I. Harper et al., TUBERCULOSIS CASE-FINDING IN REMOTE MOUNTAINOUS AREAS - ARE MICROSCOPY CAMPS OF ANY VALUE - EXPERIENCE FROM NEPAL, Tubercle and lung disease, 77(4), 1996, pp. 384-388
Setting: In the remote hills of North-East Nepal tuberculosis case-fin
ding is believed to be low. The Britain-Nepal Medical Trust (BNMT), a
well funded non-governmental organisation supporting Tuberculosis Cont
rol Programmes in this area, has a stable structure and sufficiently h
igh case-holding to explore ways to increase case-finding. Objectives:
To increase case-finding without decreasing case-holding, by expandin
g outreach services into remote areas away from existing health servic
es. Design: Between 1990 and 1993, 45 temporary outreach tuberculosis
diagnostic 'microscopy camps' were run in the eight districts covered
by the BNMT (population 1330 000). Camp-diagnosed patients were follow
ed up by cohort. Results: The camps did not appreciably increase the l
ow rate of case-finding. However, the percentage of women who attended
the camps was significantly higher than at existing services, as was
the number diagnosed with smear-positive tuberculosis. The cured treat
ment completion rate of this camp-diagnosed cohort was 76%. Cost analy
sis revealed a low overall additional cost to the programme; however,
it would be prohibitively expensive for an under-funded government hea
lth service. Conclusions: The implications of these camps go beyond tu
berculosis control in their ability to reach those who would otherwise
not utilise health care facilities.