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National Tuberculosis Programme
Nepal
Post-Disaster Rapid Assessment of the National Tuberculosis Program:
Preliminary Report
26th May, 2015
Government of Nepal
Ministry of Health & Population
Department of Health Services
National Tuberculosis Centre
Thimi, Bhaktapur
Post-Disaster Rapid Assessment of the National Tuberculosis Program: Preliminary Report
26th May, 2015
1. Introduction
Nepal was hit by a massive earthquake on 25 April (11:56 local time) of a magnitude of 7.9 on
the Richter Scale, the epicenter in Barpak VDC in Gorkha district, 80 km northwest of
Kathmandu. Continued aftershocks followed throughout Nepal with one reaching a magnitude
of 6.7 on the Richter Scale the following day. Two weeks later, on 12 May (12:50 local time), a
big aftershock measuring 7.4 Richter Scale struck, 176 km North East of Kathmandu in Dolakha
District, creating further damaged to both new and previously affected areas. The aftershocks
continue to be a daily occurrence and multiple in number. For a real-time updates and a
pictorial representation of the seismic activity in Nepal please refer to the below link:
https://www.google.com/fusiontables/DataSource?docid=1rs_s8_CD7xVbhplVm2fkw15H_R9H
NZIT9MTC8UPt#map:id=3
The last time Nepal experience devastation of this magnitude was in 1934 and despite the
country’s preparedness plan, this disaster has left a huge challenge for us to rebuild our
national heritage, our livelihoods and our healthcare system.
2. Impact of Disaster to the Nation
As reported in the World Health Organization (WHO) 3rd Health Cluster Bulletin, more than 5.6
million people have been affected by this disaster.1 On the 26th of May the Disaster Risk
Reduction Portal, MoHA reported at least 8,673 deaths and more than 21,952 injures as a result
of the 25th April earthquake and 12th May aftershock.2 This number is expected to continue to
rise over the coming weeks as further rubble is cleared.
Nearly 76,9907 house have been damaged and 4,231 Government facilities completely
destoryed. This earthquake has impacted the entire country however 14 districts were notably
the hardest hit; Sindhuplachok, Kathamndu, Nuwakot, Dhading, Rasuwa, Gorkha, Kavre,
Bhatapur, Lalitpur, Dolakha, Makwanpur, Ramechhap, Solukhumbu and Okhaldunga. Tweleve
of these districts are located in the central developmental region and almost all are either
mountainous or hilly districts- a challenge for accessibility.3
1http://www.who.int/hac/global_health_cluster/countries/HEALTH_CLUSTER_BULLETIN_num3_18May15.pdf?ua=1
2
http://drrportal.gov.np/
3
http://heoc.mohp.gov.np/health/
Post-Disaster Rapid Assessment of the National Tuberculosis Program: Preliminary Report
26th May, 2015
The International Organization for Migration (IOM) estimate 2.8 million individuals have been
displaced across the 39 affected districts with 75,000 Internally Displaced Persons (IDPs)
located within the Kathmandu Valley.4
Unofficial reporting indicates many IDPs have migrated from Sindhupalchok and Dolakha to
Kathmandu Valley. Unofficial data indicates there are 21,601 people living in temporary camps
in the Kathmandu Valley across 64 different sites. Outside of official communal camp sites there
are a large number of people living under tarpaulins, temporary structures and open sky.
Emergency shelter and health assistance are vital in preparation for the impending monsoon
season and have been highlighted as priority sectors for intervention. IOM are working in close
coordination with the Government of Nepal and humanitarian partners to ensure that
displaced populations have access to basic services. The earthquake has severely disrupted the
health system and, combined with the public health risks of displacement, puts IDPs at far
greater risk of morbidity and mortality, particularly communicable diseases inclusive of TB,
practically living in cramped conditions.5
Real-time updates and in depth details on the overall impact of the disaster is available from
the link below:
http://drrportal.gov.np/
3. Impact of Disaster to the Health System:
A rapid assessment of health-care facilities by WHO and the Ministry of Health and
Population in the earthquake-stricken areas has found that hospitals in 4 of the worstaffected districts are completely destroyed or too badly damaged to function. Five other
major hospitals, providing important health care in the districts, were found to be
functioning but urgently in need of further medical supplies. Preliminary findings from the
assessment, found that while there was a shortage of supplies, sufficient health personnel
were available to treat patients arriving in the functioning hospitals.6
Further assessments from HEOC indicate 1,023 health facilities have sustained full and or partial
damage, 7 of the districts hospital are running entirely from temporary hospital tents, with 10
tents spread throughout these 7 districts. To date 8 health workers have died, 63 have been
injured and 2 are still missing. 10 Female community health volunteers are been reported dead
4http://www.iom.int/sites/default/files/press_release/file/IOM-Nepal-Appeal-April-2015.pdf
5 ibid
6
http://who.int/mediacentre/news/releases/2015/health-assessment-nepal/en/
Post-Disaster Rapid Assessment of the National Tuberculosis Program: Preliminary Report
26th May, 2015
which has great significance in rural areas as these individuals are the ones closest to the
community and normally the first point of contact for health related issues. 7
The key challenges following the earthquake is outbreak surveillance and control of
communicable diseases inclusive of Tuberculosis, the continuation of treatment for chronic
conditions, re-establishment and continuation the general health services that have been
destroyed or discontinued in addition to specific services such as maternal and child health and
mental health amongst others.
