Characteristics of adults and children diagnosed with tuberculosis in Lilongwe, Malawi: findings from an integrated HIV/TB clinic

Abstract

Objectives To describe initial registration characteristics of adult and pediatric TB patients at a large, public, integrated TB and HIV clinic in Lilongwe, Malawi, between January 2008 – December 2010. Methods Routine data on TB patient category and TB type, stratified by HIV and ART status, were used to explore differences in proportions among TB-only, TB/HIV co-infected patients not on ART, and TB/HIV co-infected patients on ART using Chi-square tests.. Trends over time illustrate strengths and weaknesses of integrated service provision. Results Among 10,143 adults, HIV ascertainment and ART uptake were high and increased over time. The proportion of relapse was highest among those on ART (5%). The proportion of smear-positive pulmonary TB (PTB) was highest among HIV-negative TB patients (34.9%); extra-pulmonary TB (EPTB) was lowest among TB-only (16.2%). Among 338 children <15 years, EPTB and smear-positive PTB were more common among TB-only patients. Time trends showed significant increases in the proportion of adults with smear-positive PTB and the proportion of adults already on ART before starting TB treatment. However, some co-infected patients still delay ART initiation. Conclusions HIV ascertainment and ART uptake among co-infected patients is successful and improving over time. However, delays in ART initiation indicate some weakness linking TB/HIV patients into ART during TB follow-up care. Improved TB diagnostics and screening efforts, especially for pediatric patients, may help improve quality care for co-infected patients. These results may aid efforts to prioritize TB and HIV prevention, education, and treatment campaigns for specific populations.

Cancer obscures extrapulmonary tuberculosis (EPTB) at a tertiary hospital in Northern Malawi

“…This study has established that EPTB is more common in males (3.0%) than females (1.8%). This is similar to studies conducted in African countries and elsewhere which found that men are more affected than women [ 7 – 9 , 15 , 24 , 25 ]. The possible explanation to this similarity finding could be due to resemblance in health-seeking behaviour in our set up whereby females seek medical care more frequently and earlier than males, hence posing more chance for male to be a highly affected group of people [ 26 , 27 ].…”

Prevalence of extrapulmonary tuberculosis among people living with HIV/AIDS in sub-Saharan Africa: a systemic review and meta-analysis

“… Notes: The number of studies and the sample size contributed by 12 countries from SSA that had included studies were as follows: ten studies with 2,837 people with HIV/AIDS were from Ethiopia, 18 – 27 four each were from Nigeria (2,042) 28 – 31 and South Africa (13,929), 32 – 35 and three were from Cameroon (2,246). 11 , 36 , 37 Two each were from Uganda (245) 38 , 39 and Zambia (471), 40 , 41 one each was from Tanzania (175), 42 Benin (521), 43 Burkina Faso (112), 44 Malawi (5,561), 45 Kenya (846), 46 and Gabon (205) 47 ( Table 1 ). …”

Risk factors for mortality in Malawian children with human immunodeficiency virus and tuberculosis co-infection

“…4 Some high-burden African settings have reported a pediatric TB-HIV co-infection burden of 43.4% and above. 5,6 In Malawi, high TB incidence (191 per 100 000 population in 2011) and HIV prevalence (11% in 2009), along with limited TB diagnostic tools and challenges in early infant diagnosis of HIV, make management of co-infected children a challenge, resulting in poor outcomes. 7–10 …”