Under-reporting of diagnosed tuberculosis to the national surveillance system in China: an inventory study in nine counties in 2015

Li, Tao; Shewade, Hemant Deepak; Soe, Kyaw; Rainey, Jeanette J.; Zhang, Hui; Du, Xin; Wang, Lixia

doi:10.1136/bmjopen-2018-021529

Cited by 25 publications

(42 citation statements)

References 20 publications

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“…The Chinese law on infectious diseases requires that PTB, but not extrapulmonary TB (EPTB) be notified. Second, child patients with TB are treated at paediatric hospitals or large general hospitals, which are not directly linked to the TBIMS 16 17. Third, although we believed that many child TB, especially EPTB cases are not reported in China, the actual proportion may be less than 6% after 2010 18 19.…”

Section: Discussionmentioning

confidence: 99%

The epidemiology of pulmonary tuberculosis in children in Mainland China, 2009–2015

Yang

Jiang

et al. 2019

Arch Dis Child

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ObjectiveTo describe the incidence and epidemiological characteristics of child pulmonary tuberculosis (PTB) notified to the Chinese Center for Disease Control and Prevention (CDC) Tuberculosis Information Management System (TBIMS) from 2009 to 2015.Study designA database of child PTB for 31 provinces in mainland China over 7 years was retrospectively analysed. The spatiotemporal distribution of child PTB was described.ResultsIn total, 35,710 child PTB cases were notified to the TBIMS, representing only 0.60% of all 5,991,593 PTB case notifications. The average annual notified incidence of child PTB was 2.44/ per 100,000 children (95% CI: 1.77–3.10) and decreased by 52.53% in all age groups during the study period. Tibet had the highest incidence (15.95/ per 100,000 children), followed by Guizhou and Xinjiang. However, the case numbers were the most in Guizhou. The 0-1 year and 12–14 years of age groups exhibited the most cases. The positive rates of sputum smears, bacteriology and chest X-rays abnormality were 21.5%, 21.7% and 98.1%, respectively, which were lower than those 15 years of age and older (all p-values<0.0001).ConclusionThe notified incidence of child PTB in mainland China decreased substantially over 7 years. Future prevention and control of PTB in children should focus on the 0–1 and 12–14 years of age groups, and Tibet and Guizhou provinces. However, the notified incidence is still low, relative to adults, suggesting substantial under-reporting. Thus, more effective care seeking, identification and registration of children with TB are crucial.

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Section: Discussionmentioning

confidence: 99%

The epidemiology of pulmonary tuberculosis in children in Mainland China, 2009–2015

Yang

Jiang

et al. 2019

Arch Dis Child

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“…A special module in TBIMS acts as an interface between TBIMS and IDRS, and information for one case can be simultaneously updated in these two systems. However, under-reporting of diagnosed TB has also existed in China [14]. A recent retrospective inventory studies conducted in nine counties, by reviewing medical records at the participating health facilities and county-level social insurance system databases, reported that nearly 20% of TB patients were not reported to TBIMS, being higher percentage for children with TB, 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 [14,15].…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors of tuberculosis among the elderly population in China: a prospective cohort study

