Changes in utilization of TB health services in Nepal (original) (raw)
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PLOS ONE
Background Nepal has achieved a significant reduction of TB incidence over the past decades. Nevertheless, TB patients continue to experience barriers in access, diagnosis and completion of the treatment. The main objective of this study was to explore the factors affecting the access to the health services, diagnosis and the treatment completion for TB patients in central and western Nepal. Methods Data were collected using in-depth interviews (IDI) with the TB patients (n = 4); Focus Group Discussions (FGDs) with TB suspected patients (n = 16); Semi Strucutred Interviews (SSIs) with health workers (n = 24) and traditional healers (n = 2); and FGDs with community members (n = 8). All data were audio recorded, transcribed and translated to English. All transcriptions underwent thematic analysis using qualitative data analysis software: Atlas.ti. Results Barriers to access to the health centre were the long distance, poor road conditions, and costs associated with travelling. In addition, lack of awareness of TB and its consequences, and the belief, prompted many respondents to visit traditional healers. Early diagnosis of TB was hindered by lack of trained health personnel to use the equipment, lack of equipment and irregular presence of health workers. Additional barriers that impeded the adherence
Engaging Private Health Care Providers to Identify Individuals with TB in Nepal
International Journal of Environmental Research and Public Health, 2021
In Nepal, 47% of individuals who fell ill with TB were not reported to the National TB Program in 2018. Approximately 60% of persons with TB initially seek care in the private sector. From November 2018 to January 2020, we implemented an active case finding intervention in the Parsa and Dhanusha districts targeting private provider facilities. To evaluate the impact of the intervention, we reported on crude intervention results. We further compared case notification during the implementation to baseline and control population (Bara and Siraha) notifications. We screened 203,332 individuals; 11,266 (5.5%) were identified as presumptive for TB and 8077 (71.7%) were tested for TB. Approximately 8% had a TB diagnosis, of whom 383 (56.2%) were bacteriologically confirmed (Bac+). In total, 653 (95.7%) individuals were initiated on treatment at DOTS facilities. For the intervention districts, there was a 17%increase for bacteriologically positive TB and 10% for all forms TB compared to bas...
Wellcome Open Research
Background: WHO’s 2015 End TB Strategy advocates social and economic (socioeconomic) support for TB-affected households to improve TB control. However, evidence concerning socioeconomic support for TB-affected households remains limited, especially in low-income countries. Protocol: This mixed-methods study in Nepal will: evaluate the socioeconomic impact of accessing TB diagnosis and care (Project 1); and create a shortlist of feasible, locally-appropriate interventions to mitigate this impact (Project 2). The study will be conducted in the Chitwan, Mahottari, Makawanpur, and Dhanusha districts of Nepal, which have frequent TB and poverty. The study population will include: approximately 200 people with TB (Cases) starting TB treatment with Nepal’s National TB Program and 100 randomly-selected people without TB (Controls) in the same sites (Project 1); and approximately 40 key in-country stakeholders from Nepal including people with TB, community leaders, and TB healthcare professi...
Experiences of Tuberculosis in a Tarai Village, Nepal
Dhaulagiri Journal of Sociology and Anthropology, 2019
In focus is the experience of being a Tuberculosis (TB) patient in the mid-west Tarai of rural Nepal. The information derives from a longitudinal qualitative study between 2005 to 2017 in one and the same community. The findings show few changes in the experience of being a TB patient. The availability of anti-TB medicine free of cost within the government health services was greatly appreciated. The cause of TB, ways and means of transmissions, and the need for preventive measures, however, were not well understood. In the case of Child-TB, the expectation of numerous visits to the government treatment centre for the picking up of medicines was a strong deterrant. In consequence, most child-TB cases were diagnosed and treated within the private sector. The distribution system of the medicines, particularly within the government system, clearly added to the burden of being a TB patient and much would have been gained had the arrangement been more patient-friendly, a difference which most likely had also resulted in more children being treated within the public services rather than within the money-geared private sector. Various misunderstandings about the cause/s of the disease need to be addressed. And, much would be gained was the central directive of "patient support", truly implemented and was a true "two-way communication" to take place.
