Tuberculosis case-finding in Eastern Nepal

Two methods of case-finding used in Eastern Nepal have been compared. The differences in terms of outcome and patient compliance in one district have been examined in detail and compared with results in 4 other neighbouring districts. The 2 methods compared were active case-finding (ACF) carried out by mobile teams and self referral (SR) of patients to the existing services. The results can be summarised thus: 1 In a district with established tuberculosis services an active case-finding campaign revealed patients that had not presented for treatment of their own accord. 2 These patients tended to be older than self-referred patients and there was a higher proportion of women. 3 ACF patients defaulted from treatment more than SR patients and older women were more likely to default than older men. 4 Proximity to a health facility or treatment at a health post (HP) did not decrease the proportion defaulting in the ACF group but both these factors positively influenced the default rate in SR patients. 5 Over 90% of ACF patients had their first period of default within 6 months of starting treatment and if they returned they were more likely than SR patients to default again. 6 The number of ACF patients completing 1 year's treatment with sputum conversion was significantly lower than SR patients in this and 3 other districts. 7 In a district where no separate tuberculosis services existed the cure rate among ACF patients was significantly lower than in 4 districts where separate services had been established.