Cheng

Sun²,

Zhang

et al. 2020

Infect Dis Poverty

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Background: China is facing challenges of the shifting presentation of tuberculosis (TB) from younger to elderly due to an ageing population, longer life expectancy and reactivation disease. However, the burden of elderly TB and influence factors are not yet clear. To fill the gap, we generated a cohort study to measure the magnitude of TB incidence and associated factors among the elderly population aged 65 years and above in China. Methods: In this cohort established in 2013 through a prevalence survey conducted in selected sites, a total of 34 076 elderlies without TB were enrolled into two-year follow-up. We used both active and passive case findings to find out all TB patients among them. The person-year (PY) incidence rates for both bacteriologically positive TB and active TB were calculated. Cox proportional regression model was performed to test effect of risk factors, and the population attributable fraction (PAF) of each risk factor contributing to incident TB among elderlies was calculated. Results: Over the two-year follow-up period, a total of 215 incident active TB were identified, 62 of which were bacteriologically positive. The incidence rates for active TB and bacteriologically positive TB were 481.8 per 100 000 PY (95% CI: 417.4-546.2 per 100 000 PY) and 138.9 per 100 000 PY (95% CI: 104.4-173.5 per 100 000 PY), respectively. Incident cases detected by active case finding were significantly higher (P < 0.001). Male, non-Han nationality, previously treated TB, ex/current smoker and body mass index (BMI) < 18.5 presented as independent predictors for developing TB disease. For developing bacteriologically positive TB, the biggest contribution was from self-reported ex or current smoker (18.06%). And, for developing active TB, the biggest contribution was from non-Han nationality (35.40%), followed by male (26.80%) and age at 75 years and above (10.85%). Conclusions: Ageing population in China had a high TB incidence rate and risk to develop TB disease, implying that National TB Program (NTP) needs to prioritize for elderly. Active case finding should be applied capture more active TB cases among this particular population, especially for male, non-Han nationality, and those with identified risk factors.

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“…In a report published in 2015, IDRS covered all provincial, prefectural, and county CDCs, 98% of medical institutions at or above the county administrative level, and 94% of community medical institutions [11]. TBIMS is the surveillance system for the national TB program (NTP) and is used for managing the full course of treatment of PTB patients, and does not capture information on TB presumptive patients [12]. TBIMS is accessible by all government-appointed TB-designated facilities, which could be local CDCs, TB dispensaries or TB-designated hospitals [12].…”

Section: Introductionmentioning

confidence: 99%

“…TBIMS is the surveillance system for the national TB program (NTP) and is used for managing the full course of treatment of PTB patients, and does not capture information on TB presumptive patients [12]. TBIMS is accessible by all government-appointed TB-designated facilities, which could be local CDCs, TB dispensaries or TB-designated hospitals [12]. These two systems are independent, but there is a function within the systems to link information about patients diagnosed with TB.…”

Section: Introductionmentioning

confidence: 99%

“…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]. However, the results of the 2015 study were not representative of TB surveillance system quality in other areas of China.…”

Section: Introductionmentioning

confidence: 99%

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

YANG

Smith-Jeffcoat

et al. 2020

Preprint

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Background: The reliability of disease surveillance may be restricted by sensitivity or the ability of the system to capture all disease. Our objective was to quantify under-reporting and concordance of recording persons with tuberculosis (TB) in the national TB surveillance systems: Infectious Disease Reporting System (IDRS) and TB Information Management System (TBIMS). Methods: This retrospective review includes patients identified in 2016 from six counties in Guangdong, Jiangsu, Henan, Heilongjiang, Sichuan, and Yunnan provinces. County staff linked TB patients identified from facility-specific health and laboratory information systems with TB patients recorded in IDRS and TBIMS. Under-reporting was calculated as the percentage of TB patients not recorded in IDRS or TBIMS. Timeliness, patients recorded within 24 hours after diagnosis, and concordance, accuracy and completeness of key variables when compared to medical records, were analyzed through comparing sampled patient-records with corresponding patient-records in health facilities. Multivariable logistic regression was used to examine factors associated with under-reporting. Results: We found 505 (10.7%) patients diagnosed with TB 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, 10.7% and 7.1% were found having inconsistent home address. The risk of under-reporting to both IDRS and TBIMS was greatest in TB diagnosis at a tertiary health facilities and non-residents; the risk of under-reporting to TBIMS was greatest with patients aged 65 or older and extrapulmonary TB (EPTB).Conclusions: We found that more than one in four TB patients were not recorded in TBIMS. 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. Additional human resources for data collection and management, and monitoring and evaluation systems are needed to improve national surveillance systems and TB prevention, diagnosis and treatment services.

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Under-reporting of diagnosed tuberculosis to the national surveillance system in China: an inventory study in nine counties in 2015

Cited by 25 publications

References 20 publications

The epidemiology of pulmonary tuberculosis in children in Mainland China, 2009–2015

The epidemiology of pulmonary tuberculosis in children in Mainland China, 2009–2015

Incidence and risk factors of tuberculosis among the elderly population in China: a prospective cohort study

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

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