Using health and demographic surveillance to understand the burden of disease in populations: the case of tuberculosis in rural South Africa.
OBJECTIVE
To utilize the Agincourt health and demographic surveillance system (HDSS) platform to assess the burden of pulmonary tuberculosis (PTB) in a rural South African sub-district.


METHODS
During 1999, data from three sources were combined to estimate disease prevalence amongst a non-migrant adult population: (1) passive case-finding (PCF) through hospital register data; (2) active case finding (ACF) using a systematic household assessment of chronic coughers; and (3) verbal autopsy (VA) data on cause of death.


RESULTS
Of 66,840 residents, 38,251 permanent adult residents were included in the analysis. A total of 102 cases of PTB were detected through PCF. ACF sweep detected 366 chronic coughers with 6 cases of confirmed PTB. Among 28 PTB deaths detected by VA, 13 (46%) were not previously identified by the health service. The total PTB prevalence was 157/100,000; 110/100,000 of prevalent cases were detected by PCF. Among undetected cases, 24/100,000 were identified through ACF, while 23/100,000 were detected by the VA process.


CONCLUSIONS
Amongst prevalent PTB cases in the permanent adult population, 70% were detected by the health service; 15% of cases were undiagnosed in the community, while an equal proportion died of PTB prior to diagnosis. The latter groups contributed disproportionately to infectiousness in the community through prolonged duration of symptoms. As most of these cases presented to the health service on a number of occasions, strengthening early case detection should remain the cornerstone of TB control efforts. Strategies to strengthen the application of health & demographic surveillance systems to disease surveillance are discussed.
Pronyk
Paul M
PM
Rural AIDS & Development Action Research Programme, School of Public Health, University of Witwatersrand, South Africa. pronyk@soft.coj.za
Kahn
Kathleen
K
Tollman
Stephen M
SM
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000401:mortality; D000328:Adult; D001344:Autopsy / Q000379:methods; D017281:Cost of Illness; D003710:Demography; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D006801:Humans; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D012423:Rural Health; D012424:Rural Population / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000401:mortality