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Free Content Estimating tuberculosis burden and reporting in resource-limited countries: a capture-recapture study in Iraq

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BACKGROUND: The global target for tuberculosis (TB) control set by the Millennium Development Goals is a decrease in TB incidence by 2015. Direct measurement of country-level TB incidence using population-based methods is impractical, emphasising the need for well-performing surveillance systems and, where these are not available, accurate quantification of incidence and under-reporting of TB.

OBJECTIVE: To estimate TB incidence and TB under-reporting in Iraq in 2011.

METHODS: Prospective longitudinal surveillance was established among all eligible public and private non-National TB Programme (NTP) providers in a random sample of eight of the 18 Iraqi governorates from May to July 2011. Record linkage with the NTP and three-source capture-recapture analysis of data were then conducted using log-linear modelling.

RESULTS: A total of 1985 TB cases were identified after record linkage. The NTP registered 1677 patients (observed completeness 84%). The estimated total number of TB cases was 2460 (95%CI 2381–2553), with identified TB cases representing 81% (95%CI 69–89) after adjusting for sampling design. The estimated ratio of notified to incident cases was 69% (95%CI 58–76).

CONCLUSIONS: We estimate 14 500 TB cases in Iraq in 2011, of which 31% (95%CI 24–42) were unreported. TB surveillance needs to be strengthened to reduce under-reporting.
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Keywords: capture-recapture analysis; record linkage; resource-limited; surveillance; tuberculosis

Document Type: Research Article

Affiliations: 1: World Health Organization Iraq Office, Amman, Jordan 2: National Tuberculosis Control Programme, Baghdad, Iraq 3: Centre for Infections, Health Protection Agency, London, United Kingdom 4: Stop TB Unit, World Health Organization, Eastern Mediterranean Regional Office, Cairo, Egypt 5: Stop TB Department, World Health Organization, Geneva, Switzerland 6: Tuberculosis Control Department, Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands

Publication date: 2013-04-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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