Malawi: Crisis in the Wards - Malawi's Battle Against Childhood TB Crippled By Lack of Skilled Health Workers

Malawi is facing a serious challenge in fighting childhood tuberculosis (TB). A shortage of skilled health workers in district hospitals is hindering diagnosis and treatment. Dr. Samuel Chirwa, Head of Pediatric TB at the National Tuberculosis and Leprosy Elimination Program (NTLEP), shared this concern during a media briefing in Salima. He warned that urgent action is needed to protect vulnerable children.

"Case detection in children is dangerously low," said Chirwa. He explained that many suspected cases are sent to major hospitals like Kamuzu Central, Queen Elizabeth, and Mzuzu. This happens because district hospitals lack the capacity to diagnose TB in children.

In 2024, Malawi reported 1,224 cases of childhood TB, all treated. However, experts believe this number may be much lower than reality. Many cases likely go undetected due to the shortage of health workers and poor diagnostic facilities.

To address this issue, Chirwa announced new stool testing for TB in children. This method will make sample collection easier and improve early detection. "We're introducing stool sample testing for young children who cannot produce sputum," he said.

In districts like Chiradzulu, the situation is dire. District TB Officer Patrick Chikuni noted that past training efforts have been undone by staff attrition. "We trained several clinicians in advanced sample collection for child TB," he said, "but most have been transferred." No refresher or replacement training has occurred since then.

Chiradzulu Hospital recorded only four pediatric TB cases in early 2025. Health officials worry this number could be significantly underreported. As children are referred long distances for basic care, experts urge the Ministry of Health to invest in pediatric TB services at the district level.

Every delay in diagnosis puts a child's life at risk.