Background Tuberculosis remains a public problem that is considered one of the top causes of morbidity and mortality worldwide. The National Tuberculosis Control Program in Yemen was established in 1970 and included in the national health policy under the leadership of the Ministry of Public Health and Population to monitor tuberculosis control. The surveillance system must be evaluated periodically to produce recommendations for improving performance and usefulness. Objective This study aims to assess the usefulness and the performance of the tuberculosis surveillance system attributes and to identify the strengths and weaknesses of the system. Methods A quantitative and qualitative evaluation of the national tuberculosis surveillance system was conducted using the Centers for Disease Control and Prevention’s updated guidelines. The study was carried out in 10 districts in Sana’a City. A total of 28 public health facilities providing tuberculosis services for the whole population in their assigned catchment areas were purposively selected. All participants were interviewed based on their involvement with key aspects of tuberculosis surveillance activities. Results The tuberculosis surveillance system was found to have an average performance in usefulness (57/80, 71%), flexibility (30/40, 75%), acceptability (174/264, 66%), data quality (4/6, 67%), and positive predictive value (78/107, 73%), and poor performance in simplicity (863/1452, 59%) and stability (15%, 3/20). In addition, the system also had a good performance in sensitivity (78/81, 96%). Conclusions The tuberculosis surveillance system was found to be useful. The flexibility, positive predictive value, and data quality were average. Stability and simplicity were poor. The sensitivity was good. The main weaknesses in the tuberculosis surveillance system include a lack of governmental financial support, a paper-based system, and a lack of regular staff training. Developing an electronic system, securing governmental finances, and training the staff on tuberculosis surveillance are strongly recommended to improve the system performance.

BACKGROUND Tuberculosis (TB) surveillance system in Yemen has not been evaluated before and it is not clear if the system is able to monitor the TB problem in Yemen efficiently and effectively OBJECTIVE This study aimed to assess the usefulness of the national tuberculosis surveillance system, assess the performance of tuberculosis programs regarding the eight attributes and identify strengths and weakness of the system. METHODS A quantitative and qualitative evaluation of the National Tuberculosis surveillance system was conducted using the Centers for Disease Control and Prevention (CDC) updated guidelines. The study was carried out in ten districts in Sana’a City. Twenty-eight public health facilities providing TB services for whole population in their assigned catchment areas in Sana’a city were purposively selected. All key stakeholders were interviewed based on their involvement with key aspects of TB surveillance activities. RESULTS A total of 54 persons participated in the evaluation. The overall score percent for usefulness was 71%, indicating an average rank. The TB Surveillance System had an average flexibility (score percent = 78%), poor stability (score percent = 15%), poor simplicity (score percent = 59%), and poor acceptability (score percent = 12%). The timeliness was ranked as average. The sensitivity of the TB surveillance system was 96% and the PPV of the TB surveillance system was 73%. CONCLUSIONS The usefulness, flexibility, PVP, timeliness, and data quality of the TB surveillance system were rated as an average. The system’s stability, acceptability and simplicity were rated as poor. The main weaknesses in the TB surveillance system include lack of governmental financial support, paper-based system, and lack of regular staff training. Developing an electronic system, involvement of private sector in reporting system, securing governmental financial support, and training the staff on TB surveillance are strongly recommended to improve the performance of the system.

BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is a major challenge to ending TB occurrence by 2035. In Yemen, the 2011 survey showed an MDR-TB prevalence of 1.4% among new cases and 14.4% among previously treated cases. The National Tuberculosis Control Program (NTCP) established four MDR-TB sentinel surveillance sites in 2013 to monitor the MDR-TB situation. In Yemen, the 2011 survey showed an MDR-TB prevalence of 1.4% among new cases and 14.4% among previously treated cases. The NTCP established four MDR-TB sentinel surveillance sites in 2013 to monitor the MDR-TB situation. OBJECTIVE This study aimed to assess the performance of MDR-TB surveillance and determine its strengths and weaknesses. METHODS We used the updated Center for Diseases Control and Prevention guidelines for evaluating public health surveillance systems. Interviews were conducted with NTCP managers and Regional MDR-TB centers’ staff using a semistructured questionnaire. We used a 5-point Likert scale to assess the usefulness and other attributes (eg, simplicity and flexibility). The mean percentage was calculated for each attribute and used for the final rank of the performance: poor (<60%), average (60%-80%), and good (>80%). RESULTS The MDR-TB surveillance system achieved good performance in usefulness (87%), acceptability (82%), and data quality (91%); average performance in flexibility (61%) and simplicity (72%); and poor performance in stability (55%). The overall performance score was average (74%). Although strong commitment, good monitoring, and well-trained staff are the main strengths, depending on an external fund is a major weakness along with unavailability of the MDR-TB unit at the governorate level. CONCLUSIONS Although the MDR-TB surveillance system has achieved an average overall performance, more efforts are required to improve its stability by ensuring constant power supply to enable laboratories to perform necessary diagnostic and follow-up tests. Gradual replacement of donors’ funds by the government is recommended. Scaling up of MDR-TB services and removing access barriers are crucial.