Tuberculosis programme changes and treatment outcomes in patients with smear-positive pulmonary tuberculosis in Blantyre, Malawi

Malawi is one of the poorest countries in the world. Despite the lack of resources, the country has a good tuberculosis (TB) recording and reporting system, developed in 1984 by the International Union against Tuberculosis and Lung Disease. Since 1985, Malawi has experienced an upsurge in TB notifications, mainly because of the HIV epidemic. The number of notified TB cases rose from 5334 in 1985 to 19 496 in 1994, according to the Malawi national TB programme. The national cure rate decreased from 80% in 1988 to 63% in 1992, as the TB programme struggled to cope with increasing numbers of patients while the economic situation worsened. The deterioration in treatment outcomes was more pronounced in the large cities of Blantyre and Lilongwe than elsewhere. This feature causes concern because Queen Elizabeth Central Hospital, Blantyre, and Kamuzu Central Hospital, Lilongwe, diagnose and treat 30-40% of all registered TB cases in Malawi. We have assessed the rates of TB notifications and treatment outcomes in Queen Elizabeth Central Hospital and the measures introduced to improve treatment outcomes.