Evaluating the use of pathology in improving diagnosis in rural Malawi|
Kachimanga, Chiyembekezo; Phiri, Atupere; Manase, Fatsani; Cundale, Katie; Talama, George; Kamiza, Steve; Nazimera, Lawrence; Jumbe, Arnold; Kalanga, Noel; Fosiko, Nedson; Masamba, Leo; Masamba, Leo Wroe, Emily B. & Wroe, Emily B.
Limited data exists on histologically confirmed cancers and tuberculosis in rural Malawi, despite the high burden of both conditions.
One of the main reasons for the limited data is the lack of access to pathology services for diagnosis. We reviewed histopathology
results of patients in Neno District, one of the poorest rural districts in Malawi, from May 2011 to July 2017, with an emphasis on
cancers and tuberculosis.
This is a retrospective descriptive study reviewing pathology results of samples collected at Neno health facilities and processed at
Kamiza Pathology Laboratory. Data was entered into Microsoft Excel and cleaned and analysed using Stata 14.
A total of 532 specimens were collected, of which 87% (465) were tissue biopsies (incision or core biopsies), and 13% (67) were
cytology samples. Of all specimens, 7% (n=40) of the samples had non-diagnostic results. Among the results that were diagnostic
(n=492), 37% (183) were malignancies, 33% (112) were infections and inflammatory conditions other than tuberculosis, 20% (97)
were benign tumours, 7% (34) were tuberculosis, 4% (21) were pre-malignant lesions, 5% (23) were normal samples, and 4% (22) were
other miscellaneous conditions. Among the malignancies (n=183), 62% (114) were from females and 38% (69) from males. Among
females, almost half of the cancers were cervical (43%, n= 49), followed by Kaposi sarcoma (14%, n=16), skin cancers (9%, n=10),
and breast cancer (8%, n=9). In males, Kaposi sarcoma was the most common cancer (35%, n=24), followed by skin cancers (17%,
n=12). About 75% (n=137) of the cancers occurred in persons aged 15 to 60 years.
Histopathology services at a rural hospital in Malawi provides useful diagnostic information on malignancies, tuberculosis and other
diagnoses, and can inform management at the district level.
malignancies; Tuberculosis; Malawi; Neno; pathology