Tuberculosis case finding in remote mountainous areas - Are microscopy camps of any value? Experience from Nepal

Abstract

Setting: In the remote hills of North-East Nepal tuberculosis case-finding is believed to be low. The Britain-Nepal Medical Trust (BNMT), a well funded non-governmental organisation supporting Tuberculosis Control Programmes in this area, has a stable structure and sufficiently high case-holding to explore ways to increase case-finding. Objectives: To increase case-finding without decreasing case-holding, by expanding outreach services into remote areas away from existing health services. Design: Between 1990 and 1993, 45 temporary outreach tuberculosis diagnostic ‘microscopy camps’ were run in the eight districts covered by the BNMT (population 1330 000). Camp-diagnosed patients were followed up by cohort. Results: The camps did not appreciably increase the low rate of case-finding. However, the percentage of women who attended the camps was significantly higher than at existing services, as was the number diagnosed with smear-positive tuberculosis. The cured treatment completion rate of this camp-diagnosed cohort was 76%. Cost analysis revealed a low overall additional cost to the programme; however, it would be prohibitively expensive for an under-funded government health service. Conclusions: The implications of these camps go beyond tuberculosis control in their ability to reach those who would otherwise not utilise health care facilities.