Evaluation of Pulmonary Tuberculosis Surveillance System in adult patients aged 15 year-old up at Ratchaburi Hospital, Ratchaburi Province, Thailand, since October 1, 2017 to September 30, 2018

Abstract

Background: Pulmonary tuberculosis (TB) is an important public health problem around the world including Thailand. The evaluation of TB surveillance system (TBSS) by Case Definition for Surveillance 2003 in Ratchaburi Hospital in the fiscal year 2013, found fair sensitivity and positive predictive value (PPV) with good timeliness. At present, Ratchaburi Hospital reports TB patients through TBCM online program and applies molecular biology to detect TB. Therefore, the TBSS should be re-evaluated for improving the effectiveness of TBSS.
Methods: Cross-sectional study of both quantitative and qualitative were done in all patients at Ratchaburi Hospital aged from 15 years old up, since October 1, 2017 to September 30, 2018. Quantitative study using data from Tuberculosis Case Management (TBCM) reports, TBCM online registration, records of sputum results and outpatient medical records. Qualitative Study using interviewing officials involved in TBSS for comments on TBSS.
Results: The sensitivity and PPV of TBSS by definition of TB in Communicable Diseases Act 2015 as same as the definition of TB in National Tuberculosis Control Program Guideline, Thailand, 2018 were 78.05% and 100%, respectively. The accuracy of anti-TB drugs started date and patient’s address were 98.44% and 97.40%, respectively. The data of name, surname, gender and age were accurate 100%. Timeliness was 91.67% with good representativeness. The evaluation of TB patient reporting steps through TBSS found all data were obtained from the records of sputum results, TB in-patient department, TB clinic and outpatient department. The qualitative study found everyone acknowledged the usefulness of TBSS and absolutely agreed that TB was a disease required for surveillance system. However, TBSS should be improved in stability and simplicity.
Conclusion and discussion: Sensitivity and PPV of present TBSS in Ratchaburi Hospital were better than TBSS in fiscal year 2013. These resulted from the reporting of TB patients through TBCM online and the application of new definition according to the 2015 Act, which replaced the definition of infectious diseases in 2003, which has been redefined to cover diagnose patients with suspected tuberculosis with negative sputum by other methods such as molecular biology. However, the instability and difficulty of TBSS could affect the sensitivity of TBSS.