Harmonization of the tuberculosis management protocols


Harmonization of the tuberculosis management protocols in the Bhutanese refugee camps IOM’s primary medical activity in Nepal is conducting health assessments for refugees in the resettlement process since December 2007. At that time the difference in Tuberculosis (TB) management protocols, especially considering that the “resettlement” protocol was superior, was a matter of concern for all parties involved in tuberculosis (TB) management in the camps (Association of Medical Doctors of Asia (AMDA), United Nations High Commission for Refugees (UNHCR), IOM and National Tuberculosis Programme (NTP)). In coordination and collaboration with all concerned parties, IOM started to implement harmonization of the detection and treatment protocols for refugees who are not under resettlement pipeline since December 2008 through funding from the US and Canada. Activities under this protocol include chest X-ray (CXR) for refugees to be screened for TB, sputum smears and cultures, contact evaluation of identified TB case, Drug Susceptibility Testing (DST), individualized treatment based on the results of DST, isolation and treatment of complex TB cases including multi-drug resistant TB in Magic Mountain Isolation Center (MMIC) and provision of supplementary feeding. The project directly benefits refugees suffering from TB, indirectly – their families and the entire refugee community. Importantly, the project builds capacity of the national medical professionals in TB detection and management including active TB contact evaluation and TST inoculation and reading.

Under this project, more than 3,000 refugees with suspicion of suffering from TB were tested bacteriologically and 437 were found to be culture-positive. More than 40 of them with drug resistant TB benefited from individualized treatment. 24 cases with MDR TB and complex TB cases got treatment in isolation facility. Five AMDA laboratory staff received on-the job training in IOM laboratory and more than 30 AMDA medical staffs (doctors, paramedics and DOT workers) received training on laboratory method of TB diagnosis, interpretation of laboratory tests, TB treatment, management of side-effects of TB treatment, chest X-ray reading, TB epidemiology and infection control. The project is being implemented in coordination with AMDA, UNHCR and the government of Nepal.


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