QUALITY OF CARE REVIEW REPORT · • A malaria test was performed for all suspected malaria cases. However, all the tests that were documented returned a positive malaria result,

QUALITY OF CARE REVIEW REPORT

2017/18

Ministry of HealthMbabane, Eswatini

CHAPTER 1: BACKGROUND AND INTRODUCTION

1.1. Objectives

CHAPTER 2: METHODS AND APPROACH

2.1. Data Collection and Analysis

CHAPTER 3: QUALITY OF CARE REVIEW

3.1. Record Review for Patients on Antiretroviral Therapy (ART)

3.1.1. Patient Profile

3.1.2. CD4 Count Prior to Initiation

3.1.3. Viral Load Testing

3.1.4. Adherence

3.1.5. TB Status

3.1.6. Recent Weight

3.1.7. Isoniazid Preventive Therapy (IPT)

CHAPTER 4: MALARIA RECORD REVIEW

4.1. Sample Selection

4.2. Physical Examination

4.2.1. Symptoms and Conditions Assessed

4.2.3. Malaria Screening

4.3. Provision of Antimalarial Combination Therapy (ACTs)

CHAPTER 5: RECORD REVIEW FOR PATIENTS ON TB TREATMENT


5.2. Length of time on treatment: Client Profile

5.3. Delay in Diagnosis and TB Treatment

5.4. Diagnosis

5.5. TB drugs’ collection

5.6. TB/HIV integration

5.7. Drug Susceptibility Testing (DST) for patients on first line

5.8. TB follow-up testing

5.9. Growth Monitoring in children with TB

CHAPTER 6: OTHER FINDINGS

CHAPTER 7: CONCLUSIONS AND RECOMMENDATIONS

7.1. Conclusions

7.2. Recommendations

ANNEXURES

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TABLE OF CONTENTS

Quality of Care Review i

ART Antiretroviral Therapy

DQR Data Quality Review

IHFAN International Health Facility Assessment Network

HFA Health Facility Assessment

HIV Human Immunodeficiency Virus

MoH Ministry of Health

PTB Pulmonary Tuberculosis

QoC Quality of Care

SAM Service Availability Mapping

SAP Service Provision Assessment

SARA Service Availability and Readiness Assessment

TB Tuberculosis

USAID United States Agency for International Development

WHO World Health Organization

LMIS Laboratory Management Information System

IP Internet Protocol

DHS Demographic and Health Surveys

M&E Monitoring and Evaluation

PLHIV People Living with HIV

ACRONYMS

iiQuality of Care Review

1Quality of Care Review

EXECUTIVE SUMMARY

The Quality of Care Review was conducted in a nationally-representative sample of 20 facilities found in the 4 regions of the country. The sample comprised of public, private and non-governmental health facilities, and results were stratified by facility level, operating authority and ownership.

The assessment involved reviewing patient and facility records in a sample of health facilities on the quality of care provided for HIV, Tuberculosis and Malaria. A review team collected the required data at health facilities by administering data collection tools with responsible personnel at these facilities. Data were captured into a Microsoft Access 2016 Database and cleaning was performed in Microsoft Excel 2016. Thereafter, data were imported into Stata 13 software for analysis. A summary of findings is presented below.

ART Record Review

For the purpose of the ART programme quality of care review, the following documents were reviewed for completeness; (i) Pre-ART registers, (ii) The ART registers, (iii) The Chronic Care File, and the (iv) Laboratory register (where available). The results presented below come from 17 out of the 20 health facilities that were sampled for the purposes of the review. Two of the health facilities that were part of the sample did not offer ART services at the time of the assessment, while the other facility had permanently closed.

Results indicate that:

• There is good documentation of other routine HIV/AIDS services including, CD4 monitoring, weight status, TB testing and adherence to ART.

• Recommended clinical practice is followed for most HIV/ART services such as; weight monitoring, adherence to ART, monitoring of CD4 cell counts, intermittent preventative treatment of TB, and others.

• Eighty-two percent of the patients had CD4 testing prior to initiating ART.

• Only 38% of patients had documentation of prior viral load testing.

Record Review for Malaria Suspects

All cases were diagnosed through a malaria test and had received antimalarial drug prescription and were eligible for review. Cases were identified from monthly summary reports that facilities complete for the Immediate Notification System Summary Report. Ten patients were then selected from 3 different reporting months, starting with the most recent month. Systematic random sampling was then used to identify five (5) records for reviewing. Sources of documentation that were used included (i) laboratory registers, (ii) the Laboratory Management Information System (LMIS) and (iii) outpatient registers. Most of the health facilities that participated in the review kept individual patient records for all malaria patients. A few of these records were in an electronic database, but most were paper files.

The review found that:

• Most health facilities were trying to maintain patient records for malaria, albeit inconsistently. • Some health facilities do not document names of drugs issued to patients in the monthly Immediate Disease

Surveillance Report as per protocol.

• Some health facilities are also still using their own data collection tools as opposed to the nationally sanctioned data collection material.

• Only 68% of patients reviewed for malaria had received a physical exam.

• Eighty-eight percent of those with a physical exam also had a temperature documented. • A malaria test was performed for all suspected malaria cases. However, all the tests that were documented

returned a positive malaria result, indicating potential non-documentation of tests that returned negative. • A fifth (20%) of the malaria cases had no record of receiving anti-malaria drugs.

Record Review for TB Patients

All patients with Drug Susceptible Pulmonary Tuberculosis that had completed 5 consecutive months on first line TB treatment were eligible for selection. The TB register was used to identify 10 patients who fulfilled the eligibility criteria. The team systematically selected a maximum of 5 patient cards for review. Sources of documentation that were used included (i) a laboratory register (where available), (ii) a computer database (where available) and (iii) a presumptive TB register.

Specific findings for TB include the following: • There was evidence of provision of Intermittent Preventative Treatment of TB in only 24% patients that were

eligible for IPT.

• About 24% of the TB cases reviewed were for patients that had been on first line Drug Susceptible TB (DS-TB) treatment for 7 to 9 months.

• Sixty-four percent of newly-diagnosed PTB cases are initiated on first line TB treatment on the same day of diagnosis.

• Eight percent of TB patients were diagnosed using 2 positive sputum tests, the majority (89%) have been diagnosed using Xpert MTB/Rif.

• Eighty-four percent of patients are compliant with scheduled return dates for clinical review and drug refills.

• Half of the patients reviewed for TB were HIV-positive.

• Eighty-eight percent of the 55 patients in the TB review had documentation of Drug Susceptibility Testing (DST). There was no indication of whether DST was ordered for the rest.

• Ten percent of patients that received DST testing had a positive result.

• Eighty-five percent of patients started on TB treatment were re-assessed at month 5 and 72% at the end of treatment.

Other Findings

The following were noted as strengths of the documentation procedures in facilities whose data recording systems were assessed;

• Health facilities have designated focal personnel that are responsible for managing patient information.

• Most health facilities were using Ministry of Health standard registers and reporting tools.

• Most health facilities were compliant with recommended documentation procedures in the areas that were assessed.

The following weaknesses were also noted;

• There are some health facilities that were recording laboratory tests in exercise books as opposed to the standard laboratory register.

• There is inconsistent filling and/or undocumented original data collection processes.

• Computer’s filing systems were not well ordered and/or unprotected, which could result in loss of original data documentation, or in manipulation of the data.

Conclusions

The review indicates general quality of care in most of the areas that were assessed. The quality of documentation, however, is lacking especially for malaria services. In several health facilities, filing systems were unsystematic and/or, on occasion, unprotected. Although a majority of facilities had filing systems, most were in disarray. Specific deficiencies included: poorly organised documents in files, missing data and documents and poor labelling of files.

Some Recommendations

Recommendation 1: Ministry of Health (MoH) should continue to train and mentor health facility personnel on the importance of proper and consistent documentation of service delivery.

Recommendation 2: MoH and partners should ensure that staff at health facilities are trained on revised tools and that these tools are rolled out in a co-ordinated timeous manner.

Recommendation 3: There is a need for holding regular sessions to get feedback from health facilities on data collection and management activities.

Recommendation 4: Both MoH and health facilities should ensure that data collection instruments are up-to-date and consistent with the approved programme guidelines or protocols.

Recommendation 5: MoH should reinforce the message to all health providers about the importance of data quality, consistent documentation, and proper filing procedures and protocols.


EXECUTIVE SUMMARY



ART Record Review



















eligible for IPT.









Other Findings









Conclusions








EXECUTIVE SUMMARY



ART Record Review



















eligible for IPT.









Other Findings










Conclusions









CHAPTER 1 Background and Introduction

The Quality of Care review is part of the recommended country Health Facility Assessments by the World Health Organization. Unlike the service provision assessment that has been conducted several times in Eswatini, this was the first Quality of Care Assessment for the country.

1.1. Objectives

The Objective of this assessment was to review patient and facility records to assess treatment and care services in three disease areas: (i) HIV/ART Programme, (ii) Tuberculosis (TB) and (iii) Malaria. This was done by extracting patient records or a history of patient contacts in a sample of health facilities. This review informed the assessment of (i) quality of care for patients within the facility, (ii) the degree of adherence to local standards and guidelines and (iii) how well service providers or clinicians were documenting client experiences in a sample of facilities.

CHAPTER 2

Methods and Approach

The sample for this assessment encompassed all regions of Eswatini. The monitoring and Evaluation (M&E) Unit conducted the sampling of regions and health facilities using a two-stage, weighted probability sample to get a nationally representative sample of health facilities that also permitted stratification by region. Sampling weights were included during statistical analysis to account for health facilities’ selection probability in a multistage sample design. The probability of a health facility to be included was calculated as number of facilities selected over total number of facilities in the region. Sampling weights at first stage were calculated as a reciprocal of the probability of a district to be included in a SAVVY sample. It should be noted that results presented in the figures are the number of observations (weighted counts) and results presented as percentages are based on weighted observations.

The overall sample of 20 health facilities was selected for the exercise and represents approximately 10% of the estimated 287 health facilities in Eswatini that was based off the master facilities list for the 2013 SAM. Specialists and referrals were omitted from the health facility sample and are therefore NOT represented in the results presented here. The total number of facilities in the sample are presented in Annexure I. Data were collected at 17 facilities, representing 85% of the target sample. Two facilities dropped out in the final analysis because they were not offering any service related to the programme areas that the review was assessing and one health facility had permanently closed operations. Out of the 3 facilities where data were not collected, one was in the Hhohho region, one in Manzini and one in Shiselweni.


