HOW TUTSA (TURKISH NATIONAL TUBERCULOSIS SURVEILLANCE

STUDY) WAS CONDUCTED?

*Dr. Suha Özkan, **Dr. Feyzullah Gümüşlü, **Dr. Ülgen Güllü, **Şefika İpek, **Funda Baykal, **Murat Akça

*Ankara Tuberculosis Dispensary**MoH, Tuberculosis Control Department

To collect, collate and analyse case-based data of all Tuberculosis cases registered and treated in dispensaries in 2005.

Overall Objective

To provide national data on Tuberculosis(TB) in conformity with WHO standards,

To assess TB data with regard to provincial distribution and to plan activities based on evidence,

Delivery of national data to European TB Surveillance Center (EuroTB) and WHO, in a complete and accurate way.

Specific Objectives

Simplicity

Timeliness

EfficiencyCost-

effectivenessOwnership

A good surveillance system should:

Not collect unuseful data

Permit continuous analyses

Avoid duplication and provide required outputs

Be computerized not labour

Be owned by users

General principles for data collection

What is the objective?

What type of data should be collected?

Which data collection methods should be employed?

By whom and how assessment should be done?

How to make use of data by users?

(TUTSA)

Turkish National Tuberculosis Surveillance Study

WHO Europe-region, 32 out of 52 countries collect case-based data (2006).

When aggregate data collected by WHO recommended quarterly forms, the following were unavailable:

• Results of sputum culture testing• Results of drug sensitivity testing• Site of disease for extrapulmonary • Country of origin and nationality data etc.

So case-based individual data collection was required.

Required types of data were identified considering WHO country report (CISID) and case-based recording data standards (EuroTB data file).

Availability of data types in dispensary records were assessed.

A form was prepared complying with the requirements.

An instructions manual was prepared to facilitate the usage of forms.

TUTSA - February 2006

Preparation of case-based data collection form and instructions

manual

H R E S

İLİ / VSD ADI : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Basil Tipi

bakı

lmad

ı

sonu

ç yo

k

İlaç duyarlılık testi

sonu

ç yo

k

sonu

ç va

r H=hassas R=rezistan

TANIDA BAKTERİYOLOJİ

İnceleme yapılan

Materyal

mikroskopi kültür

pozit

if

nega

tif

bakı

lmad

ı

sonu

ç yo

k

pozit

if

nega

tif

Hastalığın Yeri

Akc

iğer

Ac.

Dış

ı

Ac dışı tutulan organ

Sıra No

TB hasta defterine

kayıt tarihiHastanın Adı Soyadı Baba Adı

Ted.

Baş

arıs

ızlığ

ı

Kron

ik

Nakil

gel

en

Cinsiyeti

E K

Yaşı Yorum ve Bilgi

2005 YILINDA VEREM SAVAŞ DİSPANSERİNE KAYDOLAN TÜBERKÜLOZ HASTALARI (TUTSA - 2005)SAYFA NO:

Uyruğu

T.C.dışı (Ülke adını

yazınız)T.C.

OLGU TANIMI

Yeni

Nüks

Ted.

Ter

kten

dön

en

February 2006

TUTSA – Case-based data collection form

A soft-ware for data-base was programmed.

Soft-ware for recording

TUTSA - February 2006

EuroTB data file for tuberculosis cases notified in 2005

version May 2006

Features of the programme:• Safe and confidential,• Prevents erratic input,• Multi-terminal data entry,• Easy to analyse,• Transferrable,• Uses standard coding system of Euro-TB.

TUTSA - March 2006

Data collection sheets and instructions manual have been pilotted in 25 dispensaries in different provinces with different features.

Data collection sheet was finalized taking into account the feedback from piloting sites.

Piloting the data collection sheet

TUTSA - April 2006

Conformity with European Surveillance System

Dr. Dennis Falzon from EuroTB provided feedback to TUTSA during National TB Programme Review

TUTSA was found to be in conformity with European surveillance system

He motivated us in case-based data collection studies

TUTSA - May 2006

For all dispensaries, by using Form 21 data, number of TB cases recorded was identified

Sufficient number of data sheet and instructions manual have been sent to Provincial TB Coordinators

Delivery of sheets and manual have been ensured

Provincial TB Coordinators were asked to accept filled in sheets and check or fill them in themselves if required.

