Over 3200 individuals recently underwent systematic screening for tuberculosis (TB) as part of an active case-finding initiative in high-risk areas in Nepal. Led by the National Tuberculosis Control Centre in collaboration with the WHO Country Office for Nepal, this initiative aimed to bring essential TB screening services directly to the communities affected by last year's floods.
In September 2024, Nepal experienced heavy rainfall, resulting in severe flooding and landslides. The disaster claimed over 200 lives and caused widespread destruction across 20 of the country's 77 districts, including damage to 47 health facilities. Given the increased risk of disease transmission in the aftermath of floods, it was crucial to intensify case detection of TB among vulnerable populations.
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An active case-finding initiative for tuberculosis conducted in Namobuddha Municipality, Kavrepalanchok, Bagmati Province - a high-risk area among flood-affected municipalities in Nepal. Photo credit: WHO Nepal
A total of seven screening camps were conducted in Kavrepalanchowk, Lalitpur, Sindhupalchowk and Sindhuli districts between 2-25 February 2025. These camps utilized advanced diagnostic tools, integrating X-ray-based computer-aided detection with Gene-Xpert testing. Individuals were systematically screened with X-ray-based computer-aided detection and those with X-ray abnormalities were tested with Gene-Xpert. People diagnosed with TB were immediately enrolled in free treatment programs. Among the 3200 screened, nearly 280 were tested with Gene-Xpert.
“In Nepal, over 70% of the people with TB are asymptomatic as per the National TB Prevalence Survey conducted in 2018. Active TB case finding with X-ray-embedded AI is what we needed. I am very thankful to WHO that we could conduct this screening camp using X-ray-embedded AI in flood-affected areas. This will support our efforts of finding the missing TB cases early,” says Dr Prajowl Shrestha, director of the National Tuberculosis Control Centre.
To maximize outreach, 60 female community health volunteers working in the selected municipalities were engaged in this initiative and trained to raise awareness along with identification of risk groups for TB screening in the communities.
TB remains a major public health issue in Nepal and is among the top ten causes of death in the country. With an estimated 68 000 incident TB cases in 2023, only 54% were enrolled in treatment. Strengthening active case finding at the local level, combined with multi-sectoral engagement, is crucial to addressing underdiagnosis and underreporting of TB.
"TB is preventable and curable. By early detection of people with TB now, we have helped initiate appropriate treatment and prevent further spread in the community," says Dr Kenza Bennani, Team Lead for the Communicable Diseases Programme at WHO Nepal.
WHO Nepal will continue to provide support to the national TB programme. Ending TB is possible through collaborative, multi-sectoral efforts, increased investments in TB across sectors, and strong partnerships between all stakeholders and affected communities.
The active case-finding activity in flood-affected areas is part of the United Nation's Joint Recovery Action Plan and is funded by the Swiss Agency for Development Cooperation.