Thesis (M. Cur.) -- University of Limpopo, 2014 / The present study presents data about the factors that are affecting the implementation of the National Tuberculosis Control Programme by the professional nurses in the Mogalakwena Municipality of the Waterberg District in the Limpopo Province. Despite the intervention by the then Waterberg District Department of Health and Social Development through continual training and workshops of professional nurses in respect of the NTCP, there are still more challenges observed in terms of TB management. Aim of the study The aim of the study was to identify and describe the factors that are affecting the implementation of the NTCP and the findings may be utilised to describe the strategies to increase TB cure rate in the Mogalakwena Municipality of the Waterberg District. Research Methodology A quantitative research approach was used to conduct this study. One hundred and thirty one professional nurses employed at 28 clinics of the Mogalakwena Municipality were selected to participate in the study. The researcher distributed the questionnaires at the clinics. A structured questionnaire with both open and closed-ended questions was administered. The questionnaire was pretested in the Mahwelereng Local Area which did not form part of the main study. Results Of the 131 respondents, 33.6% were the largest age group of between 40 – 50 years followed by 24.4% who were older than 50 years in contrast with the smallest age group of 18 – 28 years that comprised 18.3% of the population. Sixteen per cent of the respondents were male while 84.0% were female. The findings show that 83.2% of respondents held a diploma in nursing while 16.8% had a degree in nursing. The findings indicate that 98.4% of the respondents were reported to be having knowledge about TB while 1.6% reported not having knowledge. The findings v indicate that 98.4% of the respondents had knowledge about TB suspect screening according to the NTCP in contrast with 1.6% of the participants who did not have knowledge about TB screening. About 95.4% of the respondents reported tracing of TB defaulters while 4.6% of the respondents reported that TB defaulters were not traced. Sixty point three per cent 63.3% of the respondents thought that a negative attitude of professional nurses was the main cause of poor implementation of the NTCP while 30.5% of them disagreed with the statement. Conclusion Respondents demonstrated non-compliance to the implementation of the NTCP, ignorance to acquire skills and negative attitude towards the programme that was consistently significant with other similar studies. The study recommends an updated training programme of all TB trained nurses, as well as values clarification about the importance of the implementation of the NTCP in the management of the TB disease.

The epidemiological study of tuberculosis (TB) has been ongoing for several decades, but the most effective control strategy is yet to be completely understood. The basic reproduction number, R₀, has been found to be plausible indicator for TB control rate. The R₀ value is the average number of secondary TB cases produced by a typical infective individual in a completely susceptible population during its entire infectious period. In this study we develop two SEIR models for TB transmission; one involving treatment of active TB only, with the second incorporating both active TB treatment and post-exposure prophylaxis (PEP) treatment for latent TB. Using the next generation matrix method we obtain R₀. We determine the disease free equilibrium (DFE) point and the endemic equilibrium (EE) point. Global stability conditions of DFE are determined using the Castillo-Chavez theorem. Through model analysis of the reproduction number, R₀, we find that for R₀ < 1, the infection will die out. The value of R₀ > 1 implies that the disease will spread within the population. Through stability analysis, we show that the model exhibits backward bifurcation, a phenomenon allowing multiple stable states for fixed model parameter value. MATLAB ode45 solver was used to simulate the model numerically. Using the Latin Hypercube Sampling technique the model is sensitive to treatment and disease transmission parameters, suggesting that to control the disease, more emphasis should be placed on treatment and on reducing TB transmission. For the second model, which incorporated treatment with post-exposure prophylaxis for latently infected individuals, by means of simulations, we found that treatment of latently infected individuals may reduce R₀. Numerical simulations on the latter model also showed that it may be better to introduce a hybrid of active treatment and post-exposure treatment of the latent class. The force of infection was found to reduce when this hybrid control strategy is present. Contour plots and PRCC values highlighted the important parameters that influence the size of the Infective class. The implications of these findings are that TB control measures should emphasise on treatment. Our simplified models assume that there is homogeneous mixing. The model used have not been validated against empirical data. / M.Sc. University of KwaZulu-Natal, Pietermaritzburg 2014.

