title: Completeness and Reliability of the Republic of South Africa National Tuberculosis (TB) Surveillance System.
abstract: BACKGROUND
  Accurate surveillance data are paramount to effective TB control. The Republic of South Africa's National TB Control Program (NTP) has conducted TB surveillance since 1995 and adopted the Electronic TB Register (ETR) in 2005. This evaluation aimed to determine the completeness and reliability of data in the Republic of South Africa's TB Surveillance System.
  
  
  METHODS
  Three of nine provinces, three subdistricts per province, and 54 health facilities were selected by stratified random sampling. At each facility, 30 (or all if <30) patients diagnosed in Quarter 1 2009 were randomly selected for review. Patient information was evaluated across two paper and four electronic sources. Completeness of program indicators between paper and electronic sources was compared with chi-square tests. The kappa statistic was used to evaluate agreement of values.
  
  
  RESULTS
  Over one-third (33.7 %) of all persons with presumptive TB recorded as smear positive in the TB Suspect Register did not have any records documenting notification, treatment, or management for TB disease. Of 1339 persons with a record as a TB patient at the facility, 1077 (80 %) were recorded in all data sources. Over 98 % of records contained complete age and sex data. Completeness varied for HIV status (53-86 %; p < 0.001) and DOT during the intensive phase of treatment (17-54 %; p < 0.001). Agreement for sex was excellent across sources (kappa 0.94); moderate for patient type (0.78), treatment regimen (0.79), treatment outcome (0.71); and poor for HIV status (0.33).
  
  
  CONCLUSIONS
  The current evaluation revealed that one-third of persons diagnosed with TB disease may not have been notified of their disease or initiated on treatment ('initial defaulters'). The ETR is not capturing all TB patients. Further, among patients with a TB record, completeness and reliability of information in the TB Surveillance System is inconsistent across data sources. Actions are urgently needed to ensure that all diagnosed patients are treated and managed and improve the integrity of surveillance information.
authors.affiliation: Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA. lpp8@cdc.gov.|Global Tuberculosis Branch, Division of Global HIV/AIDS and Tuberculosis, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-10, Atlanta, GA, 30333, USA. lpp8@cdc.gov.
authors.forename: Laura Jean
authors.initials: LJ
authors.lastname: Podewils
authors.affiliation: Unit for Clinical and Biomedical Tuberculosis Research Unit, Medical Research Council of South Africa, Durban, South Africa. nonkqubela.bantubani@mrc.ac.za.
authors.forename: Nonkqubela
authors.initials: N
authors.lastname: Bantubani
authors.affiliation: Global AIDS Program, U.S. Centers for Disease Control and Prevention, Pretoria, South Africa. ccbristow@gmail.com.
authors.forename: Claire
authors.initials: C
authors.lastname: Bristow
authors.affiliation: Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA. lizabronner@gmail.com.|Unit for Clinical and Biomedical Tuberculosis Research Unit, Medical Research Council of South Africa, Durban, South Africa. lizabronner@gmail.com.
authors.forename: Liza E
authors.initials: LE
authors.lastname: Bronner
authors.affiliation: Global AIDS Program, U.S. Centers for Disease Control and Prevention, Pretoria, South Africa. petersa@sa.cdc.gov.
authors.forename: Annatjie
authors.initials: A
authors.lastname: Peters
authors.affiliation: Unit for Clinical and Biomedical Tuberculosis Research Unit, Medical Research Council of South Africa, Durban, South Africa. alexanderpym@hotmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Pym
authors.affiliation: Department of Tuberculosis Control, Republic of South Africa National Department of Health, Pretoria, South Africa. MametD@health.gov.za.
authors.forename: Lerole David
authors.initials: LD
authors.lastname: Mametja
mesh_terms: D000328:Adult; D003140:Communicable Disease Control / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D015203:Reproducibility of Results; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy