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Marahatta, SB, and BJ Karki. "Tuberculosis in Nepal: Diagnosis and Treatment Barriers." Journal of Manmohan Memorial Institute of Health Sciences 2 (September 26, 2016): 1–2. http://dx.doi.org/10.3126/jmmihs.v2i0.15784.
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Adhikari, Nilaramba, L. R. Joshi, B. Subedi, D. Acharya, M. Adhikari, P. Thapa, R. Sultana, and K. B. Karki. "Tuberculosis in Nepal: Situation, Challenges and Ways Forward." SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS 17, no. 1 (July 26, 2019): 34–40. http://dx.doi.org/10.3126/saarctb.v17i1.25026.
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Introduction: Globally, tuberculosis is a major public health problem. Moreover, the emergence of drug resistant forms of TB has threatened TB prevention and treatment efforts. Despite the long history of tuberculosis prevention efforts, tuberculosis still ranks among the top ten causes of deaths in Nepal. Furthermore, Nepal being land locked with two high TB burden countries i.e. India and China, it has added difficulties to National Tuberculosis program. Hence this study aims to review the situation of National Tuberculosis Program in Nepal and explore the possible challenges and ways forward for NTP to strengthen the TB diagnostics and treatment services in Nepal.
Methods: This study is based on the review of available literatures and data sources related to tuberculosis prevention, care and control. Secondary data published by National Tuberculosis Program in the annual report for the year 2015, 2016 and 2017 were considered for the situation analysis of tuberculosis in Nepal. We used different platforms like Google scholar, PubMed to search relevant literatures.
Results: This has been a huge gap between WHO TB estimates and TB cases notification by the national system. It was 22% in 2015, 27% in 2016 and 29% in 2017. However National Tuberculosis Program has maintained treatment success rate consistently above 90%. Tuberculosis program has yet not achieved universal HIV testing, although HIV testing among TB patients has increased rapidly. Similarly, only 75%, 1994 received DST out of 2601 retreatment TB cases have received DST in 2017 despite guideline suggest mandatory drug susceptibility testing for retreatment TB cases.
Conclusion: Case notification has reduced gradually. It is difficult to achieve the target envisioned by NSP 2016-21 if the current case notification trend persists. NTP needs to expand service sites ensuring minimum quality standards as well as scale up targeted intervention addressing human right issues to identify the missing TB cases. NTP needs to regulate the quality of diagnosis and treatment TB services offered by private sector.
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Agarwal, Neha, Prajowl Shrestha, and Ramesh Chokhani. "Allergic BronchoPulmonary Aspergillosis in Nepal." Journal of Nepal Medical Association 52, no. 196 (December 31, 2014): 1020–23. http://dx.doi.org/10.31729/jnma.2806.
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Allergic BronchoPulmonary Aspergillosis is clinically under recognized and often misdiagnosed in Nepal. A total of 15 cases of ABPA were enrolled in this case series. Cases were followed up after the 3 months of start of treatment and clinical responses were assessed. The mean age of the patients was 33.06 ± 9.2 yrs. 80% were male. 26.6% patients were empirically on antitubercular treatment at the time of presentation. 40% patients were misdiagnosed and already treated as pulmonary Tuberculosis. 10 patients were previously treated as cases of refractory asthma. Majority of patients had significant eosinophillia and raised total serum IgE. All patients required treatment with bronchodilator and systemic steroid. 80% patients underwent remission with the treatment. Pulmonary Tuberculosis and refractory bronchial asthma are common condition that leads to the misdiagnosis of this disease.
Keywords: ABPA; bronchial asthma; central bronchiectasis; eosinophil count; serum IgE.
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Arora, Sunita, Gursharan Singh Narang, and Prabhjot Kaur Dhillon. "Neurological Worsening in a Child of Miliary Tuberculosis with Neuro-Tuberculosis on Anti Tubercular Treatment." Journal of Nepal Paediatric Society 35, no. 2 (January 20, 2016): 185–88. http://dx.doi.org/10.3126/jnps.v35i2.10406.
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A seven and half year old male child presenting with pyrexia of unknown origin was diagnosed to be a case of miliary tuberculosis. Neuroimaging revealed multiple discrete ring as well as nodular enhancing lesions indicative of tuberculomas. After the initial response to ATT along with systemic steroids the child again presented with severe headache along with vomiting towards the end of intensive phase. Repeat neuroimaging showed appearance of new lesions with perilesional edema. Child was started again on systemic steroids and Streptomycin was added to the anti tubercular regimen, to which the child responded well.J Nepal Paediatr Soc 2015;35(2):185-188
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Shrestha, S., GB Pradhan, K. Bhoomi, BL Shrestha, and CL Bhattachan. "Abdominal Tuberculosis in Nepal Medical College Teaching Hospital, Kathmandu." SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS 5, no. 1 (May 7, 2010): 39–42. http://dx.doi.org/10.3126/saarctb.v5i1.3083.
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Abdominal Tuberculosis is a common extra pulmonary manifestation of tuberculosis. The wide spectrum of presentation makes abdominal tuberculosis difficult to diagnose and treat. Retrospective review of cases with abdominal tuberculosis presenting to the Surgery Department of Nepal Medical College Teaching Hospital from January 2002- June 2007 was done to describe our experience of abdominal tuberculosis over a 5 year period. We found total 32 patients with abdominal tuberculosis, among which 13 had concurrent pulmonary tuberculosis. The most common clinical presentation, i.e. a triad of abdominal pain, fever and weight loss was present in 13 who had symptoms of pulmonary tuberculosis presented to physicians and the remaining 19 presented acutely to surgeons with symptoms of pain and obstruction. Chest X ray, abdominal ultrasound and barium meal follow through done to find associated abnormalities. Diagnostic Laparoscopy was performed in 10 and 3 patients with peritonitis underwent emergency laparotomy which revealed multiple ileal perforations in 2 cases and one had multiple strictures with small bowel perforation. Diagnosis of tuberculosis, attended at surgeons was confirmed by demonstrating caseating granulomas in histology and Acid Fast Bacilli Positive, culture for M. tuberculosis from peritoneal fluid. All patients were started anti tuberculosis treatment. Abdominal tuberculosis is a relatively common finding and should always be considered in the differential diagnosis of abdominal pain, fever and weight loss. Key Words: Tuberculosis; abdominal tuberculosis; Acid Fast Bacilli; ileocaecal disease DOI: 10.3126/saarctb.v5i1.3083 SAARC J. Tuber. Lung Dis. HIV/AIDS 2008 Vol.5(1) 39-42
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Kumar, MK, P. Kumar, and A. Singh. "Anti-Tubercular Treatment of Tuberculous Meningitis Cause Paradoxical Multiple Neurotuberculoma." Journal of Nepal Paediatric Society 34, no. 3 (April 8, 2015): 236–38. http://dx.doi.org/10.3126/jnps.v34i3.10752.
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Tuberculosis is the most common cause of infectious disease related mortality worldwide. Paradoxical reactions to antituberculous treatment have created difficulties in the management of extrapulmonary tuberculosis, particularly central nervous system tuberculosis. We report a three years baby with tuberculous meningitis, who was treated outside with anti-tuberculous drugs without steroid one month back and presented in our emergency as status epilepticus. This case emphasizes the importance of addition of steroid along with anti-tubercular drugs in the treatment of central nervous system tuberculosis. J Nepal Paediatr Soc 2014;34(3):236-238 DOI: http://dx.doi.org/10.3126/jnps.v34i3.10752
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Kumar. Shrestha, Sailesh, Ratna Bhattarai, Lok Raj Joshi, Suvesh Kumar Shrestha, Rajendra Basnet, Anil Thapa, and Kedar Narsingh Kc. "1361. Knowledge, Attitude, and Practices on Drug-Resistant Tuberculosis Infection Control Among Healthcare Workers in Nepal: A Cross-Sectional Study." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S493. http://dx.doi.org/10.1093/ofid/ofz360.1225.
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Abstract Background Healthcare centers are important sites for tuberculosis transmission, particularly in low-income settings where the burden of tuberculosis is high and infection control practices are often inadequate. This study aims to assess the knowledge, attitude, and practices of drug-resistant tuberculosis infection control among the healthcare workers under the National Tuberculosis Control Program in Nepal. Methods In this descriptive cross-sectional survey, we studied the healthcare workers from all the functioning drug-resistant tuberculosis treatment centers across Nepal between March 1, 2018 and March 15, 2018. Nepal Health Research Council provided ethical clearance. Trained enumerators obtained informed consent and conducted face-to-face interviews with a pretested questionnaire to collect data on the basic characteristics of healthcare workers, their self-reported knowledge, attitude, and practice on tuberculosis infection control. We assigned a score of one to the correct response and zero to the incorrect or no response and calculated a composite score in each of the knowledge, attitude, and practice domains. We ascertained the healthcare workers as having good knowledge, appropriate attitude, and optimal practices when the composite score was at least 50%. We summarized the numerical variables with median and interquartile range (IQR) and the categorical variables with proportions. Results A total of 95 out of 102 healthcare workers from 11 drug-resistant tuberculosis treatment centers participated in the study. There were 46 male and 49 female respondents. The median age was 33 years (IQR 26–42). The majority of them (53, 56%) were mid-level paramedics. The median work experience in drug-resistant tuberculosis was 2 years (IQR 1–5). We found 91 (96%) respondents had a good knowledge of tuberculosis infection control with the median knowledge score of 14 (IQR 12–14), 49 (52%) respondents had an appropriate attitude with the median attitude score of 5 (IQR 4–6) and 35 (37%) respondents had optimal practices with the median practice score of 5 (IQR 4–7). Conclusion Healthcare workers at the drug-resistant tuberculosis treatment centers in Nepal had good knowledge of tuberculosis infection control but it did not translate into an appropriate attitude or optimal practices. Disclosures All authors: No reported disclosures.
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Thapa, Astha, Agnimshwor Dahal, Saroj Yadav, Keshav Raj Sigdel, Sudeep Adhikari, Sulav Khanal, Buddha Basnyat, and Roman Dhital. "Case Report: Acute isoniazid intoxication after intentional ingestion." Wellcome Open Research 7 (August 22, 2022): 219. http://dx.doi.org/10.12688/wellcomeopenres.18068.1.
