National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
South-East Asia Regional Office, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India.
BMJ Open. 2019 Jan 28;9(1):e021529. doi: 10.1136/bmjopen-2018-021529.
The WHO estimates that almost 40% of patients diagnosed with tuberculosis (TB) are not reported. We implemented this study to assess TB under-reporting and delayed treatment registration in nine counties in China.
A retrospective inventory study (record review).
Counties were selected using purposive sampling from nine provinces distributed across eastern, central and western regions of China in 2015.
Under-reporting was calculated as the percentage of patients with TB not reported to TB Information Management System (TBIMS) within 6 months of diagnosis. Delayed registration was estimated as the percentage of reported cases initiating treatment 7 or more days after diagnosis. Multivariable logistic regression and an alpha level of 0.05 were used to examine factors associated with these outcomes.
Of the 5606 patients with TB identified from project health facilities and social insurance systems, 1082 (19.3%) were not reported to TBIMS. Of the 4524 patients successfully reported, 1416 (31.3%) were not registered for treatment within 7 days of diagnosis. Children, TB pleurisy, patients diagnosed in the eastern and central regions and patients with a TB diagnosis recorded in either health facilities or social insurance system-but not both-were statistically more likely to be unreported. Delayed treatment registration was more likely for previously treated patients with TB, patients with negative or unknown sputum results and for patients diagnosed in the eastern region.
Almost one in every five patients diagnosed with TB in this study was unknown to local or national TB control programmes. We recommend strengthening TB data management practices, particularly in the eastern and central regions, and developing specific guidelines for reporting paediatric TB and TB pleurisy. Patient education and follow-up by diagnosing facilities could improve timely treatment registration. Additional studies are needed to assess under-reporting elsewhere in China.
世界卫生组织（WHO）估计，近 40%的结核病（TB）患者未被报告。我们开展此项研究，旨在评估中国 9 个县的结核病漏报和延迟治疗登记情况。
回顾性存量研究（记录审查）。
2015 年，我们从中国东部、中部和西部的 9 个省中采用立意抽样的方法选择了县。
在诊断后 6 个月内，未向结核病信息管理系统（TBIMS）报告的结核病患者比例计算为漏报率。报告病例的延迟登记率估计为诊断后 7 天以上开始治疗的病例比例。采用多变量逻辑回归和 0.05 的α水平来检查与这些结局相关的因素。
从项目医疗机构和社会保险系统中发现的 5606 例结核病患者中，有 1082 例（19.3%）未向 TBIMS 报告。在成功报告的 4524 例患者中，有 1416 例（31.3%）未在诊断后 7 天内登记治疗。儿童、结核性胸膜炎、在东部和中部地区诊断的患者以及在医疗机构或社会保险系统中记录有但不在两者中均记录有结核病诊断的患者，更有可能未被报告。有既往结核病治疗史、痰检结果为阴性或未知以及在东部地区诊断的患者更有可能延迟治疗登记。
在这项研究中，每 5 例诊断的结核病患者中就有 1 例不为当地或国家结核病控制规划所知晓。我们建议加强结核病数据管理实践，特别是在东部和中部地区，并制定专门的报告儿童结核病和结核性胸膜炎的指南。诊断机构对患者进行教育和随访，可提高及时治疗登记率。还需要在中国其他地方开展评估漏报率的研究。
