Effects of Coronavirus Disease Pandemic on Tuberculosis Notifications, Malawi

Soko, Rebecca Nzawa; Burke, Rachael M.; Feasey, Helena R.A.; Sibande, Wakumanya; Nliwasa, Marriott; Henrion, Marc Y.R.; Khundi, McEwen; Dodd, Peter J.; Ku, Chu Chang; Kawalazira, Gift; Choko, Augustine T.; Divala, Titus H.; Corbett, Elizabeth L.; MacPherson, Peter

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.