Exploring post-TB morbidity in urban Blantyre, Malawi (ExPo-TB)
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Date
2021-10-18
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Publisher
Liverpool School of Tropical Medicine
Abstract
This is a cross-sectional study
The clinical problem
Previous work completed in urban Blantyre, Malawi has demonstrated a high burden of ongoing respiratory morbidity amongst adults successfully completing pulmonary tuberculosis (PTB) treatment, including structural lung damage and abnormal spirometry in over a third of patients. These findings are consistent with data from
other settings. We have since shown that this post-TB lung disease (PTLD) is associated with chronic symptoms, ongoing health seeking, and adverse socioeconomic outcomes in Malawi. However, there remain no guidelines
for the clinical management of post-TB lung disease, and services for symptomatic former TB patients remain limited.
In a recent NIHR funded programme of stakeholder engagement around post-TB care in East Africa, in which we interviewed 39 policy makers, funders, health care providers, and TB-survivors in Malawi and Kenya, a need was expressed for more local, programmatic data on the burden of post-TB morbidity, in order to inform decision
making around investment in the prevention and management of post-TB morbidity.
In addition, the management of TB survivors presenting to health services with chronic or recurrent respiratory symptoms (cough, chest pain, breathlessness, sputum) was identified as a key area of clinical concern for patients
and providers. In the absence of standardised clinical care pathways, these patients are frequently managed with empirical antibiotics or TB retreatment, whilst underling PTLD remains undiagnosed and untreated.
This cross-sectional study will leverage existing links between the Malawi-Liverpool-Wellcome Trust (MLW) and the Malawi National TB Programme (NTP) in urban-Blantyre to address these challenges, by systematically measuring the existing burden of post-TB morbidity, and describe the existing context of post-TB care.
Aims and Broad objectives
The aim of this study is to describe the burden, experiences and management of post-TB morbidity amongst TB survivors in urban Blantyre.
Specific objectives
1. To systematically measure the burden of residual physical and psychosocial morbidity experienced by TBsurvivors within urban Blantyre, at TB treatment completion.
2. To understand produce a narrative analysis of TB-survivor beliefs about residual or recurrent respiratory symptoms after TB treatment completion, and how this informs health seeking practices experiences of health seeking, in Bangwe township.
3. To understand produce a narrative analysis of the beliefs and practices of health care providers in urban Blantyre, when managing TB survivors with residual or recurrent respiratory symptoms after TB treatment completion.
Description
Keywords
Tuberculosis Morbidity in Blantyre Urban