National Tuberculosis Program

Nepal

ANNUAL REPORT
2072/73 (2016)

Government of Nepal
Ministry of Health & Population
Department of Health Services
National Tuberculosis Center
Thimi, Bhaktapur
Abbreviations
ACF Active TB Case Finding
ACSM Advocacy, Communication and Social Mobilization
AHW Axillary Health Worker
AIDS Acquired Immune Deficiency Syndrome
ANM Axillary Nurse Midwives
ARI Acute Respiratory Infection
ART Anti-Retro Viral
BCG Bacille-Calmette-Guérin
BPKIHS BP Koirala Institute for Health Science
CAT I & II Category I and II
CDR Central Development Region
CNR Case Notification Rate
CSS Community Support Strengthening
DM diabetes mellitus
DOTS Directly Observe Treatment Short Course
DRTB Drug Resistant Tuberculosis
DST Culture and Drug Susceptibility Test
EDR Eastern Development Region
EP Extra Pulmonary
EQA External Quality Assessment
F Female
FDR Far Western Development Region
FQ Fluoroquinolones
FSW Female Sex Worker
GDF Global Drug Facility
GFATM Global Fund to fight AIDS, TB and Malaria
HIV Human Immunodeficiency Virus
HMIS Health Management Information System
I/NGO International/Non-Governmental Organization
IPT Isoniazide Preventable Therapy
ISTC International Standard for TB Care
LJ Lowenstein-Jensen
LPA Line Probe Assay
LTBI Treatments for latent TB infection
M Male
M&E Monitoring and Evaluation
MCs Microscopy centers
MDGs Millennium Development Goals
MDR-TB Multidrug-resistant TB
MGIT Establish Liquid Culture
MOH Ministry of Health
MOHP Ministry of Health and Population
MSM Men Who Have Sex with Men
MWDR Mid-Western Development Region
NCASC National Centre for AIDS and STD Control
NGO nongovernmental organization
NIP National Immunization Programme
NRL The National TB Reference Laboratories
NSA Global Fund Single-Stream Funding
NSP National Strategic Plan
NSP New Smear Positive
NTC National Tuberculosis Center
NTP National Tuberculosis Programme
OPD Out Patient Door
PAL Practical Approach to Lung Health
PHC Primary Health Centre
PHN Public Health Nurse
PLHIV People Living with HIV/AIDS
PMU Programme Management Unit
PPM Public Private Mix
PPMO Public Procurement Monitoring Office
PS Prevalence Survey
PSU Primary sampling unit
R/DTLO Regional/District Tuberculosis Leprosy Officer
RAD Return After Defaulter
RIT Research Institute for Tuberculosis
RR Rifampicin Resistance
RTC Regional Tuberculosis Centre
SCC Short Course Chemotherapy
SCI Save the Children International
SDGs Sustainable Development Goals
SLD Second Line Drugs
SRL Supranational TB Reference Laboratory
SS+ Sputum Positive
SSU Secondary Sampling Unit
T/STCs Treatment /Sub-Treatment Centers
TA Technical Assistance
TAG Technical Advisory Group
TB Tuberculosis
TOT Training of Trainers
TSR Treatment Success Rate
USD US Dollar
UVGI Ultraviolet germicidal irradiation
VCT Voluntary Counseling and Testing
VDC Village development committee
WDR Western Development Region
WHO World Health Organization
XDR Extensively Drug Resistant Tuberculosis
Executive Summary
Tuberculosis (TB) remains one of the major public health problems in Nepal. In 2015/16,
total of 32,056 cases of TB were notified and registered at NTP. There were 97% newer cases
registered (New and Relapse) among all TB cases. 73 % of all TB cases were pulmonary cases
and out of them 75% were bacteriologically confirmed. Among those bacteriologically confirmed,
28% were confirmed using Xpert MTB/RIF testing.
Nearly half of all TB cases (42%) of the cases were reported only from Central Region, where
as in terms of eco-terrain distribution, Terai belt reported more than half of cases (56%). Most
cases were reported in the middle age group with the highest of 20 % in 15-24 year of age. The
childhood TB is around 6% and Males were nearly 1.8 times more than female with reported
TB case.
Among 32,056 cases, 61% of cases were reported and managed under regular TB services.
Whereas, Private sectors contributed around 18% in referring and managing TB cases while
community involvement in referring TB cases was reported around 21%. Case Notification
rate (CNR) reported is 112/100,000. The rate of change is CNR is – 9 %. The decrease in
CNR even further from 2015 without much significant change in Incidence rate bring a need
to intensify efforts to identify the missing cases in the community.
TB-HIV co-infection rate in Nepal is 1.1% (HIV among TB) and 8.5% (TB among HIV)
based on the sentinel survey, 2016.
The definitions of TB treatment outcomes discussed here are for drug susceptible TB. Newly
registered cases (New and Relapse), were 90% treated successfully this year. But, the
success rates for the retreatment (Loss to follow up and failure) cases had relatively poor
treatment outcome with only 86% success rate. There is a huge need to scale up the HIV
testing for TB patients and vice-versa although 18% of TB patient have been tested for HIV.
The annual trend Success rates at National level for newer cases (new and relapse) is
constantly higher than 90% but the trend of success rates for the Retreatment cases (Loss to
follow-up and retreatment) have been constantly lesser but was stable around 90%.
Nationwide, the proportion of new cases with multidrug-resistant TB (MDR-TB) was 2.2%
among new cases and 15.4% among retreatment cases based on DRS survey carried out in
2011/12, and new surveillance on MDR TB has not been done in recent years. In 2015/16,
total of 309 MDR TB, Pre XDR 77, and 17 XDR TB was enrolled for treatment. Treatment
Success Rate (TSR) of MDR patients was 71%, however the TSR of XDR is low at 35%. The
drug resistant pattern in Nepal showed much higher levels of resistance to fluoroquinolones
(36%). Among the MDR patients, 8% further develop XDR.
TB services were provided through 4,321 treatment centres, 96 Urban DOT centres, 576
Microscopic centers and 27 Xpert centers in the country. DRTB services were provided
through 14 treatment centers and 81 Treatment Sub-centers. Though the DR TB services are
ambulatory, facility based services were also provided though 6 hostels and 1 DR home for
patient without access or needing inpatient services. Culture and DST facilities for DR TB
cases were provided from NRL/NTC and GENETUP reference laboratories at the central
level.
In 2015/16, USD 15,780,009 budget was allocated to the National TB Programme from the
Domestic, Global Funds, & LHL International, out of allocated amounts USD 6,299,280
(40%) consumed by the programme.
 TABLE OF CONTENTS

CHAPTER 1: INTRODUCTION 1

CHAPTER 2: THE BURDEN OF DISEASE 8

CHAPTER 3: DRUG RESISTANCE TUBERCULOSIS (DR-TB) 28

CHAPTER 4: DIAGNOSIS AND TREATMENT 32

CHAPTER 5: TB PREVENTION SERVICES 40

CHAPTER 6: UNIVERSAL HEALTH COVERAGE, SOCIAL PROTECTION AND

ADDRESSING SOCIAL DETERMINANTS 43

CHAPTER 7: NATIONAL TB PREVALENCE SURVEY 44

CHAPTER 8: PLANNING, MONITORING AND EVALUATION 47

CHAPTER 9: TB FINANCING 52

CHAPTER 10: RESEARCH AND DEVELOPMENT 55

CHAPTER 11: CAPACITY BUILDING AND DEVELOPMENT 59

CHAPTER 12: LOGISTICS MANAGEMENT 61

CHAPTER 13: HUMAN RESOURCES MANAGEMENT 62

CHAPTER 14: PARTNER’S CONTRIBUTION IN TB 63

CHAPTER 15: KEY CONSTRAINTS AND CHALLENGES 87

ANNEXURE 88
 LIST OF TABLES

TABLE 2.1: TARGETS OF REDUCTION IN TB DISEASE BURDEN SET IN WHO’S END TB STRATEGY 11
TABLE 2.2: CASE NOTIFICATION (ALL FORMS OF TB), 2015/16 16
TABLE 3.1: ESTIMATED AGAINST REGISTERED NUMBER OF RR/MDR TB 28
TABLE 4.1: REGION WISE DISTRIBUTION OF SPUTUM MICROSCOPY SERVICES IN NEPAL 33
TABLE 4.2 OVERALL AGREEMENT RATE 34
TABLE 4.3: GENEXPERT LOCATIONS 35
TABLE 4.4 ANNUAL GENE XPERT TEST 37
TABLE 5.1 NUMBER OF PLHIV ENROLLED IN IPT 41
TABLE 5.2 COVERAGE OF BCG VACCINE HAS REDUCED IN 2015/16 COMPARED TO PREVIOUS YEAR. 42
TABLE 7.1 TIMELINE OF NTPS 45
TABLE 9.1: FINANCIAL STATUS OF 2015/16 53

LIST OF FIGURES

FIGURE 2.1: DISTRIBUTION OF TB BURDEN AMONG DISTRICT BASED ON CNR(ALL FORMS OF TB) 15
FIGURE 2.2: REGION WISE DISTRIBUTION OF ALL TB CASE 17
FIGURE 2.3: ECO-TERRAIN WISE DISTRIBUTION OF ALL TB CASE 17
FIGURE 2.4: AGE WISE PERCENT DISTRIBUTION OF ALL TB CASES 18
FIGURE 2.5: AGE WISE DISTRIBUTION OF ALL TB CASE AMONG CHILDREN (6 % OF TOTAL TB) 18
FIGURE 2.6: GENDER WISE PERCENTAGE DISTRIBUTION OF ALL TB CASES 18
FIGURE 2.7: PERCENTAGE OF NON-NTP SECTOR OF CASE REGISTRATION AT NATIONAL LEVEL 19
FIGURE 2.8: PERCENT DISTRIBUTION OF PRIVATE SECTOR AND COMMUNITY REFERRAL TO TB
PROGRAM ON REGIONAL LEVEL 20
FIGURE 2.9: PERCENT DISTRIBUTION OF PRIVATE SECTOR AND COMMUNITY REFERRAL TO TB
PROGRAM ON ECO-TERRAIN LEVEL 20
FIGURE 2.10: ANNUAL FIVE YEAR TREND OF CNR (IN NUMBER AND RATE) AT NATIONAL LEVEL 21
FIGURE 2.11: ANNUAL TREND OF CNR IN NUMBER AND RATE OF 5 YEARS AT REGIONAL LEVEL 21
FIGURE 2.12: ANNUAL TRENT OF CNR IN NUMBER AND RATE OF 5 YEARS AT ECO-TERRAIN LEVEL 23
FIGURE 2.12: PERCENT DISTRIBUTION OF TB HIV TESTING AND ENROLLMENT IN ART 24
FIGURE 2.13: PERCENTAGE DISTRIBUTION OF TREATMENT OUTCOME OF TB (ALL FORMS)- NATIONAL
LEVEL 26
FIGURE 2.14: PERCENTAGE DISTRIBUTION OF TREATMENT OUTCOME OF TB(PBC)-NATIONAL LEVEL 26
FIGURE 2.15: ANNUAL TREND OF SUCCESS RATES OF NEWLY DIAGNOSED CASES 27
(NEW + RELAPSE) COMPARED WITH THE RETREATED CASES (NATIONAL) 27
FIGURE 3.1 ESTIMATED AND REPORTED NO. OF RR/MDR-TB OF 2072/73 28
FIGURE 3.2 CASE FINDING OF ALL FORMS OF DR-TB FOR 3 YEARS 29
FIGURE 3.3 CASE FINDING BY REGISTRATION CATEGORY 30
FIGURE 3.4 TREND OF TREATMENT OUTCOME OF RR/MDR-TB 31
FIGURE 4.1 NATIONAL AND REGIONAL WISE POSITIVITY RATE 34
FIGURE 4.2: GENE XPERT CENTRES IN NEPAL 35
FIGURE 4.3: CULTURE LABORATORIES IN NEPAL 38
FIGURE 8.1 SUPERVISION SYSTEM & SCHEDULE 47
FIGURE 8.2 MONITORING & EVALUATION 48
FIGURE 9.1 ANNUAL NTP BUDGET VS EXPENDITURE 54
 CHAPTER 1: INTRODUCTION

1.1 Background
Tuberculosis (TB) is a public

health problem in Nepal, as it is
responsible for ill health among TB is an infectious disease caused by the bacillus
thousands of people each year. TB Mycobacterium tuberculosis. It particularly affects the
is the sixth leading cause of death lungs (pulmonary TB) but can affect other sites as well
in the country. During this (extra pulmonary TB). The disease is spread in the air
reporting year, NTP registered when people who are sick with pulmonary TB expel
32,056 TB cases. Among them bacteria, for example by coughing. Overall, a relatively
14,954 (47%) were new smear small proportion of people infected with M. tuberculosis
positive TB cases, 2,492 (6%) will develop TB disease. TB is also more common
were smear positive retreatment among men than women, and affects mainly adults in the
most economically productive age groups.
cases, treatment after failure,
treatment after lost to follow up, The most common method for diagnosing TB
other previously treated and other nationwide is sputum smear microscopy, in which
treatment history unknown, bacteria are observed in sputum samples examined under
similarly 5,850 (18%) were a microscope. Following recent advances in TB
sputum smear negative and 8,760 diagnostics, the use of rapid molecular tests offered from
(27%) were extra-pulmonary TB 32 centres to diagnose TB and drug-resistant TB is
cases. Out of total registered cases increasing in Nepal. Likewise, 2 national reference
laboratories are also offering sputum culture facilities in
in NTP, there were 11,560 (36%)
the country.
female and 20,496 (64%) male.
According to the latest WHO data The currently recommended treatment for new cases of
published in 2014 Tuberculosis drug-susceptible TB is a six-month regimen (fixed dose
Deaths in Nepal reached 5,506 or combination) of four first-line drugs: isoniazid,
3.47% of total deaths. The age rifampicin, Ethambutol and pyrazinamide. Cured Rates
adjusted Death Rate is 27.80 per was 88% and Treatment Success Rates was 91% for new
100,000 of population ranks Nepal cases reported in 2014/15. Treatment for multidrug-
resistant TB (MDR-TB), defined as resistance to
43 in the world.
isoniazid and rifampicin (the two most powerful anti-TB
The majority of TB cases and
drugs) is longer, and requires more expensive and more
deaths occur among men, the
toxic drugs. For most patients with MDR-TB, the current
burden of disease among women regimens recommended by WHO last 20-24 months, and
seems significantly lower (2:1). treatment success rate was 73%.
TB mortality is unacceptably high
given that most deaths are
preventable if people can access tuberculosis care for diagnosis and the correct
treatment is provided. Short-course regimens of first-line drugs that can cure around
90% of all cases (Treatment success rate reported in 2015/16) have been recorded for
a decade. Nepal NTP has adopted the global WHO’s END TB Strategy as the TB
control strategy of the country.

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Vision of END TB Strategy-2016-35

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             
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             
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•       

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• 
•           
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

1.2 NTP Strategic Aim and Policies

1.2.1 Vision
TB Free Nepal

1.2.2 Goal
To reduce the TB incidence by 20% by the year 2021 compared to 2015 and increase
case notifications by a cumulative total of 20,000 from July 2016 to July 2021,
compared to the year 2015.

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 1.2.3 Objectives
Objective 1: Increase case notification through improved health facility-based
diagnosis; increase diagnosis among children (from 6% at baseline, to 10% of total
cases by 2021); examination of household contacts and expanded diagnosis among
vulnerable groups within the health service, such as PLHIV (from 179 cases at
baseline to over 1,100 cases in 2020/21), and those with diabetes mellitus (DM).
Objective 2: Maintain the treatment success rate at 90% patients (all forms of TB)
through to 2021
Objective 3: Provide DR diagnostic services for 50% of persons with presumptive
DR TB by 2018 and 100% by 2021; successfully treat at least 75 % of the diagnosed
DR patients
Objective 4: Further expand case finding by engaging providers for TB care from the
public sector (beyond MoH), medical colleges, NGO sector, and private sector
through results based financing (PPM) schemes, with formal engagements (signed
MoUs) to notify TB cases.1
Objective 5: Strengthen community systems for management, advocacy, support and
rights for TB patients in order to create an enabling environment to detect & manage
TB cases in 60% of all districts by 2018 and 100% by 2021
Objective 6: Contribute to health system strengthening through HR management and
capacity development, financial management, infrastructures, procurements and
supply management in TB
Objective 7: Develop a comprehensive TB Surveillance, Monitoring and Evaluation
system
Objectives 8: To develop a plan for continuation of NTP services in the event of
natural disaster or public health emergency

1.2.4. Strategic interventions for objectives

a. Strategic intervention for objective 1
Increase case notification through improved health facility-based diagnosis; increased
diagnosis among children, examination of household contacts and expanded diagnosis
among vulnerable groups within the health service, such as PLHIV, and those with
diabetes mellitus (DM).
o Improved and sustained public health facility based TB case finding
o Strengthen and expand TB diagnostic services
o Enhance TB diagnosis and treatment among children
o Active TB Case Finding (ACF)
o Strengthen TB-HIV collaboration between NCASC and NTP at all levels

1 In the first place the new PPM approach will be phased in in 3 districts to fully understand the
results based financing (PPM) schemes with non-state service providers and to ensure the formal
engagements (signed MoUs) are effective. Lessons will be learnt and applied in subsequent
districts.

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b. Strategic interventions for objective 2
Maintain the treatment success rate at 90% patients (all forms of TB) by 2020
o Ensure and strengthen uninterrupted supply and storage of quality assured
first-line TB drugs for all TB patients
o Promote psychosocial support system for TB patients

c. Strategic interventions objective 3

Provide MDR diagnostic services for 50% of persons with suspected MDR TB by
2018 and 100% by 2021; successfully treat at least 75 % of the diagnosed MDR
patients
o Establishment and operationalization of formal structures for DR TB
o Expansion of DR TB Treatment Services
o Capacity Building of Service Providers

d. Strategic interventions for objective 4

Further expand case finding by engaging providers for TB care from the public sector,
beyond MoH, medical colleges, NGO sector, and private hospitals and practitioners
through results based PPM financing schemes, with formal engagements (signed
MoUs) to notify TB cases. 100 municipalities by 2021
o Establishment and operationalization of formal structures for PPM
o Engagement of Medical Colleges and their hospitals

e. Strategic interventions objective 5

Strengthen community systems for management, advocacy, support and rights for TB
patients in order to create an enabling environment to detect & manage TB cases in
60% of all districts by 2017 and 100% by 2020
o Mobilize local community for TB case detection, treatment delivery and
patient support in districts
o Strengthen and expand advocacy and communications activities

f. Strategic interventions objective 6

Contribute to health system strengthening through HR management and capacity
development, financial management, infrastructures, procurements and supply
management in TB
o HR Management (including recruitment)
o Capacity building of all levels
o Infrastructure

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 g. Strategic interventions objective 7

Develop a comprehensive Surveillance, Monitoring and Evaluation system, research

and innovation

Focused justification for some key elements of the M&E Plan

Estimates of TB burden
The recent Epi review makes clear that there is considerable uncertainty around the
estimates of TB burden, i.e. of incidence, prevalence and mortality, in Nepal, which
makes it difficult to develop national targets for TB control. Therefore, a priority of
the NTP should be to work towards obtaining accurate data with which to inform
future interventions. The key areas of focus are:
• Provide better, timely and accurate notification of all TB cases, by improving
the TB surveillance system and related activities. Strengthening of the
surveillance system requires enhancing capacity for data management and
analytical practices of the M&E teams primarily at national, but also
regional/district levels, a focus on data quality, and regular, routine analyses of
data to inform progress towards achieving targets and key indicators.
• A prevalence survey, which will provide accurate data on TB prevalence in
Nepal. It can also indicate whether variation exists in TB burden between
different regions and eco-terrains.

Monthly reviews of data

The national level and regional/district level workshops that are currently held every 4
months are intended, under pressure from the Global Fund, to be held every 6 months.
The reasons for this (we guess) are they are felt to be unfocused and unproductive
meetings, and this is a bid to save money. This Plan takes the view that now is not the
time to reduce their frequency. The NTC and the M&E unit that should be created
with the hire of the epidemiologist and database manager needs to significantly
improve the surveillance and M&E work of the NTP, by preparing material
beforehand, presenting the data and appropriate analyses, defining the problems and
discussing solutions with the RTLOs/DTLOs who are the ones who need to take
corrective action in the field. This Plan intends to greatly improve the focus and
conduct of these meetings. Cutting the frequency of these meetings now, before the
Plan has a chance to work, would send the wrong signal about the importance of
M&E and reduce the opportunities to address under-reporting.

Measurement of presumed cases

The NTP should collate and analyse data on presumptive TB cases routinely in order
to assess the success of the TB control programme over time. When notifications
begin to fall (as they are currently (August 2016)) the examination of presumed cases
should rise, or at least remain stable, in a well-functioning programme. A fall in
number of presumed cases examined suggests a deterioration of programme
performance. Such data will also enable the NTP to determine whether any increases

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in CNR are due to increases in the number of patients tested for TB as a result of
better access to health care, expansion of TB services or active case finding.

Case-based, web-based electronic recording and reporting system

Such systems are now technically feasible and affordable and can automatically
generate reports that would take hours in paper-based systems. Currently, lack of
disaggregated TB data in the routine NTP surveillance system limits sub-group
analysis and design of district specific targeted interventions to reach the unreached
groups. The newly introduced electronic TB register should address this.

Childhood TB
Evidence of under-reporting was found during the standards and benchmarks
assessment (See Laura Anderson’s Epidemiological Assessment, Appendix 3, B2.3
for details). Surveillance should be strengthened around childhood TB in order to
assess the level of under-reporting and to ensure accurate monitoring of the diagnosis
and treatment of TB in children. Contact tracing activities, including source case
finding and engagement of paediatricians as part of PPM activities are encouraged.
The NTP currently lacks national guidelines on management and diagnosis of
childhood TB. These should be developed. All these “non-surveillance activities” are
in the activities for strategic intervention 1.3.

TB/HIV
New recording and reporting forms which include details on HIV are currently being
rolled out across the country and therefore data should be monitored closely by
DTLOs to ensure completeness and accuracy. The NTP should carry out HIV testing
on all TB patients – gradually rolling out to the remaining 40 districts currently
uncovered and data from all tests should be recorded and reported.

Treatment outcomes
The recording and reporting mechanisms for extra-pulmonary cases should be
reviewed as part of activities in 7.3, in order to capture treatment outcomes accurately.

h. Strategic interventions for objective 8

Management of public health emergencies.
Develop a plan, based on national risk assessment, to provide rapid, prioritized,
resumption of any interrupted TB services

1.3 Brief Organizational Overview of NTP

The National Tuberculosis Programme (NTP) is fully integrated within the general
primary health care system of Government of Nepal. National Tuberculosis Centre
(NTC) is the focal point of the NTP. It is responsible for formulating programme
policies, strategy and planning.
Central laboratory at the NTC is the focal point for the NTP laboratory network,
which is responsible for policy and guideline development, training, quality control

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 and supervision. Technical support, monitoring and evaluation, training, supervision,
logistics, health education, communication, and research are key functions of NTC.
Furthermore, quantification and procurement and supply of anti-tuberculosis drugs are
key responsibilities of the NTC. The NTC is procuring both first and second line anti
TB drugs for the TB patients from Global Drug Facility (GDF). Drugs are distributed
through the system of Logistics Management Division of the Department of Health
Services. NTC has also established Programme Management Unit (PMU) at the
central level for overall management of the Global Fund grants and provide technical
inputs to formulate policies, program, implementation, monitoring and evaluation for
the programme.
At the Regional level, NTP activities are planned and carried out in coordination and
cooperation with the Regional Health Directorate. The Regional Tuberculosis Centre
(RTC) in Pokhara provides technical support to TB control activities in the Western
Region in coordination with National Tuberculosis Center. There is full time
permanent Regional TB Leprosy Officers (RTLO) appointed in each region. Regional
levels are responsible for programme implementation within the regions. In addition,
the regional office is responsible for training, monitoring & evaluation and
supervision of programme activities. Regional office also provides logistical support,
supply of TB drugs and other requirement through Regional Logistic Management
Division
The main aim of the report is to provide a comprehensive and up-to-date assessment
of the TB epidemic and progress in prevention, diagnosis and treatment of the disease
at national, regional and district levels, based primarily on data that are reported by
districts to NTP in annual rounds of TB data collection. This 2016 annual TB report is
the twenty-one in the series of annual reports, and uses data reported by a total of 75
districts.

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 CHAPTER 2: THE BURDEN OF DISEASE

MDR
TB TB/HIV
TB

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 KEY FACTS AND MESSAGES

Global targets and milestones for reductions in the burden of TB disease in the period 2016–2035 have
been set as part of the Sustainable Development Goals (SDGs) and WHO’s End TB Strategy.

The first milestones of the End TB Strategy, set for 2020, are a 35% reduction in the absolute number of
TB deaths and a 20% reduction in the TB incidence rate, compared with levels in 2015. To reach these
milestones, the TB incidence rate needs to be falling by 4–5% per year globally by 2020 and the
proportion of people with TB who die from the disease (the case fatality ratio or CFR)a needs to be
reduced to 10% globally by 2020.

Globally, the absolute number of TB deaths (excluding TB deaths among HIV-positive people) and the
TB incidence rate has fallen since 2000. The number of TB deaths fell from 1.8 million in 2000 to 1.4
million in 2015. However, the global rate of decline in the TB incidence rate was only 1.5% from 2014
to 2015 and the CFR in 2015 was 18%. TB is one of the top 10 causes of death worldwide and caused
more deaths than HIV in 2015. In Nepal, however though the case notification rates have been
decreasing since 2015, but the estimated incidence is nearly similar (158 in 2015 and 156 per 100,000
in 2016), meaning NTP Nepal is still to identify the missing cases in the community and bring them to
treatment. It is estimated that around 8000-10000 cases are missed to be diagnosed in the community
or even if diagnosed are not reported to the NTP. It is estimated that in Nepal, every day, there are 120
New TB cases, 20 Deaths because of TB and 25 cases are missed to be diagnosed.

Worldwide in 2015, there were an estimated 10.4 million incident TB cases. An estimated 62% of these
cases were male, and 90% of cases were adults. Six countries accounted for 60% of the global total:
India, Indonesia, China, Nigeria, Pakistan and South Africa. The rate of progress in these countries will
have a major influence on whether or not the 2020 global milestones are achieved. In Nepal, around
64% of TB is reported in Male whereas nearly 95% of TB was reported in adults. NTP still has a lot of
challenge to diagnose and manage childhood TB cases in the country. (Childhood TB around 6%).

An estimated 11% of incident TB cases in 2015 were HIV- positive. The proportion was highest in
countries in the WHO African Region, and exceeded 50% in parts of southern Africa. Nepal has
however less burden of HIV (estimated prevalence around 0.17)_. It is estimated that around 8% of
HIV are co-infected with TB and around 1.8% of TB with HIV in Nepal (TB HIV sentinel survey,
Nepal, 2016).

Following WHO guidance issued in May 2016, all cases of rifampicin-resistant TB (RR-TB), including
those with Multidrug-resistant TB (MDR-TB), should be treated with a second-line MDR-TB
treatment regimen. Globally in 2015, there were an estimated 480 000 new cases of MDR-TB and an
additional 100 000 people with rifampicin-resistant TB who were also newly eligible for MDR-TB
treatment; India, China and the Russian Federation accounted for 45% of these cases. In Nepal, burden of
DR TB is not as high as there in the Region or globally. There are around 400 cases of DR TB annually and
is similar for past 3 years. The lack of availability and early screening of suspects with Rapid DST may still
be the main reasons for this stagnation of DR TB cases in the country.

Until national notification and vital registration systems (with standard coding of causes of death) of
high coverage and quality are present in all countries, national TB prevalence surveys will continue to
provide the best method for directly measuring the burden of TB disease and identifying actions
required to reduce that burden in an important subset of countries. Nepal is also planning to carry out
the First TB prevalence survey currently and plans to have its results by 2019.

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2.1 The burden of disease caused by TB
The burden of tuberculosis (TB) disease can be measured in terms of:

• Incidence – the number of new and relapse cases of TB arising in a given time
period, usually 1 year;
• Prevalence – the number of cases of TB at a given point in time; and
• Mortality – the number of deaths caused by TB in a given time period, usually
1 year.

Global targets and milestones for reductions in the burden of TB disease have been
set as part of the Sustainable Development Goals (SDGs) and WHO’s End TB
Strategy. SDG3 includes a target to end the global TB epidemic by 2030, with TB
incidence (per 100 000 population) defined as the indicator for measurement of
progress.

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 Table 2.1: Targets of reduction in TB disease burden set in WHO’s End TB
Strategy

INDICATORS MILESTONES TARGETS

2020 2025 2030 2035
Percentage reduction in the
absolute number of TB deaths
35 75 90 95
(compared with 2015 baseline)

Percentage reduction in the TB

incidence rate (compared with
20 50 80 90 (~10/100 000
2015 baseline)
population)
In context of Nepal, as we are yet to carry out the prevalence survey for TB, which is
the first-ever national surveys among the 12 other countries which are carrying out
the PS the burden for our context will be mostly based on Case Notification Rates.

TB incidence has never been measured at national level because this would require
long- term studies among large cohorts of people (hundreds of thousands),
involving high costs and challenging logistics. Notifications of TB cases provide a
good proxy indication of TB incidence in countries that have both high-
performance surveillance systems (for example, there is under-reporting of
diagnosed cases) and where the quality of and access to health care means that few
cases are not diagnosed).

For Nepal, as we estimated that we are still missing around (8000-10,000) cases a
year, we can’t entirely use CNR to reflect TB incidence of the country. This is also
the reason Nepal is going to carry out the National TB Prevalence Survey. This is
why until NTC completes the first PS, most of the estimation and analysis will be
based on the WHO estimates. In 2016, there were an estimated 59 (27–100)
thousand prevalent cases with the prevalence rate of 211 (99-365), annual incident
cases of 44(39-50) with incidence rate of 156 (137–176), whereas 32056 cases
have been notified to NTP, with annual case notification rate of 112/100,000.
WHO estimated 6.1 (4.4–8.0) thousand people died from TB (death Rate: 21 (15–
28), where only 915 TB deaths were only reported to NTP (Rate 2.8).

There were total 403 RR/MDR TB (Including XDR) reported this year and
around 9.7% people died of DR TB this year. It is estimated that around 8% of HIV
are co-infected with TB and around 1.1% of TB with HIV in Nepal (TB HIV
sentinel survey, Nepal, 2014). NTP tested around 17% of all TB in Nepal where 5%
of them had HIV positive. Childhood TB is reported around 6% among all TB cases
and Male were nearly 1.8 times more reported to have TB than Female in the
country, which is similar to the regional and global scenario.

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The MDG target of halting and reversing TB prevalence and death rate from 1990 to
2015 has already been achieved. Estimated prevalence rate in 1990 from 348
(162–602) to 211 (99–365) in 2015. Similarly, death rate of 52 (32–70) from 1990 is
now estimated to be around 21 (15–28). Target of reaching case detection rate of
85% by 2014 has also been achieved in year 2015 and is maintained since, along with
cure rate of 90% by 2016.

WHO definitions of TB cases recommended for use since March 2013 and that
were used by Nepal since 2015.

Bacteriologically confirmed case of TB:

A patient from whom a biological specimen is positive by smear microscopy,

culture or WHO-approved rapid diagnostic test (such as Xpert MTB/RIF). All such
cases should be notified, regardless of whether TB treatment is started.

Clinically diagnosed case of TB:

A patient who does not fulfill the criteria for bacteriologically confirmed TB but
has been diagnosed with active TB by a clinician or other medical practitioner who
has decided to give the patient a full course of TB treatment. This definition
includes cases diagnosed on the basis of X-ray abnormalities or suggestive
histology and extra pulmonary cases without laboratory confirmation. Clinically
diagnosed cases subsequently found to be bacteriologically positive (before or
after starting treatment) should be reclassified as bacteriologically confirmed.

Pulmonary TB:

Any bacteriologically confirmed or clinically diagnosed case of TB involving the

lung parenchyma or the tracheobronchial tree. TB is classified as pulmonary TB
because there are lesions in the lungs. Tuberculosis intra-thoracic lymphadenopathy
(mediastinal and/or hilar) or tuberculous pleural effusion, without radiographic
abnormalities in the lungs, constitute a case of extra-pulmonary TB. A patient
with both pulmonary and extra pulmonary TB should be classified as a case of
pulmonary TB.

Extra pulmonary TB:

Any bacteriologically confirmed or clinically diagnosed case of TB involving

organs other than the lungs, e.g. abdomen, genitourinary tract, joints and bones,
lymph nodes, meninges, pleura, skin.

New case of TB:

A patient who has never been treated for TB or has taken anti-TB drugs for less than
one month.

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 Retreatment case of TB:

A patient who has been treated for one month or more with anti-TB drugs in the
past. Retreatment cases are further classified by the outcome of their most recent
course of treatment into four categories.

1. Relapse patients have previously been treated for TB, were declared cured or
treatment completed at the end of their most recent course of treatment,
and are now diagnosed with a recurrent episode of TB (either a true relapse or
a new episode of TB caused by reinfection).

2. Treatment after failure patients have previously been treated for TB

and their most recent course of treatment failed i.e. they had a positive
sputum smear or culture result at month 5 or later during treatment.

3. Treatment after loss to follow-up patients have previously been treated for
TB and were declared ‘lost to follow-up’ at the end of their most recent course
of treatment.

4. Other previously treated patients are those WHO have previously been
treated for TB but whose outcome after their most recent course of treatment
is unknown or un-documented.

Case of multidrug-resistant TB (MDR-TB): TB that is resistant to two first-line

drugs: isoniazid and rifampicin. For most patients diagnosed with MDR-TB,
WHO recommends treatment for 20 months with a regimen that includes second- line
anti-TB drugs.

Case of rifampicin-resistant TB (RR-TB): A patient with TB that is resistant

to rifampicin detected using phenotypic or genotypic methods, with or without
resistance to other anti-TB drugs. It includes any resistance to rifampicin, whether
mono-resistance, multidrug resistance, poly-drug resistance or extensive drug
resistance.

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 TB Case Notification Rates in 2015/16:

Summary

In 2015/16, total of 32056 cases of TB were notified and registered at NTP. There
were 97% newer cases registered (New and Relapse) among all TB cases. 73 % of all
TB cases were pulmonary cases and out of them 75% were bacteriologically confirmed.
Among those bacteriologically confirmed, 28% were confirmed using Xpert MTB/RiF
testing.

Nearly half of all TB cases (42%) of the cases were reported only from Central
Region, where as in terms of eco-terrain distribution, Terai belt reported more than
half of cases (56%). Most cases were reported in the middle age group with the
highest of 37 % in 15-34 year of age. The childhood TB is around 6% and Males
were nearly 1.8 times more than Female with reported TB case.

Among 32056 cases, 61% of cases were reported and managed under regular TB
services. Whereas, Private sectors contributed around 18% in referring and managing
TB cases while community involvement in referring TB cases was reported around
21%.

Case Notification rate (CNR) reported is 112/100,000. The rate of change is CNR is
– 9 %. The decrease in CNR even further from 2015 without much significant
change in Incidence rate bring a need to intensify efforts to identify the missing
cases in the community.

