Resources for controlling tuberculosis in Malawi

Objective To document resources for controlling tuberculosis (TB) in Malawi . Methods We performed a countrywide study of all 43 hospitals (3 central, 22 district and 18 mission) which register and treat patients with TB. To col lect data for 1998 on the TB-related workload, diagnostic facilities, progr amme staff and treatment facilities, we used laboratory, radiographic and T B registers, conducted interviews and visited hospital facilities. Findings The data show that in 1998, 88 257 TB suspects/patients contribute d approximately 230 000 sputum specimens for smear microscopy, 55 667 chest X-rays were performed and 23 285 patients were registered for TB treatment . There were 86 trained laboratory personnel, 44 radiographers and 83 TB pr ogramme staff. Of these, about 40% had periods of illness during 1998. Appr oximately 20% of the microscopes and X-ray machines were broken. Some 16% o f the hospital beds were designated for TB patients in special wards, but e ven so, the occupancy of beds in TB wards exceeded 100%. Although stocks of anti-TB drugs were good, there was a shortage of full-time TB ward nurses and 50% of district hospitals conducted no TB ward rounds. In general, ther e was a shortage of facilities for managing associated HIV-related disease; central hospitals, in particular, were under-resourced. Conclusion Malawi needs better planning to utilize its manpower and should consider cross-training hospital personnel. The equipment needs regular mai ntenance, and more attention should be paid to HIV-related illness. The pol icies of decentralizing resources to the periphery and increasing diagnosti c and case-holding resources for central hospitals should be continued.