1634. Epidemiology of tuberculosis in Nepal
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Limited information is available on the epidemiology of tuberculosis and risk factors of multidrug drug resistance tuberculosis (MDR-TB) in Nepal. This study was designed to explore the epidemiology of tuberculosis and risk factors associated with MDR-TB in Nepal. The objectives of the study were to find out the distribution of tuberculosis in central Nepal and  to assess determinants of MDR tuberculosis in terms of socioeconomic, cultural, educational and behavioral factors; environmental factors, biological   factors and health service factor in Central Nepal.


The first part of the study was retrospective study done by assembling the secondary information on tuberculosis cases reported in the Central Nepal and to explore the determinants of MDR-TB, matched case control study was conducted.


The case notification, incidence and prevalence rate of Central Nepal were calculated as: 151/100,000; 182/100,000 and 245/100,000 respectively. As per the routine reports, MDR-TB in central Nepal is in increasing trend. The cause of drug resistant in Nepal is the result of complex web of biomedical, sociocultural and behavioral interaction and reporting of individual risk factor is over simplified. However, Injecting drug users are 5.13 times risk of MDR-TB, more likely to suffer from cirrhosis/liver infection, (p<0.001), diabetes (p=0.002) heart disease (p=0.044), gastritis (p=0.015), seizure (p=0.045). As per our study 179 (96.4%) MDR-TB cases had previous history of TB compared to none of the control (p<0.001). As per the finding, history of prior TB, previous smoking habit with OR= 4.5 (95%CI =1.24-16.20); social discrimination with OR=5.83 (95%CI =1.77-19.71) remained as the independent predictors of MDR-TB.


The persistence of the stigmatization of MDR-TB and of the people who suffer from it acts as a serious obstacle to the TB control. The present study clearly outlines that the pro-poor approach should augment and enhance the core objectives of national TB control programs to identify and effectively treat more TB patients. The provision of drug therapy in the treatment centres alone cannot address the problem of MDR-TB. Strengthening of DOTS program and to ensure completion of the treatment to avoid future risk of the development of MDR-TB seems crucial endeavour.

Sujan Babu Marahatta, Community Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal


S. B. Marahatta, None

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