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WS on Surveillance & Epidemiology of Tuberculosis in the Western Pacific Region

Explore indirect estimation methods for TB burden, mortality, and incidence, analyze country data presentation, and strengthen data collection to improve estimates. Address issues with estimation process and enhance TB mortality data measurement. Comprehensive review to identify problems and implement effective solutions.

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WS on Surveillance & Epidemiology of Tuberculosis in the Western Pacific Region

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  1. WS on Surveillance & Epidemiologyof Tuberculosis in the Western Pacific Region Review of Day 3 Dr Pratap Jayavanth Stop TB/WHO/Cambodia

  2. Agenda for Day 3 • Review of Day 2 • Indirect Estimates & Analytic problems • Exercises on indirect estimates of TB burden • TB mortality • Exercise on mortality • Group work on country data presentation

  3. Indirect Estimates • Direct estimation of the incidence of disease requires two population-based surveys done shortly apart from each other (within 1-2 years) • Indirect estimation of incidence of disease is hence done much more frequently. • Four indirect measures of TB incidence: • Incidence TB= notification /proportion detected • Incidence TB= prevalence/duration • Incidence TB= incidence infection/Styblo ratio • Incidence TB=deaths/case fatality rate

  4. What’s wrong with estimation process? • Many estimates are based on guesses, often inaccurate or too biased to judge case detection • Method 1: Weak, if the surveillance system is of poor quality • Method 2: Likelihood of underestimating duration (eg treatment delay) • Method 3: Styblo ratio breaks down if incidence is not stable or affected by HIV • Method 4: CFR becomes less accurate if there are many defaulters and transfer outs.

  5. Standards & norms in TB Epidemiology • Identify problems, lots of methods are available, select the best solution ! • Explore the variation in your data:   -Compare with known standards -Anomalies, deviations, inconsistencies • Look at list of indicators [WHO has developed a compendium of indicators in collaboration with CDC, & others].

  6. Data Collection on TB deaths and mortality • Types of Health Information system in WPR -1.Strong HIS [supported by non-routine data collection system] -2.Relatively advanced HIS [depending on limited non-routine data] -3.Weak routine HIS, heavily dependant on surveys • Issues: -1. Under reporting -2. Discrepancies in data and -3. Coding problem

  7. Strengthening Data Collection on TB deaths and mortality Steps to be taken: • Establish an effective data collection system • Streamline the different systems to improve quality of estimates • Conduct periodical studies to ensure there are no gaps in reporting • Institutionalize a good coordinating mechanism between concerned departments

  8. TB Mortality • TB deaths ranked 5th in the WPR (986/day) and 9th, in terms of DALY • League tables Rank Condition % DALY 1 LRI 6.1 10 TB 2.5 • In the case of TB, 90% of DALY’s due to death

  9. TB Deaths & Mortality Data • How to measure/estimate TB deaths ? 1. Vital registration 2. Population surveys 3. Incidence x case fatality rate

  10. Comments on Country Data (1) • Japan: More details related to age and place (metropolitan and other areas to analyse the trends on discontinuity (1980 ); why there is stagnation? • Malaysia: Incidence rates for different parts of Malaysia, & changes in mortality, & match with data from HIV units • Mongolia: More details required to study the problem of increasing trend of all forms-TB cases (over-diagnosis?) since many years, while the ss+ number remains more or less constant.

  11. Comments on Country Data (2) • Philippines: Need to estimate the case detection rates and also the mortality rates. • Hong Kong: Since case detection should be higher than estimated by WHO, cross checking of incidence estimation and ss+ cases. Average age of TB is increasing (age of pop. and age of epidemic ?) • PNG: Need to address issues related to incomplete data, difference in analysis, provide TB cohort data and HIV data • VTN: Need to monitor data from the whole country and estimate incidence using Styblo method and investigate ss+ rates (trends by age and sex)

  12. Comments on Country Data (3) • Lao PDR: Need to improve case notification by age and sex  • Fiji: Re-examine the data esp. related to the increase in cases during 1990s • Korea: To explore the best way to estimate ARI and CDR (age groups overestimated, apply new methods. Improve case reporting and true CDR • Cambodia: Improve notification rates & study trends in mortality. Prevalence Survey results to be finalized. • China: Estimation from provinces, prevalence surveys

  13. Thank you

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