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Exploring the challenges for programmatic management of drug-resistant tuberculosis in Nepal


Document type: mthesis
Download file(s): 455717 (816.001 MB)
Abstract: BACKGROUND: In Nepal, 45% of general population is infected with tuberculosis (TB) and 49,000 new TB cases occur every year. Latest anti-tuberculosis drug resistance survey 2006-2007 showed that prevalence of multi drug-resistant tuberculosis (MDR-TB) is 2.9% among new cases and 11.7% among previously treated cases. Until July 2011, 1026 MDR-TB and 27 extensively drug-resistant TB (XDR-TB) cases have been registered for treatment. Emergence of MDR-TB with XDR-TB poses a new challenge for effective TB control in Nepal. OBJECTIVE: To explore the challenges for programmatic management of drug-resistant tuberculosis in Nepal in order to make recommendations. METHOD: Literature review was done by internet search. Relevant articles, reports and information were collected in relation to MDR-TB in Nepal. FINDINGS: Service related challenges for programmatic management of drug-resistant tuberculosis are very low MDR-TB detection, unclear patient tracing mechanism, narrow high risk targeted case findings, lacking MDR-TB rapid diagnostic tool, relatively inflexible directly observed treatment (DOT), inadequate patient support services, poor responsiveness and lack of adequate operational research in relation to MDR-TB. The possible patient related factors are social stigma and discrimination, misconception about TB, financial and geographical inaccessibility and poor awareness that TB services are free. CONCLUSIONS AND RECOMMENDATIONS: Emergence of MDR-TB in Nepal is posing a threat which requires an urgent public health response. Recommendations are introduction of rapid diagnostic test, wider high risk targeted case finding Strategy, individualized and flexible DOT, scaling up patient support services, stigma and discrimination reduction strategy, patient tracing mechanism and operational research.
Authors: Sharma, G.N.
Country: Nepal
Category: Research
Department: Development, Policy and Practice
Institute: KIT - Royal Tropical Institute
Keywords: disease prevention and control , health services
Language: eng
Organization: KIT - Royal Tropical Institute
Organization: VU - Vrije Universiteit Amsterdam
PAGE: xi, 61
Place: Amsterdam
Publisher: KIT - Royal Tropical Institute [etc.]
Year: 2012
Region: South Asia
Right: © 2012 Sharma
Subject: Health and Nutrition
Title: Exploring the challenges for programmatic management of drug-resistant tuberculosis in Nepal
Training: Master of Public Health