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HOW TUTSA (TURKISH NATIONAL TUBERCULOSIS SURVEILLANCE STUDY) WAS CONDUCTED?

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. Overall Objective.

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HOW TUTSA (TURKISH NATIONAL TUBERCULOSIS SURVEILLANCE STUDY) WAS CONDUCTED?

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  1. 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

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

  3. Specific Objectives • 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.

  4. A good surveillance system should: Timeliness Simplicity Permit continuous analyses Not collect unuseful data Cost-effectiveness Be computerized not labour Efficiency Ownership Avoid duplication and provide required outputs Be owned by users

  5. 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?

  6. (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.

  7. TUTSA - February 2006 Preparation of case-based data collection form and instructions manual • 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.

  8. February 2006 TUTSA – Case-based data collection form

  9. TUTSA - February 2006 Soft-ware for recording • A soft-ware for data-base was programmed. • 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.

  10. TUTSA - March 2006 Piloting the data collection sheet • 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.

  11. 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

  12. TUTSA - May 2006 Distibution of Data Collection Sheets • 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.

  13. TUTSA - June 2006 Training of Doctors 319 dispensary doctors were briefed on TUTSA and patient records during the training programme organised by MoH TB Control Department in Ankara

  14. TUTSA - June 2006 • Prepared software was loaded • A system of 5 computers was established • Staff training on data entry was accomplished

  15. TUTSA - June 2006 TUTSA Programme Monitor

  16. TUTSA - June 2006 Types of data entered into TUTSA database • 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

  17. 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

  18. 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.

  19. TUTSA - August 2006 Interventions to TUTSA • Duplications of records were eliminated • Matching of transfer ins and outs • Addition of bacteriological test results • Deletion of test results other than sputum (to comply with EuroTB data sheet)

  20. TUTSA - August 2006 Single record • 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

  21. 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

  22. TUTSA - August 2006 • A cross check was accomplished and missing records were added • An increase in culture results • An increase by 31% in DST results

  23. TUTSA - August 2006 Materials other than sputum • 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

  24. 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.

  25. 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.

  26. TUTSA – March 2007 European Surveillance (EuroTB) Turkey Page 2006 2007 Difference = TUTSA

  27. 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.

  28. Future Planning TUTSA Turkish National Tuberculosis Surveillance Study Network 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.

  29. Results • 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. Before starting we used to say “TUTSA” (In Turkish, we hope it works) and TUTTU! (IT WORKED)

  30. 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. Many Thanks

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