Latest situation updates and further details of overall impact of disaster to the Nepali health
system is available in the link below:
http://heoc.mohp.gov.np/health/
4. Impact of Disaster to the Tuberculosis Control Program:
Rationale for rapid assessment and formation of rapid response committee
The challenges Nepal’s recent earthquakes pose for the National Tuberculosis Program are
significant. In Nepal, TB remains an ongoing public health burden, with health officials keen to
ensure that advances in recent years are not threatened.
Historically when there is a disaster of high scale, focus is immediately directed towards the
rescue and relief efforts and care and control of communicable diseases such as TB are rarely
addressed during the acute phase. Literature arising from lesson learn post Haiti and Japan
earthquakes indicate the benefit of starting surveillance for TB in the acute phase in TB
endemic countries, as there is a high risk of TB silently spreading.8 This is of particular concern
among IDPs where the risk of transmission is higher.9
With this in mind, the Nepal’s National Tuberculosis Centre formed a Rapid Response
Committee on the 20th May 2015 that has set about conducting a Post-Disaster Rapid
Assessment of the National Tuberculosis Program for effective management of TB cases and
continuation of its services to maintain the achievements of TB program till date.
7
http://heoc.mohp.gov.np/health/
8
http://www.ncbi.nlm.nih.gov/pubmed/23174381#
http://www.researchgate.net/publication/260716753_Tuberculosis_Control_in_Acute_Disaster_Settings_Case_Studies_from_t
he_2010_Haiti_Earthquake
9
http://www.ncbi.nlm.nih.gov/pubmed/24581013
Post-Disaster Rapid Assessment of the National Tuberculosis Program: Preliminary Report
26th May, 2015
The committee has conducted a rapid assessment of the structural damage to and functionality
of DOTS and microscopy centers following the earthquake. Refer to Annex A for the district
breakdown of the rapid assessment, please find a summary of the impact below, data updated
as of 3pm on the 26th May:
Structural impact on and functionality of DOTS centers in the 14 most affected districts:
Number of DOTS Centers: 779
Number of DOTS centers fully damaged: 281
Number of DOTS centers partially damaged: 256
Data missing from Lalitpur and Solukhumbu
Number of DOTS centers non-functioning: 6
Data missing from Ramechhap, Lalitpur, Kavre and Dhading
Number of DOTS centers functioning out of temporary tents: 353
Data missing from Ghorka and Kavre
Number of DOTS centres where Drugs completely damaged/unrecoverable: 46
Data missing from Dhading, Rasuwa, Gorkha and Lalitpur
Number of DOTS centre where immediate supply of anti-TB medicine was required: 5
Data missing from Gorkha
Structural impact on and functionality of microcopy centers in the 14 most affected districts:
Number of microcopy centers: 130
Number of microscopy centers non-functioning: 27
Data missing from Solukumbu
Please note 10 microcopy centers were not function prior to the earthquake due to human resource shortages.
Number of microscopy centre where immediate supply of chemicals was required: 3
Data missing from Solukumbu
5. Impact of Disaster on TB patients:
With logistical support from WHO the NTC rapid response committee have started tracing TB patients in
the 14 most affected districts, with a priority to reach those with Drug Resistant TB (DR TB). For a district
Post-Disaster Rapid Assessment of the National Tuberculosis Program: Preliminary Report
26th May, 2015
break down of information refer to Annex A and for a detailed DR TB patient tracing and assessment
refer to Annex B.
