Under-reporting of diagnosed tuberculosis to the national surveillance system in China: an inventory study in nine counties in 2015
Under-reporting of diagnosed tuberculosis to the national surveillance system in China: an inventory study in nine counties in 2015
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DOI：
10.1136/bmjopen-2018-021529
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发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Wang, Lixia
中科院分区：
文献类型：
--
作者：
Li, Tao;Shewade, Hemant Deepak;Wang, Lixia
目的世界卫生组织估计，近40%的结核病患者未报告。我们实施了这项研究，以评估中国9个县的结核病漏报和延迟治疗登记情况。设计（记录回顾）。设置县是使用有目的的抽样从分布在东部，主要和次要结局指标漏报率计算为未向结核病信息中心报告的结核病患者百分比。管理系统（TBIMS）在诊断后6个月内。延迟登记估计为诊断后7天或更长时间开始治疗的报告病例的百分比。多变量Logistic回归和α水平为0.05被用来检查与这些outcome.Results项目卫生设施和社会保险系统确定的5606例结核病患者，1082（19.3%）没有报告给TBIMS的因素。在成功报告的4524例患者中，1416例（31.3%）未在诊断后7天内登记治疗。儿童、结核性胸膜炎、东部和中部地区确诊的患者以及在卫生机构或社会保险系统（但不是两者）中记录的结核病诊断患者在统计学上更有可能未报告。延迟治疗登记是更有可能为以前治疗过的结核病患者，阴性或未知的痰结果的患者和东部region.Conclusion几乎每五个诊断为结核病的患者在这项研究中是未知的地方或国家结核病控制计划的患者。我们建议加强结核病数据管理实践，特别是在东部和中部地区，并制定报告儿童结核病和结核性胸膜炎的具体指南。通过诊断设施对患者进行教育和随访，可以改善及时的治疗登记。需要更多的研究来评估中国其他地方的漏报情况。
Objective The WHO estimates that almost 40% of patients diagnosed with tuberculosis (TB) are not reported. We implemented this study to assess TB under-reporting and delayed treatment registration in nine counties in China.Design A retrospective inventory study (record review).Setting Counties were selected using purposive sampling from nine provinces distributed across eastern, central and western regions of China in 2015.Primary and secondary outcome measures Underreporting was calculated as the percentage of patients with TB not reported to TB Information Management System (TBIMS) within 6 months of diagnosis. Delayed registration was estimated as the percentage of reported cases initiating treatment 7 or more days after diagnosis. Multivariable logistic regression and an alpha level of 0.05 were used to examine factors associated with these outcomes.Results Of the 5606 patients with TB identified from project health facilities and social insurance systems, 1082 (19.3%) were not reported to TBIMS. Of the 4524 patients successfully reported, 1416 (31.3%) were not registered for treatment within 7 days of diagnosis. Children, TB pleurisy, patients diagnosed in the eastern and central regions and patients with a TB diagnosis recorded in either health facilities or social insurance system-but not both-were statistically more likely to be unreported. Delayed treatment registration was more likely for previously treated patients with TB, patients with negative or unknown sputum results and for patients diagnosed in the eastern region.Conclusion Almost one in every five patients diagnosed with TB in this study was unknown to local or national TB control programmes. We recommend strengthening TB data management practices, particularly in the eastern and central regions, and developing specific guidelines for reporting paediatric TB and TB pleurisy. Patient education and follow-up by diagnosing facilities could improve timely treatment registration. Additional studies are needed to assess under-reporting elsewhere in China.