The burden of disease caused by TB can be measured in terms of, prevalence and
mortality. As, Prevalence survey is yet to be carried out, the true prevalence and
projected incidence rates are rather not discussed here. This chapter discusses TB
scenario in terms of Case Notifications Rates (CNR), Case Detection Rates (CDR),
Cure Rates and Death Rates. The, discussion is more stratified in terms of
Developmental region and further ore analysis has been done in terms of terrains
(mountain, hill and Terai) as characteristics and dynamics of these different terrains
are of similar characteristics.

TB case notification (2015/16) data, National Level

The definitions of TB cases recommended by WHO as part of an updated

recording and reporting frame- work issued in March 2013. These updated
definitions were necessary to accommodate diagnosis using Xpert MTB/RIF and
other WHO-endorsed molecular tests, as well as offering an opportunity to improve
aspects of the previous (2006) framework, such as inclusion of more comprehensive
reporting of TB cases among children.

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 FIGURE 2.1: DISTRIBUTION OF TB BURDEN AMONG DISTRICT BASED ON CNR
(ALL FORMS OF TB)

The National Case Notification Rate (All forms) is 112 / 100,000 population. Based
on the CNR, there are 21 Districts which are considered high burden, 31 districts
considered as Medium Burden and 1 3 High burden districts are mostly from the
Terai belt and mostly concentrated in Central region.

Notifications of TB cases in 2015/16 are summarized for all districts in Table 2.2 In
2015/16, total of 32056 cases of TB were notified and registered at NTP. There were
97% newer cases registered (New and Relapse) among all TB cases. 73 % of all TB
cases were pulmonary cases and out of them 75% were bacteriologically confirmed.
Among those bacteriologically confirmed, 28% were confirmed using Xpert
MTB/RiF testing.

Nearly half of all TB cases (42%) of the cases were reported only from Central
Region, where as in terms of eco-terrain distribution, Terai belt reported more than
half of cases (56%).

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 Table 2.2: Case notification (all forms of TB), 2015/16
New cases or previous treatment history unknown Replase Percentage of
Burden of
ALL FORMS PBC Pulmonary Pulmonary pulmonary cases
TB based TERRIAN Districts CNR Extra-
on CNR
New+Replase Bacteriologically Clinically Bacteriologically Clinically Extra-pulmonary bacteriologically
pulmonary
Confirmed Diagnosed Confirmed Diagnosed confirmed
HILL Bhaktapur 619 180 315 269 45 235 46 6 7 51
HILL Makawanpur 770 173 504 446 120 124 58 4 2 68
HILL Surkhet 670 171 196 178 174 267 20 7 3 30
FLAT Dang 1013 166 506 419 274 204 87 2 7 51
HILL Sindhuli 495 162 333 266 86 67 67 0 2 68
FLAT Banke 888 158 540 480 121 195 61 2 5 63
High Burden Districts (21 Districts)

FLAT Kanchanpur 775 155 622 545 170 286 78 4 3 82

HILL Kathmandu 3149 154 1234 1033 320 1373 207 15 68 41
FLAT Chitwan 993 153 526 428 168 247 100 13 15 55
HILL Lalitpur 803 151 330 280 92 358 52 1 5 43
HILL Palpa 358 141 191 166 37 124 25 1 4 53
FLAT Rupandehi 1371 138 568 497 440 324 72 17 7 42
FLAT Parsa 906 135 517 455 192 179 62 3 2 58
FLAT Bara 1033 134 619 555 198 193 65 9 4 61
FLAT Mahottari 890 131 481 452 329 75 29 0 1 54
FLAT Sarlahi 1093 129 532 467 366 167 65 7 1 50
HILL Arghakhanchi 258 128 120 102 55 74 18 5 3 47
FLAT Kailali 1109 126 453 395 137 161 58 6 2 42
FLAT Nawalparasi 872 125 513 446 120 210 67 6 8 60
FLAT Jhapa 1086 123 674 607 138 256 67 5 2 63
FLAT Bardiya 555 121 334 304 76 125 30 2 0 62
FLAT Sunsari 989 116 580 532 100 262 51 2 0 62
HILL Rolpa 268 115 143 123 47 70 20 2 2 54
HILL Pyuthan 270 114 152 126 54 57 26 0 0 59
HILL Gulmi 295 111 122 107 61 104 15 5 2 42
FLAT Rautahat 855 109 422 383 267 146 40 4 0 51
HILL Rukum 237 107 116 99 50 68 17 0 0 50
FLAT Morang 1117 107 636 555 116 315 81 0 0 59
FLAT Kapilvastu 624 99 411 369 101 101 42 0 0 67
HILL Tanahu 328 97 184 159 39 83 25 3 8 57
HILL Gorkha 247 96 157 149 18 68 8 1 0 65
Medium Burden (28 Districts)

HILL Syangja 248 93 139 128 37 68 11 3 1 56

HILL Salyan 239 92 122 98 41 72 24 0 0 51
HILL Udayapur 307 90 195 172 49 62 23 0 0 64
HILL Nuwakot 255 90 147 127 45 53 20 1 0 60
HILL Kaski 485 88 233 203 32 200 30 0 3 49
HILL Lamjung 150 88 84 75 26 35 9 0 2 58
HILL Dhankuta 145 86 81 70 7 57 11 0 0 56
MOUNTAIN Darchula 120 86 70 58 36 14 12 0 0 58
HILL Dhading 296 85 178 148 18 83 30 4 7 62
MOUNTAIN Bajhang 175 83 93 76 23 48 17 1 4 55
MOUNTAIN Rasuwa 36 81 13 13 9 13 0 1 0 36
FLAT Dhanusha 634 78 361 337 139 116 25 3 2 58
HILL Baitadi 204 78 121 110 34 43 11 0 1 61
MOUNTAIN Manang 5 78 3 3 0 2 0 0 0 60
FLAT Siraha 525 77 328 314 122 64 14 5 1 63
MOUNTAIN Humla 43 77 13 10 10 16 3 2 0 35
HILL Dadeldhura 117 77 65 60 22 24 7 0 1 58
MOUNTAIN Dolakha 144 77 63 56 23 51 7 4 2 44
MOUNTAIN Kalikot 110 73 44 36 18 41 8 3 0 44
HILL Parbat 108 73 63 54 11 28 9 0 3 60
HILL Kavre 285 72 152 120 31 93 32 0 2 54
HILL Jajarkot 134 71 62 51 26 40 11 2 1 47
HILL Dailekh 201 71 94 88 38 69 6 0 0 47
HILL Doti 146 68 100 92 15 29 8 0 0 70
MOUNTAIN Bajura 100 68 62 59 8 23 4 0 0 64
FLAT Saptari 460 67 321 315 93 42 7 1 0 70
HILL Okhaldhunga 98 65 45 41 8 43 4 0 1 46
Low Burden Disease (26 Districts)

HILL Achham 176 64 111 102 21 30 13 0 0 70

HILL Myagdi 71 63 42 40 5 22 2 0 0 61
MOUNTAIN Sindhupalchok 184 63 106 100 26 44 6 3 4 58
HILL Khotang 117 62 50 45 8 58 5 1 0 43
MOUNTAIN Sankhuwasabha 87 55 46 44 10 31 2 0 0 53
HILL Baglung 146 52 88 76 11 45 12 0 1 61
MOUNTAIN Mugu 31 51 13 13 4 14 0 0 0 42
HILL Ilam 147 48 86 79 22 35 7 1 3 59
HILL Ramechhap 99 48 53 50 16 27 3 1 0 55
MOUNTAIN Jumla 50 42 23 20 6 19 3 0 0 50
HILL Bhojpur 65 39 33 27 4 27 6 0 0 51
HILL Panchthar 76 39 45 41 12 17 4 1 1 59
MOUNTAIN Taplejung 43 33 14 12 1 26 2 0 2 33
MOUNTAIN Mustang 4 32 2 2 0 1 0 0 0 75
HILL Terhathum 27 27 16 15 3 8 1 0 0 59
MOUNTAIN Dolpa 8 20 8 7 0 0 1 0 0 100
MOUNTAIN Solukhumbu 19 18 4 4 6 7 0 0 0 32
National 32056 112 17023 14983 5587 8358 2069 169 205 54

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 2.2 Ecological and developmental region wise case distribution

Regional Distribution of cases shows that around half (42%) of all cases were
reported in the central region, while Far western region has the lowest number of
cases of TB (9%). The distribution of new cases and retreatment cases was also
similar as the total notified cases. Nationally, it was seen that around 73% of all
pulmonary cases were bacteriologically confirmed this year, where central region
had only 71% pulmonary cases confirmed bacteriologically.

Looking at the percent distribution among terrain, there was a huge variance among
Hill, Mountain and Terai. Terai had the highest case burden with 55% where was
mountains had the least with 4% of all forms of TB. The distribution of new cases
was also similar, but distribution o f R e t re at m e nt c a s e s w a s e v e n more diverse,
with 61 % in Terai and only 4 % in Mountain. Though the cases were more in
Terai, but bacteriological confirmation were the least (72%) in Terai among other
eco-terrain with highest (78%) in Mountain.

FIGURE 2.2: REGION WISE FIGURE 2.3: ECO-TERRAIN WISE

DISTRIBUTION OF ALL TB CASE DISTRIBUTION OF ALL TB CASE

15% 9% 17%

17% 42%

Eastern Region Central Region

Western Region Mid-Western Region
Far Western Region

2.2.2 Percent Distribution by Age and Sex

Around 6% of cases were registered this year in childhood Age group and adult TB
was around 94% nationally, where Male were nearly 1.8 times reported more
than Female. Among the childhood TB population, most of them were (4%)
between 5-14 years’ age group. In country context like Nepal, where reach of health
system is still a big challenge and where it is estimated that nearly 20-25% of cases

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are being missed to be diagnosed from the community every year, the estimated TB in
children should not be less than 10-15%. But, given that the program is yet to notify
more than 6-7% of cases, TB transmission and early diagnosis of TB in children is a
huge challenge. In Nepal Male was nearly twice as more reported to have TB than
Female which is nearly same in the region and global context also. (M/F = 1.8:1)

FIGURE 2.4: AGE WISE PERCENT FIGURE 2.5: AGE WISE

DISTRIBUTION OF ALL TB CASES DISTRIBUTION OF ALL TB CASE AMONG
CHILDREN (6 % OF TOTAL TB)

FIGURE 2.6: GENDER WISE PERCENTAGE DISTRIBUTION OF ALL TB CASES

36

Female:
Male:
64

Contribution of Public-public and public- private mix initiatives and community to TB

case notifications and treatment support in 2014.

Ensure proper diagnosis, standardized treatment and prompt notification of all TB

cases to NTPs requires collaboration with the full range of health care providers.
Engaging all care providers in TB care and control is component four of the Stop TB
Strategy and part of pillar two (of three) of the post-2015 End TB Strategy.

Despite the best efforts of health systems, about one third of people who develop TB
globally are still either not diagnosed, or their cases are not reported. Difficulty in
accessing health facilities is one of the reasons why people with TB may not be
diagnosed, and can also have a negative impact on treatment adherence. Access to

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 health care can be affected by social and political factors (such as stigma and
discrimination, and the availability of cross-border services for migrants), and
economic barriers (for example, the cost of transport).

Like many other countries, it is estimated that a major bulk of TB cases are being
managed by the private sectors and most of which go unreported to the NTP.
2015/16 data shows that NTP itself is able to capture 61% of total registered
cases. Regarding the remaining 39%, Private sectors are involved in referring
and/or registering 18 % of cases. Far western seems to have very less contribution
from private sectors whereas the highest contribution was reported in the Western
Region. Community involvement in referring the TB cases nationally is around
21,. with highest referral from Central region and least in far western region.
Looking at the Eco-terrain distribution; Terai and mountain had fairly high
involvement of private sectors referral to TB program. Similarly, community
referrals are nearly twice as more in Terai compared to mountain and almost
negligible in mountainous region.

FIGURE 2.7: PERCENTAGE OF NON-NTP SECTOR OF

CASE REGISTRATION AT NATIONAL LEVEL
70
59
60

50

40

30
21
20 18

10
2
0
NTP PRIVATE COMMUNITY OTHERS

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 FIGURE 2.8: PERCENT DISTRIBUTION OF PRIVATE SECTOR AND
COMMUNITY REFERRAL TO TB PROGRAM ON REGIONAL LEVEL

25%

20%

15%

10%

5%

0%
Eastern Region Central Region Western Region Mid-Western Far Western
Region Region
NTP PRIVATE COMMUNITY OTHERS

FIGURE 2.9: PERCENT DISTRIBUTION OF PRIVATE SECTOR AND COMMUNITY REFERRAL TO

TB PROGRAM ON ECO-TERRAIN LEVEL

Mountain Hill Terai

31.5
24.9

13.5
9.1
8.4

6.9
2.8

1.5
0.6
0.5
0.3

0.0

NTP PRIVATE COMMUNITY OTHERS

2.3 Annual trends

The TB case notification has been stagnant over a decrease, but the decline of cases
were appreciated from 2015 (drop of 10% CNR from year 2014.) The cases notified
this year has further decrease from year 2015, with 9% drop of CNR from 123 in
year 2015 to 112 per 100,000 in 2016. Looking at the regional level, CNR is in
decreasing trend in all the regions. Far western region had the most significant drop
of 16%. Similarly, there is decreasing trend of CNR in all ecological regions. Terai
has significantly reduced this year. (-13%) followed by the mountain and hill.

District level CNR for last five year is shown in Annex and treatment level
analysis should be done to find out more detail of the actual reasons for this
significant reduction in case notifications.

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 FIGURE 2.10: ANNUAL FIVE YEAR TREND OF CNR (IN NUMBER AND RATE) AT NATIONAL
LEVEL
38000 160
37000 136 140
125 130 123
36000

Case notification rate

120
35000 112
100
34000
80
33000
60
32000
31000 40

30000 20

29000 0
68/69 69/70 70/71 71/72 72/73
National Total Notified Case Notification Rate

FIGURE 2.11: ANNUAL TREND OF CNR IN

NUMBER AND RATE OF 5 YEARS AT REGIONAL LEVEL

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 FIGURE 2.12: ANNUAL TRENT OF CNR IN
NUMBER AND RATE OF 5 YEARS AT ECO-TERRAIN LEVEL

2.4 TB/HIV Co-infections

TB HIV Co-infection is being addressed by the TB control program. Among the

registered TB cases, 18% of them have been tested for HIV, with 4.5 % out of them
positive for HIV and 89% of them on ART. Though the numbers are still not as
planned, but there has been an increase in the cases being tested from previous
years.

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 FIGURE 2.12: PERCENT DISTRIBUTION OF TB HIV TESTING AND
ENROLLMENT IN ART

Percent of TB/HIV Co-infection

IN ART % 73 89

POSITIVE % AMONG HIV TESTED 7.0 4.5

% OF HIV TESTED AMONG TB 7 18

ALL FORMS 34112 32056

2014/15 2015/16

2.5 Treatment outcome

Summary of Treatment Outcome

The definitions of TB treatment outcomes discussed here are for drug

susceptible TB. Newly registered cases (New and Relapse), were 90% treated
successfully this year. But, the success rates for the Retreatment (Loss to
Follow Up and Failure) cases had relatively poor treatment outcome with only
86% success rate. There is a huge need to scale up the HIV testing for TB
patients and vice-versa although 18% of TB patient have been tested for HIV.
The annual trend Success rates at National level for newer cases (New and
Relapse) is constantly higher than 90% but the trend of success rates for the
Retreatment cases (Loss to Follow-up and Retreatment) have been constantly
lesser but was stable around 90%.

Definitions of treatment outcomes for new and relapse cases recommended for
use since March 2013 by WHO and that were used by NTP since 2014/15

Cured:
A pulmonary TB patient with bacteriologically-confirmed TB at the beginning of
treatment who was smear- or culture- negative in the last month of treatment and on
at least one previous occasion.
Completed treatment:

A TB patient who completed treatment without evidence of failure but with no

record to show that sputum smear or culture results in the last month of treatment

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 and on at least one previous occasion were negative, either because tests were not
done or because results are unavailable.
Died:

A TB patient who died from any cause during treatment.

Failed:

A TB patient whose sputum smear or culture is positive at month five or later

during treatment.

Lost to follow-up:

A TB patient who did not start treatment or whose treatment was interrupted for
two consecutive months or more.

Not evaluated:

A TB patient for whom no treatment outcome is assigned. This includes cases

‘transferred out’ to another treatment unit as well as cases for whom the
treatment outcome is unknown to the reporting unit. Successfully treated: A patient
who was cured or who completed treatment.

Cohort:

A group of patients in whom TB has been diagnosed, and who were registered for
treatment during a specified time period (e.g. the cohort of new cases registered in
the calendar year 2012). This group forms the denominator for calculating
treatment outcomes. The sum of the patients included in the above treatment
outcome categories should equal the number of cases registered.

Definition of TB Treatment Outcomes

The definitions of TB treatment o u t c o m e s for new and relapse cases of TB that

are recommended by WHO as part of an updated recording and reporting
framework issued in March 2013, and used in the 2015 round of global TB data
collection.

Nationally, the treatment success rate for 34121 cases of the new and relapse cases
that were treated in the 2014/15 cohort was more than 90%. It is impressive that
even with the big size of the national treatment; still the treatment success rate first
improved and has subsequently been sustained at a high level achieving the MDG
set for 2015. Among the previously Treated cases excluding relapse (Failure and
Loss to follow up), the success rates were relatively lower (86%).

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 FIGURE 2.13: PERCENTAGE DISTRIBUTION OF TREATMENT OUTCOME OF TB
(ALL FORMS)- NATIONAL LEVEL

3% 2% 2%
1%

Cure
Complete
46% Failure
Died
Lost to flowup
46%
Not Evaluate

FIGURE 2.14: PERCENTAGE DISTRIBUTION OF TREATMENT OUTCOME OF TB

(PBC) - NATIONAL LEVEL

3% 3% 2%
1%

6%
Cure
Complete
Failure
Died
Loss to follow up
Not Evaluate

85%

2.6 Annual Trend of Treatment outcomes for National level

The trend of Success rates for TB has been higher than 90% consistently for few years
now. The annual trend Success rates at National level for newer cases (New and
Relapse) is constantly high around 90% but the trend of success rates for the
Retreatment cases (Loss to Follow-up and Retreatment) have been constantly
lesser but was stable around 80-85%. It was this year where the Success rates for the
retreatment cases have been to the lowest of around 72%.

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 FIGURE 2.15: ANNUAL TREND OF SUCCESS RATES OF NEWLY DIAGNOSED CASES
(NEW + RELAPSE) COMPARED WITH THE RETREATED CASES (NATIONAL)
100% 90% 90% 91% 90% 92% 90%

80% 85% 85% 84% 86%

83%
72%
60%

40%

20%

0%
67/68 68/69 69/70 70/71 71/72 72/73

New and Replase Retreatment (excluding Relapse)

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 CHAPTER 3: DRUG RESISTANCE TUBERCULOSIS (DR-TB)

3.1 Burden:
In 2014, WHO estimated that 2.2% (1.3 – 3.8%) of all new pulmonary TB cases and
15.0% (10-23%) of all retreatment cases were MDR-TB, which was similar to
proportions detected in the recent Drug Resistance Survey (DRS) 2011/2012.

An Extensively-Drug Resistant TB (XDR-TB) survey conducted by GENETUP in

2012 estimated the prevalence of pre-XDR (with ofloxacin resistance) at 28% and
XDR at 8% amongst MDR-TB cases. Resistance to an injectable agent was estimated
at around 2-3%.

Based on estimation the case finding for DR-TB by Laboratory confirmation and
reported DR-TB by types are as follows for FY 2072/73:

Table 3.1: Estimated against registered number of RR/MDR TB

Estimated no. of DR-TB For Registered no. of RR/MDR TB

enrollment

RR/MDR- Pre XDR-TB XDR-TB RR/MDR- Pre XDR-TB XDR-TB

TB with SLI or FQ TB with SLI or
Resistance FQ Resistance

446 83 31 309 77 17

FIGURE 3.1 ESTIMATED AND REPORTED NO. OF RR/MDR-TB OF 2072/73

446

309

83 77
31 17

RR/MDR-TB Pre XDR-TB XDR-TB

Estimated Reported

Above table and chart, show the estimated no. of laboratory diagnosed RR/MDR-TB
and registered no. of RR/MDR-TB for treatment of FY 2072/73. 69.3.0% of estimated
RR/MDR-TB cases, 93.0% of Pre XDR-TB and only 55.0% of XDR-TB cases were
enrolled for treatment.

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 FIGURE 3.2 CASE FINDING OF ALL FORMS OF DR-TB FOR 3 YEARS
379
349
309

64 77
25 9 15 17

RR/MDR-TB Pre XDR-TB XDR-TB

2070/71 2071/72 2072/73

Figure 3.2 shows the case finding trend of all forms of RR/MDR-TB for 3
consecutive fiscal years. 61% and 17% in fiscal year 2071/72 and 2072 /73
respectively increased case finding rate of Pre XDR-TB, increased trend of XDR-TB
also noted in 2071/72 and 2072/73 by 53% and 12% respectively. Case finding trend
of RR/MDR-TB was increased in fiscal year 2071/72 by 8% but decreased in 2072/73
by 22.6%.
Case finding done along with rapid DST means by Xpert or by conventional method
using solid media and DST. Conventional test facility available in two National
Reference Laboratories i.e; GENETUP and NTC whereas Xpert in 27 centres in the
county( Total 30 GenXpert). In this fiscal year total 667 culture was performed in 2
labs and among them 98 test are from new TB cases and 569 from retreated TB cases.
The contribution of MDR-TB diagnosis through conventional test gave 13 cases
found positive to MDR by this test. Total 15083 Xpert test was performed among
suspect, new and retreatment TB cases and 258 cases were found Rifampicin
Resistance.

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 FIGURE 3.3 CASE FINDING BY REGISTRATION CATEGORY
131

103 106 106

100
84
76
58 62 61
51
43

12 12 15 11 16
5

New Relapse Lost after FU Cat I failure Cat II failure Others

2070/71 2071/72 2072/73

Figure 3.3 shows the RR/MDR-TB case finding by registration category in FY

2070/71, 2071 and 2072/73. The trend seems not significant for three consecutive
years but case finding among new cases is remarkably in increasing trend i.e; new
RR/MDR-TB contribution in registration category covering 14.6%, 15.3% and 1.20%
for 3 consecutive years means NTP is simultaneously diagnosing early RR/MDR-TB
cases. Likewise the contribution of “category II failure after first line treatment” in
registration category is in decreasing trend i.e; 30.8%, 28.0%, 25 % for consecutive
year means again early case diagnosis is improving before cases reached category II
failure.
A total of 309 RR/MDR-TB cases registered for treatment in FY 2072/73 among
them 50 cases (16.0%) from Eastern region, 123 cases (39.8%) from Central region,
58 cases (18.7%) from Western region, 28 cases ( 9%) from Mid-western region and
50 cases ( 16.1%) from Far-western region. Almost half of the total RR/MDR-TB
cases registered in Central region.

Case Holding
Drug Resistance patient getting ambulatory treatment management from 17 DR-TB
Treatment Centre and 83 DR-TB Treatment Sub-centre from 46 districts. For those
patient who need residential care and management due to various reason benefitted
through 6 DR-TB Hostel, 1 DR-TB Home, 1 DR-TB Referral Centre and 1 TB
Hospital established in the country. Sputum culture follow-up mainly carried by two
national reference laboratories by using sputum courier. Biochemical, smear, clinical
and chest x-ray follow-up regularly provided by concern DR-TB Treatment Centre.

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 Treatment Outcome

FIGURE 3.4 TREND OF TREATMENT OUTCOME OF RR/MDR-TB

76
71
67

12 11
9 9 11 8 8
11
7

Rx Success Died Failure Loss to F/U & TO

2068/69 2069/70 2070/71

Figure 3.4 shows the treatment outcome of RR/MDR-TB only. Trend of treatment
success rate is decreasing by 5% and 4% on cohort of FY 2069/70 and 2070/71
respectively. % of died and failure is in increasing trend during the treatment period
especially on cohort of FY 2070/71.
Treatment success rate of XDR-TB is extremely low ranging from 13% to 33% for
consecutive year. Most of the XDR-TB patient died within the treatment period due to
disease severity, complication and toxicity.

Challenges in DR-TB management:

• Lack of surveillance of presumptive DR-TB cases (Retreatment, non-converter,

DR-TB contacts, TB/HIV co-infected, health worker working in DR-TB
management).
• Sample collection and testing: No full coverage of sample currier system and
referral tracking mechanism.
• Insufficient in-patient facility for treatment initiation and complication
management.
• Inadequate Infection Control System established in health institutions.
• No active and effective tracking mechanism for initial lost to follow-up.

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 CHAPTER 4: DIAGNOSIS AND TREATMENT

4.1 Diagnosis of TB, DR-TB and TB- HIV

Early diagnosis and treatment of tuberculosis is the major interventions to reduce the
TB incidence in Nepal. Success in early detection and treatment will automatically
break the chain of disease transmission and decreases the mortality of patient. For the
early diagnosis of the disease various tools had been used and have also demonstrated
to be efficient and effective, in spite of their limitations.

These are areas to be taken in mind for every programmer.

I. To ensure early detection of tuberculosis

II. To detect all cases of drug resistant tuberculosis
III. To roll out new diagnostics
IV. To implement systematic screening for tuberculosis among selected high
risk group

4.2 Diagnostic tools for Tuberculosis

4.2.1 Laboratory Diagnosis

• Sputum smear microscopy

• Culture and DST
• Molecular technique

i) GeneXpert

ii)Line Probe Assay

iii) Loop mediated isothermal amplification (LAMP)

• Biopsy Examination for tissue

• Fine Needle Aspiration Cytology for fluids
• Montoux test – Hypersensitivity reaction test
• Lipoarabinomannan (LAM)
• Interferon-gamma assay (IGRA)

4.2.2 Radiological Diagnosis

• Chest X-Ray
• USG
• Ultrasound
• C.T Scan
• MRI

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 Smear Microscopy:
Smear microscopy plays a key role in diagnosing tuberculosis and monitoring its
treatment. It is the primary method for diagnosis of pulmonary tuberculosis in low and
middle-income countries. Though it has low sensitivity but it is a simple, rapid and
inexpensive technique, it also has a poor track record in diagnosing extra- pulmonary
tuberculosis, pediatric tuberculosis and tuberculosis in patients confected with HIV: it
provides no information on the viability and drug susceptibility of the bacilli, and it
cannot distinguish between Mycobacterium tuberculosis complex and non-tubercle
Mycobacteria. It only detects Acid Fastness of bacillus. ZiehlNeelsen (Light
Microscopy) and Auramine O (Fluorescence Microscopy) staining techniques are
applicable to detect acid fastness of bacillus. Fluorescene Microscopy has high
sensitivity than light microscopy.

Smear Microscopy Network Coverage

Currently there are 576 microscopy centers delivering sputum microscopy
examination throughout the country. Majority of the microscopy centers are
established within government health facilities; some are established in non-
governmental organizations as well as in the private sector. NTP is responsible for
providing laboratory reagents, chemicals and other equipment’s to each of the
microscopy centers. In addition this, NTP conducts sputum microscopy basic training
to newly recruited laboratory personnel. The distribution of microscopic centre is
based on the population density and burden of disease. Terai belt is highly dense
populous area where most of microscopy centers are located. Mountain belt is under-
serve as geographically.

Table 4.1: Region wise distribution of sputum microscopy services in Nepal

Region Microscopic Centers

Eastern 128
Central 194
Western 98
Mid-Western 80
Far Western 76
National 576

External Quality Assessment (EQA) of each level microscopy center is an important

part of NTP. An EQA programme is needed to ensure that smears are performed and
interpreted correctly and that all microscopy centers achieve an accepted level of
performance. The implementation of EQA for microscopy has the advantage of both
strengthening laboratory networks and improving diagnostic quality. An EQA report
of sputum microscopy is used for planning, supervision, training, slide rechecking,
report feedback and maintaining quality of microscopes.

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There are well established networks between the microscopy centers (MCs) at PHC,
DHO/DPHO, Hospitals, Zonal Hospitals, Sub Regional Hospitals, Regional Hospitals
and Central Hospitals from government and Hospitals/ Health institutions from
private sector. These MCs are participated for EQA in their respective Regional
Quality Control Centers (RQCCs) 5 RTQCCs in each region and National Quality
Control Center (NQC) in the national level (NTC) Microscopy centers send the
examined slides to their respective regional TB quality control centers via district
health office according to LQAS method. Five Regional TB quality control centers
(RTQCCs) are functioning smoothly with help of skilled and trained quality control
assessors. EQA for sputum microscopy is carried out by RHD/EDR, Biratnagar for
eastern region, RHD/CEN Hetuda, RTC Pokhara for western region, RHD Surkhet for
mid-western region and RHD/Far-western region. NTC perform as a national quality
control assessor. The overall agreement rate is an indicator to monitor the quality of
smear examination. Agreement rate falls on 99 % for FY 2016/17.

FIGURE 4.1 NATIONAL AND REGIONAL WISE POSITIVITY RATE

180000 9% 10%
9% 9%
160000 8%
7%
140000 7% 8% 8%
7%
120000
6%
100000
5%
80000
4%
60000
3%
40000 2%
20000 1%
0 0%
EDR CDR WDR MWDR FWDR National

Total Suspected Positive Positivity rate

Table 4.2 Overall Agreement Rate

Region Eastern Central Western Mid-Western Far-western Total

Agreement
Rate in % 99% 99% 98.32% 98% 99.47% 98.8%

GeneXpert MTB/RIF
The Xpert MTB/RIF is a fully automated and cartridge-based technological platform
that integrates sample processing, DNA extraction and amplification, for TB and
MDR-TB diagnosis. It has similar sensitivity to culture, targets Mycobacterium
tuberculosis specifically and enables simultaneous detection of rifampicin resistance

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via rpoB gene. The Xpert MTB/RIF test is a valuable, highly sensitive, and specific
new tool for early TB detection and for determining rifampicin resistance. While it
should be noted that mono-resistance to rifampicin is found in approximately 5% of
rifampicin resistant strains, a high proportion of rifampicin resistance is associated
with concurrent resistance to isoniazid. Thus, detecting resistance to rifampicin can be
used as a marker for MDR-TB with a high level of accuracy. The use of Xpert
MTB/RIF started in Nepal from 2011/2012. Currently, there are 30 Xpert MTB /RIF
centers located in different part of the country as listed below. Fifteen more machines
will be installed shortly.

FIGURE 4.2: GENE XPERT CENTRES IN NEPAL

Table 4.3: GeneXpert locations

S.N. Health Facility City/District Module Owner

type
1. Dhanusha DHO Janakpur, Dhanusha 2 NTC
2. Chandranigahpur PHC Chandranigahpur, 2 NTC
Rautahat
3. Regional TB Centre Pokhara, Kaski 2 NTC
4. DPHO Rhupandhai (Butawal Butawal, Rupandehi 2 NTC
Clinic)
5. Mid-Western Regional Surkhet 2 NTC
Hospital

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 6. Nepalgunj Medical College Nepalgunj, Banke 2 NTC
7. Seti Zonal Hospital Dhangadhi, Kailali 4 NTC
8. Manohara PHC Kathmandu 2 HERD
9. HERD laboratory Kathmandu 2 HERD
10. Chitwan DHO Bharatpur, Chitawan 2 NTC
11. Doti Hospital Doti 2 NTC
12. Van 1 and 2 4+4 HERD
13. Ilam District Hospital Ilam 2 NTC
14. Mechi Zonal Hospital, Bhadapur, Jhapa 4 NTC
15. NATA, ,Morang Biratnagar 4 NTC
16. Mangalbare PHC Morang 2 NTC
17. BPKIHS Dharan 2 NTC
18. Sagarmatha Zonal Hospital Rajbiraj 4 NTC
Saptari
19. Mirchaiya PHC Siraha 4 NTC
20. National TB Centre Bhaktapur 4+4 NTC
21. Narayani sub-regional Birgunj 4 NTC
hospital
22 Udayapur DHO Gaighat 2 NTC
23 United Mission Palpa 2 NTC
Hospital , Palpa
24 TUTH, Maharjgunj Maharajgunj, 2 NTC
Kathmandu
25 Bayalpata Community Achham 2 NTC
Hospital
26 Okhaldhunga Community Okhaldhunga 2 NTC
Hospital
27 Genetup Kalimati Kathmandu 4 Other
donor

WHO currently recommends the use of Xpert MTB/RIF for rapid TB diagnosis in
children, people living with HIV and for diagnosing severe forms of TB. It is also
recommended for diagnosis of Rifampicin Resistance (RR-TB) in MDR-TB
presumptive cases.

During this reporting period, a total of 23,818 suspected TB patient were tested by
Gene Xpert. Among the total test, 4176 were diagnosed as MTB with rifampicin
sensitive, 379 were diagnosed as MTB with rifampin resistance. Where GeneXpert
report of Two Xpert site (Baglung ZH and Surkhet RH) were not available during the
reporting period.

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 Table 4.4 Annual Gene Xpert test

MTB
MTB MTB Test
MTB detecte
GeneXpert detected detected Failure Total
S.N d
Center Not Rifampici Rifampicin (Invalid, Test
Rifampicin
Detecte n
Resistant
Indetermina Error, No
d Sensitive te result)
1 DHO Clinic Ilam 862 62 3 1 41 969
DPHO
2 1487 284 20 1 81 1873
Bhadrapur
3 PHC Mangalbare 1209 179 6 1 125 1520
NATA
4 1264 277 26 2 79 1648
Biratnagar
5 BPKHIS Dharan 1854 326 16 4 76 2276
DHO Clinic
6 972 151 6 4 62 1195
Rajbiraj
7 PHC Mirchaiya 899 157 11 1 55 1123
8 Udaypur,DHO 742 76 0 1 19 838
TUTH,
9 63 26 0 1 4 94
Maharjagunj
Genetup,
10 234 181 24 1 30 470
Kalimati
11 HERD 3126 298 13 6 401 3844
12 Dhanusa, DPHO 293 97 17 4 38 449
13 Chapur, Hospital 200 41 6 3 33 283
14 Parsa 1002 389 21 3 177 1592
15 Chitwan, DPHO 81 49 6 1 21 158
16 RTC, Pokhara 473 186 21 2 63 745
17 DZH, Baglung 0 0 0 0 0 0
18 Butwal, Hospital 157 146 42 5 48 398
19 Palpa Mission 75 36 9 0 57 177
20 Surkhet Regional 0 0 0 0 0 0
Nepalgunj
21 69 204 25 0 16 314
Hospital
22 Dhangadhi ZH 350 166 43 4 74 637
23 Dang Hospital 33 28 3 0 1 65
24 Doti Hospital 0 1 0 0 1 2
Bailpata
25 133 33 7 1 27 201
Community
Okhaldunga
26 6 4 0 0 1 11
Hospital
27 NTC Bhaktapur 1934 779 54 15 154 2936
National 17518 4176 379 61 1684 23818

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Culture and Drug Susceptibility Test (DST)
Culture of Mycobacterium tuberculosis remains the gold standard for both diagnosis
and drug susceptibility testing, and also the method of choice to monitor DR-TB
treatment. Conventional culture method using Lowenstein-Jensen (LJ), while cheap
and simple have the major disadvantage of being very slow result turnout. LJ cultures
take 8 weeks for negative result and four to six weeks after initial culture for drug
susceptibility testing. The National TB Reference Laboratories (NRL), NTC and
GENETUP, are providing culture and DST services. They are quality assured and
accredited by Supranational TB Reference Laboratory (SRL) Gauting, Germany. SRL
Gauting, Germany is supervising and maintaining regular EQA of these laboratories.

