Towards TB elimination in Malawi: a 5-year analysis of key indicators for TB control using surveillance data.

Abstract

Background: Malawi's TB Control Programme emphasises data-driven approaches for monitoring TB control efforts, but programmatic indicators have never been systematically evaluated. This study evaluates the performance of Malawi's TB Control Programme, providing insights into national trends, geographical distributions, and programmatic gaps in TB care.

Methods: Aggregate TB data collected through Malawi's District Health Information System from 2018 to 2022 were analysed cross-sectionally. We analysed trends in TB incidence and case notification rates (CNRs), calculated performance indicators, and assessed district-level variations using time-series plots and statistical comparisons. Population estimates were derived from the 2018 census and adjusted for annual growth.

Findings: Malawi reported 18,025 new persons with TB in 2022. From 2005 to 2018, TB incidence and CNRs declined by 68.6% and 54.5%, respectively. The highest CNRs were recorded among men aged 35-64 years. Treatment success rates improved overall, reaching 89.2% in 2022, though disparities persisted for HIV-positive patients and those treated at tertiary facilities.

Conclusion: Challenges remain in Malawi's TB control efforts, particularly in addressing case detection gaps in high-burden districts and improving outcomes for vulnerable populations. Strengthening active case finding, enhancing diagnostic capacity, and addressing socio-economic determinants of health are essential for sustaining progress and achieving END-TB Strategy goals.