Evaluation of tuberculosis surveillance system in Afghanistan: a teaching case-study
Khwaja Mir Islam Saeed, Shoaib Naeemi, Mir Salamuddin Hakim
Corresponding author: Khwaja Mir Islam Saeed, Technical Advisor for Afghanistan Field Epidemiology Training Program (AFETP), Eastern Mediterranean Public Health Network (EMPHNET) Afghanistan National Public Health Institute, Ministry of Public Health, Afghanistan 
Received: 25 Dec 2024 - Accepted: 25 Oct 2025 - Published: 17 Feb 2026
Domain: Infectious diseases epidemiology,Infectious disease,Public health
Keywords: Case-study, Afghanistan, tuberculosis, evaluation, surveillance
Funding: This work received no specific grant from any funding agency in the public, commercial, or non-profit sectors.
This article is published as part of the supplement Teaching Case Studies in Field Epidemiology and Public Health for the Eastern Mediterranean Region, commissioned by Eastern Mediterranean Public Health Network (EMPHNET).
©Khwaja Mir Islam Saeed et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Khwaja Mir Islam Saeed et al. Evaluation of tuberculosis surveillance system in Afghanistan: a teaching case-study. Pan African Medical Journal. 2026;53(1):6. [doi: 10.11604/pamj.supp.2026.53.1.46336]
Available online at: https://www.panafrican-med-journal.com//content/series/53/1/6/full
PDF in process Case study 
Evaluation of tuberculosis surveillance system in Afghanistan: a teaching case-study
Evaluation of tuberculosis surveillance system in Afghanistan: a teaching case-study
Khwaja Mir Islam Saeed1,&, 
Shoaib Naeemi2, Mir Salamuddin Hakim3
&Corresponding author
Afghanistan is suffering from double burden of health problems including communicable and noncommunicable diseases. Tuberculosis (TB) continues to be a major public health challenge in Afghanistan. Medicines and diagnostics are made available free of charge in the country. Almost 65,000 cases and 11,000 deaths were estimated to be caused by TB in Afghanistan in 2016. In 2017, more than 47,000 cases were detected and enrolled for treatment. Out of all health facilities, 71% are providing Directly Observed Treatment (DOTS) services. There are two surveillance systems including the National Tuberculosis Control Programme [NTP] and the Health Management Information System [HMIS] for regular collection of TB data?. An evaluation of these surveillance systems in January-February 2010 was done to identify their strengths and weaknesses and to formulate recommendations for improvement. Attributes of the programs were evaluated using US Centers for Disease Control and Prevention guidelines for evaluation of public health surveillance system. The goal of this case study is to develop competencies and consolidate understanding of participants to learn how the surveillance system works and why there is a need to evaluate the system and how to do that. This case study stimulates the students to conduct evaluation of public health surveillance system. The case study is designed for training of novice field epidemiology trainees. To be used as adjunct training material, the case study provides the trainees with competencies in evaluating the surveillance system and describing the system attributes.
General instructions: the case study is developed from a real and published evaluation report with some modification and should be used as a supporting training material for residents of field epidemiology training program at intermediated and advance level. Moreover, the concept surveillance and its theory of evaluation should have been clarified by facilitators in classroom ahead of working on this cases study. The case study could be practiced individually or in group of about 4-6 participants each while the facilitator guides the discussion. The facilitator may make use of flip charts to illustrate certain points. Additional instructor´s notes for facilitation are coupled with each question in the instructor´s guide to aid facilitation.
Audience: this case study is developed for residents on first workshop of field epidemiology. However, other residents of same discipline could use it easily. These participants are commonly health care workers working in the country departments of health whose background may be as medical doctors, nurses, environmental health officers or laboratory scientists who work in public health-related fields and at least biology discipline background.
Prerequisites: as mentioned earlier, before using this case study, participants should have received lectures on introduction to surveillance, operations of surveillance and surveillance evaluation. Being involved in diseases surveillance is suggested to lead the group work.
Materials needed: calculators, paper sheets, flip charts, markers, computers with MS Excel and Epi info v.7
Level of training and associated public health activity: Newly enrolled residents - Disease Surveillance and Evaluation of Public Health Surveillance.
Time required: 2-3 hours.
Language: English and local languages
- Download the case study student guide;
- Request the case study facilitator guide.
The authors declare no competing interests.
The original study was conducted from January to March 2010 and supported by CDC, Atlanta and Field Epidemiology and Laboratory Programme, National Institute of Health, Islamabad, Pakistan as well as Afghanistan National Public Health Institute. In addition, the National TB Control Programme and Health Management Information System at Ministry of Public Health were supportive in the evaluation. So, the data belongs to a program in 2010 and used here just for teaching purposes.
- World Bank. World Bank Survey: Living Conditions Remain Dire for the Afghan People. World Bank. November 22, 2022. Accessed on 25 Dec 2024.
- World Health Organization. Afghanistan. Accessed on 25 Dec 2024.
- AP news. Counting the costs of America's 20-year war in Afghanistan. AP NEWS. 30 April 2021. Accessed on 25 Dec 2024.
- Afghanistan: Human Development Indicators. United Nations Development Programme (UNDP). Accessed on 25 Dec 2024.
- Hijratullah Kakar. 15,000 cancer patients annually die in Afghanistan. Pajhwok Afghan News. May 20, 2021. Accessed on 25 Dec 2024.
- Banafsha Binesh. Officials: Traffic Incidents Decreased in Afghanistan Compared to Last Year. TOLOnews. November 21, 2022. Accessed on 25 Dec 2024.
- UNESCO. Afghanistan. 27 November 2016. Archived from the original on 10 May 2017. Accessed on 25 Dec 2024.
- Word Health Organization (WHO). Tuberculosis: situation Update. Accessed on 25 Dec 2024.
- WHO. WHO consolidated guidelines on tuberculosis. Module 3: Diagnosis - rapid diagnostics for tuberculosis detection 2021 update. Geneva: World Health Organization; 2021. Accessed on 25 Dec 2024.
- Tiemersma EW, van der Werf MJ, Borgdorff MW, Williams BG, Nagelkerke NJ. Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review. PLoS One. 2011 Apr 4;6(4):e17601. PubMed | Google Scholar
- Houben RMGJ, Dodd PJ. The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling. PloS Medicine. 2016 Oct 25;13(10):e1002152 eCollection 2016 Oct. PubMed | Google Scholar
- Vynnycky E, Fine PE. Lifetime risks, incubation period, and serial interval of tuberculosis. American journal of epidemiology. 2000 Aug 1;152(3):247-63. PubMed | Google Scholar
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