No one knows how many Malawians have TB, but officials fear that only half of those with the disease are able to access testing and treatment. What is known is that "TB is a huge public health problem," said Daniel Nyangulu, technical adviser to Malawi's National TB Control Program (NTCP).

Numerous challenges have thwarted TB control efforts in Malawi, including:
*Rural setting. The UN says 85 percent of Malawians live in rural areas where they must travel an average of three miles to reach a clinic or hospital.
*Poverty. In rural areas, 60 percent of residents live below the poverty level of $1 per day.
*Low knowledge of TB. Nyangulu said few rural residents understand TB or its symptoms.

A new initiative by NTCP seeks to overcome these challenges. Major activities include:
*In remote areas without health clinics, volunteers are collecting sputum from people with TB symptoms, then transporting it to labs for testing.
*The program encourages everyone in an infected person's household, especially children, to be tested.
*NTCP's TB testing centers are offering HIV screening as well as TB tests, in the hope of identifying those who are co-infected.
*At large hospitals, walk-in testing centers are being set up so those needing TB screening can be dealt with expeditiously.
*In Malawi's prisons, correctional authorities are being encouraged to offer TB testing to all new inmates, as well as to test other prisoners on a regular basis.

In addition, the health department is embarking on a national TB prevalence survey. The knowledge of just how widespread TB is in Malawi is seen as key to developing strategies to contain it, Nyangulu said.