|Year : 2019 | Volume
| Issue : 3 | Page : 192-195
Tuberculosis case detection rate: An observation on the change in 12-year period (2005–2016)
Beuy Joob1, Viroj Wiwanitkit2
1 Sanitation 1 Medical Academic Center, Bangkok, Thailand
2 Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India
|Date of Submission||18-Jan-2019|
|Date of Decision||28-Jan-2019|
|Date of Acceptance||31-Jan-2019|
|Date of Web Publication||10-Sep-2019|
Dr. Beuy Joob
Sanitation 1 Medical Academic Center, Bangkok
Source of Support: None, Conflict of Interest: None
Background: Tuberculosis is an important problem that causes the public health problem in several countries. The case detection is an important process for early diagnosis and management of disease. The case detection is still the important problem in several settings including Thailand. Methods: The authors appraised on the official report on the tuberculosis detection rate in Thailand comparing between 20005 and 2016, a 12-year-period under the implementation of active tuberculosis case searching campaign. Results: Comparing to the previous reported rate in 2005, 76%, there is no statistically significant different rates (proportional t-test, P > 0.05). Conclusion: The problem of tuberculosis case detection is still observable. There is a need for searching for the additional method for increasing the tuberculosis detection rate.
Keywords: Detection, rate, search, tuberculosis
|How to cite this article:|
Joob B, Wiwanitkit V. Tuberculosis case detection rate: An observation on the change in 12-year period (2005–2016). Biomed Biotechnol Res J 2019;3:192-5
|How to cite this URL:|
Joob B, Wiwanitkit V. Tuberculosis case detection rate: An observation on the change in 12-year period (2005–2016). Biomed Biotechnol Res J [serial online] 2019 [cited 2021 Nov 29];3:192-5. Available from: https://www.bmbtrj.org/text.asp?2019/3/3/192/266561
| Introduction|| |
Infection is still the important public health problem worldwide. There are many important problematic infections including tuberculosis. Tuberculosis is an important mycobacterial infection that can be seen in several countries around the world.,, Tuberculosis is an important problem that causes the public health problem in several countries. The high prevalence of tuberculosis is observable in several poor developing countries. The mentioned high prevalence is usually due to lack of resource, limited health infrastructure, and poverty.,
Several poor Asian and African countries presently have tuberculosis as an important main local public health problem. To have the update epidemiological data, the primary data collected from reports of the recorded register are very important. In endemic area, the surveillance system for collection of epidemiological data of tuberculosis is generally performed. To have the data, it requires good data from the case records from the medical centers in the setting. Basically when a medical center gets the case of tuberculosis, the case has to be recorded and recorded to the corresponding local public health for data registry. This process mainly relies on good disease diagnosis. The case detection is an important process for early diagnosis and management of disease. The case detection is still the important problem in several settings including to Thailand. Underdiagnosis, missed diagnosis, and error in diagnosis are not uncommon. The basic simple diagnosis tools including microscopic examination of stained smear for acid-fast bacilli and X-ray investigation might not effective in case diagnosis. Lack of good modern diagnostic tool is a common situation seen in any remote rural area where the tuberculosis is usually endemic. In some limited specific areas of developing countries, the complex modern tuberculosis technology might be available. In those areas, the use of more complex tool such as molecular diagnosis might be helpful, but the diagnostic problem is still observable. In Thailand, the errors of in-house polymerase chain reaction (PCR) test for tuberculosis is reported. False results of the test are not uncommon and the problems of the quality control of the locally available tests are frequently seen due to the lack of high-skilled medical scientist and clinical practitioners.
For disease diagnosis, Chuchottaworn noted that the poor diagnosis technology was an important problem and developed capacity of tuberculosis laboratory was required to be able to diagnose tuberculosis.
