Proposing indicators for evaluation of tuberculosis control programmes in large cities based on the experience of Barcelona

OBJECTIVE: To evaluate the effectiveness of the Barcelona Tuberculosis (TB) Control Programme and to propose evaluation indicators. MATERIALS AND METHODS: Using quantitative indicators, the results and impac t of the programme over the period 1987 to 1999 were evaluated. Statistical analysis was based on a description of indicators, including tests for tre nds, and on the evolution of the incidence. RESULTS: The incidence of tuberculosis rose between 1987 and 1991 (P = 0.10 ), and fell between 1991 and 1999 (P < 0.001). During the study period stat istically significant improvements were observed in the percentage of cases notified by the medical profession, adherence to treatment and the percent age of cases on directly observed treatment (DOT), and meningitis among chi ldren aged 0 to 4 years fell notably. However, diagnostic delay in smear-po sitive cases and the percentage of cases whose contacts were examined did n ot vary significantly. The evaluation indicated an average annual decline i n tuberculosis incidence of 6.7%, and rates of adherence to treatment (94.5 % among smear-positive cases) achieved their objectives. The average median diagnostic delay (36 days) and the percentage of cases with contacts exami ned (mean 59.8%) were rather less optimistic. CONCLUSIONS: The results of the evaluation were in general positive. Declin e in incidence, meningitis in children, treatment adherence rates, diagnost ic delay and percentage of cases with studied contacts were considered the best indicators for evaluation of TB programmes.