Evaluation of the Tuberculosis Case Notification System, Mhondoro-Ngezi District, Zimbabwe, 2016

Background: Zimbabwe was 17th among 22 tuberculosis (TB) high burdened countries. In Zimbabwe, the TB case notification system tracks data on case detection and treatment. Mhondoro-Ngezi district was reporting less than half provincial case average of 251 cases per 100,000 population per year. Data were always two weeks late. We evaluated the surveillance system and determined reasons for low notification. Methods: A descriptive cross sectional study was conducted using the updated CDC guidelines. Structured questionnaires, notification registers and forms were used to collect data. Epi Info 7 was used to calculate means and frequencies. Results: All 17 facilities providing TB services were selected. Only two of these were diagnostic centres. Of the 41 health workers, 32 (78%) were nurses. All facilities were notifying and 38 (93%) of health workers had notified cases. Notification forms were available at all facilities and were transported to the district office by government vehicles once completed. Ten minutes on average were needed to complete a form and this was easy for 89% health workers. Data were being analysed at facilities by 83% of health workers and 71% took action after analysis. Feedback from district level was being received by 85% of health workers. The reasons for low notification included: few diagnostic centres, passive case detection and poor community involvement. Conclusions: The TB case notification system was acceptable, simple, representative and useful. Reasons for low notification included: few diagnostic centres, passive case detection and poor community involvement. As a result of this evaluation, a third diagnostic centre is being set up.