1. Further explorations of surveillance data
Cross-checking estimates of TB incidence (EMR)
Identifying districts with poor diagnosis (Syria)
Exploring diagnostic accuracy (Jordan)
Explaining variation in treatment outcomes (S. Africa)
Strengthening evidence for trends in TB incidence (Morocco)
Strengthening evidence for DOTS impact (Peru)
Understanding the limits of DOTS impact (China)

2. Standards and norms in TB epidemiology: 2 approaches
1. Comparisons with known standards e.g.
ss+ inc = 50 * ARTI (Styblo)
ss+/pulmonary cases = 70%
EP/all TB = 15-20%
2. Anomalies, deviations, and inconsistencies:
incidence inversely related to average age
regional variation in sex ratio
provincial differences in suspects/cases
See indicator list

5. Smear-positive diagnosis by province, Syria
1.0
0.9
0.8
0.7
0.6
ss+/all pulmonary
0.5
0.4
0.3
0.2
0.1
0.0 A Ar D H I K L M OS Q R RD S SW T Z

7. TB suspects by province: Jordan
7000
6000
5000
4000
Suspects/100,000 population
3000
2000
1000
IRBID
SALT
ZARKA
MA'AN
KARAK
AQAUBA
AMMAN
MAFRAQ
TAFILAH
MADABA

12. Compliance with treatment, Hlabisa, South Africa1
0.9
Probability of remaing on
treatment
0.8
Clinic
0.7
Volunteer
CHW
0.6 15 30 45 60 75 90
105
120
135
150
165
180
Days

13. Compliance with short-course chemotherapy1
0.9
proportion remaining
compliant
0.8
0.7
0.6
0.5 1 2 3 4 5 6
months
Yougelson & Joubert, SAMJ 1991

16. Changing aetiology of tuberculosis
Netherlands model, yr-olds
160
140
120
progressive primary
100
exogenous reinfection
Incidence rate/100K/year 80
endogenous reactivation 60 40 20
1950
1953
1956
1959
1962
1965
1968
1971
1974

17. 1995 to 2000

19. Reward for diagnostic effort: Peru
0.04
0.03
0.02
rate/increase in smear exam rate
Increase in notification
0.01
-0.01
92-93
93-94
94-95
95-96
96-97
97-98
98-99
Years compared

21. Source of retreatment patients Changshou County, China70 60
n = 288 50 40
percentage 30 20 10
out of county
in county, out
in project
project