Date of Award


Document Type

Honors Thesis (Open Access)


Colby College. Environmental Studies Program


Gail Carlson

Second Advisor

Philip Nyhus

Third Advisor

William McDowell


Despite Tuberculosis (TB) being a highly curable disease, it continues to result in over 5% of deaths in the Sub-Saharan African country of Malawi. Coupled with HIV, the disease remains one of the leading causes of death in Malawi. In the summer of 2015, I joined a research team from Partners in Hope to conduct a survey evaluating the health centers that provide TB care in the Kasungu region of Malawi. After visiting 23 health centers, the results of the 47-question survey were compiled and analyzed to provide information on the capabilities and practices at each health center. The results of the survey revealed several factors that may result in an under-diagnosis of TB in Kasungu. Complications arising from dual infection of HIV and TB render the standard microscope diagnosis method less accurate, and patients are not being referred to the district hospital to receive a proper diagnosis by over 90% of health centers. The quality of record keeping was found to be insufficient at over 40% of health centers, which limited this study’s ability to track patients from one site to another. The sputum collection system using satellite collection sites, which is designed to decrease the burden of travel on patients needing TB diagnosis services, is almost completely defunct. Health center staff, who are themselves overworked, identified lack of transportation as a major barrier for patients to receive care for TB. In order to diagnose a higher percentage of TB cases in Kasungu, health center staff needs to be provided with more information to follow referral procedures and keep patient records with more accuracy. Subsidized transportation would additionally reduce the burden of travel on patients and allow for more diagnoses to be made. TB record-keeping supplies, in short supply at most of the health clinics, should be delivered along with the readily available TB medications.


Tuberculosis, Malawi, Diagnosis, Treatment, Kasungu