title: Estimating tuberculosis burden and case detection in Pakistan.
abstract: BACKGROUND
  The National Tuberculosis Control Programme (NTP) in Pakistan has officially achieved a tuberculosis (TB) case detection rate of 64% in 2011, with an estimated incidence rate of 230 per 100 000 population, but is likely to be missing an unknown number of patients, particularly in the private sector.
  
  
  METHODS
  All public and private sector providers in 12 randomly selected districts of Pakistan were included.
  
  
  OBJECTIVE
  To estimate TB incidence and TB notification rates in Pakistan in 2012.
  
  
  METHODS
  A surveillance system was established among all eligible non-NTP providers in selected districts from January to March 2012. Record linkage and capture-recapture analysis was conducted.
  
  
  RESULTS
  Of 8346 TB cases identified after record linkage, 6061 were registered with the NTP. The estimated number of unobserved TB cases was 10 030 (95%CI 7800-12 910), which meant that the proportion of notified cases was 32% (95%CI 17-49). The calculated annual incidence was 878 000 cases (95%CI 573 000-1 675 000), corresponding to a rate of 497/100 000 (95%CI 324-948) annually in the population.
  
  
  CONCLUSIONS
  The study estimated that the proportion of cases notified to the NTP was low, with actual incidence rates being higher than official estimates. TB surveillance should be strengthened to reduce under-reporting.
authors.affiliation: National Tuberculosis Control Programme Pakistan, Islamabad, Pakistan.
authors.forename: R
authors.initials: R
authors.lastname: Fatima
authors.affiliation: Health Protection Agency, London, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Harris
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France; and University of Stellenbosch, Cape Town, South Africa.
authors.forename: D A
authors.initials: DA
authors.lastname: Enarson
authors.affiliation: University of Bergen, Bergen, Norway.
authors.forename: S G
authors.initials: SG
authors.lastname: Hinderaker
authors.affiliation: National Tuberculosis Control Programme Pakistan, Islamabad, Pakistan.
authors.forename: E
authors.initials: E
authors.lastname: Qadeer
authors.affiliation: National Tuberculosis Control Programme Pakistan, Islamabad, Pakistan.
authors.forename: K
authors.initials: K
authors.lastname: Ali
authors.forename: A
authors.initials: A
authors.lastname: Bassili
authors.affiliation: World Health Organization Eastern Mediterranean Regional Office, Cairo, Egypt.
authors.forename: A
authors.initials: A
authors.lastname: Bassilli
mesh_terms: D018563:Disease Notification; D006801:Humans; D015994:Incidence; D008498:Medical Record Linkage; D016347:Medical Records Systems, Computerized; D010154:Pakistan / Q000453:epidemiology; D011159:Population Surveillance; D017149:Private Sector; D017150:Public Sector; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology*