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The Leaving no-one behInd: transforming Gendered pathways to Health for TB (LIGHT) consortium aims to provide evidence on gender-sensitive pathways and approaches to help stop the spread of tuberculosis (TB).

As part of its work with the consortium, researchers of the African Institute for Development Policy (AFIDEP), between 14 and 17 November 2022, trained civil society actors and government officials working to prevent and end tuberculosis in Malawi on evidence-informed decision-making (EIDM).

Rebecca Karimu Mtambo, Senior Tuberculosis Quality Management Officer at Malawi’s Ministry of Health, National TB and Leprosy Elimination Programme, took part in the four-day training, and in this interview, she discusses why it was important to her and the impact it would have on her work going forward.

Among the first things one learns in Economics 101 is opportunity cost – whether it is time or money, there is something else you could be doing or have if you do decide on a particular thing. Therefore, given all you could do, why did you find it important to be trained on EIDM? 

I prioritised this EIDM training because on the whole, I considered it would be valuable to my work supporting TB prevention and care, as well as ending TB in Malawi. This approach to decision-making has exposed me to new perspectives. It has been useful in sharpening my ability to think through plans, thereby reducing the possibility of hasty decisions. It also provides an approach which helps in challenging assumptions – you consider hard data, and generally a broad range of evidence rather than feelings, biases or opinions, and in the process come to a well-founded conclusion. There is also the aspect of cost-effectiveness in that it is often expensive to test every possible solution. However, by exploring scholarly research, and by reading case studies, one can learn a great deal, especially about interventions in somewhat similar settings. This process of thoughtful, informed decision-making provides a means to carefully weigh the different options and to choose the best available and cost-effective intervention with a high probability of success.

What nugget, tip, or insight from this training has impacted your outlook, and how would you apply it to your day-to-day job? 

I have benefited a lot from the different components of the training – knowing how to develop a search strategy, access evidence, assess sources, and translate health research into policies and interventions. I believe this knowledge is a core resource that would support my work in the TB programme.

Specifically in your day-to-day job with regard to TB prevention and care, based on your experience, what would you consider the most important intervention we need now to help curb the spread and reduce the number of deaths?

The World Health Organization (WHO) End TB Strategy includes targets and milestones for substantial reductions in the annual number of TB deaths by 2035. My day-to-day work involves examining patient files and performing death audits to find out the root cause of TB mortality and to examine patterns. Accurate and reliable data is therefore essential to my work. Variables captured include age, sex, HIV status, type of tuberculosis, other existing co-morbid conditions, and phase of treatment. The reduction in TB deaths can only be achieved if everyone who develops TB can access timely, high-quality TB treatment. The primary purpose of data is to understand factors that are contributing to TB mortality, and this information is used to evaluate and improve the TB programme’s performance in addressing barriers to and delivering quality health care.

How will the EIDM training you’ve received contribute towards achieving that?

The skills I have gained through this training will be useful in my work analysing the root cause of TB deaths, and making recommendations on what we in the TB programme should target in order to reduce deaths in the country from the disease.

The LIGHT consortium, based on the evidence, emphasizes a gendered approach to end TB. Adult men account for 58% of TB cases in Malawi based on 2021 figures with cascading effects for everyone including women and children. What is your experience of this gender gap in TB while working to end the disease?

From my experience, I have seen that indeed more adult men are diagnosed with TB. Certain behaviours and social roles increase their exposure and susceptibility to infection. Men in Malawi often travel for work to other high TB-burden countries like South Africa; they work in quarries where they are exposed to silica which increases the risk of developing TB.

Heavy consumption of alcohol and tobacco are also risk factors for TB due to their immunosuppressive effects, and adult men tend to drink and smoke more than women. Finally, a lot of men who are HIV positive do not often adhere to antiretrovirals (ARVs), and this increases their risk of developing active TB due to low immunity.

What are your recommended avenues to address this gap, and how is your engagement with the LIGHT consortium supporting your work?

Officials working in the Ministry of Gender, Community Development & Social Welfare and those working in the Ministry of Health can come together as part of one health system to educate and sensitize men about TB. I would be happy and glad to work hand in hand with the LIGHT consortium to address the gap through engagements with key populations such as men living with HIV, men in prisons, and men in the mining industry. We can also conduct further research concerning gender-related factors influencing tuberculosis exposure and susceptibility. I gained a lot from the training, and I look forward to working together to help end TB in Malawi.

This is the second instalment of a two-part interview series.