NRL at NTC is in process to establish Liquid Culture (MGIT). The MGIT system is
based on a glass tube containing 7H9 brought together with fluorescence quenching–
based oxygen sensor. When inoculated with Mycobacterium tuberculosis,
consumption of oxygen produces fluorescence when illuminated by a UV lamp. The
fully automated version can incubate up to 960 samples for Mycobacterium
tuberculosis diagnosis through culture of samples (pulmonary and extra-pulmonary)
and Drug Susceptibility testing.

FIGURE 4.3: CULTURE LABORATORIES IN NEPAL

Molecular Diagnosis
Both laboratories are capacitated to perform LPA for FD/SLDs directly on smear
positive sputum samples and culture isolates. LPA is a DNA strip test that allows
simultaneous identification of Mycobacterium tuberculosis complex and genetic
mutation to anti tuberculosis drugs.

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 The development and implementation of rapid diagnostic techniques for the
identification of DR or MDR strains of Mycobacterium tuberculosis is important to
cut the chain of disease transmission and reducing the mortality rate.

The establishment of three regional culture laboratories in Eastern region (BPKIHS),

Western region (RTC, Pokhara) and Mid-West region (Surkhet regional Hospital) is
proposed. Minimum one will perform DST for FLD on solid media. All three
laboratories will be provided with aXpert MTB/RIF.

Finally, laboratories are not just technologies, equipment and buildings; they are
people and system that manage the processes and standards required to produce
accurate and timely results. Successful implementation of any diagnostic tests will
still require functional networks of laboratories with trained and motivated staff,
quality management systems and safe working environments. A new focus on
expanding and strengthening laboratory systems for quality-assured microscopy,
culture methods and DST will help achieve the targets for global TB control.

4.3 Quality Management System:

Quality Management System is ISO 15189 standard. The aim of this system is to
delivery of quality service at National Reference Laboratory.NTP Nepal is planning to
implement QMS system. The first phase of QMS is to make quality management
plan. Head of laboratory will develop laboratory plan. The second step for QMS is to
nominate quality officer. Train all lab staff to QMS and activate to prepare laboratory
SOPs, are the respective steps.

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 CHAPTER 5: TB PREVENTION SERVICES

KEY FACTS AND MESSAGES

Preventing new infections of Mycobacterium tuberculosis and its progression to active

TB disease is crucial to achieve what National TB Program of Nepal has envisioned to
end by 2035.

The intervention which was implemented in 2015/16 for TB prevention are: treatment
of LTBI for people living with HIV (PLHIV); infection control; and Bacille-Calmette-
Guérin (BCG) vaccine.

A total of 1929 PLHIV were started on TB preventive treatment in 2016, based on data
from NCASC. This was a large increase compared to 2014 which was just 43.

Despite progress in providing TB preventive treatment to people living with HIV,

much more remains to be done on TB prevention for children under five years of age
who are contact of TB cases. There is a need to improve initiation, completion
reporting of TB preventive treatment for this risk group.

BCG vaccination is being provided as part of national childhood immunization

programmes. The coverage of BCG vaccine has reduced in 2015/16 compared to
previous year

Preventing new infections of Mycobacterium tuberculosis as well as their progression

to active TB disease is crucial to reduce TB burden and death. Therefore, importance
needs to be given to prevention part in order to achieve what NTP has envisioned to
end by 2035. To reduce the incidence of TB by 80% and 90% in 2030 and 2035
respectively, compared to 2015, needs to have more effective treatments for latent TB
infection (LTBI) and a new vaccine capable of preventing reactivation of LTBI in
adults.

Nepal, have three major categories of health interventions that were done for TB
prevention in 2015/16:
• Treatment of LTBI – Through isoniazid daily for 6 months, with particular
attention to people living with HIV (PLHIV);
• Prevention of transmission of Mycobacterium tuberculosis through infection
control; and
• Vaccination of children with the Bacille-Calmette-Guérin (BCG) vaccine.
The three main sections of this chapter present and discuss the status of progress in
provision of these services.

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 5. 1 Treatment of latent TB infection

LTBI is defined as a state of persistent immune response to Mycobacterium

tuberculosis without clinically-manifested evidence of active TB disease. There was
one particular risk groups for whom specific efforts to diagnose and treat LTBI were
done which was among PLHIV.

5. 1. 1 People living with HIV

There has been a considerable increase in the provision of preventive TB treatment in

recent years. As shown in the table below in 2016, PLHIV started on preventive
treatment as compared to previous years, Nepal has also increase IPT enrollment.

Table 5.1 Number of PLHIV enrolled in IPT

Year Number of PLHIV enrolled in IPT

2016 1929
2015 1886
2014 43

Most of this progress has occurred following definition of a four-symptom algorithm

for screening for TB among people living with HIV.

5.1.2 Children contacts under 5 years of age who are household

contacts of TB cases

Children under 5 years of age who are in contact of TB cases are in high risk of
developing TB due to low immune system. Even though importance of IPT among
children under 5 has always been identified in NTP, IPT was not provided in the year
2016. In this regards, initiation of IPT among children under 5 years old have been
highlighted in National Strategic Plan of TB, 2016-21 and NTP is implementing IPT
among children under 5 years old, specially to the children who are in contact of PBC
cases at household from the year 2017.

5.2 TB infection control

TB infection control is one of the key components of the End TB Strategy. The risk of
TB transmission is high in health-care and other congregate settings. This puts health-
care workers at greater risk of TB infection and disease, and nosocomial outbreaks of
DR TB.

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TB infection control as part of national infection prevention and control policy, and
TB infection programmes at national and subnational level have been envisioned in
NSP-TB 2016/21 as well as several intervention have been planned to achieve it.
Currently as a part of infection control, 17 DR treatment centers were provided with
exhaust fan, Ultraviolet germicidal irradiation (UVGI), N95 mask and simple surgical
mask. Beside this infection prevention sessions are incorporated in all TB related
trainings.

5.3 BCG Vaccination

BCG is the only vaccine that is currently available in Nepal. More effective vaccine to
reduce the risk of infection with Mycobacterium tuberculosis and the risk of
progression from infection to active TB disease in adults is needed.
BCG vaccination has been shown to prevent disseminated disease; this category
includes TB meningitis and military TB, which are associated with high mortality in
infants and young children. As per National Annual Report by Department of Health
Services 2015/16, National Immunization Programme (NIP) is one of the
government’s highest priority programmes. It made a large contribution to Nepal’s
achievement of Millennium Development Goals (MDG) 4 and 5 by reducing
morbidity and mortality among children and mothers from vaccine preventable
diseases. The coverage of BCG vaccine has reduced in 2015/16 compared to previous
year.

Table 5.2 Coverage of BCG vaccine has reduced in 2015/16 compared to previous
year.

2070/71 2071/72 2072/73

Immunization
(2013/14) (2014/15) (2015/16)
% of children under one year immunized
99 94 87
with BCG
Annual Report, Department of Health Services, 2015/16

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 CHAPTER 6: UNIVERSAL HEALTH COVERAGE, SOCIAL PROTECTION AND
ADDRESSING SOCIAL DETERMINANTS

6.1 Social Protection Programme in NTP

6.1.1 Skill Training to Drug Resistant Tuberculosis Patient (DR-TB)

National Tuberculosis Programme (NTP) has been implementing skill training to DR

TB patients since 2009. Around 100 DR TB patients were already trained on different
vocational trainings e.g. candle making, file and folder making, tailoring, mobile
phone repairing, electricity wiring, motorbike or repairing trainings. This training has
been supporting to the patients to integrate in their society and continued their skills
for their livelihoods. This support also helped to motivate and encourage completing
their treatment.

6.1.2 Nutritional and transportation allowances

NTP has been providing nutritional and transportation allowance to DRTB and
retreatment cases in the country. During reporting year, 819 DRTB patients received
nutritional and transportation allowances (NPR 2,000 per patient/month). Similarly,
2,700 retreatment TB cases also received same allowances (NPR 500 per patient/per
month). This support also helped to motivate and encourage completing their
treatment.

6.1.3 Hostel facilities

During the reporting year, 6 hostels and 1 Drug Resistant (DR) home offered
accommodation, food, treatment and care supports to the needy DRTB patients for
intensive phase of treatment. Altogether, 210 DRTB patients benefited from the
hostels throughout the year. This support also helped to improve treatment adherence
of the patients.

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 CHAPTER 7: NATIONAL TB PREVALENCE SURVEY

7.1 Introduction

The Annual Report of National Tuberculosis Program (2014) shows that the case
notification rate (CNR) of all forms of TB has remained stagnant for last 10 years in
Nepal even when each layered and analyzed in the regional/ eco-terrain level. So, the
Government of Nepal needs to know the reality of TB prevalence in the country
instead of being based on estimates of it by WHO. This is very important for Nepal so
that evidence based TB control program and activities can be designed and
implemented to move the country towards “End TB” strategy. Therefore,
understanding the actual burden of TB in Nepal by National TB Prevalence Survey
(NTPS) is considered to be very important for developing appropriate strategies/plans
for effective TB control program in Nepal. The prevalence of TB is the number of TB
cases that exist in the population at a given point in time. It is usually reported as the
total number of prevalent cases in a country, or as the number of prevalent cases for a
given unit of population e.g. the number of cases per 100000 population. The survey
is cross-sectional and population-based study to identify number of people with TB
disease among the sample population.

In this survey, all survey participants will be screened using interviews and chest X-
rays. Sputum samples are then taken from all those with abnormal chest X-rays
suggestive to TB and/or symptoms suggestive of pulmonary TB and are tested in
laboratories to identify individuals with bacteriologically-positive pulmonary TB (that
is, Xpert MTB/RIF detected pulmonary TB, smear positive TB and/or culture-positive
TB). A Case for NTPS is when an eligible survey participant has at least one Xpert
MTB/RIF+ve (GX+) result, given that the result is not regarded as cross
contaminated, among any of the two specimens tested (Spot and Morning). The
survey focuses on the measurement of pulmonary TB among adults. Yet, it cannot
meaure the prevalence of extra-pulmonary TB among adults or the prevalence of TB
disease in children.

Gen Xpert has been used as a main tool in this survey which has been identified as an
innovative and useful system for rapid detection of TB and identification of
Rifampicin (RIF) resistance. The results are found to be superior to smear microscopy
and comparable to culture. NTPS will be mainly based on Xpert/MTB testing through
Gen Xpert machine rather than culture because country’s lab capacity is limited to
carry out huge volumes of culture at the time of survey and Xpert/MTB testing has
proven to be useful in other countries carrying out prevalence survey.
Cross sectional population based study will be conducted for this survey in 99
clusters. Sampling population will be people with age ≥ 15 years of selected clusters
and total sample size is 57610.

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 7.2 Goal and objectives of survey

The goal of survey is to gain a better understanding of the burden of disease caused by
TB in the community of Nepal.

Objectives are:
1. To measure the prevalence of overall Xpert MTB/RIF detected pulmonary
TB among ≥15 years population in Nepal in 2017.

2. To extrapolate prevalence of bacteriologically confirmed TB prevalence

based on the results of culture and Xpert MTB/RIF tests.

3. To describe the health seeking behaviour of people with TB symptoms.

4. To describe the health service (TB services) utilization practices of

participants who have or had TB disease.

7.3 Timeline of National TB Prevalence Survey

Table 7.1 Timeline of NTPS

Events Start date

Final Protocol Jan, 2017
Ethical clearance from Nepal Health Research
Council (NHRC) By June, 2017
Data management software for PS developed by By end of June or mid- July
The outsource agency for field work selected by By end of May, 2017
Pretesting of Tools By end of July 2017
Training completed (central and field staffs) By August 2017
Piloting (also include pre-visit) By September, 2017
*From Sept 19 to October 27- National Festival and
public holiday in most of those days
Pre-visit I By November 2017 (50 clusters)
December 2017- June 2018 (1 month of mid-term
Field work I review in between)
Mid Term review March 2018 (RIT and WHO)
Pre-visit II July 2018 (49 clusters)
Field work II August 2018 – March 2019
* Tentatively from Sept 19 to October 27- National
Festival and public holiday in most of those days.
Data analysis, report write up and dissemination Aug-19

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Based on the timeline set, NTPS Protocol is expected to be finalized and endorsed by
Ministry of Health by Jan 2017. In order to conduct the survey, ethical approval by
National Health Research Council is expected by June, 2017. The NTPS is a paperless
survey, so, an outsource agency (OSA) will be recruited to develop forms/ formats in
software form and data management system to be used in survey. Similarly, an OSA
for field operation will be selected. All the tools that will be used in survey, will be
pre-tested before going for training of NTPS staffs. By September 2017, piloting of
NTPS will be done in three clusters. Pre-visit and field operation has been planned
into two phases for the study. In first phase, pre-visit will be done in 50 clusters
followed by field operation in those clusters. Mid-term review of NTPS will be done
in March, 2018. Pre-visit and field operations of remaining 49 clusters are expected to
complete by March 2019. After that, data analysis will be done and report will be
written. The NTPS report is expected to be disseminated by August, 2019.

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 CHAPTER 8: PLANNING, MONITORING AND EVALUATION

8.1 Planning, Monitoring & Evaluation

National Tuberculosis Centre is responsible for formulating long and short terms plan
to fight against Tuberculosis throughout the country. National Tuberculosis
Programme already developed National Strategy Plan for 2010 to 2015. On the basis
of that plan, NTC lunched the respected activities. The new Strategic plan for 2016 to
2020 is in process for finalization. NTC always develop an annual plan based on
strategic plan considering Programme needs of district and region.

Supervision and monitoring is carried out through regular visits to all levels of the
Programme as per NTP policy. In addition to supervision and monitoring, quarterly
reporting of activities is carried out at trimester Planning, Monitoring and Evaluation
(PME) workshop at all levels of the Programme.

FIGURE 8.1 SUPERVISION SYSTEM & SCHEDULE
















 


The NTP maintains a regular monitoring system, which includes case finding, smear
conversion, treatment outcome and Programme management reports from all levels of
the Programme. Data is initially analyzed by the District Health Office during the
district level Planning, Monitoring and Evaluation workshops. District TB and
Leprosy Officers (DTLOs) report on treatment center and district during the Regional
Planning, Monitoring and Evaluation workshops. Finally, Regional TB and Leprosy
Officers (RTLOs) report by district at national PME workshops. Planning, Monitoring
and Evaluation workshops take place every four months all levels of the Program.

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 FIGURE 8.2 MONITORING & EVALUATION
Monitoring and Evaluation

International International Review Annual

National Reporting & Planning Four

National
Workshop Monthly

Regional Reporting & Four

Regional
Planning Workshop Monthly

District Reporting & Planning Four

District
Workshop Monthly

Treatment Center Reporting & Four

Treatment Centre
Planning Workshop Monthly

The LHL International Technical Advisory Committee carried out a Programme

review of NTP Nepal this year. The major Strength’s, constraints and key
recommended ways forward were as follows:
Strengths in the fight against tuberculosis (TB) in Nepal noted were:
1. Domestic investment from the Government of Nepal on tuberculosis (TB) control
has increased substantially.
2. Human resource in the National Tuberculosis Centre (NTC) has been strengthened
by additional staff and supported by Save the Children, WHO Nepal Office and
KNCV.
3. The National Strategic Plan (NSP) for Tuberculosis Prevention, Care and Control
2016/17-2020/21 has been prepared.
4. The TB Act making the notification of TB mandatory has been submitted by NTC
to Ministry of Health.
5. Nepal NTP has reduced the use of case detection rate in monitoring of
tuberculosis case finding.
6. Supervision and blinded rechecking of slides is carried out across the majority of
the microscopy network.
7. Line probe assay for second line drugs is available at both national reference
laboratories(NRLs).
8. NTC has designed an E-master TB register to capture case-based information of
registered TB cases.
9. An action plan of programmatic management of drug-resistant TB (PMDT) has
been prepared.
10. The prevalence survey protocol has been finalized and multiple agencies have
been engaged.
11. There was no reported stock out of first and second line drugs.

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 Several constraints were identified:
There has been substantial reduction in TB case finding in the year 2014/2015
compared to 2013/2014, mainly in Central and Eastern Development Regions, due to
decreased detection of clinically diagnosed TB cases.

1. The number of presumptive TB cases examined in several microscopy centres was

too small. In most regions a significant proportion of microscopy centres were not
functioning, mainly due to a lack of staff. Referral of cases from microscopy
centres to treatment centres was not comprehensively tracked.
2. Case management of TB was not consistent; some treatment centres provided
anti-TB drugs to patients to be taken at home without supervision.
3. Examination request forms, registers and reporting forms for Xpert tests did not
capture sufficient details of the type of patients for tacking programme
performance; a mechanism to track Xpert tests has not yet been established.
4. The proportion of treatment success for treated multidrug-resistant TB (MDR-TB)
cases has decreased, not reaching the global target of 75%; the 9-month MDR-TB
regimen has not yet been introduced and new drugs (bedaquiline and delamanid)
remain unavailable in Nepal. There was significant resistance to fluroquinolones
in MDR-TB patients and it was observed that fluoroquinolones were
inappropriately used in the treatment of patients with respiratory symptoms.
5. A high proportion of TB patients were not tested for HIV infection, of those that
were tested some were not linked to care.
6. Childhood TB is likely to be under-detected and contact examination was largely
lacking.
7. Public Private Partnership remains weak, with limited information on diagnosis
and treatment of tuberculosis in the private sector.
8. There are substantial numbers of vacant posts of NTP, and DTLOs in districts
with high burden of TB are over-loaded.
9. Data of sputum smear examinations including EQA, Xpert tests, and drug
susceptibility testing were not regularly collected and analysed, and not presented
in the annual TB control report.
10. Laboratory methodologies for culture, drug susceptibility testing (DST) and
microscopy vary across different laboratories and in some cases are not in line
with international standards. Laboratory infrastructure is generally below
minimum requirements for safety.
11. Counselling of patients is weak and Information Education and Communication
(IEC) materials are not available in the majority of treatment centres.

Key recommendations of the technical advisory committee:

1. Nepal NTP should conduct the following activities to strengthen case finding :
o Prepare a protocol outlining procedures to investigate why there has been
substantial reduction in TB case finding in the year 2014/2015, especially
in Central and Eastern Development Regions. The findings of TB Reach
projects should be reviewed.
o Accessibility and affordability of chest radiographic examination and
management of smear/Xpert negative presumptive TB should be assessed.

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 o Non-functional microscopic centres should be reactivated, or removed if
they are not critical.
o Encourage the identification of presumptive TB cases in microscopy
centres with a low number of cases examined for diagnosis. Medical
officers must be engaged.
o Develop a policy to enforce sputum smear examinations in patients with
respiratory symptoms before they are treated with fluoroquinolones.
o Consider providing the first dose of anti-TB treatment at the referring
centre and ensure that cases referred from microscopy centres arrive at
treatment centres timely.
2. Case management of TB should be strengthened, particularly at treatment centres
with a relatively high proportion of loss-to-follow-up/outcome-not-evaluated. A
system to bring late patients back onto treatment involving existing community
actors should be developed.
3. Assess the contribution of Xpert tests in TB case finding and assess the proportion
of rifampicin resistance in different risk groups. Examination request forms,
registers and reporting forms of Xpert test should be revised to capture each type
of case (new, retreatment, contact of DR-TB, HIV, non- converters), and data
must be collected and analyzed regularly.
4. Introduce the 9-month MDR-TB regimen, paying attention to the following:
o Line probe assay for the detection of fluoroquinolone and second line
injectable resistance should be performed directly on sputum specimens,
and, if direct test fails, on culture isolates. Phenotypic DST should be done
to detect resistance missed by line probe assay.
o Clearly define the objectives of the pilot phase and scale up nationwide as
early as possible.
o Follow WHO’s recommendations on dosage of Moxifloxacin.
o Adverse drug reactions (ADRs), especially prolongation of QTc interval,
should be closely monitored and health workers should be trained for
managing ADRs.
o Obtain Bedaquiline through Jensen donation programme.
o Ensure sufficient patient support is provided consistently and according to
plan.
5. If feasible assign a focal person for HIV/TB from among those who are currently
working in NTC, to facilitate HIV/TB activities, with the aim of ensuring the
testing of a high proportion of TB patients and the linkage of these HIV-infected
cases to care.
6. Training on childhood TB needs to be conducted and contact examination
strengthened; isoniazid preventive therapy should be provided to children under 5
years old who have household contact with a bacteriologically confirmed TB
cases.
7. A focal person of Public Private Partnership needs to be recruited, who should
develop a comprehensive plan to enhance case finding of TB and ensure
comprehensive reporting and proper management of TB cases in private sector.
Collaboration models between NTP and the private sector need to be established.
8. Supervision must be strengthened to ensure good quality of data from sputum
smear examinations, external quality assurance, Xpert tests, and drug
susceptibility testing. Data needs to be regularly collected and analysed at all
level; key findings should be presented in the annual TB control reports.

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 9. A human resource plan should be developed to review the need of the NTC and to
address vacancy of sanctioned posts.
10. Laboratory methodologies and quality assurance for culture, DST and microscopy
need to be updated to be in line with international standards of practice across the
whole network, including both NRLs. This could be addressed by the engagement
of long term international level laboratory technical assistance supported by
partners.
11. The laboratory infrastructure across the network needs to be evaluated and
improved. Unsafe practices (e.g. use of locally produced sub-standard safety
cabinets) need to be addressed.
12. Develop and distribute patients friendly IEC materials and a counselling package
to health workers.
The NTP manager should develop a plan to investigate to what extent smoking,
diabetes and other co-morbidities have contributed to avoidable burden of TB and
carry out interventions to reduce both the prevalence and magnitude of impact of
these risk factors. Activities related to HIV/TB should be strengthened.

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 CHAPTER 9: TB FINANCING

9.1 Financial Status of NTP

The responsibility for the NTP resides with the Ministry of Health (MoH), which sets
its annual budget each fiscal year. Altogether, Government of Nepal has allocated
US$ 15.78 million amounts to the National TB Program for the fiscal year 2015/16
with GON contribution being of USD 7,05 million (44.93%) and USD 8,61 million
(55.27%) from EDP of total allocated budget of USD 15.78 National TB Program.
The contribution of GON in last F/Y 2014/15 was 26,5% which has increased to
44.93% in the F/Y 2015/16.
Next to the government contribution, the NTP has a longstanding history of external
financial support from both national and international sources. The total available
budget for TB control in Nepal was boosted substantially with the approval of the first
Global Fund Grant in 2005 (Round 4). Round 7 was approved in 2008 and later
integrated into the Global Fund Single-Stream Funding (NSA) ending on the F/Y
2014/15.After the completion of NSA Phase in F/Y 2014/15, Global Fund grant to the
Nepal for F/Y 2015/16 was routed through the costed extension plan of NSA phase
deciding the Save the Children as PR & NTC as main implementing partner. Signing
of tripartite agreement between the MOH, Save the Children& the GFATM was
executed on the 6th of November 2015 followed by the MOU between DOHS & Save
The Children on dated 24th November, 2015 to implement the Global Fund 12 months
costed extension of TB program with the approved budget of USD 8.6 million.
Most of the funding for TB control is channeled through the government account
(“The Redbook”). Domestic contribution has been stable for many years until 2008
with around 500,000- 600,000 USD/year. Since 2008 the government of Nepal has
increased the financial support to the fight against TB, trying to decrease the donor
dependency. This has resulted in that the absolute national contribution which has
been increased to 44.93% as national contribution as compared to last year of
26.5%.This demonstrates commendable political commitment to fight TB in Nepal.
About 55% of NTP budget for F/Y 2015/16 is provided by the Global Fund to fight
AIDS, TB and Malaria (GFATM) under the costed extension plan for F/Y 2015.16
The below mentioned table provides the details of budget allocations. The allocated
fund was from domestic, Global Funds, & LHL International.

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 Table 9.1: Financial Status of 2015/16

Total
S.N Activity %
Budget Exp
Laboratory infrastructure 10%
1 2,897,062 1,579,560
equipment and supplies
National TB Programme staff
2 (Central unit and subnational 1,125,175 727,147 5%
TB staff
Drug Susceptible TB drug 2,779,306 1,201,984 8%
3
Drug Susceptible TB: 11%
4 2,843,943 1,768,218
Programme Costs
5 Drug resistant TB: Drug 2,955,178 9,657 0%

Drug resistant TB: Programme 0%

6 568,018 75,489
Costs
Collaborative TB/HIV 0%
7 102,281 44,351
Activities
Patient Support 560,950 210,338 1%
8
Operational research and 2%
9 1,328,565 371,896
surveys
All Other Budget Lines for TB 619,530 310,641 2%
10
40%
15,780,009 6,299,280

In regards to financing at the implementation level, District Health Officers submit

plans and budget requests to the central level. After approval by technical and
financial officers of NTC, they receive budget allocation. Fiscal accountability and
reporting at the District Health Office level appear to be sound and efficient.
Normally patient are charged for examination and x-rays (based on the ability to pay)
prior to TB diagnosis but not for drugs and clinical follow-up. There is, however, a
significant economic burden faced by tuberculosis patients and their families who
have to travel or relocate nearby centers where tuberculosis treatment is given.
Moreover, TB ordinary patients have to bear the cost of drugs prescribed to treat side
effects of anti-tuberculosis medications. The Programme has managed ancillary drug
and other clinical management costs for MDR-TB patients.
Quality of care and patient friendliness have been improved (e.g. by further
decentralization of services). The Global Fund program evaluation in 2012
demonstrated that the (health system?) costs per TB DOTS patient have more than
doubled from 2007/08 to 2011/12 and that the costs per MDR patient has increased by
about 22%. It seems that this trend has still not changed since 2011 and that the costs
per patient diagnosed and treated are still rising.

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It is therefore of paramount importance to monitor those trends, especially in the light
of introducing new and expensive diagnostic tools, like for instance Expert MTB/Rif,
which alone will probably consume more than 500,000 USD year.

FIGURE 9.1 ANNUAL NTP BUDGET VS EXPENDITURE

18,000,000

16,000,000

14,000,000

12,000,000

10,000,000
Budget
8,000,000 Exp
6,000,000

4,000,000

2,000,000

-
GON Global Fund LHL Total

Figure 9.1 clearly presents the trend of contributions from different sources and its
expenditure for F/Y 2015/16.

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 CHAPTER 10: RESEARCH AND DEVELOPMENT

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10.1 Background
NTC has research section headed by chest physician and one research officer, one
health assistant and one Public Health Nurse working as members for this section.
The responsibilities however are yet to be given to the above mentioned position.
However, NTC carried out following research activities in 2015/16.

10.2 TB Prevalence Survey

NTC has planned to carry out TB Prevalence Survey (PS) in Nepal since 2012.
Recently the protocol has been finalized and is waiting to be endorsed by the Steering
committee for full actions. Survey protocol has been drafted and action plan have
been developed for PS with the technical support of Research Institute for
Tuberculosis (RIT), Japan. The piloting for the survey is planned to be carried out in 3
sites and the actual field work to stat from September, 2017 for the period of 17
months. The report is expected to be produced by 2019.

10.3 Research on Tuberculosis and Diabetic

NTC is conducting the research on prevalence of diabetes and risk factors among new
and relapse tuberculosis cases in Kathmandu valley, Nepal, as a coauthor, which is
principally being led by NCGM and with local partnership with JANTRA also as a
coauthor and for local field mobilization and data collection. The research is
undertaking prevalence survey on Diabetes and Risk factors among new and relapse
tuberculosis cases in Kathmandu valley with the support of National Centre of Global
Health. The objective of the study is to assess the association of diabetes mellitus with
new and relapse positive TB cases. The first phase of the data collection was
completed. The findings of the research are planned to publish and disseminate by
2017.

10.4 Research on Tuberculosis and Service Accessibility

NTC is carrying out the research project titled " barriers to access, case detection, and
treatment completion: Mainstreaming a pro-poor approach for TB control in Nepal"
as a co-author and is led by Dr Sujan Babu Marahatta, Associate Professor,
Manmohan Memorial Medical College/Manmohan Memorial Institute of Health
Sciences under the grant sponsored WHO-TDR, the Special Programme for Research
and Training in Tropical Diseases World Health Organization. The project will
explore the existing tuberculosis control program in Nepal with regards to barriers
towards access, case detection and treatment completion and devise the pro-poor
initiatives for TB control in Nepal. Since this research will explore the factors
associated with barriers to treatment, case detection and adherence which largely
influence the TB control program, the findings from this study will be highly
beneficial in formulation of the TB control policy and consequent TB control
strategies.

10.5 Study on Impact of Community Based (CB) DOTS

NTC has planned to study the impact of Community Based DOTS from 2017.
Comparative study between common DOTS and Community DOTS will be the
focused area.

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 10.6 TB/HIV Sentinel Survey
The prevalence of HIV is raising in Nepal and effective control measures for AIDS as
well as for TB is more important now than ever before. NTP is regularly surveys to
detect how often HIV occurs in TB patients. Likewise, NTP conducting a sentinel
surveillance in 12 site. Data collection was started and results of this survey will be
available by end of 2017. Sustaining and further enhancing partnership remains one of
the primary focuses of the NTP during survey.

10.7 Survey on Household infection control practices of DR-TB

patients in Nepal
To assess the knowledge, attitude and practice of infection control measure by DR-TB
patients in their household in Nepal, NTP starts survey in 7 DR sites. This survey was
conducting under the STC funding. Data collection of the survey was completed and
result will be disseminating by the end of July 2017.

Areas for research in Nepal NTP for future

1. Surveillance of HIV MDR-TB & TB Burden
2. GeneXpert Challenges, a qualitative study
3. CB-DOTS assessment.
4. Situation analysis of microscopic centers on Nepal.
5. Study on the effectiveness of IPT among risk population
6. Study on Contract Tracing (Early Diagnosis for treatment Adherence)
7. Surveillance of resistance to anti-TB drugs
8. Regular surveillance of XDR TB among MDR TB patients
9. Study on the relationship between Acute Respiratory Infection (ARI) and
Tuberculosis on case detection.
10. Impact measurement of the Programme through prevalence survey in
representative sample of the population.
11. Analysis of the issues regarding cross border migration to develop strategies
for their diagnosis and treatment.
12. Review of access, acceptability and utilization of NTP services by vulnerable
population including women, poor, HIV positive population, slum dwellers
etc.
13. Prospective long-term cohort studies among patients registered in the
Programme to identify risk factors for failure, death and default during
treatment.
14. Review of NTP progress and impact towards achievement of Millennium
Development goals.
15. Health seeking behavior of the community including delay in TB diagnosis
and treatment
16. Diagnostic delay in women and its impact on children
17. Review and analysis of treatment supervision and patient support approaches
and mechanism for policy development.
18. The study on incidence of relapse among cured patients of CAT I using six
and eight-month treatment regimens
19. Review of treatment compliance in general population ecological region and
ethnic groups.

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 20. Effects of nutritional status of patients on TB treatment outcomes
21. Burden of TB on the basis of DALYs can be analyzed to see the economic
burden to the nation due to TB.
22. Correlation of alcohol and tobacco use with TB relapse
23. Evaluation of first generation is thermal nucleic acid amplification.
24. Evaluation of fast based DST
25. Assess the impact of trainings (TB modular and Refresher) conducting for
health worker
26. Investment Vs Cases Notification in 30 high burden districts of Nepal

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 CHAPTER 11: CAPACITY BUILDING AND DEVELOPMENT

11.1 Introduction
Staff training, exposure to workshops and seminar at national and international
level is a part of capacity building and development of human resources of an
organization. It is one of the most important part of human resource management
and concerned with organizational activity aimed for better performance of staffs
in organizational settings. Training is the process of enhancing the knowledge, skills
and capabilities of employees for doing a particular job. Training enables an
employee to perform their jobs effectively. Similarly, by participating in workshops
and seminar, knowledge level of employees are enhanced. These are cost-effective
ways to develop organizational capacity.

11.2 Objectives of training

• To orient new employees
("induction training")
• To introduce new technology,
systems or other changes
• To improve productivity
• To support employee progression
and promotion
• To Improved knowledge, skill and
attitude

11.3 Training Need Assessment Process of NTP

In National TB Program, training need assessment is done on the basis of baseline
information. TB/ Leprosy Officer at district level, send request letter to NTC
mentioning about type of training required and number of staffs require training. On
this basis, NTC plans and conducts training. NTP provides basic and refresher
training to the staffs working for NTP.

11.4 Trainings conducted and achievement

In FY 2072/73, following training and workshops were conducted under NTP
SN Name of training No. of participant
1 Basic DRTB Modular training 116
2 Basic TB training for Medical Officer 57
3 Clinical Management Training for Medical Officer 58
4 Basic TB Training for DTLOs 16
5 Basic Sputum Microscopy Training 20
6 LQAS Training 60
7 DRTB Workshop 122
8 Health Communication Training 40
9 Basic Modular Training 620
10 Skill training to DRTB patient at NATA Morang& Bandipur 18

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 The table above shows that 116 staffs were trained with Basic DRTB Modular
training. This training was provided to staffs (Medical Officer, paramedics, nursing
and lab staffs) working in DR treatment Center and Sub-centre. 57 Medical officers
were trained with Basic TB training and 58 Medical Officers were trained with
Clinical Management training at NTC from all over the country to improve their
diagnostic and management knowledge and skill. Basic TB training provided to 16
DTLOs who are newly recruited, to enhance their better understanding of NTP and
upgrade their managerial skill. Laboratory service has been considered to be backbone
of NTP, so, different laboratory trainings were planned and conducted in this FY to
train laboratory staffs. e.g. Basic Sputum Microscopic Training to 20 staffs, LQAS
training to 60 staffs. DRTB workshop was organized in all five regions and at central
level in which 122 staffs participated. The objective of the workshop was to collect
and verify data, review program and develop an action plan. In order to improve
service provider and patient relationship, Health Communication training was
provided to 40 health workers working in TB treatment center and Sub-center in
Pokhara and Dharan.620 health workers working in TB treatment center and Sub-
center level were trained with Basic Modular Training district level. NTP has been
providing skill trainings like mobile repairing, sewing etc. to engage and enhance
DRTB patients’ skill which supports in their income generation as well. In this FY, 18
DRTB patients from NATA Morang and Bandipur were trained with skill training.

11.5 Training monitoring and follow-up mechanism

Trained staffs are monitored and followed up while going for supervision and
monitoring at facility level. They are followed from Central, Regional and District
level. Onsite coaching is also provided to the staffs to improve their knowledge and
skill level.