Trata-se de um estudo exploratório cujo objetivo foi avaliar o “desempenho" dos serviços de saúde que executam o DOTS/TS Domiciliar no Programa de Controle da Tuberculose (PCT) em Unidades de Saúde do Município de Ribeirão Preto. Utilizou-se como referencial metodológico os enfoques básicos para avaliação da qualidade da atenção médica Estrutura-Processo-Resultado proposto por Donabedian (1980) e modificado por Tanaka e Melo (2001) e Starfield (2002). Elaborou-se os seguintes indicadores: Cobertura, Aproveitamento dos recursos, Agilidade do desempenho, Monitoração da administração da medicação e Tempo gasto por visita domiciliar. Os dados foram coletados em 4 PCT por meio da Técnica de Observação Sistemática das visitas domiciliares, realizadas pelo profissional de saúde responsável pela supervisão do tratamento do paciente durante o mês de julho de 2003. Foram acompanhados todos os pacientes que no período em estudo receberam DOTS/TS no domicílio e aqueles que foram incluídos na supervisão durante a coleta de dados. A avaliação do desempenho foi realizada na relação de indicadores e complementada em função da análise por indicador a partir da média e do intervalo de confiança. Os indicadores estudados mostraram que o planejamento de recursos, a organização do trabalho pela equipe de saúde, a definição de funções e a sistematização das ações no processo de tratamento do doente de tuberculose podem influenciar no melhor desempenho do serviço de saúde em termos de cobertura, aproveitamento dos recursos, agilidade, monitoração da administração da medicação e tempo gasto por visita domiciliar. Assim, perante as restrições de recursos humanos e materiais no setor saúde, existe a necessidade de reconsiderar outras formas de supervisão e/ou integração das atividades de tratamento e controle da doença a outras estratégias de intervenção que resultem no uso racional dos recursos, melhor cuidado de saúde e sucesso do tratamento. / This exploratory study aimed to evaluate the “performance" of health services that execute Domiciliary DOTS/TS in the Tuberculosis Control Program (TCP) at Health Units in Ribeirão Preto. The methodological reference framework was based on the basic focuses for medical care quality evaluation Structure-Process-Outcome proposed by Donabedian (1988) and modified by Tanaka and Melo (2001) and Starfield (2002). The following indicators were elaborated: Coverage, Use of recourses, Performance agility, Medication administration monitoring and Time spent per home visit. Data were collected in 4 TCP by means of the Systematic Observation Technique of home visits, realized by the health professional who was responsible for supervising the patient’s treatment in July 2003. All patients were accompanied who were receiving domiciliary DOTS/TS during the study period, as well as those included in the supervision during data collection. The performance evaluation was accomplished in the indicator list and complemented in function of the analysis per indicator, based on mean values and confidence intervals. The studied indicators demonstrated that the planning of resources, the health team’s organization of its work, the definition of function and the systemization of actions in tuberculosis patients’ treatment can influence in the sense of achieving a better performance by the health service in terms of coverage, use of resources, agility, medication administration monitoring and time spent per home visit. Thus, in view of health sector restrictions in terms of human and material resources, there is a need to reconsider other forms of supervising and/or integrating treatment and control activities with other intervention strategies that can result in the rational use of resources, a better healthcare and a successful treatment.

