Malawi is facing a critical shortage of tuberculosis drugs, with health officials warning that stocks will run out by the end of September.
It comes just months after the World Health Organization (WHO) revealed that the country had successfully reduced tuberculosis (TB) cases by 40% over the past decade.
In March, the WHO’s country representative, Dr Neema Rusibamayila Kimambo, announced that Malawi had also seen a high rate of success in treating TB and a significant reduction in the number of deaths.
But the health ministry, which was already badly hit by the cuts in aid from the US, UK and other donors, has been forced to warn the public of low stocks of first-line TB medicines across Malawi, which means patients may find their treatment disrupted or ended.
Dr Samson Mndolo, Malawi’s secretary for health, said the low stock was down to disruption in the global supply of pharmaceutical ingredients, worsened by declining international support and aid, and said newly diagnosed patients may be denied access to the standard drug regimens.
Some hospitals in the country have already reported having to borrow stock from other facilities.
In the city of Blantyre, the TB officer, Lackson Namuku Gama, said the district pharmacy had no stocks at all of the TB drugs to distribute to the 45 health facilities it supplies.
Gama said: “We registered zero stock of the TB drug at our district pharmacy, especially the RHZE, which is the main drug used in the initial phase of treatment. To save our patients, we had to run up and down and borrow from other facilities to ensure we have something to give to our patients.
“We have scaled down on the dose ration given to the patients,” he said.
Gama said the district has also run out of the cartridges used for diagnosis of TB samples and that they had been forced to stop all testing.
The TB officer for the neighbouring district of Rumphi, Umar Mwamadi, estimated that the district had enough stocks of drugs to last another month.
“We are not yet affected by the stock out, but we are also at a greater risk because our drug can only take us up to mid or late September,” he said.
Wongani Nyirenda, a hospital official in Machinga district, said stocks were also low there.
“The situation is manageable because we can mobilise drugs from one facility or district which has [stocks] to another, which is in need, to save lives. But the problem may get worse in the next few weeks when all facilities will be [without supplies],” said Nyirenda.
A Malawi health rights activist, Maziko Matemba, called on the government to intervene to avoid chaos as more facilities across the country struggled to find supplies.
“It is high time African countries should start manufacturing some of these drugs,” he said.
Despite the decline in cases, TB remains a public health concern in Malawi and has been hit badly by the drop in international funding, with an estimated incidence rate of 119 per 100 000 people (compared with eight per 100,000 in the UK) and a mortality rate of 38.6 per 100,000. According to the US Centers for Disease Control and Prevention (CDC), 47% of TB cases in Malawi are co-infected with HIV.
Malawi is one of the world’s poorest countries, with 70% of its 21.66 million people living in extreme poverty, on less than $2.15 a day, and 51% of the population eating less than the minimum daily calorie intake.