Distibution of Data Collection Sheets

TUTSA - June 2006

319 dispensary doctors were briefed on TUTSA and patient records during the training programme organised by MoH TB Control Department in Ankara

Training of Doctors

TUTSA - June 2006

Prepared software was loaded

A system of 5 computers was established

Staff training on data entry was accomplished

TUTSA - June 2006

TUTSA Programme Monitor

• Dispansary name

• Patient registery date

• Dispansary registry no

• Name of the patient

• Name of father

• ID number

• Sex

• Age

• Nationality

• Case definition according to previous treatment history

• Pulmonary/Extrapulmonary

• Site of disease

• Material type obtained for bacteriological examination

• Result of sputum microscopy

• Result of sputum culture

• result of DST

• Type of Bacillus

• Implementation of DOTS

• Treatment outcome

Types of data entered into TUTSA databaseTUTSA - June 2006

TUTSA – June and July 2006

Data sheets filled in dispensaries have been collected under the supervision of provincial TB Coordinators and collected at MoH.

Each record was double checked by the experienced staff at the TB Control Department

For erratic or missing records, the following were accomplished;

• Telephone calls to dispensaries for correction

• Erratic records were asked again

• For some provinces, all sheets were returned and marking erratic information, full review was asked.

No doubtful information without confirmation and validation have been entered into database

TUTSA – July- August 2006

Almost 21.000 individual records in 1500-1600 pages were filed in 5 directories.

Almost 1200-1500 patients data were entered into the database daily by the dedicated staff.

Interventions to TUTSA

TUTSA - August 2006

1. Duplications of records were eliminated

2. Matching of transfer ins and outs

3. Addition of bacteriological test results

4. Deletion of test results other than sputum (to comply with EuroTB data sheet)

TUTSA - August 2006

Any patient with double recording with the same case definition was reduced to a single record.

In case of transfer outs, the record at the first admitted place was held, a list was kept to ask for treatment outcomes from the transferred dispensary.

Double recording was identified in 2,4% of all records (n=499);

• No of double recorded patients: 486

• No of triple recorded patients : 13

Double/ triple recording was reduced to a single record

Total number of cases were counted as 20.535

Single record

TUTSA - August 2006

Complementary bacteriological information

Results of microscopic examination were existent

There were missing results of culture and DST.

• Results of sputum cultures obtained in hospitals were not forwarded to the TB dispensaries.

Culture and DST results were collected from 10 laboratories by using a standard sheet.

• Laboratories of Training type Chest Hospitals

• Regional TB laboratories

• Laboratory of Hygiene Center

TUTSA - August 2006

A cross check was accomplished and missing records were added

An increase in culture resultsAn increase by 31% in DST results

Arrived form the lab

Assessed Added to TUTSA

Addition (%)

Hygiene Center 580 580 117 20

İstanbul Taksim 775 775 168 21

Ankara Regional L 336 336 19 5

Antalya Regional L 206 206 22 10

Bursa Regional L 166 166 65 39

Konya Regional L 33 33 1 3

Süreyyapaşa Hosp 1980 946 291 30

Yedikule Hosp 124 124 53 42

Ankara Atatürk Hsp 724 724 93 12

İzmir Hosp 190 190 59 31

TOTAL 5114 4080 888 21

TUTSA - August 2006

European Surveillance (EuroTB),

• Only spontaneous and induced sputum microscopy results are accepted,

• BAL, GL and other materials are not accepted

Pul-TB : 157

Extrapul-TB : 113

270 positive sputum smears were deleted and recorded as N/A in total, as a result

Of the mentioned 270 records, the culture results were preserved

Materials other than sputum

TUTSA - September 2006

Notification to WHO and European Surveillance

Data base have been locked for further changes after all records have been checked.

CISID Report, coded case-based records of 2005 cohort, DST Surveillance report were sent timely.

TUTSA – March 2007

Treatment outcomes

A list of recorded patients of each dispensary were sent for obtaining treatment outcomes and implementation of DOTS.

Data in the forms filled in under the supervision of provincial TB coordinators are being entered into the database after checks at the TB Control Department.

Controls and verification of missing or doubtful data are still underway.

TUTSA – March 2007

European Surveillance (EuroTB) Turkey Page20072006

Difference = TUTSA

TUTSA – April 2006

Turkish Thoracic Society

9th Annual Congress - 2006

A presentation was shown as an example to see the effect of individual case reporting system.

Future Planning

TUTSA

Turkish National Tuberculosis Surveillance StudyNetwork

First Step:

Transfer of data from all dispensaries to the database via a web based programme.

Second Step:

Recording of patients from laboratories and hospitals via the same network and leaving no patient unrecorded.

Results

Before starting we used to say “TUTSA”

(In Turkish, we hope it works)

Individual data have been obtained for an annual cohort for the first time

Verification was accomplished with numerous controls

Most updated information on the status of TB in Turkey has been available.

and

TUTTU!(IT WORKED)

Acknowledgements;• Dispensary doctors and staff,

• Provincial TB Coordinators,

• Provincial Health Directorates,

• MoH TB Control Department ,

• High officials of MoH,

• Cem Bey who programmed the software,

• Dr.Dennis Falzon and Dr.Lucica Ditiu,

who motivated us.