Tuberculosis in Nepal: case-finding and quality control of sputum-smear examination

Abstract

To strengthen National Tuberculosis Programme (NTP) in Nepal, where tuberculosis still remains as one of major infectious diseases, the tuberculosis control project organized by the Japan International Cooperation Agency (JICA) has been carried out since April 1987. The programme has covered 55 districts out of 75 districts in the whole country, and the population in the project area was about 90% of the total population. 1) The numbers of sputum examination and of detected smear positive patient have decreased in 55 districts during the period from 1988 to 1991. The number of newly registered smear positive patients has decreased too, while the number of newly registered smear negative patients has increased during the same period. 2) Detection rate of smear positive pulmonary tuberculosis out of sputum examined cases was 11.0% in 1990-1991. The highest rate was observed in the central region (15.9%) and the rate was lowest in the mid-western region (6.7%). The rate was also high in plain (Terai) area (12.6%), while low in mountain area (7.3%). 3) At National Tuberculosis Centre (NTC), agreement rate between smear microscopy and culture examination has increased from 86.5% in 1990 to 88.9% in 1992. 4) Quality control of sputum-smear examination for the laboratories of the District Public Health Office (DPHO) was carried out in 1991. In smear staining, inadequate decolorization was obvious. In smear reading, agreement rate between positive and negative results was 90.3%. Disagreement rates in positive slides and negative slides were 16.3 and 2.4%, respectively. Correlation between the quality of smear-staining technique and of smear reading result was clearly observed.