A one-day training of data collectors was organised to orient participants on how to use the data collection tools. Two data collectors were engaged and received training. A participatory teaching and learning approach was used that included presentations with question and answer sessions and practice on understanding and filling in the questionnaires. The team visited health facilities and administered data collection questionnaires to respective facility personnel that were responsible for specific services. Data was captured into a Microsoft Access database

and cleaning was performed in Microsoft Excel. Thereafter, data were imported into Stata 13 software for analysis. All data sets were analysed using a survey design methodology.

CHAPTER 3

Quality of Care Review


ART remains the intervention that can help lower the risk of HIV transmission as well as improve the health and increase length of life of people living with HIV (PLHIV). As part of Eswatini's vision to prevent AIDS-related morbidity and mortality, and to eliminate new HIV infection, the country rolled out new Integrated HIV treatment guidelines in 2015.

For the purpose of the ART programme quality of care review, the following documents were reviewed for completeness; (i) Pre-ART registers, (ii) The ART registers, (iii) The chronic care file and the (iv) laboratory registers (where available). The results presented below come from 17 out of the 20 health facilities that were sampled for the purposes of the review. Two of the health facilities that were part of the sample did not offer ART services at the time of the assessment, while the other facility had permanently closed.


The 2015 HIV treatment guidelines recommend that people with HIV start ART soon after diagnosis. ART registers were used to create a list of patient file numbers from which 10 patient file numbers were identified. To qualify for the review, clients must have completed at least 6 months on ART. From these 10 patient files, 5 were systematically selected for the record review exercise. The same procedure was used in all the 17 health facilities that were visited.

Figure 1: Length of time on ART (n=85)

Figure 1 above present the number of months that patients had completed on ART at the time of the assessment.

CHAPTER 1 Background and Introduction

The Quality of Care review is part of the recommended country Health Facility Assessments by the World Health Organization. Unlike the service provision assessment that has been conducted several times in Eswatini, this was the first Quality of Care Assessment for the country.

1.1. Objectives

The Objective of this assessment was to review patient and facility records to assess treatment and care services in three disease areas: (i) HIV/ART Programme, (ii) Tuberculosis (TB) and (iii) Malaria. This was done by extracting patient records or a history of patient contacts in a sample of health facilities. This review informed the assessment of (i) quality of care for patients within the facility, (ii) the degree of adherence to local standards and guidelines and (iii) how well service providers or clinicians were documenting client experiences in a sample of facilities.

CHAPTER 2

Methods and Approach

The sample for this assessment encompassed all regions of Eswatini. The monitoring and Evaluation (M&E) Unit conducted the sampling of regions and health facilities using a two-stage, weighted probability sample to get a nationally representative sample of health facilities that also permitted stratification by region. Sampling weights were included during statistical analysis to account for health facilities’ selection probability in a multistage sample design. The probability of a health facility to be included was calculated as number of facilities selected over total number of facilities in the region. Sampling weights at first stage were calculated as a reciprocal of the probability of a district to be included in a SAVVY sample. It should be noted that results presented in the figures are the number of observations (weighted counts) and results presented as percentages are based on weighted observations.

The overall sample of 20 health facilities was selected for the exercise and represents approximately 10% of the estimated 287 health facilities in Eswatini that was based off the master facilities list for the 2013 SAM. Specialists and referrals were omitted from the health facility sample and are therefore NOT represented in the results presented here. The total number of facilities in the sample are presented in Annexure I. Data were collected at 17 facilities, representing 85% of the target sample. Two facilities dropped out in the final analysis because they were not offering any service related to the programme areas that the review was assessing and one health facility had permanently closed operations. Out of the 3 facilities where data were not collected, one was in the Hhohho region, one in Manzini and one in Shiselweni.


A one-day training of data collectors was organised to orient participants on how to use the data collection tools. Two data collectors were engaged and received training. A participatory teaching and learning approach was used that included presentations with question and answer sessions and practice on understanding and filling in the questionnaires. The team visited health facilities and administered data collection questionnaires to respective facility personnel that were responsible for specific services. Data was captured into a Microsoft Access database


and cleaning was performed in Microsoft Excel. Thereafter, data were imported into Stata 13 software for analysis. All data sets were analysed using a survey design methodology.

CHAPTER 3



ART remains the intervention that can help lower the risk of HIV transmission as well as improve the health and increase length of life of people living with HIV (PLHIV). As part of Eswatini's vision to prevent AIDS-related morbidity and mortality, and to eliminate new HIV infection, the country rolled out new Integrated HIV treatment guidelines in 2015.

For the purpose of the ART programme quality of care review, the following documents were reviewed for completeness; (i) Pre-ART registers, (ii) The ART registers, (iii) The chronic care file and the (iv) laboratory registers (where available). The results presented below come from 17 out of the 20 health facilities that were sampled for the purposes of the review. Two of the health facilities that were part of the sample did not offer ART services at the time of the assessment, while the other facility had permanently closed.


The 2015 HIV treatment guidelines recommend that people with HIV start ART soon after diagnosis. ART registers were used to create a list of patient file numbers from which 10 patient file numbers were identified. To qualify for the review, clients must have completed at least 6 months on ART. From these 10 patient files, 5 were systematically selected for the record review exercise. The same procedure was used in all the 17 health facilities that were visited.

Figure 1: Length of time on ART (n=85)

Figure 1 above present the number of months that patients had completed on ART at the time of the assessment.


3.1.2. CD4 Count Prior to Initiation

According to the 2015 Integrated HIV management guidelines, CD4 cell counts should be done at 6-month intervals after ART initiation and that health providers can stop CD4 monitoring once the patient has 2 consecutive CD4s of >350cells/mm3 and is virologically suppressed.

Overall, 82% of the patients whose files were reviewed indicated that a CD4 count was done prior to initiating ART. Possible reasons for no documentation of testing in 18% include; no test being done and inefficient filing and documentation systems.

3.1.3. Viral Load Testing

Only 38% of patients had documentation of viral load testing during their follow up (Figure 2). Of the 85 patients that were assessed, only 16% had documentation of viral load testing at 6 months. Only 37 of the 85 patients had been on ART for 12 or more months and were therefore eligible for a 12-month viral load test. Of these, only 9 (24%) had had this testing. Thirty-two of the 85 patients had had previous viral load testing. Of these, 13% had a documented undetectable load test, 66% had a detectable viral load and results were unknown for the rest of the patients (22%).

Figure 2: Proportion of patients with documentation on viral load testing

3.1.4. Adherence

The standard local clinical definition of adherence has been “taking >95% of medications in the right way at the right time”. According to national guidelines adherence to treatment is assessed by health workers through pill counts and some self-reporting by patients during each clinic visit and then recorded in the chronic care file.

Figure 3 below shows that 78% of files that were reviewed had documentation of adherence monitoring. The patients that had been on treatment for a longer duration were, however, more likely to lack this documentation. Most newly-initiated patients (12 months or less) had their files in good order and as result had most of the documentation related to monitoring adherence.


Figure 3: Adherence documentation by months of follow-up

3.1.5. TB Status

Figure 4 below presents findings of the review of documentation on whether the TB status for ART patients was recorded during clinical visits. In total TB status was documented in 87% of the client files reviewed and there was 100% documentation when stratified by follow-up time, the exception being patients on 12 to 24 months of treatment where half had no documentation.

Figure 4: Documentation of TB status by months of follow up


Figure 5: below, presents the availability of documents in patients’ chronic care files indicating weight measurements during the most recent visit. The majority (88%) of patients had documentation that their weight was taken during a most recent clinical visit. There was 100% documentation when stratified by follow-up time, the exception being half of the patients that had been on treatment for 12 to 24 months and 35 of those that had been on treatment for 6 to 12 months.

Figure 5: Documentation of patientsʼ weight by months of follow-up


The World Health Organization (WHO) recommends the PLHIV who are unlikely to have active TB should receive at least 6 months of IPT as part of a comprehensive package of HIV care. Figure 6 below, presents data on whether there is any indication that a patient is receiving Isoniazid or has ever received Isoniazid at any point in the past 24 months. Overall, there was poor documentation on this variable and it was impossible to assess in 11% of the files. Twenty-four percent of the files assessed had prior or current IPT and 66% had never had it.

Figure 6: Documentation Intermittent Preventative Treatment (IPT) of TB in the past 24 months

Figure 3: Adherence documentation by months of follow-up

3.1.5. TB Status

Figure 4 below presents findings of the review of documentation on whether the TB status for ART patients was recorded during clinical visits. In total TB status was documented in 87% of the client files reviewed and there was 100% documentation when stratified by follow-up time, the exception being patients on 12 to 24 months of treatment where half had no documentation.

Figure 4: Documentation of TB status by months of follow up


Figure 5: below, presents the availability of documents in patients’ chronic care files indicating weight measurements during the most recent visit. The majority (88%) of patients had documentation that their weight was taken during a most recent clinical visit. There was 100% documentation when stratified by follow-up time, the exception being half of the patients that had been on treatment for 12 to 24 months and 35 of those that had been on treatment for 6 to 12 months.

Figure 5: Documentation of patientsʼ weight by months of follow-up


The World Health Organization (WHO) recommends the PLHIV who are unlikely to have active TB should receive at least 6 months of IPT as part of a comprehensive package of HIV care. Figure 6 below, presents data on whether there is any indication that a patient is receiving Isoniazid or has ever received Isoniazid at any point in the past 24 months. Overall, there was poor documentation on this variable and it was impossible to assess in 11% of the files. Twenty-four percent of the files assessed had prior or current IPT and 66% had never had it.

Figure 6: Documentation Intermittent Preventative Treatment (IPT) of TB in the past 24 months



CHAPTER 4

Malaria Record Review

4.1. Sample SelectionAll cases diagnosed through a malaria test and prescribed antimalarial drugs were eligible to be selected for review. Cases were identified from the monthly summary reports that facilities complete and report through an Immediate Notification System Summary Report. Ten patients were then selected from 3 different reporting months, starting with the most recent month. The team then used systematic random sampling to identify five (5) records for review. Sources of documentation that were used included (i) laboratory registers, (ii) the Laboratory Management Information System (LMIS) and (iv) outpatient registers. Most of the health facilities who participated in the review kept individual patient records for all malaria patients. Some of these records were in electronic computer databases, but most were in paper files.

4.2. Physical Examination

In total, malaria curative services was offered in 5 of the sampled (20) health facilitates. All of the health facilities that were keeping records for malaria were located in Lubombo and Shiselweni regions. Out of the 25 client records reviewed, 68 percent (17) had an indication that a physical exam was conducted. Eighty-eight percent of those with a physical exam also had a temperature documented.

