The Ciskei tuberculosis information system

The organization and evaluation of tuberculosis services have been badly neglected in developing countries. The Ciskei information system controls (a) the issue of treatment of tuberculosis outpatients and (b) the notification of patients and their movements throughout treatment. "TB teams" of one to two nurses and a health assistant, based in each district, monitor the issue of treatment to outpatients. Compliance varies between about 50-80 pc in different districts. A central computerised tuberculosis register collects information about all patients coming under treatment and their subsequent movements until treatment stops. Its value is more in monitoring and correcting the running of the service than in collecting information. It uses alphabetical lists to reduce double registrations, enter follow up information, eliminates duplicates if entered and identify relapses. Reminder letters are sent out automatically when required. Tabulations can be done from the data file, special series of sputum positive patients studied and relapses analysed. There were 1,711 sputum positive registrations in 1991, compared with 1,741 in 1990. More occurred in the winter months. The three year self referred relapse rate is just over four pc. Intensive follow up of 584 patients showed 12 different outcomes; of 404 recorded as completing treatment, 1.7 pc relapsed later, compared with 11.7 pc of the others. The register has been invaluable to the monitoring, control and evaluation of the TB programme in Ciskei. Documentation is limited to copies of forms needed anyway for the ongoing care of patients.