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Volume 27, Number 7—July 2021

Effects of Coronavirus Disease Pandemic on Tuberculosis Notifications, Malawi

Rebecca Nzawa Soko1, Rachael M. Burke1Comments to Author , Helena R.A. Feasey, Wakumanya Sibande, Marriott Nliwasa, Marc Y.R. Henrion, McEwen Khundi, Peter J. Dodd, Chu Chang Ku, Gift Kawalazira, Augustine T. Choko, Titus H. Divala, Elizabeth L. Corbett2, and Peter MacPherson2
Author affiliations: Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi (R. Nzawa Soko, R.M. Burke, H.R.A. Feasey, W. Sibande, M. Nliwasa, M.Y.R. Henrion, M. Khundi, A.T. Choko, T.H. Divala, E.L. Corbett, P. MacPherson); London School of Hygiene and Tropical Medicine, London, UK (R. Nzawa Soko, R.M. Burke, H.R.A. Feasey, M. Khundi, T.H. Divala, E.L. Corbett, P. MacPherson); University of Malawi College of Medicine, Blantyre (M. Nliwasa); Liverpool School of Tropical Medicine, Liverpool, UK (M.Y.R. Henrion, P. MacPherson); University of Sheffield, Sheffield, UK (P.J. Dodd, C.C. Ku); District Health Office, Blantyre (G. Kawalazira)

Main Article

Table 2

Quotations from in-depth interviews with health officers about reasons for reduced tuberculosis notifications due to coronavirus disease epidemic in Malawi, June–December 2020*

Theme, quote no. Participant no., sex Quote
Fear of COVID-19 contagion at health facilities
Q1 02, F “People were afraid of getting infected if they come to the facility.”
09, F
“… they were afraid saying that if the workers are found with COVID, so if we go there they will infect us.”
COVID-19 related health facility closures
Q3 03, F “…they were told that the clinic had been shut down and people are not being assisted… which means people were just staying in their homes and the TB was just being spread amongst them.”
Q4 02, F “Our facility wasn’t closed, but there was a certain week that we were just going but we were not working because there was no PPE, so people were afraid. There were no gloves, no masks how were we going to work? So a sit-in happened.”
Q5 05, F “Yes we had a strike at this hospital and the strike occurred in all health centres. The reason behind the strike was that COVID-19 was at its peak but we didn’t have PPE which was putting us at risk.”
07, M
“The first strike was against shortage of PPEs and the second strike was organized by Interns who were complaining that they are making them work on this dangerous disease of COVID-19 yet they are not being employed… And the other strike was about risk allowance.”
Effects of COVID-19 prevention measures on healthcare access
Q7 04, F “…then government announced that wearing of mask is mandatory some people who couldn’t manage wear the mask were making a decision of not going to the hospital instead, some were complaining that they suffocate in a mask.”
Q8 08, F “…all patients should be wearing masks when coming here but some patients were ignoring and when we send them back to go and get a mask some patients were ending up not coming back.”
08, F
“Some people travel from far communities to come here and the increase in transport fare also influenced some people to fail to come to the hospital.”
Similarity of TB and COVID-19 symptoms leading to reduced access to TB care
Q10 02, F “… sometimes they think that if they test positive [for COVID-19], people will discriminate them, they have fear of unknown. So during this period people weren’t coming to say I have a cough, test me, they were just staying at home buying Bactrim and drinking it at home.”
Q11 06, F “the signs and symptoms of COVID-19 and TB were somehow similar so because the signs were similar people were scared to come to the hospital because they were assuming that instead of testing them for TB we will test them for COVID-19”
Q12 07, M “They were communicating that if a person has fever then that is a sign of COVID-19 and that particular person is required to go into isolation so people were afraid to come to the hospital when they have fever because of the messages that they may be isolated with their families.”
01, M
“… they were expecting that someone who has COVID-19 coughs and sneezes severely, and has fever and headaches, so when they ask about those, the same things that a TB patient presents, that was when those people were being sent back to go home and call the COVID-19 help line.”
Reduced healthcare worker capacity to support TB testing
Q14 05, F “… we were no longer asking many questions once the person tells us that she has dry cough we were running away from that person… Because if the person has dry cough the first thing that we were thinking of is COVID-19.”
Q15 11, F “I was scared because it was difficult to know if the patient is coughing because of TB or COVID-19.”
Q16 01, M “… in the laboratory… the ones that are involved in the testing, they were refusing to handle sputum because they were taught that sputum has the highest concentration of COVID-19 so some were dodging which was resulting in delays.”

*COVID-19, coronavirus disease; PPE, personal protective equipment; TB, tuberculosis.

Main Article

1These first authors contributed equally to this article.

2These last authors contributed equally to this article.

Page created: May 04, 2021
Page updated: June 16, 2021
Page reviewed: June 16, 2021
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