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P95 Why have TB notifications decreased by 50% in four years, in a rural district of Zimbabwe?
  1. HE Patrick1,
  2. E Manomano2,
  3. S Sah2,
  4. N Kwenzakwenkosi3,
  5. C Mushore3,
  6. RD Barker4
  1. 1National Institute for Health and Clinical Excellence, London, UK
  2. 2TB Alert, Brighton, UK
  3. 3Department of Health and Child Welfare, Manicaland Province, Zimbabwe
  4. 4King's Health Partners, London, UK


Introduction Annual TB notifications in Buhera District, Manicaland, peaked at 1,665 in 2008 and fell to 866 in 2012. The fall in TB notifications is disproportionate to national trends.1 We considered three possible reasons for the fall in TB incidence; a real reduction related to improved health of the population, an apparent reduction due to failure to identify or register new cases, and an apparent reduction due to fewer patients coming from outside the district to use relatively high quality services. We analysed existing data and planned further exploration.

Methods We used the district’s electronic TB database maintained by the charity TB Alert. We also accessed data relating to a recent pilot of the use of GeneXpert in the District. We planned further analyses to explore within district variation in notifications. We planned interviews with TB coordinators, primary care, hospital staff and senior staff from within and outside the province.

Results The district TB register appeared complete. Treatment success rates increased from 2006 (55%) but stabilised at 65–70%. The proportion of TB patients who died peaked at 20% in 2006 and reduced to 10.5% in 2011 possibly due to changes in case ascertainment. Re-treatment cases increased from 2% in 2007 to 8.5% in 2012. Use of the GeneXpert machine identified 1 case of multi-drug resistant TB in 2008, increasing to 29 cases in 2012. The proportion of TB patients coming from outside the district seeking services appears to be constant, but high, at 22% in 2008 and 23% in 2012.

Conclusions Initial analyses suggest that TB documentation in the district is well maintained.2 However there are significant changes in the local epidemiology of TB and the dramatic fall in the local incidence of tuberculosis is not completely explained. Further exploration of local TB documentation and practice associated with consultation with national and international TB experts should help to clarify the situation.


  1. World Health Organisation. Global Tuberculosis Report, 2012.

  2. Scott KM, Millard FJC, Smith RM, Manomano E, Glenshaw M, Barker RD. Five years of support for a tuberculosis programme in rural Zimbabwe: What has been achieved? Thorax 2009;64 (Suppl IV):A11.

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