Tuberculosis (TB) is a two-stage disease, acquisition of infection and progression to disease. A complex interaction exists between the individual and their environment that determines who acquires infection and who progresses to disease. According to TB literature, 10% of individuals with infection will develop TB disease (1;2). Tuberculosis has been described a disease of poverty, but other factors may be important. The contribution of both individual measures, such as ethnic origin, gender and age and area-level measures, or socio-economic factors, to this two-stage process is not well understood. Understanding tuberculosis epidemiology and identifying those at risk for developing TB is important for effectively controlling the disease. The objective of this study was to determine the individual (age, gender, ethnic origin, geographic location) and area-level measures (income, home ownership, housing density, education, and employment) that contribute to the progression from tuberculosis infection to disease. Data from all Canadian-born Caucasians, Status Indians, and non-Status Indians and Metis, with an initial positive tuberculin skin test (TST) documented in the Saskatchewan TB Control database from January 1, 1986 to January 31, 2002 was analyzed. Exclusion criteria included any previous BCG vaccination, treatment for latent TB infection, or missing data. Individual data was obtained from the TB Control database. Area-level measures were obtained by matching individual postal codes with Canada census data to obtain information from enumeration areas. Outcome was time to TB disease at > 1 month following a documented positive tuberculin skin test. Analysis was completed using Cox regression proportional hazards model. 7588 individuals with a positive tuberculin skin test were included in the study and of these 338 (4.5%) developed TB disease. Thirty-four out of 4140 (0.8%) of Caucasians, 183 out of 2649 (6.9%) of Status Indians and 121 out of 799 (15.1%) non-Status Indians and Metis developed TB. The rate of progression to TB was 5.6/1000 person years for the entire study population. The incidence for Caucasians was 0.9/1000 person years, 7.7/1000 person years for Status Indians and 16.0/1000 person years for non-Status Indians and Metis. In the Cox regression model, including individual and area-level measures, the risk factors association with the progression to TB was age and ethnic origin (< 19 years of age HR 3.7, 95% CI 2.8 - 4.8 compared to > 19 years and ethnic origin HR 5.1, 95% CI 3.0 - 8.6 for Status Indians and HR 7.4, 95% CI 4.1-13.3 for non-Status Indians and Metis both compared to Caucasians). No socio-economic factor was consistently associated with progression to disease. We have found that age and ethnic origin are associated with an increased risk of TB infection progressing to disease. The differences in TB rates between Saskatchewan Caucasians and Status Indians, non-Status Indians and Metis can be explained by Grigg's natural history curve of TB epidemiology within a population (3). The Aboriginal population of Saskatchewan is much earlier in its epidemic resulting in higher disease rates compared to the Caucasian population. Identifying those at risk of developing TB and understanding the determinants of TB epidemiology are important for establishing successful TB control programs.

Tuberculosis (TB) is a two-stage disease, acquisition of infection and progression to disease. A complex interaction exists between the individual and their environment that determines who acquires infection and who progresses to disease. According to TB literature, 10% of individuals with infection will develop TB disease (1;2). Tuberculosis has been described a disease of poverty, but other factors may be important. The contribution of both individual measures, such as ethnic origin, gender and age and area-level measures, or socio-economic factors, to this two-stage process is not well understood. Understanding tuberculosis epidemiology and identifying those at risk for developing TB is important for effectively controlling the disease. The objective of this study was to determine the individual (age, gender, ethnic origin, geographic location) and area-level measures (income, home ownership, housing density, education, and employment) that contribute to the progression from tuberculosis infection to disease. Data from all Canadian-born Caucasians, Status Indians, and non-Status Indians and Metis, with an initial positive tuberculin skin test (TST) documented in the Saskatchewan TB Control database from January 1, 1986 to January 31, 2002 was analyzed. Exclusion criteria included any previous BCG vaccination, treatment for latent TB infection, or missing data. Individual data was obtained from the TB Control database. Area-level measures were obtained by matching individual postal codes with Canada census data to obtain information from enumeration areas. Outcome was time to TB disease at > 1 month following a documented positive tuberculin skin test. Analysis was completed using Cox regression proportional hazards model. 7588 individuals with a positive tuberculin skin test were included in the study and of these 338 (4.5%) developed TB disease. Thirty-four out of 4140 (0.8%) of Caucasians, 183 out of 2649 (6.9%) of Status Indians and 121 out of 799 (15.1%) non-Status Indians and Metis developed TB. The rate of progression to TB was 5.6/1000 person years for the entire study population. The incidence for Caucasians was 0.9/1000 person years, 7.7/1000 person years for Status Indians and 16.0/1000 person years for non-Status Indians and Metis. In the Cox regression model, including individual and area-level measures, the risk factors association with the progression to TB was age and ethnic origin (< 19 years of age HR 3.7, 95% CI 2.8 - 4.8 compared to > 19 years and ethnic origin HR 5.1, 95% CI 3.0 - 8.6 for Status Indians and HR 7.4, 95% CI 4.1-13.3 for non-Status Indians and Metis both compared to Caucasians). No socio-economic factor was consistently associated with progression to disease. We have found that age and ethnic origin are associated with an increased risk of TB infection progressing to disease. The differences in TB rates between Saskatchewan Caucasians and Status Indians, non-Status Indians and Metis can be explained by Grigg's natural history curve of TB epidemiology within a population (3). The Aboriginal population of Saskatchewan is much earlier in its epidemic resulting in higher disease rates compared to the Caucasian population. Identifying those at risk of developing TB and understanding the determinants of TB epidemiology are important for establishing successful TB control programs.

