Reporter 452, 22 May 2000

Nuffield helping to bring medicine to the mountains

Research at Leeds is helping a Himalayan kingdom get to grips with its biggest public health problem - and may provide life-saving guidelines for health services in dozens of other developing countries.

Almost half of the 20 million people of Nepal are passively infected with tuberculosis, and some 440,000 people develop the disease each year. Because a large swathe of the population lives in remote hilly areas, hours or days away from the nearest health centre, it has been all but impossible to ensure that patients complete the six or eight months of essential daily antibiotic treatment.

Dr James Newell, of the Nuffield Institute’s international division, has been working with the kingdom’s National TB Programme to devise more effective strategies to tackle the problem. TB is the greatest single cause of adult mortality in Nepal, currently claiming about 10,000 lives each year.

"Ours is very much a joint effort with Nepalese authorities and non-governmental organisations. Conditions are difficult there but we are working with some excellent people," said Dr Newell.

Funded by the Department for International Development, the five-year programme has sought ways of improving delivery of the World Health Organization’s ‘directly observed therapy’ approach in the country’s most inaccessible regions. The Nuffield is working jointly with the London School of Hygiene and Tropical Medicine.

The strategy involves raising public awareness, especially among the vulnerable poor; promoting diagnosis through sputum microscopy, which is both cheaper and more sensitive than X-rays; and ensuring that treatments are delivered and monitored, even in difficult conditions like the present rainy season.

A trial has been set up in ten districts to see whether family members or community workers can stand in for medical professionals to ensure that patients complete the treatment. Another initiative is building co-operation between the public health service and private practitioners, where many patients seek treatment.

"Unlike some diseases in which environmental factors play a major part, the only way TB can be tackled is by curing individual patients," said Dr Newell.

"Unless patients finish the full course of treatment, the danger arises of drug-resistant strains developing for which there are no available and affordable drugs. It is essential that we involve all potential partners to combat this killer disease."

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