Hence, it is no doubt that the efficacy of the case detection process is still an important issue. In Thailand, in the same province, the difference of case detection rate is observed, and there might be the possible hidden problem on the case detection process. To realize the situation by the reappraisal of the available data will be useful and can help us recognized the overlooked hidden problem. Searching for additional process to the standard tuberculosis case detection is recommended. An appraisal on the case detection process is an important basic assessment on the success of tuberculosis case control. In the present short report, the authors perform appraisal on the active tuberculosis case detection process in Thailand, a tropical country in Indochina, where tuberculosis is still the serious local public health problem.
| Methods|| |
This study is a retrospective study. The aim is to perform an appraisal on the case detection process of tuberculosis. The setting of the study is Thailand, a tropical country in Southeast Asia. The authors appraised on the official report on the tuberculosis detection rate in Thailand comparing between 2005 and 2016, a 12-year period under the implementation of active tuberculosis case-searching campaign. The published data from the local Thai Ministry of Public Health; (https://www.tbthailand.org/download/Manual/NTP2018.pdf) are used as primary data for further assessment. For an operative definition of the detection rate, the definition in the previous report, “case detection rate = recorded notification case/WHO estimated incidence,” is used. This is a mathematical model based study and required no informed consent or ethical approval.
Comparison between the rate seen in 2005 and 2016 is done. The difference is assessed by proportional t-test. This test is not a study on human, animal, or specimen and required no informed consent requesting/ethical committee assessment.
| Results|| |
According to the presently available data in 2015, the detection rate is equal to 58.9% (70,114/119,000). The decreasing of the detection rate was observable. Comparing to the previously reported rate in 2005, 76%, there is no statistically significant difference of rates (proportional t-test, P > 0.05)
| Discussion|| |
Thailand is a tropical country in Indochina. This area has many endemic infectious diseases including several important tropical infections such as malaria and dengue. In Thailand, tuberculosis is also an important public health problem. The emerging drug-resistant strain of tuberculosis is observable in Thailand has been reported for a very long time and this problem is still the main problem clinical mycobacterial disease management in this area.,, As noted by Chuchottaworn, the multidrug resistance is an important problem in Thailand. The problem has been seen at a very high rate for a very long time although there is no increasing rate.
To manage the disease is still an important public health target in Thailand. The concept for early detection and prompt treatment, according to the preventive medicine principle, might be applicable in disease control. The early diagnosis of tuberculosis by effective tool and good anti-tuberculosis drug treatment management becomes an important public health strategy for tuberculosis control. As already noted, the diagnosis of tuberculosis is a critical step for tuberculosis control and management. In Thailand, as earlier mentioned, the problem of tuberculosis diagnosis is not uncommon. Basically, in general practice, the basic investigation for tuberculosis diagnosis in Thailand is the microscopic technique. The classical examination of the Ziehl–Neelsen acid-fast-stained slide is routinely practice in tuberculosis clinic in Thailand. Tansuphasiri et al. performed a study on laboratory diagnosis techniques for tuberculosis in Thailand and found that the microscopic examination of Ziehl-Neelsen acid-fast-stained slides had very poor diagnostic property. Tansuphasiri et al. suggested for an alternative approach using direct identification of Mycobacterium tuberculosis from sputum on Ziehl–Neelsen acid-fast-stained slides by the use of silica-based filter combined with PCR assay. As noted by McCarthy et al., Mycobacteriology laboratories in resource-limited, high tuberculosis disease burden settings usually had the problem on diagnostic proficiency. Hence, the implementation of the basic technique in quality control of laboratory process is needed. The implementation of quality management system is usually required. Finding of the quality control is necessary and cannot be omitted. Setting of referencing laboratory where the modern gold standard referencing method is available that can act as a center for quality control of the tuberculosis laboratories is important. Tansuphasiri et al. also concluded that PCR test applied to DNA extracted from Ziehl–Neelsen-stained smears could be a valuable approach for rapid identification of the pathogen and was a recommended mean to evaluate quality of the control of local laboratories in tuberculosis screening. The setting of the international network for solving the problem of the diagnostic problem for diagnosis is also a newly proposed concept. The good example is the report on the development on international network, consisting the laboratories in China, India, Italy, South Africa, Thailand, and the USA, for rifampicin bioavailabilities laboratory by Ellard.
