Poor quality of data and care cast doubts on reported success of Uganda’s TB programme: a study of the unit tuberculosis registers of three Ugandan hospitals

Abstract

With the global resurgence of TB as a public health threat especially in association with HIV-coinfection, accompanied by mismanagement which has led to the emergence of multi-drug resistant TB disease, it is important that care for patients and record-keeping be enhanced. The objective of this study was to analyze the recording of TB cases in Unit Tuberculosis Registers of three Ugandan hospitals in order to identify and quantify the deficiencies in the data registered, for improvement. The design was a retrospective study of the Unit Tuberculosis Registers, with interviews of the staff responsible for entering the data. The setting was three hospitals in the South-Eastern zone of the National Tuberculosis and Leprosy Programme of Uganda - St Francis Buluba Hospital in Mayuge District, Jinja Regional Referral Hospital in Jinja District and Iganga Hospital in Iganga District. All the patients records of cases of tuberculosis entered in the Unit Tuberculosis Registers during 2002 were analysed for the standard TB programme indicators. The Main outcome measures were errors, misclassifications and missing data for each patient registered. The study identified areas for intervention to improve data accuracy. Many so-called cases were diagnosed clinically and never confirmed by laboratory sputum smear examination. Most cases had pulmonary TB. Despite a highly-rated national TB programme, these key field sites showed a cure rate of only 13%, a treatment completion rate of 26% and a treatment-defaulter rate of 29%. These findings are much worse than the reported national figures at the time and suggest a need for the national level to strengthen lower levels further, in order to improve case management, follow-up and reporting.