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Isoniazid is an anti-tuberculosis medication that is extensively used for treatment and prevention of tuberculosis. Acute isoniazid poisoning is characterized by a clinical triad of recurrent seizures, raised anion gap metabolic acidosis and coma. The seizures are unresponsive to standard anticonvulsant drugs, instead requiring pyridoxine administered in a dose equal to the amount of isoniazid consumed. Due to the high incidence of tuberculosis in low-income countries like Nepal, isoniazid intoxication should be considered in any patient who present with such unresponsive seizures and coma. We report a case of a 31 years old woman from Nepal, who intentionally ingested 12 grams of isoniazid and presented with generalized tonic-clonic seizures. She was successfully managed with 10 grams of pyridoxine along with other supportive management, including sodium bicarbonate for metabolic acidosis and mechanical ventilation. Doctors working in low-income countries, like Nepal, where tuberculosis is endemic, should be well acquainted with presentations and management of isoniazid intoxication.
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Kumar, Gaurav, N. Jha, SR Niraula, DK Yadav, S. Bhattarai, and PK Pokharel. "Gender Based Barriers In Accessing Tuberculosis Treatment: A Qualitative Study From Eastern Nepal." SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS 10, no. 2 (January 28, 2014): 15–20. http://dx.doi.org/10.3126/saarctb.v10i2.9708.
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Introduction: Previous studies have demonstrated longer length of delays in diagnosis and treatment among men and women, especially among women experiencing longer duration of delay in accessing tuberculosis treatment. So, the study was conducted to explore responsible factors among men and women affecting longer duration in accessing tuberculosis treatment. Methodology: Qualitative approach with FGD sessions among people from community, DOTS providers and pulmonary tuberculosis patients were conducted separately in between March 2012 to May 2012. Results: The perception of fear, hiding symptoms, social stigmas and traditional beliefs were common among women. The study revealed that social and cultural barrier, ignorance of symptoms, home remedies, fear of stigma, access to health centre from rural areas, poor knowledge of TB signs and symptoms, beliefs on traditional healers were the common reason for the longer delays in diagnosis. Conclusions: The fi ndings suggested that knowledge, information, perception regarding TB among men and women were lacking, especially among females. This warrants awareness for early diagnosis and control of disease. SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS; 2013; X(2); 15-20 DOI: http://dx.doi.org/10.3126/saarctb.v10i2.9708
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Ghimire, H. B., H. S. Rimal, and P. Parajuli. "Treatment Outcome of Drug Resistance Tuberculosis From a Centre of Eastern Region, Nepal." Birat Journal of Health Sciences 1, no. 1 (March 31, 2017): 20–26. http://dx.doi.org/10.3126/bjhs.v1i1.17092.
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Introduction Drug resistance tuberculosis (DRTB) has become major problem worldwide with difficulty in treatment. Objective The study is conducted to find the incidence and outcomes of DRTB in one of the eastern tuberculosis treatment centre of Nepal.Methodology We collected all the cases of DRTB being treated from national anti-tuberculosis association of Biratnagar, Nepal. There were altogether 154 patients, who had sputum culture with resistance of at least one anti tubercular drug (ATD), included in this study.Results Of 154 total patients, 36 patients were resistant to rifampicin only, 84 patients were resistant to isoniazid and rifampicin, 18 patients were resistant to isoniazid, rifampicin and ethambutol and 16 patients were resistant to isoniazid, rifampicin and either streptomycin or fluoroquinolone. There was overall 71% cure rate in case of drug resistance tuberculosis. There was only statistical difference between cured and died patients in case of sputum conversion time with earlier sputum conversion in cured patients. Similarly, patients who were previously treated with category 2 ATD had only resistance to ethambutol or streptomycin or fluoroquinolone besides resistance to isoniazid and rifampicin compared to new patients and patients treated with category 1 regimen; as these groups were not found to be resistant to first three drugs.Conclusion There was overall 71% cure rate in case of drug resistance tuberculosis. Earlier sputum conversion was seen in cured patients compared to those who died during the treatment. Multiple drugs were resistant in patients previously treated with category 2 Anti-tubercular drugs.Birat Journal of Health Sciences 2016 1(1): 20-26
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Adhikari, Nilaramba, Ratna Bhattarai, Rajendra Basnet, Bhim Singh Tinkari, Badri Nath Gyawali, and Lok Raj Joshi. "Prevalence of Human Immunodeficiency Virus Infection among Tuberculosis Patients in Nepal." Journal of Nepal Health Research Council 17, no. 01 (April 28, 2019): 15–20. http://dx.doi.org/10.33314/jnhrc.v17i01.1768.
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Background: National Tuberculosis Program has envisioned to provide human immunodeficiency virus testing for all tuberculosis patients. However, human immunodeficiency virus testing coverage among notified tuberculosis patients is very low in Nepal. Hence, it is difficult to reflect the prevalence of human immunodeficiency virus infection among Tuberculosis patients based on the information available from the routine system. Hence National Tuberculosis Program carried out sentinel surveillance to assess the prevalence of human immunodeficiency virus infection among tuberculosis patients and its associated factors in Nepal.Methods: This study is cross-sectional study type conducted at six sentinel sites across the country. This study lasted for six months starting from March 2017 to August 2017. The sample size was calculated using Epiinfo STATCAL application assuming confidence interval at 95%, 85% power and 5% non-response rate. The required sample size was 1672 tuberculosis patients. Ethical approval was obtained from Nepal Health Research Council. All types of tuberculosis patients who were equal or above 15 years were included in the study. Human immunodeficiency viruse testing was performed among tuberculosis patients as per the testing algorithm recommended by national guideline.Results: The study was carried out among 1664 tuberculosis patients registered for tuberculosis treatment during the study period. More than two thirds of tuberculosis patients (67%) were male. The median age of tuberculosis patients was found 32 years. During human immunodeficiency virus testing, 41 out of 1664 tuberculosis patients were found human immunodeficiency virus positive resulting human immunodeficiency virus infection seroprevalence among tuberculosis patients to 2.5%. Prevalence of human immunodeficiency virus infection was significantly associated with age (P=0.002), caste/ethnicity (P=0.025), religion (P=0.015) and occupation (P=0.014) of tuberculosis patients.Conclusions: Prevalence of human immunodeficiency virus infection among tuberculosis patients was found 2.5%. Information and access to tuberculosis/human immunodeficiency virus services needs to be increased toaddress tuberculosis-human immunodeficiency virus co-infection in Nepal.Keywords: HIV; prevalence; TB; TB-HIV coinfection.
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Gupta, Ravi Shankar, Tarannum Khatun, Akhtar Alam Ansari, Amrullah Shidiki, Dipak Bhargava, Bidhya Gupta, and Anirban Majumder. "Problems and Solution to Diagnose Extrapulmonary Tuberculosis in Central Region of Nepal." Med Phoenix 1, no. 1 (July 31, 2017): 41–43. http://dx.doi.org/10.3126/medphoenix.v1i1.17888.
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Extrapulmonary Tuberculosis is high, challenging the clinicians to make correct diagnosis. Microscopy, culture and fine needle aspiration cytology have their limitations in regard to specificity and sensitivity. In this report, polymerase chain reaction is used for detecting and distinguishing Extrapulmonary Tuberculosis. A case of retropharyngeal abscess was selected from which pus was collected which was negative for microscopy and culture in routine microbiology as well as mycobacteriology. Cytopathological examination was also negative. Polymerase chain reaction was applied to detect Mycobacterium tuberculosis specific IS6110 gene. The patients responded with anti-tuberculosis treatment well. Polymerase chain reaction was introduced for diagnosis of Extrapulmonary Tuberculosis since it can be done within hours, monitor therapy and also differentiate Mycobacterium tuberculosis from other Mycobacterial species.MED Phoenix Volume (1), Issue (1) July 2016, page: 41-43
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Adhikari, Nilaramba, Ratna Bahadur Bhattarai, Rajendra Basnet, Lok Raj Joshi, Bhim Singh Tinkari, Anil Thapa, and Basant Joshi. "Prevalence and associated risk factors for tuberculosis among people living with HIV in Nepal." PLOS ONE 17, no. 1 (January 28, 2022): e0262720. http://dx.doi.org/10.1371/journal.pone.0262720.
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Background Worldwide tuberculosis (TB) takes more lives than any other infectious diseases. WHO estimates around 68,000 incident TB cases in Nepal. However, in 2018 only around 27,232 new TB cases were reported in the national system, resulting around 40,768 incident TB cases missing every year in Nepal. National Tuberculosis Control Center carried out this study in anti-retroviral therapy (ART) sites to estimate the prevalence of TB and identify the associated risk factors for TB among the people living with Human Immunodeficiency Virus (PLHIVs) in Nepal. Methods It was a cross-sectional institution-based study conducted between March and August 2018. Six ART sites with high caseloads of PLHIVs were selected. PLHIVs who were equal or above 18 years of age and were in ART program at the selected study sites were considered eligible for the study. Diagnosis of tuberculosis among PLHIVs who agreed to participate in the study was carried out as per the National Tuberculosis Management Guideline of National Tuberculosis Program of Nepal. Results Among 403 PLHIVs, tuberculosis was diagnosed in 40 (9.9%) individuals. Median age of the participants was 36 (30–43) years. Prevalence of TB was significantly higher among male PLHIVs than female PLHIVs (13.6% Vs 5.8%; P = 0.02) and Dalit ethnic group compared to Brahmin/Chettri (22.0%Vs5.9%, P = 0.01). The risk of developing TB was found significant among those with HIV stage progressed to WHO stage 3 and 4 (OR = 4.85, P<0.001) and with the family history of TB (OR = 4.50, P = 0.002). Conclusions Prevalence of TB among PLHIVs in Nepal was found 9.9%. Risk of developing TB was higher among PLHIVs who were male, Dalit, with HIV stage progressed to WHO stage 3 and 4 and with family history of TB. Hence, targeted interventions are needed to prevent the risk of developing TB among PLHIVs. Similarly, integrated, and comprehensive TB and HIV diagnosis and treatment services are needed for the management of TB/HIV co-infection in Nepal.