I de vesteuropeiske landene har nedgangen i forekomst av tuberkulose stagnert de senere tiårene hovedsakelig på grunn av økt tilstrømning av mennesker fra høyinsidensland for tuberkulose. Det er stilt spørsmål om tuberkulosekunnskapene blant helsepersonell er tilstrekkelige. Studier har vist betydelige variasjoner i utformingen av tuberkulosekontrollen av innvandrere. WHO har medvirket til utvikling av policydokumenter for tuberkulosekontroll i europeiske lavinsidensland. Hensikten med denne studien var tosidig: 1) å se på i hvilket omfang nasjonale og engelskspråklige legetidsskrifter hadde publisert fagartikler om tuberkulose blant innvandrere i Danmark, Norge og Sverige og beskrive artiklene som kunnskapskilder for leger og annet helsepersonell, og 2) å beskrive de tre landenes policydokumenter for tuberkulosekontroll på noen spesifikke områder. Materialet består av 27 tidsskriftsartikler publisert i 1995-2004 og 18 policydokumenter. Studien er utvidet og oppdatert på basis av en tidligere publisert undersøkelse. Tidsskriftsartiklene inneholdt mye relevant fagstoff for helsepersonell. Artiklene viste at tuberkuloseforekomst, smitteforhold og praktisk kliniske utfordringer har mange likhetstrekk i de tre landene. Antallet artikler i nasjonale tidsskrifter ble imidlertid vurdert som for lavt til å kunne utgjøre en viktig kunnskapskilde. Det bør publiseres mer om tuberkulose blant innvandrere i nasjonale tidsskrifter da disse har en viktig klinisk og helsepolitisk betydning. Policydokumentene viste forskjeller i landenes policy for ankomstscreening, forebyggende behandling, BCG-vaksinering og bruk av direkte observert terapi. Ankomstscreening for personer fra høyinsidensland for tuberkulose er frivillig i Danmark og Sverige og obligatorisk i Norge. Studien kunne ikke forklare ulikhetene i de tre nabolandenes policy. Lokal motstand mot internasjonale føringer på tuberkuloseområdet er vist ved studier fra andre land. Obligatorisk ankomstscreening er omdiskutert og reiser etiske problemstillinger når det gjelder individers integritet og slike undersøkelsers betydning for folkehelsen / In recent decades, the decline of tuberculosis has stagnated in Western Europe mainly due to increased immigration from high-prevalence countries. Policies for control of tuberculosis among immigrants in these countries are very varied. Frameworks for tuberculosis control in European countries with a low incidence of disease have been published in collaboration with the WHO. The aim of this study was twofold: 1) To find out what has been published on tuberculosis among immigrants in Denmark, Norway and Sweden in medical journals and to describe the scientific literature as a source for updated knowledge for doctors and other health professions, and 2) to describe national policy documents on specified parts of the policy. The material consists of 27 medical papers published between 1995 and 2004 and 18 policy documents. This paper is based on a previously published study and an updated literature review. The medical papers were highly relevant as scientific information for health personnel. The review of the papers showed that there were many similarities between the three countries. However, the number of papers in the national medical journals was too low to represent an important source of knowledge. More publishing in national medical journals is recommended because these have clinically and health political importance. The policy documents showed differences in the countries policy on screening on arrival, preventive therapy, BCG-vaccination and use of direct observed therapy. Screening on arrival for people from countries with a high incidence of tuberculosis is voluntary in Denmark and Sweden and mandatory in Norway. The study could not explain the differences in policy in the three neighbouring countries. Local resistance to international guidelines for tuberculosis control is described in studies from other countries. Mandatory screening of new entrants is controversial and raises ethical issues concerning individuals’ integrity and the importance of screening for public health. / <p>ISBN 91-7997-150-4</p>

