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. 2015 Jul 29:15:295.
doi: 10.1186/s12879-015-1047-0.

Factors associated with unreported tuberculosis cases in Spanish hospitals

Concepción Morales-García  1   2 , Teresa Rodrigo  3   4   5 , Marta M García-Clemente  6   7 , Ana Muñoz  8   9 , Pilar Bermúdez  10   11 , Francisco Casas  12   13 , María Somoza  14   15 , Celia Milá  16   17 , Antón Penas  18   19 , Carmen Hidalgo  20   21 , Martí Casals  22   23 , Joan A Caylá  24   25   26 ; Working Group on Under-reporting of Tuberculosis in Spain
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Factors associated with unreported tuberculosis cases in Spanish hospitals

Concepción Morales-García et al. BMC Infect Dis. .

Abstract

Background: Under-reporting of tuberculosis (TB) cases complicates disease control, hinders contact tracing and alters the accuracy of epidemiological data, including disease burden. The objective of the present study is to evaluate the proportion of unreported TB cases in Spanish healthcare facilities and to identify the associated factors.

Methods: A multi-center retrospective study design was employed. The study included TB cases diagnosed in 16 facilities during 2011-2012. These cases were compared to those reported to the corresponding public health departments. Demographic, microbiological and clinical data were analyzed to determine the factors associated with unreported cases. Associated factors were analyzed on a bivariate level using the x(2) test and on a multivariate level using a logistic regression. Odds ratios (OR) and 95 % confidence intervals (CI) were calculated.

Results: Of the 592 TB cases included in the study, 85 (14.4 %) were not reported. The percentage of unreported cases per healthcare center ranged from 0-45.2 %. The following variables were associated to under-reporting at a multivariate level: smear-negative TB (OR = 1.87; CI:1.07-3.28), extrapulmonary disease (OR = 2.07; CI:1.05-4.09) and retired patients (OR = 3.04; CI:1.29-7.18). A nurse case manager was present in all of the centers with 100 % reporting. The percentage of reported cases among the smear-positive cases was 9.4 % and 19.4 % (p = 0.001) among the rest of the study population. Smear-positive TB was no associated to under-reporting.

Conclusions: It is important that TB Control Programs encourage thorough case reporting to improve disease control, contact tracing and accuracy of epidemiological data. The help from a TB nurse case manager could improve the rate of under-reporting.

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Figures

Fig. 1
Fig. 1
Geographical location of the participating healthcare centers in the study
See this image and copyright information in PMC

References

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