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 CHAPTER 12: LOGISTICS MANAGEMENT
Process of Quantification, Procurement, Distribution and Storage of drugs

12.1 Quantification
Quantification of TB drugs done on the basis of:

• Estimated number of cases of different categories of TB

• Annual consumption of medicines and commodities
• Allocated budget
• Stock in hand

12.2 Procurement
• All Procurement from GoN Budget is done as per provisions in Public
Procurement Monitoring Office (PPMO) Act and Regulations
• Procurement is done on the basis of quantification as mentioned above
• Both NTC and SCI, Nepal are involved in procurement process as per budget
allocated from GON Sources and GFATM Sources respectively
• Both NCB and ICB methods including e-bidding processes are followed
• All types of laboratory Chemicals, Commodities and Equipments;
o First Line Drugs (FLDs); Second Line Drugs (SLDs) and other
Consultancy Services are procured

12.3 Distribution
• Distribution is made on the basis of orders generated from Trimesterly
Workshop
• NTC supplies all kinds of logistics including FLDs to Five Regional Medical
Stores and Regional Tuberculosis Center to supply in turn for its respective
districts but NTC supplies directly to following districts (due to proximity
reason):
o Ramechhap, Dolakha, Sindhupalchowk, Kavrepalanchok, Bhaktapur,
Kathmandu, Lalitpur, Dhading, Nuwakot, Rasuwa and Solukhumbu
• In the case of Second Line drugs NTC supplies directly to the DR Treatment
Centers and to some Sub –Centers
• Distribution is done on the basis of FEFO Principle
• In case of FLDs, buffer stock of 4 months is given to Districts but no buffer
is given in case of DR Drugs due to short Shelf Life

12.4 Storage
• All the drugs and commodities are stored in the NTC Store based on
different categories
• There is a provision of Air Conditioner for appropriate temperature of
storage
• Recently, a Cold Room has been constructed to store thermo-labile
products

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 CHAPTER 13: HUMAN RESOURCES MANAGEMENT
The performance of health care systems is closely related to the numbers, distribution,
knowledge, skills and motivation of its workforce, particularly of those individuals
delivering the services. Improvements in global health are greatly dependent on how
well health systems can meet the demands placed on them by governments,
programmes, communities and ultimately individuals.

Human resources for National Tuberculosis Programme in Nepal consist of all

categories of clinical and non-clinical staffs who make each individual and public
health intervention happen. These workforces have been deployed at the different
levels i.e community, district, region, and central. To support the National
Tuberculosis Programme addition workforce has been from external development
parteners such from WHO, Save The Children (Global Fund), LHL and KNCV,
Damein Foundation.

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 CHAPTER 14: PARTNER’S CONTRIBUTION IN TB

14.1 World Health Organization (WHO)

World Health organization (WHO) has been supporting TB program in Nepal. The
Center of Disease Control unit at WHO CO, headed by the International Medical
officer and supported by National professional officers, supports TB program in the
country. The main role of WHO is to provide best practices and recommend them to
NTP, PR and partners for timely and effective management of different key activities.
Recently TB program has been made a top priority from SEARO for Nepal. WHO
supports TB program specially by providing technical support in key strategic areas
and as required by NTP. Recently, there had been TA support for PMDT revision,
introduction of shorter regimen, aDSM development. The mission also supported in
development of newer clinical treatment and diagnostic algorithm for the country in
alignment with 2017 WHO revised recommendations for Treatment and 2016 GLI
recommendation for Diagnosis. WHO also supported in development of laboratory
strategic plan and support in development of National Strategic Plan for TB program
2016-21. WHO also supported in carrying out the GLC missions in the country

Besides these key TA supports, WHO also supported in development of major

documents like annual reports, TB HIV collaboration guidelines, training guidelines
etc. WHO has also supported in carrying out prevalence survey for TB in the country;
from the development of the protocol together with RIT japan and NTC followed by
reviewing the developed protocol for Global Task Force at WHO HQ and also taken
up the responsibility to quality assure the field implementation of PS in the country.

14.2 SAARC Tuberculosis and HIV/AIDS Centre (STAC)

Background

SAARC TB and HIV/AIDS Centre (STAC) is one of the Regional Centers of South
Asian Association for Regional Cooperation (SAARC).

The Centre supports the National TB Control Programmes (NTPs) and National
HIV//AIDS Control Programme (NACPs) of the SAARC Member States
(Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka).
The Centre coordinates the progress and new findings of NTPs and NACPs among
the SAARC Members States and supports for implementation of SAARC Regional
Strategies on controlling /elimination of tuberculosis as well as prevention of
HIV/AIDS in the Region.

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Goal, Objective, Vision and Mission

The goal of the Centre is to minimize the mortality and morbidity due to TB and
HIV/AIDS in the region and to minimize the transmission of both infections until TB
and HIV/AIDS are major public health problems in the SAARC Region.

The objective of the Centre is to work for prevention and control of TB and
HIV/AIDS in the region by coordinating the efforts of the National TB Control
Programs and National HIV/AIDS Control Programs of the SAARC Member States.

The vision of the SAARC TB and HIV/AIDS Centre (STAC) be the leading institute
to support and guide SAARC Member States to make the region free of TB and
HIV/AIDS.

The Mission of the SAARC TB and HIV/AIDS Centre is to support the efforts of
National TB and HIV/AIDS Control Programs through evidence based policy
guidance, coordination and technical support.

Programme delivery areas The Centre has been working/coordinating for

implementation of different activities related to TB & HIV/AIDS prevention and
control in the SAARC Member States, such as advocacy, programme communication
and social mobilization (ACSM) by implementing the programs of SAARC Goodwill
Ambassadors for HIV/AIDS, perform as SAARC Regional Reference Laboratory,
dealing with Human Resource Development by organizing trainings,
workshops/meeting etc., act as a Regional Resource Centre, conduct Research/Study
related to TB and HIV/AIDS, act as WHO collaborating center and conduct its
activities based on the regional requirements and recommendations of NTPs &
NACPs of SAARC Member States.

14.3 Save the Children

Save the Children is the world’s leading independent children’s right organization
with members in 30 countries and programs in more than 120 countries. Save the
Children fights for children’s rights and delivers lasting improvements to children’s
lives in Bhutan, Nepal and around the world. Save the Children has been working in
Nepal since 1976 focusing on programs on Child Rights, Governance and Protection,
Education, Health and Nutrition, Livelihood and Humanitarian response and
preparedness in all 75 districts of the country through four regional offices in
Biratnagar, Kathmandu, Butwal and Nepalgunj. Through its various programs, Save
the Children aims to create an environment which enables a child to reach his/ her full
potential.

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 Global Fund programs of Save the Children in brief Save the Children is the Principal
Recipient for all three Global Fund grants (HIV, Malaria and Tuberculosis) in Nepal
since 16 July 2015. Save the Children has been managing the HIV component of
Global Fund grant in Nepal since 16 November 2008. Effective from 16 July 2015,
Save the Children has been awarded with the PRship for Malaria and Tuberculosis
grant as well to be implemented through Epidemiology and Disease Control Division
(EDCD) and National Tuberculosis Center (NTC) under the Ministry of Health, Nepal
respectively, as main implementing agencies. Tuberculosis grant effective from 16
July 2015, Save the Children has been managing Tuberculosis program all over the
country through main implementing agency (NTC). Save the Children works together
with National Tuberculsosi Cencte and its sub recipients; Nepal Anti-Tuberculosis
Association (NATA), TB Nepal, NAPID Nepal, HERD and BNMT. Major activities
under Tuberculosis grant are: National TB Prevalence Survey, early diagnosis of
people with infectious pulmonary TB by sputum smear examination, strengthening
network of microscopic centers, strengthen quality control measures, treatment of
MDR and XDR cases, strengthening culture and drug susceptibility tests (DST),
expansion of microscopic camps in hard to reach areas, etc. The key activities of SRs
are contract tracing, transportation of sputum transportation, diagnosis and
management of childhood TB, Public Private Management (PPM), implementation of
IPT, etc.

The total budget of the Global Fund for tuberculosis for FY 2016/17 is 6.4 million
USD. A Programme Management Unit is based at National Tuberculosis Centre,
Bhaktapur to provide technical support, implement GF funded activities and system
strengthens of NTC. SCI is supporting to implement and monitoring and evaluation of
Tuberculosis Programme at regional and district level. A Regional Program
Coordinator is deputed in each region to support to implement, supervise and monitor
TB program at regional and district level.

14.4 LHL International Tuberculosis Foundation, Norway

The Government of Nepal requested LHL International TB Foundation (LHLI) to

assist and support the NTP for its national training and supervision activities in 1994.
LHLI has been supporting to the NTP in Nepal especially focusing on capacity
building by training and supervision activities at various levels since 1995. The
Ministry of Health (MoH) and LHLI signed a an agreement for four years co-
operation in 1995 (1995-1998) and further five years co-operation (1999-2003, 2004-
2008, 2009- 2013), one-year extension for 2014 and currently there is a 3 years (2015-
2017) cooperation with a possibility of extension. LHLI, in collaboration with the
union, has served as a technical advisor for the development of the programme.

The objective of the cooperation is to form a partnership where LHLI provides

technical and financial support to strengthen NTP's capacity to reach the goal of the

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program: To reduce mortality, morbidity and transmission of tuberculosis until it is no
longer a public health problem in Nepal.

LHLI has been supporting NTP in the following areas:

• Devising training programs, educational materials and teaching arrangements for

the various categories of health personnel, community volunteers, and private
practitioners at the national, regional, district and community level.
• Capacity building of RTLOs/DTLOs who are responsible for the training at the
national, regional and district level, which in turn are to train health personnel.
• Carrying out supervision from central, regional and district level and integrating
training within the supervision process of the NTP.
• Supporting the technical assistance for the national prevalence survey
• Annual visit of the technical advisory committee
• Implementing skill development training for MDR patients
• Supporting community DOTS program
The LHLI supported to implement following major activities of NTP in 2016

TB management training (Bangalore)

8 District TB/Leprosy Officers (DTLO) from all over the country participated in TB
Management training in Bangalore, India from 16 to 20 January 2016. The
participants really got an opportunity to enhance their capacity to manage the
programme in their respective district.

Workshop/ meeting external

This budget is basically used to organise meeting of Technical Advisory Group

(TAG) for revising policy and address policy issues in NTP. The international
consultant visited Nepal to review and finalise the PMDT plan and there were
organised several meetings with Partners and Stakeholders to finalise the plan.

Commemoration of World TB day

NTP commemorated World TB day (24th March). The big social event was organized
at national level with support of different NTP stakeholders. All over Nepal, the event
was celebrated by organizing media workshops, government briefings and other
events to educate people about the symptoms of TB; build awareness to utilize the
resources for early diagnosis and treatment of TB and celebrate the survival of those
who have recovered.

Similarly, different events were organized to draw the attention of policy makers,
community people and other stakeholders on the tuberculosis prevention, control and
management in Nepal. All the government authorities including honorable Health
Secretary, Partners and Donors representative were made their commitment to unite
End TB in coming days like previous years.

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 Health Communication Training

The basic health communication training was organised in Nepalgunj, Banke district
and 14 health workers from DRTB treatment centre and sub-centres were participated
in the training. During training, aware their own communication habits, basic
communication skills, five minutes communication model, dealing your emotion and
reaching their goal contents were discussed. Similarly, follow up workshop with
trained health workers was organised in Mahendranagar, Kanchanpur and 16
participants helaht personal were participated. During the workshop, they gained
knowledge on training facilitation and management and prepared action plan to train
urban health volunteer on health communication. Moreover, trained health workers on
health communication at Nepalgunj, Banke, organised health communication training
to urban health volunteers. There were 240 volunteers from the urban participated in
the training. After training, the participants will monitor an impact of TB booklet and
counsel to the presumptive and TB patients to diagnosed and improve treatment
adherence.

Skill development training to DRTB patient

This is one of the very an effective strategy for DRTB patients in the country to
reduce the depression of patients, rising after medication. It also helps to improve the
economic aspects and well rehabilitated in their respective community. Six DRTB
patients were trained on sewing and cutting training at Bandipur DR home and they
also received sewing machine from the project and can continue their skill after
discharge from the DR home. In addition to this, NPR 4,00,000 thousands released to
Bandipur DR Home to organize need based skill training to DRTB patients. Likewise,
13 DRTB patients engaged in beauty parlor, cycle repairing, mobile repairing and
driving trainings based on their interest at NATA Morang from direct funding. Which
is very impressive social protection program for the patients. This program should
gradually be expended in other parts of the country as this has recommended in the
WHO End TB Strategy as a core component.

Printing of booklets for TB patients

1,500 TB booklets were printed and will be distributed at Nepalgunj Urban and the
impact will measure by recently trained health volunteers. Similarly, 500 training
manuals on health communication training to health volunteers were also printed and
plan to distribute in Pokhara and Mahendranagar to organize training to helath
volunteers in those places.

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Community DOTS

National Tuberculosis Programme has been implementing CBDOT programme in the

country. This year, LHLI supported to implement the programme in 5 districts of
Nepal.

Summary of Financial Status of 2016

The approved NTP support budget for 2016 was NPR 11.12 million, of which NPR
10 Million was spent only (89%) budget during January to December 2016.

14.5 International Organisation for Migration

Introduction of IOM

Established in 1951, the International Organization for Migration (IOM) is an

Intergovernmental Organization working in the field of migration management. IOM
joined the United Nations (UN) and became UN Migration Agency in September
2016. Nepal became the IOM member state in 2006. In 2007, the Government of
Nepal (GoN) and IOM signed a memorandum of understanding to encourage
cooperation and the delivery of services to Nepal, which is a country of origin, transit
and destination of migration. IOM’s initial focus in the country was on the
resettlement of Bhutanese refugees. Currently, IOM Nepal is committed to the
comprehensive management of migration through the facilitation of migration,
provision of direct assistance for the enhancement of the social and economic
development of Nepal.
IOM has diversified its areas of cooperation with the GoN into additional fields such
as Forced Migration, Migration and Development, Facilitating Migration and
Regulating Migration. IOM also believes that migrants and mobile populations
benefit from an improved standard of physical, mental, and social wellbeing, which
enables them to substantially contribute towards the social and economic development
of their home communities and host societies. In order to improve the wellbeing of
migrants, the IOM established a Migration Health Division (MHD) which specializes
in migration health. Through the MHD, the IOM conducts health assessments of
Bhutanese refugees and immigrants bound for the USA, UK and many other
countries. This includes TB screening, and treatment as well. There is also a clinic in
the refugee transit center in Kathmandu, and a specialized isolation center for the
treatment of highly-infectious and drug-resistant TB cases in Damak. MHD also
supports National TB Programme (NTP) in the implementation of TB related
activities in Nepal.
Vision of IOM Nepal

Migration for the benefit of Nepal and not anymore as a sole escape from poverty;
IOM wants migrants from and in Nepal to be valued, treated in an orderly humane
way, and enabled to contribute actively towards the social and economic development
of their country, their home communities and host societies.

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 Mission statement of IOM Nepal

As UN agency for migration, IOM in Nepal works with its partners in government,
civil society, private sectors and the international community to assist in meeting the
growing operational and policy challenges and opportunities of migration
management by:
• Providing expert advice, research, technical cooperation and operational
assistance to Nepal’s national and provincial institutions and relevant
stakeholders to enhance capacities on migration management.
• Working together with institutional partners, civil society, and the migrants to
maximize the impact of migration to contribute to Nepal’s socio-economic
development, cultural transformation and human development.

Key TB activities performed in 2072/73

• TB screening for Bhutanese Refugees and immigrants: Under Migration
Health Assessment activity for outbound Bhutanese Refugees and Immigrants,
active case detection for TB takes place as a routine ongoing activity. This
includes chest X-ray for above 15 years age group and Mantoux test for 2 to 14
yrs. This year, a total 8,977 refugees were assessed in IOM clinic, out of which
1,207 (13.45%) had abnormal chest x-ray findings. A total of 99 TB cases were
identified out of which 4 were MDR TB which is 4.04% of all identified TB
cases. Likewise, over 12,000 immigrants were screened for TB out of which 42
TB cases were diagnosed and treated, including one MDR TB case. This shows
TB case prevalence as 350 per 100,000 among screened immigrants. The
immigrants are not labour migrants and belong to upper middle income group on
socio economic standards.
• TB REACH Project: IOM continued to implement TB REACH project which
aimed to improve case detection of Tuberculosis in Nepal. As part of the project,
IOM supported NTP to introduce, operate and expand GeneXpert technology in
Nepal. Through this project, IOM also implemented the active case finding
activities in private sector, conducted operation research on optimal diagnostic
tools for TB diagnosis and implemented post disaster TB screening activities in
the displacement settings aftermath of 2015 Earthquake.
- Operation of GeneXpert Centres: IOM continued to support in the operation
of the ten GeneXpert Centres in the project areas. Monthly monitoring visits
were conducted to all GeneXpert centres to monitor the GeneXpert testing
activities and provide guidance to laboratory staff to ensure smooth operation,
including data quality audit and data collection. In 2072/73, a total of 12,696
tests were performed in ten GeneXpert centres and a total of 2,145 tests were
positive with 130 Rifampicin Resistant cases. The overall positivity rate was
16.9%. The positive cases were enrolled in the Directly Observed Treatment
Short-course (DOTS) in the respective health facilities. The project has also
established a referral mechanism from periphery level microscopic centres to
GeneXpert centres through sputum transportation system.

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 - Active Case Finding in private sector: IOM in collaboration with Sahara
Nepal implemented active case finding in Morang, Jhapa, Sunsari, Sirha,
Saptari and Udaypur District. Finding Actively, Testing and Treating (FAST)
strategies were used and patients attending Out-Patient Department (OPD)
were screened for TB from over 100 private health care facilities from the
project areas. Over 150,000 clients in the OPD were screened, over 15,000 TB
suspects were identified and tested for TB and nearly 1,000 TB cases were
detected and enrolled in DOTS.
- Operational Research: IOM conducted an operation research titled “Study of
Diagnostic Algorithms for Optimal Detection of Tuberculosis in the Tertiary
Care Centre of Eastern Nepal”. The operational research was conducted in BP
Koirala Institute of Health Science (BPKIHS), Dharan. A total of 1,250 TB
suspects having TB symptoms were recruited from Outpatient Department of
BPKIHS to further conduct 3 tests in parallel; Chest X-ray, sputum smear and
Xpert MTB/RIF. Six testing algorithms were generated from the available 4
main data sets to compare the TB detection yield. The research findings
suggested that Xpert (MTB/Rif) provides higher yield of TB cases when used
as direct test rather than as an add-on test. IOM plans to publish the findings in
near future.
- Post Disaster TB Project: The major earthquakes in April and May 2015 in
Nepal affected around 2.8 million people from 14 out of 75 districts, leading
to massive population displacement. Along with humanitarian assistance, IOM
Nepal provided technical and logistical support to the National Tuberculosis
Center (NTC) to conduct a post disaster needs assessment (PDNA). As per the
recommendation of PDNA, IOM implemented post disaster TB activities in
Kathmandu, Lalitpur, Bhaktapur, Sindhuplachowk and Gorkha districts. This
included TB screening activities, chest camps and revitalization of TB
services. Over 15,000 Internally Displaced Persons (IDPs) were screened for
TB and a total of 1,432 people were identified of having TB symptoms,
specimen was collected and tested from 1,106 TB suspects, 28 were identified
of having TB and they were enrolled in TB treatment. IOM also conducted a
total of 46 chest camps and provided service to a total of 2,355 people with
chest symptoms. Furthermore, IOM supported in the revitalization of 55
DOTS Centers in Sindhupalchowk district.

Key Achievements

• TB screening and treatment service was provided to nearly 12,000

immigrants and 9,000 refugees from IOM Clinics.
• All related NTP staff were trained on the operation and maintenance of
GeneXpert machines and all 10 machines were functioning smoothly by the
end of the fiscal year. Over 2,000 active TB cases were detected with
GeneXpert test and they were enrolled in the treatment.
• Private sector in the project areas was sensitized on TB. Over 150,000 OPD
patients were screened, over 15,000 TB suspects were identified and tested
for TB and nearly 1,000 TB cases were detected and enrolled in DOTS from
the private sector.

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 • The operation research provided useful finding for TB program which
suggested that Xpert (MTB/Rif) provides higher yield of TB cases when
used as direct test rather than as an add-on test.
• Over 15,000 IDPs were screened for TB and a total of 1,432 people were
identified of having TB symptoms, specimen was collected and tested from
1,106 TB suspects, 28 were identified of having TB and they were enrolled
in TB treatment.
• A total of 2,355 IDPs benefitted from the Chest Camps and received basic
medical treatment and medicines
• A total of 55 DOTS Centres were supported in Sindhupalchowk district as
part of revitalization of TB services.

Moving Forward

• Continue to provide high standard TB screening and treatment services to

immigrants and refugees as part of migration health assessment.
• Proper close out of TB REACH project. This includes discussion with NTP
and other stakeholders for the hand over and sustainability of GeneXpert
instruments after the project phase out.
• Share the challenges, best practices and lesson learned from TB REACH
project with NTP and stakeholders.
• Provide technical and logistic support to NTP in the operation of National TB
Prevalence Survey.
• Engage in the project development and implementation in collaboration with
NTP and other partners whenever opportunities arises.
• Provide technical support to NTP and other partners on TB and migration
issues.
• Work with NTP and partners for global commitments and action on TB
prevention and care for migrants.

14.6 BNMT Nepal

Introduction

BNMT Nepal is built on the foundation of commitment, expertise and experience of

theBritainNepal Medical Trust (BNMT UK), which has been working in Nepal since
1967. BNMT UK from its inception, has always lived with the principle of evidence
based advocacy and operational research for designing its programmes and
continuously monitoring, evaluation and fine-tuning its implementation strategies to
reach the hard to reach population. (.) As a charitable, non-sectarian, non-
governmental organization, BNMT Nepal focuses on promoting universal coverage

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and health equity, accountability and effectiveness in the Nepalese health sector.
These principles have embedded into the practice of BNMT Nepal.

Vision: To improve health and wellbeing of Nepalese people

Mission: To ensure equitable access to quality health care and enabling environment
for socially and economically disadvantaged people.

BNMT Nepal is implementing ‘National Tuberculosis Program’ from January 2017.

The project is funded by Global Fund and the Primary Recipient (PR) of the project is
Save the Children International. BNMT Nepal is working as a Sub Recipient (SR) in
order to contribute and support the National Strategic Plan 2016 to 2021. The duration
of the project is 15 months. The total budget for this project is NPR 66,566,246.00.

The project is implementing in seven districts in Eastern Development Region (i.e.

Ilam, Jhapa, Morang, Saptari, Sunsari, Siraha and Udayapur) and thirteen districts in
Mid and Far Western Development Region (i.e. Achham, Baitadi, Banke, Bardiya,
Dadeldhura, Dang, Doti, Kailali, Kanchanpur, Pyuthan, Rolpa, Salyan and Surkhet).
The project’s Goal and objectives are set to contribute and support to achieve the
National Strategic Plan (2016-2021) with following goal and objectives:

Goal
Reduce TB incidence by 20% and increase case notifications by a cumulative total of
20,000 by 2021

Objectives
Objective 1: Increase case notification: Cumulative total additional 20,000 by 2021.
Objective 2: Maintain the treatment success rate at 90%
Objective 3: Provide DR diagnostic services for 50% of persons with presumptive DR
TB by 2018 and 100% by 2021; successfully treat at least 75 %
Objective 4: Engaging providers for TB care from the public sector (beyond MoH),
medical colleges, NGO sector, and private sector through results based
financing (PPM) schemes
Objective 5: Strengthen community systems for management
Objective 6: Contribute to health system strengthening
Objective 7: Develop a comprehensive TB Surveillance, Monitoring and Evaluation
system
Objective 8: To develop a plan for continuation of NTP services in the event of
natural disaster or public health emergency

Key activities performed in 2072/73 (2015/16):

BNMT had implemented the activities which contributed and supported to increase
the case notification of TB. However, the project had started from January 2017. The
following key activities were carried out during the period March to June 2017.

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 TB Case Detection and Prevention:
• There are 151 DOTS Centers linked to the courier system in hard to reach
Terai districts. Sputum sample were collected from 171 presumptive TB cases
and 16 TB were diagnosed through this system.
• There are 412 DOTS Centers linked to the courier system in hard to reach hill
districts. Sputum samples were collected from 896 presumptive TB Cases and
20 TB cases were detected.

Mandatory Contact Tracing:

• Visits were carried out 1,798 PBC and childhood TB by FCHVs, Health
Volunteers or others for family contact tracing; 8,079 family contacts were
screened and 98 TB cases were detected.

Presumptive DR TB cases screening and detection

• There are 348 DOTS Centers linked to Microscopic Centers in courier system
• Screened 138 presumptive DR TB cases through courier system out of which,
only 2 DR TB cases were diagnosed.
• Screened 78 family members contacts of DR TB and only 2 DR TB cases
were detected.

Other activities
• There were 97 events organized to orient the school children on TB
• There were 14 events organized to provide orientation for Health teachers
on TB.
• Interaction Programs were organized for Public Private Practitioners on
National TB program. There were 3 events with 180 participants.
• Strengthened referral mechanism in TB/HIV. There were 27 events
organized for cross referral of TB/HIV and 656 health workers participated
in the orientation training.
• There were 2 events organized to initiate orientation on Isoniazid
Preventive Therapy (IPT) for RTLO and DTLO in Nepalganj and Hetauda
with 42 participants.
• Orientation program was conducted for BNMT staff on courier system
strengthening, initiation of IPT, malnutrition and childhood TB in EDR
and MWDR/FWDR regions.
• Activities such as strengthening courier system and TB screening of
malnourished children orientation to 231 health workers have been
completed in Ilam, Jhapa, Morang, Saptari, Sunsari in 9 events.

Continuous support for Quality Control in EDR

• Total slides examined: 530

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 • Reagents supply: 100 liters
• Districts laboratory supervisors workshop: 25 participants
• Laboratory management workshop: 105 participants in EDR, 82
participants in MWDR and 100 participants in FWDR
• LQAS Training: 40 participants
• Supervision/monitoring visit of Microscopy Centre: 10 MCs
o Rajbiraj DPHO, Kanchanpur PHC, Kadarbona PHC, Gaighat
Hospital, Beltar PHC, Inaruwa Hospital, Itahari PHC, Chatra PHC,
Rangeli Hospital, Jhurkiya PHC
o Laboratory strengthening program are going to be achieved.

Key achievements

• Built foundation for field programs for the active TB case notification
• Detected 132 TB cases in hard to reach Terai and Hill districts through courier
and mandatory contact tracing
• Linked DOTS and MCs in courier system
• Oriented health workers for courier system, screening of malnourished
children for TB, childhood TB and IPT
• Joint supervision with RHD, DHO, RTLO and DTLO
• Developed cross referral mechanism of TB/HIV
• Oriented teachers and students on TB
• Sensitized Public and Private sectors Practitioners for National Tuberculosis
Program
• Prepared foundation for initiation of IPT, screening of malnourished child for
TB, childhood TB screening and diagnosis
• Strengthened labs by organizing lab workshops and support to manage
infection control

14.7 NATA

NATA is a non-governmental, non-profit making voluntary organization established in

1953 with a vision to make the nation free from TB and a mission to promote health of
people ensuring quality service and right to prevent and cure TB and other infectious
diseases related to lungs and HIV. It is affiliated with the IUATLD, and is one of the
members of the South East Asian Region. NATA has a long standing history of
collaboration with National Tuberculosis Programme (NTP) as one of the oldest and key
partners. At present it has 38 district branches in Nepal. Since its inception, it has been
conducting various preventive and curative activities to fight against TB.
NATA has been appointed as a Sub-Recipient (SR) for the implementation of DR TB
management programs at national level.

Activities
• Awareness raising activities
• Diagnosis and treatment of MDR TB at Kalimati Chest Hospital

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 • German Nepal Tuberculosis Project
• DOTS service
• Drug Resistance (DR) TB management services
• DR hostel
• HIV counseling and testing service
• Culture, DST and other laboratory services
• Research and surveillance

Remarkable activities executed in the year 2072/73

3rd International Conference of the Union SEAR-2016

NATA hosted 3rd international conference of The Union South-East Asia Region
(SEAR) on 26th and 27th of May 2016, at Hotel Yak and Yeti, Kathmandu .The
conference proved to be a great forum for medical experts, doctors, researchers, social
workers, health policy makers and pharmaceuticals involved in TB and other lung
disease fields. Besides, it showed up a remarkable number of participants representing
different government and nongovernmental organizations from the sector in the SEA
region as well as round the globe. In total 210 national and international participants
took part in the conference. The Scientific session included Plenary; Symposium;
Plenary; Workshop; Presentation (Power point Presentation and Poster Presentation).

KATHMANDU DECLARATION 3rd Conference of the UNION South East

Asia Region (SEAR) 26th –27th May, 2016, Kathmandu, Nepal

No need to include (NATA, as the conference participants representing various

agencies, community groups and people with tuberculosis of the South East Asia
Region, recognize that every individual has the right to be protected from
Tuberculosis and gain adequate support measures to cure his/her disease. …… ;

62nd National Tuberculosis Day

NATA has been celebrating its

Establishment Day as National
Tuberculosis Day each year on
Mangsir 13. As a part of
celebration various awareness
activities were executed at
implementing district branches.
Besides, NATA central also
organized a ceremony at central
office to celebrate National Tuberculosis Day.

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 World TB Day:
Every year world TB Day is
celebrated in the honor of Dr.
Robert Koch who served the
mankind with the Discovery of
bacteria causing TB. With the
theme of “Unite to End TB"
NATA central and its branches
organized various awareness
raising activities. NATA central
also organized Free Health
Checkup for 3 days via the services available at the central office. Total 77 people
were examined in the free health checkup program. 77 people had free x-ray and free
blood test of 64 people was done. Talk Show regarding Tb was also aired through
Ujjyalo FM. of President Devendra Bahadur Pradhan was broadcasted in Ujjyalo F.M.
, NATA also took part in the exhibition which was organized by NTC within its
premises where calendar, Booklets, leaflets, Brochure, Postures related to TB
awareness was exhibited and distributed.

KEC Scholarship 2072

Encouraging the spirit of true volunteerism; every Year NATA in collaboration with
Kathmandu Engineering College provides scholarship to the children of NATA
volunteer, member of junior NATA and children of NATA staffs.

Programmatic achievement 2072/73

SN Activity Unit Achievement
1 First line TB Services
No. of
1.1 Patients visited in OPD 7789
visits
No. of
1.2 Presumptive TB cases screened in OPD 3737
patients
No. of
1.3 Presumptive TB cases Examined in lab 3874
patients
No. of
1.4 TB cases found smear positive from lab 437
patients
No. of
1.5 TB cases enrolled for treatment in the center 67
patients
TB cases referred to another treatment centers for No. of
1.6 369
treatment patients
TB cases received any kind of support e.g charity No. of
1.7 291
for treatment, travel and nutritional allowances etc patients
2 Services for DR TB cases
No. of
2.1 Patients visited in OPD 7789
visits
2.2 Presumptive DR TB cases screened in OPD No. of 215

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 patients
Presumptive DR TB cases collected sputum for No. of
2.3 215
examination of c/dst patients
No. of
2.4 TB cases found culture positive and drug resistant 32
patients
No. of
2.5 DR TB cases enrolled for treatment in the center 25
patients
TB cases received any kind of support e.g charity No. of
2.6 239
for treatment, travel and nutritional allowances etc patients
3 In-patient Services
No. of
3.1 New Admission 289
patients
No. of
3.2 Total Firstline TB Patients Admitted 150
patients
No. of
3.3 Total DR TB Patients admitted 55
patients
Total patients admitted other than TB showing No. of
3.4 78
chest complications patients
No. of
3.5 Total Discharge 232
patients
No. of
3.5 Referred to Higher centers 44
patients
No. of
3.6 Death 7
patients
4 DR Hostels Service
No. of
4.1 Total patients enrolled 38
patients
No. of
4.2 Discharge 22
patients
No. of
4.3 Referred 1
patients
5 DR reference lab
Total No. of presumptive DR cases tested for c/dst
for the diagnosis of DR TB including primary and No. of
5.1 1374
secondary TB infection (includes DST of FLD and patients
SLD)
No. of
Family members of DR cases tested for c/dst
5.2 DR 169
(contact tracing)
contacts
No. of
5.3 Total number of MDR cases diagnosed from c/dst 57
patients
Total number of XDR and Pre-XDR cases No. of
5.4 125
diagnosed from c/dst patients
No. of
5.5 Presumptive TB cases tested in Gene-xpert 227
patients
Total number of patients diagnosed MTB with No. of
5.6 10
Rifampicin resistance from gene-xpert patients

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General Laboratory
1 General patients 2605 16332
2 DR TB patients 183 5844
VCT
1 OPD patients 255 4
2 DR TB patients 62 1

Future Plans
• To expand district branches throughout the country.
• To improve the quality services of Kalimati chest hospital, National reference
lab, General lab via construction of improvised building.
• To involve the maximum numbers of volunteers in TB control program.

13.8 Health Research and Social Development Forum (HERD)

Introduction

Health Research and Social Development Forum (HERD), established in 2004, is a

national non-governmental organization with an aim to promote quality of life of
people, especially women and children, the poor and the disadvantaged communities.
HERD works across the nation in terms of 3 components: research, survey,
monitoring and evaluation; health systems delivery; and policy development adopting
a systems approach driven by equity, needs and priorities of the country, in line with
the global framework. HERD develops, test and deliver evidence-based, feasible, and
cost-effective interventions relating to health and social development. Research
undertaken by HERD focuses particularly in the areas of health policy, health systems
development, and health service delivery of various government programmes to foster
the relevance and effectiveness of the research in priority setting and evidence
informed policy decisions.

HERD Focus on Tuberculosis

Tuberculosis has been one of the priority service components for the organization
since its inception. HERD was the sub recipient of the Global Fund Round-7 and
NSA grants (Phase I and Phase II), focusing on 5 service delivery areas: Laboratory
Network, Health Systems Strengthening-Practical Approach to Lung Health (PAL),

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 TB HIV collaboration, Public Private Mix (PPM) and Advocacy, Communication and
Social Mobilization (ACSM).

Key Activities and Achievements in FY 2072-73

In the recent years (May 2013 to November 2015), HERD in collaboration with NTP,
implemented the TB REACH project in urban areas of 22 districts of Nepal through
an innovative strategy to reach the unreached high-risk population and provide TB
services to them using a mobile van with embedded diagnostic services. The project
was able to identify 1643 new TB cases. Even after the project was completed,
HERD through its internal resources mobilized the van and Gene Xpert for TB case
detection in different areas. Also, HERD worked as a Gene Xpert Referral Site for
private and public hospitals, leading to strengthening of Public Private Partnership in
TB control program. A total of 299 TB cases were detected and a total of 12
Rifampicin resistant TB cases were detected. The number of tests performed through
Gene Xpert during this fiscal year is given below:

MTB Not MTB+/RIF MTB+/RIF MTB+/RIF Error/Invalid/No Total

Detected ‘S’ ‘R’ ‘I’ Result

3126 299 12 6 535 3,978

HERD has contributed in participation in different levels of meetings, discussions and

workshops of the NTP. HERD has also provided technical support in finalization of
the 5 years plan of NTP, NSP 2015-2021.

Planned Activities

HERD plans to continue to engage in different activities of the NTP and provide
technical assistance to NTP. Also, HERD shall continue to provide diagnostic
services through mobile van and Gene Xpert. HERD has been providing its helping
hand for over a decade supporting National Tuberculosis Programme in terms of
organizing national events, advocating for better focus on addressing tuberculosis
related issues at the national level collaborating with Ministry of Health and
associated divisions and directorates, civil society, private sector and the media.