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Vaidya, Binit, and Shweta Nakarmi. "Simultaneous Adalimumab and Antitubercular Treatment for Latent Tubercular Infection: An Experience from Nepal." International Journal of Rheumatology 2019 (April 1, 2019): 1–6. http://dx.doi.org/10.1155/2019/2034950.
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Introduction. In Nepal, adalimumab is the most common agent being used, but in a disease activity-based dose tapering to address the economic constraints. Another constraint is the high risk of reactivation of tuberculosis in countries with high burden, especially with the use of tumor necrosis factor blocking agents. Though there are recommendations for screening and treatment of latent tuberculosis infection (LTBI) before using adalimumab, data is not clear regarding the appropriate screening schedule and the timing of initiation of biologic therapy. Methodology. This retrospective review of prospectively followed cohort of spondyloarthropathy patients aimed to evaluate the efficacy of simultaneous initiation of adalimumab with LTBI treatment. Patients fulfilling either the modified New York criteria for ankylosing spondylitis or Assessment in SpondyloArthritis international Society criteria and who were refractory to oral treatment were screened with Mantoux (≥10mm) and interferon gamma release assay (QuantiFERON) to detected LTBI. Those who tested positive were started on rifampicin/isoniazid combination for 3 months and adalimumab treatment on the same day. The patients were followed up at 2 weeks, 4 weeks, 12 weeks, and then every 3 months for 2 years. Results. Out of 784 patients diagnosed, 92 were receiving adalimumab. LTBI was detected by positivity of either Mantoux or QuantiFERON in 29.3% patients. None of the patients with LTBI who were started on the 2 drug regime simultaneous with adalimumab developed activation of tuberculosis. However, two patients testing negative for both the tests developed tubercular pleural effusion during treatment. Conclusions. Our findings indicate that screening for LTBI should be more frequent in patients from high tuberculosis burden countries; treatment of LTBI with rifampicin/isoniazid combination for 3 months is effective in preventing reactivation even when adalimumab is started simultaneously.
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Jaiswal, Saroj Kumari, Chandni Jaishwal, Shumneva Shrestha, Sudish Jaiswal, Aabhushan Bikram Mahara, Amar Suwal, and Randhir Sagar Yadav. "FACTORS ASSOCIATED WITH RELAPSE, DEFAULTER AND TREATMENT FAILURE IN TUBERCULOSIS TREATMENT IN EASTERN NEPAL." International Journal of Current Advanced Research 7, no. 05 (May 28, 2018): 12905–11. http://dx.doi.org/10.24327/ijcar.2018.12911.2286.
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Shrestha, Prakash, Hemanta Khanal, Prasanna Dahal, and Pranita Dongol. "Programmatic Impact of Implementing GeneXpert MTB/ RIF Assay for the Detection of Mycobacterium Tuberculosis in Respiratory Specimens from Pulmonary Tuberculosis Suspected Patients in Resource Limited Laboratory Settings of Eastern Nepal." Open Microbiology Journal 12, no. 1 (February 28, 2018): 9–17. http://dx.doi.org/10.2174/1874285801812010009.
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Background:In Nepal, introduction of GeneXpert MTB/RIF assay (Xpert assay) as an initial confirmation test for tuberculosis (TB) has been considered to have impact as a significant decrease in number of clinically diagnosed pulmonary tuberculosis (PTB) cases than previous years. This study aims to find out the distribution profile of suspected tuberculosis cases according to patients age, gender, treatment history and HIV status as well as to evaluate the utility of the Xpert assay over conventional acid-fast bacilli (AFB) staining method for the proper diagnosis ofM. Tuberculosisin respiratory specimens from the tuberculosis (TB) suspected patient samples.Methods:The prospective cross-sectional analytical study was conducted in National Anti-Tuberculosis Center (NATA) center- Biratnagar and Primary Healthcare Center (PHC) - Manglabare, Morang District, of eastern Nepal from January 2014 to August 2014. Laboratory investigation was done by conventional AFB staining followed by Xpert assay.Results:A total of 1549 sputum samples were initially analyzed. AFB staining resulted in 1441 AFB smear negative samples and 88 AFB smear positive samples, whereas 20 samples were directly processed for Xpert assay. The male: female smear positive ratio was 2.8:1 and was higher among age groups (21-40) years. Tuberculosis among HIV patients was found 22.22%. Xpert assay demonstrates that out of 1441 smear negative AFB cases, 258 were found to have TB positive, whereas out of 88 smears positive AFB cases 12 were found to have TB negative. The sensitivity of the Xpert assay in patients classified as AFB smear positive was found 85.4% and the specificity in smear negative patients was 81%.Conclusion:The study concluded that implementation of Gene Xpert MTB/RIF assay is a helpful tool for early and rapid detection of tuberculosis with greater sensitivity and specificity over traditional AFB staining techniques.
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Engelbrektsson, Ulla-Britt, and Madhusudan Subedi. "Experiences of Tuberculosis in a Tarai Village, Nepal." Dhaulagiri Journal of Sociology and Anthropology 13 (December 29, 2019): 1–10. http://dx.doi.org/10.3126/dsaj.v13i0.25890.
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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.
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Palikhey, Anjan, Dil Kapoor Kohar, Amit Kumar Shrivastava, Jharana Shrestha, Laxmi Shrestha, Chandrajeet Kumar Yadav, Jyoti Priyanka, Lokeshwar Chaurasia, and Dipendra Chaudhary. "Adherence to Anti-tubercular Agents in DOTS Center in Western Nepal." MedS Alliance Journal of Medicine and Medical Sciences 2, no. 3 (August 20, 2022): 6–11. http://dx.doi.org/10.3126/mjmms.v2i3.47654.
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INTRODUCTION: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and is one of the major public health problems in developing countries like Nepal. Despite the availability of effective tuberculosis treatment regimens, patients must take a combination of anti-tubercular drugs for at least six months and may endure numerous side effects, making treatment compliance exceedingly difficult to maintain. The primary objective of the study was to assess the adherence rate to anti-tubercular agents and to find the prevalence of adverse drug reactions to the anti-tubercular therapy. MATERIALS AND METHODS: This study was an observational study conducted in the DOTS centers of UCMS-TH, Bhairahawa, and Lumbini Provincial Hospital Butwal. A semi-structured questionnaire was used to collect data from 170 participants to determine the adherence rate to anti-tubercular therapy and the incidence of associated adverse drug reactions. Statistical Package for Social Sciences (SPSS Version 20) program was used to enter and analyze the data. The association between adherence and other variables was established using the Chisquare test. RESULTS: The adherence rate to anti-tubercular therapy was found to be 159 (93.5%). The major reasons for non-adherence include forgetfulness 8 (72.72%) followed by adverse effects 2 (18.18%) and transport difficulty in reaching the health facility 1 (9.1%). The prevalence of adverse drug reactions was 58 (34.12%) (27.1 - 41.2 at 95% Confidence Interval). Adherence was significantly associated with the experience of adverse effects, literacy, marital status, area of residence, and age of the participants. CONCLUSIONS: The adherence rate to anti-tubercular therapy was very high, which can be the primary determinant of tuberculosis treatment success.
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HARPER, IAN. "ANTHROPOLOGY, DOTS AND UNDERSTANDING TUBERCULOSIS CONTROL IN NEPAL." Journal of Biosocial Science 38, no. 1 (November 3, 2005): 57–67. http://dx.doi.org/10.1017/s0021932005000982.
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This paper argues for the inclusion of ethnography as a research methodology for understanding the effects of public health policy. To do this, the implementation of DOTS (Directly Observed Therapy, Short-course) – the World Health Organization (WHO) prescribed policy for the control of the infectious disease tuberculosis – is explored in the context of Nepal. A brief history of DOTS and its implementation in Nepal is outlined, and the way it has been represented by those within the Nepal Tuberculosis Programme (NTP) is described. This is followed by an outline of the research done in relation to this, and the ethnographic methods used. These ethnographic data are then interpreted and analysed in relation to two specific areas of concern. Firstly, the effects around the epidemiological uses of ‘cases’ is explored; it is argued that a tightening of the definitional categories so necessary for the programme to be stabilized for comparative purposes has profound material effects in marginalizing some from treatment. Secondly, the paper examines some of the implications and effects relating to the way that the ‘directly observed’ component was implemented. The discussion explores how current debate on DOTS has been played out in some medical journals. It argues for the importance of ethnography as a method for understanding certain questions that cannot be answered by particular, and increasingly dominant, research ideologies informed by randomized controlled trials. This raises important issues about the nature of ‘evidence’ in debates on the relationship of research to policy.
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Bichha, R. P., K. K. Jha, V. S. Salhotra, A. P. Weerakoon, K. B. Karki, and Navneet Bichha. "An Epidemiological Study to Find out Risk Factors of Multi Drugs Resistance Tuberculosis in Nepal." SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS 14, no. 2 (March 13, 2018): 31–38. http://dx.doi.org/10.3126/saarctb.v14i2.19335.
