Effects of Coronavirus Disease Pandemic on Tuberculosis Notifications, Malawi

Soko, Rebecca Nzawa; Burke, Rachael M; Feasey, Helena R A; Sibande, Wakumanya; Nliwasa, Marriott; Henrion, Marc Y.R.; Khundi, McEwen; Dodd, Peter J; Ku, Chu Chang; Kawalazira, Gift; Choko, Augustine; Divala, Titus; Corbett, Elizabeth L.; MacPherson, Peter

doi:10.3201/eid2707.210557

Cited by 71 publications

(79 citation statements)

References 18 publications

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“…The findings were conveyed in a variety of formats including letters, editorials, expert opinion, reports, webinars, feature articles, news articles, and traditional research articles. In terms of countries, the included articles were from Portugal [ 28 ], Ethiopia [ 29 ], Japan [ 30 ], China [ 9 ], Malawi [ 31 ], the United States of America [ 32 ], Pakistan [ 33 , 34 ], Nigeria [ 35 , 36 , 37 ], India [ 38 , 39 , 40 ], South Africa [ 41 , 42 , 43 ], one provided recommendations for high burdened settings [ 44 ], one presented evidence from LMIC [ 45 ], and one study was addressed to all the countries [ 46 ]. The primary healthcare settings ranged from clinics, outpatient departments, general practitioner’s practices, PHC centers, and pharmacies.…”

Section: Resultsmentioning

confidence: 99%

“…Another study from Ethiopia showed that patient flow had significantly decreased in the first months of the COVID-19 lockdowns compared with the same period from the previous year [ 29 ]. Moreover, TB case notifications at primary healthcare centers in Malawi were shown to be disproportionately lower than at a regional hospital in Malawi [ 31 ]. The current evidence shows that the COVID-19 pandemic has created a scenario where fewer TB cases were detected than usual.…”

Section: Resultsmentioning

confidence: 99%

“…All of the participants struggled to access healthcare facilities. Rumors on the closure of certain facilities meant that patients were not seeking care for a period of time in Malawi [ 31 ]. In India, 17.3% of patients defaulted on their TB treatment and others consulted general practitioners and private pharmacies for treatment due to the difficulty in accessing healthcare facilities [ 38 ].…”

Section: Resultsmentioning

confidence: 99%

“…A survey by the Stop TB partnership found that in several countries, fear of contracting COVID-19 kept patients away from visiting clinics [ 47 ]. Likewise, in Malawi, fear and ignorance of COVID-19 meant that many healthcare personnel refused to see or treat anyone displaying symptoms resembling COVID-19 [ 31 ]. Moreover, staff were increasingly reluctant to handle any sputum samples or observe sputum collection.…”

Section: Resultsmentioning

confidence: 99%

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Evidence of TB Services at Primary Healthcare Level during COVID-19: A Scoping Review

et al. 2021

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Tuberculosis (TB) is still a major public health concern, despite the availability of preventative and curative therapies. Significant progress has been made in the past decade towards its control. However, the emergence of the novel coronavirus disease 2019 (COVID-19) has disrupted numerous essential health services, including those for TB. This scoping review maps the available evidence on TB services at the primary healthcare (PHC) level during the COVID-19 period. A comprehensive literature search was conducted in PubMed, Web of Science, Medline OVID, Medline EBSCO, and Scopus. A total of 820 articles were retrieved from the databases and 21 met the eligibility criteria and were used for data extraction. The emerging themes were the effect of the COVID-19 pandemic on TB services, patient and provider experiences, recommendations for TB services during the COVID-19 period, and the implementation of the recommendations. The review found that the mitigation strategies, as well as fear and stigma experienced at the start of the COVID-19 pandemic may have led to TB cases potentially going undetected, which may threaten TB treatment outcomes. Therefore, efforts must be directed at finding these missing cases and ensuring that PHC facilities are equipped to adequately diagnose and treat them.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Evidence of TB Services at Primary Healthcare Level during COVID-19: A Scoping Review

et al. 2021

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“…Tuberculosis surveillance data from high TB-endemic settings have revealed significant declines in TB notification between 2019 (the pre-COVID era) and 2020 (the COVID era) ( 22 ). The decline in TB notification in the African settings has been of the order of ∼20% ( 23 , 24 ). The decline in TB notifications has been attributed to disruption in TB service provisions, some of which have been related to closure of facilities that provide TB services and redirection of resources, including human, financial, and equipment (such as the Xpert platforms and others) to the COVID-19 response to confront a public health threat that was perceived to be more urgent and bigger.…”

Section: Tuberculosis and Covid-19 In Africa: What Has Happened?mentioning

confidence: 99%

Lung health in Africa: challenges and opportunities in the context of COVID-19

Ozoh

Ngahane

Zar

et al. 2021

American Journal of Physiology-Lung Cellular and Molecular Phys

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Impact of the COVID‐19 pandemic on TB services at ART programmes in low‐ and middle‐income countries: a multi‐cohort survey

Marti,

Zürcher,

Enane

et al. 2022

J Int AIDS Soc.

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Introduction: COVID-19 stretched healthcare systems to their limits, particularly in settings with a pre-existing high burden of infectious diseases, including HIV and tuberculosis (TB). We studied the impact of COVID-19 on TB services at antiretroviral therapy (ART) clinics in low-and middle-income countries. Methods: We surveyed ART clinics providing TB services in the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium in Africa and the Asia-Pacific until July 2021 (TB diagnoses until the end of 2021). We collected sitelevel data using standardized questionnaires. Results: Of 46 participating ART clinics, 32 (70%) were in Africa and 14 (30%) in the Asia-Pacific; 52% provided tertiary care. Most clinics (85%) reported disrupted routine HIV care services during the pandemic, both in Africa (84%) and the Asia-Pacific (86%). The most frequently reported impacts were on staff (52%) and resource shortages (37%; protective clothing, face masks and disinfectants). Restrictions in TB health services were observed in 12 clinics (26%), mainly reduced access to TB diagnosis and postponed follow-up visits (6/12, 50% each), and restrictions in TB laboratory services (22%). Restrictions of TB services were addressed by dispensing TB drugs for longer periods than usual (7/12, 58%), providing telehealth services (3/12, 25%) and with changes in directly observed therapy (DOT) (e.g. virtual DOT, 3/12). The number of TB diagnoses at participating clinics decreased by 21% in 2020 compared to 2019; the decline was more pronounced in tertiary than primary/secondary clinics (24% vs. 12%) and in sites from the Asia-Pacific compared to Africa (46% vs. 14%). In 2021, TB diagnoses continued to decline in Africa (-8%) but not in the Asia-Pacific (+62%) compared to 2020. During the pandemic, new infection control measures were introduced or intensified at the clinics, including wearing face masks, hand sanitation and patient triage. Conclusions: The COVID-19 pandemic led to staff shortages, reduced access to TB care and delays in follow-up visits for people with TB across IeDEA sites in Africa and the Asia-Pacific. Increased efforts are needed to restore and secure ongoing access to essential TB services in these contexts.

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Effects of Coronavirus Disease Pandemic on Tuberculosis Notifications, Malawi

Cited by 71 publications

References 18 publications

Evidence of TB Services at Primary Healthcare Level during COVID-19: A Scoping Review

Evidence of TB Services at Primary Healthcare Level during COVID-19: A Scoping Review

Lung health in Africa: challenges and opportunities in the context of COVID-19

Impact of the COVID‐19 pandemic on TB services at ART programmes in low‐ and middle‐income countries: a multi‐cohort survey

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