By Owen Nyaka, contributor:
After 16 years of marriage, Suche, from Nkhata Bay District, was abandoned by her husband.
He decided to marry another woman, leaving Suche to cope alone with life-threatening and highly contagious multi-drug-resistant tuberculosis (MDR-TB).
In 2003, Suche was one of three MDR-TB patients identified at Nkhata Bay District Hospital, according to Mavuto Khomba, the district’s TB officer.
He mentioned that in 2024, there were 200 cases of TB, including 16 children.
Suche’s two young children, both under five, are at risk. Her aunt, who brews a local alcoholic drink called mkontho, is not a reliable caregiver.
Although her aunt is an ex-TB patient, she cannot be trusted to care for Suche or her children.
The children often go without proper nutrition and are exposed to harmful smoke from open fires used in brewing mkontho.
At times, their house becomes overcrowded with heavily intoxicated mkontho customers, some of whom are chain-smokers of unprocessed cigarettes known as chingambwe.
Though it is believed that the children contracted TB from adult contacts, like many young children, they remain largely invisible in the fight to end TB.
Suche’s children, like most children in Malawi and beyond, face significant challenges in diagnosing TB.
Pulmonary TB, the most common form, presents with respiratory symptoms.
Diagnosis is often confirmed through sputum analysis and chest X-rays, but young children struggle to produce sputum for testing.
Deputy Director of the National TB and Leprosy Elimination Programme (Ntlep), Kuzani Mbendera, explains that it is not practical to ask young children to submit sputum.
“As they grow older, they are better able to produce sputum, but for the youngest children, sputum tests are typically ineffective.
“It takes only a small number of TB bacteria to cause illness in a child and even if sputum is collected, the bacteria present may be so few that they are difficult to detect, even with advanced testing,” Mbendera says.
A TB specialist at Ntlep, Samuel Chirwa, adds that while chest X-rays are helpful in diagnosing TB in both adults and children, they rely on visible changes in the lungs caused by TB.
“However, due to the paucity of TB bacteria in young children, these changes may be minimal or non-existent.
“TB diagnosis is often based on epidemiological and clinical features – looking at where TB is common and the symptoms presented,” Chirwa explains.
Other diagnostic methods depend on the type of TB suspected, such as gastric aspirates or body fluids when TB meningitis is suspected.
Mbendera states that there are techniques to obtain sputum from children.
Since children swallow sputum instead of coughing it out, a feeding tube can be inserted through the nose or mouth into the stomach to collect it.
Alternatively, as swallowed sputum is eventually digested and excreted in stool, stool samples can be tested for TB.
“The stool method is simpler and more acceptable than using a feeding tube. However, even with these tech
