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Impact of COVID-19 on tuberculosis notifications in Blantyre Malawi: an interrupted time series analysis and qualitative study with healthcare workers
Rebecca Nzawa; Rachael M Burke; Helena R A Feasey; Wakumanya Sibande; Marriott Nliwasa; Marc YR Henrion; McEwen Khundi; Pete Dodd; Chu-Chang Ku; Gift Kawalazira; Augustine Choko; Titus Divala; Elizabeth L Corbett; Peter MacPherson.
Affiliation
  • Rebecca Nzawa; Malawi Liverpool Wellcome Trust Clinical Research Programme
  • Rachael M Burke; London School of Hygiene and Tropical Medicine
  • Helena R A Feasey; London School of Hygiene and Tropical Medicine
  • Wakumanya Sibande; Malawi Liverpool Wellcome Trust Clinical Research Programme
  • Marriott Nliwasa; University of Malawi College of Medicine
  • Marc YR Henrion; Malawi Liverpool Wellcome Trust Clinical Research Programme
  • McEwen Khundi; London School of Hygiene and Tropical Medicine
  • Pete Dodd; University of Sheffield
  • Chu-Chang Ku; University of Sheffield
  • Gift Kawalazira; Blantyre District Health Office
  • Augustine Choko; Malawi Liverpool Wellcome Trust Clinical Research Programme
  • Titus Divala; London School of Hygiene and Tropical Medicine
  • Elizabeth L Corbett; London School of Hygiene and Tropical Medicine
  • Peter MacPherson; Liverpool School of Tropical Medicine
Preprint in English | medRxiv | ID: ppmedrxiv-21253601
ABSTRACT
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-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.
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Full text: Available Collection: Preprints Database: medRxiv Type of study: Experimental_studies / Qualitative research Language: English Year: 2021 Document type: Preprint
Full text: Available Collection: Preprints Database: medRxiv Type of study: Experimental_studies / Qualitative research Language: English Year: 2021 Document type: Preprint
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