Undernotification and underreporting of tuberculosis in Zambia: a national data quality assessment.
Undernotification and underreporting of tuberculosis in Zambia: a national data quality assessment.
复制标题
DOI：
10.1186/s12913-022-08431-2
复制
发表时间：
2022-08-22
影响因子：
2.8
通讯作者：
Malama, K.
中科院分区：
文献类型：
--
作者：
Lungu, P. S.;Kabaso, M. E.;Mihova, R.;Silumesii, A.;Chisenga, T.;Kasapo, C.;Mwaba, I;Kerkhoff, A. D.;Muyoyeta, M.;Chimzizi, R.;Malama, K.
尽管赞比亚在全国实施了几项高影响力的干预措施和创新措施，以加强结核病检测和提高结核病服务质量，但自2004年以来，通报率一直在下降。对赞比亚国家结核病和麻风病规划（NTLP）进行了全国范围的数据质量评估（DQA），以量化可能发生的结核病通报少报和漏报的程度。全国解决方案对赞比亚所有10个省的高负担地区的卫生设施进行了回顾性的DQA。通过多步骤验证过程对多个常规规划数据源进行三角测量，以列举2019年1月1日至8月31日期间诊断出的独特结核病患者总数；包括细菌学确诊和临床诊断的结核病患者。漏报定义为通过DQA确定的未在设施治疗登记册中记录的结核病患者数量，而漏报定义为未向国家结核病处理方案报告的已通报结核病病例数量。总体而言，对55个县的265个卫生设施进行了评估，从中确定了28,402名结核病患者；94.5%的结核病患者年龄≥15岁，65.1%为男性，52.0%为hiv阳性，89.6%为新发/复发病例。在所有结核病例中，32.8% （95%CI: 32.2-33.3）未通报。漏报与年龄≥15岁（校正患病率优势比[aPOR] = 2.4 [95%CI: 2.0-2.9]）、hiv阳性状态（aPOR = 1.6 [95%CI: 1.5 - 1.8]）、新发/复发结核病例（aPOR = 17.5 [95%CI: 13.4-22.8]）、临床诊断结核病例（aPOR = 4.2 [95%CI: 3.8-4.6]）和在医院确诊相关（范围，aPOR = 1.5 [95%CI: 1.3-1.6]至2.6 [95%CI: 2.3-2.9]）。各省未通报结核病病例的比例存在很大的异质性（范围为18.2%至43.6%）。在22199例有进一步数据的结核病患者的亚分析中，55.9% （95%CI: 55.2-56.6）的患者被通知并报告给NTLP， 32.8% （95%CI: 32.2-33.4）的患者未被通知，11.3% （95%CI: 10.9-11.7）的患者未报告给NTLP。赞比亚首个全国性结核病规划DQA的调查结果表明，所有省份的结核病病例都存在严重的漏报和漏报现象。这突出表明，迫切需要实施一个强有力的综合数据管理系统，以便及时登记和报告所有得到诊断和治疗的结核病患者。
Despite national implementation of several high impact interventions and innovations to bolster tuberculosis (TB) detection and improve quality of TB services in Zambia, notifications have been declining since 2004. A countrywide data quality assessment (DQA) of Zambia’s National TB and Leprosy Programme (NTLP) was undertaken to quantify the degree to which undernotification and underreporting of TB notifications may be occurring. The NTLP conducted a retrospective DQA of health facilities in high burden districts in all ten Zambian provinces. Multiple routine programmatic data sources were triangulated through a multi-step verification process to enumerate the total number of unique TB patients diagnosed between 1st January and 31st August 2019; both bacteriologically confirmed and clinically diagnosed TB patients were included. Undernotification was defined as the number of TB patients identified through the DQA that were not documented in facility treatment registers, while underreporting was defined as the number of notified TB cases not reported to the NTLP. Overall, 265 health facilities across 55 districts were assessed from which 28,402 TB patients were identified; 94.5% of TB patients were ≥ 15 years old, 65.1% were male, 52.0% were HIV-positive, and 89.6% were a new/relapse case. Among all TB cases, 32.8% (95%CI: 32.2–33.3) were unnotified. Undernotification was associated with age ≥ 15 years old (adjusted prevalence odds ratio [aPOR] = 2.4 [95%CI: 2.0–2.9]), HIV-positive status (aPOR = 1.6 [95%CI: 1.5–1.8]), being a new/relapse TB case (aPOR = 17.5 [95%CI: 13.4–22.8]), being a clinically diagnosed TB case (aPOR = 4.2 [95%CI:3.8–4.6]), and being diagnosed at a hospital (range, aPOR = 1.5 [95%CI: 1.3–1.6] to 2.6 [95%CI: 2.3–2.9]). There was substantial heterogeneity in the proportion of unnotified TB cases by province (range, 18.2% to 43.6%). In a sub-analysis among 22,199 TB patients with further data available, 55.9% (95%CI: 55.2–56.6) were notified and reported to the NTLP, 32.8% (95%CI: 32.2–33.4) were unnotified, and 11.3% (95%CI: 10.9–11.7) went unreported to the NTLP. The findings from Zambia’s first countrywide TB programme DQA demonstrate substantial undernotification and underreporting of TB cases across all provinces. This underscores the urgent need to implement a robust and integrated data management system to facilitate timely registration and reporting of all TB patients who are diagnosed and treated.
登录
查看更多内容
影响因子：
3.7
作者：
Kapata N;Chanda-Kapata P;Ngosa W;Metitiri M;Klinkenberg E;Kalisvaart N;Sunkutu V;Shibemba A;Chabala C;Chongwe G;Tembo M;Mulenga L;Mbulo G;Katemangwe P;Sakala S;Chizema-Kawesha E;Masiye F;Sinyangwe G;Onozaki I;Mwaba P;Chikamata D;Zumla A;Grobusch MP
通讯作者：
Grobusch MP
影响因子：
24.3
作者：
Uplekar, Mukund;Atre, Sachin;Raviglione, Mario
通讯作者：
Raviglione, Mario
影响因子：
4.5
作者：
Podewils LJ;Bantubani N;Bristow C;Bronner LE;Peters A;Pym A;Mametja LD
通讯作者：
Mametja LD
影响因子：
2.9
作者：
Li, Tao;Shewade, Hemant Deepak;Wang, Lixia
通讯作者：
Wang, Lixia
影响因子：
6.4
作者：
Chin, Daniel P.;Hanson, Christy L.
通讯作者：
Hanson, Christy L.