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Introduction: Drug resistant tuberculosis is a threat to tuberculosis control worldwide. Previous anti- tuberculosis treatment is a widely reported risk factor for multi drug resistant tuberculosis (MDR-TB), whereas other risk factors are less well described. In Nepal National Tuberculosis Control Programme initiated DOTSPLUS Pilot project from September 2005 using standardized treatment regimen.Objective: To explore the risk factors for MDR-TB in Nepal.Methodology: Institution based matched case control study with a case: control ratio of 1:2 was carried out in three regions of Nepal. Fifty five cases and 110 controls were selected. Current MDR-TB patients on treatment from DOTS–Plus clinic were enrolled as cases. Controls were age, sex matched cured TB patients and who had completed treatment either from the same centre or any DOTS Centre adjacent to that DOTS Plus Centre. Data was collected by a trained research assistant using interviewer administered structured questionnaire. Matched analysis was done using SPSS 16 version. Confounding effects were controlled by using matching, matched analysis and regression analysis.Results: In matched analysis following were the significant risk factors for MDR-TB in Nepal.(1) HIV Sero positivity (OR 15.9, CI 1.9- 133.0) (2) Travel cost more than 50 NRs per day (OR 6.5, CI 2.4- 9.8) (3) Contact history of TB (OR 3.8, CI 2.2- 6.6) (4) Living in a nuclear family (OR 6.0, CI 2.6- 13.9)(5) Non adherence to DOTS (OR 18.6, CI 2.27- 151.0) (6) Distance to treatment centre more than 5 Km ( OR 3.9, CI 1.5- 10.) (7) Previous history of TB ( OR 12.0, CI 5.4 -26.5)(8) Living in a rural area (OR 4, CI 2.1- 8.5) (9) Unmarried (Crude OR 3.3,CI 1.6- 6.8) (10) Un-employment (OR 3.4,CI 1.6-7.6)(11) Living in a rented house (OR 3.5, CI 1.77- 3.67) (12) Single bed room (OR 2.8, CI 1.13- 6.9). Using muti-variate analysis except living in a rented house and single bed room other variables were positive significant predictors for MDR –TB in Nepal.Conclusions: Many risk factors were related to the DOTS. Strengthening of DOTS programme to tackle the identified risk factors can reduce the MDR –TB burden in Nepal.SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS, Vol. 14, No. 2, 2017, Page: 31-38
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Prasad Paudel, Dille. "Treatment Compliance of Tuberculosis and Factors Associated in Bhaktapur District in Nepal." Journal of Health and Allied Sciences 1, no. 1 (November 27, 2019): 38–43. http://dx.doi.org/10.37107/jhas.91.
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Hurtig, A. K. "Linking private and public sectors in tuberculosis treatment in Kathmandu Valley, Nepal." Health Policy and Planning 17, no. 1 (March 1, 2002): 78–89. http://dx.doi.org/10.1093/heapol/17.1.78.
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Kharel, R. K., R. Sultana, R. P. Bichaa, R. P. Pant, A. P. Weerakoon, and K. B. Karki. "The Prevalence and Determinants of Active Tuberculosis among Diabetes Patients in Tertiary Care Hospitals of Nepal 2018." SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS 17, no. 2 (December 31, 2019): 22–28. http://dx.doi.org/10.3126/saarctb.v17i2.49111.
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Introduction: Researches implicated diabetes as independent risk factor for multi-drug resistant tuberculosis and unfavorable outcome of treatment. There is no data to address the association between diabetes mellitus (DM) and tuberculosis (TB) in Nepal. Thus we assessed the burden and demographics of active tuberculosis among diabetic patients attending tertiary care hospitals in Nepal.
Methods: A cross-sectional study was conducted in adult DM patients attending seven tertiary care hospitals representing five development region of the country. Relevant data were collected and participants were screened for active TB (symptom screening and microbiological diagnosis).
Results: Among the 520 enrolled DM patients screened, 23 had active TB. The prevalence was 4.42% (CI 2.96 - 6.54). The positive cases had older age group with the mean age of 59.73 ± 17.36 years with male predominance of 78% (18/23). Among the 23 positive cases, only two (8.69 %) had extra pulmonary TB. Diabetic control had significant (p=0.006) relationship to develop Tuberculosis. The comorbid conditions e.g., Hypertension (OR 13, 95% CI: 4.54 to 37.14); diabetic nephritis (OR 9.25, 95% CI: 2.03 to 42.20); and Diabetic neuropathy (OR 26.66, 95% CI: 5.16 to 137.71) are significant risk factors to develop tuberculosis among the diabetes patients. There were no significant differences in occupation, literacy rate, tobacco or alcohol consumption, HbA1c levels between TB and non-TB participants.
Conclusion: The prevalence of tuberculosis among diabetic patients is low in Nepal. This is the result of tertiary care hospital outdoor patients only, thus representativeness was compromised. Thus to assess the magnitude of comorbidities, mandatory screening in all level were recommended.
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Mishra, Gokul. "Health Seeking Behaviour among Past and Current Tuberculosis Patients in a Low-Income Country." TEXILA INTERNATIONAL JOURNAL OF PUBLIC HEALTH 9, no. 3 (September 30, 2021): 194–203. http://dx.doi.org/10.21522/tijph.2013.09.03.art017.
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In Nepal, the estimated incident cases are 0.07 million, of them, 0.03 million people are diagnosed and enrolled in the treatment annually, and numbers of undiagnosed people living with tuberculosis (TB) might be a threat to achieving END TB strategy targets. Understanding health-seeking behaviour and care pathways is crucial to reducing missed cases and decreasing TB transmission. The objective of the study was to identify the health-seeking behavior of TB patients and understand the reasons behind TB diagnostic and treatment delays in Nepal. This was a cross-sectional, population-based survey carried out in 99 clusters of 55 districts (total of 77) of Nepal. Primary Sampling Units were Village Development Committees or Municipalities and wards selected using systematic proportional to population size method. Of the total 54,200 people who attended in the survey, 1,825 had a history of TB and asked their health-seeking practice. 62% and 72% of the TB patients utilised the government health facilities for diagnosis and treatment. 18% of the TB patients said that they received diagnosis services, and 16% of patients took their treatment from outside of the country, especially India, due to fear of stigma and easy access to the services. The majority of the TB patients utilised government health facilities to receive diagnosis and treatment services. Some of the participants sought TB services from private health care providers, and a significant proportion of participants received them from India due to difficulty in accessing local services and fear of stigma and discrimination. Keywords: Community Based Directly Observed Treatment, Health Seeking Behaviour, Prevalence Survey, Tuberculosis.
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Sharma, Sunita, and Neeta Tamrakar. "Factors Associated with Treatment Compliance among Tuberculosis Patients Receiving Directly Observed Treatment Short Course Therapy." Journal of Health and Allied Sciences 5, no. 1 (November 21, 2019): 48–52. http://dx.doi.org/10.37107/jhas.35.
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Tubercular infection is still a pervasive public health problem in Nepal despite the massive efforts of National Health Service stakeholders. This study was carried out to identify the factors associated with treatment compliance among Tuberculosis Patients Receiving DOTS in 11 centres of Pokhara valley. A cross-sectional descriptive study design was used to collect information from 142 Tuberculosis patients. Purposive sampling method was used and chi-square test was used at 5% level of significance. Pattern of compliance was categorized as; compliance and non-compliance. Out of 142 respondents, majority (94.37%) of respondents was compliant and minority (5.63%) was non-compliant. Among non-compliant patients, (75.0%) of respondents missed their medicine in intensive phase and the reasons for non-compliance were carelessness of patients, forgetfulness of patients, confusion of staff, side effects of medicines and agitation by political parties. The study found no significant association of treatment compliance with demographic factors, patient related factors, health service factors and social factors (p>0.05). The finding was satisfactory that the compliance of TB patients was high i.e. (94.37%) of respondents were compliant. About (6.00%) of respondents were non-compliant. The reasons for non-compliance were due to their own cause rather than health service factors. They themselves were responsible for being non-compliant. Tuberculosis, being a major public health problem; six percent non-compliance is still a serious health problem and being non-compliant; these patients can transmit tuberculosis to many other healthy people in the family and community. Therefore, tuberculosis patients should be more conscious on treatment compliance to improve their health as well as of family and community.
Key words: Compliance, non-compliance, DOTS Therapy
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Shrestha, Umid Kumar, Dinesh Shrestha, Ramila Shrestha, and Arnab Ghosh. "Clinical profile of 103 patients with abdominal tuberculosis in Nepal." Journal of Advances in Internal Medicine 4, no. 2 (March 5, 2017): 51–56. http://dx.doi.org/10.3126/jaim.v4i2.16896.
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Background and aims: The nonspecific clinical features of abdominal tuberculosis (TB) have made its diagnosis difficult, which can lead to the poor outcome in patients who are not able to receive early treatment. Hence, the aim of our study was to determine the clinical profile of abdominal TB in the patients of Nepal.Methods: This is a prospective observational study in which 103 patients with abdominal TB were analyzed for clinical profiles from May 2010 to April 2015. All diagnosed patients received anti-tubercular treatment (ATT) and were followed up at 1 and 6 months of ATT.Results: Among 103 patients of abdominal TB [males 48 (46.6%), females 55 (53.4%); mean age 33.1 years (±12.9)], 47.6% had histopathological examination (HPE) confirmation, 27.2% had high ascitic adenosine deaminase (ADA) value and another 25.2% had suggestive imaging findings. The common symptoms were abdominal pain (84.5%), weight loss (75.7%), anorexia (63.1%), chronic diarrhea (56.3%) and fever (52.4%). The mean weight was <50 Kg, hemoglobin <11 gm/dl and Erythrocyte Sedimentation Rate >40 mm/first hour. The sites involved were ileo-cecal (35.9%), peritoneal (27.2%), ileal (15.5%), colonic (15.5%), lymph nodal (3.9%) and gastroduodenal (1.9%). The sensitivity of HPE for diagnosis of abdominal TB was 47.6% (95% confidence interval 37.6% to 57.6%). All patients of abdominal TB had a good clinical response after ATT.Conclusion: The common symptoms of abdominal TB were abdominal pain, weight loss, anorexia, chronic diarrhea and fever. Since the diagnosis of abdominal TB by HPE may not always be positive, other parameters such as ascitic ADA value, imaging findings and associated supportive clinical features have to be considered, and a therapeutic trial of ATT may be indicated so that all patients of abdominal TB can be treated early in the course of disease.
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Timalsina, Bivek, Bidur Kutu, Rusna Pradhan, and Bhagwan Maharjan. "Comparative Study on Ziehl-Neelsen Staining (Light Microscopy), Auramine O Staining (Iled- Fluorescent Microscopy) and Culture on LJ Media of Sputum Samples for the Diagnosis of Pulmonary Tuberculosis." International Journal of Medicine and Biomedical Sciences 1, no. 1 (October 30, 2015): 4–14. http://dx.doi.org/10.55530/ijmbiosnepal.v1i1.4.
