Impact of COVID-19 on tuberculosis notifications in Blantyre Malawi: an interrupted time series analysis and qualitative study with healthcare workers
Soko, Rebecca Nzawa;
Burke, Rachael M;
Feasey, Helena RA;
Sibande, Wakumanya;
Nliwasa, Marriott;
Henrion, Marc YR;
Khundi, McEwen;
Dodd, Peter J;
Ku, Chu Chang;
Kawalazira, Gift;
+4 more...Choko, Augustine T;
Divala, Titus H;
Corbett, Elizabeth L;
MacPherson, Peter;
(2021)
Impact of COVID-19 on tuberculosis notifications in Blantyre Malawi: an interrupted time series analysis and qualitative study with healthcare workers.
medRxiv preprint.
ISSN 1468-5833
DOI: https://doi.org/10.1101/2021.03.15.21253601
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Abstract
COVID-19 may impact on tuberculosis (TB) diagnosis and care. We analysed a city-wide electronic TB register in Blantyre, Malawi and interviewed TB officers. Malawi had no official “lockdown” but closed schools and borders on 23-March 2020. In interrupted time series analysis, there was an immediate 35.9% reduction in TB notifications (95% CI 22.0 to 47.3%) in April, which recovered to near pre-pandemic numbers by December 2020, but with 333 (95% CI 291 to 375) fewer cumulative notifications than anticipated. Women and girls were impacted (30.7% fewer cases, 95% CI 28.4 to 33.0%) more than men and boys (20.9% fewer, 95% CI 18.5 to 23.3). Fear of COVID-19 infection, temporary facility closure, inadequate protective equipment and COVID-19 stigma with similar presenting symptoms to TB were mentioned. Public health measures could benefit both TB and COVID-19, but only if diagnostic services remain accessible and are considered safe to attend.