The World Health Organization (WHO) estimated that more than four million tuberculosis (TB) cases are missed by national TB surveillance systems annually (WHO, 2017). Although the WHO declared that finding these missed TB cases is a top priority to reach Global End TB targets, still the number and characteristics of missed cases are largely unknown in most high TB burden countries (WHO, 2015).
In Zambia, TB remains a significant public health problem and one of the leading causes of morbidity and mortality. Following an exponential increase in the number of new and relapse TB cases notified to the National TB program from the mid-1980's that peaked in 2003 to 504/100,000 population, there has been a gradual decrease in the number of cases and the notification rate reduced to 231/100,000 population in 2016.
However, the first National TB Prevalence Survey in Zambia, conducted from 2013 – 2014, found that the prevalence of bacteriologically confirmed TB in the adult population was 638/100,000 (range 502–774). For all forms of TB in all age groups the prevalence was 455/100,000 population. These rates are much higher than previously estimated by the World Health Organization (WHO, 2013), implying that more TB cases are being missed. For instance, in 2016, despite WHO estimating 62,000 incident TB cases in Zambia, only 38,326 new and relapse TB cases were notified.
The reason for the declining TB notifications can be as a result of under-diagnosis or underreporting of TB cases to the national program. Under-reporting can be due to TB cases being diagnosed but are not started on anti-TB treatment (pre-treatment lost to follow-up) or TB patients are on TB treatment but are not reported to the National TB Program.
In responding to these challenges of the missed TB cases, the World Bank in collaboration with the East, Central and Southern Africa Health Community (ECSA-HC) is supporting the implementation of the Southern Africa TB and Health Systems Support (SATBHSS) Project. The project is being implemented in Lesotho, Malawi, Mozambique and Zambia with the main objectives of:
- Improving coverage and quality of TB control and occupational lung disease services; and
- Strengthening the regional capacity to manage the burden of TB and occupational diseases.
Under the SATBHSS Project, funds have been made available for technical support for regional innovation through generation and sharing of knowledge and evidence from TB prevention and control interventions. The Ministry of Health through the National Tuberculosis and Leprosy Program (NTLP), therefore seeks to recruit a suitably qualified and experienced consulting firm to assess and quantify the level of TB underreporting in Zambia through an inventory study.