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Tuberculosis case finding in remote mountainous areas--are microscopy camps of any value? Experience from Nepal.

Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease

Adult, Community-Institutional Relations, Costs and Cost Analysis, Female, Follow-Up Studies, Humans, Male, Mass Screening, economics, Middle Aged, Nepal, Rural Health Services, Sex Factors, Sputum, microbiology, Treatment Outcome, prevention & control, Tuberculosis, Pulmonary, drug therapy

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      Abstract

      In the remote hills of North-East Nepal tuberculosis case-finding is believed to be low. The Britain-Nepal Medical Trust (BNMT), a well funded non-governmental organisation supporting Tuberculosis Control Programmes in this area, has a stable structure and sufficiently high case-holding to explore ways to increase case-finding. To increase case-finding without decreasing case-holding, by expanding outreach services into remote areas away from existing health services. Between 1990 and 1993, 45 temporary outreach tuberculosis diagnostic "microscopy camps' were run in the eight districts covered by the BNMT (population 1330000). Camp-diagnosed patients were followed up by cohort. The camps did not appreciably increase the low 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 treatment completion rate of this camp-diagnosed cohort was 76%. Cost analysis revealed a low overall additional cost to the programme; however, it would be prohibitively expensive for an under-funded government health service. The implications of these camps go beyond tuberculosis control in their ability to reach those who would otherwise not utilise health care facilities.

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