Impact of COVID-19 on tuberculosis notifications in Blantyre Malawi: an interrupted time series analysis and qualitative study with healthcare workers

Rebecca Nzawa Soko

; Rachael M Burke

; Helena RA Feasey

; Wakumanya Sibande

; Marriott Nliwasa

; Marc YR Henrion

; McEwen Khundi

; Peter J Dodd

; Chu Chang Ku

; Gift Kawalazira; +4 more... Augustine T Choko

; Titus H Divala

; Elizabeth L Corbett

; Peter MacPherson

; (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: 10.1101/2021.03.15.21253601

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<jats:title>Abstract</jats:title><jats:p>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<jats:sup>-</jats:sup>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.</jats:p>