Nepal's TB control program operates under the DOTS strategy — Directly Observed Treatment, Short-course. Every dose is observed. Every patient is registered. Every sputum examination result is recorded at months 2/3, month 5, and at the end of treatment. The registration system isn't administrative overhead; it's the surveillance infrastructure that the National Tuberculosis Programme reports against and the Ministry of Health uses to measure program effectiveness against national incidence targets.
Registration and Case Classification
Fiscal Years, Registration Years, Registration Month, and Registration Day establish the entry point into the national TB register. In Nepal's public health reporting, fiscal year tracking matters because DOTS program performance is evaluated against annual cohort outcomes — the percentage of registered cases in a given fiscal year who complete treatment successfully, are cured, fail treatment, die, or default. Without accurate registration dating, the cohort analysis breaks down.
Disease Types and Registration Category classify the case by both clinical presentation (pulmonary smear-positive, pulmonary smear-negative, extrapulmonary) and registration category (new, relapse, treatment after failure, treatment after default). These two classifications determine the Treatment Category — the specific drug regimen and duration — under Nepal's NTP guidelines aligned with WHO recommendations.
Refer/Diagnosis documents the referring facility or diagnostic source. In Nepal's decentralized health system, TB diagnosis may happen at a district hospital, a health post, or a private facility, with treatment managed at a different level of the health system. The referral chain is part of the treatment accountability record.
HIV Co-Infection and Drug Resistance
HIV Infection, ART, and CPT are the co-management fields for TB-HIV co-infected patients — the subset of TB cases with the highest mortality risk without correct concurrent management. A TB patient with confirmed HIV infection requires Anti-Retroviral Therapy and Cotrimoxazole Preventive Therapy alongside the TB treatment regimen. The fields document whether these co-therapies have been initiated, which affects both the treatment outcome expectation and the monitoring requirements.
Drug Resistance is the field that flags patients identified as having drug-resistant TB (MDR-TB or XDR-TB) — a different treatment category requiring second-line drugs, longer treatment duration, and more intensive monitoring. In Nepal, drug resistance testing is a critical component of the TB control strategy given the proximity to India, where MDR-TB rates are significant.
Sequential Sputum Examination
2/3 Examination, 2/3 Months Result, 2/3 Months Lab No., 2/3 Months Date — 5 Examination, 5 Months Result, 5 Months Lab No., 5 Months Date — Last Examination, Last Months Result, Last Lab No., Last Date are the three sequential sputum monitoring windows that define treatment response.
A patient who was sputum smear-positive at registration and converts to smear-negative at the 2/3 month examination has an expected treatment trajectory. One who remains positive at month 5 has a treatment failure that requires a resistance investigation and regimen change decision. The sequential laboratory results — with their lab reference numbers and dates — are the clinical evidence for that decision and the documentation required for national programme reporting.
Treatment Outcome and Outcome Date close the case record with the final classification: cured, treatment completed, treatment failed, died, lost to follow-up, or not evaluated. These six outcome categories are the international standards for TB cohort analysis and are the metrics Nepal's NTP reports to WHO in annual country reports.
Cast Code captures the caste/ethnicity identifier used in Nepal's health system data for equity analysis — tracking whether TB outcomes differ systematically across ethnic groups, which is a public health indicator relevant to targeted intervention planning.