Online Program

Urban poor tuberculosis patients in directly observed therapy in kathmandu, Nepal

Wednesday, November 6, 2013

Roshani Dahal, MPH, Brown University, Providence, RI
Xeno Acharya, MPH, Epidemiology, Infectious Disease, Harvard School of Public Health, Boston, MA
Vivek Dhungana, MBBS, Department of Emergency Medicine, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
Objective: Given the public health importance of tuberculosis (TB), this study aimed to characterize the urban poor TB patients and assess the impact of Directly Observed Treatment Short course (DOTS) on employment in Kathmandu, Nepal. Methods: We used Probability Proportional to Size sampling to randomly select eleven DOTS centers in Kathmandu, Bhaktapur, and Lalitpur districts during 2012, and extracted data using on-site health records. A 29-question, 10-minute, structured survey was verbally administered to assess sociodemographic data, employment, and estimated cost and time for diagnosis among 217 DOTS-registered patients between 19 and 65 years of age, with pulmonary or extrapulmonary TB diagnosis who were actively taking anti-TB medicine. Results: Urban poor (58%) differed statistically significantly from urban non-poor (42%) on illiteracy, unemployment, rental housing, overcrowding, and private access to water and sanitation. Urban poor patients mainly used personal savings (51%, p<0.01) and money credit (46%, p<0.05) to pay for TB diagnosis. Among urban poor pulmonary TB cases, median time to diagnosis was 30 days (p<0.05) and the median cost was $40.63 per patient (p<0.05), respectively. After starting DOTS regiment, 44.4% of urban poor manual laborers became unemployed compared to 36.1% in the urban non-poor population (p<0.001). Implications: Unemployment increase during TB treatment exacerbate patients' already fragile economic condition. Further study should explore the relationship between the economic burden due to TB treatment and its impact on quality of life for TB patients among the growing urban poor population.

Learning Areas:

Program planning
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
Compare the characteristics of urban poor versus urban non-poor tuberculosis patients currently undergoing DOTS therapy Assess social and economic challenges these patients face during treatment Identify gaps in tuberculosis control policies directed at growing urban poor populations

Keyword(s): Tuberculosis, Underserved Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am trained in qualitative and quantitative research in public health, have a strong foundation in basic sciences research. I was born in Nepal and I understand the language and cultural context. This research was part of my MPH thesis, so I am very familiar with the background literature on international tuberculosis control and management.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.