Falsified data in tuberculosis programme

False data is appearing about the persons who have died of tuberculosis (TB). There are also allegations that persons who do not have TB are being listed as TB patients. These manipulations in data are being carried out simply to meet certain targets. TB specialists say unless this tendency is halted, it will be difficult to bring tuberculosis under control in the country.

According to reports from the field, during April-June this year, 26 persons died of drug-resistant tuberculosis. However, investigations by the concerned government officials revealed that three of the TB patients had actually died beforehand. The monitoring and evaluation wing of the National TB Control Programme could not even locate the addresses of several of the deceased persons.

For the past few years there have been allegations of persons without TB being listed as TB patients, the same sputum sample be used in the name of several persons, the same deceased persons being showed as deceased several times, and so on. The National TB Control Programme, however, has taken no initiatives to stop such discrepancies.

According to the World Health Organisation (WHO), Bangladesh ranks 6th among the 22 countries with highest prevalence of tuberculosis. The Directorate General of Health Services (DGHS) said that 292,940 new tuberculosis patients had been detected in 2020 in the country. Last year the sputum samples of 2.7 million (27 lakh) persons with TB symptoms was tested. Presently 458 GeneXpert machines, 1136 microscopes and 126 digital x-ray machines are being used in the country for tests and treatment of the disease.

At the field level, 25 NGOs under BRAC leadership are providing services to identify TB patients and provide them with treatment. Other than that, the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) assists the government in TB detection, analysis and research.

Government officials have said that under the National TB Control Programme, details of all TB patients are collected and reviewed every three months. After four reviews in a year, the annual report is finalised. The final report is then sent to WHO and other donor agencies.

At a field level, information was sent on the death of 26 persons in the six divisions of Barishal, Chattogram, Dhaka, Khulna, Rajshahi and Sylhet. The deceased included 13 males and 13 females.

The National TB Control Programme found this figure to be too high and took initiative to investigate the matter. The monitoring and evaluation wing of the programme tried to obtain details of every deceased person.

In the documents of a deceased person of Narsingdi, the date of death was given as 27 June. The son and wife of the deceased person told the monitoring and evaluation wing that the man had died in the last week of September. In the same district, when the officials contacted a man who was reported to have died on 25 June, they came to know he had actually passed away before 28 September the previous year. There are more such examples. In a brief review, the monitoring and evaluation officials said the details of the patients are not being recorded properly.

National TB Control Programme officials said NGO field workers collect the sputum of suspected patients and get this tested at the laboratory. Over 2 million to 2.5 million (20 lakh to 25 lakh) samples are tested every year. From there, around 200,000 or 250,000 persons are diagnosed with TB. Their details are collected by the field workers. The field workers also provide the detected patients with medicines and monitor whether they are taking the medicines as prescribed.

Speaking to Prothom Alo, the Kamalnagar upazila health and family planning officer in Lakshmipur, Abu Taher, said that the results of certain sample tests in January-February this year seemed unusual. More patients were being detected in the results of the NGO laboratories compared to the government laboratories. The civil surgeon and divisional director were informed of the matter. The higher officials spoke to the NGOs.

These problems had cropped up in the past too. Towards the beginning of 2015, a report published in the International Journal of Tuberculosis and Lung Diseases, pointed to false data being provided about patients. Researching about drug-resistant tuberculosis patients, researchers listed 1480 patients. Of them, the information given on 12 patients was false or deceptive.

However, from gene analysis, the researchers found that a sample collected of one person had been used as samples for several persons in the laboratory. The research article said that this practice could corrupt the national programme.

Two concerned specialists, speaking to Prothom Alo, said the tendency to inflate the number of patients is an old practice. The national programme's strategy paper stated that the rate of TB deaths must be brought down by 75 per cent (compared to 2015) by the year 2025. In this span of time, the rate of TB transmission has to be decreased by 50 per cent. The field workers faced the pressure of fulfilling the target figures.

The NGOs also fixed certain targets for the field workers. It is compulsory for them to detect new patients in their work areas every month. Many try to simply increase the figures in order to meet the target, several government officials told Prothom Alo.

Head of BRAC's health department, Akramul Islam, said a field worker is given responsibility of a certain area, but not given any target to detect any certain number of patients. He said, "There is scope for inaccuracies in the sample test results in the laboratory. No technology or machine gives 100 per cent accurate results."

Renowned chest disease specialist Professor Ali Hossain told Prothom Alo, the records of TB patients need to be accurate. If a person without TB is enlisted as a TB patient and is administered drugs, this can be dangerous. The higher authorities must immediately take steps to halt this.

The monitoring and evaluation wing of the National TB Control Programme have said in their recommendations, the patient detection method must be improved along with the quality of the national programme's records including detailed information of the tuberculosis patients.

Line director of the programme, Professor Md Samiul Islam, told Prothom Alo, "Whenever we see discrepancies in the data, we carry out investigations and take necessary action. We are also placing importance on technological excellence."

* This report appeared in the print and online editions of Prothom Alo and has been rewritten for the English edition by Ayesha Kabir