Impact on continuation of Anti-TB Treatment (ATT):
Number of TB patients enrolled in ATT on 24th April: 698
Data missing from Kathmandu, Gorkha, Kavre, Bhaktapur, Lalipur, Dolakha, Makawanpur and Solukhumbu
Number of TB patients continuing ATT after 25th April: 517
Data missing from Sindhupalchowk, Kathmandu, Gorkha, Kavre, Bhaktapur, Lalipur, Dolakha, Makawanpur and Solukhumbu
Number of TB patients deceased: 6
Data missing from Solukumbu and Kathmandu
Number of TB patients injured: 14
Note: most injuries are minor and all injured TB patients are continuing with ATT
Data missing from Solukumbu, Kahtmandu and Sindhupalchowk
Number of TB patients who have discontinued ATT: 1
Data missing from Sindhupalchowk, Gorkha, Bhaktapur, Lalipur, Dolakha, Makawanpur and Solukhumbu
Number of TB patients who status is unknown: 188
Data missing from Sindhupalchowk, Bhaktapur, Lalipur, Makawanpur and Solukhumbu
Impact on TB patients living conditions:
Number of TB patients who houses are completely damaged: 220
Data missing from Sindhupalchowk, Nuwakot , Dhading, Rasuwa, Gorkha, Kavre, Lalipur, Dolakha, and Solukhumbu
Number of TB patients who are living under temporary shelter (tents): 226
Data missing from Sindhupalchowk, Nuwakot , Dhading, Rasuwa, Gorkha, Kavre, Lalipur, Dolakha, and Solukhumbu
Drug-Resistant TB (DR TB) patients:
Number of DR TB patients enrolled in ATT on 24th April: 151
Number of DR TB patients continuing ATT after 25th April: 134
Number of DR TB patients deceased: 0
Number of DR TB patients injured: 0
Number of DR TB patients who have discontinued ATT: 0
Post-Disaster Rapid Assessment of the National Tuberculosis Program: Preliminary Report
26th May, 2015
Number of DR TB patients who status is unknown: 16
Number of DR TB patients on clinic-based DOTS: 102
Number of DR TB patients on community-based DOTS: 1
Number of DR TB patients taking ATT by other means: 31
Other means collecting ATT supply of one week or more to be taken at home
Number of DR TB patients living in home: 45
Number of DR TB patients living in hostel/hospital: 14
Number of DR TB patients who are living in community temporary shelters: 22
Number of DR TB patients who are living in temporary shelters with family or alone: 26
6. Qualitative analysis of interview with TB heath care workers and TB
patients in Bhaktapur District:
On 21 May, NTC and WHO staff met with District TB and Leprosy Officers in Bhaktapur to
explore issues surrounding post-earthquake TB care and control in the district. The team also
met with TB patients living in temporary camps in order to identify patients’ immediate needs
and ensure their continued care and access to treatment.
All interview were recorded and consent obtained through verbal translation of informed
consent form, which was signed by all participants.
Interview with TB health care worker:
A guided question interview (refer to annex B) was conducted with one TB health care worker,
the District Tuberculosis and Leprosy Officer for Bhaktapur. The 15-minute interview was
transcribed and key themes identified:
Concern of transmission among internally displaced person in temporary camps
“There are 109 Tuberculosis patients whose houses are completely damaged, they are living in
camps…I have concern about the spread of TB in shelters if patients stay 6-8 months in shelter it
can be really threatening, shelter for TB patients would be better”
Difficulty in tracing patients
“We are in charge of local residents and linked to Kavre and Sindhupalchowk districts, we know
of 6 [TB patients] missing in Bhaktapur and 3 in Sindhupalchowk we are trying to track missing
patients but mobilization of volunteers to visit their houses is difficult in this scenario”.
Post-Disaster Rapid Assessment of the National Tuberculosis Program: Preliminary Report
26th May, 2015
"We have planned to mobilize health facility management committee member to trace the
missing patients"
Need for psychosocial counseling
"All of the patients are depressed and scared from the earthquake, they need psychosocial
counseling to recover…Many of the TB health care providers are also depressed and they too
need counseling"
Interview with TB Patients:
A guided question interview (refer to Annex C) was conducted with 2 MDR-TB patients living in
temporary camps in Bhaktapur and 1 EPTB patient living a temporary structure alone. The 40minutes of interviews were transcribed and key themes identified:
Patients recognize the importance of continuing ATT after earthquake
All patient reported continuing with their ATT. One patient had a six-day supply of anti-TB
medicines from before the earthquake as he was attending the Deo Puja festival and did not
want to be without his drugs in case clinics were closed for the festival. After the earthquake he
continued taking his drugs in the temporary camp. He keeps them safe in a Bhujia (snack)
packet as “it is waterproof and it protects them from the rain and sun”
Other patients who did not have a supply of ATT pro-actively sough their medication:
“The hospital doctor and health worker told me I have to have daily medicine. So I send my wife
to go get after the earthquake”
One patient went to visit the house of a National Anti TB Association scout volunteer known to
him:
“I found her, she had been trapped inside her demolished house. Once she got out, she went
back inside the house to get me medicine for 5 days… it was important to both of us.”
