Strengthening data collection on TB Deaths/Mortality

Types of HIS in WPR Strong HIS supplemented by non-routine data collection system Relatively advanced HIS with limited non-routine information Weak routine HIS, heavily dependent on survey information

ESTIMATED DEATHS AND DALYs BY SELECTED DISEASES IN 2002, WPRO   Estimated Deaths DALYs in Millions Rank Total Deaths Deaths Per day Tuberculosis 5 360 000 986 5.95 9 HIV/AIDS 12 46 000 126 1.97 13 Diarrhoeal diseases 10 149 000 408 6.53 8 Childhood diseases* 11 53 000 145 2.26 Hepatitis 40 000 110 0.70 14 Malaria 15 11 000 30 0.43 Respiratory infections 4 511 000 1 400 8.54 6 Perinatal conditions 350 000 959 14.44 Nutritional deficiencies 26 000 71 4.36 Malignant neoplasms 2 2 315 000 6 342 24.82 3 Diabetes mellitus 191 000 5230 3.26 Cardiovascular diseases 1 3 817 000 10 458 32.34 Respiratory diseases** 1 609 000 4 408 15.50 Mental disorders (suicides) 7 333 000 912 6.82 Neuro-psychiatric disorders 165 000 452 46.52 * Pertussis, poliomyelitis, diphtheria, measles, tetanus Source: The WHR 2003 ** Chronic obstructive pulmonary diseases and asthma.   Updated 22 April 2004

TB deaths reported Mongolia 598 (2000) Philippines 28038 (1998) China 6860 (1999) selected areas PNG 211 (1980)

TB deaths in Malaysia Year Hospital TB Program Statistics Dept 1996 439 601 539 1997 425 637 574 1998 487 685 569 1999 534 778 575 2000 536 942 NA 2001 645 1052 NA 2002 562 1035 NA

Health information dept Ministry of Health Health information dept Health related ministries National statistics office Private health care NGO etc Other components of HIS Hospital information system RPH TB Malaria Environmental health Oral health Communicable disease etc

Issues of concern Underreporting (not reported or not reported correctly) Data discrepancy from various data systems (communication problem/data sources) Diagnostic & coding problem (skill-related)

What need to be done Set up one if there is none Streamline the various systems for better estimates thro’ constant dialogue Periodical study (e.g.cross-matching on death documentation) to assess extent of underreporting, where are the gaps of reporting Institutionalize better coordinating mechanism between depts

By contrast, the WHO “requirements” for TB data have viewed by many as an obstacle to use of data by nurses and district managers in the TB program because there are so many indicators and data elements that local users get lost. Brainstorming with TB nurses on their requirements, the Eastern Cape Department of Health developed a 12-item data list for TB to replace the 160 items that “WHO required,” but this was not acceptable due to WHO requirements. While many of these data may be useful for international comparisons (over half of the items had to do with race and age breakdowns and unusual types of TB) they confuse the user and obscure the important information on which management decisions at the clinic should be made. WHO does not clearly distinguish between its own needs and data that are recorded for local use and decision making. More recently, an electronic, computerized TB register has been introduced to capture all the information on each patient — some 40,000 new cases in Eastern Cape and 150,000 in South Africa annually. This will provide all the detailed information national and international managers could want, leaving space for a few simple indicators to drive case finding, sputum exams, and early identification of dropouts in the monthly routine data set. Source:2nd international RHINO workshop on: enhancing quality & use ofr routine health information at district level OCT 2003, Eastern Cape, South African

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