Examining the sensitivity of the surveillance system to detect TB cases in Afghanistan

Abstract Background Tuberculosis (TB) remains a global public health threat. World Health Organization (WHO) End TB strategy recommends that effective TB control relies on general health systems, especially, on integrated and well-functioning PHC facilities. Despite, integration in Basic Package of Health Services (BPHS), evidence demonstrates that a large number of TB cases are not captured. 25000 TB cases are missed every year (Aloudal, 2015). 49% of individuals, recorded at health facilities as presumptive to have TB have not been screened (HMIS, 2016). This study intended to evaluate different dimensions of TB surveillance system and the Primary Health Care (PHC) facilities' role in TB active case finding. Methods We conducted a cross-sectional study. The study was implemented in eleven provinces of Afghanistan in from August to November 2016. The geographic and demographic representativeness determined the choice of provinces. All primary health care facilities in studied provinces equated to 870, therefore, considering a 95 % confidence interval, a sample size of 161 facilities established the sample frame. A stratified sampling strategy facilitated the selection of sampled facilities within different categories from an inclusive list of all facilities. Results The study found that the overall sensitivity of TB surveillance systems in-country is 56.30 %. This means that 43.70 % of 171 TB cases had remained undetected. 43.81 % of studies facilities used at least one accepted active case finding strategy while 56.20 % implemented none. In studied areas, 83.33 % of 11 studied DHs and 69.57 % of 35 studied CHCs had a referral system for MDR-TB patients. Conclusion To enhance sensitivity and boost case findings, it is essential to implement case-finding strategies targeted at high-risk groups in specific areas. The high-risk groups include IDPs, returnees, slum residents, prisoners, and addicts. Additionally, it is necessary to train private pharmacists and traditional healers to identify and refer individuals with TB symptoms for follow up and further evaluation at the PHC level.