Tuberculosis Remains A Major Public Health Problem In Nepal

The study showing that Maximum case reportings on tuberculosis; which is grossly underestimating. But according to the world health organization; the country is needing to get its act together to meet the WHO goal of eliminating tuberculosis by 2035. As tuberculosis remains a major public health problem in Nepal; with over 32,000 notifying cases and an estimating 7,000 deaths per year.

But accurate surveillance of the cases notifying; and the flow of information to the centre is endangered. Federalisation has so far not created clear mechanisms that will ensure these essential functions continue. If decentralised procurement of drugs continues, it will increase procurement costs significantly and risk the purchase of poor quality drugs.

Nepal participating at the United Nations High Level Meeting on tuberculosis; in September 2018 and, with all the other nations of the world; committing to end tuberculosis as a public health problem by 2035. Despite the terrain, this was one of the most thorough surveys ever done. Final results will be published at the end of the year, but preliminary findings show there is about two-thirds more TB than was previously estimated.

Major public health problem

But over 20 years, Nepal has had a National tuberculosis Programme; which providing nationwide coverage of basic services for drug sensitive TB and, more recently, for drug resistant TB. Treatment results compare favourably with other countries. The NTP has successfully introducing modern rapid diagnostic technology; and electronic reporting of cases, starting a collaboration with the private sector to ensure proper management of patients; and begun a program to find and treat children with TB.

Successive governments have allowing the technical staff of the National TB Centre to be hollowing out; eroding its capacity to develop policies and lead their implementation. But the National Strategic Plan, written three years ago, is underfunding; and only partially implementing. Most staff responsible for TB activities are now not training to carry out the work.

Insensitive sputum microscopy

Diagnosis is mostly by outdated and insensitive sputum microscopy.  Transport of specimens to laboratories is still inadequate. Consequently, GeneXpert utilisation has been slow to increase. The private health sector is massive and growing. Over 70% of people with TB first go to private clinics, yet diagnosis and treatment are of variable quality, leading to drug resistance.

However, phase out sputum microscopy for diagnosis and move to GeneXpert testing, and make sure contracted organisations achieve case-finding targets. If they do not, stop the activities and redirect the resources to more effective areas. Fully engage with the private sector to ensure patients there are diagnosing and treating according to national guidelines.