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14.9 TB Nepal

Introduction
TB Nepal a non-governmental , non religious, non political and non-profit making
voluntary organization was founded in 2060 BS (2003 AD). . The goal of the
organization is Sustainable Improvement in health & quality of life of poor and
marginalized TB , Leprosy and HIV affected people in MWR .

TB Nepal began treating TB patients in the Mid western region (MWR ) of Nepal
since 2003 ( 2060 BS ) as a DOTS and sputum microscopy centre. Nepalgunj TB
Referral center Banke is the center for the diagnosis and treatment of complicated TB
cases with 24 hours in-patients care facility.
TB Nepal is situated in the center of Nepalgunj municipality, close to the Indian
boarder. TB Referral Center Nepalgunj provides services mainly to the people of the
Banke, Bardiya district, Karnali zone and to the people from other region and from
the border side of India. It is the busiest center of tuberculosis and Leprosy providing
services to large number of people.

OPD service.
Nepalgunj TB Referral Centre have 2 separate ( TB and Leprosy ) OPD services.
Near about 30597 patients visited ( Male 20445 and 10152 female ) in TB OPD in this
year 2072 / 073.

MDR TB Service.
Nepalgunj TB Referral Center is one of the DOTS (Directly Observed Treatment
Short course) center of the mid-west region. The center provides daily DOTS
(Directly Observed Treatment Short course) to first line TB patients and second line
TB (MDR TB treatment) service to Multi-drug resistant TB patients. The centre also
supervises and monitors MDR TB activities in the 7 MDR TB sub-centres of the Mid
Western region. This is the only DOTS & MDR TB center in the region where
services are available in outpatients and in-patient basis. 43 new MDR TB cases were
registered with in the year 2072 / 2073 .Now 35 MDR TB patients are taking second
line TB treatment from this center. MDR TB treatment success rate is 80 %.

In-patients facility
Nepalgunj TB referral Center has in-patient service with 29 beds for TB and where
care is provided to seriously ill TB patients who require in-patient care and who
cannot access such care other place. In-patients service is available 24 hours in every
day. Patients with extensive lung involvement, TB meningitis, spinal TB, MDR TB,
TB patients with HIV/ AIDS Co-infection, side effect of drugs and its reaction and

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 seriously ill TB suspects benefits in in-patient service. Patient’s recreation,
Counseling, advocacy and health education services are also provided to In-patients
and their families. Nutritious Food and accommodation is provided free of cost. 536
TB patients were admitted in 2072 / 2073 ( 2015 / 016 AD ) .Bed occupancy rate was
75 % and average length of stay was 6 days at TB side. 1.31 % death rate of admitted
patients.

Laboratory service
Nepalgunj TB Center has a well-equipped laboratory where necessary investigations
are performed for the diagnosis of TB. Sputum test is the main function of the
laboratory. In addition other tests such as basic blood tests, mantoux tests HIV test,
urine tests and stool tests are carried out in the laboratory. Fluorescence microscopy
facility is available in this center. 503 sputum samples was sent to GENETUP
Kathmandu for culture & sensitivity testing. Sputum smear test 10242 , HIV test 885 ,
Mantoux test 710 and near about 22000 basic blood tests were tested in our
Laboratory in this year. 4 monthly quality control report was found excellent
according to Government Quality control Laboratory.

Skill transfer Activities

TB Nepal Nepalgunj TB referral Centre has provision of skill transfer activities
about TB and leprosy treatment to the BHS (Basic Health Service) staffs of
government of Nepal or to other suitable partner NGO staffs or to independent
individuals who recently passed their course. TB center continue to build up
relationships with Government of Nepal & with other Non-government organizations
by providing support and In-service training and thus improving the quality of TB
work (care) in Midwestern region of Nepal in the longer term. 38 Health Assistant
and 80 nursing students were benefited by exposure to the clinic in 2072 /2073. 2
ANM, 2 staff nurse and 1 CMA were completed their 3 months course. In this period
3 lab assistant came from GO /N and NGO side for TB sputum smear and leprosy
skin smear training.
Charity / poor fund
TB Nepal Nepalgunj TB Referral Center has Charity /Poor fund and have provision of
financial assistance to poor and needy patients. Near about 5500 patients benefited
from this Charity/Poor Fund in year 2072 / 2073 through medicine charity,
investigation charity, support in transportation fare and food and accommodation.
Charity is given on the completion of socio-economic assessment form of the patients
and their families. Food and accommodation are free for all admitted patients.

OPD service
The center provides the following TB specific functions:
- TB / Leprosy suspects registration and screening.

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- TB / Leprosy diagnosis
- TB case registration and TB treatment on DOTS.
- Referrals after diagnosis.
- Counseling and advocacy of patients for appropriate care in respective center in
needs
- Health education to In and outpatients.
- Late or defaulted TB and Leprosy patients chasing.

Awareness Rising and Epidemic Control

Beside the regular services, the center was actively involved in awareness raising
activities in World Tuberculosis Day, Leprosy Day and HIV/AIDS Day. The staffs (a
Medical Doctor and other Paramedics) were also heavily involved in the epidemic
control in coordination with the District Health Office. TB Nepal actively involved in
earth quake re-construction activities in coordination with the Ministry of health.
Monitoring and Evaluation
TB Center staff participated in TB / Leprosy quarterly meeting at district and regional
level. Time to time supervisory visit by DTLO, RTLO and NTC supervisor takes
place. Regular monitoring and supervisory visit is conducted by NTC, Global fund
NTC and Global Fund supervisory visit took place in theye. Nepalgunj TB Referral
Centre has its own internal monitoring and evaluation of the center activities by
internal staff (taking interviews with patients and recorded by an independent
outsider) on monthly, four monthly and yearly. TB Nepal actively involved in
regional base TB / leprosy supervision and training .

14.10 Japan-Nepal Health and Tuberculosis Research Association

(JANTRA)

Introduction

Japan-Nepal Health and Tuberculosis Research Association (JANTRA) is a non-

profitable and non-governmental organization affiliated with the Research Institute of
Tuberculosis/Japan Anti-Tuberculosis Association (RIT/JATA), Japan. Since its
establishment, it has maintained an excellent track record of working in TB control
program in urban and rural areas including hard to reach population. It is successful in
completion of different TB projects such as Global Fund in the Central and Western
Region, TB Reach project in Kathmandu valley, Post Disaster TB project and
prevalence of TB/diabetes co-morbidity survey in Kathmandu valley. JANTRA is an
active member of National Tuberculosis Control Programme. It is recognized as a
trusted partner of the National Tuberculosis Program (NTP). JANTRA has
operational relationships with the key stakeholders and government agencies such as
Divisions, Centers, Regional Health Director (RHD), District Health and Public
Health Offices (D/HPO), private health providers, Clinics and health volunteers.

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 JANTRA is providing TB diagnosis and treatment services through its laboratory and
DOTS center. It is also a DR TB sub treatment center for Kathmandu. It has been
implementing Community –Based Urban TB Control Program since 2008 with the
objective to provide diagnosis & treatment services, support and care to TB patients.
JANTRA has been conducting TB awareness activities in schools, factories, slums
and hard to reach population. JANTRA has been conducting program to provide
psychosocial counseling and nutritional support to the under treatment TB patients in
Kathmandu and Bhaktapur district since March 2016. JANTRA is undertaking a
follow up survey to determine the relapse rate among TB cured diabetic patient in
Kathmandu valley.

With these project/activities, JANTRA is contributing to early TB diagnosis,

systematic screening of contacts, and high-risk groups, treatment, care and support. It
is providing social protection and addressing the social determinants of tuberculosis
by delivering services on psychosocial counseling and nutritional support and
promoting research. Thus, its programs are in line with 3 pillars and components of
end TB strategy that is aimed to end TB by 2050.

Mission:

Franchise to promote health and prevent from health problems through the application
of evidence based public health practices, quality health services and research in
Nepal.

Objectives:

• To enhance collaboration between TB patients, civil society organizations,

Research Institutions, Universities, government agencies and donors.
• To help to care and support for those who are infected and affected by
Tuberculosis, for the purpose of controlling all forms of TB (TB, DR,
TB/HIV)
• To reduce stigma and discrimination related with TB and its co-infection
• To improve community health through designing innovative models and its
effective implementation up to grassroots level by knowing the local context

Key activities performed in 2072/73

a) Urban TB Control Project partnership with Research Institute of

Tuberculosis / Japan Anti-Tuberculosis Association (RIT/JATA) –
Innovative DOTS / MDR treatment service, community participation in terms
of TB control, increase service seeking practice, strengthen networks working
for the TB control and enhance capacity of the health workers are the
intervention of the project.
b) TB REACH Wave – 4 (2014 to 2016) : The project was implemented
partnership with UNOPS in Kathmandu Valley, project thrusts were ;
Increased case finding, among vulnerable population, PPM, street children,
waste management collectors

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 c) Post Disaster Recovery Project (2015 to 2016): The intervention areas was:
Active TB case finding among internally displaced people by earthquake,
establish sample currier mechanism and social mobilization and enrollment of
the diagnosed TB cases for the treatment.
Key achievements

a) Increased early TB detection rate in the project areas.

b) Enhanced capacity of the health worker to deliver quality health service to
the needy people.
c) Increased correct understanding on TB and health service seeking practice
among at-risk population.
d) Increased engagement of private pharmacy, private health workers and
stakeholders in TB care program.
e) Established and operationalized referral, cross-referral and counter referral
mechanism between private pharmacy, private hospital, TB diagnostic
center, DOTS center, HTC and MDR center.
f) Enhanced access of TB care service through Mobile Microscopic camp in
strategic location, where access of TB service is nominal.

Future Plan

JANTRA is committed to enhanced quality and patient friendly service for the needy
population, so, future plan of the JANTRA's encompasses;

- Patient friendly service

- Uplift capacity of the health workers for problem based and result based
counselling
- Enhance health service and information accessibility
- Strengthen capacity of health institution to offer quality health service
- Increase knowledge and skill of high-risk population and service seeking
practice.

14.11 National partnership for Integrated-Development-Nepal

(NAPID-Nepal)

Background
National Partnership for Integrated
Development-Nepal (NAPID-Nepal)
established in 2006 A.D. is a nonprofit
service based, non-governmental
organization registered in District
Administration Office Kancahnpur,
affiliation with social welfare council,
Kathmandu and working in the field of
health and human right in Far-western region

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 of Nepal. Since 2011 NAPID-Nepal is being implementing regional level Drug
Resistant (DR-TB) Hostel and treatment service and TB/HIV awareness and advocacy
program in joint collaboration with National Tuberculosis center Thimi Bhaktapur,
Far-western regional health directorate-Dipayal, Seti Zonal Hospital, Dhangadhi and
District Public health Office, Kailali and Kanchanpur. From this F/Y 2016/017
NAPID Nepal has been acting as a Sub Recipient (SR) with Save the Children US/
Global Fund and implementing DR TB hostel program in Dhangadhi, Kailali.

Vision/Mission:-
NAPID-Nepal striving towards healthier and more equitable society and committed
to improvement of health and rights of Nepalese people, especially those whose
health needs and rights are often not met e.g. rural, the poor, women, children,
adolescents, dalit, disabled, TB patients and their families, PLHIV and their families,
migrants, orphans and other disadvantaged group, through sustainable health services,
capacity building and empowerment.

Goal: -
To assist Nepal to achieve the millennium development goal by increasing the
percentage of Healthy, wealthy and more educated people in Nepal.

Objective (Health sector):-

To improve the health status of the population of the most vulnerable groups,
particularly those whose health needs are often not met-women and children, the poor,
the underprivileged and the marginalized populations through providing the
promotive, preventive, curative and rehabilitative health services.

Strategy:-
To develop the partnership and coordination with government organizations(GOs),
international non-governmental organizations (INGO’s), donors, other non-
governmental organizations (NGOs) and community-based organizations (CBOs) and
communities.

Core activities

• Establishment and operation of DR-TB hostel in Dhangadhi, Kailali and

provide food, shelter and treatment to DR-TB and TB-HIV co infected
Patients.
• Sputum collection and courier to Genetup Kathmandu for Culture and DST
through SZH.
• Regular laboratory investigation of MDR-TB patients:- potassium, create nine,
LFT,TSH etc through SZH.
• Counseling to MDR-TB patients, their families and community.
• Treatment of DR-TB patients.
• Side effect management of DR-TB patients.
• TB /HIV awareness and advocacy.

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Geographical Coverage

Other Achievements
• Normal Side effect management of 12 cases
• Culture and DST services to all 26 cases regularly through SZH.
• Laboratory investigation to 26 cases through SZH.
• Regular and periodic counseling to patients-26, families-150 and community-
2 time
• participate district and regional TB and MDR-TB review meeting- 3 time
• TB/HIV-AIDS awareness to migrants and their families. 2time
• Lasting solution to manage regular laboratory investigation of DR-TB
patients:- potassium, sodium, create nine, LFT,TSH & sputum smear etc
• To follow up defaulter patient.
• Capacity building of Staffs regarding management of DR-TB and HIV
program

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 CHAPTER 15: KEY CONSTRAINTS AND CHALLENGES

15.1 Key Constraint & Challenges

The Nepal NTP has regularly been facing several challenges and constraints, which
influence inability to expand and sustain the vision of the programme. Following are
the key challenges and constraints faced by the NTP in order to reach intended goals
and targets of the programme in last fiscal year.

Challenges:

• Insufficient income generation program for patient and their family members.
• Inadequate TB management training to medical doctors
• Minimum interventions for strengthening PPM component
• Lack of operational research regarding increasing retreatment cases
• Lack of patient friendly TB treatment service
• Existing currier system for slide- not adequate
• Inadequate TB IEC materials
• Difficult to coordinate with regional and provincial hospitals.

Action to be taken:

• Expansion of CBDOT programme in the country

• Strengthen Public Private Mix approach
• Strengthen the Community Support System programme
• Plan for operational research on TB
• Develop and distribute patients centered TB IEC materials
• Pilot patient friendly treatment centers in the country

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 ANNEXURE

Annex 1: District wise case notification rate

Eastern Development Region

Dhankuta
Case Notification Rate Treatment Outcome

Illam
Case Notification Rate Treatment Outcome

Jhapa
Case Notification Rate Treatment Outcome

ANNUAL REPORT 2072/73

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Khotang
Case Notification Rate Treatment Outcome

Morang
Case Notification Rate Treatment Outcome

Okhaldhunga
Case Notification Rate Treatment Outcome

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Panchathar
Case Notification Rate Treatment Outcome

Sankhuwasava
Case Notification Rate Treatment Outcome

Saptari
Case Notification Rate Treatment Outcome

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Siraha
Case Notification Rate Treatment Outcome

Solukhumbhu
Case Notification Rate Treatment Outcome

Sunsari
Case Notification Rate Treatment Outcome

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Taplejung
Case Notification Rate Treatment Outcome

Terathum
Case Notification Rate Treatment Outcome

Udayapur
Case Notification Rate Treatment Outcome

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Central Development Region
Bara
Case Notification Rate Treatment Outcome

Bhaktapur
Case Notification Rate Treatment Outcome

Chitwan
Case Notification Rate Treatment Outcome

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Dhading
Case Notification Rate Treatment Outcome

Dhanusa
Case Notification Rate Treatment Outcome

Dolakha
Case Notification Rate Treatment Outcome

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Kathmandu
Case Notification Rate Treatment Outcome

Kavre
Case Notification Rate Treatment Outcome

Lalitpur
Case Notification Rate Treatment Outcome

ANNUALANNUAL REPORT 2072/73

REPORT 2072/73 95 95
Mohattari
Case Notification Rate Treatment Outcome

Makawanpur
Case Notification Rate Treatment Outcome

Nuwakot
Case Notification Rate Treatment Outcome

ANNUAL REPORT
ANNUAL 2072/73
REPORT 2072/73 96 96
Parsa
Case Notification Rate Treatment Outcome

Ramechap
Case Notification Rate Treatment Outcome

Rasuwa
Case Notification Rate Treatment Outcome

ANNUAL
ANNUAL REPORTREPORT
2072/73 2072/73 97 97
Rautahat
Case Notification Rate Treatment Outcome

Sarlahi
Case Notification Rate Treatment Outcome

Sinduli
Case Notification Rate Treatment Outcome

ANNUALANNUAL
REPORTREPORT
2072/73
2072/73 98 98
Sindupalchowk
Case Notification Rate Treatment Outcome

ANNUAL
ANNUAL REPORTREPORT
2072/73 2072/73 99 99
Western Development Region
Arghakhanchi
Case Notification Rate Treatment Outcome

Baglung
Case Notification Rate Treatment Outcome

Gorkha
Case Notification Rate Treatment Outcome

ANNUAL REPORT
ANNUAL2072/73
REPORT 2072/73 100 100
Gulmi
Case Notification Rate Treatment Outcome

Kapilvastu
Case Notification Rate Treatment Outcome

Kaski
Case Notification Rate Treatment Outcome

ANNUAL
ANNUAL REPORTREPORT
2072/73 2072/73 101 101
Lamjung
Case Notification Rate Treatment Outcome

Manang
Case Notification Rate Treatment Outcome

Mustang
Case Notification Rate Treatment Outcome

ANNUAL REPORT
ANNUAL2072/73
REPORT 2072/73 102 102
Myagdi
Case Notification Rate Treatment Outcome

Nawalparasi
Case Notification Rate Treatment Outcome

Palpa
Case Notification Rate Treatment Outcome

ANNUAL
ANNUAL REPORTREPORT
2072/73 2072/73 103 103
Parbat
Case Notification Rate Treatment Outcome

Rupandehi
Case Notification Rate Treatment Outcome

Syangja
Case Notification Rate Treatment Outcome

ANNUAL REPORT
ANNUAL2072/73
REPORT 2072/73 104 104
Tanahu
Case Notification Rate Treatment Outcome

ANNUAL
ANNUAL REPORTREPORT
2072/73 2072/73 105 105
Mid-Western Development Region
Banke
Case Notification Rate Treatment Outcome

Bardiya
Case Notification Rate Treatment Outcome

Dailekh
Case Notification Rate Treatment Outcome

ANNUAL REPORT 2072/73

ANNUAL REPORT 2072/73 106 106
Dang
Case Notification Rate Treatment Outcome

Dolpa
Case Notification Rate Treatment Outcome

Humla
Case Notification Rate Treatment Outcome

ANNUAL
ANNUAL REPORT
REPORT 2072/73
2072/73 107 107
Jajarkot
Case Notification Rate Treatment Outcome

Jumla
Case Notification Rate Treatment Outcome

Kalikot
Case Notification Rate Treatment Outcome

ANNUAL REPORT 2072/73

ANNUAL REPORT 2072/73 108 108
Mugu
Case Notification Rate Treatment Outcome

Pyuthan
Case Notification Rate Treatment Outcome

Rolpa
Case Notification Rate Treatment Outcome

ANNUAL
ANNUAL REPORT
REPORT 2072/732072/73 109 109
Rukum
Case Notification Rate Treatment Outcome

Salyan
Case Notification Rate Treatment Outcome

Surkhet
Case Notification Rate Treatment Outcome

ANNUAL REPORT 2072/73

ANNUAL REPORT 2072/73 110 110
Far-Western Development Region
Achham
Case Notification Rate Treatment Outcome

Baitadi
Case Notification Rate Treatment Outcome

Doti
Case Notification Rate Treatment Outcome

ANNUAL
ANNUAL REPORT
REPORT 2072/73 2072/73 111 111
Bajhang
Case Notification Rate Treatment Outcome

Bajura
Case Notification Rate Treatment Outcome

Dadeldhura
Case Notification Rate Treatment Outcome

ANNUAL REPORT
ANNUAL2072/73
REPORT 2072/73 112 112
Darchula
Case Notification Rate Treatment Outcome

Kanchanpur
Case Notification Rate Treatment Outcome

Kailali
Case Notification Rate Treatment Outcome

ANNUAL
ANNUAL REPORT
REPORT 2072/73 2072/73 113 113
 Annex 2 Case Notification Rate 2072-73 (2016)

ANNUAL REPORT 2072/73

ANNUAL REPORT 2072/73 114 114
Annex 3: District wise positivity rate of sputum microscopy

ANNUAL
ANNUAL REPORT 2072/73
REPORT 2072/73 115 115
 Annex 4: District Wise Target Against Achievement of Notified Cases
All Forms
As pe r CNR target Proportion of notified cases (all forms) 2016
Actual notified
of 145 notifie d TB Percent of % Child % HIV status
S.N Districts cases(All forms) %
cases (All forms) achievement PBC % Case (0-14) known among TB
2016 Pulmonary
2016 years patients
1 Achham 400 176 44 82 70 6 55
2 Arghakhanchi 292 258 88 70 47 6 36
3 Baglung 403 146 36 68 61 4 40
4 Baitadi 378 204 54 78 61 1 68
5 Bajhang 307 175 57 69 55 6 27
6 Bajura 214 100 47 72 64 8 31
7 Banke 814 888 109 77 63 9 27
8 Bara 1121 1033 92 81 61 4 1
9 Bardiya 666 555 83 77 62 7 22
10 Bhaktapur 499 619 124 60 51 6 6
11 Bhojpur 242 65 27 57 51 8 14
12 Chitwan 944 993 105 73 55 3 3
13 Dadeldhura 221 117 53 79 58 4 21
14 Dailekh 412 201 49 66 47 18 17
15 Dang 887 1013 114 79 51 7 8
16 Darchula 203 120 59 88 58 3 48
17 Dhading 504 296 59 69 62 7 10
18 Dhankuta 244 145 59 61 56 6 22
19 Dhanusha 1172 634 54 81 58 6 91
20 Dolakha 272 144 53 63 44 5 0
21 Dolpa 58 8 14 100 100 0 0
22 Doti 310 146 47 80 70 3 58
23 Gorkha 373 247 66 72 65 4 12
24 Gulmi 387 295 76 64 42 5 22
25 Humla 81 43 53 63 35 5 21
26 Ilam 441 147 33 74 59 3 21
27 Jajarkot 273 134 49 69 47 5 10
28 Jhapa 1279 1086 85 76 63 3 11
29 Jumla 172 50 29 62 50 8 6
30 Kailali 1277 1109 87 73 57 8 29
31 Kalikot 218 110 50 63 44 8 0
32 Kanchanpur 724 775 107 79 60 4 44
33 Kapilvastu 915 624 68 84 67 5 25
34 Kaski 796 485 61 56 49 7 12
35 Kathmandu 2960 3149 106 52 41 5 20
36 Kavre 573 285 50 65 54 10 7
37 Khotang 272 117 43 50 43 5 28
38 Lalitpur 771 803 104 54 43 5 1
39 Lamjung 247 150 61 75 58 7 13
40 Mahottari 983 890 91 91 54 5 9
41 Makawanpur 647 770 119 84 68 4 12
42 Manang 9 5 54 60 60 20 60
43 Morang 1514 1117 74 70 59 3 3
44 Mugu 88 31 35 55 42 3 26
45 Mustang 18 4 22 75 75 0 50
46 Myagdi 163 71 44 68 61 14 10
47 Nawalparasi 1008 872 86 75 60 5 10
48 Nuwakot 412 255 62 79 60 3 15
49 Okhaldhunga 218 98 45 55 46 11 63
50 Palpa 369 358 97 64 53 7 66
51 Parbat 215 108 50 70 60 2 3
52 Parsa 972 906 93 80 58 2 17
53 Pantchathar 283 76 27 76 59 1 7
54 Pyuthan 344 270 78 79 59 6 20
55 Ramechhap 300 99 33 72 55 9 0

ANNUAL REPORT 2072/73 116

 As per CNR target Proportion of notified case s (all forms) 2016
Actual notified
of 145 notified TB Percent of % Child % HIV status
S.N Districts cases(All forms) %
cases (All forms) achievement PBC % Case (0-14) known among TB
2016 Pulmonary
2016 years patients
56 Rasuwa 64 36 56 64 36 6 0
57 Rautahat 1133 855 75 83 51 4 0
58 Rolpa 338 268 79 72 54 8 24
59 Rukum 321 237 74 71 50 14 34
60 Rupandehi 1441 1371 95 76 42 5 23
61 Sankhuwasabha 228 87 38 64 53 2 6
62 Salyan 378 239 63 69 51 9 26
63 Saptari 991 460 46 91 70 2 20
64 Sarlahi 1227 1093 89 85 50 3 15
65 Sindhuli 443 495 112 85 68 6 0
66 Sindhupalchok 424 184 43 74 58 5 0
67 Siraha 984 525 53 87 63 2 19
68 Solukhumbu 151 19 13 63 32 5 58
69 Sunsari 1239 989 80 72 62 4 0
70 Surkhet 568 670 118 58 30 28 29
71 Syangja 388 248 64 72 56 2 14
72 Tanahu 490 328 67 70 57 4 1
73 Taplejung 188 43 23 35 33 5 0
74 Terhathum 147 27 18 70 59 19 0
75 Udayapur 495 307 62 80 64 2 15

ANNUAL REPORT 2072/73 117

 Annex 5: NTP Annual Case Finding Report Fiscal Year: 2072/73 (2016)

Pulmonary (BC)
Districts

Other Other
S.N. DOTS Centre Treatment Treatment After Total Total
New Relapse Previously Treatment Transfer In
After Failure Lost to Follow-up (excluding T in) PBC
Treated History Unknown

F M F M F M F M F M F M F M F M

Banke Total 162 317 24 37 3 11 2 4 0 0 1 0 5 7 192 369 561

15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 79 225 7 23 1 5 0 2 0 1 0 0 7 1 87 256 343

Dailekh Total 20 68 1 5 0 0 0 0 0 0 0 0 0 0 21 73 94
Dang Total 157 262 28 59 1 7 0 3 1 2 0 0 5 2 187 333 520
Dolpa Total 2 5 0 1 0 0 0 0 0 0 0 0 0 0 2 6 8
Humla Total 3 7 1 2 0 0 1 1 0 0 0 0 0 2 5 10 15
Jajarkot Total 19 32 3 8 0 0 0 0 1 0 0 0 0 0 23 40 63
Jumla Total 7 13 0 3 0 1 0 1 0 0 0 0 0 1 7 18 25
Kalikot Total 19 17 4 4 1 2 0 1 0 0 0 0 0 0 24 24 48
Mugu Total 5 8 0 0 0 0 0 0 0 0 0 0 1 0 5 8 13
Pyuthan Total 26 100 6 20 2 3 0 1 0 0 0 0 1 2 34 124 158
Ropa Total 49 74 4 16 0 1 0 0 0 1 0 0 2 3 53 92 145
Rukum Total 36 63 8 9 0 1 0 1 0 0 0 0 0 0 44 74 118
Salyan Total 31 67 6 18 0 1 0 0 0 0 0 0 0 0 37 86 123
Surkhet Total 49 127 2 18 0 1 0 3 0 2 1 1 1 4 52 152 204
Mid Western Region Total 664 1385 94 223 8 33 3 17 2 6 2 1 22 22 773 1665 2438
1 Bara Total 217 337 16 49 0 4 2 3 0 0 1 0 3 7 236 393 629
2 Bhaktapur Total 91 178 12 34 0 1 0 2 0 0 0 0 1 4 103 215 318
3 Chitwan Total 139 287 29 71 1 8 1 5 0 2 0 2 6 7 170 375 545
4 Dhading Total 39 109 3 27 0 3 0 2 0 0 0 0 1 1 42 141 183
5 Dhanusha Total 113 223 6 19 1 2 0 2 0 2 0 1 4 4 120 249 369
6 Dolkha Total 7 49 1 6 0 0 0 0 0 0 0 0 1 1 8 55 63
7 Kathmandu Total 388 639 72 135 13 11 2 13 3 9 1 5 33 46 479 812 1291
8 Kavre Total 36 84 7 25 0 0 0 1 0 0 0 0 0 0 43 110 153
Lalitpur Total 109 169 13 39 0 6 0 0 1 4 1 1 10 13 124 219 343
10 Mahottari Total 157 295 7 22 1 3 0 0 0 0 0 0 0 2 165 320 485
11 Makwanpur Total 142 304 11 47 0 12 0 2 0 2 0 0 2 3 153 367 520
12 Nuwakot Total 27 100 4 16 2 4 1 0 0 0 0 0 0 1 34 120 154
Parsa Total 182 273 17 45 1 2 2 2 0 0 0 0 3 4 202 322 524
14 Ramechhap Total 15 35 0 3 0 0 0 0 0 1 0 0 0 0 15 39 54
Rasuwa Total 2 11 0 0 0 0 0 0 0 0 0 0 0 0 2 11 13
16 Rautahat Total 138 244 10 30 2 8 1 1 0 1 0 1 0 2 151 285 436
17 Sarlahi Total 174 293 14 51 1 8 3 3 0 3 0 0 3 3 192 358 550
18 Sindhuli Total 100 166 11 56 1 1 1 0 0 0 0 0 2 1 113 223 336
19 Sindupalchok Total 30 70 1 5 0 0 0 0 0 1 0 0 0 1 31 76 107
Central Region Total 2106 3866 234 680 23 73 13 36 4 25 3 10 69 100 2383 4690 7073
1 Arghakhanchi Total 33 69 0 18 1 0 0 0 0 0 0 0 1 0 34 87 121
2 Baglung Total 30 46 5 7 1 0 0 0 0 0 0 0 0 1 36 53 89
3 Gorkha Total 45 104 1 7 1 1 0 0 0 1 0 0 0 2 47 113 160
4 Gulmi Total 36 71 0 15 0 1 0 0 0 0 0 0 1 2 36 87 123
5 Kapil Total 111 258 8 34 0 7 1 1 0 0 0 0 1 0 120 300 420
6 Kaski Total 72 131 8 22 1 2 0 0 1 2 0 0 0 0 82 157 239
7 Lamjung Total 21 54 1 8 0 2 1 0 0 0 0 0 1 0 23 64 87
8 Manang Total 2 1 0 0 0 0 0 0 0 0 0 0 0 1 2 1 3
9 Mustang Total 1 1 0 0 0 1 0 0 0 0 0 0 1 1 1 2 3
10 Myagdi Total 17 23 0 2 1 0 0 0 0 0 0 0 0 0 18 25 43
11 Nawal Total 138 308 16 51 0 4 0 2 1 0 0 0 0 2 155 365 520
12 Palpa Total 57 109 6 19 0 0 0 0 0 0 0 0 0 1 63 128 191
13 Parbat Total 20 34 0 9 0 1 0 1 0 0 0 0 0 1 20 45 65
14 Rupandehi Total 172 324 15 57 1 2 0 0 2 2 1 0 1 3 191 385 576
15 Syanja Total 38 90 1 10 0 0 0 0 0 0 0 0 0 0 39 100 139
16 Tanahun Total 49 110 5 20 1 0 1 1 0 0 0 0 1 1 56 131 187
Western Region Total 842 1733 66 279 7 21 3 5 4 5 1 0 7 15 923 2043 2966
Achham Total 23 75 2 11 0 2 0 2 1 3 0 4 1 1 26 97 123
9 8 7 6 5 4 3 2 1

Baitadi Total 32 78 1 10 0 2 1 0 0 0 0 0 0 1 34 90 124

Bajhang Total 32 44 8 9 0 0 0 2 1 1 0 0 2 1 41 56 97
Bajura Total 22 36 0 4 0 0 0 0 0 1 1 0 0 2 23 41 64
Dadeldhura Total 21 37 3 4 0 1 0 0 0 0 0 2 0 0 24 44 68
Darchula Total 9 49 5 7 0 0 0 0 0 0 0 0 0 0 14 56 70
Doti Total 32 60 3 5 0 1 0 0 1 0 0 0 1 2 36 66 102
Kanchanpur Total 130 265 13 45 0 6 0 2 1 2 0 0 1 3 144 320 464
Kailali Total 165 379 23 55 0 5 1 3 0 2 0 1 1 3 189 445 634
Far-Western Region Total 466 1023 58 150 0 17 2 9 4 9 1 7 6 13 531 1215 1746
Bhojpur Total 6 21 2 4 0 0 0 0 0 0 0 0 1 4 8 25 33
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 12 58 2 9 0 0 0 0 0 0 0 0 0 0 14 67 81
Illam 25 54 2 5 0 0 0 0 0 0 0 0 0 0 27 59 86
Jhapa Total 200 407 15 52 0 0 1 1 1 4 0 0 2 10 217 464 681
Khotang Total 6 39 0 5 0 0 0 0 0 0 0 0 0 0 6 44 50
Morang Total 196 359 26 55 5 4 1 7 1 6 0 0 3 5 229 431 660
Okhaldhunga Total 9 32 3 1 0 0 0 0 0 0 0 0 3 7 12 33 45
Patchthar 9 32 1 3 0 0 0 0 0 0 0 0 0 0 10 35 45
Sakhuwasabha Total 15 29 0 2 0 0 0 0 0 0 0 0 0 3 15 31 46
Saptari 93 221 0 7 0 0 0 2 0 0 0 1 0 0 93 231 324
Siraha Total 92 222 3 11 0 1 0 2 0 0 0 0 0 1 95 236 331
Solukhumbu Total 3 1 0 0 0 0 0 0 0 2 0 0 1 0 3 3 6
Sunsari 172 357 10 41 1 2 4 10 2 8 2 1 2 8 191 419 610
Taplejung Total 7 5 0 2 0 0 0 0 0 0 0 0 1 2 7 7 14
Terhathum Total 2 13 0 1 0 0 0 0 0 0 0 0 0 0 2 14 16
Udaypur Total 56 116 7 16 0 0 0 0 0 0 0 0 0 0 63 132 195
Eastern Region Total 903 1,966 71 214 6 7 6 22 4 20 2 2 13 40 992 2,231 3223
Grand Total 4,981 9,973 523 1,546 44 151 27 89 18 65 9 20 117 190 5,602 11,844 17446

ANNUAL REPORT 2072/73 118

 Pulmonary (CD)
Districts

Treatment After Other Other Total

S.N. DOTS Centre Total (excluding Total
New Relapse Lost to Follow- Previously Treatment Transfer In pulmon
T in) PCD
up Treated History Unknown ary

F M F M F M F M F M F M F M

Banke Total 42 73 0 2 0 0 1 1 3 3 1 1 46 79 125 686

15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 29 46 2 0 0 0 0 4 0 1 0 2 31 51 82 425

