First national tuberculin survey in Nepal.

SETTING: The size of the tuberculosis (TB) problem in Nepal is unknown, as no national tuberculin or TB prevalence survey has yet been performed. OBJECTIVE: To assess the prevalence of TB infection and the annual risk of TB infection (ARTI) in primary schoolchildren in the three ecological zones (mountains, hills and terai) and Kathmandu valley. DESIGN: A representative sample of primary schoolchildren were tuberculin skin tested using the Mantoux method. The data were analysed using cut-off levels to define infection and by the mirror method. RESULTS: Of 19577 children registered, 17260 (88.2%) were available for analysis. Seventy-eight per cent had a visible bacille Calmette-Guérin scar. The best estimate of the prevalence of TB infection was 7.0% (95%CI 4.2-9.7), with an ARTI of 0.86% (95%CI 0.49-1.23) using the mirror method, with a mode at 16 mm. Although the ARTI was higher in Kathmandu and the mountains compared to the hills and terai, the difference between the areas was not significant. CONCLUSION: The ARTI in Nepal is lower than previous estimates, indicating a decrease in transmission or overestimation of previous estimates. To obtain information about the trend of the ARTI in Nepal, the survey needs to be repeated in 5 to 7 years.

Feasibility study of a district tuberculosis control programme with an 8-month short-course chemotherapy regimen utilizing the integrated health service network under field conditions in Nepal.

SETTING: Tuberculosis in Nepal has not been controlled; there is an annual risk of infection of more than 2%, a cure rate of 30-40% and a casefinding rate of 40%. The necessity of a pilot programme with short-course chemotherapy that could be applied across the nation was discussed, and an operational research project utilizing the existing basic health service network was launched. OBJECTIVE: The main objective was to assess the feasibility of integrating a tuberculosis programme into the basic health services under various field conditions, and of introducing an 8-month short-course chemotherapy regimen instead of the 12-month standard regimen. DESIGN: A tuberculosis control programme package based on the current international strategy was introduced in Dhading and Chitawan districts (population 650,000) in 1990. The reported results were confirmed by central supervision and a follow-up study. RESULTS: 454 new smear-positive cases were found in the first year. 69% were cured and 9% completed their treatment. However an 85% completion rate could be expected from the results of the follow-up study. CONCLUSION: An integrated tuberculosis control programme with short-course chemotherapy is feasible. An adequate supply of drugs and supervision are vital components. The results showed the possibility of achieving the international target of an 85% cure rate and 70% detection, even within the constraints of the field conditions in Nepal.