Completeness and Reliability of the Republic of South Africa National Tuberculosis (TB) Surveillance System.
Completeness and Reliability of the Republic of South Africa National Tuberculosis (TB) Surveillance System.
复制标题
DOI：
10.1186/s12889-015-2117-3
复制
发表时间：
2015-08-11
影响因子：
4.5
通讯作者：
Mametja LD
中科院分区：
文献类型：
--
作者：
Podewils LJ;Bantubani N;Bristow C;Bronner LE;Peters A;Pym A;Mametja LD
准确的监测数据对有效控制结核病至关重要。南非共和国的国家结核病控制规划（NTP）自1995年以来一直进行结核病监测，并于2005年采用了电子结核病登记册（ETR）。这项评价旨在确定南非共和国结核病监测系统数据的完整性和可靠性。九个省中的三个省，每个省三个分区和54个卫生设施被分层随机抽样选中。在每个机构，随机选择2009年第一季度诊断的30名（或所有<30名）患者进行审查。通过两种纸质和四种电子来源评价患者信息。纸和电子源之间的程序指标的完整性进行了比较卡方检验。使用kappa统计量评价数值的一致性。超过三分之一（33.7%）的结核病疑似登记簿中记录为涂片阳性的推定结核病患者没有任何记录，记录了结核病的通知、治疗或管理。在该机构有结核病患者记录的1339人中，1077人（80%）在所有数据源中均有记录。超过98%的记录包含完整的年龄和性别数据。在强化治疗阶段，HIV状态（53- 86%; p < 0.001）和DOT（17- 54%; p < 0.001）的完整性各不相同。各来源的性别一致性极佳（kappa 0.94）;患者类型（0.78）、治疗方案（0.79）、治疗结局（0.71）为中度; HIV状态较差（0.33）。目前的评估显示，三分之一被诊断患有结核病的人可能没有被告知他们的疾病或开始接受治疗（“初始违约者”）。ETR并没有捕捉到所有的结核病患者。此外，在有结核病记录的患者中，结核病监测系统中信息的完整性和可靠性在不同数据来源之间不一致。迫切需要采取行动，确保所有确诊患者得到治疗和管理，并提高监测信息的完整性。
Accurate 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. Three 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. Over 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). The 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.