Unit 12: Reporting & Recording Botswana National Tuberculosis Programme Manual Training for Medical Officers

Slide 12-2 Unit 12: Reporting and Recording Objectives At the end of this unit, participants will be able to: Discuss the importance of collecting data Explain the ways in which data are used Describe details for completing each reporting form Practice completion of the Botswana Treatment Card

Slide 12-3 Unit 12: Reporting and Recording Question How are TB Prevention and Control activities monitored and evaluated?

Slide 12-4 Unit 12: Reporting and Recording Monitoring & Evaluation Activities Completing reporting forms on case findings and treatment outcomes Supervisory visits Discussions during staff meetings Review of medicine stocks Staff training Follow-up Analysing data collected

Slide 12-5 Unit 12: Reporting and Recording Question Why is accurate reporting and record keeping important?

Slide 12-6 Unit 12: Reporting and Recording Importance of Reporting and Record Keeping It is an important part of the DOTS strategy It helps clinics, regions and the nation reach its programme goals It helps us know if our strategies are effective It allows us to see trends and to identify “hot spots” or high risk groups so that efforts can be targeted

Slide 12-7 Unit 12: Reporting and Recording Data Can Enhance Your Work By… Serving as positive reinforcement for a job well done Motivating staff to continue or improve their efforts Identifying areas of strengths and weaknesses Identifying training and supervision needs

Slide 12-8 Unit 12: Reporting and Recording Botswana TB R&R Forms (1) TB Suspect and Sputum Dispatch Register Mycobacteriology Request Form TB Laboratory Register

Slide 12-9 Unit 12: Reporting and Recording Botswana TB R&R Forms (2) Facility/District TB Register Patient Appointment and DOT Card TB Contact Examination Form

Slide Unit 12: Reporting and Recording Botswana TB R&R Forms (3) Electronic TB Register (ETR) Transfer of Patient MDR Treatment Card

Slide Unit 12: Reporting and Recording Botswana TB R&R Forms (4) MDR Treatment Register IPT Dispensary Tally Sheet IPT Register and Compliance Record Tuberculosis Treatment Card

Slide Unit 12: Reporting and Recording The TB Treatment Card (1) Initial source of data for the TB recording and reporting system Diagnosis and treatment information Should be completed by MDs and nurses Information from the treatment card is used to fill in the facility and district TB registers Information should be complete and accurate SOME data is better than NO data!!

Slide Unit 12: Reporting and Recording The TB Treatment Card (2)

Slide Unit 12: Reporting and Recording Name (Surname, First Name) The patient’s surname is written first, followed by the patient’s first name. If the patient has a middle name, write that in the space as well. Example: The patient’s name is Francis Mulenga

Slide Unit 12: Reporting and Recording Sex Circle the appropriate box for either male (M) or female (F) Example: Francis Mulenga is male, “M” should be recorded

Slide Unit 12: Reporting and Recording Age (in years) Correct response for this column is age in years. If patient is a child under one year old, write the number of months followed by /12 (e.g., 6 months would be 6/12) If the patient doesn’t know their age: Look on the OPD Ask year of birth Ask a family member

Slide Unit 12: Reporting and Recording Omang/Passport # Fill in the 9-digit Omang number or Passport number of each TB patient in the space provided. If the patient does not have an identification number, leave this column blank. Example: Francis Mulenga’s Omang number is

Slide Unit 12: Reporting and Recording Address in Full The best description of where the patient lives should be written in this section (street address or plot number). The HCW needs to know enough to FIND the person if s/he has to!! Example: Francis Mulenga lives in a blue house near the Shell petrol station in plot 45 Request at least one mobile phone number for patient and close relative

Slide Unit 12: Reporting and Recording Pretreatment History and Clinical Findings This section, below “Alternative address,” should be written in There are no codes

Slide Unit 12: Reporting and Recording Registration and Transfer Information Unit TB No: The Unit TB number consists of four parts A: District Number (2 digits) B: Health facility Code number (3 digits) C: Specific serial number of the patient starting with 001 at the beginning of each year D: Year of registration

Slide Unit 12: Reporting and Recording Transfer Information (1) Transferred/Moved Out: If a patient transfers to a facility in another district during treatment (“transfer out”), or moves to another facility in the same reporting unit (“move out”), fill in the “To” column with the name of the health facility to which the patient transferred/ moved A separate BNTP form entitled Notice of Transfer of a Patient must be completed for all patients transferring or moving

Slide Unit 12: Reporting and Recording Transfer Information (2) Example: a patient with registration number “089/04” was moved out to Ext. 14 Clinic on 02 October 2004.

Slide Unit 12: Reporting and Recording Transfer Information (3) Transferred/Moved In: Patients transferred or moved in from another reporting unit to your health facility, should be (re-)registered in the TB register. Enter your unit TB number, along with the patient’s new registration number, in the second line of the box. Put an “X” in the “IN” column Note that this is a duplicate TB treatment card, as the original card remains at the original health facility

Slide Unit 12: Reporting and Recording Transfer Information (4) The receiving clinic must complete the Response to a Transfer of a Patient and return to sending clinic.

