Assessing the Quality of Reporting to China's National TB Surveillance Systems.

Tao Li,Hui Guo,Lijia Yang,Xin Du,Hui Zhang,Sarah E Smith-Jeffcoat,Wei Chen,Alice Wang

doi:10.3390/ijerph18052264

Abstract

(1) Background: The reliability of disease surveillance may be restricted by sensitivity or ability to capture all disease. Objective: To quantify under-reporting and concordance of recording persons with tuberculosis (TB) in national TB surveillance systems: the Infectious Disease Reporting System (IDRS) and Tuberculosis Information Management System (TBIMS). (2) Methods: This retrospective review includes 4698 patients identified in 2016 in China. County staff linked TB patients identified from facility-specific health and laboratory information systems with records in IDRS and TBIMS. Under-reporting was calculated, and timeliness, concordance, accuracy, and completeness were analyzed. Multivariable logistic regression was used to examine factors associated with under-reporting. (3) Results: We found that 505 (10.7%) patients were missing within IDRS and 1451 (30.9%) patients were missing within TBIMS. Of 171 patient records reviewed in IDRS and 170 patient records in TBIMS, 12.3% and 6.5% were found to be untimely, and 10.7% and 7.1% were found to have an inconsistent home address. The risk of under-reporting to both IDRS and TBIMS was greatest at tertiary health facilities and among non-residents; the risk of under-reporting to TBIMS was greatest with patients aged 65 or older and with extrapulmonary TB (EPTB). (4) Conclusions: It is important to improve the reporting and recording of TB patients. Local TB programs that focus on training, and mentoring high-burden hospitals, facilities that cater to EPTB, and migrant patients may improve reporting and recording.

Highlights

We investigated whether TB patients reviewed were residents, which was defined as someone recorded in the county or who had lived in the county for more than six months, which is usually indicated via self-report in medical records and confirmed based on the type of medical insurance, since non-residents have different insurance categories
We identified a total of 4698 TB patients (702 from primary health facilities, 1479 from secondary health facilities, and 2517 from tertiary health facilities), of which 4327 were pulmonary tuberculosis (PTB) patients (3028 patients diagnosed clinically and 1299 patients confirmed in laboratory) and 371 pleurisy or other extrapulmonary TB (EPTB) patients
Our results show that 10.7% and 30.9% of TB patients in the six participating counties were under-reported to Infectious Disease Reporting System (IDRS) and not recorded for treatment in Tuberculosis Information Management System (TBIMS), respectively

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Disease surveillance data are a vital source of information for national and international policymakers, and can be used to evaluate the burden and time trends of diseases [1]. The reliability of disease surveillance may be limited by sensitivity, or the ability of the system to capture all persons with disease. Many national disease surveillance systems may provide an incomplete picture due to under-reporting diseases of public health importance [2,3,4,5,6]

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Conclusion