. Clients who screen positive for TB symptoms are separated from the rest of care seekers and provided with information on TB, including TB symptoms, transmission, prevention, TB testing, and TB treatment. Sputum mugs along with instructions are provided to the clients and after checking the sputum sample for quality, the FP delivers it to the laboratory for testing.
Presumptive TB clients are recorded in a Presumptive TB register managed by the FPs and reconciled with the clinic Presumptive TB register at the end of each day.
TB Diagnostic tools available at the hospital include GeneXpert platform with four modules, Urine LAM and TB microscopy. The FP checks for results at the end of the day and, if the test has not been conducted, they follow-up with the laboratory to ensure that the sputum sample is tested. On an average, each FP screens 18 clients per day.
Conclusion
The FAST methodology implemented by DAPP Malawi at St Martin’s has drastically increased the number of newly diagnosed TB patients. Before the FAST approach was introduced at St. Martin’s hospital, clients seeking various services at the hospital were not systematically screened for TB and that clients with symptoms of TB freely mingled with everyone else, thereby increasing the risk of TB transmission within the hospital setting.
Despite being preventable and treatable, TB remains one of the world’s leading infectious disease killers, taking the lives of 1.5 million people each year. USAID leads the U.S. Government’s global TB efforts, working with partners around the world, including Malawi, on the shared goals of reaching every person with TB, curing those in need of treatment, and preventing the spread of new infections.
