Evaluation of the Tuberculosis Surveillance System in District Hyderabad, Province Sindh-Pakistan, 2012

Aims: To identify strengthens and weaknesses of Tuberculosis (TB) surveillance system of District Hyderabad and suggest recommendations for improvement.
Study Design: Descriptive evaluative study
Place and Duration of Study: This research work was conducted in Provincial directorate of health, district health offices, and TB sentinel sites of District Hyderabad, between February and March, 2012.
Methodology: A total of 26 stakeholders were identified by using purposive sampling technique based on their involvement in and relevance to the TB surveillance system. Data was collected by review of medical records and stakeholder interviews by using “Centers of Disease Control (CDCs) Updated Guidelines for the Evaluation of Surveillance Systems. Attributes were rated as good, fair and poor on the basis of obtained score.
Results: System was good in simplicity and flexibility due to simple case definition and adaptation of new changes. Presence of laboratory component and 90% completeness of forms led to good rank in data quality. The system covered limited (n=12) health facilities which caused fair representativeness. The staff was highly motivated to provide accurate, consistent and complete information and suggested good acceptability of system. Due to quarterly reporting, timeliness was poor and led to delays in outbreak identification and mitigation responses. Sensitivity and positive predictive value were 26% and 56.8% respectively. The system was fair in stability as supported by ministry of health with multinational donors.
Conclusion: The TB Surveillance system was satisfactory in all attributes except representativeness, sensitivity, and timeliness. Increased establishment of sentinel sites at public and private health facilities and added frequency in reporting time were recommended.