Trata-se de um estudo exploratório cujo objetivo foi avaliar o “desempenho” dos serviços de saúde que executam o DOTS/TS Domiciliar no Programa de Controle da Tuberculose (PCT) em Unidades de Saúde do Município de Ribeirão Preto. Utilizou-se como referencial metodológico os enfoques básicos para avaliação da qualidade da atenção médica Estrutura-Processo-Resultado proposto por Donabedian (1980) e modificado por Tanaka e Melo (2001) e Starfield (2002). Elaborou-se os seguintes indicadores: Cobertura, Aproveitamento dos recursos, Agilidade do desempenho, Monitoração da administração da medicação e Tempo gasto por visita domiciliar. Os dados foram coletados em 4 PCT por meio da Técnica de Observação Sistemática das visitas domiciliares, realizadas pelo profissional de saúde responsável pela supervisão do tratamento do paciente durante o mês de julho de 2003. Foram acompanhados todos os pacientes que no período em estudo receberam DOTS/TS no domicílio e aqueles que foram incluídos na supervisão durante a coleta de dados. A avaliação do desempenho foi realizada na relação de indicadores e complementada em função da análise por indicador a partir da média e do intervalo de confiança. Os indicadores estudados mostraram que o planejamento de recursos, a organização do trabalho pela equipe de saúde, a definição de funções e a sistematização das ações no processo de tratamento do doente de tuberculose podem influenciar no melhor desempenho do serviço de saúde em termos de cobertura, aproveitamento dos recursos, agilidade, monitoração da administração da medicação e tempo gasto por visita domiciliar. Assim, perante as restrições de recursos humanos e materiais no setor saúde, existe a necessidade de reconsiderar outras formas de supervisão e/ou integração das atividades de tratamento e controle da doença a outras estratégias de intervenção que resultem no uso racional dos recursos, melhor cuidado de saúde e sucesso do tratamento. / This exploratory study aimed to evaluate the “performance” of health services that execute Domiciliary DOTS/TS in the Tuberculosis Control Program (TCP) at Health Units in Ribeirão Preto. The methodological reference framework was based on the basic focuses for medical care quality evaluation Structure-Process-Outcome proposed by Donabedian (1988) and modified by Tanaka and Melo (2001) and Starfield (2002). The following indicators were elaborated: Coverage, Use of recourses, Performance agility, Medication administration monitoring and Time spent per home visit. Data were collected in 4 TCP by means of the Systematic Observation Technique of home visits, realized by the health professional who was responsible for supervising the patient’s treatment in July 2003. All patients were accompanied who were receiving domiciliary DOTS/TS during the study period, as well as those included in the supervision during data collection. The performance evaluation was accomplished in the indicator list and complemented in function of the analysis per indicator, based on mean values and confidence intervals. The studied indicators demonstrated that the planning of resources, the health team’s organization of its work, the definition of function and the systemization of actions in tuberculosis patients’ treatment can influence in the sense of achieving a better performance by the health service in terms of coverage, use of resources, agility, medication administration monitoring and time spent per home visit. Thus, in view of health sector restrictions in terms of human and material resources, there is a need to reconsider other forms of supervising and/or integrating treatment and control activities with other intervention strategies that can result in the rational use of resources, a better healthcare and a successful treatment.

Thesis (MSc (Biomedical Technology))--Cape Peninsula University of Technology, 2017. / According to the Namibia National Tuberculosis Control Programme (NTCP) report of 2008, Namibia has one of the highest TB infection rates in the world with a case notification rate of 748/100,000. Rapid, specific and sensitive diagnosis of Mycobacterium tuberculosis (MTB) is needed for correct TB patient management. One of the aims of this study was thus to compare direct microscopy with two rapid molecular diagnostic tools (viz. GeneXpert MTB/RIF and Hain Genotype® MTBDR plus assay) for the identification of MTB from samples collected from the Khomas Region, Windhoek, Namibia. Only patients with positive TB sputum collected at the clinics and health facilities in the Khomas Region, Windhoek were eligible for the study. Three hundred and eighty-four samples were confirmed acid-fast positive by utilising the auramine staining method. The rifampicin (RIF) resistance profile detected by both molecular techniques was then compared for characterisation of the samples as drug resistant. Lastly, participants completed a survey, which included questions related to demographic and epidemiological data. Demographic data included patient age, gender, region of residence and history of treatment. The data was collected using a structured questionnaire and was captured in an Excel spreadsheet. It was then imported into Statistical Package for Social Sciences (SPSS) Version 25 for data analysis. A memorandum of understanding was also signed with the Namibia Institute of Pathology (NIP) to obtain permission to use their samples and the equipment at their site.

Made available in DSpace on 2016-08-19T17:37:07Z (GMT). No. of bitstreams: 1 DISSERTACAO_VIVIANE SOUSA FERREIRA.pdf: 2117204 bytes, checksum: fd5f7d50ab5ca236a4db080343d04ef2 (MD5) Previous issue date: 2014-11-28 / Tuberculosis is an infectious and contagious disease that for decades represents a problem to public health. Are reported annually about 90,000 cases of the disease only in Brazil. Amogn these these patients reported about 3000 has given outcome for death every year. In the state of Maranhão, eight counties are considered priority in combating the disease, is considered priority the municipality that has an incidence of 40 / 100,000 cases / year. This study was conducted in the city of Imperatriz - MA which is considered by the Ministério da Saúde one of the priority municipalities in combating the disease. The study aimed to evaluate the Municipal Program for Tuberculosis Control in Imperatriz-MA, considering the sociodemographic, clinical, epidemiological, number of cases, diagnostic and service offering, type of closure and other indicators. This is an descriptive evaluation study, evaluation parameters defined for the study are established by the Ministério da Saúde. The study results showed that most of the patients 63.3% were male, aged 20 to 39 years and of mixed ethnicity. Regarding education, except for the year 2011, the highest percentages were in illiterate people. There was a higher frequency of disease in patients with type input new case 85.1% of 90.7% pulmonary form. Of the total cases identified most did not perform HIV testing, less than what was stipulated in the target for new cases were identified each year as well as the diagnostic offer proved insufficient in the number of smear and sputum examination. The smear was not performed in 25.5% of patients and most patients do not undergo sputum 89.4%. Concluded with the results of this research in relation to socioeconomic, clinical and epidemiological profile the city resembled enough to other cities in Brazil and the world, allowing the higher frequencies in males, brown and low education. Regarding the assessment of the Municipal Tuberculosis Control Program, the results showed that the indicators established by the Ministério da Saúde are not being met. A key outcome is for the number of new cases reported, which should decrease over the years, but the diagnostic offer should be satisfactory for this result be considered good, which does not happen in the city. / A Tuberculose é uma doença infecciosa e contagiosa que há décadas