National Prevalence and Patterns of Drug-Resistant Tuberculosis in Nepal: A Cross-Sectional Survey-Based Study

Background: Drug-resistant tuberculosis (DRTB) is an escalating public health challenge globally, and Nepal is no exception. The country’s first national TB prevalence survey in 2018/19 estimated that around 2,200 people develop DRTB each year—1.6 times more than previously believed. This increase highlights the difficulty Nepal faces in tackling the DRTB burden. Nepal ranks 22nd worldwide and 6th in the WHO South-East Asia Region for MDR/RR TB, underscoring the urgency of the issue. Methods: To understand the current situation, we reviewed grey literature from the Nepal National Tuberculosis Programme (NTP) and the WHO, along with expert presentations and peer-reviewed studies from databases such as Scopus, Medline, and Google Scholar. We analyzed the findings and presented them through summaries, graphs, and figures. Results: Although 2,200 MDR/RR TB cases are estimated annually, only 687 (31%) were confirmed by laboratory tests in 2020/21. Of these, just 418 (61%) were officially reported to the NTP. Many patients fall through the cracks—59% remain undiagnosed, and 39% of confirmed cases are never linked to care. Only 269 people started treatment, and the death rate among treated patients was 13%. Older survey data showed drug resistance in 2.2% of new TB cases and 15.4% of retreatment cases. Early results from the ongoing DRTB survey are expected to give updated insights. Resistance to fluoroquinolones is particularly concerning, found in 35% of cases. Conclusion: DRTB remains a serious and under-addressed problem in Nepal. Strengthening diagnostic services, ensuring timely treatment, and improving patient support systems are urgently needed to curb its growing impact.