Completeness and Reliability of the Republic of South Africa National Tuberculosis TB Surveillance SystemReportar como inadecuado

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BMC Public Health

, 15:765

First Online: 11 August 2015Received: 22 May 2013Accepted: 03 August 2015DOI: 10.1186-s12889-015-2117-3

Cite this article as: Podewils, L.J., Bantubani, N., Bristow, C. et al. BMC Public Health 2015 15: 765. doi:10.1186-s12889-015-2117-3


BackgroundAccurate surveillance data are paramount to effective TB control. The Republic of South Africa’s National TB Control Program NTP has conducted TB surveillance since 1995 and adopted the Electronic TB Register ETR in 2005. This evaluation aimed to determine the completeness and reliability of data in the Republic of South Africa’s TB Surveillance System.

MethodsThree of nine provinces, three subdistricts per province, and 54 health facilities were selected by stratified random sampling. At each facility, 30 or all if <30 patients diagnosed in Quarter 1 2009 were randomly selected for review. Patient information was evaluated across two paper and four electronic sources. Completeness of program indicators between paper and electronic sources was compared with chi-square tests. The kappa statistic was used to evaluate agreement of values.

ResultsOver one-third 33.7 % of all persons with presumptive TB recorded as smear positive in the TB Suspect Register did not have any records documenting notification, treatment, or management for TB disease. Of 1339 persons with a record as a TB patient at the facility, 1077 80 % were recorded in all data sources. Over 98 % of records contained complete age and sex data. Completeness varied for HIV status 53-86 %; p < 0.001 and DOT during the intensive phase of treatment 17-54 %; p < 0.001. Agreement for sex was excellent across sources kappa 0.94; moderate for patient type 0.78, treatment regimen 0.79, treatment outcome 0.71; and poor for HIV status 0.33.

ConclusionsThe current evaluation revealed that one-third of persons diagnosed with TB disease may not have been notified of their disease or initiated on treatment ‘initial defaulters’. The ETR is not capturing all TB patients. Further, among patients with a TB record, completeness and reliability of information in the TB Surveillance System is inconsistent across data sources. Actions are urgently needed to ensure that all diagnosed patients are treated and managed and improve the integrity of surveillance information.

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Autor: Laura Jean Podewils - Nonkqubela Bantubani - Claire Bristow - Liza E Bronner - Annatjie Peters - Alexander Pym - Lerole D


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