Figure 7: Documentation of Physical Exam

4.2.1. Symptoms and Conditions Assessed

Overall, 96% had documentation of assessment of malaria symptoms. Seventy-two percent presented with symptoms of a high fever, 32% showed symptoms of being anaemic and another 32% presented with symptoms of lethargy, listlessness or fatigue (Figure 8).

32%

68%

No Yes

ART Antiretroviral Therapy

DQR Data Quality Review

IHFAN International Health Facility Assessment Network

HFA Health Facility Assessment

HIV Human Immunodeficiency Virus

MoH Ministry of Health

PTB Pulmonary Tuberculosis

QoC Quality of Care

SAM Service Availability Mapping

SAP Service Provision Assessment

SARA Service Availability and Readiness Assessment

TB Tuberculosis

USAID United States Agency for International Development

WHO World Health Organization

LMIS Laboratory Management Information System

IP Internet Protocol

DHS Demographic and Health Surveys

M&E Monitoring and Evaluation

PLHIV People Living with HIV

Figure 8: Documentation of symptoms and conditions assessed

4.2.3. Malaria Screening Data from the sample records indicate that a malaria test was performed for all suspected malaria cases. Figure 9 shows that about half of the cases (48%) reviewed were screened using a blood smear, while 44% were screened using the malaria Rapid Diagnostic Test (RDT). About 8 percent of the cases were screened using a combination of both tests. All the tests conducted returned a positive malaria result. In all the cases, the test and the results were recorded in the laboratory register or some form of documentation was available for verification.

Figure 9: Documentation of Malaria Screening

The review also revealed that, in as much as there are standard tools for documentation, e.g., Laboratory Management Information System (where available) and the Laboratory Register, some facilities continue to use their own hybrid systems of documenting laboratory services. A case in point is one health facility in the Lubombo region, where 2 quire notebooks were being used as opposed to the standard national laboratory register.


4.3. Provision of Antimalarial Combination Therapy (ACTs)

In about a fifth (20%) of the malaria cases that were reviewed, there was no indication in the patient record that any anti-malaria drugs were prescribed/provided to the client.

CHAPTER 5

Record review for patients on TB treatment


All TB patients with Drug Susceptible Pulmonary Tuberculosis and who had completed 5 consecutive months on first line TB treatment were eligible for selection. Patients who dropped out before completing 5 months of treatment and those who were referred elsewhere for treatment (e.g., drug-resistant cases) were excluded from the sample. TB registers were used to identify 10 patients who fulfilled these criteria. The team then systematically selected a maximum of 5 patient cards for review. Other sources of documentation that were used included (i) laboratory registers, (ii) computer databases, where available and (iv) presumptive TB registers.

5.2. Length of time on treatment: Client Profile

The record review files indicate that the average length of time on treatment for the selected patient was 6.2 months. About 24% of the cases reviewed were for patients that have been on first line Drug Susceptible TB (DS-TB) treatment for 7 to 9 months.

5.3. Delay in Diagnosis and TB Treatment

The review found that the average time between diagnosis and treatment was 1 day (range: 0-7 days). Figure 10 below shows that 64% of newly-diagnosed PTB cases are initiated on first line TB treatment on the same day of diagnosis. Only 8% of the PTB cases were documented to have been initiated 5 days and over after initial diagnosis.

Figure 10: Number of days between diagnosis and initiation of TB treatment (n=55)

Quality of Care Review 11


5.4. Diagnosis

Figure 11: Procedures used to diagnose TB

Figure 11 above shows the TB diagnosis procedures used in the country. The review found that 89% of TB patients were diagnosed using Xpert MTB. Eight per cent of TB patients had documentation of 2 positive sputum samples. The majority of patients diagnosed with TB have had one sputum sample collected.

5.5. TB drugs collection Figure 12 below presents information from a review of patients’ records pertaining to their return to TB units for drug refills. The review revealed that patients returned on time on 84% of the appointment dates. The others either had no documentation or there was not sufficient documentation to determine if the patient’s return for a refill was timely.

Figure 12: Timing of Drug Collection TB patients

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5.6. TB/HIV integration

Over 70% of TB patients in Eswatini are also HIV-positive, and TB is responsible for about a quarter of deaths among people living with HIV. The QoC team reviewed 55 patient files from 11 TB units. All the files that were assessed also documented patients’ HIV status. Thirty-one patients were HIV-positive and all but one were on both ART and cotrimoxazole prophylaxis (Figure 13).

Figure 13: Documentation of HIV/TB activities

5.7. Drug Susceptibility Testing (DST) for patients on first line Out of the 55 files reviewed, 49 (88%) had documentation of Drug Susceptibility Testing (DST). There was no indication of whether DST was ordered for the rest. Out of the 49 patients who had DST, 89% (43) had a negative DST result recorded in their files, and the others had a positive DST result. There was no indication as to whether those with positive DST results were initiated on second line (DR-TB) treatment.

5.8. TB follow-up testing

Figure 14 below present results of the review of documentation of patient follow-up by health providers at the TB units that were assessed. The review showed that 8% of the patients started on TB treatment were re-assessed at month 2 or 3, 85% at month 5 and 72% at the end of treatment.

13


Figure 14: Documentation of TB patient follow up testing

5.9. Growth Monitoring in children with TB

Out of the 55 patients reviewed 6 (11%) were children under 5. The review revealed that 5 out 6 children had an age-specific growth chart in their file indicating their recent weight.

CHAPTER 6

Other findings

The following were noted as strengths of the documentation procedures in the programmes whose data recording systems were assessed for the purposes of the quality of care review;





• Some health facilities that were recording laboratory tests in exercise books as opposed to the standard laboratory register.

• Some health facilities were still using an older version of the Immediate Notification Report when reporting treated malaria cases yet a new tool was rolled out years ago.

• There is inconsistent completion and/or undocumented original data collection processes.

• Computer-based filing systems were not well-ordered and/or unprotected, which could result in loss of original data documentation, or in manipulation of the data.

14


CHAPTER 7

Conclusions and Recommendations

7.1. Conclusions

The review indicates general quality of care in most of the areas that were assessed. The quality of documentation, however, is lacking, especially for malaria services. In several health facilities, filing systems were unsystematic and/or, on occasion, unprotected. Although a majority of facilities had filing systems, most were in disarray. Specific deficiencies included: poorly organised documents in files, missing data and documents and poor labelling of files.

7.2. Recommendations

Recommendation 1: MoH should continue to train and mentor health facility personnel on the importance of proper and consistent documentation of service delivery.





15

ANNEXURES

Annexure I: List of health facilities


Facility Ownership Type GPS Latitude

GPS Longitude

1) Luve clinic

Private(Non-Industrial) owned by nurse(s) Clinic without maternity -26.31907 31.48605

2) Manzini health care clinic

Private(Non-Industrial) owned by doctor(s) Clinic without maternity -26.49989 31.37823

3) Zakhele Remand Centre clinic Government Clinic without maternity -26.50611 31.37013

4) St Theresa's clinic Mission Clinic with maternity -26.50345 31.38013

5) Cabrini health care NGO's Specialised Clinic -26.85402 31.76907

6) Good Shepherd hospital Mission Specialised Hospital -26.46875 31.9614

7) Illovo Sugar hospital Industrial Private Hospital 26.79598 31.93418

8) Matsanjeni health centre Government Health Centre 27.25409 31.75048

9) Mhlosheni clinic Government Clinic without maternity -27.18929 31.39284

10) Baylor C.O.E clinic NGO's Clinic without maternity 26.31871 31.1315

11) Mahwalala Red Cross clinic NGO's Clinic with maternity -26.33054 31.11174

12) Maguga Clinic

Government Clinic without maternity -26.07466 31.26676

13) Ngonini Estate clinic Industrial Clinic without maternity -25.78974 31.399

14) NATICC clinic NGO's Specialised Clinic -27.11796 31.19551

15) Hhukwini clinic Government Clinic without maternity -26.33414 31.23503 16) Family Life Association clinic

(Mbabane) NGO's Clinic without maternity -26.32452 31.13976

17) Siteki Nazarene clinic Mission Clinic without maternity -26.44572 31.93681

18) Siphofaneni clinic Government Clinic without maternity -26.68407 31.68154

19) Nkwene Clinic Government Clinic without maternity -26.86618 31.3078

20) Zheng Yong clinic Industrial Clinic without maternity -27.08872 31.15948

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g po

int a

nd th

en se

lect e

very

oth

er p

atien

t (to

a m

axim

um o

f 5) f

or re

cord

revie

w 01

NU

MBER

OF

ELIG

IBLE

PAT

IENT

S ID

ENTI

FIED

02

NOTE

NUM

BER

OF O

RIGI

ALLY

SEL

ECTE

D SA

MPLE

PAT

IENT

S RE

PLAC

ED

DUE

TO M

ISSI

NG IN

DIVI

DUAL

PAT

IENT

REC

ORDS

AND

INFO

RMAT

ION

IS N

OT

IN R

EGIS

TER.

NUMB

ER R

EPLA

CED

NO

NE ...

........

........

........

........

........

..... 0

0

17


An

nex

ure

II:

ART

Reco

rd R

evie

w G

uid

e (c

on

tinu

ed)

PLEA

SE A

NSW

ER T

HE F

OLLO

WIN

G QU

ESTI

ONS

FOR

EACH

PAT

IENT

(USI

NG IN

FORM

ATIO

N FR

OM T

HE R

EGIS

TER(

S) A

ND/O

R PA

TIEN

T CA

RD/D

ATAB

ASE)

1402

QU

ESTI

ONS

PATI

ENT

1 PA

TIEN

T 2

PATI

ENT

3 PA

TIEN

T 4

PATI

ENT

5

A b

C D

e f

01

Is th

e ind

ividu

al pa

tient

reco

rd av

ailab

le?

YES

........

........

........

.......

1 NO

.......

........

........

........

.. 2

YES

........

........

........

........

. 1

NO ...

........

........

........

........

2 YE

S ....

........

........

........

.... 1

NO ...

........

........

........

.......

2 YE

S ....

........

........

........

.... 1

NO ...

........

........

........

.......

2 YE

S ....

........

........

........

.... 1

NO ...

........

........

........

.......

2 02

Ho

w ma

ny fu

ll mon

ths

has t

he p

atien

t bee

n en

rolle

d in

ART

as o

f to

day?

DON’

T

KNOW

.......

........

........

.. 98

DON’

T

KNOW

.......

........

........

.... 98

DON’

T

KNOW

.......

........

........

... 98

DON’

T

KNOW

.......

........

........

... 98

DON’

T

KNOW

.......

........

........

... 98

03

W

as a

conf

irmat

ory

HIV

test

cond

ucte

d pr

ior to

the

patie

nt sta

rting

on

ART?

