title: Estimating tuberculosis burden and reporting in resource-limited countries: a capture-recapture study in Iraq.
abstract: BACKGROUND
  The global target for tuberculosis (TB) control set by the Millennium Development Goals is a decrease in TB incidence by 2015. Direct measurement of country-level TB incidence using population-based methods is impractical, emphasising the need for well-performing surveillance systems and, where these are not available, accurate quantification of incidence and under-reporting of TB.
  
  
  OBJECTIVE
  To estimate TB incidence and TB under-reporting in Iraq in 2011.
  
  
  METHODS
  Prospective longitudinal surveillance was established among all eligible public and private non-National TB Programme (NTP) providers in a random sample of eight of the 18 Iraqi governorates from May to July 2011. Record linkage with the NTP and three-source capture-recapture analysis of data were then conducted using log-linear modelling.
  
  
  RESULTS
  A total of 1985 TB cases were identified after record linkage. The NTP registered 1677 patients (observed completeness 84%). The estimated total number of TB cases was 2460 (95%CI 2381-2553), with identified TB cases representing 81% (95%CI 69-89) after adjusting for sampling design. The estimated ratio of notified to incident cases was 69% (95%CI 58-76).
  
  
  CONCLUSIONS
  We estimate 14 500 TB cases in Iraq in 2011, of which 31% (95%CI 24-42) were unreported. TB surveillance needs to be strengthened to reduce under-reporting.
authors.affiliation: World Health Organization Iraq Office, Amman, Jordan.
authors.forename: S
authors.initials: S
authors.lastname: Huseynova
authors.forename: D S
authors.initials: DS
authors.lastname: Hashim
authors.forename: M R
authors.initials: MR
authors.lastname: Tbena
authors.forename: R
authors.initials: R
authors.lastname: Harris
authors.forename: A
authors.initials: A
authors.lastname: Bassili
authors.forename: I
authors.initials: I
authors.lastname: Abubakar
authors.forename: P
authors.initials: P
authors.lastname: Glaziou
authors.forename: K
authors.initials: K
authors.lastname: Floyd
authors.forename: N A
authors.initials: NA
authors.lastname: van Hest
mesh_terms: D003906:Developing Countries / Q000191:economics; D018563:Disease Notification; D006295:Health Resources / Q000191:economics; D006801:Humans; D015994:Incidence; D007493:Iraq / Q000453:epidemiology; D016014:Linear Models; D008137:Longitudinal Studies; D008498:Medical Record Linkage; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011446:Prospective Studies; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology