Effects of Coronavirus Disease Pandemic on Tuberculosis Notifications, Malawi
Rebecca Nzawa Sokoa b c d e f g✉, Rachael M. Burkea b c d e f g, Helena R. A. Feaseya b c d e f g, Wakumanya Sibandeb c d e f g, Marriott Nliwasab c d e f g h, Marc Henrionb c d e f g i, McEwen Khundia b c d e f g, Peter J. Doddc d e f g j, Chu-Chang Kuc d e f g j, Gift Kawalazirac d e f g k, Augustine Talumba Chokob c d e f g, Titus Henry Divalaa b c d e f g, Elizabeth Lucy Corbetta b c d e f g, Peter MacPhersona b c d e f g i
- aLondon School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- bMalawi Liverpool Wellcome Clinical Research Programme, Queen Elizabeth Central Hospital, Chipatala Avenue, Blantyre, Malawi
- cLiverpool School of Tropical Medicine, Liverpool, UK
- dLondon School of Hygiene and Tropical Medicine, London, UK
- eMalawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
- fUniversity of Malawi College of Medicine, Blantyre (M. Nliwasa)
- gUniversity of Sheffi eld, Sheffi eld, UK
- hCollege of Medicine, University of Malawi, Mahatma Ghandi Road, Blantyre, Malawi
- iLiverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
- jUniversity of Sheffield, Sheffield, UK
- kDistrict Health Office, Blantyre, Southern Region, Malawi
- ✉Corresponding author
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Abstract
The coronavirus disease (COVID-19) pandemic might affect tuberculosis (TB) diagnosis and patient care. We analyzed a citywide electronic TB register in Blantyre, Malawi and interviewed TB officers. Malawi did not have an official COVID-19 lockdown but closed schools and borders on March 23, 2020. In an interrupted time series analysis, we noted an immediate 35.9% reduction in TB notifications in April 2020; notifications recovered to near prepandemic numbers by December 2020. However, 333 fewer cumulative TB notifications were received than anticipated. Women and girls were affected more (30.7% fewer cases) than men and boys (20.9% fewer cases). Fear of COVID-19 infection, temporary facility closures, inadequate personal protective equipment, and COVID-19 stigma because of similar symptoms to TB were mentioned as reasons for fewer people being diagnosed with TB. Public health measures could benefit control of both TB and COVID-19, but only if TB diagnostic services remain accessible and are considered safe to attend.