Dailekh Total 11 27 0 0 0 0 0 0 0 0 0 0 11 27 38 132
Dang Total 103 171 1 1 1 1 0 0 0 0 0 3 105 173 278 798
Dolpa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8
Humla Total 3 7 0 2 0 0 0 0 0 0 0 0 3 9 12 27
Jajarkot Total 10 12 2 0 0 1 0 1 2 2 2 3 14 16 30 93
Jumla Total 3 3 0 0 0 0 0 0 0 0 0 0 3 3 6 31
Kalikot Total 6 12 2 1 0 0 0 0 0 0 0 0 8 13 21 69
Mugu Total 3 1 0 0 0 0 0 0 0 0 1 1 3 1 4 17
Pyuthan Total 11 43 0 0 0 0 0 0 0 0 0 1 11 43 54 212
Ropa Total 16 30 1 1 0 0 0 0 0 1 0 1 17 32 49 194
Rukum Total 22 28 0 0 0 1 0 0 0 0 1 0 22 29 51 169
Salyan Total 11 30 0 0 0 1 0 1 0 0 0 0 11 32 43 166
Surkhet Total 62 110 0 7 0 2 0 4 2 0 1 1 64 123 187 391
Mid Western Region Total 332 593 8 14 1 6 1 11 7 7 6 13 349 631 980 3418
1 Bara Total 67 131 5 4 0 0 0 0 0 0 0 1 72 135 207 836
2 Bhaktapur Total 11 34 3 3 0 0 2 1 0 0 0 0 16 38 54 372
3 Chitwan Total 53 114 4 9 0 1 0 0 0 1 1 3 57 125 182 727
4 Dhading Total 4 13 0 4 0 0 0 0 0 1 0 2 4 18 22 205
5 Dhanusha Total 47 91 1 2 0 2 2 0 0 1 1 1 50 96 146 515
6 Dolkha Total 10 13 1 3 1 0 0 0 0 0 0 0 12 16 28 91
7 Kathmandu Total 126 191 7 8 1 2 2 6 2 1 6 20 138 208 346 1637
8 Kavre Total 10 21 0 0 0 0 1 0 0 0 0 2 11 21 32 185
Lalitpur Total 34 57 0 1 0 0 1 0 1 0 0 1 36 58 94 437
10 Mahottari Total 130 199 0 0 0 0 0 0 0 0 0 0 130 199 329 814
11 Makwanpur Total 40 80 0 4 0 0 0 0 0 0 2 3 40 84 124 644
12 Nuwakot Total 11 34 1 0 0 1 0 0 0 0 0 0 12 35 47 201
Parsa Total 75 117 1 2 0 0 0 3 0 0 0 2 76 122 198 722
14 Ramechhap Total 3 13 1 0 0 0 0 0 0 0 0 0 4 13 17 71
Rasuwa Total 4 4 0 1 0 0 0 0 0 1 0 0 4 6 10 23
16 Rautahat Total 112 155 1 3 0 0 0 1 0 0 0 0 113 159 272 708
17 Sarlahi Total 135 231 3 4 0 0 1 1 0 0 0 0 139 236 375 925
18 Sindhuli Total 31 55 0 0 0 0 0 0 0 0 0 0 31 55 86 422
19 Sindupalchok Total 8 18 0 3 0 0 0 0 0 0 0 2 8 21 29 136
Central Region Total 911 1571 28 51 2 6 9 12 3 5 10 37 953 1645 2598 9671
1 Arghakhanchi Total 20 35 0 5 0 0 0 0 0 0 0 0 20 40 60 181
2 Baglung Total 5 6 0 0 0 0 0 0 0 0 0 0 5 6 11 100
3 Gorkha Total 4 14 0 1 0 0 0 0 0 0 0 0 4 15 19 179
4 Gulmi Total 22 39 1 4 0 0 0 0 0 0 0 2 23 43 66 189
5 Kapil Total 27 74 0 0 0 0 0 1 0 0 0 0 27 75 102 522
6 Kaski Total 14 18 0 0 0 0 0 0 0 0 0 0 14 18 32 271
7 Lamjung Total 8 18 0 0 0 0 0 0 0 0 0 0 8 18 26 113
8 Manang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3
9 Mustang Total 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 3
10 Myagdi Total 1 4 0 0 0 0 0 0 0 0 0 0 1 4 5 48
11 Nawal Total 53 67 2 4 2 1 1 2 0 0 0 2 58 74 132 652
12 Palpa Total 12 24 0 1 0 0 0 0 0 1 1 0 12 26 38 229
13 Parbat Total 1 9 0 0 0 0 0 0 0 1 1 1 1 10 11 76
14 Rupandehi Total 184 254 7 10 0 0 2 4 0 2 0 2 193 270 463 1039
15 Syanja Total 12 25 1 2 0 0 0 0 0 0 0 0 13 27 40 179
16 Tanahun Total 10 29 0 3 0 1 0 1 0 0 0 0 10 34 44 231
Western Region Total 373 616 11 30 2 2 3 8 0 4 3 7 389 660 1049 4015
Achham Total 9 7 0 0 0 0 0 0 1 4 0 0 10 11 21 144
9 8 7 6 5 4 3 2 1

Baitadi Total 7 23 0 0 0 0 1 0 1 3 0 0 9 26 35 159

Bajhang Total 10 13 0 1 0 0 0 0 0 0 0 0 10 14 24 121
Bajura Total 2 6 0 0 0 0 0 0 0 0 0 0 2 6 8 72
Dadeldhura Total 7 15 0 0 0 1 0 1 0 0 0 0 7 17 24 92
Darchula Total 13 23 0 0 0 0 0 0 0 0 0 1 13 23 36 106
Doti Total 4 9 0 0 0 0 0 0 1 1 0 2 5 10 15 117
Kanchanpur Total 55 81 2 4 0 0 1 1 1 0 1 2 59 86 145 609
Kailali Total 58 107 0 4 0 1 2 2 1 4 1 3 61 118 179 813
Far-Western Region Total 165 284 2 9 0 2 4 4 5 12 2 8 176 311 487 2233
Bhojpur Total 0 4 0 0 0 0 0 0 0 0 0 2 0 4 4 37
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 0 7 0 0 0 0 0 0 0 0 0 0 0 7 7 88
Illam 12 10 0 1 0 0 0 0 0 0 0 0 12 11 23 109
Jhapa Total 40 96 2 3 0 0 0 3 0 2 4 3 42 104 146 827
Khotang Total 3 5 0 1 0 0 0 0 0 0 0 0 3 6 9 59
Morang Total 36 79 0 0 0 0 5 6 1 0 0 2 42 85 127 787
Okhaldhunga Total 3 5 0 0 0 0 0 1 0 0 0 1 3 6 9 54
Patchthar 6 6 0 1 0 0 0 0 0 0 0 1 6 7 13 58
Sakhuwasabha Total 2 8 0 0 0 0 0 0 0 0 0 0 2 8 10 56
Saptari 33 60 0 1 0 0 0 0 0 0 0 0 33 61 94 418
Siraha Total 38 84 1 4 0 0 0 1 0 0 2 2 39 89 128 459
Solukhumbu Total 2 4 0 0 0 0 0 0 0 0 0 2 2 4 6 12
Sunsari 37 62 0 2 0 0 2 2 0 1 2 4 39 67 106 716
Taplejung Total 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 15
Terhathum Total 0 3 0 0 0 0 0 0 0 0 0 0 0 3 3 19
Udaypur Total 19 30 0 0 0 0 0 1 0 0 0 1 19 31 50 245
Eastern Region Total 232 463 3 13 0 0 7 14 1 3 8 18 243 493 736 3959
Grand Total 2,013 3,527 52 117 5 16 24 49 16 31 29 83 2,110 3,740 5850 23296

ANNUAL REPORT 2072/73 119

 Extra Pulmonary (BC or CD)
Districts

Treatment After Other Other

S.N. DOTS Centre Total (excluding Total
New Relapse Lost to Follow- Previously Treatment Transfer In
T in) EP
up Treated History Unknown

F M F M F M F M F M F M F M

Banke Total 84 106 2 3 0 0 2 0 1 4 4 0 89 113 202

15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 52 68 0 0 2 0 1 2 3 2 1 1 58 72 130

Dailekh Total 28 41 0 0 0 0 0 0 0 0 0 0 28 41 69
Dang Total 84 119 3 4 0 0 0 4 0 1 0 1 87 128 215
Dolpa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Humla Total 6 10 0 0 0 0 0 0 0 0 0 0 6 10 16
Jajarkot Total 18 22 1 0 0 0 0 0 0 0 0 0 19 22 41
Jumla Total 5 14 0 0 0 0 0 0 0 0 0 0 5 14 19
Kalikot Total 9 32 0 0 0 0 0 0 0 0 1 0 9 32 41
Mugu Total 2 12 0 0 0 0 0 0 0 0 2 4 2 12 14
Pyuthan Total 26 30 0 0 0 0 1 0 1 0 1 0 28 30 58
Ropa Total 31 37 0 2 0 0 1 1 2 0 1 1 34 40 74
Rukum Total 27 41 0 0 0 0 0 0 0 0 0 0 27 41 68
Salyan Total 39 33 0 0 0 1 0 0 0 0 0 1 39 34 73
Surkhet Total 103 163 1 2 0 0 6 3 1 0 2 3 111 168 279
Mid Western Region Total 514 728 7 11 2 1 11 10 8 7 12 11 542 757 1299
1 Bara Total 86 107 1 3 0 0 0 0 0 0 1 3 87 110 197
2 Bhaktapur Total 114 119 5 2 0 0 1 4 0 2 3 2 120 127 247
3 Chitwan Total 105 140 2 13 0 0 1 3 2 0 9 5 110 156 266
4 Dhading Total 40 43 1 6 0 0 0 1 0 0 4 3 41 50 91
5 Dhanusha Total 47 67 0 2 0 0 0 1 0 2 4 2 47 72 119
6 Dolkha Total 16 35 1 1 0 0 0 0 0 0 1 3 17 36 53
7 Kathmandu Total 686 674 38 30 3 4 31 33 4 9 25 40 762 750 1512
8 Kavre Total 39 54 1 1 1 1 2 1 0 0 0 1 43 57 100
Lalitpur Total 176 171 2 3 0 0 0 3 3 8 2 2 181 185 366
10 Mahottari Total 35 40 0 1 0 0 0 0 0 0 0 0 35 41 76
11 Makwanpur Total 60 64 0 2 0 0 0 0 0 0 5 2 60 66 126
12 Nuwakot Total 21 32 0 0 0 0 0 1 0 0 0 1 21 33 54
Parsa Total 76 102 0 2 1 1 1 0 0 1 0 2 78 106 184
14 Ramechhap Total 10 17 0 0 0 0 0 1 0 0 0 3 10 18 28
Rasuwa Total 5 8 0 0 0 0 0 0 0 0 0 0 5 8 13
16 Rautahat Total 51 94 0 0 0 0 1 0 0 1 4 4 52 95 147
17 Sarlahi Total 63 104 1 0 0 0 0 0 0 0 2 0 64 104 168
18 Sindhuli Total 15 52 0 2 0 0 2 2 0 0 2 4 17 56 73
19 Sindupalchok Total 18 26 2 2 0 0 0 0 0 0 0 3 20 28 48
Central Region Total 1663 1949 54 70 5 6 39 50 9 23 62 80 1770 2098 3868
1 Arghakhanchi Total 29 44 2 1 0 0 0 0 0 1 3 0 31 46 77
2 Baglung Total 20 25 1 0 0 0 0 0 0 0 0 0 21 25 46
3 Gorkha Total 32 36 0 0 0 0 0 0 0 0 1 0 32 36 68
4 Gulmi Total 40 64 0 2 0 0 0 0 0 0 0 0 40 66 106
5 Kapil Total 43 58 0 0 0 0 1 0 0 0 0 0 44 58 102
6 Kaski Total 80 118 2 1 0 0 6 5 2 0 0 1 90 124 214
7 Lamjung Total 18 17 0 2 0 0 0 0 0 0 3 1 18 19 37
8 Manang Total 1 1 0 0 0 0 0 0 0 0 0 0 1 1 2
9 Mustang Total 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1
10 Myagdi Total 10 12 0 0 1 0 0 0 0 0 0 0 11 12 23
11 Nawal Total 83 127 4 4 0 0 2 0 0 0 2 3 89 131 220
12 Palpa Total 36 85 0 4 0 0 0 1 1 2 2 0 37 92 129
13 Parbat Total 8 20 1 2 0 0 0 1 0 0 0 4 9 23 32
14 Rupandehi Total 163 159 2 5 0 0 1 0 0 2 2 1 166 166 332
15 Syanja Total 29 39 1 0 0 0 0 0 0 0 1 0 30 39 69
16 Tanahun Total 25 58 4 4 0 1 4 1 0 0 2 0 33 64 97
Western Region Total 618 863 17 25 1 1 14 8 3 5 16 11 653 902 1555
Achham Total 8 20 0 0 0 0 0 2 2 0 2 1 10 22 32
9 8 7 6 5 4 3 2 1

Baitadi Total 11 32 0 1 0 0 1 0 0 0 0 1 12 33 45
Bajhang Total 19 27 3 1 0 1 1 0 0 2 1 0 23 31 54
Bajura Total 8 15 0 0 0 0 2 3 0 0 0 1 10 18 28
Dadeldhura Total 9 15 1 0 0 0 0 0 0 0 0 0 10 15 25
Darchula Total 9 5 0 0 0 0 0 0 0 0 1 0 9 5 14
Doti Total 11 18 0 0 0 0 0 0 0 0 2 0 11 18 29
Kanchanpur Total 68 92 1 1 0 0 2 1 0 1 3 0 71 95 166
Kailali Total 117 168 2 1 0 0 3 4 0 1 1 2 122 174 296
Far-Western Region Total 260 392 7 4 0 1 9 10 2 4 10 5 278 411 689
Bhojpur Total 13 14 0 0 0 0 0 1 0 0 4 1 13 15 28
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 22 35 0 0 0 0 0 0 0 0 0 0 22 35 57
Illam 16 18 2 1 0 0 0 0 0 1 0 0 18 20 38
Jhapa Total 116 138 2 0 0 0 1 0 2 0 3 7 121 138 259
Khotang Total 22 36 0 0 0 0 0 0 0 0 2 2 22 36 58
Morang Total 141 171 0 0 0 0 6 9 2 1 8 3 149 181 330
Okhaldhunga Total 19 24 0 1 0 0 0 0 0 0 5 2 19 25 44
Patchthar 9 8 0 1 0 0 0 0 0 0 0 0 9 9 18
Sakhuwasabha Total 8 23 0 0 0 0 0 0 0 0 0 5 8 23 31
Saptari 17 25 0 0 0 0 0 0 0 0 0 1 17 25 42
Siraha Total 25 39 0 1 0 0 0 1 0 0 0 1 25 41 66
Solukhumbu Total 3 4 0 0 0 0 0 0 0 0 1 4 3 4 7
Sunsari 121 138 0 0 0 0 5 6 1 2 7 4 127 146 273
Taplejung Total 16 9 0 2 0 0 0 0 0 1 1 3 16 12 28
Terhathum Total 5 3 0 0 0 0 0 0 0 0 0 0 5 3 8
Udaypur Total 31 31 0 0 0 0 0 0 0 0 0 3 31 31 62
Eastern Region Total 584 716 4 6 0 0 12 17 5 5 31 36 605 744 1349
Grand Total 3,639 4,648 89 116 8 9 85 95 27 44 131 143 3,848 4,912 8760

ANNUAL REPORT 2072/73 120

ANNUAL REPORT 2072/73 120

 Treatment regimen (Adult) Treatment regimen (Child 0-14 Years)
Districts

Total All
Total All Total Total
S.N. DOTS Centre (including T in)
Excluding notified Cat I Cat II Total Adult Cat I Cat II Cat III Total Child
Trnsfer IN cases

F M F M F M F M F M F M F M F M F M

Banke Total 337 569 327 561 888 281 476 31 61 312 537 15 14 0 0 10 18 25 32 337 569
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 184 383 176 379 555 148 325 15 34 163 359 13 16 0 1 6 10 19 27 182 386
Dailekh Total 60 141 60 141 201 45 117 1 5 46 122 14 19 0 0 0 0 14 19 60 141
Dang Total 384 640 379 634 1013 315 517 33 80 348 597 13 25 0 0 23 18 36 43 384 640
Dolpa Total 2 6 2 6 8 2 6 0 0 2 6 0 0 0 0 0 0 0 0 2 6
Humla Total 14 31 14 29 43 10 27 2 4 12 31 2 0 0 0 0 0 2 0 14 31
Jajarkot Total 58 81 56 78 134 49 59 4 14 53 73 4 5 0 0 0 3 4 8 57 81
Jumla Total 15 36 15 35 50 13 30 0 2 13 32 1 2 0 1 0 0 1 3 14 35
Kalikot Total 42 69 41 69 110 32 52 7 11 39 63 0 3 0 0 2 4 2 7 41 70
Mugu Total 14 26 10 21 31 14 24 0 0 14 24 0 2 0 0 0 0 0 2 14 26
Pyuthan Total 75 200 73 197 270 61 169 8 22 69 191 3 6 0 0 2 4 5 10 74 201
Ropa Total 107 169 104 164 268 91 136 6 21 97 157 1 1 0 1 9 10 10 12 107 169
Rukum Total 94 144 93 144 237 72 112 9 11 81 123 5 4 0 0 8 17 13 21 94 144
Salyan Total 87 153 87 152 239 72 120 6 20 78 140 9 12 0 1 0 0 9 13 87 153
Surkhet Total 231 451 227 443 670 159 293 4 30 163 323 70 129 0 1 0 0 70 130 233 453
Mid Western Region Total 1704 3099 1664 3053 4717 1364 2463 126 315 1490 2778 150 238 0 5 60 84 210 327 1700 3105
1 Bara Total 395 649 395 638 1033 351 561 29 64 380 625 19 23 0 1 0 0 19 24 399 649
2 Bhaktapur Total 243 386 239 380 619 206 323 20 48 226 371 14 9 0 0 2 3 16 12 242 383
3 Chitwan Total 346 653 337 656 993 305 536 39 116 344 652 6 18 1 0 2 1 9 19 353 671
4 Dhading Total 81 198 87 209 296 75 164 4 36 88 198 6 10 0 0 0 0 6 10 85 210
5 Dhanusha Total 226 424 217 417 634 192 331 6 30 198 361 14 24 18 45 2 3 34 72 232 433
6 Dolkha Total 39 111 37 107 144 31 98 4 10 35 108 0 0 0 0 4 3 4 3 39 111
7 Kathmandu Total 1443 1876 1379 1770 3149 1203 1560 157 226 1303 1715 71 76 3 0 9 14 83 90 1443 1876
8 Kavre Total 97 191 97 188 285 76 155 12 28 88 183 6 5 0 0 2 3 8 8 96 191
Lalitpur Total 353 478 341 462 803 319 397 19 58 338 455 15 22 0 0 0 0 15 22 353 477
10 Mahottari Total 330 562 330 560 890 308 521 9 26 317 547 13 13 0 1 0 0 13 14 330 561
11 Makwanpur Total 248 502 253 517 770 214 421 9 50 163 334 7 14 0 0 1 1 4 10 231 486
12 Nuwakot Total 67 190 67 188 255 59 164 7 22 65 184 1 4 0 0 0 0 1 4 67 190
Parsa Total 359 558 356 550 906 128 195 8 14 136 209 12 8 0 0 1 0 13 8 149 217
14 Ramechhap Total 29 73 29 70 99 24 63 1 3 25 66 4 5 0 2 0 0 4 7 29 73
Rasuwa Total 11 25 11 25 36 9 23 0 2 9 25 2 0 0 0 0 0 2 0 11 25
16 Rautahat Total 320 545 316 539 855 299 479 11 44 310 523 11 19 0 1 0 0 11 20 321 543
17 Sarlahi Total 400 701 395 698 1093 365 614 20 69 385 683 13 10 0 0 5 8 18 18 403 701
18 Sindhuli Total 165 339 161 334 495 142 265 14 57 156 322 11 16 0 0 2 1 13 17 169 339
19 Sindupalchok Total 59 131 59 125 184 49 109 3 10 52 119 0 1 0 0 0 0 0 1 52 120
Central Region Total 5211 8592 5106 8433 13539 4355 6979 372 913 4618 7680 225 277 22 50 30 37 273 359 5004 8256
1 Arghakhanchi Total 89 173 85 173 258 77 133 3 23 80 156 9 16 0 2 0 0 9 18 89 174
2 Baglung Total 62 85 62 84 146 47 73 7 8 54 81 2 4 0 0 1 1 3 5 57 86
3 Gorkha Total 84 166 83 164 247 77 151 2 10 79 161 4 5 0 0 0 1 4 6 82 160
4 Gulmi Total 100 200 99 196 295 91 169 2 21 93 190 2 0 0 1 6 7 8 8 101 198
5 Kapil Total 192 433 191 433 624 176 382 8 38 184 420 6 8 0 2 2 0 8 10 192 430
6 Kaski Total 186 300 186 299 485 165 266 15 28 180 294 4 7 1 0 5 5 10 12 190 306
7 Lamjung Total 53 102 49 101 150 46 85 3 12 49 97 4 5 0 0 0 0 4 5 53 102
8 Manang Total 3 3 3 2 5 3 3 0 0 3 3 0 0 0 0 0 0 0 0 3 3
9 Mustang Total 4 4 2 2 4 4 2 0 1 4 3 1 0 0 0 0 0 1 0 5 3
10 Myagdi Total 30 41 30 41 71 24 33 1 2 25 35 1 3 0 0 4 3 5 6 30 41
11 Nawal Total 304 577 302 570 872 257 491 25 73 282 564 16 15 2 0 2 1 20 16 302 580
12 Palpa Total 115 247 112 246 358 97 203 7 25 104 228 11 19 0 0 0 0 11 19 115 247
13 Parbat Total 31 84 30 78 108 27 69 2 11 29 80 2 4 0 0 0 0 2 4 31 84
14 Rupandehi Total 553 827 550 821 1371 509 713 28 84 537 797 11 25 0 0 5 5 16 30 553 827
15 Syanja Total 83 166 82 166 248 79 149 2 12 81 161 2 4 0 0 0 1 2 5 83 166
16 Tanahun Total 102 230 99 229 328 85 191 12 33 97 224 3 5 0 0 2 1 5 6 102 230
Western Region Total 1991 3638 1965 3605 5570 1764 3113 117 381 1881 3494 78 120 3 5 27 25 108 150 1988 3637
Achham Total 49 132 46 130 176 42 110 2 16 44 126 3 5 0 0 2 1 5 6 49 132
9 8 7 6 5 4 3 2 1

Baitadi Total 55 151 55 149 204 50 130 4 16 54 146 1 4 0 0 0 1 1 5 55 151

Bajhang Total 77 102 74 101 175 56 78 13 18 69 96 7 6 1 0 0 0 8 6 73 94
Bajura Total 35 68 35 65 100 26 54 2 9 28 63 7 5 0 0 0 0 7 5 35 68
Dadeldhura Total 41 76 41 76 117 36 68 4 7 40 75 1 0 0 0 0 1 1 1 41 76
Darchula Total 37 85 36 84 120 28 53 5 5 33 58 0 0 0 0 0 0 0 0 33 58
Doti Total 55 98 52 94 146 54 86 5 4 59 90 0 3 0 0 0 1 0 4 59 94
Kanchanpur Total 279 506 274 501 775 246 429 18 62 264 491 7 8 0 0 8 7 15 15 279 506
Kailali Total 375 745 372 737 1109 312 622 25 64 337 686 10 9 0 0 23 37 33 46 370 732
Far-Western Region Total 1003 1963 985 1937 2922 850 1630 78 201 928 1831 36 40 1 0 33 48 70 88 994 1911
Bhojpur Total 26 51 21 44 65 22 40 2 5 24 45 2 6 0 0 0 0 2 6 26 51
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 36 109 36 109 145 33 92 2 9 35 101 1 6 0 0 0 2 1 8 36 109

Illam 57 90 57 90 147 50 76 4 8 54 84 3 6 0 0 0 0 3 6 57 90
Jhapa Total 389 726 380 706 1086 353 649 21 55 373 704 15 21 0 1 0 0 15 22 389 726
Khotang Total 33 88 31 86 117 30 77 0 6 30 83 3 5 0 0 0 0 3 5 33 88
Morang Total 431 707 420 697 1117 382 607 35 78 417 685 11 14 0 0 3 8 14 22 431 707
Okhaldhunga Total 42 74 34 64 98 33 69 3 3 36 72 6 2 0 0 0 0 6 2 42 74
Patchthar 25 52 25 51 76 23 47 1 5 24 52 1 0 0 0 0 0 1 0 25 52
Sakhuwasabha Total 25 70 25 62 87 25 66 0 2 25 68 0 1 0 0 0 1 0 2 25 70
Saptari 143 318 143 317 460 138 305 0 8 138 313 3 5 1 0 1 0 5 5 143 318
Siraha Total 161 370 159 366 525 150 345 4 22 154 367 6 3 0 0 1 0 7 3 161 370
Solukhumbu Total 10 17 8 11 19 9 17 0 0 9 17 1 0 0 0 0 0 1 0 10 17
Sunsari 368 648 357 632 989 335 567 16 59 351 626 13 15 0 3 4 4 17 22 368 648
Taplejung Total 26 24 24 19 43 24 20 0 4 24 24 2 0 0 0 0 0 2 0 26 24
Terhathum Total 7 20 7 20 27 6 16 0 1 6 17 1 3 0 0 0 0 1 3 7 20
Udaypur Total 113 198 113 194 307 105 176 7 16 112 192 1 6 0 0 0 0 1 6 113 198
Eastern Region Total 1,892 3,562 1,840 3,468 5308 1,718 #### 95 281 1,812 #### 69 93 1 4 9 15 79 112 1,892 3,562
Grand Total 11,801 20,854 11,560 20,496 32056 ##### #### 788 #### ##### #### 558 768 27 64 159 209 740 1,036 11,578 20,471

ANNUAL REPORT 2072/73 121

ANNUAL REPORT 2072/73 121

 Age group distribution (All New Cases)
Districts

Total New
S.N. DOTS Centre Cases Child
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65+ Total
cases

F M F M F M F M F M F M F M F M F M F M

Banke Total 123 194 10 20 19 28 77 75 87 57 87 44 69 35 70 31 69 17 66 288 496

15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 160 339 6 9 9 16 40 28 61 28 56 22 47 16 45 28 47 18 44 155 325

Dailekh Total 59 136 2 2 13 20 37 8 33 21 21 2 15 5 20 4 18 4 7 59 136
Dang Total 344 552 8 20 22 17 67 51 98 48 63 39 66 44 96 70 95 62 94 344 549
Dolpa Total 2 5 0 0 0 0 0 1 2 1 2 0 1 0 0 0 0 0 0 2 5
Humla Total 12 24 1 0 1 0 2 3 7 2 4 2 4 1 8 1 2 1 1 12 26
Jajarkot Total 47 66 0 0 0 7 7 10 6 13 15 12 20 8 12 2 3 2 2 47 65
Jumla Total 15 30 0 1 2 1 4 1 3 4 13 6 8 1 1 0 0 0 1 14 28
Kalikot Total 34 61 1 2 1 5 9 5 9 9 20 10 14 5 10 4 2 0 1 35 63
Mugu Total 10 21 0 0 0 1 1 3 3 3 2 3 3 0 6 3 4 0 3 12 22
Pyuthan Total 63 173 0 1 5 9 15 7 24 12 23 7 24 5 26 10 29 13 36 59 172
Ropa Total 96 141 3 4 6 7 20 22 26 17 11 15 21 12 20 11 25 10 27 96 141
Rukum Total 85 132 5 6 8 14 33 12 16 11 20 14 19 11 20 15 18 9 19 85 132
Salyan Total 81 130 4 4 5 8 21 18 21 15 32 11 10 9 20 10 23 9 12 81 130
Surkhet Total 214 400 26 51 38 73 188 48 65 27 54 25 45 18 42 20 33 14 38 216 401
Mid Western Region Total 1345 2404 66 120 129 206 521 292 461 268 423 212 366 170 396 209 368 159 351 1505 2691
1 Bara Total 371 575 4 9 16 14 43 71 82 58 67 49 92 51 98 76 103 46 110 371 575
2 Bhaktapur Total 216 332 1 0 17 17 35 78 67 60 74 26 50 14 48 10 23 10 53 216 332
3 Chitwan Total 290 525 0 8 8 12 28 100 112 69 79 31 85 31 99 25 70 33 76 297 541
4 Dhading Total 36 62 1 1 8 10 20 17 23 17 24 13 29 15 34 5 32 7 33 83 186
5 Dhanusha Total 207 381 5 10 10 13 38 44 68 32 32 27 58 29 52 37 73 24 74 208 380
6 Dolkha Total 33 97 0 0 4 3 7 5 26 8 14 6 12 6 12 0 16 4 14 33 97
7 Kathmandu Total 1200 1504 22 21 56 62 161 450 414 294 424 156 225 95 171 62 104 65 83 1200 1504
8 Kavre Total 85 154 1 4 12 11 28 25 22 15 24 11 21 10 31 7 22 4 21 85 156
Lalitpur Total 316 395 4 11 11 15 41 90 77 93 90 42 55 33 72 24 25 22 52 319 397
10 Mahottari Total 316 528 2 7 21 17 47 45 89 73 69 47 88 56 83 49 93 23 82 316 528
11 Makwanpur Total 229 445 2 5 12 8 27 70 79 48 72 33 65 33 93 13 73 18 50 229 445
12 Nuwakot Total 58 165 0 0 1 6 7 15 33 11 34 12 33 10 23 5 17 4 19 58 165
Parsa Total 139 199 4 4 9 4 21 27 27 21 17 28 27 20 33 14 41 16 46 139 199
14 Ramechhap Total 29 65 0 2 4 3 9 8 4 4 10 4 14 4 9 1 10 4 13 29 65
Rasuwa Total 11 23 0 0 2 0 2 5 5 2 4 0 6 0 2 0 2 2 4 11 23
16 Rautahat Total 305 494 0 4 13 16 33 58 84 57 66 40 63 42 86 48 88 47 87 305 494
17 Sarlahi Total 382 635 1 1 17 17 36 54 71 81 107 81 119 54 131 53 112 42 75 383 633
18 Sindhuli Total 150 276 0 2 10 17 29 23 55 32 39 24 45 25 47 10 30 26 41 150 276
19 Sindupalchok Total 65 126 0 0 7 2 9 12 2 8 16 14 26 4 24 3 16 2 9 50 95
Central Region Total 4438 6981 47 89 238 247 621 1197 1340 983 1262 644 1113 532 1148 442 950 399 942 4482 7091
1 Arghakhanchi Total 82 148 0 0 5 11 16 15 22 9 19 11 23 9 31 13 17 20 26 82 149
2 Baglung Total 55 77 0 1 2 3 6 8 14 4 21 14 12 8 11 6 11 6 8 48 81
3 Gorkha Total 81 154 0 1 5 5 11 12 24 19 30 18 30 14 28 7 22 6 17 81 157
4 Gulmi Total 98 174 0 2 8 5 15 10 30 15 28 19 33 14 21 18 34 14 21 98 174
5 Kapil Total 181 390 3 4 12 13 32 44 71 38 75 25 61 18 48 19 57 17 70 176 399
6 Kaski Total 166 267 4 7 9 11 31 44 56 32 50 27 53 11 31 19 28 20 29 166 265
7 Lamjung Total 47 89 2 1 3 4 10 12 15 13 13 2 12 5 14 4 14 6 16 47 89
8 Manang Total 3 2 0 0 1 0 1 1 0 0 1 0 1 1 0 0 0 0 0 3 2
9 Mustang Total 2 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 2 2
10 Myagdi Total 28 39 0 2 5 3 10 7 8 3 5 5 7 3 3 1 5 4 5 28 38
11 Nawal Total 274 502 4 7 16 17 44 62 80 47 67 23 77 34 79 32 88 39 70 257 485
12 Palpa Total 105 218 1 4 8 13 26 19 36 9 25 14 28 16 33 17 38 21 41 105 218
13 Parbat Total 29 63 1 0 0 1 2 1 4 6 5 6 16 7 8 7 16 1 13 29 63
14 Rupandehi Total 519 737 8 10 19 27 64 114 132 102 107 83 104 69 108 72 116 52 133 519 737
15 Syanja Total 79 154 0 3 2 0 5 16 17 14 15 7 28 10 28 18 25 12 38 79 154
16 Tanahun Total 84 197 0 4 6 3 13 22 40 16 19 15 28 2 29 7 29 12 42 80 194
Western Region Total 1833 3212 23 46 101 116 286 387 549 327 480 270 514 222 473 240 500 230 529 1800 3207
Achham Total 40 102 0 3 4 3 10 7 19 7 15 4 17 6 21 5 13 7 11 40 102
9 8 7 6 5 4 3 2 1

Baitadi Total 50 133 0 2 1 0 3 15 24 8 33 11 21 5 21 6 19 4 13 50 133

Bajhang Total 61 84 0 0 7 4 11 14 19 14 23 12 8 7 11 5 7 2 12 61 84
Bajura Total 32 57 1 0 6 1 8 5 15 2 9 4 13 12 8 2 11 0 2 32 59
Dadeldhura Total 37 67 0 2 2 1 5 6 16 13 15 5 5 6 7 2 10 3 11 37 67
Darchula Total 31 77 0 0 1 2 3 2 7 7 14 7 22 3 9 2 1 0 0 22 55
Doti Total 47 87 0 3 1 1 5 11 17 13 12 7 13 9 21 4 9 4 15 49 91
Kanchanpur Total 253 438 3 2 11 13 29 55 96 56 77 44 71 34 69 35 54 15 56 253 438
Kailali Total 340 654 15 28 20 20 83 76 136 60 117 45 96 43 97 42 68 39 92 340 654
Far-Western Region Total 891 1699 19 40 53 45 157 191 349 180 315 139 266 125 264 103 192 74 212 884 1683
Bhojpur Total 11 25 0 2 1 2 5 4 6 5 8 2 6 4 5 1 5 2 3 19 37
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 34 100 0 0 1 8 9 13 20 11 23 1 19 4 15 1 11 3 5 34 101

Illam 53 82 0 1 3 1 5 15 16 9 20 8 12 7 10 6 7 5 11 53 78
Jhapa Total 356 641 2 6 13 9 30 71 114 81 130 77 109 46 112 37 82 29 77 356 639
Khotang Total 31 80 0 0 3 3 6 6 15 6 19 1 8 5 15 6 5 4 15 31 80
Morang Total 373 609 2 4 13 19 38 86 101 94 103 54 102 47 101 33 82 44 96 373 608
Okhaldhunga Total 31 61 1 0 7 3 11 7 14 8 13 3 8 1 10 0 11 4 5 31 64
Patchthar 24 46 0 0 1 0 1 5 10 4 9 6 8 7 7 0 8 1 4 24 46
Sakhuwasabha Total 25 60 0 0 0 2 2 4 8 9 17 7 10 3 14 0 9 2 2 25 62
Saptari 143 306 1 1 3 3 8 6 19 15 25 12 20 7 28 4 22 8 28 56 146
Siraha Total 155 345 0 1 5 3 9 25 51 21 38 24 48 28 60 28 60 24 84 155 345
Solukhumbu Total 8 9 0 0 1 0 1 5 2 1 4 0 2 0 1 1 0 0 2 8 11
Sunsari 330 557 2 8 15 12 37 80 97 80 97 35 82 45 78 43 98 30 86 330 558
Taplejung Total 24 14 0 0 2 0 2 7 5 6 7 7 2 3 3 0 0 1 3 26 20
Terhathum Total 7 19 0 0 1 4 5 0 3 2 2 0 2 3 3 0 3 0 1 6 18
Udaypur Total 106 177 0 0 1 6 7 6 15 30 32 32 54 23 32 10 24 4 14 106 177
Eastern Region Total 1,711 3,131 8 23 70 75 176 340 496 382 547 269 492 233 494 170 427 161 436 1,633 2,990
Grand Total 10,218 17,427 163 318 591 689 1761 2,407 3,195 2,140 3,027 1,534 2,751 1,282 2,775 1,164 2,437 1,023 2,470 10,304 17,662

ANNUAL REPORT 2072/73 122

ANNUAL REPORT 2072/73 122
 Age group distribution (All Relapse Cases)
Districts

Total of All
S.N. DOTS Centre Relapse Cases
0-4 5-14 total child cases 15-24 25-34 35-44 45-54 55-64 65+ Total

