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Home / The International Journal of Tuberculosis and Lung Disease, Volume 17, Number 4

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.

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: 01 April 2013

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