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Open Access Screening retreatment tuberculosis patients for drug resistance in mid-west Nepal: how well are we doing?

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Setting:

Multidrug-resistant tuberculosis (MDR-TB, defined as resistance to isoniazid and rifampicin) is poorly detected in Nepal; one reason may be poor functioning of culture and drug susceptibility testing (CDST) services for retreatment tuberculosis (TB) patients. Objective:

To determine, among retreatment TB patients in mid-west Nepal, 1) the number of patients registered for treatment between July 2011 and July 2012; 2) the number submitting sputum specimens for CDST to the Central Reference Laboratory (CRL), Kathmandu, along with the results; and 3) the length of time for submission and receipt of specimens. Design:

Retrospective cohort study involving the review of treatment and laboratory registers from the Nepalgunj TB Referral Centre and the CRL. Results:

Of 431 retreatment patients, 66 (15%) submitted sputum samples, of which 63 reached the CRL. Of these, 39 (62%) were culture-positive; 13 (33%) patients had MDR-TB. The CDST results of 19 patients were received back at the TB Referral Centre. The median turnaround time from sending specimens to receipt of results at the TB Referral Centre was 119 days. Conclusion:

Less than 10% of retreatment TB patients in mid-West Nepal had CDST results recorded, leading to the underdiagnosis of MDR-TB in the region. Urgent solutions are needed to rectify this problem.

Keywords: Nepal; central reference laboratory; culture and drug susceptibility testing; multidrug-resistant tuberculosis; operational research; retreatment tuberculosis

Document Type: Research Article

Affiliations: 1: International Nepal Fellowship, Pokhara, Nepal 2: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France 3: School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India 4: Public Health Foundation of India, New Delhi, India 5: The Union, South-East Asia Regional Office, New Delhi, India 6: Nepal Anti Tuberculosis Association, GENETUP Central Reference Laboratory, Kathmandu, Nepal

Publication date: 21 March 2014

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  • Public Health Action (PHA), The Union's quarterly Open Access journal, welcomes the submission of articles on operational research. It publishes high-quality scientific research on health services, providing new knowledge on how to improve access, equity, quality and efficiency of health systems and services.

    The Editors will consider any manuscript reporting original research on quality improvements, cost-benefit analysis, legislation, training and capacity building, with a focus on all relevant areas of public health (e.g. infection control, nutrition, TB, HIV, vaccines, smoking, COVID-19, microbial resistance, outbreaks etc).

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