F M F M F M F M F M F M F M F M F M F M

Banke Total 26 42 0 0 0 0 0 77 2 4 8 4 2 9 7 7 4 9 3 9 26 42
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 9 23 0 0 0 0 0 40 0 2 3 0 4 7 1 5 1 4 0 5 9 23
Dailekh Total 1 5 0 0 0 0 0 37 0 0 0 0 0 0 1 2 0 3 0 1 1 6
Dang Total 32 64 0 0 0 0 0 67 3 3 1 4 4 10 4 10 8 21 12 16 32 64
Dolpa Total 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Humla Total 1 4 0 0 0 0 0 2 0 1 0 1 0 0 0 0 0 2 1 0 1 4
Jajarkot Total 6 8 0 0 0 0 0 7 0 0 2 1 1 4 2 1 1 1 0 1 6 8
Jumla Total 0 3 0 0 0 0 0 4 0 0 0 1 0 0 0 0 0 0 0 0 0 1
Kalikot Total 6 5 0 0 0 0 0 9 0 0 2 3 2 1 1 2 0 0 0 0 5 6
Mugu Total 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pyuthan Total 6 20 0 0 0 0 0 15 0 0 2 4 2 4 1 3 1 5 1 2 7 18
Ropa Total 5 19 0 0 0 1 1 21 1 1 1 3 1 3 1 6 1 4 0 1 5 19
Rukum Total 8 9 0 0 0 0 0 33 0 1 3 0 2 2 3 3 0 1 0 2 8 9
Salyan Total 6 18 0 0 0 1 1 22 2 0 0 2 1 0 0 6 2 6 1 4 6 19
Surkhet Total 3 27 0 0 0 0 0 188 2 4 1 5 0 6 0 6 0 3 0 3 3 27
Mid Western Region Total 109 248 0 0 0 2 2 523 10 17 23 28 19 46 21 51 18 59 18 44 109 247
1 Bara Total 22 56 0 0 0 0 0 43 0 2 1 8 5 3 5 12 7 16 4 15 22 56
2 Bhaktapur Total 20 39 0 0 1 0 1 36 5 2 7 7 2 8 2 6 1 12 2 4 20 39
3 Chitwan Total 35 92 0 0 0 0 0 28 9 9 5 13 4 20 8 15 4 14 5 22 35 93
4 Dhading Total 3 11 0 0 0 0 0 20 2 4 0 11 2 4 0 6 0 8 1 3 5 36
5 Dhanusha Total 7 23 0 0 0 0 0 38 0 2 0 2 3 2 3 6 1 5 0 6 7 23
6 Dolkha Total 3 10 0 0 0 0 0 7 1 1 0 2 0 3 1 1 0 1 1 2 3 10
7 Kathmandu Total 117 173 0 0 3 0 3 164 31 31 44 45 15 25 12 39 6 23 6 10 117 173
8 Kavre Total 10 27 0 0 0 0 0 28 3 4 2 6 2 2 1 6 1 8 1 1 10 27
Lalitpur Total 15 43 0 0 0 0 0 41 1 5 6 8 3 11 3 10 1 5 1 4 15 43
10 Mahottari Total 7 23 0 0 0 0 0 47 0 1 0 5 1 7 3 5 2 3 1 2 7 23
11 Makwanpur Total 11 45 0 0 0 0 0 27 1 5 3 2 0 9 4 13 2 9 1 7 11 45
12 Nuwakot Total 7 20 0 0 0 0 0 7 1 0 2 4 2 7 1 6 1 3 0 0 7 20
Parsa Total 7 14 0 0 0 0 0 21 0 0 2 0 2 2 1 1 0 7 2 4 7 14
14 Ramechhap Total 0 4 0 0 0 0 0 9 0 0 0 0 0 1 0 0 0 2 0 1 0 4
Rasuwa Total 0 1 0 0 0 0 0 2 0 0 0 0 0 1 0 0 0 0 0 0 0 1
16 Rautahat Total 10 35 0 0 0 1 1 34 0 4 1 1 3 6 1 7 2 8 3 8 10 35
17 Sarlahi Total 15 57 0 0 0 0 0 36 1 1 1 1 1 7 3 11 7 21 2 15 15 56
18 Sindhuli Total 11 58 0 0 0 0 0 29 0 3 2 2 5 15 0 12 0 12 4 14 11 58
19 Sindupalchok Total 3 13 0 0 0 0 0 9 1 2 1 2 0 2 0 0 1 1 0 0 3 7
Central Region Total 303 744 0 0 4 1 5 626 56 76 77 119 50 135 48 156 36 158 34 118 305 763
1 Arghakhanchi Total 2 24 0 0 0 0 0 16 1 1 1 0 0 4 0 7 0 6 0 6 2 24
2 Baglung Total 6 7 0 0 0 0 0 6 1 0 3 0 0 0 1 2 1 0 1 4 7 6
3 Gorkha Total 1 8 0 0 0 0 0 11 0 0 0 0 0 1 1 4 0 1 0 2 1 8
4 Gulmi Total 1 21 0 0 0 1 1 16 0 0 0 1 1 1 0 5 0 12 0 3 1 23
5 Kapil Total 8 34 0 0 0 1 1 33 0 2 3 5 1 4 1 3 1 4 1 7 7 26
6 Kaski Total 10 23 0 0 1 0 1 32 2 1 3 6 1 3 2 4 2 5 0 1 11 20
7 Lamjung Total 1 10 0 0 0 0 0 10 0 0 0 2 0 2 1 2 0 2 0 2 1 10
8 Manang Total 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Mustang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Myagdi Total 0 2 0 0 0 0 0 10 0 0 0 1 0 1 0 0 0 0 0 0 0 2
11 Nawal Total 22 59 0 0 0 0 0 44 2 2 4 9 3 16 1 12 4 10 8 15 22 64
12 Palpa Total 6 24 0 0 0 0 0 26 1 1 2 3 0 5 1 6 2 3 0 6 6 24
13 Parbat Total 1 11 0 0 0 0 0 2 0 0 0 0 0 2 0 1 0 5 1 3 1 11
14 Rupandehi Total 24 72 0 0 0 0 0 64 5 3 5 13 4 14 3 18 4 11 4 13 25 72
15 Syanja Total 3 12 0 0 0 0 0 5 2 1 0 1 1 2 0 3 0 4 0 0 3 11
16 Tanahun Total 9 27 0 0 2 0 2 15 3 0 1 5 1 3 1 8 0 7 1 4 9 27
Western Region Total 94 334 0 0 3 2 5 291 17 11 22 46 12 58 12 75 14 70 16 66 96 328
Achham Total 2 11 0 0 0 0 0 10 1 0 1 2 0 2 0 4 0 2 0 1 2 11
9 8 7 6 5 4 3 2 1

Baitadi Total 1 11 0 0 0 0 0 3 0 1 0 0 1 4 0 1 0 3 0 2 1 11
Bajhang Total 11 11 0 0 0 0 0 11 2 2 6 2 0 2 3 2 0 2 0 1 11 11
Bajura Total 0 4 0 0 0 0 0 8 0 0 0 2 0 0 0 2 0 0 0 0 0 4
Dadeldhura Total 4 4 0 0 0 0 0 5 0 0 1 2 2 1 0 0 0 2 0 1 3 6
Darchula Total 5 7 0 0 0 0 0 3 0 0 0 0 2 1 2 4 0 0 0 0 4 5
Doti Total 3 5 0 0 0 0 0 5 0 1 0 0 1 1 1 0 0 0 0 2 2 4
Kanchanpur Total 16 50 0 0 0 0 0 29 1 3 6 6 1 14 1 14 4 10 3 3 16 50
Kailali Total 25 60 0 0 0 1 1 84 6 4 7 10 4 15 1 7 3 11 4 12 25 60
Far-Western Region Total 67 163 0 0 0 1 1 158 10 11 21 24 11 40 8 34 7 30 7 22 64 162
Bhojpur Total 2 4 0 0 0 0 0 5 0 0 2 1 0 0 0 2 0 1 0 0 2 4
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 2 9 0 0 0 0 0 9 0 0 2 0 0 0 0 3 0 3 0 2 2 8
Illam 4 7 0 0 0 0 0 5 2 2 0 1 1 1 2 2 0 0 0 0 5 6
Jhapa Total 19 55 0 0 0 0 0 30 3 4 6 7 3 11 2 9 3 14 2 10 19 55
Khotang Total 0 6 0 0 0 0 0 6 0 0 0 1 0 3 0 2 0 0 0 0 0 6
Morang Total 26 55 0 0 0 0 0 38 2 4 3 5 8 12 4 14 4 10 7 4 28 49
Okhaldhunga Total 3 2 0 0 0 0 0 11 1 1 1 0 1 1 0 0 0 0 0 0 3 2
Patchthar 1 5 1 0 0 0 1 2 0 0 0 1 0 1 0 1 0 1 0 1 1 5
Sakhuwasabha Total 0 2 0 0 0 0 0 2 0 0 0 1 0 0 0 0 0 0 0 0 0 1
Saptari 0 8 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 1 0 1
Siraha Total 4 16 0 0 0 1 1 10 0 0 0 3 0 3 3 3 1 3 0 4 4 17
Solukhumbu Total 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sunsari 10 43 0 0 0 0 0 37 1 4 2 4 3 6 2 16 2 9 0 4 10 43
Taplejung Total 0 4 0 0 0 0 0 2 0 2 0 0 0 2 0 0 0 0 0 0 0 4
Terhathum Total 0 1 0 0 0 0 0 5 0 0 0 1 0 0 0 0 0 1 0 0 0 2
Udaypur Total 7 16 0 0 0 0 0 7 0 0 1 1 1 7 2 5 2 2 1 1 7 16
Eastern Region Total 78 233 1 0 0 1 2 178 9 17 17 26 17 47 15 57 12 44 10 27 81 219
Grand Total 651 1,722 1 0 7 7 15 1776 102 132 160 243 109 326 104 373 87 361 85 277 655 1,719

ANNUAL REPORT 2072/73 123

ANNUAL REPORT 2072/73 123

 Annex 6: NTP Annual Treatment Outcome Report
Fiscal Year: 2072/73 (2016)
New

Lost to Not
Districts

DOTS Centre Registered Cured Completed Failure Died Total

Follow-up Evaluated

F M F M F M F M F M F M F M F M

Banke Total 163 310 137 249 6 11 6 8 8 22 6 14 2 12 165 316

15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 112 224 105 193 6 7 0 7 4 9 2 12 5 4 122 232

Dailekh Total 20 55 17 44 1 8 1 0 1 1 0 1 0 1 20 55
Dang Total 177 316 145 262 20 26 2 2 3 13 2 8 2 5 174 316
Dolpa Total 0 4 0 4 0 0 0 0 0 0 0 0 0 0 0 4
Humla Total 4 3 4 3 0 0 0 0 0 0 0 0 0 0 4 3
Jajarkot Total 16 33 13 25 2 6 0 0 0 0 0 0 1 0 16 31
Jumla Total 12 19 0 1 3 5 1 0 1 0 0 0 0 0 5 6
Kalikot Total 18 38 15 31 3 4 0 0 0 1 0 1 0 1 18 38
Mugu Total 5 5 5 4 0 1 0 0 0 0 0 0 0 0 5 5
Pyuthan Total 43 79 36 58 1 5 3 5 2 8 1 2 0 1 43 79
Ropa Total 39 94 36 79 1 4 0 0 1 7 1 4 0 0 39 94
Rukum Total 27 66 27 65 0 0 0 1 0 0 0 0 0 0 27 66
Salyan Total 28 69 23 58 1 4 0 1 1 4 2 1 1 1 28 69
Surkhet Total 54 103 48 84 0 5 2 3 2 5 0 2 2 4 54 103
Mid Western Region Total 718 1,418 611 1,160 44 86 15 27 23 70 14 45 13 29 720 1,417
Bara Total 187 354 145 265 31 57 0 2 4 18 6 11 1 1 187 354
8 7 6 5 4 3 2 1

Bhaktapur Total 78 150 74 133 0 4 0 1 2 5 0 0 2 7 78 150

Chitw an Total 151 283 127 236 4 6 1 7 6 8 7 19 6 7 151 283
Dhading Total 42 79 38 75 2 3 0 0 1 1 2 0 0 0 43 79
Dhanusha Total 155 283 134 242 12 14 0 1 2 8 4 14 3 4 155 283
Dolkha Total 7 26 7 23 0 0 0 0 0 0 0 0 0 3 7 26
Kathmandu Total 429 634 364 516 15 51 14 9 4 13 8 17 24 28 429 634
Kavre Total 31 107 24 87 5 11 0 3 0 3 0 0 2 3 31 107
Lalitpur Total 101 169 94 156 2 2 2 2 2 3 1 3 0 3 101 169
12 11 10

Mahottari Total 176 331 147 263 23 49 3 4 1 3 2 12 0 0 176 331

Makw anpur Total 83 240 75 213 6 17 1 1 0 3 1 5 0 1 83 240
Nuw akot Total 42 69 33 49 4 12 2 0 2 2 1 6 0 0 42 69
Parsa Total 182 274 155 231 18 22 0 1 3 6 3 10 2 1 181 271
14

Ramechhap Total 11 47 10 36 1 8 0 2 0 0 0 1 0 0 11 47
Rasuw a Total 1 17 1 15 0 2 0 0 0 0 0 0 0 0 1 17
17 16

Rautahat Total 125 272 111 241 1 14 0 2 3 8 1 5 0 1 116 272

Sarlahi Total 209 427 185 364 20 47 0 5 2 5 1 5 1 2 209 428
Sindhuli Total 49 152 43 139 1 2 1 2 0 2 4 7 0 0 49 152
19

Sindupalchok Total 20 59 17 42 1 8 0 0 0 2 2 7 0 0 20 59
Central Region Total 2,079 3,973 1,784 3,326 146 329 24 42 32 90 43 122 41 61 2,070 3,971
Arghakhanchi Total 38 75 33 70 1 3 1 0 2 2 0 0 1 0 38 75
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Baglung Total 16 52 14 44 0 3 0 0 2 4 0 0 0 1 16 52
Gorkha Total 39 72 37 63 1 6 1 2 0 1 0 0 0 0 39 72
Gulmi Total 32 85 25 76 4 1 0 1 1 5 1 1 1 1 32 85
Kapil Total 137 290 120 248 0 0 6 9 6 23 5 8 0 2 137 290
Kaski Total 68 144 64 133 0 0 0 3 3 4 0 2 1 2 68 144
Lamjung Total 9 48 9 41 0 0 0 0 0 0 0 0 0 7 9 48
Manang Total 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2 0
Mustang Total 2 2 1 2 0 0 0 0 0 0 1 0 0 0 2 2
Myagdi Total 15 24 15 23 0 0 0 0 0 0 0 1 0 0 15 24
Naw al Total 167 307 144 265 6 22 4 3 12 9 0 4 1 4 167 307
Palpa Total 51 95 47 85 2 0 1 1 0 5 1 2 0 2 51 95
Parbat Total 15 28 15 20 0 0 0 1 0 1 0 6 0 0 15 28
Rupandehi Total 208 407 184 372 5 3 1 1 13 18 2 7 3 6 208 407
Syanja Total 35 102 31 91 1 5 0 0 2 5 1 1 0 0 35 102
Tanahun Total 50 103 43 75 0 10 2 2 1 6 2 4 2 6 50 103
Western Region Total 884 1,834 784 1,608 20 53 16 23 42 83 13 36 9 31 884 1,834
Achham Total 42 72 35 51 4 11 0 1 0 3 3 6 0 0 42 72
9 8 7 6 5 4 3 2 1

Baitadi Total 28 73 19 62 4 5 1 0 1 5 2 1 1 0 28 73
Bajhang Total 41 32 25 17 14 11 0 0 0 2 1 2 1 0 41 32
Bajura Total 24 36 21 30 1 3 0 0 0 2 2 1 0 0 24 36
Dadeldhura Total 15 56 13 42 0 1 0 1 1 4 0 5 1 3 15 56
Darchula Total 30 48 29 43 0 3 0 0 1 0 0 0 0 2 30 48
Doti Total 30 90 27 82 2 4 0 0 1 3 0 1 0 0 30 90
Kanchanpur Total 118 300 108 260 1 2 0 3 3 13 3 11 3 11 118 300
Kailali Total 208 389 168 301 8 18 5 6 9 16 9 27 9 21 208 389
Far-Western Region Total 536 1,096 445 888 34 58 6 11 16 48 20 54 15 37 536 1,096
Bhojpur Total 5 32 3 25 0 3 0 0 1 0 0 4 1 0 5 32
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 9 36 9 34 0 0 0 0 0 2 0 0 0 0 9 36
Illam 23 55 21 45 2 9 0 0 0 0 0 1 0 0 23 55
Jhapa Total 226 523 211 462 3 12 1 4 3 13 5 18 3 14 226 523
Khotang Total 16 37 16 37 0 0 0 0 0 0 0 0 0 0 16 37
Morang Total 190 437 173 364 0 17 0 6 7 26 5 13 5 11 190 437
Okhaldhunga Total 11 17 8 5 1 4 0 0 1 1 0 1 1 6 11 17
Patchthar 19 31 16 28 3 3 0 0 0 0 0 0 0 0 19 31
Sakhuw asabha Total 19 48 19 46 0 0 0 0 0 0 0 0 0 2 19 48
Saptari 73 157 69 146 2 10 1 1 1 0 0 0 0 0 73 157
Siraha Total 116 251 109 232 3 4 0 0 4 10 0 4 0 1 116 251
Solukhumbu Total 18 22 18 22 0 0 0 0 0 0 0 0 0 0 18 22
Sunsari 178 388 157 297 5 22 3 6 1 15 6 32 6 16 178 388
Taplejung Total 5 15 0 9 3 4 0 0 0 0 1 0 1 2 5 15
Terhathum Total 12 23 12 20 0 1 0 1 0 1 0 0 0 0 12 23
Udaypur Total 54 105 53 97 0 3 0 1 1 1 0 2 0 1 54 105
Eastern Region Total 974 2,177 894 1,869 22 92 5 19 19 69 17 75 17 53 974 2,177
Grand Total 5,191 10,498 4,518 8,851 266 618 66 122 ### 360 107 332 95 211 5,184 10,495

ANNUAL REPORT 2072/73 124

 Re la pse
Lost to Not
Districts

DOTS Ce ntre Re gistere d Cured Comple tedFailure Died Follow- Eva luat Total
up ed
F M F M F M F M F M F M F M F M

Banke Total 18 37 15 27 0 2 1 1 1 2 0 4 2 2 19 38
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 11 26 9 19 0 0 0 0 0 4 0 2 0 1 9 26
Dailekh Total 2 3 2 2 0 0 0 0 0 1 0 0 0 0 2 3
Dang Total 23 66 20 49 2 9 1 1 0 3 0 0 1 1 24 63
Dolpa Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Humla Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Jajarkot Total 5 5 4 4 0 1 0 0 0 0 0 0 0 0 4 5
Jumla Total 2 2 0 2 1 0 0 0 0 0 0 0 0 0 1 2
Kalikot Total 3 5 2 4 0 0 0 0 0 0 0 1 1 0 3 5
Mugu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pyuthan Total 2 17 1 11 1 3 0 2 0 0 0 1 0 0 2 17
Ropa Total 5 12 4 10 0 0 1 0 0 1 0 0 0 1 5 12
Rukum Total 5 11 5 11 0 0 0 0 0 0 0 0 0 0 5 11
Salyan Total 7 14 7 10 0 1 0 0 0 2 0 1 0 0 7 14
Surkhet Total 6 36 4 31 0 0 0 1 0 3 1 0 1 1 6 36
Mid We stern Region Total 89 236 73 182 4 16 3 5 1 16 1 9 5 6 87 234
Bara Total 23 50 16 40 3 4 0 1 2 4 2 1 0 0 23 50
8 7 6 5 4 3 2 1

Bhaktapur Total 9 34 9 31 0 0 0 0 0 3 0 0 0 0 9 34
Chitw an Total 30 68 23 57 0 1 3 1 0 4 3 2 1 3 30 68
Dhading Total 3 19 3 19 0 0 0 0 0 0 0 0 0 0 3 19
Dhanusha Total 4 40 3 30 0 2 0 2 1 4 0 2 0 0 4 40
Dolkha Total 2 4 2 3 0 0 0 0 0 0 0 0 0 1 2 4
Kathmandu Total 60 119 50 89 0 5 0 1 2 5 2 2 6 17 60 119
Kavre Total 5 22 4 20 1 2 0 0 0 0 0 0 0 0 5 22
Lalitpur Total 28 35 24 31 0 0 2 0 1 2 0 2 1 0 28 35
12 11 10

Mahottari Total 5 15 5 11 0 0 0 0 0 1 0 3 0 0 5 15
Makw anpur Total 7 36 7 36 0 0 0 0 0 0 0 0 0 0 7 36
Nuw akot Total 4 21 3 14 1 4 0 0 0 3 0 0 0 0 4 21
Parsa Total 15 44 15 37 0 3 0 0 0 1 0 2 0 1 15 44
14

Ramechhap Total 0 11 0 8 0 2 0 1 0 0 0 0 0 0 0 11
Rasuw a Total 0 4 0 3 0 1 0 0 0 0 0 0 0 0 0 4
17 16

Rautahat Total 7 30 6 28 1 1 0 0 0 1 0 0 0 0 7 30
Sarlahi Total 23 79 23 67 0 5 0 1 0 4 0 0 0 2 23 79
Sindhuli Total 3 23 2 21 0 0 0 0 0 0 1 2 0 0 3 23
19

Sindupalchok Total 1 16 1 15 0 1 0 0 0 0 0 0 0 0 1 16
Central Re gion Tota l 229 670 196 560 6 31 5 7 6 32 8 16 8 24 229 670
Arghakhanchi Total 2 23 1 22 0 0 0 0 0 1 0 0 1 0 2 23
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Baglung Total 3 21 2 21 0 0 0 0 1 0 0 0 0 0 3 21
Gorkha Total 4 11 4 8 0 0 0 0 0 3 0 0 0 0 4 11
Gulmi Total 3 18 2 14 0 0 0 0 1 3 0 0 0 1 3 18
Kapil Total 11 25 10 19 0 0 0 1 1 4 0 1 0 0 11 25
Kaski Total 5 20 5 15 0 0 0 0 0 2 0 1 0 2 5 20
Lamjung Total 2 3 2 2 0 0 0 0 0 1 0 0 0 0 2 3
Manang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mustang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Myagdi Total 1 5 1 5 0 0 0 0 0 0 0 0 0 0 1 5
Naw al Total 15 58 14 52 0 1 0 3 0 1 0 1 1 0 15 58
Palpa Total 5 19 5 17 0 0 0 0 0 1 0 0 0 1 5 19
Parbat Total 2 8 2 7 0 0 0 0 0 0 0 1 0 0 2 8
Rupandehi Total 19 62 18 58 0 1 0 1 1 0 0 1 0 1 19 62
Syanja Total 2 18 1 17 0 0 0 1 1 0 0 0 0 0 2 18
Tanahun Total 6 26 6 20 0 1 0 0 0 1 0 2 0 2 6 26
We ste rn Region Total 80 317 73 277 0 3 0 6 5 17 0 7 2 7 80 317
Achham Total 2 14 2 8 0 1 0 1 0 2 0 2 0 0 2 14
9 8 7 6 5 4 3 2 1

Baitadi Total 4 15 3 12 0 1 1 0 0 2 0 0 0 0 4 15
Bajhang Total 3 7 2 3 1 3 0 1 0 0 0 0 0 0 3 7
Bajura Total 4 4 2 3 0 0 0 0 0 0 2 1 0 0 4 4
Dadeldhura Total 4 15 3 11 0 0 0 0 1 2 0 1 0 1 4 15
Darchula Total 2 3 2 3 0 0 0 0 0 0 0 0 0 0 2 3
Doti Total 5 11 5 8 0 0 0 1 0 2 0 0 0 0 5 11
Kanchanpur Total 24 71 23 57 0 3 1 3 0 4 0 2 0 2 24 71
Kailali Total 18 75 16 59 0 3 1 1 0 8 0 2 1 2 18 75
Far-We stern Region Total 66 215 58 164 1 11 3 7 1 20 2 8 1 5 66 215
Bhojpur Total 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 0 4 0 4 0 0 0 0 0 0 0 0 0 0 0 4
Illam 1 2 1 2 0 0 0 0 0 0 0 0 0 0 1 2
Jhapa Total 21 61 18 52 1 3 1 0 1 2 0 4 0 0 21 61
Khotang Total 0 3 0 3 0 0 0 0 0 0 0 0 0 0 0 3
Morang Total 18 72 18 64 0 1 0 1 0 2 0 2 0 2 18 72
Okhaldhunga Total 1 5 1 3 0 0 0 0 0 0 0 1 0 1 1 5
Patchthar 2 3 0 1 2 2 0 0 0 0 0 0 0 0 2 3
Sakhuw asabha Total 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2
Saptari 4 13 4 13 0 0 0 0 0 0 0 0 0 0 4 13
Siraha Total 4 21 4 19 0 0 0 0 0 2 0 0 0 0 4 21
Solukhumbu Total 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 2
Sunsari 12 46 10 40 0 1 0 0 1 4 0 0 1 1 12 46
Taplejung Total 1 1 0 0 0 1 0 0 0 0 1 0 0 0 1 1
Terhathum Total 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2
Udaypur Total 1 9 1 8 0 0 0 0 0 1 0 0 0 0 1 9
Eastern Re gion Tota l 65 248 57 215 3 10 1 1 2 11 1 7 1 4 65 248
Gra nd Total 529 1,686 457 #### 14 71 12 26 15 96 12 47 17 46 527 1,684

ANNUAL REPORT 2072/73 125

ANNUAL REPORT 2072/73

 Treatment After Failure
Lost to Not
Districts

DOTS Centre Registered Cured CompletedFa ilure Die d Follow - Evalua t Tota l
up ed
F M F M F M F M F M F M F M F M

Banke Total 9 4 8 3 0 0 1 0 0 0 1 0 0 1 10 4
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 0 5 1 3 0 0 0 0 0 0 0 2 0 0 1 5
Dailekh Total 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1
Dang Total 0 2 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Dolpa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Humla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jajarkot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kalikot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mugu Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Pyuthan Total 0 3 0 3 0 0 0 0 0 0 0 0 0 0 0 3
Ropa Total 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0
Rukum Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salyan Total 0 3 0 3 0 0 0 0 0 0 0 0 0 0 0 3
Surkhet Total 3 4 3 3 0 0 0 0 0 0 0 0 0 1 3 4
Mid We ste rn Region Total 13 23 13 17 0 0 1 0 0 1 1 2 0 2 15 22
Bara Total 4 11 4 10 0 1 0 0 0 0 0 0 0 0 4 11
8 7 6 5 4 3 2 1

Bhaktapur Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Chitw an Total 1 7 1 4 0 0 0 1 0 1 0 0 0 1 1 7
Dhading Total 0 1 1 2 0 1 0 0 0 0 0 0 0 0 1 3
Dhanusha Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Dolkha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kathmandu Total 10 11 7 9 0 0 0 0 0 0 2 0 1 2 10 11
Kavre Total 0 4 0 3 0 0 0 0 0 1 0 0 0 0 0 4
Lalitpur Total 3 0 3 0 0 0 0 0 0 0 0 0 0 0 3 0
12 11 10

Mahottari Total 2 5 1 5 0 0 1 0 0 0 0 0 0 0 2 5
Makw anpur Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Nuw akot Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Parsa Total 1 3 1 3 0 0 0 0 0 0 0 0 0 0 1 3
14

Ramechhap Total 3 2 0 2 0 1 0 0 0 0 0 0 0 0 0 3
Rasuw a Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 16

Rautahat Total 1 4 1 4 0 0 0 0 0 0 0 0 0 0 1 4
Sarlahi Total 1 3 1 2 0 0 0 1 0 0 0 0 0 0 1 3
Sindhuli Total 3 0 3 0 0 0 0 0 0 0 0 0 0 0 3 0
19

Sindupalchok Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Central Region Total 29 56 23 49 0 3 1 2 0 2 2 0 1 3 27 59
Arghakhanchi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Baglung Total 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2 0
Gorkha Total 3 4 3 4 0 0 0 0 0 0 0 0 0 0 3 4
Gulmi Total 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1
Kapil Total 7 10 5 5 0 1 1 3 0 0 1 1 0 0 7 10
Kaski Total 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2
Lamjung Total 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0
Manang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mustang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Myagdi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Naw al Total 3 3 3 3 0 0 0 0 0 0 0 0 0 0 3 3
Palpa Total 1 3 1 3 0 0 0 0 0 0 0 0 0 0 1 3
Parbat Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Rupandehi Total 2 1 2 1 0 0 0 0 0 0 0 0 0 0 2 1
Syanja Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Tanahun Total 0 3 0 2 0 0 0 0 0 0 0 0 0 1 0 3
Western Region Total 19 28 17 21 0 1 1 3 0 1 1 1 0 1 19 28
Achham Total 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0
9 8 7 6 5 4 3 2 1

Baitadi Total 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 2
Bajhang Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Bajura Total 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0
Dadeldhura Total 0 3 0 3 0 0 0 0 0 0 0 0 0 0 0 3
Darchula Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Doti Total 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1
Kanchanpur Total 3 6 3 4 0 0 0 1 0 0 0 1 0 0 3 6
Kailali Total 4 12 4 10 0 0 0 0 0 1 0 0 0 1 4 12
Far-Western Region Total 9 25 9 18 0 2 0 1 0 1 0 2 0 1 9 25
Bhojpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Illam 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0
Jhapa Total 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1
Khotang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Morang Total 1 4 1 4 0 0 0 0 0 0 0 0 0 0 1 4
Okhaldhunga Total 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1
Patchthar 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0
Sakhuw asabha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Saptari 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Siraha Total 0 12 0 12 0 0 0 0 0 0 0 0 0 0 0 12
Solukhumbu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sunsari 2 5 1 5 0 0 0 0 0 0 1 0 0 0 2 5
Taplejung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Terhathum Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Udaypur Total 0 2 0 1 0 0 0 0 0 1 0 0 0 0 0 2
Ea ste rn Region Total 6 26 4 24 1 0 0 1 0 1 1 0 0 0 6 26
Grand Total 76 158 66 129 1 6 3 7 0 6 5 5 1 7 76 160

ANNUAL REPORT 2072/73 126

 Treatment After Lost to Follow-up
Lost to Not
Districts

DOTS Centre Registered Cured CompletedFailure Died Follow- Evaluat Total

up ed
F M F M F M F M F M F M F M F M
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Banke Total 0 2 0 0 0 1 0 1 0 0 0 0 0 0 0 2
Bardiya Total 0 2 1 1 0 0 0 0 0 1 0 1 0 0 1 3
Dailekh Total 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1
Dang Total 3 1 3 1 0 1 0 0 0 0 0 1 0 0 3 3
Dolpa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Humla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jajarkot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kalikot Total 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1
Mugu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pyuthan Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ropa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rukum Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Salyan Total 0 3 0 3 0 0 0 0 0 0 0 0 0 0 0 3
Surkhet Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mid W estern Region Total 3 10 4 6 0 2 0 1 0 1 0 4 0 0 4 14
8 7 6 5 4 3 2 1

Bara Total 1 10 1 7 0 1 0 2 0 0 0 0 0 0 1 10
Bhaktapur Total 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Chitw an Total 0 6 0 3 0 0 0 0 0 1 0 1 0 1 0 6
Dhading Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dhanusha Total 1 6 1 4 0 1 0 0 0 1 0 0 0 0 1 6
Dolkha Total 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0
Kathmandu Total 1 9 1 6 0 0 0 0 0 1 0 2 0 0 1 9
Kavre Total 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1
Lalitpur Total 1 7 1 7 0 0 0 0 0 0 0 0 0 0 1 7
12 11 10

Mahottari Total 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1
Makw anpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nuw akot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Parsa Total 2 4 2 3 0 0 0 1 0 0 0 0 0 0 2 4
14

Ramechhap Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rasuw a Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 16

Rautahat Total 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2
Sarlahi Total 1 9 1 6 0 1 0 1 0 0 0 0 0 1 1 9
Sindhuli Total 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1
19

Sindupalchok Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Central Region Total 10 57 8 42 1 3 0 4 0 3 1 4 0 2 10 58
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Arghakhanchi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Baglung Total 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2
Gorkha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gulmi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kapil Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Kaski Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lamjung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Manang Total 0 2 0 1 0 1 0 0 0 0 0 0 0 0 0 2
Mustang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Myagdi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Naw al Total 0 6 0 4 0 1 0 0 0 0 0 1 0 0 0 6
Palpa Total 1 2 1 2 0 0 0 0 0 0 0 0 0 0 1 2
Parbat Total 0 4 0 4 0 0 0 0 0 0 0 0 0 0 0 4
Rupandehi Total 1 5 0 3 0 0 0 0 1 1 0 1 0 0 1 5
Syanja Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Tanahun Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Western Region Total 2 24 1 19 0 2 0 0 1 1 0 2 0 0 2 24
9 8 7 6 5 4 3 2 1

Achham Total 0 4 0 2 0 1 0 0 0 0 0 1 0 0 0 4
Baitadi Total 1 3 1 2 0 1 0 0 0 0 0 0 0 0 1 3
Bajhang Total 2 1 1 0 1 0 0 0 0 0 0 1 0 0 2 1
Bajura Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dadeldhura Total 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1
Darchula Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Doti Total 0 3 0 2 0 1 0 0 0 0 0 0 0 0 0 3
Kanchanpur Total 1 7 1 6 0 1 0 0 0 0 0 0 0 0 1 7
Kailali Total 2 5 2 5 0 0 0 0 0 0 0 0 0 0 2 5
Far-W estern Region Total 6 25 5 18 1 4 0 0 0 1 0 2 0 0 6 25
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bhojpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dhankuta Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Illam 0 2 0 1 0 1 0 0 0 0 0 0 0 0 0 2
Jhapa Total 0 3 0 3 0 0 0 0 0 0 0 0 0 0 0 3
Khotang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Morang Total 2 9 2 8 0 0 0 0 0 0 0 0 0 1 2 9
Okhaldhunga Total 0 3 1 1 0 0 0 0 0 0 0 0 0 0 1 1
Patchthar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sakhuw asabha Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Saptari 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0
Siraha Total 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1
Solukhumbu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sunsari 3 10 2 4 0 2 0 0 0 3 1 1 0 0 3 10
Taplejung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Terhathum Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Udaypur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Eastern Region Total 7 29 7 19 0 3 0 0 0 3 1 1 0 1 8 27
Grand Total 28 145 25 104 2 14 0 5 1 9 2 13 0 3 30 148

ANNUAL REPORT 2072/73 127

 Others Previously Tre ated
Lost to Not
Districts

DOTS Centre Registered CuredCompletedFailure Died Follow- Evaluat Total

up ed
F M F M F M F M F M F M F M F M

Banke Total 2 6 1 5 0 0 0 0 1 0 0 0 0 0 2 5
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 2 0 1 0 1 1 0 0 0 0 0 0 0 0 2 1
Dailekh Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dang Total 1 0 1 1 0 3 0 0 0 0 0 0 0 0 1 4
Dolpa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Humla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jajarkot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kalikot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mugu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pyuthan Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ropa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rukum Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salyan Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Surkhet Total 0 2 0 1 0 0 0 0 0 0 0 0 0 1 0 2
Mid Western Region Total 5 8 3 7 1 4 0 0 1 0 0 0 0 1 5 12
Bara Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 7 6 5 4 3 2 1

