KATHMANDU, 25 March 2008 (IRIN) - Ram Hari Chaudhary is worried his poverty-stricken family will suffer after he was recently diagnosed with tuberculosis (TB). It could take him months to get back to work to support his wife and three children.

"I am very worried about my family as they totally depend on me," said Chaudhary, who came to Kathmandu in 2006 from Bardiya District in southwestern Nepal, in a bid to escape poverty in his village.

About 90,000 people in Nepal reportedly have one form of TB or another, and the number is increasing by about 40,000 every year, according to the government's National Tuberculosis Centre (NTC).

TB kills 5,000-7,000 people every year, with most fatalities among those with drug-resistant TB, which can develop when patients fail to adhere to their treatment regimen, according to the NTC.

Local doctors told Chaudhary he would be cured in two months if he took daily medication under the Directly Observed Treatment Short-Course (DOTS) programme, through which patients have to take medicines every day in front of trained health workers. The medication is not effective unless doses are taken daily.

Thanks to the national DOTS programme implemented by the NTC, the anti-TB drive has been successful, according to the World Health Organization (WHO) in Nepal office.

According to NTC, the success of the anti-TB drive can be seen in the reduction in annual TB-related deaths from 10,000 to less than 7,000 in the last decade, and in the increased detection and treatment success rates.

"The treatment success rate has increased to a great extent, and has been helping to save a lot of lives," said Puspa Malla, director of NTC. She said there was a case detection rate of 70 percent and a treatment success rate of 88 percent.

Introduced in Nepal in 1996, DOTS has expanded from a few hundred to 4,000 centres, including public health institutions and rural clinics. Nearly 60 percent of health institutions have been providing DOTS treatment and the service is expanding to the rest of the country, said government officials.

International aid

Health officials said international aid for TB programmes had improved the situation considerably. Over 14 key agencies from Germany, UK, Japan, the Netherlands, Norway and France have been actively supporting the national TB programme.

Experts have found the best way to improve the efficacy of DOTS is by raising awareness and educating patients. Nepal's success in that regard has attracted a large number of aid agencies especially after the government categorised the TB programme as a high priority.

According to the NTC, Nepal's efforts in terms of TB control are regarded as a model for other developing countries. Treatment success rates have more than doubled from 40 percent in 1994 to over 88 percent now.

The programme was also not affected by the decade-long armed conflict, which ended in November 2006. Despite frequent strikes, shutdowns and road blockades, sufficient stocks of the drug were available in all centres so patients had enough medicines.

"Patients continue to show up for treatment despite hardships," said Ramesh Shrestha, a local health worker who said displaced families were continuing to receive DOTS treatment as it was available in most of health centres and the drugs were free.

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