Factors associated with unreported tuberculosis cases in Spanish hospitals

Abstract

BackgroundUnder-reporting of tuberculosis (TB) cases complicates disease control, hinders contact tracing and alters the accuracy of epidemiological data, including disease burden. The objective of the present study is to evaluate the proportion of unreported TB cases in Spanish healthcare facilities and to identify the associated factors.MethodsA multi-center retrospective study design was employed. The study included TB cases diagnosed in 16 facilities during 2011–2012. These cases were compared to those reported to the corresponding public health departments. Demographic, microbiological and clinical data were analyzed to determine the factors associated with unreported cases. Associated factors were analyzed on a bivariate level using the x2 test and on a multivariate level using a logistic regression. Odds ratios (OR) and 95 % confidence intervals (CI) were calculated.ResultsOf the 592 TB cases included in the study, 85 (14.4 %) were not reported. The percentage of unreported cases per healthcare center ranged from 0–45.2 %. The following variables were associated to under-reporting at a multivariate level: smear-negative TB (OR = 1.87; CI:1.07-3.28), extrapulmonary disease (OR = 2.07; CI:1.05-4.09) and retired patients (OR = 3.04; CI:1.29-7.18). A nurse case manager was present in all of the centers with 100 % reporting. The percentage of reported cases among the smear-positive cases was 9.4 % and 19.4 % (p = 0.001) among the rest of the study population. Smear-positive TB was no associated to under-reporting.ConclusionsIt is important that TB Control Programs encourage thorough case reporting to improve disease control, contact tracing and accuracy of epidemiological data. The help from a TB nurse case manager could improve the rate of under-reporting.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1047-0) contains supplementary material, which is available to authorized users.

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

“…This may be related to a higher rate of comorbidity in patients aged 65 or older, which could necessitate treatment in non-TB-designated health facilities. This is consistent with the bivariate analysis in a study conducted in Spain [14]. We also found that the [39].…”

“…Our ndings are similar to some studies conducted in other countries in which the under-reporting rate of TB ranged from 6-68% [14,16,17,[24][25][26][27][28][29][30]. Fatima et al estimated that almost 68% of persons with TB were not noti ed to the NTP in Pakistan, many because a large private sector did not report to the NTP [28].…”

“…Compared with patients with laboratory-con rmed and clinically-diagnosed PTB, patients with TB pleurisy or other EPTB were signi cantly more likely to be underreported. This underreporting associated with type of TB was also described in other studies [8,12,14,31,32]. Additionally, the reporting requirements of TB pleurisy and other EPTB vary by province.…”

“…Multiple countries, including Kenya, Spain, Korea, Cape Verde and Egypt, have conducted inventory studies to assess TB under-reporting [13][14][15][16][17]. In 2015, China implemented a study in nine counties to identify TB under-reporting to TBIMS [12].…”

Pulmonary Versus Extrapulmonary Tuberculosis Associated Factors: A Case-Case Study

“…Finally, no revision of TB under-reporting was included in this study, but TB underreporting was low, 11.1% (3/24), in the Hospital General of Castellon during 2011-2012 period. 38 From PTB-associated factors, health promotion and preventive and control measures could be addressed. Several actions may be proposed, including the battle against poverty and housing shortage; promotion of full employment; health education against the consumption of tobacco, alcohol, and other drugs; and finally accurate control of TB patient and their contacts.…”