Tuberculosis mortality rates and trends in Bangladesh: secondary analysis of mortality data

Overview

While Bangladesh is making remarkable progress in achieving population health outcomes, tuberculosis (TB)persists as one of the major public health issues with high rates of incidence, prevalence, and death. Under the National Tuberculosis Control Program (NTP), and with partnership and support from BRAC, icddr,b and other non-government organisations which are implementing the DOTS programme, there has been considerable development in terms of an increase in the case notification rate from 31 in 100,000 in 1993 to 71 in 100,000 in 2006. Despite such improvements, the absolute number of (reported) TB cases has risen from 85,410 in 2004 to 190,893 in 2013. In 2013, the estimated prevalence of people with TB was 639 (95% CI 330-1000), incidence 350 (95% CI 310-400) and mortality rate 80 (95% CI 51-110) per 100,000 population.

The information currently available on TB mortality in Bangladesh, as provided by different sources, is fragmented. Thus, there is a need for uniformity in using the standard tools and proceduresin determining TB related deaths. Further, the quality of available data has always been a question, which limits effective use and interpretation of findings derived from the existing databases.

Therefore, assessment of available data sets, identification of gaps,and triangulation has become critically important. Furthermore, there is a need for appropriate statistical analyses of available data sets and synthesis of evidence base to provide a national, close-to-exact picture on TB mortality. This would also help to determine the progress made so far and guide informed policy decisions for TB prevention and control in Bangladesh.

With the funding support from The Global Fund to Fight AIDS, Tuberculosis and Malaria(GFATM), the James P Grant School of Public Health, BRAC University(JPGSPH), in collaboration with BRAC, icddr,b and National TB Program, is currently conducting a study onTB mortality in Bangladesh. The study seeks to determine the tuberculosis mortality situation in Bangladesh.

Specific objectives of the study:
• To estimate the TB mortality rate using the databases currently available.
• To determine the age, sex and geographic distribution of TB mortality.
• To determine the gaps in the currently available data, such as the use of standard procedures. for data collection, definition, validation, and data management.
• To assess the TB mortality trends over the past 10 years.

Activities

This research study has been designed and divided into two phases: in phase I, analyses of secondary data related to tuberculosis (TB) mortality in Bangladesh will be conducted;inphase II,the primary TB mortality data collection was conducted using verbal autopsy. In phase I, the following databases were reviewed:
• Health & Demographic Surveillance Systems (HDSS) (icddr,b)
• Death related data reported by National Tuberculosis Program (NTP)
• Bangladesh Demographic & Health Survey (BDHS) (NIPORT)
• Sample Vital Registration System (SVRS) (BBS)
• Bangladesh Maternal Mortality and Health Care Survey (BMMS) (NIPORT)
• National AIDS/STD Programme (NASP)
• National Institute of Chest Diseases and Hospital (NIDCH) (DGHS, MoHFW)
• Health Management Information System (DGHS, MoHFW)

Activities completed and the current status of phase I:
• The different datasets as indicated above have now been obtained and are being cleaned for a range of analyses.
• Thorough analyses of the data collection procedure took place in each datasets, resulting in the identification of the strengths and the gaps.
• A draft reporting is under progress, and the final report is expected to be completed by February 2016.

Activities completed and the current status of phase II:
• Preparatory works for phase II of the study are underway.
• A range of available verbal autopsy (VA) tools have been reviewed.
• A workshop on tuberculosis mortality was held on 28 December 2015 with participation from TB experts. The workshop focused on preparing and adopting VA tools for phase II of the TB mortality study.

Partners/donors

Funding support: The Global Fund to Fight AIDS, Tuberculosis and Malaria
Strategic partners: BRAC, icddr,b, and National Tuberculosis Program