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Increasing Tuberculosis Register Data Quality In Botswana With Continuous Quality Improvement Activities

Nora J Kleinman, Shreshth Mawandia, Botshelo Kgwaadira, Jessica Broz, Hilda Matumo, Robert Moumakwa, Bazghina-werq Semo & Jenny H Ledikwe

1.1 Background: Tuberculosis (TB) is the leading infectious disease killer worldwide. Botswana has over three times the global rate. The Botswana National Tuberculosis and Leprosy Programme leads TB control efforts with a focus on strengthening data systems.

1.2 Objective: To describe continuous quality improvement (CQI) activities conducted at health facilities, assess their impact on TB data completeness, and present information on data accuracy and insights from TB data managers.

1.3 Methods: In 2015, CQI interventions were conducted at 62 public health facilities to strengthen TB data quality in Botswana. In the first two visits, data on record completeness was collected in and number and percent of complete records were calculated by district, facility type, and data section. Data completeness was assessed for same cohort of patients over time using a McNemar test and between the first to second cohort using a chi-squared test. At the third visit, accuracy data was collected between primary and secondary data sources and number and percent of accurate records calculated.

1.4 Results: Following CQI activities, data completeness in the standardized TB form increased from 32.1%-88.1% per section to 46.5%-93.4%. There was a statistically significant increase in total data completeness for a single cohort across time, as well as from the first to the second cohort (both p<0.001). Assessing data accuracy was challenging due to missing primary sources, however records with sources had high accuracy in each section (up to 90.2%).

1.5 Conclusions: CQI activities raised accountability for TB data documentation and increased data completeness in Botswana, but gaps remain, warranting continued efforts.