HERD - NEPAL

Improving identification and diagnosis of TB suspects in Nepal

Diagnostic delays arising from inefficient management of TB suspects could potentially contribute to continued transmission. Long delays between sputum submission and smear examination, and loss of cases during referrals may contribute to low case detection. Patients may decline to go to referral centres for diagnosis, but the magnitude of the problem and reasons have never been investigated. The samples should be processed and the result reported within 24 hours of receipt at the laboratory. In Nepal, sputum microscopy services are available up to the district level (district hospitals and primary health centres). According to the NTC guideline, peripheral facilities (health posts and sub health posts) should prepare sputum slides from suspects and send them to microscopy centres. Often patients disappear during the course of referral though. This problem potentially affects early diagnosis and treatment of infectious TB cases. Nevertheless, there is a paucity of evidence about problems of the current TB suspect management at different levels of the health system.

The purpose of this study was to understand policies and practices of TB suspect management and test effective options for improving early identification and diagnosis of TB suspects in Nepal. In this study current policies and practices of management of TB suspects were reviewed in order to identify gaps that limit early diagnosis and develop effective interventions at different levels in the health system. Two intervention models developed in collaboration with NTP and the district health office were piloted in one/four purposefully selected districts representing. The new intervention model which entails peripheral facilities to send sputum slides from suspects to microscopy centre was prospectively compared with the ongoing suspect management (referral of suspects to diagnostic centres).