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Tuberculosis is a particular infectious disease caused by Mycobacterium tuberculosis .The disease primarily affects the lungs and cause pulmonary tuberculosis diagnosed with smear positive. The prospective case-control study was conducted in the Nepal Anti-Tuberculosis Association (NATA), GENETUP lab, Kalimati, Kathmandu from July 2010 to October 2010, on sputum samples from patient visiting at the GENETUP lab with suspected pulmonary tuberculosis cases without treatment and follow-up cases after DOTS and MDR treatment. A total of 299 sputum samples (170 from 78 suspected cases, 42 from 22 follow-up cases with DOTS treatment and 87 from Follow-up cases with MDR) were collected aseptically. The study clearly indicated that the case detection rate (efficacy) of fluorescent microscopy (AO stain) is remarkably higher than that of ZN (light microscopy) ,with aided advantages of less eye strain, easy visualization, less time consuming and even detection of low number of bacteria (paucibacillary cases) in comparison to ZN method. the correct diagnosis of pulmonary tuberculosis requires combination of AO (fluorescent microscopy), culture and biochemical analysis.
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GC, G., Basista Rijal, and A. P. Sharma. "SURVEILLANCE OF ANTI-TUBERCULAR DRUG RESISTANCE." Journal of Nepal Medical Association 41, no. 142 (January 1, 2003): 311–13. http://dx.doi.org/10.31729/jnma.749.
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Tuberculosis is the leading cause of death in Nepal. Failure in early detection anddrug resistance are two most important problems in treatment and cure of thetuberculosis. The objective of the study was to assess the drug resistance pattern inMycobacterium tuberculosis isolated in Tribhuvan University teaching Hospital. Morethan 85% of isolates were sensitive to all the four drugs and 5.5% of isolates weremultidrug resistant. The drug resistant isolates were obtained more frequently frompreviously treated patients. More extensive studies should be carried out by independentorganizations to collect more representative data on drug resistance tuberculosis.Key Words: Tuberculosis, drug resistance and surveillance.
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Shrestha, Dipti, Bhagwan Maharjan, Jeewan Thapa, Mwangala Lonah Akapelwa, Precious Bwalya, Joseph Yamweka Chizimu, Chie Nakajima, and Yasuhiko Suzuki. "Detection of Mutations in pncA in Mycobacterium tuberculosis Clinical Isolates from Nepal in Association with Pyrazinamide Resistance." Current Issues in Molecular Biology 44, no. 9 (September 8, 2022): 4132–41. http://dx.doi.org/10.3390/cimb44090283.
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Without the proper information on pyrazinamide (PZA) susceptibility of Mycobacterium tuberculosis (MTB), PZA is inappropriately recommended for the treatment of both susceptible and multidrug-resistant tuberculosis (MDR-TB) in Nepal. This study aimed to collect information regarding PZA susceptibility in MTB isolates from Nepal by analyzing pncA and its upstream regulatory region (URR). A total of 211 MTB isolates were included in this study. Sequence analysis of pncA and its URR was performed to assess PZA resistance. First-line drug susceptibility testing, spoligotyping, and sequence analysis of rpoB, katG, the inhA regulatory region, gyrA, gyrB, and rrs were performed to assess their association with pncA mutation. Sequencing results reveal that 125 (59.2%) isolates harbored alterations in pncA and its URR. A total of 57 different mutation types (46 reported and 11 novel) were scattered throughout the whole length of the pncA gene. Eighty-seven isolates (41.2%) harbored mutations in pncA, causing PZA resistance in MTB. There was a more significant association of pncA alterations in MDR/pre-extensively drug-resistant (Pre-XDR) TB than in mono-resistant/pan-susceptible TB (p < 0.005). This first report on the increasing level of PZA resistance in DR-TB in Nepal highlights the importance of PZA susceptibility testing before DR-TB treatment.
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Mahato, R. K., W. Laohasiriwong, and R. P. Koju. "Prevalence and Determinants of Type 2 Diabetes among the Pulmonary Tuberculosis Cases in Nepal: A Cross Sectional Study." Kathmandu University Medical Journal 19, no. 4 (December 31, 2021): 474–80. http://dx.doi.org/10.3126/kumj.v19i4.49764.
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Background Since prehistoric time to the earlier 20th century, diabetes was accounted as comorbidity among tuberculosis patients, which is reducing the treatment efficiency.
Objective To investigate the prevalence and determinants of type 2 diabetes mellitus among tuberculosis patients in central development region of Nepal.
Method An analytical cross-sectional study was conducted by using structured questionnaire. Face to face interview as well as reviewing of the medical records of the tuberculosis cases has been performed during September 2018 - February 2019. The systematic random sampling was applied to select 306 tuberculosis cases. Then the respondents were examined for blood glucose level as well as Glycated haemoglobin (HbA1c) level to identify TB with Diabetes Mellitus. The proportion of respondents with fasting blood glucose level ≥ 126 mg/dl or a random blood glucose ≥ 200 mg/dl was considered as Tuberculosis with Diabetes Mellitus cases. Similarly, haemoglobin A1C ≥ 7% was accessed as amplified risk for tuberculosis. Multiple logistic regression was performed to analyse the factors associated with Tuberculosis with Diabetes Mellitus by using STATA. P value < 0.05 was taken as statistically significant.
Result A total of 306 tuberculosis patients were included in the study. The mean ± standard deviation of age of participants was 36.82±15.94 years. The proportion of male slightly exceeded than that of female with a ratio of 1.73:1. The prevalence of TBDM was 17.32% (95% CI: 13.05-21.58) of all diagnosed tuberculosis cases. Our multivariable analysis identified the factors those were associated with TBDM were age ≥ 45 years (adj.OR=3.97, 95% CI 1.81-8.71, p value 0.001), patients residing in the urban areas (adj.OR=9.75, 95% CI 1.99-47.6, p value 0.005), had Body Mass Index (BMI) <18.5 Kg/m2 (adj.OR=3.20, 95% CI 1.58-6.51, p value 0.001), had diastolic blood pressure ≥ 80 mmHg (adj.OR=2.34, 95% CI 1.17-4.66, p value 0.015) and patients who were treated with Cat II and Cat III tuberculosis treatment regimens (adj.OR=2.65, 95% CI 1.22-5.73, p value 0.013).
Conclusion The prevalence of type 2 diabetes mellitus among tuberculosis patients was higher than prevalence of diabetes in general population of Nepal and it was higher among male, urban residents, patients with low BMI and the older aged tuberculosis patients.
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Dahal, S., M. R. Banjara, D. Khadka, G. Ghimire, and S. Sharma. "Drug Susceptibility Profile of Mycobacterium tuberculosis Isolated from Patients Visiting National Tuberculosis Centre, Nepal." Tribhuvan University Journal of Microbiology 5 (September 26, 2018): 63–68. http://dx.doi.org/10.3126/tujm.v5i0.22314.
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Objectives: The objective of this study was to assess drug susceptibility pattern of Mycobacterium tuberculosis (MTB).
Methods: This cross-sectional study was carried out among 145 clinically suspected and previously treated pulmonary tuberculosis patients visiting National Tuberculosis Centre, Bhaktapur, Nepal. After obtaining written informed consent, questionnaire was administered and sputum samples were collected from each patient. Each sample was subjected to Ziehl-Neelsen (ZN) staining and cultured on Lowenstein Jensen (LJ) medium at 37ºC for 8 weeks. MTB isolates were identified by growth rate and colony morphology, confirmed by biochemical tests and drug susceptibility testing (DST) of identified isolates was performed by proportion method.
Results: A total of 49.7% (n=72) sputum samples were positive for MTB by culture and 46.9% (n=68) were positive by ZN staining. Among culture positive isolates of MTB (n= 72), 25% (n=18) were resistant to at least one drug. The prevalence of multi drug resistant tuberculosis (MDR-TB) was 15.3% (n=11) of which 5.56% (n=4) were resistant to rifampicin (RIF) only, 1.39% (n= 1) were resistant to isoniazid (INH) only. Out of 18 resistant isolates, 61.1% (n=11) were resistant to both RIF and INH, 21.43% (n=3) resistant to INH were susceptible to RIF and 26.67% (n=4) resistant to RIF were susceptible to INH. Smoking (P=0.001) and coughing (P=0.009) were statistically significant with isolation of MTB.
Conclusion: Since the prevalence of MDR-TB was high, MDR-TB strains should be identified in order to initiate second line treatment.
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Devkota, Janardan, Narmada Devkota, and Shyam Prasad Lohani. "Health Related Quality of Life, Anxiety and Depression among Tuberculosis Patients in Kathmandu, Nepal." Janaki Medical College Journal of Medical Science 4, no. 1 (January 12, 2017): 13–18. http://dx.doi.org/10.3126/jmcjms.v4i1.16380.
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Background and Objectives: Tuberculosis remains one of the major public health problems in Nepal. This study was carried out to assess the Health related Quality of life and Anxiety- Depression level of Tuberculosis patients in Kathmandu.Material and Methods: A cross-sectional study was conducted at Urban Direct Observation Treatment Short Course center using 150 study populations. Questionnaires containing socio-demographic characteristics, Self Reporting Questionnaire, Short Forms Health Survey, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale. SPSS 20, SF-36 Scoring Software were used for data management.Results: Majority of respondents (57.3%) were male, age group of 21-25 years. Majority of respondents suffered from Extra Pulmonary Tuberculosis, gland TB was in higher prevalence (31.3%). Most of the respondents found to poor HRQoL score where only 1.4% female and 1.7% male’s had above average HRQoL. There was no correlation between anxiety, depression, Mental Component Summary and Physical Component Summary score in pulmonary Tuberculosis patients unlike Extra pulmonary Tuberculosis patients, where there was strong correlation between anxiety and depression (r=0.721, p=0.000). There was negative correlation between PCS and MCS (r= -0.232, p= 0.037). There was no association between gender and PCS score on both types of TB patients. At majority of domain of HRQoL male had higher score than female.Conclusion: Co-morbidities of anxiety and depression in tuberculosis patients impact on health-related quality of life.Janaki Medical College Journal of Medical Sciences (2016) Vol. 4 (1): 13-18
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Bahadur Nepali, Ram, and Damaru Prasad Paneru. "Compliance to Directly Observed Treatment Short Course (DOTS) Chemotherapy among the Patient of Pulmonary Tuberculosis in Banke District of Nepal." Journal of Health and Allied Sciences 3, no. 1 (November 24, 2019): 17–20. http://dx.doi.org/10.37107/jhas.45.