YES

........

........

........

.......

1 NO

.......

........

........

........

.. 2

DON’

T

KNOW

.......

........

........

.. 98

YES

........

........

........

........

. 1

NO ...

........

........

........

........

2 DO

N’T

KN

OW ...

........

........

........

98

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T

KNOW

.......

........

........

... 98

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T

KNOW

.......

........

........

... 98

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T

KNOW

.......

........

........

... 98

04

W

as th

e pa

tient

CD4

do

cume

nted

prio

r to

initia

ting A

RT?

YES

DO

CUME

NTED

.... 1

06

NO, N

OT

DOCU

MENT

ED ...

........

.. 2

DON’

T KN

OW ...

........

.. 98

YES

DO

CUME

NTED

......

106

NO

, NOT

DO

CUME

NTED

.......

........

2 DO

N’T

KNOW

.......

........

98

YES

DO

CUME

NTED

..... 1

06

NO, N

OT

DOCU

MENT

ED ...

........

... 2

DON’

T KN

OW ...

........

... 98

YES

DO

CUME

NTED

..... 1

06

NO, N

OT

DOCU

MENT

ED ...

........

... 2

DON’

T KN

OW ...

........

... 98

YES

DO

CUME

NTED

..... 1

06

NO, N

OT

DOCU

MENT

ED ...

........

... 2

DON’

T KN

OW ...

........

... 98

05

Is

ther

e a

CD4

reco

rded

with

in the

1st

mont

h of

ART

?

YES

DOCU

MENT

ED ...

.......

1 NO

, NOT

DO

CUME

NTED

.......

...... 2

YES

DOCU

MENT

ED ...

........

. 1

NO, N

OT

DOCU

MENT

ED ...

........

.... 2

YES

DOCU

MENT

ED ...

........

1 NO

, NOT

DO

CUME

NTED

.......

.......

2

YES

DOCU

MENT

ED ...

........

1 NO

, NOT

DO

CUME

NTED

.......

.......

2

YES

DOCU

MENT

ED ...

........

1 NO

, NOT

DO

CUME

NTED

.......

.......

2 06

Is

the pa

tient’

s vira

l loa

d do

cume

nted

at

any t

ime?

YES

D

OCUM

ENTE

D .....

. . . .1

NO

, NOT

DO

CUME

NTED

.... 2

10

YES

D

OCUM

ENTE

D .....

... . .

.1 NO

, NOT

DO

CUME

NTED

......

210

YES

D

OCUM

ENTE

D .....

.. . . .

1 NO

, NOT

DO

CUME

NTED

..... 2

10

YES

D

OCUM

ENTE

D .....

.. . . .

1 NO

, NOT

DO

CUME

NTED

..... 2

10

YES

D

OCUM

ENTE

D .....

.. . . .

1 NO

, NOT

DO

CUME

NTED

..... 2

10

07

Is the

patie

nt’s v

iral

load

docu

ment

ed a

t 6

mont

hs o

n AR

T?

YES

D

OCUM

ENTE

D .....

. . . .1

YE

S

DOC

UMEN

TED .

.......

. . .1

YES

D

OCUM

ENTE

D .....

.. . . .

1 YE

S

DOC

UMEN

TED .

...... .

. .1

YES

D

OCUM

ENTE

D .....

.. . . .

1

18


An

nex

ure

II:

ART

Reco

rd R

evie

w G

uid

e (c

on

tinu

ed)

PLEA

SE A

NSW

ER T

HE F

OLLO

WIN

G QU

ESTI

ONS

FOR

EACH

PAT

IENT

(USI

NG IN

FORM

ATIO

N FR

OM T

HE R

EGIS

TER(

S) A

ND/O

R PA

TIEN

T CA

RD/D

ATAB

ASE)

1402

QU

ESTI

ONS

PATI

ENT

1 PA

TIEN

T 2

PATI

ENT

3 PA

TIEN

T 4

PATI

ENT

5

A b

C D

e f

NO, N

OT

DOCU

MENT

ED ...

........

.. 2

NO, N

OT

DOCU

MENT

ED ...

........

.... 2

NO, N

OT

DOCU

MENT

ED ...

........

... 2

NO, N

OT

DOCU

MENT

ED ...

........

... 2

NO, N

OT

DOCU

MENT

ED ...

........

... 2

08

Is the

patie

nt’s v

iral

load

docu

ment

ed a

t 12

mont

hs o

n AR

T?

YES

D

OCUM

ENTE

D .....

. . . .1

NO

, NOT

DO

CUME

NTED

.......

...... 2

NO

T EL

IGIB

LE ...

........

. 95

YES

D

OCUM

ENTE

D .....

... . .

.1 NO

, NOT

DO

CUME

NTED

.......

........

2 NO

T EL

IGIB

LE ...

........

... 95

YES

D

OCUM

ENTE

D .....

.. . . .

1 NO

, NOT

DO

CUME

NTED

.......

.......

2 NO

T EL

IGIB

LE ...

........

.. 95

YES

D

OCUM

ENTE

D .....

.. . . .

1 NO

, NOT

DO

CUME

NTED

.......

.......

2 NO

T EL

IGIB

LE ...

........

.. 95

YES

D

OCUM

ENTE

D .....

.. . . .

1 NO

, NOT

DO

CUME

NTED

.......

.......

2 NO

T EL

IGIB

LE ...

........

.. 95

09

Wha

t was

the

patie

nt’s

most

rece

nt vir

al loa

d?

DETE

CTAB

LE. ..

........

.... 1

NO

N-

DET

ECTA

BLE .

. 2

DON’

T KN

OW ...

. 98

13

DETE

CTAB

LE. .

.......

.......

1 NO

N-

DETE

CTAB

LE ...

..... 2

13

DON’

T KN

OW ...

... 98

13

DETE

CTAB

LE. .

.......

...... 1

NO

N-

DETE

CTAB

LE ...

.... 2

13

DON’

T KN

OW ...

.. 98

13

DETE

CTAB

LE. .

.......

...... 1

NO

N-

DETE

CTAB

LE ...

.... 2

13

DON’

T KN

OW ...

.. 98

13

DETE

CTAB

LE. ..

........

..... 1

NO

N-

DETE

CTAB

LE ...

.... 2

13

DON’

T KN

OW ...

.. 98

13

10

Was

the

patie

nt’s

viral

load

1000

or h

igher

? YE

S ...

........

........

........

... 1

NO ...

........

........

........

...... 2

DO

N’T

KNOW

.......

...... 9

8

YES

.......

........

........

........

. 1

NO ...

........

........

........

........

2 DO

N’T

KNOW

.......

........

98

YES

.......

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

... 98

YES

.......

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

... 98

YES

.......

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

... 98

11

Is th

ere

any n

ote

indica

ting

actio

n re

lated

to im

prov

ing

adhe

renc

e or

testi

ng

for d

rug

resis

tanc

e?

YES,

DO

CUME

NTED

.......

........

.. 1

NO, N

OT D

OCUM

ENTE

D . 2

YES,

DO

CUME

NTED

.......

........

.... 1

NO, N

OT D

OCUM

ENTE

D ... 2

YES,

DO

CUME

NTED

.......

........

... 1

NO, N

OT D

OCUM

ENTE

D .. 2

YES,

DO

CUME

NTED

.......

........

... 1

NO, N

OT D

OCUM

ENTE

D .. 2

YES,

DO

CUME

NTED

.......

........

... 1

NO, N

OT D

OCUM

ENTE

D .. 2

12

Is ad

here

nce

statu

s do

cume

nted

for t

he

most

rece

nt vis

it?

YES,

DO

CUME

NTED

.......

........

.. 1

NO, N

OT D

OCUM

ENTE

D . 2

YES,

DO

CUME

NTED

.......

........

.... 1

NO, N

OT D

OCUM

ENTE

D ... 2

YES,

DO

CUME

NTED

.......

........

... 1

NO, N

OT D

OCUM

ENTE

D .. 2

YES,

DO

CUME

NTED

.......

........

... 1

NO, N

OT D

OCUM

ENTE

D .. 2

YES,

DO

CUME

NTED

.......

........

... 1

NO, N

OT D

OCUM

ENTE

D .. 2

13

Is the

patie

nt eli

gible

for C

otrim

(CTX

) pr

even

tive

ther

apy

YES

........

........

........

.......

1 NO

.......

........

........

........

.. 2

DON’

T KN

OW ...

........

.. 98

YES

........

........

........

........

. 1

NO ...

........

........

........

........

2 DO

N’T

KNOW

.......

........

98

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

... 98

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

... 98

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

... 98

19


PLEA

SE A

NSW

ER T

HE F

OLLO

WIN

G QU

ESTI

ONS

FOR

EACH

PAT

IENT

(USI

NG IN

FORM

ATIO

N FR

OM T

HE R

EGIS

TER(

S) A

ND/O

R PA

TIEN

T CA

RD/D

ATAB

ASE)

1402

QU

ESTI

ONS

PATI

ENT

1 PA

TIEN

T 2

PATI

ENT

3 PA

TIEN

T 4

PATI

ENT

5

A b

C D

e f

(CPT

) acc

ordin

g to

natio

nal s

tand

ards

? 1

14

Does

the r

ecor

d sho

w th

at th

e pa

tient

is

curre

ntly o

n cotr

im

(CTX

) pre

vent

ive

ther

apy (

CPT)

?

YES

........

........

........

.......

1 NO

.......

........

........

........

.. 2

YES

........

........

........

........

. 1

NO ...

........

........

........

........

2

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

PL

EASE

ANS

WER

THE

QUE

STIO

NS B

ELOW

FRO

M TH

E RE

CORD

FOR

THE

PAT

IENT

’S MO

ST R

ECEN

T cli

nica

l (e.g

., “L

ONG”

VIS

IT—

not s

impl

y to

pick

up

drug

s).

15

Is th

ere

docu

ment

ation

th

at th

e pa

tient

was

as

sess

ed fo

r cou

gh

the m

ost r

ecen

t visi

t?

YES

D

OCUM

ENTE

D .....

...... 1

NO

, NOT

DO

CUME

NTED

.......

...... 2

YES

D

OCUM

ENTE

D .....

........

1 NO

, NOT

DO

CUME

NTED

.......

........

2

YES

D

OCUM

ENTE

D .....

.......

1 NO

, NOT

DO

CUME

NTED

.......

.......

2

YES

D

OCUM

ENTE

D .....

.......

1 NO

, NOT

DO

CUME

NTED

.......

.......

2

YES

D

OCUM

ENTE

D .....

.......

1 NO

, NOT

DO

CUME

NTED

.......

.......

