Local use of TB data in Zimbabwe led to improved data quality and better TB care

The results of a retrospective cohort study conducted by The Union in collaboration with the Zimbabwe National TB Control Programme (NTP) showed that empowering staff at local-level TB clinics to collect, tabulate, analyse and use their TB data, led to improvements in diagnoses and treatment.

The paper, published in the May issue of the International Journal of Tuberculosis and Lung Disease (IJTLD), showed that this inexpensive and sustainable approach brought improvements in the following areas: increased detection of presumed and diagnosed patients; a decline in the proportion of patients without diagnostic smear results; increased HIV testing; antiretroviral therapy coverage and treatment success; a reduction in the proportion of deaths; and improvements in quality data. 

The paper compares routine TB data from a retrospective cohort study from 2012 before and during the study period in facilities in three districts of Zimbabwe. Zimbabwe is classified as a high burden country for TB, multidrug-resistant TB and TB-HIV.

Prior to the intervention, recording and reporting data in the study districts largely followed international recommendations; TB data was generated in the facilities, but reporting started at district level, with reports being submitted to the provincial and national TB programme. Analysis occurred in a centralised manner and was fed into national and international reporting. Data was rarely analysed or used at lower levels, and feedback was not provided to the teams submitting the data. The importance of recording and reporting data was not therefore appreciated by local teams and, as a consequence, data quality was poor. Supervision and review meetings did not focus on data.

By training the staff in local facilities to work with their own quarterly TB data, they were able to assess key indicators, which were developed in adherence to the main goals of stopping transmission of TB bacilli through early detection and the effective treatment of patients without creating drug resistance. By identifying key indicator values that were outside the expected range, staff could agree on action points to address specific issues.

This is the first study to be conducted on the local use of TB data to strengthen the supervision and quality of TB data and care. Through these interventions, staff had increased ownership of TB data and were able to prioritise actions to change TB care. In addition, the intervention led to ‘data driven’ supervision and performance review meetings, where the teams and co-ordinators were encouraged to agree on recommendations for each facility and the entire district. It became possible to identify facilities with low presumptive and diagnosed TB, and for staff to question why this might be. Improvements in data quality were also achieved by making the data relevant to facility and district staff.

Progress towards achieving Sustainable Development Goals (SDGs) and the END TB strategy demands systematic and disaggregated data. However, data quality can remain a major challenge in many countries. TB patients can be under-reported or over-reported, with inaccurate treatment success rates, and gaps between notified and evaluated cases.  

The approach, feasible under routine conditions, provides a simple model to improve TB treatment and diagnosis in resource-limited settings. NTP practices can be adapted, and the approach can be expanded to other regions or countries.

The International Journal of Tuberculosis and Lung Disease (IJTLD) is the official publication of The Union. It is distributed in over 165 countries world-wide. Further information about the journal and how to take out a subscription is available on The Union website.

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