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Cape Town - The Western Cape’s electronic reporting system for drug-resistant tuberculosis is riddled with inaccuracies, a local study has revealed.
The study concluded that TB in children was under-reported and under-diagnosed. Researchers said this was worrying because it had implications for resource planning and burden estimates.
This also means the World Health Organisation (WHO), which monitors diseases and assesses the performance of different health systems worldwide, could be getting incorrect information about the state of this disease in Cape Town.
The study, by Penelope Rose and other researchers from Stellenbosch University’s Desmond Tutu TB Centre, found that only two-thirds of children clinically treated for drug-resistant TB were recorded in the electronic reporting system.
The Western Cape uses two electronic TB registers: ETR.net captures the provincial TB data, while a separate electronic register, EDR.web, is used to register drug-resistant TB.
The two registers not only allow the generation of useful TB reports on important TB programme indicators, but they are also aimed at improving quality of data and facilitating more complex data analyses.
The registers are submitted to centralised TB units before being reported to the national database and then to the WHO.
Of the 77 paediatric drug-resistant cases analysed, only 49 cases, or 64 percent, were found in the EDR.web - suggesting under-reporting.
A number of inconsistencies, including cases of eight children that were indicated as not having a confirmed diagnosis, were entered into the electronic system as if drug-resistant TB had been confirmed.
About 21 percent of children with confirmed drug-resistant TB were entered in the register as not confirmed, while clinically they had a confirmed drug resistance.
Five children who were treated for drug-resistant TB and initially registered in the electronic register, did not appear in the final count.
In addition, records of 14 children who were registered in the electronic system did not match the clinical cohort, while seven children who were treated for drug-resistant TB in earlier years were recorded in the register only last year.
While completeness and accuracy of data were relatively high for the type of drug resistance, at 94 percent, indication that treatment had started was slightly lower at 84 percent and HIV status in HIV-infected children was recorded to be 100 percent accurate.
Although the Western Cape had about 17 percent of paediatric TB, only 4.4 percent was registered as drug-resistant, prompting researchers to conclude that TB in children was under-reported and under diagnosed.
The researchers raised concerns about the fact that some facilities had no direct access to the electronic data capturing system, and still used old-fashioned paper registers.
“The process of transferring data from the paper register at facility level to the electronic register needs to be simplified with improved verification system. The roll-out of molecular diagnostic tests may lead to increased detection of both adults and children” with drug-resistant TB, wrote Rose.