Estimating tuberculosis burden and reporting in resource-limited countries: A capture-recapture study in Iraq

S. Huseynova, D. S. Hashim, M. R. Tbena, R. Harris, A. Bassili*, I. Abubakar, P. Glaziou, K. Floyd, N. A. Van Hest

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


BACKGROUND: The global target for tuberculosis (TB) control set by the Millennium Development Goals is a decrease in TB incidence by 2015. Direct measurement of country-level TB incidence using population-based methods is impractical, emphasising the need for wellperforming surveillance systems and, where these are not available, accurate quantification of incidence and under-reporting of TB. OBJECTIVE: To estimate TB incidence and TB underreporting in Iraq in 2011. METHODS: Prospective longitudinal surveillance was established among all eligible public and private non- National TB Programme (NTP) providers in a random sample of eight of the 18 Iraqi governorates from May to July 2011. Record linkage with the NTP and threesource capture-recapture analysis of data were then conducted using log-linear modelling. RESULTS: A total of 1985 TB cases were identified after record linkage. The NTP registered 1677 patients (observed completeness 84%). The estimated total number of TB cases was 2460 (95%CI 2381-2553), with identified TB cases representing 81% (95%CI 69-89) after adjusting for sampling design. The estimated ratio of notified to incident cases was 69% (95%CI 58-76). CONCLUSIONS: We estimate 14 500 TB cases in Iraq in 2011, of which 31% (95%CI 24-42) were unreported. TB surveillance needs to be strengthened to reduce under-reporting.

Original languageEnglish
Pages (from-to)462-467
Number of pages6
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number4
Publication statusPublished - 1 Apr 2013


  • Capture-recapture analysis
  • Record linkage
  • Resource-limited
  • Surveillance
  • Tuberculosis


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