Quantifying the level of under-detection of Trypanosoma brucei rhodesiense sleeping sickness cases. Odiit, M., Coleman, P. G., Liu, W., McDermott, J. J., Fevre, E. M., Welburn, S. C., & Woolhouse, M. E. J. Tropical medicine & international health : TM & IH, 10(9):840--849, September, 2005.
doi  abstract   bibtex   
To formally quantify the level of under-detection of Trypanosoma brucei rhodesiense sleeping sickness (SS) during an epidemic in Uganda, a decision tree (under-detection) model was developed; concurrently, to quantify the subset of undetected cases that sought health care but were not diagnosed, a deterministic (subset) model was developed. The values of the under-detection model parameters were estimated from previously published records of the duration of symptoms prior to presentation and the ratio of early to late stage cases in 760 SS patients presenting at LIRI hospital, Tororo, Uganda during the 1988--1990 epidemic of SS. For the observed early to late stage ratio of 0.47, we estimate that the proportion of under-detection in the catchment area of LIRI hospital was 0.39 (95% CI 0.37--0.41) i.e. 39% of cases are not reported. Based on this value, it is calculated that for every one reported death of SS, 12.0 (95% CI 11.0--13.0) deaths went undetected in the LIRI hospital catchment area - i.e. 92% of deaths are not reported. The deterministic (subset) model structured on the possible routes of a SS infection to either diagnosis or death through the health system or out of it, showed that of a total of 73 undetected deaths, 62 (CI
@article{odiit_quantifying_2005,
	title = {Quantifying the level of under-detection of {Trypanosoma} brucei rhodesiense sleeping sickness cases.},
	volume = {10},
	issn = {1360-2276 1360-2276},
	doi = {10.1111/j.1365-3156.2005.01470.x},
	abstract = {To formally quantify the level of under-detection of Trypanosoma brucei rhodesiense sleeping sickness (SS) during an epidemic in Uganda, a decision tree  (under-detection) model was developed; concurrently, to quantify the subset of undetected cases that sought health care but were not diagnosed, a deterministic  (subset) model was developed. The values of the under-detection model parameters  were estimated from previously published records of the duration of symptoms prior to presentation and the ratio of early to late stage cases in 760 SS patients presenting at LIRI hospital, Tororo, Uganda during the 1988--1990 epidemic of SS. For the observed early to late stage ratio of 0.47, we estimate that the proportion of under-detection in the catchment area of LIRI hospital was 0.39 (95\% CI 0.37--0.41) i.e. 39\% of cases are not reported. Based on this value, it is calculated that for every one reported death of SS, 12.0 (95\% CI 11.0--13.0) deaths went undetected in the LIRI hospital catchment area - i.e. 92\% of deaths are not reported. The deterministic (subset) model structured on the possible routes of a SS infection to either diagnosis or death through the health system or out of it, showed that of a total of 73 undetected deaths, 62 (CI},
	language = {eng},
	number = {9},
	journal = {Tropical medicine \& international health : TM \& IH},
	author = {Odiit, M. and Coleman, P. G. and Liu, W.-C. and McDermott, J. J. and Fevre, E. M. and Welburn, S. C. and Woolhouse, M. E. J.},
	month = sep,
	year = {2005},
	pmid = {16135190},
	keywords = {*Disease Outbreaks, Animals, Decision Trees, Diagnostic Errors, Humans, Monte Carlo Method, Probability, Trypanosoma brucei rhodesiense/*isolation \& purification, Trypanosomiasis, African/epidemiology/mortality/*parasitology, Uganda/epidemiology},
	pages = {840--849}
}
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