Kathmandu: Stakeholders emphasized the need for government-led mass screening initiatives at the community level to control tuberculosis in Nepal.
During a program titled ‘End TB, End Tobacco’ held in Kathmandu, they highlighted the effectiveness of such measures in other countries and urged the government to take proactive steps in this regard.
Professor Guy Marks, President of the International Union Against Tuberculosis and Lung Disease (The Union), emphasized the necessity of widespread tuberculosis testing in global efforts to control tobacco and tuberculosis. Citing examples from countries like Australia, he highlighted the effectiveness of mass screening for tuberculosis control. “Symptoms alone are not enough; everyone needs to be tested. It is important to conduct such tests at a rate of 50 per 100,000 population to ensure comprehensive screening,” he said. Countries have followed recommendations from the World Health Organization and focused on the use of kits and various pathological and radiological examinations.
Australia’s campaign against TB initiated around the mid-1900s serves as a notable example in this regard. The campaign provided citizens with free testing, treatment, and allowances. Despite successful tuberculosis control efforts in countries like the United States, Europe, Japan, and Australia, tuberculosis remains a significant challenge for countries with lower incomes like Nepal. Prof. Marks added, “Countries that have made efforts with political commitment have seen success in controlling TB.”
Responding to questions, Prof. Marks emphasized the need for collaborative efforts with the government to create an environment conducive to effective steps toward tuberculosis control.
Dr. Bikash Devkota, Additional Secretary at the Ministry of Health and Population, highlighted the significant role of reducing risky substance consumption in alleviating the burden of tuberculosis. “We [the government] are currently engaged in tuberculosis programs. We are aware of the necessity for this. However, when we move on to another program, we tend to forget about this one. Therefore, by remaining continuously active and focusing on result-oriented work, we can reduce the consumption of risky substances and effectively control tuberculosis.”
Currently, 35 percent of the health budget is allocated for the treatment of diseases. Dr. Devkota said that the local governments, which have direct relations with the general public across all three levels of government, have also been involved in treatment programs, indicating a need for increased awareness and activity in awareness programs. “There is a need for community-level screening for tuberculosis control by municipalities. It is essential to implement family-centered programs to reduce substance abuse. It is also necessary to create targeted plans for students.”
Dr. Tara Singh Bam, Director of Vital Strategies/The Union, shed light on the societal challenge of diagnosing tuberculosis cases only after more than 100 days since symptoms appear. Echoing other experts, he also highlighted the necessity for community-based rather than symptom-based screening.
“Individuals who consume tobacco tend to delay visiting healthcare facilities, further complicating the diagnosis of tuberculosis. When individuals who consume tobacco develop symptoms of tuberculosis, they tend to doubt it’s because of smoking, which delays their visit to health centers. They don’t even go to health centers. They believe others are affected, not themselves,” he explained.
The ABC approach implemented in Bangladesh has shown effectiveness in tuberculosis control, with up to 82 percent impact observed. Additionally, India has achieved a 76 percent effectiveness rate, while China has seen effectiveness ranging from 66 percent to 70 percent. Alongside the effective implementation of tuberculosis control laws, there is a significant role of civil societies and media, said Bam.
Dr. Prajwal Shrestha, Director of the National Tuberculosis Center, said that there has been an increase in cases, reaching up to 69,000 annually. According to government data, there were 37,777 cases last year, and 37,450 cases have been reached this year.
Joint Secretary Gopikrishna Regmi of the Ministry of Health and Population said that the government has been drafting separate laws for the control of tobacco and tuberculosis. “The ministry itself has taken the initiative for the implementation.”
According to Dr. Bhakt KC from the National Health Education, Information, and Communication Center, efforts are being made to control tobacco use as per the ‘MPOWER’ initiative. “Tobacco production companies are filing lawsuits in court, opposing some of the latest programs implemented by local governments, and the commercialization of new tobacco products poses challenges.”
Anand Bahadur Chand, the President of Action Nepal, expressed concern over the increasing number of tuberculosis cases. “Tuberculosis cases have doubled in the last 6-7 years. Many cases are still missing. There has been ongoing work in tobacco control for many years. Laws have been drafted, but implementation is crucial.”