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Improving the estimation of the tuberculosis burden in India.

Cowling K, Dandona R, Dandona L - Bull. World Health Organ. (2014)

Bottom Line: Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, National Capital Region, India .

ABSTRACT
Although India is considered to be the country with the greatest tuberculosis burden, estimates of the disease's incidence, prevalence and mortality in India rely on sparse data with substantial uncertainty. The relevant available data are less reliable than those from countries that have recently improved systems for case reporting or recently invested in national surveys of tuberculosis prevalence. We explored ways to improve the estimation of the tuberculosis burden in India. We focused on case notification data - among the most reliable data available - and ways to investigate the associated level of underreporting, as well as the need for a national tuberculosis prevalence survey. We discuss several recent developments - i.e. changes in national policies relating to tuberculosis, World Health Organization guidelines for the investigation of the disease, and a rapid diagnostic test - that should improve data collection for the estimation of the tuberculosis burden in India and elsewhere. We recommend the implementation of an inventory study in India to assess the underreporting of tuberculosis cases, as well as a national survey of tuberculosis prevalence. A national assessment of drug resistance in Indian strains of Mycobacterium tuberculosis should also be considered. The results of such studies will be vital for the accurate monitoring of tuberculosis control efforts in India and globally.

No MeSH data available.


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Estimates of the mean level of tuberculosis-attributable mortality, India, 1990–2011
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Figure 3: Estimates of the mean level of tuberculosis-attributable mortality, India, 1990–2011

Mentions: The most widely-used estimates of the national burden of tuberculosis in India are produced by the Revised National Tuberculosis Control Programme, WHO and the Global Burden of Disease Study.2,8,9 The uncertainty in these estimates is illustrated by comparing the values for tuberculosis incidence (Fig. 1), prevalence (Fig. 2) and mortality (Fig. 3) in India from these three sources for the period 1990–2011. The Revised National Tuberculosis Control Programme and WHO produce their estimates of incidence by dividing the number of case notifications by 1 minus the estimated proportion of all cases that are not reported.8 The level of underreporting has been estimated from expert opinions and from the results of two subnational studies – which indicated that only about 60% of tuberculosis cases in the study areas were notified.10,11 The Global Burden of Disease Study used substantially different methods and several covariates to try to strengthen estimates based on sparse data.12 Greater details for each methodology – and a discussion of the difficulties of measuring the success of the Revised National Tuberculosis Control Programme using rates of case detection – are provided in Appendix A.


Improving the estimation of the tuberculosis burden in India.

Cowling K, Dandona R, Dandona L - Bull. World Health Organ. (2014)

Estimates of the mean level of tuberculosis-attributable mortality, India, 1990–2011
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4221760&req=5

Figure 3: Estimates of the mean level of tuberculosis-attributable mortality, India, 1990–2011
Mentions: The most widely-used estimates of the national burden of tuberculosis in India are produced by the Revised National Tuberculosis Control Programme, WHO and the Global Burden of Disease Study.2,8,9 The uncertainty in these estimates is illustrated by comparing the values for tuberculosis incidence (Fig. 1), prevalence (Fig. 2) and mortality (Fig. 3) in India from these three sources for the period 1990–2011. The Revised National Tuberculosis Control Programme and WHO produce their estimates of incidence by dividing the number of case notifications by 1 minus the estimated proportion of all cases that are not reported.8 The level of underreporting has been estimated from expert opinions and from the results of two subnational studies – which indicated that only about 60% of tuberculosis cases in the study areas were notified.10,11 The Global Burden of Disease Study used substantially different methods and several covariates to try to strengthen estimates based on sparse data.12 Greater details for each methodology – and a discussion of the difficulties of measuring the success of the Revised National Tuberculosis Control Programme using rates of case detection – are provided in Appendix A.

Bottom Line: Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, National Capital Region, India .

ABSTRACT
Although India is considered to be the country with the greatest tuberculosis burden, estimates of the disease's incidence, prevalence and mortality in India rely on sparse data with substantial uncertainty. The relevant available data are less reliable than those from countries that have recently improved systems for case reporting or recently invested in national surveys of tuberculosis prevalence. We explored ways to improve the estimation of the tuberculosis burden in India. We focused on case notification data - among the most reliable data available - and ways to investigate the associated level of underreporting, as well as the need for a national tuberculosis prevalence survey. We discuss several recent developments - i.e. changes in national policies relating to tuberculosis, World Health Organization guidelines for the investigation of the disease, and a rapid diagnostic test - that should improve data collection for the estimation of the tuberculosis burden in India and elsewhere. We recommend the implementation of an inventory study in India to assess the underreporting of tuberculosis cases, as well as a national survey of tuberculosis prevalence. A national assessment of drug resistance in Indian strains of Mycobacterium tuberculosis should also be considered. The results of such studies will be vital for the accurate monitoring of tuberculosis control efforts in India and globally.

No MeSH data available.


Related in: MedlinePlus