2 16

Is

ther

e a

meas

ured

te

mper

atur

e or

a

comm

ent o

n his

tory

of

feve

r sta

tus

docu

ment

ed th

e mo

st re

cent

visit?

YES

D

OCUM

ENTE

D .....

...... 1

NO

, NOT

DO

CUME

NTED

.......

...... 2

YES

D

OCUM

ENTE

D .....

........

1 NO

, NOT

DO

CUME

NTED

.......

........

2

YES

D

OCUM

ENTE

D .....

.......

1 NO

, NOT

DO

CUME

NTED

.......

.......

2

YES

D

OCUM

ENTE

D .....

.......

1 NO

, NOT

DO

CUME

NTED

.......

.......

2

YES

D

OCUM

ENTE

D .....

.......

1 NO

, NOT

DO

CUME

NTED

.......

.......

2

17

Is th

ere

a me

asur

ed

weigh

t or a

comm

ent

on st

atus

of w

eight

YES

D

OCUM

ENTE

D .....

...... 1

NO

, NOT

DO

CUME

NTED

.... 2

18

YES

D

OCUM

ENTE

D .....

........

1 NO

, NOT

DO

CUME

NTED

......

218

YES

D

OCUM

ENTE

D .....

.......

1 NO

, NOT

DO

CUME

NTED

..... 2

18

YES

D

OCUM

ENTE

D .....

.......

1 NO

, NOT

DO

CUME

NTED

..... 2

18

YES

D

OCUM

ENTE

D .....

.......

1 NO

, NOT

DO

CUME

NTED

..... 2

18

8 C

ount

ry a

dapt

que

stio

n

20

An

nex

ure

II:

ART

Reco

rd R

evie

w G

uid

e (c

on

tinu

ed)


PLEA

SE A

NSW

ER T

HE F

OLLO

WIN

G QU

ESTI

ONS

FOR

EACH

PAT

IENT

(USI

NG IN

FORM

ATIO

N FR

OM T

HE R

EGIS

TER(

S) A

ND/O

R PA

TIEN

T CA

RD/D

ATAB

ASE)

1402

QU

ESTI

ONS

PATI

ENT

1 PA

TIEN

T 2

PATI

ENT

3 PA

TIEN

T 4

PATI

ENT

5

A b

C D

e f

loss f

or th

e pa

tient

the

most

rece

nt vis

it?

17a

Is th

ere

a gr

owth

char

t for

child

ren b

elow

5?

YES

........

........

........

.......

1 NO

.......

........

........

. 218

PA

TIEN

T NO

T

<

5 .....

........

...... 9

518

YES

........

........

........

........

. 1

NO ...

........

........

.......

218

PA

TIEN

T NO

T

<

5 .....

........

........

9518

YES

........

........

........

........

1 NO

.......

........

........

.. 218

PA

TIEN

T NO

T

<

5 .....

........

.......

9518

YES

........

........

........

........

1 NO

.......

........

........

.. 218

PA

TIEN

T NO

T

<

5 .....

........

.......

9518

YES

........

........

........

........

1 NO

.......

........

........

.. 218

PA

TIEN

T NO

T

<

5 .....

........

.......

9518

17

b Is

the

grow

th ch

art

sex-s

pecif

ic?

YES

........

........

........

.......

1 NO

.......

........

........

........

.. 2

YES

........

........

........

........

. 1

NO ...

........

........

........

........

2

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

17

c Is

the

grow

th ch

art

comp

leted

for t

he m

ost

rece

nt w

eight

?

YES

........

........

........

.......

1 NO

.......

........

........

........

.. 2

YES

........

........

........

........

. 1

NO ...

........

........

........

........

2

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

18

Is

ther

e do

cume

ntat

ion

that

hist

ory o

f ex

posu

re to

a p

erso

n wi

th TB

was

asse

ssed

th

e mos

t rec

ent v

isit?

YES

D

OCUM

ENTE

D .....

...... 1

NO

, NOT

DO

CUME

NTED

.......

...... 2

YES

D

OCUM

ENTE

D .....

........

1 NO

, NOT

DO

CUME

NTED

.......

........

2

YES

D

OCUM

ENTE

D .....

.......

1 NO

, NOT

DO

CUME

NTED

.......

.......

2

YES

D

OCUM

ENTE

D .....

.......

1 NO

, NOT

DO

CUME

NTED

.......

.......

2

YES

D

OCUM

ENTE

D .....

.......

1 NO

, NOT

DO

CUME

NTED

.......

.......

2

19

Was

the

patie

nt’s

TB

statu

s doc

umen

ted

for

the m

ost r

ecen

t visi

t?

YES

DOC

UMEN

TED .

........

1 NO

, NOT

DO

CUME

NTED

.......

........

....

........

........

........

........

... 2

YES

DOC

UMEN

TED .

........

.. 1

NO, N

OT D

OCUM

ENTE

D .

........

........

........

........

........

. 2

YES

DOC

UMEN

TED .

........

. 1

NO, N

OT D

OCUM

ENTE

D

........

........

........

........

........

2

YES

DOC

UMEN

TED .

........

. 1

NO, N

OT D

OCUM

ENTE

D

........

........

........

........

........

2

YES

DOC

UMEN

TED .

........

. 1

NO, N

OT D

OCUM

ENTE

D ....

........

........

........

........

.... 2

20

Wha

t was

the

patie

nt’s

TB st

atus

the

most

rece

nt tim

e this

was

do

cume

nted

?

ACTI

VE T

B ...

........

........

1 LA

TENT

TB

.......

.. 224

NO

TB

IN

FECT

ION

.......

.. 324

ACTI

VE T

B ...

........

........

.. 1

LATE

NT T

B ...

........

224

NO

TB

IN

FECT

ION

.......

.... 3

24

ACTI

VE T

B ...

........

........

. 1

LATE

NT T

B ...

.......

224

NO

TB

IN

FECT

ION

.......

... 3

24

ACTI

VE T

B ...

........

........

. 1

LATE

NT T

B ...

.......

224

NO

TB

IN

FECT

ION

.......

... 3

24

ACTI

VE T

B ...

........

........

. 1

LATE

NT T

B ...

.......

224

NO

TB

IN

FECT

ION

.......

... 3

24

21

An

nex

ure

II:

ART

Reco

rd R

evie

w G

uid

e (c

on

tinu

ed)


PLEA

SE A

NSW

ER T

HE F

OLLO

WIN

G QU

ESTI

ONS

FOR

EACH

PAT

IENT

(USI

NG IN

FORM

ATIO

N FR

OM T

HE R

EGIS

TER(

S) A

ND/O

R PA

TIEN

T CA

RD/D

ATAB

ASE)

1402

QU

ESTI

ONS

PATI

ENT

1 PA

TIEN

T 2

PATI

ENT

3 PA

TIEN

T 4

PATI

ENT

5

A b

C D

e f

21

Is th

e pa

tient

curre

ntly

enro

lled

in TB

tre

atme

nt?

YES

........

........

...... 1

26

NO ...

........

........

........

...... 2

DO

N’T

KNOW

.......

........

........

.. 98

YES

........

........

........

126

NO

.......

........

........

........

.... 2

DON’

T KN

OW ...

........

........

........

98

YES

........

........

.......

126

NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

........

.......

98

YES

........

........

.......

126

NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

........

.......

98

YES

........

........

.......

126

NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

........

.......

98

22

Is it d

ocum

ente

d th

at th

e pa

tient

was

po

sitive

for T

B an

d co

mplet

ed tr

eatm

ent

while

on A

RT?

YES

........

........

........

.......

1 NO

.......

........

........

........

.. 2

YES

........

........

........

........

. 1

NO ...

........

........

........

........

2

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

23

Is th

e pa

tient

rece

iving

IN

H pr

even

tive

treat

ment

?

YES

........

........

........

.......

1 NO

.......

........

........

........

.. 2

DON’

T KN

OW ...

........

.. 98

YES

........

........

........

........

. 1

NO ...

........

........

........

........

2 DO

N’T

KNOW

.......

........

98

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

... 98

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

... 98

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

... 98

24

Is

the pa

tient

eligib

le fo

r INH

pre

vent

ive

treat

ment

acc

ordin

g to

na

tiona

l guid

eline

s 2

YES

........

........

........

.......

1 NO

.......

........

........

........

.. 2

DON’

T KN

OW ...

........

.. 98

INH

IPT

NOT

COUN

TRY

POLI

CY ...

........

........

...... 0

YES

........

........

........

........

. 1

NO ...

........

........

........

........

2 DO

N’T

KNOW

.......

........

98

INH

IPT

NOT

COUN

TRY

POLI

CY ...

........

........

........

0

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

... 98

IN

H IP

T NO

T CO

UNTR

Y PO

LICY

.......

........

........

... 0

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

... 98

IN

H IP

T NO

T CO

UNTR

Y PO

LICY

.......

........

........

... 0

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

... 98

IN

H IP

T NO

T CO

UNTR

Y PO

LICY

.......

........

........

... 0

25

Is th

e pa

tient

ART

re

gimen

in ac

cord

ance

wi

th na

tiona

l gu

idelin

es?

YES

........

........

........

.......

1 NO

.......

........

........

........

.. 2

DON’

T KN

OW ...

........

........

...... 9

8

YES

........

........

........

........

. 1

NO ...

........

........

........

........

2 DO

N’T

KNOW

.......

........

........

.... 98

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

........

.......

98

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

........

.......

98

YES

........

........

........

........

1 NO

.......

........

........

........

... 2

DON’

T KN

OW ...

........

........

.......

98

1403

CI

RCLE

THE

LET

TER

FOR

EACH

TYP

E OF

REC

ORDS

THA

T W

ERE

USED

TO

COL

LECT

ART

INFO

RMAT

ION

FOR

THIS

FAC

ILIT

Y [C

OUNT

RY A

DAPT

]

TYP

E OF

REC

ORD

RE

GIST

ER: V

CT ...

........

........

........

........

........

........

..... A

REGI

STER

: PR

E-AR

T ...

........

........

........

........

........

.. B

REGI

STER

: AR

T ...

........

........

........

........

........

........

... C

9 Co

untry

adap

t que

stion

22

An

nex

ure

II:

ART

Reco

rd R

evie

w G

uid

e (c

on

tinu

ed)


INDI

VIDU

AL P

ATIE

NT A

RT

CARD

/CHA

RT/R

ECOR

D ....

........

........

........

........

.......

D RE

GIST

ER:

TUBE

RCUL

OSIS

......

........

........

.......

E

IN

DIVI

DUAL

PAT

IENT

TB

CARD

/CHA

RT/R

ECOR

D ....

........

........

........

........

.......

