Further explorations of surveillance data

1
Further explorations of surveillance data

• Cross-checking estimates of TB incidence (EMR)
• Identifying districts with poor diagnosis (Syria)
• Exploring diagnostic accuracy (Jordan)
• Explaining variation in treatment outcomes (S.
  Africa)
• Strengthening evidence for trends in TB incidence
  (Morocco)
• Strengthening evidence for DOTS impact (Peru)
• Understanding the limits of DOTS impact (China)

2
Standards and norms in TB epidemiology 2
approaches

• 1. Comparisons with known standards e.g.
• ss inc 50 ARTI (Styblo)
• ss/pulmonary cases 70
• EP/all TB 15-20
• 2. Anomalies, deviations, and inconsistencies
• incidence inversely related to average age
• regional variation in sex ratio
• provincial differences in suspects/cases
• See indicator list

3
Evaluating case detection and treatment outcomes
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Smear-positive diagnosis by province, Syria
1.0
0.9
0.8
0.7
0.6
ss/all pulmonary
0.5
0.4
0.3
0.2
0.1
0.0
A
Ar
D
H
I
K
L
M
OS
Q
R
RD
S
SW
T
Z
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TB suspects by province Jordan
7000
6000
5000
4000
Suspects/100,000 population
3000
2000
1000
0
SALT
IRBID
MA'AN
ZARKA
KARAK
AMMAN
AQAUBA
TAFILAH
MAFRAQ
MADABA
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Compliance with treatment,
Hlabisa, South Africa
1
0.9
treatment
Probability of remaing on
0.8
Clinic
Volunteer
0.7
CHW
0.6
0
15
30
45
60
75
90
105
120
135
150
165
180
Days
15
Compliance with short-course
chemotherapy
1
0.9
proportion remaining
0.8
compliant
0.7
0.6
0.5
0
1
2
3
4
5
6
months
Yougelson Joubert, SAMJ 1991
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Evaluating the impact of TB control
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Changing aetiology of tuberculosis
Netherlands model, 45-49 yr-olds
160
140
progressive primary
120
100
exogenous reinfection
Incidence rate/100K/year
80
endogenous reactivation
60
40
20
0
1950
1953
1956
1959
1962
1965
1968
1971
1974
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Reward for diagnostic effort Peru
0.04
0.03
0.02
Increase in notification
rate/increase in smear exam rate
0.01
0
-0.01
92-93
93-94
94-95
95-96
96-97
97-98
98-99
Years compared
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Source of retreatment patients
Changshou County, China
70
60
n 288
50
40
percentage
30
20
10
0
out of county
in county, out
in project
project