Identification of micro-regions with under-reported tuberculosis cases in Brazil, 2012-2014

Silva, Gabriela Drummond Marques da; Duarte, Elisabeth Carmen; Cruz, Oswaldo Gonçalves; Garcia, Leila Posenato

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 29 (1) • 2020 • https://doi.org/10.5123/S1679-49742020000100025 copy

Identification of micro-regions with under-reported tuberculosis cases in Brazil, 2012-2014^* * Article derived from the doctoral thesis entitled 'Estimated incidence, spatial and epidemiological analysis of tuberculosis in Brazil, 2012-2014', defended by Gabriela Drummond Marques da Silva at the University of Brasília (UnB) Public Health Postgraduate Program in 2018.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to identify Brazilian micro-regions with under-reported tuberculosis cases, from 2012 to 2014.

Methods:

this was an ecological study using data from the Notifiable Health Conditions Information System (SINAN). The indirect estimator of the proportion of notified cases (EIPCN) was calculated as the mean between the proportion of cases that adhered to treatment and the proportion of those who underwent sputum smear microscopy. Negative Binomial Regression was used to investigate evidence of under-reporting in the micro-regions selected through EIPCN.

Results:

under-reporting was suspected in 89 (17.5%) micro-regions with EIPCN below 83%. The EIPCN rate ratio in the regression model was 0.996 (95%CI 0.988;1.003) considering all the data and equal to 0.987 (95%CI 0.974;0.999) excluding the 89 micro-regions with suspected under-reporting.

Conclusion:

evidence of tuberculosis case under-reporting was found in micro-regions where basic indicators of surveillance system quality had poor performance.

Keywords:
Tuberculosis; Incidence; Epidemiological Monitoring; Ecological Studies; Quality Indicators, Health Care

Indicator	Group
	1 (n=73)		2 (n=187)		3 (n=164)		4 (n=84)
	x̄	ˢ	x̄	ˢ	x̄	ˢ	x̄	ˢ
Notification timeliness	74.9	10.8	80.6	9.2	82.4	6.2	57.6	10.2
Treatment timeliness	51.0	19.2	63.8	17.5	42.1	16.5	24.6	10.8
Cases having sputum smear microscopy (%)	75.7	9.5	91.2	5.3	88.2	6.0	88.2	8.0
Cases adhered to treatment (%)	78.0	7.9	91.7	4.7	88.7	5.5	88.7	7.4
Cases tested for HIV (%)	60.0	19.3	85.9	9.0	54.6	14.5	58.1	18.4

Indicator	Mean acceptability < 83%			Total			p-value
	No			Yes
	n	%	n	%	n	%
Completeness of number of contacts examined					n	%
Good	188	44.9	10	11.2	198	39.0	<0,001^b
Regular	170	40.6	42	47.2	212	41.7
Poor	61	14.6	37	41.6	98	19.3
Completeness data treatment started					98	19.3
Good	400	95.5	80	89.9	480	94.5	0,081^c
Regular	18	4.3	9	10.1	27	5.3
Poor	1	0.2	-	-	1	0.2
Completeness of case closure status					1	0.2
Good	398	95.0	56	62.9	454	89.4	<0,001^c
Regular	21	5.0	31	34.8	52	10.2
Poor	-	-	2	2.2	2	0.4
Completeness of sputum smear microscopy in the 2^nd month					2	0.4
Good	246	58.7	33	37.1	279	54.9	<0,001^b
Regular	142	33.9	51	57.3	193	38.0
Poor	31	7.4	5	5.6	36	7.1
Completeness of sputum smear microscopy in the 6^th month					36	7.1
Good	164	39.1	22	24.7	186	36.6	0,003^b
Regular	205	48.9	46	51.7	251	49.4
Poor	50	11.9	21	23.6	71	14.0
Mean Completeness					71	14.0
Good	301	71.8	27	30.3	328	64.6	<0,001^b
Regular	118	28.2	62	69.7	180	35.4	<0,001^b
Notification timeliness					180	35.4
Invalid	4	1.0	1	1.1	5	1.0	0,047^c
Good	48	11.5	5	5.6	53	10.4
Regular	273	65.2	52	58.4	325	64.0
Poor	94	22.4	31	34.8	125	24.6
Treatment timeliness					125	24.6
Invalid	8	1.9	4	4.5	12	2.4	0,395^c
Good	9	2.1	1	1.1	10	2.0
Regular	66	15.8	11	12.4	77	15.2
Poor	336	80.2	73	82.0	409	80.5
Cases that had sputum smear microscopy (%)					409	80.5
Good	227	54.2	4	4.5	231	45.5	<0,001^b
Regular	173	41.3	30	33.7	203	40.0
Poor	19	4.5	55	61.8	74	14.6
Cases that adhered to treatment (%)					74	14.6
Invalid	4	1.0	20	22.5	24	4.7	<0,001^c
Good	88	21.0	3	3.4	91	17.9
Regular	134	32.0	2	2.2	136	26.8
Poor	193	46.1	64	71.9	257	50.6
Cases tested for HIV (%)					257	50.6
Invalid	1	0.2	1	1.1	2	0.4	<0,001^c
Good	121	28.9	8	9.0	129	25.4
Regular	96	22.9	14	15.7	110	21.7
Poor	201	48.0	66	74.2	267	52.6
Total	419	100.0	89	100.0	508	100,0

Control variables	Micro-regions with acceptability <83%
	Yes		No
	Rate ratio	95%CI ^a	Rate ratio	95%CI ^a
Yes	0.997	0.991;1.003	0.985	0.975;0.996
No	0.996	0.988;1.003	0.987	0.974; 0.999

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[1] Correspondence: Gabriela Drummond Marques da Silva - Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brazil. Postcode: 70910-900. E-mail: gabidrumm@gmail.com