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Tubercular infection is still a pervasive public health problem in Nepal despite the massive efforts of National Health Service stakeholders. High bacterial infectivity, transmissibility, increasing drug resistance and non compliance to the therapy have been adding up challenges to prevention and control of tuberculosis. This study was conducted to observe the treatment compliance pattern among new pulmonary sputum smear positive cases of tuberculosis. A cross sectional study was carried out in the year 2009. The 114 new smear positive pulmonary tuberculosis patients registered in the six selected DOTS centres of the Banke Disrtict were randomly selected. Participants were selected from each DOTS centre by probability proportionate sampling methods. Data were analyzed by SPSS (11.0 Version) and P< 0.05 was considered as significant. Overall compliance to DOTS was 86.80 percent; of these, 57.00 percent showed excellent and regular compliance followed by nearly 30 percent good compliance. And 13.20 percent participants were non complaint to DOTS therapy. Positive Family behaviors were positively associated with compliance while alcohol consumption was found to be negatively associated with compliance however; age, sex and income were found to be non significant factors for compliance. Feeling of getting cure even before the course of DOTS therapy (feeling better after 2-3 months regular treatment) and drinking habits were found to be the major causes of non compliance. Supportive family behaviors and avoidance of alcohol consumption may promote the compliance. Excellent treatment compliance in the face of many odds is highly encouraging and the pattern can be useful in treatment despite little non compliances; furthermore compliance can be enhanced by acting on these causes of non compliances.
Key words: Pulmonary, Tuberculosis, DOTS, Banke, Nepal
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Maharjan, Suresh, Bikash Khatri, Deepa Chemjong, Bijay Khatri, and Dibya Singh Shah. "Latent Tuberculosis Infection in Potential Renal Transplant Recipients and Live Donors in a Tertiary Level Transplant Center in Nepal." Journal of Nobel Medical College 11, no. 2 (December 31, 2022): 42–47. http://dx.doi.org/10.3126/jonmc.v11i2.50452.
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Background: Active tuberculosis in transplant recipients can result from latent infection with Mycobacterium Tuberculosis in the transplant recipients, donor tissue, or de novo post-transplant infection. This study aimed to determine the prevalence of latent tuberculosis infection in potential renal transplant recipients and live donors at a tertiary-level transplant center.
Materials and Methods: This observational study was conducted from July to October 2020 among 72 potential kidney transplant recipients and their potential donors from the Department of Nephrology, Tribhuvan University Teaching Hospital. The biochemical parameters and health behaviors were measured to find the association with latent tuberculosis infection.
Results: The prevalence of latent tuberculosis infection according to Mycobacterium tuberculosis-specific interferon-gamma release assays was 20.8% in potential recipients and 16.6% in potential donors, whereas the prevalence with tuberculin skin test was 9.7% in potential recipients and 33.3% in potential donors. Low levels of hemoglobin, calcium, albumin, vitamin D and history of smoking were associated with the development of latent tuberculosis infection among potential recipients. Alcohol drinking was significantly associated with the development of latent tuberculosis infection among donors.
Conclusion: Potential renal transplant recipients and donors have a significant burden of latent tuberculosis in the pre-transplantation phase. Diagnosis and treatment of latent tuberculosis before transplantation can prevent ominous complications.
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Bichha, R. P., K. B. Karki, K. K. Jha, V. S. Salhotra, and A. P. Weerakoon. "Barriers to Directly Observed Treatment for Multi Drug Resistant Tuberculosis Patients in Nepal - Qualitative Study." SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS 16, no. 1 (June 30, 2018): 6–18. http://dx.doi.org/10.3126/saarctb.v16i1.23239.
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Introduction: To prevent the multi drug resistant tuberculosis (MDR-TB) is important to adhere long duration of drug regimen. There are many factors or barriers that are likely to affect adherence to the long treatment regimen.
Objectives: To find out the barriers for adherence to MDR –TB treatment.
Methods: The study was conducted as an institutional based qualitative study, using a convenient sampling technique. Data was collected from 50 current MDR-TB patients by trained field health workers using semi structured interviewer administered questionnaire in all regions in Nepal. Twenty five focus group discussions (FGD) were also conducted with MDR-TB patients, cured MDR-TB patients, DOTS Committee Members, health workers and close relatives of MDR-TB patients to supplement the findings.
Results: Out of 50 respondents 19 were females and 31 were males. Their age varied from 22 years to 61 years. Majority of patients had a previous history of irregular TB treatment. Forty out of fifty patients (80%) were living in either rented houses or hostels (in Mid Western Region). Knowledge about TB and MDR-TB was satisfactory in majority of participants in both studies. Majority of participants were satisfied with facilities and services provided by MDR-TB clinics. There is a very little stigma associated with MDR-TB in Nepal. FGD revealed the onset of MDR-TB was attributed to causes such as smoking, alcohol abuse, poor nutrition, and contact with TB patients. Lack of money to go to health facility daily for treatment was reported as major barriers to adhere to MDR-TB treatment.
Conclusion: Financial constraints were the major barrier for these patients. To sustain proper MDRTB programme, Government of Nepal and other organization should provide social support to these patients.
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Verma, Avatar, Narendra Bhatta, Deebya Raj Mishra, Achyut Bhakta Acharya, Rejina Shahi, Sion Hangma Limbu, and Srijan Katuwal. "Navigating challenges in management of drug resistant tuberculosis: Case experience from Nepal." Nepalese Respiratory Journal 1, no. 1 (May 23, 2022): 28–30. http://dx.doi.org/10.3126/nrj.v1i1.45299.
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Drug resistant tuberculosis (DR TB) a severe form of TB is a disease of concern. Its treatment requires multiple toxic drugs for prolonged duration because of which, often have complicated course requiring close supervision, continuous encouragement from physician, management of side effects and modification of drug regimen for successful outcome. In this report, we are presenting a case of diabetic patient suffering from DR TB highlighting key diagnostic and management challenges.
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Prakash Shah, Naveen, Anil Regmi, Aakash Acharya, Jwala K.C., Bidur Khatiwada, and Meera Hada. "Sputum Smear Non-conversion at the End of Intensive Phase of Tuberculosis Treatment at a Tertiary Center: A Descriptive Cross-sectional study." Journal of Nepal Medical Association 59, no. 243 (November 15, 2021): 1090–93. http://dx.doi.org/10.31729/jnma.7020.
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Introduction: Sputum non-conversion is smear positive tuberculosis despite anti-tubercular therapy. Various factors may lead to sputum non-conversion including resistance to anti-tubercular drugs, age, gender, disease severity, non-compliance, drugs unavailability etc. Little is known and studied about the contribution of these individual factors. Our study sought to determine the prevalence of sputum smear non-conversion in patients at the end of intensive phase of tuberculosis treatment visiting a tertiary-level institution in Nepal. Methods: A descriptive cross-sectional study was conducted among recorded data of patients undergoing sputum Acid Fast Bacilli staining at the end of intensive phase at National Tuberculosis Control Center from April 2018 to April 2020. The study was approved by Nepal Health Research Council (Registration no: 76012020 P). The convenient sampling method was adopted. The data were analyzed using Microsoft Excel. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Our study found that out of 830 samples that were tested by Acid Fast Bacilli stain at the end of intensive phase, 40 (4.82%) (3.37-6.28 at 95% Confidence Interval) were sputum smear non-converters. The mean age of sputum non-converters was 41.25±15.543 years. Conclusions: The study shows that a significant proportion of patients remain acid-fast stain positive despite the treatment. However, the proportion is low compared to other similar studies around the globe. This study provides program managers with evidence to support the development of more tailored tuberculosis care and need to conduct more intensive studies about various factors that may lead to non-conversion.
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Nepal, AK, A. Shrestha, SC Baral, R. Bhattarai, and Y. Aryal. "Tuberculosis practices among private medical practitioners in Kaski district, Nepal." International Journal of Infection and Microbiology 1, no. 2 (January 20, 2013): 68–75. http://dx.doi.org/10.3126/ijim.v1i2.7085.
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INTRODUCTION: Although the evidences suggest that more than one third tuberculosis (TB) cases are being managed in private sector, the quality of care in private sector is major concern. However, the information regarding the private practices were lacking. Therefore the study was conducted to gain insights on current practices of TB management at private sectors. MATERIALS AND METHODS: A descriptive cross sectional study, applying quantitative method, was conducted at two cities of Kaski among all private practitioners, private pharmacies and private laboratories through self administered questionnaire and structured interview schedule. RESULTS: Nearly one fourth of the TB suspects in the district were found to have consulted private providers with about 20.0% of the total smear positive cases diagnosed in private laboratories. Beside sputum microscopy, Private Medical Practitioners (PMPs) were also found to prefer other tests like X-ray, culture for TB diagnosis. Similarly, PMPs’ varying prescription of anti TB drugs beyond National TB Programme (NTP) recommendation along with their weak recording and case holding were noteworthy, and the cost of TB treatment seemed higher in private sector. Only one third of private institution had their staff trained in TB. Except some informal linkage, no collaboration between public and private sector was noted. CONCLUSIONS: Private sector was managing many TB cases in the district. However, their practice of TB management was not much satisfactory. Therefore NTP should take effective measures for Public Private Mix and to make them aware of the standards through training and orientation in order to improve the quality of care. DOI: http://dx.doi.org/10.3126/ijim.v1i2.7085 Int J Infect Microbiol 2012;1(1):68-75
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Paudel, Sagun, Retna Siwi Padmawati, Ashmita Ghimire, Choden Lama Yonzon, and Yodi Mahendradhata. "Feasibility of Find cases Actively, Separate safely and Treat effectively (FAST) strategy for early diagnosis of TB in Nepal: An implementation research." PLOS ONE 16, no. 10 (October 26, 2021): e0258883. http://dx.doi.org/10.1371/journal.pone.0258883.
