National Tuberculosis Program Update in Nepal #WorldTBDay #EndTB
- TB Free Nepal
- To reduce the mortality, morbidity and transmission of tuberculosis until it is no longer a public health problem and ultimately to eliminate TB.
Recommended: National TB Prevalence Survey, 2018-19 Key findings
- To reduce the incidence of TB by 20% by 2021 and 90% by 2035
- To reduce the TB deaths by 35% by 2020 and 95% by 2035
- To reduce the catastrophic cost to families due to TB to 0% by 2035
|SDG targets: 3.3.2 Tuberculosis incidence (per 100,000 population)||158||85||67||55||20|
Case Notification in Rates and Numbers (National) Annual Trend
- Globally, an estimated 10.0 million people fell ill with TB in 2075/76.
- Nepal population contributed to 0.35% of the global population, but with regards to TB, Nepal accounted for 0.5% of global TB cases.
- Among 32043 reported case, 82% of pulmonary cases were bacteriologically confirmed
Case notification in numbers and rates (Provincial level)
- Compared to National CNR – 109 / 100,000
- Bagmati province, Province 5 and 2 shared highest burden.
- Other provinces- under detection.
Proportion of child cases notified among TB cases
- National Childhood TB proportion- 5.5% (far less than Global estimates, under detection)
- Karnali province à very high rates (14.6%) than others, needs assessment.
Treatment Success Rate (%)
Sustained High treatment success rates in Nepal. Among reported, 32313 TB cases were successfully treated (TSR >90%) à better than global commitment of 85% or more.
DR Case notification, treatment coverage and outcome
- 392 reported cases of RR MDR; 0.6% new TB cases and 20% previously treated case (compared to 3.4% of new TB and 18% of previously treated cases globally)à possible under detection in Nepal
- Some progress in testing, detection, and treatment of MDR/RR-TB
- TB were tested for rifampicin resistance, up from 57% in 2074/75 to 78% in 205/76.
- The coverage of testing was 79% for new and 74% for previously treated TB patients.
- 71% were successfully treated (compared to global TSR of 56 %).
- 5% of MDR TB were treated with the new shorter regimen with 65% success rates.
- Key Challenges: nearly 38% are lost to follow up.
TB Preventives Services
NTP recommends TB preventive treatment for:
- household contacts under 5 years of bacteriologically confirmed pulmonary TB cases.
A total of 2026 PLHIV were started on TB preventive treatment in 2075/76, based on data from NCASC.
TBPT for children under five years who are the contacts of TB cases increased by 4-fold compared to FY 74/75 to 2,397.health
BCG vaccination is being provided as part of national childhood immunization programmes. The coverage of BCG vaccine was 92% in FY 74/75.2075/76, 2 397 children and 2 026 PLHIV received the TB preventive therapy which has improved since 2074/75. BCG vaccine can also confer protection, but mostly from severe forms of TB in children. BCG coverage in Nepal was more than 90%.
Key facts regarding Facilities
|MDR Treatment Centers||21|
|MDR Treatment Sub Centers||86|
|Microscopy Centers||604||Microscopy Centers|
|GeneXpert facility||56||Uses sputum sample, Result in 2 hour|
|Culture labs and DST||2||Duration of test is 2 month|
|Line Probe Assay(LPA)||2||Confirmation of DR TB from sputum positive samples, in 2 days|
- Domestic resources have been increased in the program 27% in 2013/14 and 55% in 2017/18.
- 3% decline of incidence per year, but gap still high.
- Treatment success rate for DSTB above 90% and DRTB- nearly 70%.
- Successfully completion of National TB prevalence survey in Nepal
- Expansion of sensitive molecular diagnostic tools (Genexpert) in the country from 22 Xpert centers in 2014 and 63 centers currently.
- DRTB patients are covered under health insurance (no premium needed).
- Tertiary hospital for TB program under construction.
- Initiated a shorter treatment regimen (9 months) for DRTB patients all over the country from 2017 and transition into all oral longer regimen as recommended by WHO.
Note: Information published here was obtained from presentation prepared by Dr. Anuj Bhattachan, Director, National Tuberculosis Program, Nepal. Download: World TB day 2020 NTP Presentation