Difficulty in adhering to daily DOTS
All patients commented on the difficulty in adhering to daily DOTS post-earthquake:
“My wife goes to get the drugs and I have one week of medication at a time – it’s difficult to go
for daily DOTS, but weekly is easy.”
“We belong to a farming group. We do not have much at this time. If they provide medicine
close by it will be easier. The 30 rupees I spend on travel could buy me two eggs to eat.”
Post-Disaster Rapid Assessment of the National Tuberculosis Program: Preliminary Report
26th May, 2015
Increased stigma in temporary camps
Patients have expressed experiencing high rates of stigma, especially when trying to secure
temporary accommodation in communal temporary camps:
“The home we were renting collapsed in the earthquake so we tried to go to a shelter. My wife
told them about my TB – that it was the non-contagious kind – but I face much discrimination in
the shelter. I think people fear transmission. The people in the shelter shouted to get away and
my wife and my two daughters cried a lot. We now stay separately from each other. My wife
can only visit one or two times a week.”
Conclusions from analysis
NTC have identified the following key areas of action from the qualitative interview analysis;
addressing living conditions of TB patients in temporary camps; increasing patient access to
infection control measures and DOTS- through patient centered approaches; minimizing stigma
and providing psychosocial support.
26th May, 2015
Post-Disaster Rapid Assessment of the National Tuberculosis Program: Preliminary Report
Annex A: Post-Disaster Rapid Assessment of National TB Program by District
Name of district
Structural assessment of DOTS centres
Functionally assessment of MCs
Situation of TB Drugs at DOTS centres
Treatment status of TB
patients
Living conditions of TB patients
Total
No
Fully
damaged
Partially
damaged
Not
damaged
Nonfunctioning
functioning
temporarily
in tents
Status
unknown
Remarks
Total
No.
NonFunctioning
Urgent
need of
chemical
Remarks
No. of centre
where Drugs
completely
damaged/
unrecoverable
No. of
centre
where
immediate
needing
supply of TB
medicine
Remarks
Total No
of TB
patients
enrolled
in tx
before
eq
Total No. of
TB patients
still
continuing
tx after eq
Dead
Disabled
/ Injured
Discontinued
tx
Status
unknown
Remarks
House
complety
damaged
Living
under
temporary
shelter
(tents)
Sindhupalchowk
79
65
1
3
1
75
0
Tatopani HP
nonfunctioning as
totally
damaged and
unable to
access due to
lanslide
4
1
No
Non
functioning
MC's since
before eq
Jalbire
because of
lack of HR
44
5
Recent
supply sent
from NTC
180
?
1
?
?
179
Death in Talamarang HP
unable to trace patients
as 40% of DOTS centres
are uncontactable and
staff are focused on eq
related trauma, when
approached on TB
related issues
unresponsive as low
priority area and do not
have means of sending
the information eg. fax,
telephone, pen & paper
?
?
Kathmandu
115
8
47
0
0
17 totally
fucntioning , 2
treatment
centers inside
the KTM
municipality
can't be
reached cause
of bloackage of
road.
35
6
25 litre
Urgent need
to send
checmicals
Non
functioning
MC's since
before eq
0
0
?
?
?
?
0
3
1 patients went to
sindhupalchok before
the quake, but didn't
come till date for F/u
and coudlnt' be tracedPolice Hospital
2 others lost from KMC
hospital
2
5
Nuwakot
66
41
23
0
2
0
Partially
damaged
centres still
providing
services
4
4
No
2
0
107
107
0
2
?
0
Minor injuries only
?
?
Dhading
54
33
17
?
8
4
9
8
No
Naubishe MC
is demolised,
Salyantar and
GajuriMicroscope
needed
?
0
304
303
1
0
0
0
Deceased: Furendra
Adhikari, 53,Male,
Budhathum- 3
?
?
Rasuwa
19
17
2
0
0
0
2
2
10 Litres
Urgent need
to send
checmicals
?
0
22
22
0
0
0
0
22
22
Gorkha
71
41
32
4
?
