Tuberculosis screening in asylum seekers in Germany: a need for better data
Screening for tuberculosis among asylum seekers is a cornerstone of tuberculosis prevention and control strategies in many European countries. Screening programmes need to follow Wilson and Jungner's classic screening criteria and should ensure that screening is based on evidence, monitoring, and quality assurance.
Asylum seekers constitute a dynamic population whose countries of origin, circumstances, and routes - and thus whose tuberculosis risk - vary over time. Therefore, health information systems should ideally produce nationally representative, timely, and reliable data for the yield and outcome of screening by country of origin to facilitate evaluation of screening performance, and to enable informed decision making at policy level.
Nationwide data for the number of asylum seekers screened by country of origin are, however, scarce in Germany. This scarcity is mainly due to a fragmented reception and public health system: the 16 federal states organise reception and registration of asylum seekers according to their own policies, including screening for, and documentation of, tuberculosis. National law requires notification of tuberculosis cases only.
Researchers and decision makers interested in performance, optimisation, and quality assurance of the screening intervention are thus forced to use either data with little geographic scope, or best available - but not always reliable - proxy data to calculate estimates of screening yield.
Use of a proxy denominator (ie, an approximation of the total number of individuals screened) to overcome the limitations of the fragmented system and to estimate national yields of screening appears to be a pragmatic solution, but the validity of this approach remains uncertain.
The whole article including a PDF version is available at The Lancet Public Health.
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