Ministry of Health and Child Care Zimbabwe National Tuberculosis Control Programme Making Sense of TB data Guide for collection, analysis and use of TB data for health workers in Zimbabwe 1 ACKNOWLEDGEMENTS The Government of Zimbabwe is grateful to the US Agency for International Development (USAID) and the International Union Against Tuberculosis and Lung Disease (The Union), through the TB CARE I/Challenge TB funding mechanisms, for the technical and financial support in developing this guide. The Ministry of Health and Child Care extends its profound gratitude to Dr Einar Heldal (Senior Consultant, The Union), Dr Riitta Dlodlo (Director - TB-HIV, The Union) and Dr. C Zishiri, (Country Director –Challenge TB and The Union), Dr. R. Ncube (Deputy Country Director Challenge TB and The Union), Dr Barnet Nyathi (former Country Director, TB CARE I and The Union) who provided technical support. A special recognition goes to Mr Nicholas Siziba, NTP Monitoring and Evaluation Officer and Mr Nqobile Mlilo, TB CARE I Monitoring and Evaluation Coordinator who worked tirelessly from the first to the final version of the guide. Remarkable acknowledgements go the Matabeleland South Provincial Health Executive and Umzingwane District Health Executive for providing their data. The following have made substantial contributions to the document. Name Designation P T Shiri National Programme Assistant, NTP M Mukorera Training Coordinator, TB CARE I, The Union E Basvi Data Manager, NTP S Khumalo Provincial TB and Leprosy Coordinator, Matabeleland North S Nkomo District TB and Leprosy Coordinator, Umzingwane L Murenga Monitoring and Evaluation Assistant, NTP K Ndlovu Health Promotion Officer, Matabeleland North L Jokonya Acting District Medical Officer, Tsholotsho T Maphosa Provincial STI/HIV Coordinator, Matabeleland North H Dube Provincial Health Information Officer, Matabeleland South M Ndlovu District Health Information Officer, Tsholotsho D Nkomo Medical Laboratory Scientist, Esigodini District Hospital M Mlotshwa District Health Information Officer, Umzingwane M Sibanda Environmental Health Officer, Tsholotsho M Nkala District TB and Leprosy Coordinator, Gwanda M Jira PHIO - PMD Mat South G Simbarewamwe Acting Provincial Health Promotion Officer, Matabeleland South L Mgutshini TB Focal Nurse, Tsholotsho District Hospital L Sibanda OI Focal Person, Tsholotsho District Hospital N Muleya Provincial TB and Leprosy Coordinator, Matabeleland South I Chamusingarevi Acting Provincial Health Promotion Officer, Manicaland M Munzara Acting Provincial Health Information Officer, Manicaland E Midzi Acting Maternal and Child Health Officer, Manicaland M Muponda District TB and Leprosy Coordinator, Manicaland E Zamba Provincial TB and Leprosy Coordinator, Manicaland P Fusire Environmental Health Officer, Manicaland K Charambira Government Medical Officer, Hauna District Hospital B V Chaibva Provincial Pharmacy Manager D Mutasa Health Promotion Officer, Rusape J Musuwo TB Focal Nurse, Rusape District Hospital C B Nyoni District Pharmacy Manager, Rusape T P Mushori District Health Information Officer, Rusape M Khaled Acting District Medical Officer, Makoni D Mapingire Acting District Nursing Officer, Makoni M Mahwe District TB and Leprosy Coordinator, Makoni E Sedze Sister-in-Charge OI, Makoni W Dhliwayo Principal Environmental Health Technician, Makoni 2 Cynthia Chiteve Monitoring and Evaluation Officer, The Union _____________________________ Dr C Sandy Deputy Director AIDS & TB Unit and NTP Manager Ministry of Health and Child Care The Global Health Bureau, Office of Health, Infectious Disease and Nutrition (HIDN), US Agency for International Development, financially supports this guide through Challenge TB under the terms of Agreement No. AID-OAA-A- 14-00029. This guide is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of Challenge TB and do not necessarily reflect the views of USAID or the United States Government. 3 FOREWORD Data collection, analysis and its use is essential in implementing an effective and efficient Tuberculosis (TB) control. It is vital for the districts, cities and provinces to be able to report timely, accurate and complete data to all levels of reporting and to use these data locally to strengthen management of both TB patients and TB control activities. This guide aims to ensure that health workers at all levels of the health care services are able to report accurately data, measure programme performance and use good quality data for decision making and planning.. It is important for national programme implementers and managers to have access to adequate information based on quality data to make policy decisions. The guide explains the National Tuberculosis Control Programme recording and reporting system and how to accurately and completely fill the TB data collection tools, analyse the data for decision making and planning. It is not a replacement of any National Tuberculosis Control Programme guidelines, instead reinforces what is mentioned in other guidelines. The target users of this guide are all health workers including health managers in all government, municipal, mission and private health facilities. It is my sincere hope that health workers will find this guide a useful tool to strengthen recording and reporting of TB data to enhance TB control in Zimbabwe. ____________________________________ Brigadier-General (Dr) Gerald Gwinji Permanent Secretary Ministry of Health and Child Care 4 Index ACKNOWLEDGEMENTS .................................................................................................................................... 2 FOREWORD .............................................................................................................................................................. 4 LIST OF ABBREVIATIONS ................................................................................................................................. 9 EXECUTIVE SUMMARY .................................................................................................................................... 10 CHAPTER 1: BACKGROUND.......................................................................................................................... 12 Summary: .............................................................................................................................................................................. 12 Rationale for the guide ........................................................................................................................................................ 12 Purpose of the guide ............................................................................................................................................................ 12 Target group for the guide .................................................................................................................................................. 13 What is new in the guide? ................................................................................................................................................... 13 How to use the guide? .......................................................................................................................................................... 14 Type of data and definitions ................................................................................................................................................ 14 Rates and percentages ......................................................................................................................................................... 17 Principles of TB control: Key questions and indicators .................................................................................................. 18 What is Data Quality? .......................................................................................................................................................... 22 Roles of different levels of health services ........................................................................................................................ 23 CHAPTER 2: DATA COLLECTION TOOLS ............................................................................................. 26 Electronic systems ................................................................................................................................................................ 29 CHAPTER 3: INTRODUCTION TO DATA TABULATION AND ANALYSIS ........................... 31 Summary: .............................................................................................................................................................................. 31 What is data tabulation and analysis? ................................................................................................................................ 31 How to make sense of data ................................................................................................................................................. 32 Indicators: Expected values and explanations for differing values ................................................................................ 33 BASIC ANALYTICAL AND EPIDEMIOLOGICAL TECHNIQUES USEFUL IN UNDERSTANDING DATA ..... 40 CHAPTER 4: DATA TABULATION, ANALYSIS & USE (AT HEALTH FACILITY, DISTRICT AND PROVINCIAL