Slide Unit 12: Reporting and Recording Transfer Information (5) Do not fill in the “REGISTERED” column– it is just to state that the patient has been registered in your health facility. Record the date that the patient came into health facility Example: the patient was re-registered with the new registration number “078/04”, when he moved in to Ext. 14 Clinic on 15 October 2004

Slide Unit 12: Reporting and Recording TB Classification (1) Purpose: Disease classification and site of disease should be recorded in this section Pulmonary disease means TB of the lungs, including patients that are smear-positive or smear-negative All other types of TB are classified as extrapulmonary disease, including pleurisy and miliary TB Patients with pulmonary AND extrapulmonary disease should be classified as pulmonary

Slide Unit 12: Reporting and Recording TB Classification (2) Make an “X” over the appropriate box for pulmonary TB or extrapulmonary TB If the patient has both pulmonary and extrapulmonary TB, mark this as pulmonary TB and fill in the site of extrapulmonary TB In the case of extrapulmonary TB, indicate the site that has been affected in the space provided Example: Francis Mulenga has pulmonary TB

Slide Unit 12: Reporting and Recording Patient Category Proper patient category necessary to determine appropriate treatment regimen Make an “X” over the box with the appropriate option. The four options are: NEW FAILURE DEFAULT RELAPSE Francis Mulenga is a new patient RETREATMENT CASES

Slide Unit 12: Reporting and Recording Sputum Examination Results: Pre-Treatment (1) Purpose: These columns record the date and results of the patient’s pre-treatment sputum smear result In all cases (except young children), three sputum examinations should be done (spot, morning, spot)

Slide Unit 12: Reporting and Recording Sputum Examination Results: Pre-Treatment (2) Date format: “dd/mm/yy” Record date of collection of sputum Results column: “P” for positive and “N” for negative Indicate the grading of the sputum result (i.e., scanty, +, ++, +++)

Slide Unit 12: Reporting and Recording Sputum Exam Results: Pre-Treatment (3) Example: Francis Mulenga gave three sputum specimens for examination, one on 12th January and two on 13th January The results were “+++”, “++”, and “+++”, respectively

Slide Unit 12: Reporting and Recording Sputum Exam Results: Intensive Phase (2 Month Exam) (1) Purpose: Two sputum smears should be done after two months of treatment

Slide Unit 12: Reporting and Recording Date format: “dd/mm/yy” Record date of collection of sputum Results column: “P” for positive and “N” for negative Example: Francis Mulenga gave one sputum specimen for examination on 15th March. The result was negative Sputum Exam Results: Intensive Phase (2 Month Exam) (2)

Slide Unit 12: Reporting and Recording Sputum Exam Results: End of Treatment (6 months) Two sputum exams should be done at the end of six months of treatment Date format: “dd/mm/yy” Record date of collection of sputum Results column: “P” for positive, “N” for negative Example: Francis Mulenga gave two sputum specimens for examination on 5th July. Results were negative

Slide Unit 12: Reporting and Recording Sputum Smear Results: End of Treatment (8 months) Category II patients should have two sputum examinations at eight months Date format: “dd/mm/yy” Record date of collection of sputum Results column: “P” for positive, “N” for negative

Slide Unit 12: Reporting and Recording Pre-Treatment Weight This section records the patient’s weight prior to treatment, in kilograms Weigh the patient, record the value in the space provided Weight is essential to determine drug dosages

Slide Unit 12: Reporting and Recording Initial Phase of Treatment Lists the fixed-dose combinations of anti-TB drugs for adults and children during the intensive phase of TB treatment Circle the anti-TB regimen that the patient is taking Example: Francis Mulenga weighs 58 kg, so he will receive the regimen circled

Slide Unit 12: Reporting and Recording HIV Status (1) This section records up to two HIV test results for each TB patient Patients with a negative test result at the beginning of treatment should be re-tested within three months or before the end of treatment

Slide Unit 12: Reporting and Recording HIV Status (2) Example: Francis Mulenga was tested HIV negative on 15 January 2005; make an “X” over the box indicating a negative result and record the date Francis Mulenga was retested two months later and had a positive test result; make an “X” over the box indicating a positive result and record the date X 15/03/05

Slide Unit 12: Reporting and Recording ART: Antiretroviral Therapy (1) This section records TB patient history of, or concurrent treatment with ART, along with the date Make an “X” over the appropriate box If the patient is on ART, or has a history of taking ART, make an “X” in the “Yes” box If the patient is HIV negative, leave the box blank If the patient is HIV-infected, but is not on ART, leave the box blank Using the format “dd/mm/yy”, record the date in the appropriate column

Slide Unit 12: Reporting and Recording ART: Antiretroviral Therapy (2) Example: The patient is not currently on ART; leave the ART status boxes blank

