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Abstract 217
TB Conference, June 2010
Durban, South Africa
Improving Monitoring and Evaluation Systems for the
Collection of TB Data at Resource Limited Public Health
Facilities in KwaZulu-Natal
Authors: R Rapiti, C Searle
Organisation: MatCH (Maternal, Adolescent and Child Health), University of the Witwatersrand, South Africa
Background
MatCH (Maternal, Adolescent and Child Health) provides monitoring and
evaluation support to the KwaZulu-Natal Department of Health at eleven
ARV initiating facilities and twenty six down-referral sites. Of those, six
clinical facilities (Don McKenzie Hospital, Charles James Hospital, Kwa Mashu
CHC, Kwa Dabeka CHC, Clairwood Hospital and R.K. Khan Hospital) provide
comprehensive Tuberculosis (TB) treatment services. Others (Prince Mshiyeni
Memorial Hospital and Addington Hospital) screen patients for TB but refer
patients to local clinics for treatment. Patients tested for HIV are also tested for
TB, and patients tested with TB are provided with HIV testing. An audit of the
statistics being reported from the clinics indicated that not all patients were
being tested for both HIV and TB. Further investigation revealed that data was
not consistently documented and processes to strengthen data collection were
required.
Method
TB data are collected from these clinical facilities on a monthly basis. A
process of evaluation in terms of quality control measures was undertaken to
determine reliability and validity of data submitted over a period of twelve
months. Several data quality issues were documented:
a. Transcription errors
b. Using a single source to collect data resulting in under reporting
c. Incomplete documentation resulting in under reporting
d. Incorrect use of the data collection tool and misinterpretation of its
indicators.
A strengthened reporting tool together with data quality training was
identified as addressing the current limitations of reporting. The tool was
developed and reviewed by the Monitoring and Evaluation Department. Data
Quality Officers were trained on:
a. Standardised procedures for reporting, including the systematic
reporting of source data
b. Limiting transcription and calculation errors
c. Implementing data quality processes at the clinical site.
A quality control process was implemented whereby the data was reviewed
within seven days of receipt. Errors were documented and submitted to the
data quality officers. A time line was agreed upon with the data quality officers
and was implemented to attend to the errors.
Results
Statistics collected over a six month period were reviewed. Whereas the
previous collection tool only collected data on HIV positive patients who were
screened for TB, the improved tool required all of the following data elements
to be completed.
a. Newly-enrolled in HIV care that were commenced on treatment for
latent TB infection
b. HIV infected persons receiving HIV care who are screened for symptoms
of TB at the last visit
c. HIV infected persons who have a positive symptom screen for TB and
have had a clinical or medical work-up for active TB disease
d. HIV infected persons diagnosed with active TB and who started TB
treatment.
The error logs revealed
Table 1: Errors noted over a six month period
Error Catogory
Month
1
Month
2
Month
3
Month
4
Month
5
Month
6
Missing Data 6 4 5 6 6 6
Invalid Data 10 6 7 4 6 6
Inconsistent reporting
of statistics
0 0 0 2 3 3
Late submission of
statistics
0 0 1 1 3 3
The missing data category indicated that there was an average of an error
rate of 1 per facility, whereas invalid data ranged between 0 6 errors.
Therefore, greatest improvement was noted in completing the tool indicating
that standardising and addressing queries surrounding the completion of the
tool minimises errors. Reconciling the statistics with source data and submission
of statistics on the due date indicated an improved level of diligence
immediately after the training, however trends over the time period indicated
that there was a lapse in meticulousness in data submission and verification of
the statistics submitted.
Conclusion
Ongoing monitoring of the data collected is required at health facilities as
different sources are currently used to collect TB data. The Pre-ART and ART
registers are ideal tools to inform the indicators. Training data personnel
on collecting the data resulted in an improvement in the reduction of data
collection errors, and served as a motivational platform to submit error free
data. Although training is one aspect to motivate staff, other means should be
explored.
This poster is made possible by the support of the American People through the United States Agency for International
Development (USAID). The contents of this poster are the sole responsibility of MatCH (Maternal, Adolescent and Child
Health) and do not necessarily reflect the views of USAID or the United States Government.