é motivo de preocupação para a saúde pública. São notificados por ano cerca de 90 mil casos da doença somente no Brasil. Destes pacientes notificados cerca de 3 mil tem o desfecho determinado por óbito a cada ano. No Estado do Maranhão, oito municípios são considerados prioritários no combate à doença, é considerado prioritário o município que tem incidência de 40/100.000 casos/ano. Este estudo foi realizado no município de Imperatriz - MA que é considerado pelo Ministério da Saúde um dos municípios prioritários no combate à doença. O estudo teve como objetivo avaliar o Programa Municipal de Controle da Tuberculose no Município de Imperatriz-MA, considerando os fatores sociodemográficos, clínico-epidemiológicos, número de casos, oferta diagnóstica e de serviço, tipo de encerramento e outros indicadores. Trata-se de um estudo do tipo avaliativo descritivo, os parâmetros de avaliação definidos para o estudo são estabelecidas pelo Ministério da Saúde. Os resultados do estudo mostraram que a maior parte dos pacientes 63,3% eram do sexo masculino, faixa etária de 20 a 39 anos e de cor parda. Em relação à escolaridade, excetuando-se o ano de 2011, os maiores percentuais foram em pessoas analfabetas. Observou-se maiores frequências da doença em pacientes com tipo de entrada caso novo 85,1%, de forma clínica pulmonar 90,7%. Do total de casos identificados a maior parte não realizou exame anti-HIV, uma quantidade menor do que a que foi estipulada na meta para casos novos foi identificada a cada ano, bem como a oferta diagnóstica se mostrou insuficiente em relação ao número de baciloscopias e exame de escarro. A baciloscopia não foi realizada em 25,5% dos pacientes e a maior parte dos pacientes não realizou exame de escarro 89,4%. Concluiu-se com os resultados desta pesquisa que em relação ao perfil socioeconômico e clínico-epidemiológico o município se assemelhou bastante aos demais municípios do Brasil e do mundo, mantendo as frequências maiores em pessoas do sexo masculino, pardos e de baixa escolaridade. Em relação à avaliação do Programa Municipal de Controle da Tuberculose, os resultados revelaram que os indicadores estabelecidos pelo Ministério da Saúde não estão sendo cumpridos. Um dos principais resultados é para número de casos novos notificados, que deve diminuir com o passar dos anos, porém a oferta diagnóstica deve ser satisfatória para este resultado ser considerado bom, o que não acontece no município.

Thesis (MScMedSc)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Introduction: Tuberculosis (TB) treatment registers and laboratory records are essential recording and reporting tools in TB control programmes. Reliable data are essential for any TB control programme but under-registration of TB cases has been well documented internationally, due to under-reporting of patients on treatment or failure to initiate treatment. The accuracy and completeness of routinely collected data are seldom monitored. Aim: This study used record linking to assess the accuracy and completeness of TB treatment register data and the feasibility of estimating the completeness of bacteriological confirmed pulmonary TB registration in two high incident communities in South Africa with capturerecapture methods. Methods: All cases of bacteriologically confirmed TB defined as 2 smear-positive results and/or at least one culture-positive result were included. Record linking was performed between three data sources: (1) TB treatment registers; and (2) all smear and culture results from (a) the nearest central laboratory, and (b) the referral hospital laboratory. To estimate the completeness of TB treatment recording three-source log-linear capture-recapture models were used, with internal validity analysis. Results: The TB treatment registers had 435 TB cases recorded of which 204 (47%) were bacteriologically confirmed cases. An additional 39 cases that were recorded as nonbacteriological cases in the TB treatment register, were reclassified as bacteriologically confirmed. In addition, there were 63 bacteriologically confirmed cases identified from the laboratory databases which were not recorded in the TB treatment register. The final total number of