Biomedical Journal of Scientific & Technical Research, 2019
Among garbage collectors, people living with TB symptoms, street children and contacts with Tuberculosis Patients total 157652 were screened, out of total screened, 32879 (21%) were identify with TB sign and symptoms. Out of total people living with TB symptoms, 83% (27346) were identified in the community and private pharmacies visited for the sputum examination. Among total examine 284 people were diagnosed as Sputum Smear Positive (SS+). Two third of diagnosed cases were male and their mean age was 37. The intensive community engagement activities and door-to-door visits has improved the health seeking behavior of the target groups. Among total diagnosed cases 269 (95%) cases enrolled to treatment from the nearby DOTS centers. This intervention contributes to identify 15% (284/1859) of the additional TB case finding in the Kathmandu valley. Out to total people living with TB symptom, 284 were diagnosed tuberculosis. Among them 193 (68%) were referred from the private sector Private Pharmacists contributed to the early diagnosis of TB by referring people living with TB sing and symptoms, who had visited in their pharmacy. They also have a critical responsibility towards ensuring a consistent supply of medicines, promoting rational use of drugs and providing information to patients and this should be no different for anti-TB medicines. The private and public sector need to work together if TB is to be brought under control. NTP needs to involve the private sector in tuberculosis control programmes, so as to ensure a more comprehensive management of TB patients. Global Scenario of TB Tuberculosis is a global pandemic, killing someone approximately, every second nearly 1.5 million in 2014 alone. One-third of the world's burden of tuberculosis (TB), or about 4.9 million prevalent cases, is found in the World Health Organization (WHO) SouthEast Asia Region (WHO, Tuberculosis in the WHO SouthEast Asia Region, 2010) [1]. The disease, which is most common among people in their productive years,1 has a huge economic impact [2]. For instance, in 2006, TB caused India to lose an estimated 23.7 billion United States dollars [3]. Fortunately, multidrug-resistant TB (MDR-TB) still occurs in fewer than 3% of new cases and 18% of re-treatment cases in the region [4]. However, the high TB incidence makes even these low percentages translate into a large number of patients. Extensively drug-resistant TB has also been reported in Bangladesh, India, Indonesia, Myanmar and Thailand [5]. More than 2 million patients are diagnosed annually by national TB pro
Strengthening Childhood TB Management in Nepal: challenges, progress and lesson learned
SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS
Introduction: Childhood tuberculosis has always been in shadows as Nepal’s Tuberculosis Program focused mainly on adults TB resulting in under diagnose with less than 10% of total TB cases notified. Lack of political commitment; absence of guideline and working group, qualified health personnel and diagnostics tool were major implementation challenges. Methodology: Assessment of childhood TB program was done and critical gap were identified. Childhood TB was prioritized in National TB strategic plan (2016-21). Collaborate with both international and national child experts, public and private organizations to develop guideline, building capacity of health care providers and establishing national working group. Childhood TB focused interventions were implemented in 40 high burden districts since March,2017 focusing on contact tracing, diagnosis, Prevention Therapy, malnourished children in the community and major hospitals. Results : Political commitment and multi-sectoral involvement...
Wellcome Open Research
BACKGROUND: The World Health Organization’s End TB (tuberculosis) Strategy advocates social and economic support for TB-affected households but evidence from low-income settings is scarce. We will evaluate the feasibility and acceptability of a locally-appropriate socioeconomic support intervention for TB-affected households in Nepal. METHODS: We will conduct a pilot randomised-controlled trial with mixed-methods process evaluation in four TB-endemic, impoverished districts of Nepal: Pyuthan, Chitwan, Mahottari, and Morang. We will recruit 128 people with TB notified to the Nepal National TB Program (NTP) and 40 multisectoral stakeholders including NTP staff, civil-society members, policy-makers, and ASCOT (Addressing the Social Determinants and Consequences of Tuberculosis) team members. People with TB will be randomised 1:1:1:1 to four study arms (n=32 each): control; social support; economic support; and combined social and economic (socioeconomic) support. Social support will be...
Changing tuberculosis trends in Nepal in the period 2001-2008
2010
To assess the trends on indicators of TB control in Nepal over a period from 2001-2008. Retrospective analysis of information from Annual Reports of NTP, Nepal from 2001-2008. The incidence of New Smear Positive (NSP) TB declined from 58.9 in 2001 to 53.4 in 2006 per 100000 populations then reversed in the period 2006-2008. This TB incidence decreased in males and the age group <45 years (except 0-14 years). The notification rate of all cases of TB declined by 3 % overall over the entire period from 2001 to 2008. Mortality among smear negative and extra pulmonary declined significantly. The failure rate and defaulter rate were declined significantly and the case detection rate (CDR) was increased significantly within the study period. Increasing trend in CDR, Treatment success rate and decreasing trend in failure rate, defaulter rate are the evidence of progress of NTP, in Nepal. Since there is reversal of incidence of NSP from 2006, a detailed analysis of existing TB control mea...
Health-seeking in Tuberculosis: a Frustrating Undertaking in Rural Nepal
In focus are delays in health seeking in connection with tuberculosis in rural Nepal. A longitudinal in-depth field study made it possible to research individual actions and processes in relation to those of relevant others. Moreover, the approach facilitated the tracing of clustering of cases over time and patterns of health-seeking processes within these. The overall picture is one of long delays. The reasons for the lengthy delays were not inactivity from the patient side but rather the opposite: a frantic search for help during which they were led astray more often than helped!