With a population of approximately 18 million people, Malawi has one of the highest estimated numbers of incident TB cases among people with HIV. Nearly 26000 people are estimated to have developed TB, and an additional 11615 are considered missing persons with TB. There is, however, another optimistic statistic. The TB treatment success rate in the nation is more than 80%. This means that Malawi needs active TB screening programs to stay ahead of the curve.
Most of the nation lives in rural areas where our OneStopTB clinics have been helpful. In 2016, Delft Imaging provided seven OneStopTB clinics to the country, fitted with EasyDR multi-functional, stationary X-ray systems. The nation was classified into seven regions, with each area assigned its OneStopTB clinic. Additionally, several training sessions were conducted for the capacity building of personnel. This included application and user training on the OneStopTB clinic and EasyDR, IT training (PACS and CAD4TB) and technical support. Each mobile clinic still functions today, with maintenance services provided every year.
Moreover, in 2016, we supplied two EasyPortable X-ray systems and the CAD4TB artificial intelligence software to the KNCV in Malawi. The solutions supported TB active case-finding activities under the Challenge TB project in Malawi.
Across 2017, 2018 and 2019, numerous sites received the CAD4TB artificial intelligence software, including the Ministry of Health (National Tuberculosis Program), Philips, and the Liverpool School of Tropical Medicine.
In 2022, we delivered a variety of solutions to Malawi. Firstly, a Delft Light portable X-ray system was delivered to the country and used by the National Tuberculosis Program. Then, later that year, Delft Imaging provided 15 MAC mobile X-ray systems and the CAD4TB software to the Ministry of Health in Malawi. In 2023, another MAC system was provided to a private hospital.
In 2024, Malawi bought a new service contract for the seven mobile clinics in the country, ensuring easy system checks and maintenance, and two more Delft Light, together with CAD4TB.
Making a difference
Over the years, different stakeholders in Malawi have published about utilising the OneStopTB clinics and the CAD4TB software. Their scientific efforts showed that digital CXR using CAD4TB with universal HIV screening significantly increased timelines and completeness of HIV and TB diagnosis.
For more information about how the OneStopTB mobile clinics are used in Malawi, please view the story ‘Targeted Active TB Case Finding Using Mobile TB Diagnostics Units in Malawi, presented by Dr. Isaias Dambe of the National TB and Leprosy Elimination Program in Malawi. The story was presented during the Q2 webinar of 2022. During the webinar, Dr. Dambe noted: “Malawians have poor health-seeking behaviour. About 36% of those sick don’t go to the hospital. Another 50% go to the hospital, but the health system can’t help them. Therefore, we realised that there is a need for active TB case-finding. We approached the WHO, and they recommended the Global Fund, which assisted us in procuring mobile X-ray diagnostic clinics for communities, especially the vulnerable. We procured seven mobile X-ray clinics from Delft Imaging to cover our nation.”
TB has been extensively used in Malawi, please view the story of ‘Computer-Aided X-ray Screening for Tuberculosis and HIV Testing: A Randomised Trial and Cost-Effectiveness Analysis in Malawi’, as presented by Dr. Peter MacPherson. The story was presented during the Delft Q4 webinar of 2022.
The CASTLE study in Malawi used CAD4TB to enhance TB diagnosis in adults with HIV through computer-aided chest X-rays and urine LAM tests. This cluster randomized trial demonstrated improved diagnostic accuracy for TB in hospitalized patients. Read the full study here.
Case Study
Dive into these impactful case studies from Malawi:
Find missing cases of TB in high-risk populations with OneStopTB Clinic in 2021: During a mass TB screening at a busy bus terminal, over 2,000 people were screened, uncovering 22 confirmed TB cases. This demonstrates how systematic screening with the OneStopTB Mobile Clinic can enhance TB case detection
Active TB Case-finding with OneStopTB Clinic in 2022: Discover how this OneStopTB Mobile Clinic is vital in identifying and treating TB effectively, emphasizing the need for expanded resources in active TB case finding.
Improving TB Case-finding in Key Populations with OneStopTB Clinic in 2023: The NTLEP’s mobile outreach for TB screening in 28 districts utilized digital X-ray, CAD4TB, and GeneXpert, revealing a high TB incidence among various high-risk groups. Learn about the significant findings from this approach, which underscores the necessity for targeted screening strategies and the effectiveness of combining X-ray and symptom screening in TB detection.