Regarding the treatment, how to have the patients attached to the tuberculosis treatment is the important issue in clinical medicine. The idea to have closed monitoring of the tuberculosis patient with special focus on the drug intake period is proposed. Directly observed therapy (DOT) for treating tuberculosis is the present concept that is recommended for disease management. Regarding DOT, the concept is because treatment of tuberculosis by anti-tuberculosis drug requires at least 6 months of drug treatment., In case that treatment is incomplete, patients may not be cured, and drug resistance may develop, hence, strict control of drug intake of the patient by DOT is the recommended mean for disease control and management. The DOT concept has been used in several countries including to Thailand.,
The Thai Ministry of Public Health tried several attempts to control and manage of the disease, but the problem still presently exists. The concurrent tuberculosis and human immunodeficiency virus infection are common in Thailand and still becomes the important challenge for tuberculosis management in Thailand. The active case searching and using the village health volunteer is the basic concept for tuberculosis control used by the Thai Ministry of Public Health. Nevertheless, the problem of the case detection is still presently seen. Due to the present 12-year-period analysis, the worsening situation can be seen. The decreased detection rate implies that there is a need for urgent reappraisal on the present control program. The problem of the case detection might be due to the newly emerging problems such as tuberculosis imported by the migrant workers from neighboring countries.,, In fact, imported tuberculosis is the present big problem for tuberculosis control in Thailand. The difficulties are on not only diagnosis but also treatment. There are some reports on new ideas to increase the efficacy of the present active tuberculosis searching in Thailand. The use of new advanced diagnostic tool or social network analysis of indexed case is the good examples.
In summary, the problem on the detection rate of tuberculosis is still seen in Thailand. Nevertheless, this situation is not different from those seen in other nearby Indochina countries. The extremely low screening rate and notification rate is reported from Cambodia. In Cambodia, limited availability of diagnostic tools and suboptimal clinician performance is the main problem contributing to a lower tuberculosis detection rate. In another Indochina country, Myanmar, the situation poor detection rate is also observed. In fact, the active screening program has just been implemented in Myanmar since 2005, and there is a long way for the future development Indeed, as noted by the WHO, several countries in Indochina are the problematic areas for global control of tuberculosis.
| Conclusion|| |
The problem of tuberculosis case detection is still observable. There is a need for searching for the additional method for increasing the tuberculosis detection rate.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Cormier M, Schwartzman K, N'Diaye DS, Boone CE, Dos Santos AM, Gaspar J, et al.
Proximate determinants of tuberculosis in indigenous peoples worldwide: A systematic review. Lancet Glob Health 2019;7:e68-80.
Standley C, Boyce MR, Klineberg A, Essix G, Katz R. Organization of oversight for integrated control of neglected tropical diseases within ministries of health. PLoS Negl Trop Dis 2018;12:e0006929.
Getahun H, Matteelli A, Abubakar I, Aziz MA, Baddeley A, Barreira D, et al.
Management of latent Mycobacterium tuberculosis
infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J 2015;46:1563-76.
Prasad A, Ross A, Rosenberg P, Dye C. A world of cities and the end of TB. Trans R Soc Trop Med Hyg 2016;110:151-2.
Bishwajit G, Ide S, Ghosh S. Social determinants of infectious diseases in South Asia. Int Sch Res Notices 2014;2014:135243.
Atun R, Weil DE, Eang MT, Mwakyusa D. Health-system strengthening and tuberculosis control. Lancet 2010;375:2169-78.
Kunakorn M, Raksakai K, Pracharktam R, Sattaudom C. Overcoming the errors of in-house PCR used in the clinical laboratory for the diagnosis of extrapulmonary tuberculosis. Southeast Asian J Trop Med Public Health 1999;30:84-90.
Chuchottaworn C. Extensively drug resistant tuberculosis (XDR-TB) in chest disease institute, 1997-2005. J Med Assoc Thai 2010;93:34-7.
Hassarangsee S, Tripathi NK, Souris M. Spatial pattern detection of tuberculosis: A Case study of Si Sa Ket province, Thailand. Int J Environ Res Public Health 2015;12:16005-18.
Naowarat S, Rojanaworarit C, Surinsak W, Umain K, Ruadreaw D, Yuenprakone S, et al.
Tuberculosis case finding: Supplement intensified case finding among acute lower respiratory infection (ALRI) hospitalized patients in Sa Kaeo province, Thailand. J Formos Med Assoc 2019. pii: S0929-6646(18)30289-4.
Jittimanee S, Vorasingha J, Mad-asin W, Nateniyom S, Rienthong S, Varma JK, et al.
Tuberculosis in Thailand: Epidemiology and program performance, 2001-2005. Int J Infect Dis 2009;13:436-42.
Panda S, Swaminathan S, Hyder KA, Christophel EM, Pendse RN, Sreenivas AN, et al.
Drug resistance in malaria, tuberculosis, and HIV in South East Asia: Biology, programme, and policy considerations. BMJ 2017;358:j3545.