Bhaktapur Total 0 4 0 4 0 0 0 0 0 0 0 0 0 0 0 4
Chitw an Total 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2
Dhading Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dhanusha Total 1 2 1 1 0 0 0 0 0 0 0 1 0 0 1 2
Dolkha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kathmandu Total 4 10 4 7 0 1 0 1 0 0 0 1 0 0 4 10
Kavre Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lalitpur Total 2 4 2 4 0 0 0 0 0 0 0 0 0 0 2 4
12 11 10

Mahottari Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Makw anpur Total 1 2 1 2 0 0 0 0 0 0 0 0 0 0 1 2
Nuw akot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Parsa Total 3 2 3 2 0 0 0 0 0 0 0 0 0 0 3 2
14

Ramechhap Total 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1
Rasuw a Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 16

Rautahat Total 3 2 3 2 0 0 0 0 0 0 0 0 0 0 3 2
Sarlahi Total 0 5 0 4 0 0 0 0 0 0 0 1 0 0 0 5
Sindhuli Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19

Sindupalchok Total 0 3 0 3 0 0 0 0 0 0 0 0 0 0 0 3
Central Region Total 14 37 14 31 0 1 0 1 0 0 0 4 0 0 14 37
Arghakhanchi Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Baglung Total 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1
Gorkha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gulmi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kapil Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kaski Total 2 3 2 3 0 0 0 0 0 0 0 0 0 0 2 3
Lamjung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Manang Total 1 2 0 1 1 0 0 0 0 0 0 0 0 1 1 2
Mustang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Myagdi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Naw al Total 0 5 0 1 0 1 0 0 0 1 0 0 0 1 0 4
Palpa Total 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0
Parbat Total 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1
Rupandehi Total 1 1 0 1 0 0 0 0 1 0 0 0 0 0 1 1
Syanja Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Tanahun Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Western Region Total 6 15 4 9 1 1 0 0 1 1 0 1 0 2 6 14
Achham Total 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1
9 8 7 6 5 4 3 2 1

Baitadi Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Bajhang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bajura Total 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1
Dadeldhura Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Darchula Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Doti Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kanchanpur Total 3 5 2 0 1 5 0 0 0 0 0 0 0 0 3 5
Kailali Total 1 2 1 2 0 0 0 0 0 0 0 0 0 0 1 2
Far-Western Region Total 4 10 3 3 1 6 0 0 0 0 0 1 0 0 4 10
Bhojpur Total 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Illam 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jhapa Total 3 5 3 4 0 0 0 0 0 1 0 0 0 0 3 5
Khotang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Morang Total 0 9 0 6 0 3 0 0 0 0 0 0 0 0 0 9
Okhaldhunga Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Patchthar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sakhuw asabha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Saptari 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Siraha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Solukhumbu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sunsari 3 0 2 0 0 0 0 0 0 0 0 0 0 0 2 0
Taplejung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Terhathum Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Udaypur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Eastern Region Total 6 16 5 11 0 3 0 0 0 1 0 0 0 1 5 16
Grand Total 35 86 29 61 3 15 0 1 2 2 0 6 0 4 34 89

ANNUAL REPORT 2072/73 128

 Previous Treatment History Unknow n
Lost to Not
Districts

DOTS Centre Registe red Cured Complete dFailure Died Follow - Evaluat Total
up ed
F M F M F M F M F M F M F M F M

Banke Total 1 2 1 1 0 0 0 0 0 0 0 0 0 0 1 1
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1
Dailekh Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dang Total 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0
Dolpa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Humla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jajarkot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kalikot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mugu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pyuthan Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ropa Total 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2
Rukum Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salyan Total 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1
Surkhet Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mid Western Region Total 1 6 1 3 1 1 0 1 0 0 0 0 0 0 2 5
Bara Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 7 6 5 4 3 2 1

Bhaktapur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Chitw an Total 1 2 1 2 0 0 0 0 0 0 0 0 0 0 1 2
Dhading Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dhanusha Total 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1
Dolkha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kathmandu Total 2 2 2 2 0 0 0 0 0 0 0 0 0 0 2 2
Kavre Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lalitpur Total 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2
12 11 10

Mahottari Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Makw anpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nuw akot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Parsa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14

Ramechhap Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rasuw a Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 16

Rautahat Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Sarlahi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sindhuli Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19

Sindupalchok Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Central Re gion Tota l 4 8 4 7 0 0 0 0 0 0 0 1 0 0 4 8
Arghakhanchi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Baglung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gorkha Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Gulmi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kapil Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kaski Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lamjung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Manang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mustang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Myagdi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Naw al Total 0 4 0 0 0 2 0 0 0 1 0 0 0 1 0 4
Palpa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Parbat Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rupandehi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Syanja Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Tanahun Total 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2 0
Western Region Total 2 6 2 2 0 2 0 0 0 1 0 0 0 1 2 6
Achham Total 2 1 2 0 0 1 0 0 0 0 0 0 0 0 2 1
9 8 7 6 5 4 3 2 1

Baitadi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bajhang Total 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 2
Bajura Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dadeldhura Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Darchula Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Doti Total 0 3 0 2 0 0 0 0 0 0 0 1 0 0 0 3
Kanchanpur Total 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1
Kailali Total 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1
Far-Weste rn Region Total 3 8 3 2 0 5 0 0 0 0 0 1 0 0 3 8
Bhojpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Illam 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jhapa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Khotang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Morang Total 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1
Okhaldhunga Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Patchthar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sakhuw asabha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Saptari 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Siraha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Solukhumbu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sunsari 0 2 0 1 0 0 0 0 0 0 0 1 0 0 0 2
Taplejung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Terhathum Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Udaypur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ea stern Region Tota l 0 3 0 2 0 0 0 0 0 0 0 1 0 0 0 3
Grand Total 10 31 10 16 1 8 0 1 0 1 0 3 0 1 11 30

ANNUAL REPORT 2072/73 129

 HIV +ve, All Types
Lost to Not
Districts

DOTS Centre Registered Cured Completed Failure Died Follow- Evaluat Total
up ed
F M F M F M F M F M F M F M F M

Banke Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dailekh Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dang Total 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 2
Dolpa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Humla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jajarkot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kalikot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mugu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pyuthan Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ropa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rukum Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salyan Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Surkhet Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mid Western Region Total 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 2
Bara Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 7 6 5 4 3 2 1

Bhaktapur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Chitw an Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dhading Total 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0
Dhanusha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dolkha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kathmandu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kavre Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lalitpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 11 10

Mahottari Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Makw anpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nuw akot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Parsa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14

Ramechhap Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rasuw a Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 16

Rautahat Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sarlahi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sindhuli Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19

Sindupalchok Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Central Region Total 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0
Arghakhanchi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Baglung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gorkha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gulmi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kapil Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kaski Total 1 5 1 5 0 0 0 0 0 0 0 0 0 0 1 5
Lamjung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Manang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mustang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Myagdi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Naw al Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Palpa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Parbat Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rupandehi Total 1 2 1 1 0 0 0 0 0 1 0 0 0 0 1 2
Syanja Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Tanahun Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Western Region Total 2 7 2 6 0 0 0 0 0 1 0 0 0 0 2 7
Achham Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 8 7 6 5 4 3 2 1

Baitadi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bajhang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bajura Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dadeldhura Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Darchula Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Doti Total 1 2 1 1 0 0 0 0 0 1 0 0 0 0 1 2
Kanchanpur Total 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 2
Kailali Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Far-Western Region Total 1 4 1 1 0 2 0 0 0 1 0 0 0 0 1 4
Bhojpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Illam 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jhapa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Khotang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Morang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Okhaldhunga Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Patchthar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sakhuw asabha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Saptari 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Siraha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Solukhumbu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sunsari 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Taplejung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Terhathum Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Udaypur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Eastern Region Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Grand Total 3 11 4 7 0 4 0 0 0 2 0 0 0 0 4 13

ANNUAL REPORT 2072/73 130

 New (Pulmonary Clinically Diagnose d)

Lost to Not
Districts

DOTS Ce ntre Registere d Complete d Fa ilure Died Total

Follow-up Evalua ted

F M F M F M F M F M F M F M

Banke Total 60 83 63 84 0 0 0 1 1 0 1 2 65 87
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 35 69 28 61 0 0 1 3 2 0 1 2 32 66
Dailekh Total 8 20 8 20 0 0 0 0 0 0 0 0 8 20
Dang Total 148 194 136 173 3 2 4 1 4 1 4 4 151 181
Dolpa Total 0 5 0 0 0 0 0 0 0 0 0 0 0 0
Humla Total 1 2 1 2 0 0 0 0 0 0 0 0 1 2
Jajarkot Total 12 12 14 12 0 0 0 0 0 0 0 0 14 12
Jumla Total 5 9 2 2 0 0 0 0 0 0 0 0 2 2
Kalikot Total 3 1 4 3 0 0 0 0 0 0 0 0 4 3
Mugu Total 2 4 2 4 0 0 0 0 0 0 0 0 2 4
Pyuthan Total 20 32 17 24 0 0 2 1 1 5 0 0 20 30
Ropa Total 17 29 15 22 0 0 2 2 0 4 0 1 17 29
Rukum Total 35 47 35 46 0 0 0 1 0 0 0 0 35 47
Salyan Total 23 40 22 38 0 0 1 0 0 2 0 0 23 40
Surkhet Total 66 102 60 98 0 1 3 3 0 0 3 0 66 102
Mid Western Region Total 435 649 407 589 3 3 13 12 8 12 9 9 440 625
Bara Total 82 117 81 115 0 0 0 1 1 0 0 1 82 117
8 7 6 5 4 3 2 1

Bhaktapur Total 24 32 24 30 0 0 0 1 0 0 0 1 24 32
Chitw an Total 66 115 56 103 0 2 3 2 2 6 5 2 66 115
Dhading Total 16 26 16 24 0 1 0 0 0 0 0 0 16 25
Dhanusha Total 59 113 56 107 0 0 1 2 0 2 2 2 59 113
Dolkha Total 6 7 6 7 0 0 0 0 0 0 0 0 6 7
Kathmandu Total 155 219 145 197 4 6 1 2 0 6 5 8 155 219
Kavre Total 20 36 18 32 0 1 1 0 0 0 1 3 20 36
Lalitpur Total 46 67 45 64 0 0 0 0 0 2 1 1 46 67
12 11 10

Mahottari Total 154 237 144 212 0 1 0 3 9 17 0 0 153 233

Makw anpur Total 40 76 23 50 0 0 0 0 0 0 0 0 23 50
Nuw akot Total 11 21 11 13 0 0 0 3 0 4 0 1 11 21
Parsa Total 125 115 117 108 0 0 4 3 4 4 0 0 125 115
14

Ramechhap Total 25 32 17 16 0 0 0 0 2 1 0 0 19 17
Rasuw a Total 0 4 0 4 0 0 0 0 0 0 0 0 0 4
17 16

Rautahat Total 107 220 103 214 1 0 0 5 1 1 1 0 107 220

Sarlahi Total 119 192 116 186 1 0 0 1 2 3 0 2 119 192
Sindhuli Total 24 44 23 43 0 0 1 1 0 0 0 0 24 44
19

Sindupalchok Total 5 15 5 15 0 0 0 0 0 0 0 0 5 14
Ce ntral Region Tota l 1,084 1,688 1,006 1,540 6 11 11 24 21 46 15 21 1,060 1,641
Arghakhanchi Total 26 43 26 42 0 0 0 1 0 0 0 0 26 43
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Baglung Total 14 23 13 21 0 0 1 2 0 0 0 0 14 23
Gorkha Total 10 16 10 16 0 0 0 0 0 0 0 0 10 16
Gulmi Total 17 44 16 40 0 0 1 4 0 0 0 0 17 44
Kapil Total 35 75 34 69 0 2 1 3 0 0 0 1 35 75
Kaski Total 13 16 12 16 0 0 1 0 0 0 0 0 13 16
Lamjung Total 1 10 1 7 0 0 0 2 0 0 0 1 1 10
Manang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mustang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Myagdi Total 2 2 2 2 0 0 0 0 0 0 0 0 2 2
Naw al Total 40 72 38 65 0 1 1 3 0 1 0 3 39 73
Palpa Total 23 38 22 35 0 0 0 3 0 0 1 0 23 38
Parbat Total 6 7 5 7 0 0 0 0 1 0 0 0 6 7
Rupandehi Total 127 258 121 248 1 1 3 4 0 0 2 5 127 258
Syanja Total 14 23 14 22 0 0 0 1 0 0 0 0 14 23
Tanahun Total 13 34 11 29 0 0 0 0 1 2 1 3 13 34
Western Region Total 341 661 325 619 1 4 8 23 2 3 4 13 340 662
Achham Total 4 13 3 9 0 0 0 3 1 1 0 0 4 13
9 8 7 6 5 4 3 2 1

Baitadi Total 10 34 10 32 0 0 0 2 0 0 0 0 10 34
Bajhang Total 6 17 5 16 0 0 1 1 0 0 0 0 6 17
Bajura Total 5 10 5 10 0 0 0 0 0 0 0 0 5 10
Dadeldhura Total 15 14 15 13 0 0 0 0 0 0 0 1 15 14
Darchula Total 12 27 12 27 0 0 0 0 0 0 0 0 12 27
Doti Total 3 19 3 17 0 0 0 1 0 1 0 0 3 19
Kanchanpur Total 65 105 58 97 0 0 1 3 2 3 4 2 65 105
Kailali Total 87 168 82 157 0 0 1 4 3 5 1 2 87 168
Far-We stern Region Total 207 407 193 378 0 0 3 14 6 10 5 5 207 407
Bhojpur Total 0 3 0 3 0 0 0 0 0 0 0 0 0 3
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 1 7 1 7 0 0 0 0 0 0 0 0 1 7
Illam 1 17 1 17 0 0 0 0 0 0 0 0 1 17
Jhapa Total 57 84 57 82 0 0 0 1 0 0 0 1 57 84
Khotang Total 2 10 2 10 0 0 0 0 0 0 0 0 2 10
Morang Total 46 109 42 99 0 1 1 4 3 4 0 1 46 109
Okhaldhunga Total 3 8 2 3 0 0 0 0 0 0 0 0 2 3
Patchthar 2 7 1 7 0 0 0 0 0 0 0 0 1 7
Sakhuw asabha Total 8 9 8 9 0 0 0 0 0 0 0 0 8 9
Saptari 91 118 90 114 0 0 0 0 0 0 1 4 91 118
Siraha Total 44 71 41 68 0 0 2 3 1 0 0 0 44 71
Solukhumbu Total 1 1 1 1 0 0 0 0 0 0 0 0 1 1
Sunsari 27 51 24 44 0 0 1 4 0 1 1 1 26 50
Taplejung Total 2 6 2 5 0 0 0 0 0 1 0 0 2 6
Terhathum Total 6 8 4 3 0 0 0 0 0 0 0 0 4 3
Udaypur Total 22 44 21 43 1 0 0 1 0 0 0 0 22 44
Eastern Region Tota l 313 553 297 515 1 1 4 13 4 6 2 7 308 542
Gra nd Tota l 2,380 3,958 2,228 3,641 11 19 39 86 41 77 35 55 2,355 3,877

ANNUAL REPORT 2072/73 131

 New EP (Ba cteriologically Confirmed or Clinica lly Diagnosed)

Lost to Not
Districts

DOTS Centre Re gistered Complete d Failure Died Total

Follow-up Evalua ted

F M F M F M F M F M F M F M

Banke Total 83 68 67 70 1 0 1 0 1 2 5 6 75 78
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 35 55 30 46 0 0 0 1 1 0 0 1 31 48
Dailekh Total 32 61 30 61 0 0 1 0 1 0 0 0 32 61
Dang Total 90 124 85 104 2 1 2 4 1 0 0 0 90 109
Dolpa Total 8 3 4 0 0 0 0 0 0 0 0 0 4 0
Humla Total 1 3 1 3 0 0 0 0 0 0 0 0 1 3
Jajarkot Total 16 29 12 23 0 0 0 0 0 0 0 0 12 23
Jumla Total 13 20 6 7 0 0 0 0 0 0 0 0 6 7
Kalikot Total 21 29 20 26 0 0 0 1 0 0 0 0 20 27
Mugu Total 7 6 7 6 0 0 0 0 0 0 0 0 7 6
Pyuthan Total 24 34 22 22 0 0 0 2 0 3 0 0 22 27
Ropa Total 48 37 45 34 0 0 2 2 1 0 0 1 48 37
Rukum Total 28 39 28 39 0 0 0 0 0 0 0 0 28 39
Salyan Total 37 45 32 42 0 0 0 1 1 0 0 0 33 43
Surkhet Total 133 172 126 166 0 0 4 1 1 2 2 4 133 173
Mid Western Region Total 576 725 515 649 3 1 10 12 7 7 7 12 542 681
Bara Total 92 100 92 100 0 0 0 0 0 0 0 0 92 100
8 7 6 5 4 3 2 1

Bhaktapur Total 136 118 123 108 0 0 2 5 1 0 10 5 136 118

Chitw an Total 116 118 105 105 0 1 3 1 2 4 6 3 116 114
Dhading Total 36 46 36 46 0 0 0 0 0 0 0 0 36 46
Dhanusha Total 58 82 56 74 0 0 1 1 0 3 1 3 58 81
Dolkha Total 17 35 16 32 0 0 0 1 0 0 1 2 17 35
Kathmandu Total 693 785 619 676 11 14 11 13 3 9 49 73 693 785
Kavre Total 47 75 44 69 0 0 1 0 2 3 0 3 47 75
Lalitpur Total 134 148 130 145 0 0 1 1 2 0 0 2 133 148
12 11 10

Mahottari Total 37 51 35 50 0 0 0 2 3 2 0 0 38 54
Makw anpur Total 41 50 28 33 0 0 0 0 0 0 0 0 28 33
Nuw akot Total 27 29 22 25 0 0 1 1 3 2 1 1 27 29
Parsa Total 81 114 75 106 0 1 2 1 4 5 0 1 81 114
14

Ramechhap Total 22 23 16 15 0 0 0 0 0 0 0 1 16 16
Rasuw a Total 8 4 8 4 0 0 0 0 0 0 0 0 8 4
17 16

Rautahat Total 60 99 60 96 0 0 0 1 0 1 0 1 60 99
Sarlahi Total 81 93 78 91 1 0 2 1 0 1 0 0 81 93
Sindhuli Total 16 19 15 18 0 0 0 0 1 1 0 0 16 19
19

Sindupalchok Total 16 35 16 35 0 0 0 0 0 0 0 0 16 35
Central Region Total 1,718 2,024 1,574 1,828 12 16 24 28 21 31 68 95 1,699 1,998
A rghakhanchi Total 43 62 41 61 0 0 2 1 0 0 0 0 43 62
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Baglung Total 15 35 15 34 0 0 0 0 0 0 0 1 15 35
Gorkha Total 12 26 12 25 0 0 0 0 0 1 0 0 12 26
Gulmi Total 42 64 41 61 0 0 0 3 0 0 1 0 42 64
Kapil Total 29 54 29 50 0 0 0 3 0 0 0 1 29 54
Kaski Total 94 81 87 79 0 0 4 0 0 0 3 2 94 81
Lamjung Total 25 16 25 15 0 0 0 0 0 0 0 1 25 16
Manang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mustang Total 3 2 3 2 0 0 0 0 0 0 0 0 3 2
Myagdi Total 10 8 10 8 0 0 0 0 0 0 0 0 10 8
Naw al Total 79 125 72 116 0 0 1 2 0 3 2 1 75 122
Palpa Total 61 87 52 84 0 0 6 3 0 0 3 0 61 87
Parbat Total 8 18 7 14 0 0 0 1 1 3 0 0 8 18
Rupandehi Total 134 179 128 171 1 1 2 2 0 0 3 5 134 179
Syanja Total 34 50 33 45 0 0 0 4 1 1 0 0 34 50
Tanahun Total 25 44 22 40 0 0 2 0 0 0 1 4 25 44
Western Region Total 614 851 577 805 1 1 17 19 2 8 13 15 610 848
A chham Total 17 10 13 7 0 0 1 0 3 3 0 0 17 10
9 8 7 6 5 4 3 2 1

Baitadi Total 19 25 17 23 0 0 1 1 1 1 0 0 19 25
Bajhang Total 15 14 11 13 0 0 1 0 2 1 1 0 15 14
Bajura Total 7 16 7 15 0 0 0 1 0 0 0 0 7 16
Dadeldhura Total 14 19 12 19 0 0 1 0 1 0 0 0 14 19
Darchula Total 5 8 5 8 0 0 0 0 0 0 0 0 5 8
Doti Total 9 13 9 13 0 0 0 0 0 0 0 0 9 13
Kanchanpur Total 56 83 51 75 1 0 0 3 1 2 3 3 56 83
Kailali Total 113 188 107 165 0 1 3 11 1 4 2 7 113 188
Far-We stern Region Total 255 376 232 338 1 1 7 16 9 11 6 10 255 376
Bhojpur Total 5 19 5 19 0 0 0 0 0 0 0 0 5 19
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 5 18 5 18 0 0 0 0 0 0 0 0 5 18
Illam 7 23 7 22 0 0 0 0 0 1 0 0 7 23
Jhapa Total 128 171 128 167 0 0 1 1 0 1 0 2 129 171
Khotang Total 28 23 28 23 0 0 0 0 0 0 0 0 28 23
Morang Total 130 160 123 146 0 0 2 5 2 4 3 5 130 160
Okhaldhunga Total 7 18 7 17 0 0 0 0 0 0 0 1 7 18
Patchthar 6 5 6 5 0 0 0 0 0 0 0 0 6 5
Sakhuw asabha Total 21 26 21 25 0 0 0 0 0 0 0 1 21 26
Saptari 20 39 20 39 0 0 0 0 0 0 0 0 20 39
Siraha Total 39 63 38 61 0 0 1 2 0 0 0 0 39 63
Solukhumbu Total 7 17 7 17 0 0 0 0 0 0 0 0 7 17
Sunsari 135 149 123 129 0 1 5 1 4 8 3 11 135 150
Taplejung Total 5 11 4 12 0 0 0 0 1 0 0 0 5 12
Terhathum Total 1 2 1 2 0 0 0 0 0 0 0 0 1 2
Udaypur Total 20 18 20 18 0 0 0 0 0 0 0 0 20 18
Eastern Region Total 564 762 543 720 0 1 9 9 7 14 6 20 565 764
Grand Total 3,727 4,738 3,441 4,340 17 20 67 84 46 71 100 152 3,671 4,667

ANNUAL REPORT 2072/73 132

 Others (Pulmonary Clinically Diagnosed)

Lost to Not
Districts

DOTS Centre Registered Completed Failure Died Total

Follow -up Evaluated

F M F M F M F M F M F M F M

Banke Total 5 12 8 16 0 0 0 1 0 0 0 0 8 17
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 11 4 10 6 0 0 0 0 0 0 0 0 10 6
Dailekh Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dang Total 5 7 5 3 0 0 0 0 0 0 0 0 5 3
Dolpa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Humla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jajarkot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kalikot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mugu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pyuthan Total 0 1 0 1 0 0 0 0 0 0 0 0 0 1
Ropa Total 2 1 2 1 0 0 0 0 0 0 0 0 2 1
Rukum Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salyan Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Surkhet Total 2 6 2 5 0 0 0 1 0 0 0 0 2 6
Mid Western Region Total 25 31 27 32 0 0 0 2 0 0 0 0 27 34
Bara Total 2 7 2 7 0 0 0 0 0 0 0 0 2 7
8 7 6 5 4 3 2 1

Bhaktapur Total 1 8 1 7 0 0 0 0 0 0 0 1 1 8
Chitw an Total 1 2 1 1 0 0 0 0 0 1 0 0 1 2
Dhading Total 0 1 0 0 0 0 0 0 0 0 0 0 0 0
Dhanusha Total 2 9 2 7 0 0 0 1 0 0 0 1 2 9
Dolkha Total 1 0 1 0 0 0 0 0 0 0 0 0 1 0
Kathmandu Total 20 16 19 14 0 0 0 1 1 0 0 1 20 16
Kavre Total 2 1 2 1 0 0 0 0 0 0 0 0 2 1
Lalitpur Total 1 6 1 5 0 0 0 0 0 1 0 0 1 6
12 11 10

Mahottari Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Makw anpur Total 0 4 0 4 0 0 0 0 0 0 0 0 0 4
Nuw akot Total 0 3 0 3 0 0 0 0 0 0 0 0 0 3
Parsa Total 4 4 4 4 0 0 0 0 0 0 0 0 4 4
14

Ramechhap Total 0 1 0 0 0 0 0 0 0 0 0 0 0 0
Rasuw a Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 16

Rautahat Total 1 0 1 0 0 0 0 0 0 0 0 0 1 0
Sarlahi Total 8 17 8 16 0 1 0 0 0 0 0 0 8 17
Sindhuli Total 1 1 1 1 0 0 0 0 0 0 0 0 1 1
19

Sindupalchok Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Central Region Total 44 80 43 70 0 1 0 2 1 2 0 3 44 78
Arghakhanchi Total 0 4 0 4 0 0 0 0 0 0 0 0 0 4
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Baglung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gorkha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gulmi Total 2 4 2 4 0 0 0 0 0 0 0 0 2 4
Kapil Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kaski Total 2 3 2 3 0 0 0 0 0 0 0 0 2 3
Lamjung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Manang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mustang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Myagdi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Naw al Total 1 4 1 4 0 0 0 0 0 0 0 0 1 4
Palpa Total 0 3 0 3 0 0 0 0 0 0 0 0 0 3
Parbat Total 0 1 0 1 0 0 0 0 0 0 0 0 0 1
Rupandehi Total 4 4 3 4 0 0 1 0 0 0 0 0 4 4
Syanja Total 2 3 2 3 0 0 0 0 0 0 0 0 2 3
Tanahun Total 3 3 2 1 0 0 1 2 0 0 0 0 3 3
Western Region Total 14 29 12 27 0 0 2 2 0 0 0 0 14 29
Achham Total 0 1 0 0 0 0 0 0 0 1 0 0 0 1
9 8 7 6 5 4 3 2 1

Baitadi Total 1 6 1 6 0 0 0 0 0 0 0 0 1 6
Bajhang Total 0 2 0 2 0 0 0 0 0 0 0 0 0 2
Bajura Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dadeldhura Total 0 3 0 3 0 0 0 0 0 0 0 0 0 3
Darchula Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Doti Total 0 5 0 5 0 0 0 0 0 0 0 0 0 5
Kanchanpur Total 1 8 1 8 0 0 0 0 0 0 0 0 1 8
Kailali Total 11 15 11 13 0 0 0 1 0 1 0 0 11 15
Far-Western Region Total 13 40 13 37 0 0 0 1 0 2 0 0 13 40
Bhojpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Illam 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jhapa Total 4 15 4 14 0 0 0 0 0 1 0 0 4 15
Khotang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Morang Total 2 7 2 6 0 0 0 0 0 0 0 1 2 7
Okhaldhunga Total 1 5 1 0 0 0 0 0 0 0 0 0 1 0
Patchthar 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sakhuw asabha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Saptari 1 0 1 0 0 0 0 0 0 0 0 0 1 0
Siraha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Solukhumbu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sunsari 0 2 0 2 0 0 0 0 0 0 0 0 0 2
Taplejung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Terhathum Total 4 7 4 7 0 0 0 0 0 0 0 0 4 7
Udaypur Total 1 0 1 0 0 0 0 0 0 0 0 0 1 0
Eastern Region Total 13 36 13 29 0 0 0 0 0 1 0 1 13 31
Grand Total 109 216 108 195 0 1 2 7 1 5 0 4 111 212

ANNUAL REPORT 2072/73 133

 Others EP (Bacteriologically Confirmed or Clinically Diagnosed)

Lost to Not
Districts

DOTS Centre Registered Completed Failure Died Total

Follow-up Evaluated

F M F M F M F M F M F M F M

Banke Total 5 11 5 10 0 0 0 0 0 0 1 0 6 10
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 8 9 8 7 0 0 0 0 0 0 0 0 8 7
Dailekh Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dang Total 5 5 7 8 0 0 0 0 0 1 0 0 7 9
Dolpa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Humla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jajarkot Total 0 1 0 1 0 0 0 0 0 0 0 0 0 1
Jumla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kalikot Total 0 0 1 3 0 0 0 0 0 0 0 0 1 3
Mugu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pyuthan Total 1 2 0 1 0 0 0 0 0 0 0 0 0 1
Ropa Total 3 2 3 2 0 0 0 0 0 0 0 0 3 2
Rukum Total 0 1 1 1 0 0 0 0 0 0 0 0 1 1
Salyan Total 0 2 0 1 0 0 0 0 0 0 0 0 0 1
Surkhet Total 6 8 5 7 0 0 0 0 0 0 0 1 5 8
Mid Western Region Total 28 41 30 41 0 0 0 0 0 1 1 1 31 43
Bara Total 1 3 1 3 0 0 0 0 0 0 0 0 1 3
8 7 6 5 4 3 2 1

Bhaktapur Total 7 6 7 5 0 0 0 1 0 0 0 0 7 6
Chitw an Total 3 3 2 3 0 0 0 0 0 0 1 0 3 3
Dhading Total 1 2 1 2 0 0 0 0 0 0 0 0 1 2
Dhanusha Total 3 8 3 6 0 0 0 0 0 3 0 0 3 9
Dolkha Total 1 0 1 0 0 0 0 0 0 0 0 0 1 0
Kathmandu Total 53 66 52 66 0 0 0 0 0 0 1 0 53 66
Kavre Total 5 2 4 2 0 0 0 0 1 0 0 0 5 2
Lalitpur Total 5 12 5 12 0 0 0 0 0 0 0 0 5 12
12 11 10

Mahottari Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Makw anpur Total 0 2 0 2 0 0 0 0 0 0 0 0 0 2
Nuw akot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Parsa Total 0 1 0 1 0 0 0 0 0 0 0 0 0 1
14

Ramechhap Total 0 1 0 1 0 0 0 0 0 0 0 0 0 1
Rasuw a Total 0 1 0 1 0 0 0 0 0 0 0 0 0 1
17 16

Rautahat Total 0 1 0 1 0 0 0 0 0 0 0 0 0 1
Sarlahi Total 2 4 2 4 0 0 0 0 0 0 0 0 2 4
Sindhuli Total 1 0 1 0 0 0 0 0 0 0 0 0 1 0
19

Sindupalchok Total 1 1 1 1 0 0 0 0 0 0 0 0 1 1
Central Region Total 83 113 80 110 0 0 0 1 1 3 2 0 83 114
Arghakhanchi Total 0 2 0 1 0 0 0 1 0 0 0 0 0 2
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Baglung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gorkha Total 1 2 1 2 0 0 0 0 0 0 0 0 1 2
Gulmi Total 0 1 0 1 0 0 0 0 0 0 0 0 0 1
Kapil Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kaski Total 7 6 5 6 0 0 0 0 0 0 2 0 7 6
Lamjung Total 0 2 0 2 0 0 0 0 0 0 0 0 0 2
Manang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mustang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Myagdi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Naw al Total 3 1 3 1 0 0 0 0 0 0 0 0 3 1
Palpa Total 3 4 3 4 0 0 0 0 0 0 0 0 3 4
Parbat Total 0 6 0 5 0 0 0 0 0 1 0 0 0 6
Rupandehi Total 3 8 3 8 0 0 0 0 0 0 0 0 3 8
Syanja Total 2 2 2 2 0 0 0 0 0 0 0 0 2 2
Tanahun Total 1 5 0 5 0 0 0 0 0 0 1 0 1 5
Western Region Total 20 39 17 37 0 0 0 1 0 1 3 0 20 39
Achham Total 3 1 2 1 0 0 0 0 1 0 0 0 3 1
9 8 7 6 5 4 3 2 1

Baitadi Total 3 1 3 1 0 0 0 0 0 0 0 0 3 1
Bajhang Total 0 4 0 2 0 0 0 1 0 1 0 0 0 4
Bajura Total 0 1 0 1 0 0 0 0 0 0 0 0 0 1
Dadeldhura Total 1 1 1 1 0 0 0 0 0 0 0 0 1 1
Darchula Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Doti Total 2 2 2 2 0 0 0 0 0 0 0 0 2 2
Kanchanpur Total 1 2 1 2 0 0 0 0 0 0 0 0 1 2
Kailali Total 5 4 5 4 0 0 0 0 0 0 0 0 5 4
Far-Western Region Total 15 16 14 14 0 0 0 1 1 1 0 0 15 16
Bhojpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 0 1 0 1 0 0 0 0 0 0 0 0 0 1
Illam 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jhapa Total 2 4 2 4 0 0 0 0 0 0 0 0 2 4
Khotang Total 0 1 0 1 0 0 0 0 0 0 0 0 0 1
Morang Total 4 10 4 10 0 0 0 0 0 0 0 0 4 10
Okhaldhunga Total 1 0 2 1 0 0 0 1 0 0 2 3 4 5
Patchthar 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sakhuw asabha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Saptari 0 1 0 1 0 0 0 0 0 0 0 0 0 1
Siraha Total 0 2 0 2 0 0 0 0 0 0 0 0 0 2
Solukhumbu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sunsari 4 15 2 15 0 0 0 0 0 0 3 0 5 15
Taplejung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Terhathum Total 2 1 2 1 0 0 0 0 0 0 0 0 2 1
Udaypur Total 5 0 5 0 0 0 0 0 0 0 0 0 5 0
Eastern Region Total 18 35 17 36 0 0 0 1 0 0 5 3 22 40
Grand Total 164 244 158 238 0 0 0 4 2 6 11 4 171 252

ANNUAL REPORT 2072/73 134

 HIV +ve, All Types

Lost to Not
Districts

DOTS Centre Registered Completed Failure Died Total

Follow-up Evaluated

F M F M F M F M F M F M F M

Banke Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Bardiya Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dailekh Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dolpa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Humla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jajarkot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumla Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kalikot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mugu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pyuthan Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ropa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rukum Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salyan Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Surkhet Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mid Western Region Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bara Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 7 6 5 4 3 2 1

Bhaktapur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Chitw an Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dhading Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dhanusha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dolkha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kathmandu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kavre Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lalitpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 11 10

Mahottari Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Makw anpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nuw akot Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Parsa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14

Ramechhap Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rasuw a Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 16

Rautahat Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sarlahi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sindhuli Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19

Sindupalchok Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Central Region Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Arghakhanchi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Baglung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gorkha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gulmi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kapil Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kaski Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lamjung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Manang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mustang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Myagdi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Naw al Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Palpa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Parbat Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rupandehi Total 1 0 1 0 0 0 0 0 0 0 0 0 1 0
Syanja Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Tanahun Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Western Region Total 1 0 1 0 0 0 0 0 0 0 0 0 1 0
Achham Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 8 7 6 5 4 3 2 1

Baitadi Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bajhang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bajura Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dadeldhura Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Darchula Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Doti Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kanchanpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kailali Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Far-Western Region Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bhojpur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Dhankuta Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Illam 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jhapa Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Khotang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Morang Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Okhaldhunga Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Patchthar 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sakhuw asabha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Saptari 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Siraha Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Solukhumbu Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sunsari 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Taplejung Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Terhathum Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Udaypur Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Eastern Region Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Grand Total 1 0 1 0 0 0 0 0 0 0 0 0 1 0

ANNUAL REPORT 2072/73 135

ANNUAL REPORT 2072/73 136