Malawi’s fight against childhood tuberculosis (TB) is under serious threat as a critical shortage of skilled health workers in district hospitals continues to stall diagnosis and treatment of the disease among children.
Dr. Samuel Chirwa, Head of Pediatric TB at the National Tuberculosis and Leprosy Elimination Program (NTLEP), made the grim revelation during a biannual media and faith leaders’ briefing held in Salima. He warned that without urgent action, children–one of the most vulnerable populations–will continue to fall through the cracks of the health system.
“Case detection in children remains dangerously low due to lack of trained personnel at district level,” said Chirwa. “Suspected cases are constantly being referred to major central hospitals–Kamuzu Central, Queen Elizabeth and Mzuzu–because district hospitals lack the capacity to diagnose TB in children.”
In 2024, Malawi registered 1,224 cases of childhood TB, all of whom were placed on treatment. But experts warn that this figure could be just the tip of the iceberg, as many cases likely go undetected due to health worker shortages and inadequate diagnostic infrastructure.
To bridge the gap, Chirwa announced the rollout of stool testing for TB in children–a method expected to ease sample collection and improve early detection.
“We’re introducing stool sample testing to make it easier to diagnose TB in young children who cannot produce sputum,” he said.
But in districts like Chiradzulu, the crisis is already biting hard. District TB Officer Patrick Chikuni admitted that despite past efforts to train clinicians in pediatric TB diagnosis, staff attrition has reversed the gains.
“We trained several clinicians in advanced sample collection for child TB, but most of them have been transferred. No refresher or replacement trainings have been conducted since then,” Chikuni lamented.
Chiradzulu Hospital has recorded just four pediatric TB cases in the first quarter of 2025–a number health officials fear could be grossly underreported.
As children continue to be referred long distances for basic diagnostic care, experts and advocates are now calling on the Ministry of Health to invest urgently in decentralizing pediatric TB services and restoring capacity at district level.
With every delay in diagnosis, a child’s life hangs in the balance.
