Tuberculosis burden in Southern province, Zambia, 2004 to 2013: Analysis of routine Tuberculosis surveillance data

Abstract

Tuberculosis (TB) burden in Zambia is high (410/100,000 population incidence in 2013), but few data at subnational level for monitoring trends in incidence, case fatality rate (CFR), or district distribution are available and routinely collected surveillance data are not regularly analysed. The aim of this work was to determine the TB trends in incidence, treatment failure, HIV testing and positivity, and fatalities in Southern Province, Zambia, during the period 2004 to 2013. Print and electronic TB registers in Southern Province were reviewed. The data were entered into MS Excel and descriptive analyses were performed. The annual incidence of TB by district and for Southern Province was calculated using population projections from Central Statistical Office. The proportion of TB patients tested for HIV was calculated. Additionally, the proportion of TB patients who tested positive for HIV in each year. The results indicated a 42% decline in TB incidence from 425/100,000 persons in 2004 to 248/100,000 in 2013. Incidences of TB in by districts varied from year to within the districts. Percentage of sputum positive TB patients with a negative sputum smear result after completing two months of rifampicin based therapy improved from 86% (2008) to 88% patients (2013). Percentage of sputum positive TB patients with a negative sputum smear result after six months of the same regimen increased from 86% (2008) to 95% (2013). Percentage of all TB patients who were tested for HIV increased from 78% in 2008 to 96.5% in 2013, while HIV positivity among those tested decreased from 73% (2008) to 65% (2013). CFR among TB patients fluctuated from 7% in 2008 to 5% in 2012 and 8% in 2013. Although Southern Province experienced overall improvements in trends in TB incidence, cure rates, and HIV testing and positivity, TB CFR remained above the MOH target of 5%. Factors associated with TB mortality in Southern Province require further investigation