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Dr. Raz Mohammed WALI Chief Migration Health Physician NTP National Seminar: 14-15 July 2014

Dr. Raz Mohammed WALI Chief Migration Health Physician NTP National Seminar: 14-15 July 2014 Pukhra, Nepal. About IOM. Migration for the benefit of all Healthy migration in healthy community International Organization for Migration (IOM) was established in 1951 .

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Dr. Raz Mohammed WALI Chief Migration Health Physician NTP National Seminar: 14-15 July 2014

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  1. Dr. Raz Mohammed WALI Chief Migration Health Physician NTP National Seminar: 14-15 July 2014 Pukhra, Nepal

  2. About IOM • Migration for the benefit of all • Healthy migration in healthy community • International Organization for Migration (IOM) was established in 1951. • The principal intergovernmental organization in the field of migration. • IOM is committed to the principle that humane and orderly migration benefit migrants and societies. • Working in more than 151 countries globally, more than 480 main and sub-offices, 9 regional hubs, 156 member states including Nepal, 10 states and organizations observers – over a billion USD budget annually. • Established in Nepal in 2006. • Implementing several large and small projects in the country with the help of more than 383 national and international staff

  3. MHD Associates Programs (Nepal) 1. USRAP Health Assessment Program (HAP) FY2013 - 39,000 and FY 2014- 25,200 exams (IME, PDMS, PEC, 2nd dose vaccination and Medical case management) 2. Non-USRP Refugees HAP (AUS,CAN,UK,NZ,NL,NOR) 4,557 in CY2013, 3. Public Health Support activities Infectious disease surveillance, operational researches 5. Immigrants (Nepalis) 10,600 exams CY2013 and 5200, CY2014 TB Rx (Aus) 4. Harmonization of TB diagnostic &Treatment protocol for Non-resettlement refugee: 100s of TB cases treated so far (passive vs active case finding?) 6. TB Reach >20,000 Tests >4,000 TB including >250 RIF Resistant MOHP 7- Labor Migration health study: Three countries project (Nepal, Bangladesh and Pakistan)

  4. Health Assessment Program Re-med : Undergone the same IME procedure (except vaccination) Initial med exam (IME) • Counseling • Physical examination • CXR • Laboratory investigation • Vaccination • 2nd dose vaccination (2013) • Hep B screening (2014) On hold with regular follow up • TB suspects • TB Treatment • Drug abuse • Alcohol dependent • Psychiatric evaluation • Chronic disease Medical Escort & Trv. Assistance • POE • Final destination

  5. Prior departure Prior Departure Medical Screening (PDMS) (Pre-departure medical screening) 3 weeks before departure at Damak • Physical assessment • Chest X-ray (Class B1TB) • Sputum smears only (Class B1 TB) Pre-Embarkation Check (PEC) • 24 hours prior departure Damak • Physical assessment • Pregnancy Test • Albendazole Deworming • Medication supplies for 4-8 weeks coverage

  6. Facilities • Group counseling and health education • Clinic (clinical Evaluation) • Radiology • Laboratory, TB and Serology including media preparations • Vaccine and reagents storage facilities • DOT and TB isolation centers • Pool of medical escorts and escort bags • Pharmacy for necessary medicines including 1st and 2nd line TB drugs

  7. TB Laboratory • Processing >120 sputum specimens/day • Conc. smear read by Fluorescent Microscope • MGIT960 Liquid & LJ Solid Culture • Molecular Line Probe Assay (LPA) • GeneXpert MTB/Rif • First Line DST (S,H,R,E,Z) • Second Line DST (AMK,KM,OLF,LEV,PAS,ETO,PAS,CS)

  8. Radiology • DR (Digital Radiography) Capacity: 56,000 exposures per year, detector lasting for 7 years • CR(Computerize Radiography) Same capacity as to DR but • Require cassette to process the image ( 2 years lasting) • Take longer time/laborious to process an image • Heavy weight machine (400 kg)

  9. TB Isolation Center 14 huts to isolate • 8 months MDR case • 2 months, non-MDR highly infectious (smear positive)

  10. Active TB case finding Protocol of USRP CDC migration Requirements: Technical Instructions for tuberculosis screening and treatment using cultures and DOT, (Oct 2009) Medical History Physical Examination Applicant 2-14 years of age Applicant ≥ 15 years of age Tuberculin Skin Test or IGRA Chest Radiograph • Medical History, examination, or CXR suggestive for tuberculosis • Individual known HIV infection TST ≥ 10 mm or IGRA positive 3 sputum smear & Culture DST for all positive culture Identification in the level of MTB-Complex

  11. Overall Active Case Finding (Data of USRP resettlement program)

  12. Passive case finding Harmonization of TB diagnostic and treatment Protocol Project Symptomatic refugees Medical History Physical Examination AMDA Health Care provider for refugee in the camp • Medical History, examination, or CXR suggestive for tuberculosis • Individual known HIV infection Chest Radiograph DST for positive culture 3 sputum smear & Culture IOM

  13. Overall Passive case finding (Data of refugees non-resettlement program)

  14. Overall Active Case Findings Rate (CXR)

  15. Overall Passive Case Findings Rate (Clinic)

  16. Smear& Culture

  17. Drug Susceptibility Testing pattern % Among TB suspects Overall INH resistance rate in the country is estimated to be around 7.5%

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