Slide Unit 12: Reporting and Recording IPT (1) This section records whether the TB patient has received IPT prior to the current TB episode, along with the date IPT started Make an “X” over the appropriate box If the patient has ever taken even one dose of IPT as part of the IPT programme, make an “X” in the “Yes” box If the patient has never taken IPT, make an “X” in the “No” box Using the format “dd/mm/yy”, record the date in the appropriate column

Slide Unit 12: Reporting and Recording IPT (2) Example: The patient received 3 months of IPT prior to developing TB; mark an “X” over the “YES” box on the treatment card X X 01/06/03 15/03/05

Slide Unit 12: Reporting and Recording Other Tests: Biopsy, PPD, Other This section records other test results for each TB patient, along with the date. Not all TB patients will have other tests, so this section may be left blank if it is not applicable Example: Francis Mulenga had a PPD result of 18 millimeters on 15 January 2005, but did not have a biopsy

Slide Unit 12: Reporting and Recording Treatment Compliance To track patient adherence to anti-TB treatment on a daily basis. Records follow-up weight at end of each calendar month HCW should enter his/her initials on each day of supervised drug administration, a “-“ for self-supervised treatment, or a “0” for any missed treatment Example: Francis Mulenga began DOT on 15 January 2005, but on 22 January, he was unable to visit the clinic and missed that day of treatment. His follow-up weight at the end of January was 59.2 kilograms

Slide Unit 12: Reporting and Recording Continuation Phase (1) This section lists the fixed-dose combinations of anti-TB drugs for adults and children during the continuation phase of treatment Record the patient’s follow-up weight Circle the anti-TB regimen that the patient is taking

Slide Unit 12: Reporting and Recording Continuation Phase (2) Example: Francis Mulenga weighs 59.4 kg at the continuation phase of treatment, so he will receive the regimen circled

Slide Unit 12: Reporting and Recording Contact Screening (1) This section records the number of people that the TB patient thinks s/he has come in contact with, along with the number of contacts screened for TB Record the number of people that the TB patient thinks they have come in contact with in the first column Of these people, record the number of contacts that have been screened using the BNTP screening form

Slide Unit 12: Reporting and Recording Contact Screening (2) Example: Francis Mulenga thinks he came in contact with 5 people Of these, 3 people have been screened for TB

Slide Unit 12: Reporting and Recording Chest X-Ray (1) Record results for up to two chest x-rays, along with the date of the chest x-ray How to fill in this section: Record the chest x-ray number in the first section Draw any abnormalities in the corresponding location on the picture of the lungs Using the format “dd/mm/yy,” record the date in the appropriate column

Slide Unit 12: Reporting and Recording Chest X-Ray (2) Example: A patient has a cavity in the right upper lobe, according to his chest x-ray from 25 December, 2004, x-ray number This section would be completed as shown below

Slide Unit 12: Reporting and Recording Culture and Sensitivity Report (1) All re-treatment cases should submit a sputum specimen for culture and drug sensitivity testing If a culture was performed, this section can be used to record the results of the drug sensitivity profile for each TB patient, along with the date

Slide Unit 12: Reporting and Recording Culture and Sensitivity Report (2) How to fill in this section: Using the format “dd/mm/yy”, record the date in the appropriate column If the sample is sensitive to a drug, mark the “Sensitive” column with an “X” If the patient is resistant to a drug, mark the “Resistant” column with an “X” Example: A culture was performed for a patient on 30 March, 2005 Result showed sensitivity to all first-line drugs

Slide Unit 12: Reporting and Recording Treatment Outcome (1) Categorise the outcome of each TB patient at the end of treatment How to fill in this section: Fill in the column with the appropriate outcome: Cured Treatment completed Treatment failure Died Defaulted/interrupted Transferred out

Slide Unit 12: Reporting and Recording Treatment Outcome (2) Example: Francis Mulenga was initially smear-positive, but converted to smear- negative after two months of treatment He had a smear-negative sputum result at 6 months. Therefore he is considered cured; make an “X” over the box for cured

Slide Unit 12: Reporting and Recording Remarks This section records specific information not captured by any of the other sections about each TB patient How to fill in this section: Following are examples of what can be written in this section: “Patient’s wife is HIV positive” “CD4 count = 50 on 12/03/05” Example: Francis Mulenga’s wife is HIV-infected; record this information in the remarks section. This remark should also be a reminder that Francis should be offered another HIV test during his treatment

Slide Unit 12: Reporting and Recording Preparing a TB Treatment Card Review Were there any sections that were difficult to understand and fill out? Do you have any other questions or concerns about the TB Treatment Card?

Slide Unit 12: Reporting and Recording Key Points Several approaches are used to monitor and evaluate the TB programme including, supervision, staff meetings, records and registers Reporting and record keeping is important to the DOTS strategy Good record keeping is vital to measuring success and motivating staff