Towards Creating TB-free Nepal

Tuberculosis (TB) persists as a formidable health challenge, especially in developing countries. In fact, about half of the global TB cases are concentrated in eight countries: Bangladesh, China, India, Indonesia, Nigeria, Pakistan, the Philippines, and South Africa. Despite considerable progress in recent years, the prevalence of tuberculosis continues to be significant in South Asian countries including Nepal. According to the World Health Organisation (WHO), in 2022, Nepal reported approximately 69,000 new cases of TB, with an incidence rate of 229 per 100,000 population. This is the second highest incidence among SAARC countries, only after Pakistan. 

TB is caused by a bacterium Mycobacterium tuberculosis that commonly target the lungs but can also affect other parts of the body, including the kidney, spine, bones, and brain. The main factor contributing to TB in Nepal are poverty and limited access to education. Individuals with lower socioeconomic status are reported to face challenges in seeking timely medical care, leading to delayed diagnosis and treatment initiation. In addition, poverty-induced malnutrition weakens the immune system, making individuals more susceptible to TB. As malnutrition remains a grave concern in Nepal, addressing nutritional deficiencies is crucial in preventing and managing tuberculosis.

Risk of transmission

TB is an infectious disease and close contact between individuals in confined spaces increases the risk of transmission. Due to crowded living conditions in many communities, Nepal remains an ideal breeding ground for TB bacteria. To make the matter worse, access to healthcare services in remote and rural areas in Nepal is often limited. This results in delayed diagnosis and treatment, further exacerbating the propagation of TB. Strengthening healthcare infrastructure, especially in underserved regions, is essential for effective control of TB. The government, in collaboration with national and international non-government organisations (NGO), has taken significant steps towards addressing the burden of TB.  The key initiative towards a TB-free Nepal includes the National TB Control Program (NTP) that has been working towards improving TB diagnosis, treatment, and prevention strategies. 

The comprehensive objectives of the NTP include increasing case notification by improving health facility-based diagnosis and expanding diagnoses among vulnerable groups like children, People Living with HIV (PLHIV), and those with diabetes mellitus. Additionally, the programme aims to maintain a high treatment success rate, provide diagnostic services for drug-resistant TB, engage diverse healthcare providers through collaborative financing schemes, strengthen community systems for TB management, contribute to health system strengthening, develop a comprehensive TB surveillance system, and establish a contingency plan for the continuation of National TB Programme services during natural disasters or public health emergencies. 

These objectives collectively seek to enhance TB detection, treatment success, and overall program resilience while addressing specific challenges and vulnerable populations. In addition to government's initiatives, NGOs also play a vital role in community-based interventions against TB by raising awareness, providing support for TB patients, and facilitating early detection and treatment. In this regard, I recently gained insights into the efforts to combat the burden of TB in Nepal through a network meeting of Hospital Partnerships, a GIZ-supported project. During the event, I had the opportunity to learn about the impactful initiatives undertaken by a NGO, Nepal Anti-Tuberculosis Association (NATA). 

The non-profit voluntary organisation, NATA, founded in 1953, is committed towards fostering public awareness of TB and implementing preventive and curative measures for TB control. Serving as one of the oldest and valued partners of the NTP, NATA has built a longstanding collaborative history. With branches in 38 districts across Nepal, NATA has continually expanded its reach, actively engaging in health education programmes and providing curative services as part of its dedicated efforts in TB prevention and control since its inception. In conjunction with other NGOs actively working towards making TB-free Nepal, NATA has made significant contributions in alleviating the burden of TB in Nepal. Their impact is evident through a multifaceted approach encompassing prevention, curative interventions, diagnostics, and research initiatives.

Community awareness

Despite the progress made in minimising the burden of TB, several challenges persist in the fight against TB in Nepal. Some of these challenges include stigma associated with the disease, limited resources, and the emergence of drug-resistant strains of TB bacteria. 

To surmount these challenges, community awareness programmes emerge as pivotal tools that effectively mitigate stigma and promote early healthcare-seeking behaviour. In fact, global experiences have validated that involving communities in the battle against TB is indispensable for achieving success. Furthermore, directing investments towards research and innovation in the realm of TB control holds the potential to yield enhanced diagnostics, treatment protocols, and vaccines. Such advancements can play a pivotal role in significantly alleviating the burden of TB in Nepal.

Sustained efforts are essential to strengthen healthcare infrastructure in rural Nepal, ensuring timely access to diagnostic and treatment services for TB. This involves implementing regular training programmes for healthcare professionals to enhance their proficiency in state-of-the-art TB diagnosis and treatment. Equipping healthcare facilities with necessary resources for accurate testing is crucial, alongside bolstering contact tracing to identify potentially exposed individuals. Improved surveillance systems are vital for monitoring disease spread and targeting interventions effectively. Collaboration with international partners with experience in TB control is important. 

Furthermore, addressing root causes, implementing prevention strategies, and ensuring healthcare access are central to reducing TB's impact. Collaboration between government, healthcare providers, and the community is pivotal for achieving the goal of a TB-free Nepal.

(The author is a senior scientist based in Germany pushpa.joshi@gmail.com)