Maranetra KN. Treatment of multidrug-resistant tuberculosis in Thailand. Chemotherapy 1996;42 Suppl 3:10-5.
Tansuphasiri U, Boonrat P, Rienthong S. Direct identification of mycobacterium tuberculosis from sputum on Ziehl-Neelsen acid fast stained slides by use of silica-based filter combined with polymerase chain reaction assay. J Med Assoc Thai 2004;87:180-9.
McCarthy KD, Metchock B, Kanphukiew A, Monkongdee P, Sinthuwattanawibool C, Tasaneeyapan T, et al.
Monitoring the performance of mycobacteriology laboratories: A proposal for standardized indicators. Int J Tuberc Lung Dis 2008;12:1015-20.
Ellard GA. The evaluation of rifampicin bioavailabilities of fixed-dose combinations of anti-tuberculosis drugs: Procedures for ensuring laboratory proficiency. Int J Tuberc Lung Dis 1999;3:S322-4.
Karumbi J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev 2015;(5):CD003343.
Brausch LM, Bass JB Jr. The treatment of tuberculosis. Med Clin North Am 1993;77:1277-88.
Cuneo WD, Snider DE Jr. Enhancing patient compliance with tuberculosis therapy. Clin Chest Med 1989;10:375-80.
Suwankeeree W, Picheansathian W. Strategies to promote adherence to treatment by pulmonary tuberculosis patients: A systematic review. Int J Evid Based Healthc 2014;12:3-16.
Akkslip S, Rasmithat S, Maher D, Sawert H. Direct observation of tuberculosis treatment by supervised family members in Yasothorn province, Thailand. Int J Tuberc Lung Dis 1999;3:1061-5.
Anuwatnonthakate A, Limsomboon P, Nateniyom S, Wattanaamornkiat W, Komsakorn S, Moolphate S, et al.
Directly observed therapy and improved tuberculosis treatment outcomes in Thailand. PLoS One 2008;3:e3089.
Turkova A, Chappell E, Chalermpantmetagul S, Negra MD, Volokha A, Primak N, et al.
Tuberculosis in HIV-infected children in Europe, Thailand and Brazil: Paediatric TB-HIV EuroCoord study. Int J Tuberc Lung Dis 2016;20:1448-56.
Phomborphub B, Pungrassami P, Boonkitjaroen T. Village health volunteer participation in tuberculosis control in Southern Thailand. Southeast Asian J Trop Med Public Health 2008;39:542-8.
Tschirhart N, Thi SS, Swe LL, Nosten F, Foster AM. Treating the invisible: Gaps and opportunities for enhanced TB control along the Thailand-Myanmar border. BMC Health Serv Res 2017;17:29.
Kaji A, Thi SS, Smith T, Charunwatthana P, Nosten FH. Challenges in tackling tuberculosis on the Thai-Myanmar border: Findings from a qualitative study with health professionals. BMC Health Serv Res 2015;15:464.
Phetsuksiri B, Srisungngam S, Rudeeaneksin J, Boonchu S, Klayut W, Norrarat R, et al.
QuantiFERON-TB gold in-tube test in active tuberculosis patients and healthy adults. Rev Inst Med Trop Sao Paulo 2018;60:e56.
Boonthanapat N, Soontornmon K, Pungrassami P, Sukhasitwanichkul J, Mahasirimongkol S, Jiraphongsa C, et al.
Use of network analysis multidrug-resistant tuberculosis contact investigation in Kanchanaburi, Thailand. Trop Med Int Health 2018. [Ahead of print].
Morishita F, Furphy VB, Kobayashi M, Nishikiori N, Eang MT, Yadav RP, et al.
Tuberculosis case-finding in Cambodia: Analysis of case notification data, 2000 to 2013. Western Pac Surveill Response J 2015;6:15-24.
Frieze JB, Yadav RP, Sokhan K, Ngak S, Khim TB. Examining the quality of childhood tuberculosis diagnosis in Cambodia: A cross-sectional study. BMC Public Health 2017;17:232.
Myint O, Saw S, Isaakidis P, Khogali M, Reid A, Hoa NB, et al.
Active case-finding for tuberculosis by mobile teams in Myanmar: Yield and treatment outcomes. Infect Dis Poverty 2017;6:77.
Wise J. WHO identifies 16 countries struggling to control tuberculosis. BMJ 1998;316:957.