{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T14:49:25Z","timestamp":1780930165616,"version":"3.54.1"},"reference-count":36,"publisher":"BMJ","issue":"1","funder":[{"name":"U.S. CDC Combating Antimicrobial Resistant Bacteria (CARB) funds"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,12,20]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The WHO estimates that almost 40% of patients diagnosed with tuberculosis (TB) are not reported. We implemented this study to assess TB under-reporting and delayed treatment registration in nine counties in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective inventory study (record review).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Counties were selected using purposive sampling from nine provinces distributed across eastern, central and western regions of China in 2015.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Under-reporting was calculated as the percentage of patients with TB not reported to TB Information Management System (TBIMS) within 6\u2009months of diagnosis. Delayed registration was estimated as the percentage of reported cases initiating treatment 7 or more days after diagnosis. Multivariable logistic regression and an alpha level of 0.05 were used to examine factors associated with these outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 5606 patients with TB identified from project health facilities and social insurance systems, 1082 (19.3%) were not reported to TBIMS. Of the 4524 patients successfully reported, 1416 (31.3%) were not registered for treatment within 7 days of diagnosis. Children, TB pleurisy, patients diagnosed in the eastern and central regions and patients with a TB diagnosis recorded in either health facilities or social insurance system\u2014but not both\u2014were statistically more likely to be unreported. Delayed treatment registration was more likely for previously treated patients with TB, patients with negative or unknown sputum results and for patients diagnosed in the eastern region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Almost one in every five patients diagnosed with TB in this study was unknown to local or national TB control programmes. We recommend strengthening TB data management practices, particularly in the eastern and central regions, and developing specific guidelines for reporting paediatric TB and TB pleurisy. Patient education and follow-up by diagnosing facilities could improve timely treatment registration. Additional studies are needed to assess under-reporting elsewhere in China.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-021529","type":"journal-article","created":{"date-parts":[[2019,1,29]],"date-time":"2019-01-29T05:43:28Z","timestamp":1548740608000},"page":"e021529","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Under-reporting of diagnosed tuberculosis to the national surveillance system in China: an inventory study in nine counties in 2015"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3176-018X","authenticated-orcid":false,"given":"Tao","family":"Li","sequence":"first","affiliation":[{"name":"National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemant Deepak","family":"Shewade","sequence":"additional","affiliation":[{"name":"South-East Asia Regional Office, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India"},{"name":"International Union Against Tuberculosis and Lung Disease (The Union), Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyaw Thu","family":"Soe","sequence":"additional","affiliation":[{"name":"Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Pyin Oo Lwin, Myanmar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanette J.","family":"Rainey","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, United States Centers for Disease Control and Prevention (CDC), Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Zhang","sequence":"additional","affiliation":[{"name":"National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Du","sequence":"additional","affiliation":[{"name":"National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixia","family":"Wang","sequence":"additional","affiliation":[{"name":"National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,1,28]]},"reference":[{"key":"2025121408001378000_9.1.e021529.1","unstructured":"World Health Organization (WHO). 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