PROTOCOL TO STUDY REFERRAL OF TUBERCULOSIS SUSPECTS AND DEFINITE TUBERCULOSIS CASES TO NATIONAL TUBE

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PROTOCOL TO STUDY REFERRAL OF TUBERCULOSIS
SUSPECTS AND DEFINITE TUBERCULOSIS CASES TO
NATIONAL TUBERCULOSIS PROGRAMME SERVICES

• Salah-Eddine Ottmani, MD, MPH
• Mukund Uplekar, MD
• CDS / STB / TBS
• WHO, Geneva

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Rational

• TB is a major cause of morbidity and mortality
• EMR 4 of world TB burden 23 SS detected
• Contribution of other health sectors to TB
  control basically unknown in most EMR countries
• Main objective of this survey assessment of the
  extent of referral of TB suspects and TB cases to
  NTP services

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Eligibility criteria

• Study setting public health facility (NTP) with
  access to TB diagnosis
• Study participant TB suspect or definite TB
  case, whatever her/his age or sex
• Study period standard working period, far from
  holiday periods or particular events (ei
  Ramadan, Eid period, world football cup, etc...)

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Case definition

• Any patient identified in study health facility
  as TB suspect or as definite TB case.
• Any patient referred to the study health facility
  as TB suspect or as definite TB case patient may
  be referred from other public health settings or
  from health services other than public

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Selection of study health facilities

• Public health facility with high turn over
  patients with accessible TB laboratory
• Easy to monitor and to supervise.
• Priority to health facilities where high number
  of TB cases are identified.
• Study population size includes at least 100 new
  SS smear-positive TB cases (?1000 -1500 study
  participants).
• The higher number of health facilities the better
  representativeness and the shorter the study
  period.
• Ideally, random sampling

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Data collection process

• Study register / health worker / study health
  facility
• Study register to be filled by health worker
  during patient visits

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Training session

• Who should be trained?
• Health workers in charge of study registers
• TB programme coordinators of districts or
  provinces
• A statistician, if possible
• What to explain?
• Study objectives
• Data collection process
• Data quality and missing data issues
• Simulation of data collection and data entry

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Data collection quality

• Information for each patient should be
  comprehensive and accurate in the study register
  (columns 7 and 8)
• Monitoring and supervision by district TB
  programme coordinator and NTP central unit

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Data entry in computer

• Epi-Info programme data entry in Rec.file
• Data entry by statistician or other
• Could be carried out at district/province or
  national level

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Data analysis and statistics

• Distribution studies of variables
• Calculation of proportions
• Stratification by health sector
• Chi square, Student -t- test
• Logistic regression analysis may be used

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Conclusion

• Simple, quick and cheap survey
• Quick snapshotof referral distribution pattern
  within NTP services
• Broad idea on contribution of health services out
  of NTP in TB case referral and detection
• Raise hypotheses for operational research
• Selection bias may be introduced