0
6
2
?
Arughat PHC
Mathi kohla
HP- need
microscope
?
?
?
?
1
2
0
0
64
63
Kavrepalanchowk
100
35
60
?
?
?
14
0
No
Panchkhal
MC,
Destroyed.
Working in
Tent.
(Pradeep
Aryal)
0
0
?
?
0
0
1
?
?
?
Bhaktapur
34
3
4
0
34
0
9
9
No
0
0
?
?
3
7
?
6
109
109
Lalitpur
55
2
?
?
55
?
18
3
No
Non
functioning
MC's since
before eq
0
0
?
?
0
0
?
0
?
?
Dolakha
56
1
9
1
54
0
6
5
10 Litres
Urgent need
to send
checmicals
?
0
45
45
0
1
0
0
Injured:Saila Shrestha,
Bhote naglang
?
?
Makawanpur
43
10
33
0
43
0
6
0
No
0
0
?
?
0
2
?
?
Injured pts continuing
DOTS
0
4
Ramechhap
56
25
28
53
0
6
6
No
0
0
40
40
0
0
0
0
23
23
Solukhumbu
17
?
?
0
17
0
7
?
?
0
0
?
?
?
?
?
?
0
0
Okhaldhunga
14
?
?
0
12
0
4
?
?
0
0
?
?
?
?
?
?
?
?
67
3
Langtang HPCollapsed, but
has no TB
patients
Haku HP- army
take the
medicines from
DPHO and
distribute when
they go there,
but no TB
patients
Lamabagar HPNon
functioning
Chamari
HP- ATT and
Register
Tukche HPHRZE 450
Tab , HRE250 Tab.
Not needed
for now.
Only to
send
regular
ones
All 70 sites
Exact Status
N/A on
medicine,
20-30%
presumed
lost all
drugs
Minor Injuries only,
Injured pts contining
DOTS
Remark
3 Living in Tents
in school
Concerntrated
camps in near
Dachi Dots
Center
2 Houses
destroyed in
Naglebare, living
in Tents
among 71, 12 TC
can't be reached.
Among whome
reached, all TB
patients are
accountable.
Dead- Thakur
purasaini, 75 yrs,
Tamrang ward 1
2- Minor Injury
EPTB patient
experinced
discrimination,
living in
temporay made
shelter on their
own
26th May, 2015
Post-Disaster Rapid Assessment of the National Tuberculosis Program: Preliminary Report
Annex B: Post-Disaster DR TB Patient Tracing and Assessment
Treatment
1=Clinic, 2= Family, 3=
Community based, 4=Other
(please explain)
S.N
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
Death
Injured
Discontinued
Tx
Status
Unknown
Treatment centre
Continuing
Tx
1
1
1
1
1
Type of
DOTS pre
earthquake
1
1
1
1
1
Type of
DOTS post
earthquake
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Tx centre pre
earthquake
GENETUP
STUPA
STUPA
GENETUP
GENETUP
Tx centre post
earthquake
GENETUP
STUPA
STUPA
GENETUP
GENETUP
1
1
1
1
1
1
1
1
1
1
1
1
NATA Hostel
STUPA
NATA Hostel
GENETUP
GENETUP
STUPA
STUPA
NATA Hostel
GENETUP
GENETUP
Kharini PHC
GENETUP
NATA Hostel
STUPA
NATA Hostel
GENETUP
GENETUP
STUPA
STUPA
NATA Hostel
GENETUP
GENETUP
Kharini PHC
GENETUP
4
1
4
1
1
1
1
1
4
1
1
4
4
1
1
4
1
1
1
1
1
1
1
4
1
1
1
3
4
4
4
4
1
1
4
4
4
4
4
4
4
GENETUP
NATA hostel
GENETUP
GENETUP
STUPA
helping handsSTUpA
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Kalimati Hostel
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Khopasi PHC
Barabishe PHC
Barabishe PHC
Barabishe PHC
Mission Hospital
Mission Hospital
DHO Makwanpur
DHO Makwanpur
DHO Makwanpur
DHO Makwanpur
DHO Makwanpur
DHO Makwanpur
GENETUP
GENETUP
Dhading
GENETUP
RTC
NATA Hostel
STUPA
Khairini PHC
GENETUP
Bir Hospital
GENETUP
GENETUP
GENETUP
GENETUP
NMC
GENETUP
NMC
KHAIRENI PHC
GENETUP
GENETUP
GENETUP
GENETUP
GENETUP
NATA hostel
GENETUP
GENETUP
STUPA
helping handsSTUpA
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
DPHO Clinic
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Patan Hospital
Khopasi PHC
Barabishe PHC
Barabishe PHC
Barabishe PHC
Mission Hospital
Mission Hospital
DHO Makwanpur
DHO Makwanpur
DHO Makwanpur
DHO Makwanpur
DHO Makwanpur