F IN

DIVI

DUAL

PAT

IENT

OPD

CA

RD/C

HART

/REC

ORD

........

........

........

........

........

... F

COMP

UTER

DAT

ABAS

E .....

........

........

........

........

...... G

RE

GIST

ER O

R DA

TABA

SE: L

ABOR

ATOR

Y ...

........

H

REGI

STER

OR

DATA

BASE

: PH

ARMA

CY ..

........

..... I

OT

HER

____

____

____

____

____

____

____

____

_ ... W

(SPE

CIFY

) 14

04:

NOTE

S TO

EXP

LAIN

ANY

ISSU

ES T

HAT

AROS

E:

23

An

nex

ure

II:

ART

Reco

rd R

evie

w G

uid

e (c

on

tinu

ed)


RE

CO

RD

RE

VIE

W:

SUSP

EC

T M

AL

AR

IA

ELIG

IBIL

ITY

: DIA

GN

OSI

S O

R P

RES

ENTI

NG

SY

MPT

OM

OF

FEV

ER, L

ETH

AR

GY

, MA

LAR

IA. O

R M

ALA

RIA

TES

T O

R A

NTI

MA

LAR

IAL

DR

UG

S PR

ESC

RIB

ED

1100

OF

FERS

CUR

ATIV

E CA

RE

SERV

ICES

NO

CUR

ATIV

E CA

RE

SERV

ICES

EN

D

SEC

TION

1: C

OVER

PAG

E FA

CILI

TY ID

ENTI

FICA

TION

01

Name

of f

acilit

y __

____

____

_ FA

CILI

TY C

ODE

02

Date

03

In

terv

iewer

Nam

e

FINA

L VI

SIT

DAY

MONT

H YE

AR

____

____

____

____

____

____

____

____

____

11

01 S

AMPL

E SE

LECT

ION:

IDE

NTIF

Y EL

IGIB

LE P

ATIE

NTS

STAR

TING

WIT

H TH

E MO

ST R

ECEN

T FU

LL M

ONTH

FOR

WHI

CH T

HERE

IS A

SUM

MARY

REPO

RT C

OMPL

ETED

. MA

KE

SURE

EIG

IBLE

PAT

IENT

S AR

E SE

LECT

ED F

ROM

AT L

EAST

3 D

IFFE

RENT

MON

THS.

PRO

VIDE

SAM

PLIN

G IN

FORM

ATIO

N FO

R AL

L AP

PLIC

ABLE

ELI

GIBIL

ITY

CRIT

ERIA

01

INCL

USIO

N CR

ITER

IA

SU

SPEC

T MA

LARI

A AD

ULT .

........

........

........

........

........

.... 1

SUSP

ECT

MALA

RIA

CHIL

D <

5 .....

........

........

... 2

02

NUMB

ER O

F EL

IGIB

LE P

ATIE

NTS

IDEN

TIFI

ED

03

NOTE

NUM

BER

OF O

RIGI

ALLY

SEL

ECTE

D SA

MPLE

PAT

IENT

S RE

PLAC

ED

DUE

TO M

ISSI

NG R

ECOR

DS

NUMB

ER R

EPLA

CED

NONE

.......

........

........

........

........

........

........

........

.. 0

An

nex

ure

III

: M

ala

ria S

usp

ects

Rec

ord

Rev

iew

Gu

ide

24


PLE

ASE

ANSW

ER T

HE F

OLLO

WIN

G QU

ESTI

ONS

FOR

EACH

PAT

IENT

(USI

NG IN

FORM

ATIO

N FR

OM T

HE R

EGIS

TER(

S) A

ND/O

R PA

TIEN

T CA

RD/D

ATAB

ASE)

1102

QU

ESTI

ONS

PATI

ENT

1

PATI

ENT

2

PATI

ENT

3

PATI

ENT

4

PATI

ENT

5

a

b

c d

e f

01

Is th

e ind

ividu

al pa

tient

reco

rd

avail

able?

YE

S ....

........

........

. 1

NO ...

........

........

.... 2

YES

........

........

..... 1

NO

.......

........

........

2 YE

S ....

........

........

. 1

NO ...

........

........

.... 2

YES

........

........

..... 1

NO

.......

........

........

2 YE

S ....

........

........

. 1

NO ...

........

........

.... 2

A PH

YSIC

AL E

XAMI

NATI

ON

01

Are

any p

hysic

al ex

am re

sults

do

cume

nted

? YE

S ....

........

........

. 1

NO ...

........

..... 2

B YE

S ....

........

........

. 1

NO ...

........

..... 2

B YE

S ....

........

........

. 1

NO ...

........

..... 2

B YE

S ....

........

........

. 1

NO ...

........

..... 2

B YE

S ....

........

........

. 1

NO ...

........

..... 2

B 02

W

hat w

as th

e te

mper

atur

e of

the

patie

nt?

.

DO

N’T

KNOW

......

........

98

.

DO

N’T

KNOW

......

........

. 98

.

DO

N’T

KNOW

......

........

98

.

DO

N’T

KNOW

......

........

98

.

DO

N’T

KNOW

......

........

98

B SY

MPTO

MS A

ND C

ONDI

TION

S AS

SESS

ED [R

ECOR

D ‘N

O’ O

NLY

IF T

HE N

OTE

INDI

ATES

THE

FIN

DING

IS N

EGAT

IVE.

REC

ORD

‘DON

’T K

NOW

’ IF T

HERE

IS N

O RE

CORD

ING

RELA

TED

TO T

HE Q

UEST

ION]

01

Ar

e an

y oth

er sy

mpto

ms o

r co

nditio

ns d

ocum

ente

d?

YES

........

........

..... 1

NO ...

........

..... 2

D

YES

........

........

..... 1

NO ...

........

..... 2

D

YES

........

........

..... 1

NO ...

........

..... 2

D

YES

........

........

..... 1

NO ...

........

..... 2

D

YES

........

........

..... 1

NO ...

........

..... 2

D

02

Was

the

patie

nt a

nemi

c?

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

03

Did

the

pat

ient h

ave

symp

toms

of t

iredn

ess/

fatigu

e/ lis

tless

ness

?

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

04

Did

the

patie

nt h

ave

symp

toms

of f

ever

? YE

S ....

........

........

. 1

NO

.......

........

........

2 DO

N’T

KNOW

... 98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

C MA

LARI

A SC

REEN

ING

AND

TREA

TMEN

T

01

Was

a m

alaria

bloo

d te

st pr

escr

ibed/

per

form

ed?

[e.g

., YE

S ....

........

........

. 1

NO ...

........

.....

05

YES

........

........

..... 1

NO

.......

........

. 05

YE

S ....

........

........

. 1

NO ...

........

.....

05

YES

........

........

..... 1

NO

.......

........

. 05

YE

S ....

........

........

. 1

NO ...

........

.....

05

An

nex

ure

III

: M

ala

ria S

usp

ects

Rec

ord

Rev

iew

Gu

ide

(con

tinu

ed)

25


1102

QU

ESTI

ONS

PATI

ENT

1

PATI

ENT

2

PATI

ENT

3

PATI

ENT

4

PATI

ENT

5

a

b

c d

e f

RDT

(or P

/C),

blood

smea

r (or

MS

) 02

W

hat m

alaria

bloo

d te

st wa

s or

dere

d/pe

rform

ed?

RDT .

........

........

.... 1

BLOO

D

SMEA

R .....

........

... 2

OTHE

R/

NOT

SPEC

IFIE

D . 3

RDT .

........

........

.... 1

BLOO

D

SMEA

R .....

........

... 2

OTHE

R/

NOT

SPEC

IFIE

D . 3

RDT .

........

........

.... 1

BLOO

D

SMEA

R .....

........

... 2

OTHE

R/

NOT

SPEC

IFIE

D . 3

RDT .

........

........

.... 1

BLOO

D

SMEA

R .....

........

... 2

OTHE

R/

NOT

SPEC

IFIE

D . 3

RDT .

........

........

.... 1

BLOO

D

SMEA

R .....

........

... 2

OTHE

R/

NOT

SPEC

IFIE

D . 3

03

Wha

t was

the

malar

ia blo

od

test r

esult

?

POSI

TIVE

.. 1

06

NE

GATI

VE ...

........

. ....

........

........

205

DON’

T K

NOW

.. 98

POSI

TIVE

.. 1

06

NE

GATI

VE ...

........

. ....

........

........

205

DO

N’T

KNO

W ..

98

POSI

TIVE

.. 1

05

NE

GATI

VE ...

........

. ....

........

........

205

DO

N’T

KNO

W ..

98

POSI

TIVE

.. 1

06

NE

GATI

VE ...

........

. ....

........

........

205

DO

N’T

KNO

W ..

98

POSI

TIVE

.......

.......

....

........

........

106

NEGA

TIVE

.......

.....

........

........

.... 2

05

DON’

T K

NOW

.. 98

04

W

hat w

ere

the

malar

ia blo

od

test r

esult

s rec

orde

d in t

he

labor

ator

y reg

ister

?

POSI

TIVE

....

06

NE

GATI

VE ...

........

. ....

........

........

........

. 2

DO

N’T

KNO

W ..

98

POSI

TIVE

....

06

NE

GATI

VE ...

........

. ....

........

........

........

. 2

DO

N’T

KNO

W ..

98

POSI

TIVE

....

06

NE

GATI

VE ...

........

. ....

........

........

........

. 2

DO

N’T

KNO

W ..

98

POSI

TIVE

....

06

NE

GATI

VE ...

........

. ....

........

........

........

. 2

DO

N’T

KNO

W ..

98

POSI

TIVE

....

06

NE

GATI

VE ...

........

. ....

........

........

........

. 2

DO

N’T

KNO

W ..

98

05

Was

clini

cal m

alaria

dia

gnos

ed?

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

06

Was

any

ant

imala

rial d

rug

pres

cribe

d or

pro

vided

? YE

S ....

........

........

. 1

NO ...

........

... 2

10

DON’

T KN

OW ...

....

........

........

.. 98

10

YES

........

........

..... 1

NO

.......

.......

210

DO

N’T

KNOW

.......

....

........

...... 9

810

YES

........

........

..... 1

NO

.......

.......

210

DO

N’T

KNOW

.......

....

........

...... 9

810

YES

........

........

..... 1

NO

.......

.......

210

DO

N’T

KNOW

.......

....

........

...... 9

810

YES

........

........

..... 1

NO

.......

.......

210

DO

N’T

KNOW

.......

....

........

...... 9

810

07

W

as a

n AC

T (e

.g.,

coar

tem)

pr

escr

ibed

or p

rovid

ed?

YES

........

........

..... 1

NO

.......

.......