bacteriologically confirmed TB cases across all 3 databases was 306, an increase of 50% over what had initially been recorded in the TB treatment register. The log-linear capture-recapture model estimated the number of bacteriologically confirmed TB cases not found in any of the data sources at 20, resulting in a total number of bacteriologically confirmed TB cases of 326 (95% CI 314-355). The completeness of registration of bacteriologically confirmed pulmonary TB cases was 79% after record linking and 75% after the capture-recapture estimate. Conclusions: The results presented in this thesis highlighted the concern regarding the accuracy and completeness of routinely collected TB recording and reporting data. A high percentage of bacteriologically confirmed cases from both laboratories were not recorded in the TB treatment registers. Capture-recapture can be useful, but not essential, for evaluation of TB control programmes, also in resource-limited settings, but methodology and results should be carefully assessed. The present study estimated the extent of the problem of underreporting of TB in South Africa and identified challenges in the process. Interventions to reduce underreporting of TB are urgently needed. / AFRIKAANSE OPSOMMING: Inleiding: Registers van tuberkulose (TB) behandeling en laboratoriumrekords is noodsaaklike instrumente in die dokumentering van en verslagdoening oor TB beheerprogramme. Betroubare data is onontbeerlik vir enige TB beheerprogram maar onderregistrasie van TB gevalle is internasionaal goed gedokumenteer. Die akkuraatheid en volledigheid van roetine data word selde gemoniteer. Doel: Hierdie studie het rekordkoppeling gebruik om die akkuraatheid en volledigheid van data in TB behandelingsregisters te ondersoek. Voorts is die uitvoerbaarheid van die vangshervangsmetodes vir die beoordeling van die volledigheid van bakteriologies bevestigde pulmonale TB registrasie in twee hoë-insidensie gemeenskappe ondersoek. Metodes: Alle gevalle van bakteriologies bevestigde TB, gedefinieer as 2 smeer-positiewe resultate en/of ten minste een kultuur-positiewe resultaat, is in die studie ingesluit. Rekordkoppeling is onderneem tussen drie databronne: (1) TB behandelingsregisters; en (2) alle smeer- en kultuurpositiewe resultate van (a) die naaste sentrale laboratorium, en (b) die verwysende hospitaallaboratorium. Om die volledigheid van TB behandelingsrekords te ondersoek is drie-bron log-lineêre vangs-hervangs modelle gebruik met interne geldigheidsontleding. Resultate: Die TB registers het 435 aangetekende TB gevalle bevat waarvan 204 (47%) bakteriologies bevestigde gevalle was. 'n Bykomende 39 gevalle wat as nie-bakteriologies bevestigde gevalle aangeteken was in die TB register is hergeklassifiseer as bakteriologies bevestig. Daar is ook 63 bakteriologies bevestigde gevalle geïdentifiseer vanuit die laboratorium databasisse wat nie in die TB register aangeteken was nie. Die finale totale aantal bakteriologies bevestigede TB gevalle oor al drie databasisse heen was 306, 'n toename van 50% in vergelyking met wat aanvanklik in die TB register aangeteken was. Die log-lineêre vangs-hervangs model het die aantal bakteriologies bevestigde gevalle wat nie in enige van die databronne gevind kon word nie as 20 gevalle geskat, wat gelei het tot 'n totaal van 326 (95% VI 314-355) bakteriologies bevestigde gevalle. Die volledigheid van registrasie van bakteriologies bevestigde TB gevalle was 79% na rekordkoppeling en 75% na die vangs-hervangs skatting. Gevolgtrekkings: Die resultate wat in hierdie tesis voorgelê is beklemtoon die besorgdheid oor die akkuraatheid en volledigheid van die aanmelding en optekening van roetine TB data. 'n Hoë persentasie van bakteriologies bevestigde gevalle van beide laboratoriums is nie in die TB register opgeteken nie. Vangs-hervangs kan nuttig wees, maar nie noodsaaklik nie, in die evaluasie van TB beheerprogramme, ook in hulpbron-arm omgewings, maar die metodologie moet omsigtig beoordeel word. Die huidige studie het die omvang van die probleem van onderrapportering van TB in Suid-Afrika beraam en uitdagings in die proses geïdentifiseer. Intervensies om onderrapportering te verminder word dringend benodig.