Publication Date


Degree Program

Department of Public Health

Degree Type

Master of Public Health


Tuberculosis is the leading cause of infectious disease in Nepal. An estimated 60% of the adult population aged between 15-45 years is infected with tuberculosis, and 45% of the total population is infected. Ten percent of people infected with TB progress to active disease. To combat tuberculosis, Directly Observed Therapy (DOT) was adopted in Nepal in 1996. DOT was administered at four national demonstration sites in 1996 and expanded over time so that 56% of the population to date have been covered by DOT. This study aimed to evaluate DOT in pulmonary TB patients in Nepal in terms of patient outcome and compliance. DOT was compared against a conventional treatment program or self-administered therapy (SAT), which served as the control group. The project was a retrospective nonconcurrant cohort study. Patients were sputum positive pulmonary TB patients aged over 15 years from Bhaktapur district in Nepal, who had undergone DOT or SAT between 1996 and 1998. Medical records of all the patients were sent to the National TB Center in Thimi, Nepal. A total of 261 patients (DOT, 161 patients and SAT, 100 patients) were included in the study. The two groups were similar in terms of age, ethnicity, and religion status. The cure rate was 86.3% for DOT, which was significantly higher than the 75.0% for the SAT group (p<0.05). The compliance rate was also higher for DOT at 90.2% versus 81.8% for the SAT group (p<0.05). The mean treatment length was 6.8 months for the SAT group and 7.4 months for the DOT group (p<0.05). Higher rates of treatment compliance and cure rate were achieved in the DOT group versus the SAT group. Thus, DOT is advocated as a means of ensuring greater TB program success.


Epidemiology | Public Health

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