Abstract

PIP: The rates of tuberculosis (TB) notifications and treatment outcomes in Queen Elizabeth Central Hospital in Blantyre, Malawi, and the measures introduced to improve treatment were assessed by analyzing patient records and treatment outcomes. From 1989 to 1991, the number of TB cases registered increased by 58%. From 1991 to 1993, the number of cases per year did not change. However, from 1991 onward the number of TB patients within Blantyre district continued to rise, and treatment outcomes in new smear-positive TB patients deteriorated substantially. In 1991 the cure rate for the last two quarters was 32% and the default rate was more than 40%. The increase in TB patients between 1989 and 1991 strained TB services and contributed to the deterioration in treatment outcomes. In 1991 measures were taken to counter the worsening trend with a focus on staffing, staff activities, treatment regimens, and sputum-collection procedures. The arrival of a physician in July 1991 and another in October 1992 led to improved diagnosis and more extensive health education of patients. In May 1993 a health surveillance assistant was hired for health education and supervision of patients. In July 1993 a district health TB officer was appointed to supervise TB activities in health centers. Also, monthly TB meetings were started for all health staff. At the end of 1993 the number of nurses were also increased. In October 1991 an outpatient regimen for smear-negative pulmonary TB and moderate extrapulmonary TB replaced the standard regimen. This new regimen consisted of 2 months of rifampicin, isoniazid, and pyrazinamide each given three times per week, followed by 2 months of daily isoniazid and ethambutol, and then 4 months of isoniazid. Then, in March 1992, another regimen was introduced: 1 month of daily streptomycin, rifampicin, isoniazid, and pyrazinamide followed by 1 month of these drugs three times per week, and then 6 months of maintenance treatment with isoniazid and thiacetazone.