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Introduction Tuberculosis is one of the leading causes of death worldwide. Diagnosing TB in an early stage and initiating effective treatment is one of the best ways to reduce the burden of tuberculosis. Feasibility of Find cases Actively, Separate safely and Treat effectively (FAST) Strategy helps to improve the early diagnosis of tuberculosis cases among inpatient settings as well as out patient department patients and prevent TB transmission in hospital. This study aimed to assess the feasibility of the FAST strategy, organizational factors, technical factors, barriers and enablers for the proper implementation of the FAST strategy in Nepal. Methods A qualitative study was conducted from April 2019 to August 2019. Data was collected by using focus group discussion, key informant interviews, and client exit interviews. A retrospective research was conducted in different hospitals in Nepal where FAST strategy was implemented. The patients, health care workers, province, district, and National level stakeholders were interviewed. Thematic analysis was used to assess the feasibility as well as barriers and enablers of the FAST strategy. Results Study identified that the ‘current setting’ of implementation and service delivery arrangement at hospitals were not well arranged as per requirements. The research findings showed hospital ownership is crucial for mobilizing staff and proper space management inside hospitals. Study identified that unavailability of a separate room, limited capacity of GeneXpert machine, irregular supply of GeneXpert cartridge, and insufficient human resources for screening and counseling are the major barriers of FAST implementation in Nepal. Conclusion FAST strategy is feasible to implement in healthcare settings in Nepal although the technical and organizational factors should be managed to ensure effective function of the strategy as per the approach. Hospital ownership is essential to mobilize health workers, improve client flow system and proper space management for FAST services.
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Yadav, D., D. K. Yadav, and R. K. Yadav. "Prevalence of multi-drug resistance and its risk factors among tuberculosis patients in Kaski, Nepal." SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS 16, no. 2 (December 31, 2018): 1–7. http://dx.doi.org/10.3126/saarctb.v16i2.23336.
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Introduction: Multidrug-resistant tuberculosis is an intense and feared problem, difficult to control and has shown a trend of increase worldwide. MDR-TB poses a therapeutic and infection control challenge with significantly higher rates of morbidity and mortality. Hence, this study was conducted with objective to assess prevalence of multidrug resistance and its risk factors among Tuberculosis patients in Kaski district.
Methods: The main component of the study comprised institutional based cross sectional study design which was conducted in directly observed treatment short course (DOTS) centers in Kaski district. The study period was from July 2016 to December 2016. The sample size for the study was 175 participants. Data collection was done through interview with used interview schedule, and review of patient treatment cards. Data were entered in Epidata software and analyzed by using SPSS 20 version software.
Results: The prevalence of multidrug resistance in Kaski district was 5.7 per cent. Variables such as TB history in past, TB treatment in past, and cured in past are found statistically significant (p<0.005). People with prior history of TB were shown to be 19 times more likely to get MDR TB than those with no prior history (OR=19.056, CI: 4.522-80.294). People with complete TB treatment in past were 0.2 times less likely to get MDR TB than those with incomplete TB treatment in past (OR=0.182, CI: 0.075-0.441).
Conclusion: Present of previous TB infection and prior treatment outcome (to be defaulted or failed in treatment) were also identified as the risk factors for developing MDR TB. Proper surveillance system is to be established in terms of complete treatment to all TB patients that leads the prevention from MDRTB and prevent potent expensive costs from medical care for MDRTB patients.
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Engelbrektsson, Ulla-Britt, and Madhusudan Subedi. "The Local Explanatory Model: A Study of Assumed Causes of Tuberculosis in Rural Nepal." Dhaulagiri Journal of Sociology and Anthropology 10 (October 4, 2016): 37–62. http://dx.doi.org/10.3126/dsaj.v10i0.15880.
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Tuberculosis (TB) constitutes one of the major public health problems in Nepal. Our theoretical framework, in this paper, is to explore people's understanding of the culturally constructed reality, the local explanatory model, for causes of Tuberculosis. The ethnographic data were collected from 'Solubang' village of Pyuthan district in 2005 and 2012/13. The finding shows that assumed and suggested cause(s) of TB are multiple but most often within a framework of great uncertainty. Compared to 2005, people were better aware of the need for timely treatment in 2012/13. The arrival of the biomedical anti-TB medicines has changed the situation for the better and is widely recognized but perception on causes of TB and its prevalence have not changed drastically, and mortality rates have not decreased at the speed hoped for.
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Nepal, AK, K. Shiyalap, S. Sermsri, and B. Keiwkarnka. "Compliance with DOTS among tuberculosis patients under community based DOTS strategy in Palpa District, Nepal." International Journal of Infection and Microbiology 1, no. 1 (October 8, 2012): 14–19. http://dx.doi.org/10.3126/ijim.v1i1.6717.
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INTRODUCTION: Palpa is one of the rural districts of Nepal with high incidence of tuberculosis (TB) where Community Based Directly Observed Treatment Short Course (DOTS) strategy was being trailed to make TB services accessible at community level. In spite of this, it has high defaulter rate; every year more than 5% patients had defaulted from the treatment and death due to TB was around 6%. The study, therefore, aimed to assess the patients’ compliance to the treatment and its associated factors. MATERIALS AND METHODS: A quantitative crosssectional study was carried out using structured interview schedule. All registered TB patients (n=101) who were on treatment were enrolled in the study. RESULTS: TB patients of younger age group were found to be more compliant to the treatment (p=0.02). Side effect of the drugs was the major reason for the non compliance (36.00%). More than half of the TB patients had poor knowledge on TB and its treatment. Compliance was found to be significantly associated with knowledge (p=0.02) and perception (p=0.02) of the patients towards TB. Similarly, the study showed positive association between the compliance and service accessibility (distance: p=0.00), availability of treatment supervisor (p=0.01) and health education (p=0.02). CONCLUSIONS: Patients’ compliance with the TB treatment was found to be associated with their knowledge and perception on TB and its treatment. Health education and proper counseling was deemed necessary for the patients. Service accessibility along with communication skills training to the providers including community health volunteers can increase compliance rate. DOI: http://dx.doi.org/10.3126/ijim.v1i1.6717Int J Infect Microbiol 2012;1(1):14-19
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Bichha, R. P., K. B. Karki, R. Sultana, K. K. Jha, V. S. Salhotra, D. K. Khadka, and A. P. Weerakoon. "Study on Culture Positivity among Sputum Smear Negative Tuberculosis Suspects attending the National Tuberculosis Centre, Nepal." SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS 16, no. 1 (June 30, 2018): 38–43. http://dx.doi.org/10.3126/saarctb.v16i1.23244.
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Background: Globally, more than half of all TB cases are not detected. If they are not diagnosed and get treatment infection transmission may continue and patients suffer and may eventually die. Pulmonary TB either smear positive or negative is normally diagnosed by Ziehl-Neelsen stained sputum smear examination microscopy. Since the culture is the gold standard, evaluation of smear negative TB cases by this method is likely to detect more cases.
Objectives: The objective of this study is to find out culture positivity among smear negative patients.
Methods: All the three sputum samples reported negative by Ziehl-Neelsen microscopy from a total of 138 new TB suspected cases more than 15 years of age at NTC Laboratory. Nepal were cultured on Lowenstein-Jensen media. Tubes showing sufficient growth (culture positive) were recorded and all the culture positive results were informed to NTC. The culture positive samples were processed for DST on first line drugs using proportion method.
Results: The culture positivity rate was 5.1% (7 of 138 cases) All the positive cultures were processed for DST on first line anti-TB drugs and none showed resistance of the total 138 suspected Tuberculosis patients, 94 (68.1%) were males and 44 were females (31.9%) with male: female ratio 1:047. The mean age of the total patients were 30.69. Nearly 42% of them belonged to 31-50 years. Mean age of the male patients was significantly higher than total of the female (p<.001).
Conclusions: Seven smear negative cases among the total of 138 suspected TB patients attending NTC were culture positive. Similar study has to be done in other parts of the country.
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Rai, Bhola, Kritika Dixit, Raghu Dhital, Poonam Rishal, Suman Chandra Gurung, Puskar Raj Paudel, Gokul Mishra, et al. "Protocol for the Addressing the Social Determinants and Consequences of Tuberculosis in Nepal (ASCOT) pilot trial." Wellcome Open Research 7 (April 26, 2022): 141. http://dx.doi.org/10.12688/wellcomeopenres.17669.1.
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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 TB education and peer-led mutual-support TB Clubs providing TB education and stigma-reduction counselling. Economic support will be monthly unconditional cash transfers during TB treatment with expectations (not conditions) of meeting NTP goals. At 0, 2, and 6 months following TB treatment initiation, participants will be asked to complete a survey detailing the social determinants and consequences of TB and their feedback on ASCOT. Complementary process evaluation will use focus group discussions (FGD), key informant interviews (KII), and a workshop with multi-sectoral stakeholders to consider the challenges to ASCOT’s implementation and scale-up. A sample of ~100 people with TB is recommended to estimate TB-related costs. Information power is estimated to be reached with approximately 25 FGD and 15 KII participants. CONCLUSIONS: The ASCOT pilot trial will both generate robust evidence on a locally-appropriate, socioeconomic support intervention for TB-affected households in Nepal and inform a large-scale future ASCOT trial, which will evaluate the intervention’s impact on catastrophic costs mitigation and TB outcomes. The trial is registered with the ISRCTN (ISRCTN17025974).
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Rai, Bhola, Kritika Dixit, Raghu Dhital, Poonam Rishal, Suman Chandra Gurung, Puskar Raj Paudel, Gokul Mishra, et al. "Protocol for the Addressing the Social Determinants and Consequences of Tuberculosis in Nepal (ASCOT) pilot trial." Wellcome Open Research 7 (April 26, 2022): 141. http://dx.doi.org/10.12688/wellcomeopenres.17669.1.
