Gendered Programming; Key To Ending TB In Malawi
For close to two years, 42-year-old Sharifu Chiunjiza from Mbalameyanyengo village in the area of Traditional Authority Kaphuka in Dedza district in Malawi has been receiving treatment for tuberculosis (TB) after being diagnosed with the disease in 2022.
Before starting treatment, Chiunjiza had been taking painkillers until his condition worsened, forcing him to go to the hospital to get tested for tuberculosis.
”I started feeling unwell some years ago; I used to take painkillers until when in January last year I went to Dedza District Hospital where after a sputum examination, I was told I had TB infection and I was referred to Bwaila Hospital in Lilongwe,” narrates Chiunjiza.
“After starting treatment, my condition is greatly improving,” he added.
Joseph Chirwa, 40, from Kande Village, Traditional Authority Fukamapiri in Nkhata-Bay, was also diagnosed with tuberculosis in June 2023 and is now on treatment.
Just like Chiunjiza, Chirwa took sometime before he started treatment and admits that most men neglect to seek TB treatment in time mostly due to neglect.
Latest World Health Organization statistics indicate that in 2022, an estimated 10.6 million people fell ill with tuberculosis worldwide, including 5.8 million men and 3.5 million women, and the global trends reflect the situation in Malawi.
Prevalence survey findings on health seeking behavior in Malawi for 2014 established that out of 3, 432 participants who were eligible for sputum examination, 79 percent reported any TB related symptoms.
Nearly 50 percent of those has consulted someone about the symptoms they had, however the findings showed that more female study participants reported consulting someone about the symptoms they had than men.
Political Analysis of TB Management
A latest political economy analysis of the TB programming in Malawi has established that although in general, there is a comprehensive regulatory framework to guide TB programming in Malawi, there is a huge gap on gendered approaches to management of the disease.
The analysis done by African Institute for Development Policy (AFIDEP) under the Leaving No-one behind: Transforming Gendered Pathways to Health for TB (LIGHT) has established that while Malawi is making progress in TB programing, gaps still exist.
The analysis conducted between 2021 and 2022 shows that there is a huge gap in policies and guidelines for gendered approaches to TB.
AFIDEP’s Research and Policy Associate Dr Benjamin Azariah Mosiwa says increasing reliance on foreign borrowing and donor aid as well as faith-based healing are some of the factors negatively affecting efforts to end TB in Malawi with the later impeding on health seeking behavior.
“Generally the national TB Control Program and the Government of Malawi have done a tremendous job in developing robust institutional frameworks that guide TB programming in Malawi, however, there are some gaps on gendered approach to TB programming in Malawi,” said Dr Mosiwa.
“Research shows that TB is predominantly among men so with such kind of discrepancies in terms of gender differences, you expect to have strong language in terms of how we approach men to receive treatment,” he adds.
According to Paradiso TB Patient Trust Executive Director Bruce Matewere, discrimination is one other key factor affecting TB response in the country.
TB and HIV fellow at the National Tuberculosis and Leprosy Elimination Program Dr Samuel Chirwa says the country is on track on end TB but admits that the gender element in TB programming is a relatively new concept.
“If you look at where we were in 2015 and where we are now, the trends have been consistently going down and with regards to the End TB Strategy, we are on track to reach that target,” says Dr Chirwa.
“But the concept of gender and TB is relatively new, however, right now, the LIGHT consortium is leading the strides to make sure TB and gender issues are addressed,” he adds.
Recently AFIDEP and other partners such as Journal Aids organized a science media café to discuss the status of TB programming in Malawi and ways to address challenges that continue to affect the response with consideration of gendered response.
Rhoda Mbeta from Menyani Village T/A Kawere in Mchinji who attended the media science café’ and works as a volunteer encouraging TB patients to adhere to treatment observed that stakeholders need to ensure that the issue of stigma is also addressed.