Tuberculosis mortality differentials in Indonesia during 2007-2008: evidence for health policy and monitoring.

BACKGROUND: Indonesia bears the third highest tuberculosis (TB) burden in the world. Current mortality estimates are based on notification and case fatality rates derived from the National TB Control Programme. OBJECTIVE: To report TB mortality measures for 2007-2008 based on death registration systems in selected populations in five provinces of Indonesia. METHODS: Data were compiled from sites in Central Java, Lampung, Gorontalo, West Kalimantan and Papua in 2007-2008, covering 2.5 million people. Overall mortality levels and TB mortality indicators were computed. Data quality was assessed in terms of completeness of death registration and strength of evidence in verbal autopsy questionnaires. RESULTS: A total of 1547 TB deaths were diagnosed in the five provinces. There was direct or indirect evidence of incomplete death registration at all sites. More than 90% of TB diagnoses from verbal autopsies were based on strong evidence. The results demonstrate high TB death rates in Papua, and significant mortality differentials across provinces. CONCLUSIONS: The measurement of cause-specific mortality is feasible by strengthening death registration in Indonesia. Observed TB mortality rates from five sites are baseline evidence for monitoring TB control programmes. Sustained efforts are required to develop death registration as a routine annual source of mortality data for Indonesia.