Full textAbstract:
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 TB education and peer-led mutual-support TB Clubs providing TB education and stigma-reduction counselling. Economic support will be monthly unconditional cash transfers during TB treatment with expectations (not conditions) of meeting NTP goals. At 0, 2, and 6 months following TB treatment initiation, participants will be asked to complete a survey detailing the social determinants and consequences of TB and their feedback on ASCOT. Complementary process evaluation will use focus group discussions (FGD), key informant interviews (KII), and a workshop with multi-sectoral stakeholders to consider the challenges to ASCOT’s implementation and scale-up. A sample of ~100 people with TB is recommended to estimate TB-related costs. Information power is estimated to be reached with approximately 25 FGD and 15 KII participants. CONCLUSIONS: The ASCOT pilot trial will both generate robust evidence on a locally-appropriate, socioeconomic support intervention for TB-affected households in Nepal and inform a large-scale future ASCOT trial, which will evaluate the intervention’s impact on catastrophic costs mitigation and TB outcomes. The trial is registered with the ISRCTN (ISRCTN17025974).
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Rai, Bhola, Kritika Dixit, Raghu Dhital, Poonam Rishal, Suman Chandra Gurung, Puskar Raj Paudel, Gokul Mishra, et al. "Protocol for the Addressing the Social Determinants and Consequences of Tuberculosis in Nepal (ASCOT) pilot trial." Wellcome Open Research 7 (November 30, 2022): 141. http://dx.doi.org/10.12688/wellcomeopenres.17669.2.
Full textAbstract:
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 TB education and peer-led mutual-support TB Clubs providing TB education and stigma-reduction counselling. Economic support will be monthly unconditional cash transfers during TB treatment with expectations (not conditions) of meeting NTP goals. At 0, 2, and 6 months following TB treatment initiation, participants will be asked to complete a survey detailing the social determinants and consequences of TB and their feedback on ASCOT. Complementary process evaluation will use focus group discussions (FGD), key informant interviews (KII), and a workshop with multi-sectoral stakeholders to consider the challenges to ASCOT’s implementation and scale-up. A sample of ~100 people with TB is recommended to estimate TB-related costs. Information power is estimated to be reached with approximately 25 FGD and 15 KII participants. CONCLUSIONS: The ASCOT pilot trial will both generate robust evidence on a locally-appropriate, socioeconomic support intervention for TB-affected households in Nepal and inform a large-scale future ASCOT trial, which will evaluate the intervention’s impact on catastrophic costs mitigation and TB outcomes. The trial is registered with the ISRCTN (ISRCTN17025974).
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Rai, Bhola, Kritika Dixit, Raghu Dhital, Poonam Rishal, Suman Chandra Gurung, Puskar Raj Paudel, Gokul Mishra, et al. "Protocol for the Addressing the Social Determinants and Consequences of Tuberculosis in Nepal (ASCOT) pilot trial." Wellcome Open Research 7 (December 13, 2022): 141. http://dx.doi.org/10.12688/wellcomeopenres.17669.3.
Full textAbstract:
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 TB education and peer-led mutual-support TB Clubs providing TB education and stigma-reduction counselling. Economic support will be monthly unconditional cash transfers during TB treatment with expectations (not conditions) of meeting NTP goals. At 0, 2, and 6 months following TB treatment initiation, participants will be asked to complete a survey detailing the social determinants and consequences of TB and their feedback on ASCOT. Complementary process evaluation will use focus group discussions (FGD), key informant interviews (KII), and a workshop with multi-sectoral stakeholders to consider the challenges to ASCOT’s implementation and scale-up. A sample of ~100 people with TB is recommended to estimate TB-related costs. Information power is estimated to be reached with approximately 25 FGD and 15 KII participants. CONCLUSIONS: The ASCOT pilot trial will both generate robust evidence on a locally-appropriate, socioeconomic support intervention for TB-affected households in Nepal and inform a large-scale future ASCOT trial, which will evaluate the intervention’s impact on catastrophic costs mitigation and TB outcomes. The trial is registered with the ISRCTN (ISRCTN17025974).
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Pokhrel, Megh Raj, Pubudu Gamage, Mausam Kalita, Aibin Shi, and Stefan H. Bossmann. "Developing New Strategies for the Treatment of Tuberculosis Employing Ruthnium(II)Quaterpyridyl Compexes." Journal of Nepal Chemical Society 23 (July 31, 2009): 2–10. http://dx.doi.org/10.3126/jncs.v23i0.2091.
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A series of ruthenium(II)quaterpyridyl complexes has been synthesized as prototypes for mycobacterial channel blockers. These Ru(II)complexes show distinct changes in their luminescence spectra when bound to the porin MspA from M. smegmatis, which is a non-pathogenic relative of M. tuberculosis. By using HPLC, we have determined binding constants of the Ru(II)-complexes to MspA in phosphate buffer (0.05M, pH = 6.8) ranging from 5.2 x 109 M-1 (Ru-C2) to 1.8 x 109 M-1 (Ru-C4). Our findings indicate that channel blocking is a promising treatment strategy for mycobacterial infections. It appears to be also a viable approach towards luminescent nanostructures, because MspA features extraordinary stability.Keywords: Ru(II)complexe, porin MspA, mycobacterial infection, tuberculosisDOI: 10.3126/jncs.v23i0.2091Journal of Nepal Chemical Society, Vol. 23, 2008/2009 Page:2-10.
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Kumar Sah, Ranjit, Dwij Raj Bhatta, Gokarna Raj Ghimire, Bhuwaneswor Prasad Kandel, Bishnu Raj Tiwari, and Jeevan Bahadur Sherchand. "Evaluation of Nitrate Reductase Assay For Rapid Detection of Drug Resistant Tuberculosis." Journal of Health and Allied Sciences 3, no. 1 (November 24, 2019): 44–46. http://dx.doi.org/10.37107/jhas.53.
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Emergence of multidrug-resistant tuberculosis (MDR-TB) urgently demands for simple, rapid and inexpensive methods of its detection for the effective treatment of drug resistant tuberculosis, particularly in low-income countries. This prospective study was carried out at National Tuberculosis Reference Laboratory and South Asian Association of Regional Cooperation (SAARC) Tuberculosis and HIV/AIDS Centre, Thimi, Bhaktapur, Nepal, from November 2009 to May 2010 to evaluate nitrate reductase assay (NRA) efficacy for rapid determination of streptomycin, isoniazid, rifampicin and ethambutol susceptibility of Mycobacterium tuberculosis strains. A total of 113 clinical isolates of M. tuberculosis were tested for four first line antitubercular drugs by nitrate reductase assay and were compared with standard proportion method. Results were available in 7-14 days by NRA as compared to proportion method which generally takes 4-6 weeks. The sensitivity and specificity of NRA were 98.1% and 100% for isoniazid, 95.1% and 98.6% for rifampicin, 91.4% and 94.9% for streptomycin, and 78.6% and 97.9% for ethambutol respectively. Agreement between NRA and proportion method were 99.1%, 97.3%, 93.8%, 95.6% for isoniazid, rifampicin, streptomycin and ethambutol, respectively. NRA is easier, inexpensive and reliable method for susceptibility testing of Mycobacterum tuberculosis for isoniazid and rifampicin, the two most important drugs for the treatment of tuberculosis. The reduction in susceptibility testing time, and higher sensitivity and specificity of NRA method is of fundamental importance in detecting MDR-TB.
Key words: Drug susceptibility, MDR-TB, NRA, proportion method
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Khadka, Dhruba Kumar, Rajendra Prasad Pant, Bikash Lamichhane, Sharat Chandra Verma, R. P. Bichha, Prakash Ghimire, and Anjana Singh. "Identification of rpoB, gyrA and embB Gene Mutations in Mycobacterium Tuberculosis Isolates from Retreatment Tuberculosis Patients in Nepal." SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS 14, no. 2 (March 13, 2018): 39–50. http://dx.doi.org/10.3126/saarctb.v14i2.19336.
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Introduction: Tuberculosis remains one of the major public health problems in Nepal and increasing trend of multi drug resistant and extensively drug resistant tuberculosis (MDR /XDR TB) is a big challenge. Rapid diagnosis and appropriate treatment of MDR/XDR TB is crucial. Identification and comparison of MDR TB using rapid molecular techniques (for rpob, gyrA, rrs and embB gene mutations) with reference to drug susceptibility test (DST) were the main objectives of this study.Methodology: A cross sectional study was carried out in National TB Centre (NTC). Gene Xpert, proportion method and Line Probe Assay (LPA) were used for first and second line drugs susceptibility testing (FLD-DST and SLD-DST). A total of 29 mucopurulent sputum samples were freshly collected from retreatment TB patients (Female 41.4%, Male 58.6%) with median age of 40 years attending to the four MDR TB treatment centres of eastern and central Nepal (via private courier and directly to National TB Reference Laboratory (NRL) at NTC from April 2013 to October 2017.Results: Among 29 sputum samples (Female 41.4%; all smear+ve, Male 58.6%; 16 smear+ve and 1 smear-ve), Gene Xpert MTB/RIF assay detected 100% M. tuberculosis and rifampicin resistance (rpoB gene resistant) of which, 100% were culture positive by conventional Lowenstein–Jensen (LJ) method. FLDDST was performed on all culture positives of which, 96.6% showed MDR TB and 3.4% showed mono resistance to isonizid only. SLD-DST on 29 MDRTB strains by LPA showed 100%, 58.6%, 44.8% wild type for rrs, gyrA and emb B genes respectively. Mutation for gyrA and emb B genes was 41.4% and 51.2% respectively, rrs genes none. Twelve (Female 6, Male 6) MDR TB strains were identified as pre-XDR-TB. Chi square (χ2) for trend was used to analyze Gene Xpert, smear, FLD-DST and LPA results.Conclusion: From this study, 29(100%) MDRTB were detected from retreatment TB cases by Gene Xpert and FLDDST. Almost 41.4% MDR TB strains were detected as pre-XDR TB by LPA, which were found to be higher in 15-60 years group of females and males. Samples from retreatment TB patients need to be tested by rapid molecular techniques with reference to culture and DST.SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS, Vol. 14, No. 2, 2017, Page: 39-50