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

WS on Surveillance & Epidemiology of Tuberculosis in the Western Pacific Region. Review of Day 3. Dr Pratap Jayavanth Stop TB/WHO/Cambodia. Agenda for Day 3. Review of Day 2 Indirect Estimates & Analytic problems Exercises on indirect estimates of TB burden TB mortality

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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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