208

DO

N’T

KNOW

.......

....

........

...... 9

808

YES

........

........

..... 1

NO

.......

.......

208

DO

N’T

KNOW

.......

....

........

...... 9

808

YES

........

........

..... 1

NO

.......

.......

208

DO

N’T

KNOW

.......

....

........

...... 9

808

YES

........

........

..... 1

NO

.......

.......

208

DO

N’T

KNOW

.......

....

........

...... 9

808

YES

........

........

..... 1

NO

.......

.......

208

DO

N’T

KNOW

.......

....

........

...... 9

808

26

An

nex

ure

III

: M

ala

ria S

usp

ects

Rec

ord

Rev

iew

Gu

ide

(con

tinu

ed)


1102

QU

ESTI

ONS

PATI

ENT

1

PATI

ENT

2

PATI

ENT

3

PATI

ENT

4

PATI

ENT

5

a

b

c d

e f

08

Was

the

ACT

pres

cribe

d/pr

ovide

d an

d do

se

as p

er g

uideli

nes?

DO

SAGE

S:

2-11

m: 25

mg ta

b (1 t

ab) x

2x

/day x

3dy

12-5

9m: 5

0mg t

ab (2

tab)

2x/da

y x 3d

y 60

+m:

100M

G (4

tab)

2x

/day x

3 dy

or

: 5-

<15 k

g: 1 t

ab 2x

/dy x

3dy

15-<

25kg

: 2 ta

b 2x/d

ay x

dy

25

-<35

kg:

3 tab

2x/da

y x 3d

y

35

+ kg

: 4

tab

2x/d

ay x

3 d

y

YES

........

........

..... 1

NO

.......

........

........

2 DO

N’T

KNOW

... 98

YES

........

........

..... 1

NO

.......

........

........

2 DO

N’T

KNOW

... 98

YES

........

........

..... 1

NO

.......

........

........

2 DO

N’T

KNOW

... 98

YES

........

........

..... 1

NO

.......

........

........

2 DO

N’T

KNOW

... 98

YES

........

........

..... 1

NO

.......

........

........

2 DO

N’T

KNOW

... 98

09

Wer

e ot

her a

ntim

alaria

l dru

gs

pres

cribe

d or

pro

vided

? YE

S ....

........

........

. 1

NO ...

........

........

.... 2

DON’

T KN

OW ...

98

YES

........

........

..... 1

NO

.......

........

........

2 DO

N’T

KNOW

... 98

YES

........

........

..... 1

NO

.......

........

........

2 DO

N’T

KNOW

... 98

YES

........

........

..... 1

NO

.......

........

........

2 DO

N’T

KNOW

... 98

YES

........

........

..... 1

NO

.......

........

........

2 DO

N’T

KNOW

... 98

11

03 N

OTES

TO

EXPL

AIN

ANY

ISSU

ES T

HAT

AROS

E:

27

An

nex

ure

III

: M

ala

ria S

usp

ects

Rec

ord

Rev

iew

Gu

ide

(con

tinu

ed)


R

ECO

RD

REV

IEW

FO

R T

UB

ERC

ULO

SIS

PATI

ENTS

15

00TU

BERC

ULOS

IS P

ATIE

NT C

ARE

SERV

ICES

OFF

ERED

T

UBER

CULO

SIS

PATI

ENT

CARE

SER

VICE

S NO

T OF

FERE

D

STOP

SE

CTIO

N 1:

COV

ER P

AGE

01

Name

of fa

cility

___

____

____

FA

CILI

TY C

ODE

02

Inclu

sion

crite

ria:

EXCL

UDE

PATI

ENTS

WHO

DRO

PPED

OUT

PRI

OR

TO C

OMPL

ETIN

G 5

MONT

HS O

F TR

EATM

ENT

OR W

HO W

ERE

REFE

RRED

ELS

EWHE

RE F

OR T

REAT

MENT

(E.G

., DR

UG R

ESIS

TANT

CA

SES)

Pulm

onar

y TB

adult

pat

ient (

> 5)

on 1

st line

tre

atme

nt a

nd o

cmple

ted

5 mo

nths

of t

reat

ment

........

........

........

........

........

........

1 Pu

lmon

ary T

B ch

ild p

atien

ts (<

5) o

n 1st l

ine

treat

ment

and

comp

leted

5 m

onth

s of t

reat

ment

........

........

........

........

........

........

2 OT

HER

ELIG

IBIL

ITY

CRIT

ERIA

___

____

____

____

____

___ .

........

........

........

.. 3

03

Date

04 I

nter

viewe

r Nam

e

FINA

L VI

SIT

DAY

MONT

H YE

AR

____

____

____

____

____

____

____

____

____

15

01 S

ample

selec

tion:

IDE

NTIF

Y SO

URCE

DOC

UMEN

T FO

R EL

IGIB

LE P

ATIE

NTS

AND

LIST

ELI

GIBL

E PA

TIEN

TS O

N TH

E LI

STIN

G FO

RM..

Revie

w th

e TB

patie

nt re

giste

r and

star

ting w

ith cu

rrent

patie

nts, id

entify

10 pa

tient

s of th

e elig

ible a

ge w

ho ha

ve co

mplet

ed 5

mont

hs of

TB

treatm

ent a

nd w

ho ar

e on 1

st line

TB

treatm

ent.

Rand

omly

selec

t 1 o

r 2 a

s a st

artin

g po

int a

nd th

en se

lect e

very

oth

er p

atien

t (to

a m

axim

um o

f 5) f

or re

cord

revie

w 01

CI

RCLE

THE

NUM

BER

FOR

THE

TYPE

OF

TB S

ERVI

CES

THAT

ARE

PRO

VIDE

D BY

THI

S FA

CILI

TY

TB D

RUG

PROV

ISIO

N AN

D PA

TIEN

T CO

MPLI

ANCE

FO

LLOW

-UP,

NO

PRES

CRIP

TION

FOR

DRU

G RE

GIME

N

OR C

LINI

CAL

FOLL

OW-U

P .....

........

........

........

........

........

........

........

........

........

.. 1

TB T

REAT

MENT

PRE

SCRI

PTIO

N AN

D CL

INIC

AL F

OLLO

W U

P

SERV

ICES

BUT

NO

COMP

LIAN

CE F

OLLO

W U

P .....

........

........

........

...... 2

03

An

nex

ure

IV

: TB

Rec

ord

Rev

iew

Gu

ide

28


ALL

THRE

E SE

RVIC

ES:

DIAG

NOSI

S, P

RESC

RIPT

ION,

CLI

NICA

L FO

LLOW

UP,

AND

COM

PLIA

NCE

FOLL

OW U

P .....

........

........

........

........

303

02

Is

the in

forma

tion a

vaila

ble fo

r ide

ntifyi

ng el

igible

patie

nts?

YES

........

........

........

........

........

........

........

........

........

........

........

........

........

........

.... 1

NO ...

........

........

........

........

........

........

........

........

........

........

........

........

.... 2

STOP

03

NU

MBER

OF

ELIG

IBLE

PAT

IENT

S ID

ENTI

FIED

04

NOTE

NUM

BER

OF O

RIGI

ALLY

SEL

ECTE

D SA

MPLE

PAT

IENT

S RE

PLAC

ED

DUE

TO M

ISSI

NG IN

DIVI

DUAL

PAT

IENT

REC

ORDS

AND

INFO

RMAT

ION

IS N

OT

IN R

EGIS

TER.

NUMB

ER R

EPLA

CED

NO

NE ...

........

........

........

........

........

..... 0

0 PL

EASE

ANS

WER

THE

FOL

LOW

ING

QUES

TION

S FO

R EA

CH P

ATIE

NT (U

SING

INFO

RMAT

ION

FROM

THE

REG

ISTE

R(S)

AND

/OR

PATI

ENT

CARD

/DAT

ABAS

E)

1502

QU

ESTI

ONS

PATI

ENT

1 PA

TIEN

T 2

PATI

ENT

3 PA

TIEN

T 4

PATI

ENT

5

A B

c d

e f

01

Is th

e pa

tient

’s he

alth

card

ava

ilable

? YE

S ....

........

........

........

........

1 NO

.......

........

........

........

.......

2 YE

S ....

........

........

........

........

1 NO

.......

........

........

........

.......

2 YE

S ....

........

........

........

........

1 NO

.......

........

........

........

.......

2 YE

S ....

........

........

........

........

1 NO

.......

........

........

........

.......

2 YE

S ....

........

........

........

........

1 NO

.......

........

........

........

.......

2 02

Nu

mber

of c

omple

ted

mont

hs o

n TB

trea

tmen

t

MONT

HS

DON’

T KN

OW ...

........

.......

98

MONT

HS

DON’

T KN

OW ...

........

.......

98

MONT

HS

DON’

T KN

OW ...

........

.......

98

MONT

HS

DON’

T KN

OW ...

........

.......

98

MONT

HS

DON’

T KN

OW ...

........

.......

98

03

Was

the

patie

nt d

iagno

sis

base

d on

2 p

ositiv

e sp

utum

spec

imen

s?

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

04

Was

the

patie

nt d

iagno

sis

base

d on

1 p

ositiv

e sp

utum

spec

imen

?

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

05

Was

pat

ient d

iagno

sis

base

d on

Xpe

rt MT

B/RI

F ra

pid di

agno

stic t

est?3

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

YES

........

........

........

... 1

07

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

06

Was

the

patie

nt d

iagno

sis

base

d on

clini

cal h

istor

y?

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

An

nex

ure

IV

: TB

Rec

ord

Rev

iew

Gu

ide

(con

tinu

ed)

29


07

Numb

er o

f day

s bet

ween

dia

gnos

is an

d sta

rt of

treat

ment

(The

day

of

diagn

osis

is “d

ay 0

”)

DAYS

SA

ME D

AY ...

........

........

.... 00

DO

N’T

KNOW

.......

........

... 98

DAYS

SA

ME D

AY ...

........

........

.... 00

DO

N’T

KNOW

.......

........

... 98

DAYS

SA

ME D

AY ...

........

........

.... 00

DO

N’T

KNOW

.......

........

... 98

DAYS

SA

ME D

AY ...

........

........

.... 00

DO

N’T

KNOW

.......

........

... 98

DAYS

SA

ME D

AY ...

........

........

.... 00

DO

N’T

KNOW

.......

........

... 98

08

W

as th

e 1s

t line

TB

treat

ment

regim

en

pres

cribe

d4?

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

09

W

as th

e mo

st re

cent

dru

g co

llecti

on o

n tim

e?

