Urban poor tuberculosis patients in directly observed therapy in kathmandu, Nepal

Objective: Given the public health importance of tuberculosis (TB), this study aimed to characterize the urban poor TB patients and assess the impact of Directly Observed Treatment Short course (DOTS) on employment in Kathmandu, Nepal. Methods: We used Probability Proportional to Size sampling to randomly select eleven DOTS centers in Kathmandu, Bhaktapur, and Lalitpur districts during 2012, and extracted data using on-site health records. A 29-question, 10-minute, structured survey was verbally administered to assess sociodemographic data, employment, and estimated cost and time for diagnosis among 217 DOTS-registered patients between 19 and 65 years of age, with pulmonary or extrapulmonary TB diagnosis who were actively taking anti-TB medicine. Results: Urban poor (58%) differed statistically significantly from urban non-poor (42%) on illiteracy, unemployment, rental housing, overcrowding, and private access to water and sanitation. Urban poor patients mainly used personal savings (51%, p<0.01) and money credit (46%, p<0.05) to pay for TB diagnosis. Among urban poor pulmonary TB cases, median time to diagnosis was 30 days (p<0.05) and the median cost was $40.63 per patient (p<0.05), respectively. After starting DOTS regiment, 44.4% of urban poor manual laborers became unemployed compared to 36.1% in the urban non-poor population (p<0.001). Implications: Unemployment increase during TB treatment exacerbate patients' already fragile economic condition. Further study should explore the relationship between the economic burden due to TB treatment and its impact on quality of life for TB patients among the growing urban poor population.