199036 Retrospective analysis of tuberculosis patients in directly observed treatment short course (DOTS) clinic in tertiary care hospital in Western Nepal

Tuesday, November 10, 2009

Kiran Sapkota, MS , Department of Health Science, MSC 3HLS, New Mexico State University, Las Cruces, NM
Robert W. Buckingham, Dr PH , Department of Health Science, MSC 3HLS, New Mexico State University, Las Cruces, NM
Kalyan Sapkota, MBBS , Manipal Teaching Hospital, Pokhara, Nepal
Vijaya K.c, MBBS , Manipal Teaching Hospital, Pokhara, Nepal
Nabaraj Adhikari, MSc , Department of Microbiology, Kantipur College of Medical Science, Kathmandu, Nepal
Lok Bahadur Thapa, MBBS , Kathmandu Model Hospital, Kathmandu, Nepal
Sabita Singh, MBBS , Manipal Teaching Hospital, Pokhara, Nepal
John Moraros, MD, PhD, MPH, CHES , Fred Hutchinson Cancer Research Center, Las Cruces, NM
Background: Tuberculosis remains one of the major public health problems in Nepal. Though DOTS program is very effective in Nepal, diagnosis of both pulmonary tuberculosis (PTB) and extra pulmonary tuberculosis (EPTB) still challenge clinicians and public health officials. This study provides a true picture of tuberculosis trend and problems in western and rural part of Nepal.

Methods: A retrospective analysis was carried out to 438 tuberculosis patients admitted to DOTS clinic in tertiary care hospital in western Nepal. Medical case records were examined with reference to patients' demographics, diagnostic tests implemented, disease pattern in PTB and EPTB, TB-HIV co-infection, relapse and death.

Results: Male to female ratio of tuberculosis was found to be 1.21. Among all the patients studied, 51.4 % were PTB and of them 58.0 % showed Acid Fast Bacilli (AFB) positive sputum smear. The common sites for EPTB were lymph nodes (33.0%), pleura (22.0%), peritoneum and/or intestine (14.0%). Among all of the diagnosed cases 4.41% showed relapse, 7.0% showed contact transmission and death was observed in 6.8% of cases. HIV-TB co-infection was found in 16.0% of the cases. PTB was diagnosed by clinical history, chest X-ray and sputum smear positivity. EPTB was diagnosed based on clinical presentation, no improvement with antibacterial therapy, biopsy and fluid analysis. No bacteriological confirmation was made in any of the EPTB cases.

Conclusion: Diagnosis of tuberculosis is still challenging in EPTB and in children in rural areas. Therefore development of rapid, simple and accurate diagnostic tools with applicability at point of care should be strengthened in Nepal.

Learning Objectives:
Participants will be able to explain about TB diagnosis, DOTS program, TB-HIV co-infection, relapse and death due to tuberculosis in tertiary care hospital in western Nepal. Participants will be able to describe obstacles in diagnosis and treatment of pulmonary and extra pulmonary tuberculosis in rural Nepal.

Keywords: TB, Nepal

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a graduate student at New Mexico State University and involved in design, data analysis and interpretation of the study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.