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

10

Do

es th

e pa

tient

hav

e an

y of t

he fo

llowi

ng

reco

rded

: a)

Ret

reat

ment

case

; b) C

ontac

t with

dr

ug re

sista

nt ca

se; c

) Tr

eatm

ent f

ailur

e; d)

+

sput

um m

icros

copy

at

2nd/3r

d5 m

onth

of

treat

ment

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

11

Was

a T

B dr

ug

susc

eptib

ility t

est f

or

rifamp

icin p

resc

ribed

or

cond

ucte

d6 ?

Yes .

........

........

........

........

.... 1

No ...

........

........

........

... 2

13

DON’

T KN

OW ..

...... 9

813

Yes .

........

........

........

........

.... 1

No ...

........

........

........

... 2

13

DON’

T KN

OW ..

...... 9

813

Yes .

........

........

........

........

.... 1

No ...

........

........

........

... 2

13

DON’

T KN

OW ..

...... 9

813

Yes .

........

........

........

........

.... 1

No ...

........

........

........

... 2

13

DON’

T KN

OW ..

...... 9

813

Yes .

........

........

........

........

.... 1

No ...

........

........

........

... 2

13

DON’

T KN

OW ..

...... 9

813

12

Was

the

drug

su

scep

tibilit

y tes

t ne

gativ

e, th

at is

, no

drug

re

sistan

ce?

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

13

Was

the 2

nd lin

e TB

treat

ment

regim

en

pres

cribe

d7 ?

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

An

nex

ure

IV

: TB

Rec

ord

Rev

iew

Gu

ide

(con

tinu

ed)

30


An

nex

ure

IV

: TB

Rec

ord

Rev

iew

Gu

ide

(con

tinu

ed)

14

Was

an

HIV

test

resu

lt re

cord

ed fo

r the

patie

nt?

YES

........

........

........

........

.... 1

NO ...

........

........

........

.. 217

YE

S ....

........

........

........

........

1 NO

.......

........

........

...... 2

17

YES

........

........

........

........

.... 1

NO ...

........

........

........

.. 217

YE

S ....

........

........

........

........

1 NO

.......

........

........

...... 2

17

YES

........

........

........

........

.... 1

NO ...

........

........

........

.. 217

15

W

as th

e pa

tient

HIV

po

sitive

? YE

S ....

........

........

........

........

1 NO

.......

........

........

...... 2

17

YES

........

........

........

........

.... 1

NO ...

........

........

........

.. 217

YE

S ....

........

........

........

........

1 NO

.......

........

........

...... 2

17

YES

........

........

........

........

.... 1

NO ...

........

........

........

.. 217

YE

S ....

........

........

........

........

1 NO

.......

........

........

...... 2

17

16

Was

the

pat

ient s

tarte

d on

ART

? YE

S ....

........

........

........

........

1

NO ...

........

........

........

........

... 2

DON’

T KN

OW ...

........

.......

98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

17

Is

the pa

tient

eligib

le for

Co

trim

(CTX

) pre

venti

ve

ther

apy (

CPT)

acc

ordin

g to

nat

ional

stand

ards

?8

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

18

Does

the r

ecor

d sho

w th

at th

e pa

tient

is

curre

ntly o

n cotr

im (C

TX)

prev

entiv

e th

erap

y (CP

T)

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

19

Was

a sp

utum

mi

cros

copy

resu

lt do

cume

nted

at t

he 2

nd

mont

h of

trea

tmen

t?

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

20

Was

a sp

utum

mi

cros

copy

resu

lt do

cume

nted

at t

he 5

th

mont

h of

trea

tmen

t

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

21

Was

a sp

utum

mi

cros

copy

resu

lt do

cume

nted

dur

ing la

st mo

nth

of tr

eatm

ent

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

NOT

ELIG

IBLE

.......

........

.. 95

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

NOT

ELIG

IBLE

.......

........

.. 95

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

NOT

ELIG

IBLE

.......

........

.. 95

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

NOT

ELIG

IBLE

.......

........

.. 95

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

NOT

ELIG

IBLE

.......

........

.. 95

22a

Was

mea

sure

d or

cli

nicall

y ass

esse

d weig

ht ch

ange

doc

umen

ted

for

ever

y clin

ical v

isit?

YES

........

........

........

........

.... 1

NO ...

........

........

........

.. 223

YE

S ....

........

........

........

........

1 NO

.......

........

........

...... 2

23

YES

........

........

........

........

.... 1

NO ...

........

........

........

.. 223

YE

S ....

........

........

........

........

1 NO

.......

........

........

...... 2

23

YES

........

........

........

........

.... 1

NO ...

........

........

........

.. 223

31


An

nex

ure

IV

: TB

Rec

ord

Rev

iew

Gu

ide

(con

tinu

ed)

22b

Is th

ere

a gr

owth

char

t for

ch

ildre

n be

low 5

? YE

S ....

........

........

........

........

1 NO

.......

........

........

...... 2

23

PATI

ENT

NOT

<5 .

........

........

.......

9523

YES

........

........

........

........

.... 1

NO ...

........

........

........

.. 223

PA

TIEN

T NO

T

<

5 .....

........

........

... 95

23

YES

........

........

........

........

.... 1

NO ...

........

........

........

.. 223

PA

TIEN

T NO

T

<

5 .....

........

........

... 95

23

YES

........

........

........

........

.... 1

NO ...

........

........

........

.. 223

PA

TIEN

T NO

T

<

5 .....

........

........

... 95

23

YES

........

........

........

........

.... 1

NO ...

........

........

........

.. 223

PA

TIEN

T NO

T

<

5 .....

........

........

... 95

23

22c

Is th

e gr

owth

char

t sex

-sp

ecific

? YE

S ....

........

........

........

........

1 NO

.......

........

........

........

.......

2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

22

d Is

the

grow

th ch

art

comp

leted

for t

he m

ost

rece

nt w

eight

?

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

23

Is

a clin

ical a

sses

smen

t of

chan

ges i

n sy

mpto

ms

docu

ment

ed e

very

clini

cal

visit

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

YES

........

........

........

........

.... 1

NO ...

........

........

........

........

... 2

24

Was

a lis

t of h

ouse

hold

cont

acts

for t

he p

atien

t re

cord

ed?

YES

........

........

........

........

.... 1

NO

.......

........

........

...... 2

29

YES

........

........

........

........

.... 1

NO

.......

........

........

...... 2

29

YES

........

........

........

........

.... 1

NO

.......

........

........

...... 2

29

YES

........

........

........

........

.... 1

NO

.......

........

........

...... 2

29

YES

........

........

........

........

.... 1

NO

.......

........

........

...... 2

29

25

Ar

e th

ere

any c

hildr

en <

5

on th

e co

ntac

t list?

Ye

s .....

........

........

........

........

1 No

.......

........

........

.......

228

DO

N’T

KNOW

.......

.. 98

28

Yes .

........

........

........

........

.... 1

No ...

........

........

........

... 2

28

DON’

T KN

OW ...

...... 9

828

Yes .

........

........

........

........

.... 1

No ...

........

........

........

... 2

28

DON’

T KN

OW ...

...... 9

828

Yes .

........

........

........

........

.... 1

No ...

........

........

........

... 2

28

DON’

T KN

OW ...

...... 9

828

Yes .

........

........

........

........

.... 1

No ...

........

........

........

... 2

28

DON’

T KN

OW ...

...... 9

828

26

W

ere

all ch

ildre

n <

5 on

co

ntac

t list

scre

ened

? Ye

s .....

........

........

........

........

1 No

.......

........

........

........

........

2 DO

N’T

KNOW

.......

........

... 98

Yes .

........

........

........

........

.... 1

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

Yes .

........

........

........

........

.... 1

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

Yes .

........

........

........

........

.... 1

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

Yes .

........

........

........

........

.... 1

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

27

Wer

e all

child

ren

< 5

on

cont

act li

st sta

rted

on

prev

entiv

e th

erap

y?

Yes .

........

........

........

........

.... 1

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

Yes .

........

........

........

........

.... 1

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

Yes .

........

........

........

........

.... 1

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

Yes .

........

........

........

........

.... 1

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

Yes .

........

........

........

........

.... 1

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

28

Wer

e all

hou

seho

ld me

mber

s of t

he p

atien

t sc

reen

ed fo

r TB?

Yes .

........

........

........

... 1

30

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

Yes .

........

........

........

... 1

30

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

Yes .

........

........

........

... 1

30

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

Yes .

........

........

........

... 1

30

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

Yes .

........

........

........

... 1

30

No ...

........

........

........

........

.... 2

DON’

T KN

OW ...

........

.......

98

29

Was

any

hou

seho

ld me

mber

of t

he p

atien

t sc

reen

ed fo

r TB?

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

YES

........

........

........

........

.... 1

NO

.......

........

........

........

.......

2 DO

N’T

KNOW

.......

........

... 98

32


An

nex

ure

IV

: TB

Rec

ord

Rev

iew

Gu

ide

(con

tinu

ed)

30

CIRC

LE T

HE L

ETTE

R FO

R EA

CH T

YPE

OF R

ECOR

DS T

HAT

WER

E US

ED T

O CO

LLEC

T TB

INFO

RMAT

ION

FOR

THIS

FAC

ILIT

Y [C

OUNT

RY A

DAPT

LIS

T]

TYP

E OF

REC

ORD

RE

GIST

ER: V

CT ...

........

........

........

........

........

........

..... A

REGI

STER

: PR

E-AR

T ...

........

........

........

........

........

.. B

REGI

STER

: AR

T ...

........

........

........

........

........

........

... C

INDI

VIDU

AL P

ATIE

NT A

RT

CARD

/CHA

RT/R

ECOR

D ....

........

........

........

........

.......

D RE

GIST

ER:

TUBE

RCUL

OSIS

......

........

........

.......

E

IN

DIVI

DUAL

PAT

IENT

TB

CARD

/CHA

RT/R

ECOR

D ....

........

........

........

........

.......

F IN

DIVI

DUAL

PAT

IENT

OPD

CA

RD/C

HART

/REC

ORD

........

........

........

........

........

... F

COMP

UTER

DAT

ABAS

E .....

........

........

........

........

...... G

RE

GIST

ER O

R DA

TABA

SE: L

ABOR

ATOR

Y ...

........

H

REGI

STER

OR

DATA

BASE

: PH

ARMA

CY ..

........

..... I

OT

HER

____

____

____

____

____

____

____

____

_ ... W

(SPE

CIFY

)

Q150

3 NO

TES

TO E

XPLA

IN A

NY IS

SUES

THA

T AR

OSE:

33

Documents

QUALITY OF CARE REVIEW REPORT · • A malaria test was performed for all suspected malaria cases. However, all the tests that were documented returned a positive malaria result,