Surveillance Quality Indicators Highlight the Need for Improving Tuberculosis Diagnostics and Monitoring in a Hyperendemic Area of the Brazilian Amazon Region

Abstract

The city of Ananindeua, State of Pará, Brazil, is a hyperendemic area for tuberculosis (TB). The present study describes the population characteristics and epidemiological indicators of TB cases from Ananindeua, from 2018 to 2020. The TB cases were screened from the Municipal Health Department of Ananindeua database, and the secondary data were obtained from the Brazilian Notifiable Diseases Information System (SINAN). A high percentage of cases did not undergo a rapid molecular test (74.9%) or culture (84.8%) for diagnosis of TB; a chest X-ray examination for diagnosis of TB was performed in 74.47% of new cases. The SINAN form data was incomplete on susceptibility test results (<0.01–92.7). Sputum smear microscopy for monitoring treatment was recorded in the follow-up form in 34.3% and after the 6th month in 61.1% of cases. The cure rate (60.31%) was below the recommendation by the Brazilian Ministry of Health. The quality indicators showed many weaknesses: (I) lack of availability of smear microscopy as a diagnostic test in a hyper-endemic area; (II) low availability of specific exams such as culture and rapid molecular test (RMT); (III) low adherence to smear microscopy to monitor the evolution of cases during treatment; (IV) absence of drug susceptibility test data; (V) failure to fill in essential variables for TB surveillance.