Tuberculosis cure rates and the ETR.Net: investigating the quality of reporting treatment outcomes from primary healthcare facilities in Mpumalanga province, South Africa

Abstract

BackgroundTuberculosis control programs rely on accurate collection of routine surveillance data to inform program decisions including resource allocation and specific interventions. The electronic TB register (ETR.Net) is dependent on accurate data transcription from both paperbased clinical records and registers at the facilities to report treatment outcome data. The study describes the quality of reporting of TB treatment outcomes from facilities in the Ehlanzeni District, Mpumalanga Province.MethodsA descriptive crossectional study of primary healthcare facilities in the district for the period 1 January – 31 December 2010 was performed.New smear positive TB cure rate data was obtained from the ETR.Net followed by verification of paperbased clinical records, both TB folders and the TB register, of 20% of all new smear positive cases across the district for correct reporting to the ETR.Net. Facilities were grouped according to high (>70%) and low cure rates (≤ 70%) as well as high (> 20%) and low (≤ 20%) error proportions in reporting. Kappa statistic was used to determine agreement between paperbased record, TB register and ETR.Net.ResultsOf the100 facilities (951 patient clinical records), 51(51%) had high cure rates and high error proportions, 14(14%) had a high cure rate and low error proportion whereas 30(30%) had low cure rates and high error proportions and five (5%) had a low cure rate with low error proportion. Fair agreement was observed (Kappa = 0.33) overall and between registers. Of the 473 patient clinical records which indicated cured, 383(81%) was correctly captured onto the ETR.Net, whereas 51(10.8%) was incorrectly captured and 39(8.2%) was not captured at all. Over reporting of treatment success of 12% occurred on the ETR.Net.ConclusionsThe high error proportion in reporting onto the ETR.Net could result in a false sense of improvement in the TB control programme in the Ehlanzeni district.

Multi‐drug‐resistant tuberculosis clusters in Mpumalanga province, South Africa, 2013–2016: A spatial analysis

“…Ehlanzeni district carries the highest burden of MDR‐TB. This finding is in line with previous studies that assessed MDR‐TB in the province [19,20]. Ehlanzeni district is also characterized by a high prevalence of HIV (17.5%), followed by Gert Sibande with an HIV prevalence of 17.3% and Nkangala at 11.1% [20].…”

“…In Mpumalanga province, MDR‐TB cases have increased from 190 in 2009 to 385 in 2011 [19]. In 2016, Mpumalanga was identified as a province with the highest rate of TB that is resistant to rifampin (RIF) [20].…”

Do private health providers adhere to National Tuberculosis Guideline while assigning treatment outcome? Findings from a lower middle-income country

“…Overall, treatment success in this study was overreported by a difference of 30.4%. This figure is higher than findings from South African study where TSR was overreported by 12% (24) but lower than findings from KwaZulu natal study where only 34.8% of the reported cure rate was validated (25). It was obvious in our study that HCWs poorly understood how 'treatment completed' differed from 'cured'.…”

Assessment of facility-based tuberculosis data quality in an integrated HIV/TB database in three South African districts

“…The TB module in TIER.Net was designed to capture patient level TB data electronically so that integrated TB and HIV information could be immediately accessible and used for improving client care at facility level. The electronic TB register (ETR.Net) preceded the TB module in TIER.Net and was warehouse of TB data since 2004; recognized as a valuable tool to guide program management of TB services [11]. ETR.Net was decommissioned around March 2019, in support of an integrated TB and HIV information system.…”