Diagnostic and treatment of tuberculosis in rural Nepal.

Thesis Report.

ABSTRACT:

Background : Tuberculosis (TB) is a contagious disease caused by Mycobacterium tuberculosis. The disease is still common in developing countries and caused 1.6 million deaths worldwide in 2005. TB is the most common cause of death among adults aged 15-49 in Nepal. World Health Organization (WHO) introduced a new program to fight TB in 1995 called DOTS.

Objective: The main focus of the study was to learn more about TB and the performance of the TB-control program in a developing country like Nepal. We also wanted to study tendencies in treatment outcome and the patients' own knowledge about TB. Materials and methods: Diagnostic information of 3469 patients was collected from the TB-clinic in United Mission Hospital Tansen (UMHT). Treatment outcome was found for 312 of 534 patients referred from UMHT to Palpa District Hospital. The study period was from 16th of July 2003 to 15th of July 2006. A small survey using a questionnaire was performed on 51 patients attending the TB-clinic in UMHT. The patient data was analysed using the computing program SPSS.

Results:The gender distribution registered in UMHT's TB-clinic was 70% of the patients came from other districts than Palpa, 20% from Palpa District and 10% from India. 70% had pulmonary TB and 29% had extra pulmonary TB. Women tended to have more extra pulmonary TB than men. Treatment outcome was found for only 58% of the patients referred for treatment to Palpa District Hospital from UMHT. Among these patients treatment success was 81%, 4% below WHO's goal for TB-treatment. The survey showed a low level of knowledge about TB. The patients had to travel several hours and pay expensive travelling costs to reach UMHT.

Conclusion :A program like DOTS seems to be efficient considering the limited resources available in Nepal. Still the results of our study suggest that more focus on the interception of already diagnosed patients and more information to the people about TB could be beneficial for the TB control program.

Eng.