THE PATTERN OF TUBERCULOSIS IN QUEEN-ELIZABETH-CENTRAL-HOSPITAL, BLANTYRE, MALAWI - 1986-1995

SETTING: Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. OB JECTIVE: To determine the pattern of tuberculosis (TB) cases over a pe riod of ten years. DESIGN: TB registers for QECH for the years 1986-19 95 (January 1st to December 31st) were obtained and clinical informati on on the type of TB in each patient was recorded. Human immunodeficie ncy virus (HIV) test results of adults with smear-positive pulmonary T B (PTB) and children with TB between 1993 and 1996 were recorded from case notes. RESULTS: There were 19 377 TB cases, 10 982 men and 8 395 women, registered over the ten-year period. Of these, 4 691 (24%) case s were in children aged 0-14 years and 11 890 (61%) cases were in adul ts aged 15-44 years. The number of cases increased from 657 in 1986 to 2 734 in 1995, and the proportion of cases with extrapulmonary TB (EP TB) rose from 11% in 1986 to 33% in 1995. The largest increase in case s was in children and in young adults aged 15-44 years. In all age gro ups, PTB was more common than EPTB. There were significant increases i n the proportion of adult TB cases with pleural effusion. Of these who were tested, 72% of adults with smear-positive PTB and 64% of childre n with TB were found to be HIV-seropositive. CONCLUSION: There has bee n a dramatic increase in cases of TB and changes in disease pattern in QECH during the last 10 years, which is related to the HIV epidemic.