DHO Makwanpur
GENETUP
GENETUP
1
1
1
1
1
1
BIR HOSP
GENETUP
GENETUP
GENETUP
KHAIRENI
Bharatpur
BIR HOSP
1
1
1
1
1
1
1
1
Dhading
BIR HOSP
GENETUP
KHAIRENI PHC
GENETUP
BIR HOSP
GENETUP
KHAIRENI PHC
1
1
1
KHAIRENI PHC
KHAIRENI PHC
1
1
1
1
1
1
GENETUP
NMC
GENETUP
NMC
1
1
1
1
1
1
1
1
1
1
4
1
1
1
1
GENETUP
GENETUP
STUPA
STUPA
GENETUP
GENETUP
GENETUP
STUPA
STUPA
GENETUP
Housing status
reason,
if
moved
In tent at
community
camp
In tent
with
family/
alone
At
hostel/
hopital
At
Home
1
Other
Unknown
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
4
1
1
GENETUP
RTC
NATA Hostel
STUPA
Khairini PHC
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Bir Hospital
1
1
1
1
1
NMC
1
NMC
KHAIRENI PHC
GENETUP
GENETUP
GENETUP
GENETUP
1
1
1
1
1
1
1
1
1
1
1
1
KHAIRENI
Bharatpur
1
1
1
1
1
1
1
1
1
1
1
1
1
1
26th May, 2015
Post-Disaster Rapid Assessment of the National Tuberculosis Program: Preliminary Report
108
109
110
11
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
1
1
1
1
1
1
1
1
1
4
Bharatpur
GENETUP
Bharatpur
GENETUP
1
1
1
1
1
GENETUP
NMC
GENETUP
NMC
1
1
1
1
1
4
1
STUPA
STUPA
STUPA
STUPA
1
1
1
4
1
Bharatpur
Bharatpur
1
1
1
1
1
1
1
1
GENETUP
NMC
NATA Hostel
NMC
NATA Hostel
1
1
1
STUPA
STUPA
1
1
1
1
1
1
1
1
1
1
4
1
1
1
1
Bir hospital
Dhading
NATA Hostel
NATA Hostel
GENETUP
Dhading
NATA Hostel
NATA Hostel
GENETUP
1
1
1
DHADING
DHADING
1
1
1
1
1
1
1
1
1
1
1
1
1
134
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
4
1
1
KHAIRANI PHC
GENETUP
KHAIRENI PHC
Helping Hands
Bharatpur
STUPA
KHAIRANI PHC
Bharatpur
GENETUP Hostel
Helping Hands
GENETUP
GENETUP
GENETUP
KHAIRANI PHC
GENETUP
KHAIRENI PHC
Helping Hands
Bharatpur
STUPA
KHAIRANI PHC
Bharatpur
GENETUP Hostel
Helping Hands
TB Nepal
GENETUP
GENETUP
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
0
0
17
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
22
26
Please note patient names have been removed to retain patient confidentially
14
45
8
2
Post-Disaster Rapid Assessment of the National Tuberculosis Program: Preliminary Report
26th May, 2015
Annex C: Guided Interview Questions
For TB patient:
1)
2)
3)
4)
5)
How and from where are you obtaining your anti-TB medication?
Have you had any disruption to your treatment, if so, for how long?
What are your living conditions post earthquake?
How are you managing your nutrition after the earthquake?
Have you experienced any discrimination/stigma?
e.g. do you have any difficulty in sharing a tent or meals with other people?
6) Do you have access to face masks and other infection control measures?
7) How to you think DOTS services should be provided post earthquake?
8) Have you been advised on your future treatment plan?
i.e. where you will continue to get medicines etc.
For TB health care worker:
1) How soon after the earthquake did you go back to work?
2) Have you been able to work normal hours?
3) Has there been anything preventing you from working? If so please explain
i.e. lack of medicines, no running water, no electricity, no patients, family issues
4) Do you have any missing patients?
5) Do you have any concern about how DOTS will run in the future? How do you think it
should run?
6) What are you doing for suspected TB cases? How are you diagnosing patients?
i.e. clinically, microscopy, GeneXpert etc.
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