# Presentation: 247286

## TB LABORATORY NETWORK IN MALAWI

**MAXWELL GONDWE**
**AND **
**JONES MICHONGWE**
** ****NAIROBI - KENYA**

## NTP OVERVIEW

**MALAWI DEMOGRAPHY**
- One of the poorest country in Africa
- Total area (square km) 118,484
- Growth rate 2.0
- Population  of 11..5 million people
- 65% of the population are poor
- Life expectancy – Male 40  and Female 44
- Infant mortality 121/1000 live births
- Maternal mortality 1120/100,000 live births
- National sero-prevalence 15% of people aged 15 -49
- GDP – US 200 per capita
- Health expenditure – U$ 12.4/ capita 25% for Government

## GOAL

- To eliminate Tuberculosis and reduce the burden of ill health due to Tuberculosis in patients and suspects.

**PURPOSE**

- To improve on an equitable basis the case detection, quality of diagnosis and treatment outcome

## THE TREND OF TB CASES

## TB TREATMENT OUTCOMES

## ORGANIZATION

- Tuberculosis Laboratory services in  Malawi
- are integrated into general Health Services

## Tuberculosis Laboratory Services have been
organized according to the three levels of
General health services;-

The peripheral (District, Rural, Mission and Health centres) Laboratories          85

The intermediate (Central Hospitals) Laboratories            4

The Central (CRL) Laboratory         1

**organized according to the three levels of**
**General health services;-**
- The peripheral (District, Rural, Mission and Health centres) Laboratories          85
- The intermediate (Central Hospitals) Laboratories            4
- The Central (CRL) Laboratory         1

## TB MICROSCOPY CENTRES 2001

| Type of Hospital | Northern Region | Central Region | Southern Region | Total |
| --- | --- | --- | --- | --- |
| Government Hospitals | 7 | 10 | 11 | 28 |
| Mission Hospitals | 8 | 11 | 98 | 27 |
| Rural Hosp and HCs | 3 | 6 | 11 | 20 |
| Private Hosp & clinics | 4 | 4 | 7 | 15 |
| TOTAL | 22 | 31 | 37 | 90 |

## TRAINING

- Technicians undergo an initial three year period at the Malawi College of Health Sciences or Malamulo College of Health Sciences to a Diploma level.  Others go to South Africa, Australia or the UK for a higher Diploma or Degree
- After graduation the Technicians go for TB Laboratory orientation at the CRL for 2 weeks
- TB Microscopists in the Health centres are either trained at the District Laboratory or the CRL for a minimum of 4 weeks

## In-service and refresher training courses are conducted at CRL for one week

Non- performing staff sometimes receive on-spot training at the station by Laboratory Supervisors

Some Technicians do attend international courses organized by the IUATLD or other related organizations

- Non- performing staff sometimes receive on-spot training at the station by Laboratory Supervisors
- Some Technicians do attend international courses organized by the IUATLD or other related organizations

## SUPERVISION

- The country has been divided into three Zones (Southern, Central, Northern )
- We have three Zonal Laboratory Supervisors – 1 in each of the Zones
- Supervisors visit all the Laboratories in their respective zones quarterly
- CRL TB Officers compliment the supervision
- Every institution is visited at least twice a year

## SUPPLIES

- The NTP procures some laboratory supplies twice a year.  These include TB staining reagents, microscopes, slide storing boxes, funnels, diamond pens, markers, filter papers, lens tissue and immersion oil – supported by donor stakeholders

## QUALITY CONTROL

- Each and every microscopy center keeps all the examined slides in the slide storing boxes
- The supervisor blindly selects 12 slides from the lot and re-examine
- The supervisor gives the technician 13 slides of known results to re-examine.  The results are then discussed after being plotted on the correlation table
- All technicians are encouraged to keep unstained positive and negative slides as staining controls
- All Laboratories are supplied with standard operating procedures
- The supervisor observes the technicians doing the actual work

## PROBLEMS

- Man Power – 141 qualified staff (by 2001) against 90 centres
- Transportation of sputum
- Turn over of Laboratory staff
- Negligence of procedures by Technicians
- Infrastructure – some Laboratories are very small

## VISION OF NTP ON DIAGNOSIS

- Regular update of diagnostic guidelines and need to adhere to the guidelines
- Implement good and effective quality control system for sputum smear examination (IUATLD)
- A quality assurance that has holistic approach (Transfer of samples , record keeping, communication of results) and not only clinical and Laboratory skills
- Regular availability of working tools
- Feedback of reports

## THANK YOU !!!