165 Changing tuberculosis trends in Nepal in the period 2001-2008 L Shrestha, 1 KK Jha 2 and P Malla 3 1 Community Medicine, Technical Advisor, HIV/AIDS, Save the Children, Nepal, 2 Director, SAARC TB and HIV/AIDS Centre, Bhaktapur, Nepal, 3 Director, National Tuberculosis Center, Bhaktapur, Nepal Corresponding author: Dr. Lochana Shrestha, Technical Advisor, HIV/AIDS, Save the Children, Nepal GPO Box 9517, Kathmandu, Nepal ; e-mail: shresthalochana@yahoo.com ABSTRACT To assess the trends on indicators of TB control in Nepal over a period from 2001-2008. Retrospective analysis of information from Annual Reports of NTP, Nepal from 2001-2008. The incidence of New Smear Positive (NSP) TB declined from 58.9 in 2001 to 53.4 in 2006 per 100000 populations then reversed in the period 2006- 2008. This TB incidence decreased in males and the age group <45 years (except 0-14 years). The notification rate of all cases of TB declined by 3 % overall over the entire period from 2001 to 2008. Mortality among smear negative and extra pulmonary declined significantly. The failure rate and defaulter rate were declined significantly and the case detection rate (CDR) was increased significantly within the study period. Increasing trend in CDR, Treatment success rate and decreasing trend in failure rate, defaulter rate are the evidence of progress of NTP, in Nepal. Since there is reversal of incidence of NSP from 2006, a detailed analysis of existing TB control measures is required. If the success is continued and quality care is provided as per International Standard of TB Care, the Millennium Development Goals will be an achievable target. Keywords: Tuberculosis, trend, indicators of TB. INTRODUCTION Nepal is situated between India and China. It has an estimated population of above 26 million. 1 Tuberculosis (TB) is still a potential threat to public health, and it requires close epidemiological surveillance at national and international levels to ensure efficient control of the disease. It still remains one of the major public health problems in Nepal. Health services for TB are provided by Government of Nepal’s Basic Health Services, Private sectors and international or national non governmental organizations. While TB is a serious problem in low and middle income group in this country, 2 Nepal is working for the control of the disease by launching National TB Control Programme in 1965 and adopted DOTS strategy in 1996. By the year 2001 DOTS based TB control services were provided in all the 75 districts of the country. Government of Nepal is committed to fight against TB and it has given the status of priority for this programme. There is commitment from different donors to support New Stop TB strategy, which has been adopted by the programme in 2006 in order to provide more comprehensive TB control measures. The Programme has achieved both the global target of tuberculosis as 70.0% case detection and treatment success rate of 88.0%. 3 Multi Drug Resistant TB management programme has been launched subsequently in 2005, which is considered a global model for ambulatory treatment. However, there are several critical challenges and issues which need to be addressed to move towards the achievement of Millennium Development Goals (MDG) goals. Among the SAARC Member States (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka), Nepal is not ranked as High Burden Country by WHO. 4 However, according to TB control programme of Nepal, about 50.0% population is infected with TB, of which 60.0% are adult. Every year, 21,827 smear positive infectious TB incidence cases are expected to rise in the country. Although introduction of DOTS has already reduced the numbers of deaths, however 5,000 to 7,000 people still continue to die each year. 3 Now that tuberculosis control programmes are being urged to assess progress towards the MDG, 5 our aim is to provide some insight information in this regard by assessing the trends of TB indicators in Nepal from 2001 to 2008 which might help to identify the factors that need to address to meet MDG within specific timeframe. MATERIALS AND METHOD National Tuberculosis Centre (NTC) is the single unit situated in Bhaktapur district, which is dealing exclusively with TB Control Programme of Nepal. Annual reports of TB Control Programme have been published since its inception. A retrospective analysis was conducted on routine programme data in annual reports of the programme from 2000/2001 to 2007/08. Original Article Nepal Med Coll J 2010; 12(3): 165-170