Effects of Coronavirus Disease Pandemic on Tuberculosis Notifications, Malawi
Rebecca Nzawa Soko, Rachael M. Burke, Helena R. A. Feasey, Wakumanya Sibande, Marriott Nliwasa, Marc Henrion, McEwen Khundi, Peter J. Dodd, Chu Chang Ku, Gift Kawalazira, Augustine Choko, Titus Divala, Elizabeth L. Corbett, Peter MacPherson
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.