Performance of Multidrug-Resistant Tuberculosis Surveillance in Yemen: Interview Study

Abstract

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is a major challenge to ending TB occurrence by 2035. In Yemen, the 2011 survey showed an MDR-TB prevalence of 1.4% among new cases and 14.4% among previously treated cases. The National Tuberculosis Control Program (NTCP) established four MDR-TB sentinel surveillance sites in 2013 to monitor the MDR-TB situation. In Yemen, the 2011 survey showed an MDR-TB prevalence of 1.4% among new cases and 14.4% among previously treated cases. The NTCP established four MDR-TB sentinel surveillance sites in 2013 to monitor the MDR-TB situation.ObjectiveThis study aimed to assess the performance of MDR-TB surveillance and determine its strengths and weaknesses.MethodsWe used the updated Center for Diseases Control and Prevention guidelines for evaluating public health surveillance systems. Interviews were conducted with NTCP managers and Regional MDR-TB centers’ staff using a semistructured questionnaire. We used a 5-point Likert scale to assess the usefulness and other attributes (eg, simplicity and flexibility). The mean percentage was calculated for each attribute and used for the final rank of the performance: poor (<60%), average (60%-80%), and good (>80%).ResultsThe MDR-TB surveillance system achieved good performance in usefulness (87%), acceptability (82%), and data quality (91%); average performance in flexibility (61%) and simplicity (72%); and poor performance in stability (55%). The overall performance score was average (74%). Although strong commitment, good monitoring, and well-trained staff are the main strengths, depending on an external fund is a major weakness along with unavailability of the MDR-TB unit at the governorate level.ConclusionsAlthough the MDR-TB surveillance system has achieved an average overall performance, more efforts are required to improve its stability by ensuring constant power supply to enable laboratories to perform necessary diagnostic and follow-up tests. Gradual replacement of donors’ funds by the government is recommended. Scaling up of MDR-TB services and removing access barriers are crucial.

Evaluation of the National Tuberculosis Surveillance System in Sana’a, Yemen, 2018: Observational Study

“…Similar findings have been reported in Afghanistan and Zimbabwe [ 7 , 13 ]. However, this finding is not consistent with the findings in previous studies in Yemen, Pakistan, and South Africa [ 8 , 12 , 14 ].…”

“…It helps in monitoring trends of tuberculosis and estimates the need for antituberculosis drugs and laboratory reagents at all levels. These findings are similar to other studies in Afghanistan, Yemen, and Pakistan [ 7 , 8 , 12 ].…”

“…In addition, prolonged procedures to release funds from the Global Fund to implement tuberculosis control activities may lead to abandoning the activity implementation. Although, this finding is similar to what has been reported in Yemen and Zimbabwe [ 8 , 13 ]. Other studies showed stable tuberculosis surveillance systems [ 7 , 14 ].…”

“…The score percent of each attribute was interpreted as the following: greater than 80% was ranked as good, between 60% to 80% was ranked as average, and lesser than 60% was ranked as poor [ 7 , 8 ]. Data quality was assessed by reviewing documents such as quarter report, while the sensitivity and positive predictive value (PPV) were calculated using the following equation:…”

Emerging Status of Multidrug-Resistant Bacteria and Fungi in the Arabian Peninsula

“…The active surveillance and constant preventive efforts to control MDR infections and associated diseases can improve healthcare facilities and the socio-economic status of patients [ 375 ]. Specifically, MDR E. coli is predominantly associated with urinary tract infections in pregnancy [ 54 , 61 , 102 ].…”