Tuberculosis (TB) remains a major public health problem in Nepal, high in settings marked by prevalent gender and social inequities. Various social stratifiers intersect, either privileging or oppressing individuals based on their characteristics and contexts, thereby increasing risks, vulnerabilities and marganilisation associated with TB. This study aimed to assess the inclusiveness of gender and other social stratifiers in key health related national policies and the Health Management Information System (HMIS) of National Tuberculosis Programme (NTP) by conducting an intersectional analysis of TB cases recorded via HMIS. A desk review of key policies and the NTP’s HMIS was conducted. Retrospective intersectional analysis utilized two secondary data sources: annual NTP report (2017–2021) and records of 628 TB cases via HMIS 6.5 from two TB centres (2017/18–2018/19). Chi-square test and multi-variate analysis was used to assess the association between social stratifers and types of TB, registration category and treatment outcome. Gender, social inclusion and concept of intersectionality are incorporated into various health policies and strategies but lack effective implementation. NTP has initiated the collection of age, sex, ethnicity and location data since 2014/15 through the HMIS. However, only age and sex disaggregated data are routinely reported, leaving recorded social stratifiers of TB patients static without analysis and dissemination. Furthermore, findings from the intersectional analysis using TB secondary data, showed that male more than 25 years exhibited higher odds [adjusted odds ratio (aOR) = 4.95, 95% confidence interval (CI): 1.60–19.06, P = 0.01)] of successful outcome compared to male TB patients less than 25 years. Similarly, sex was significantly associated with types of TB (P < 0.05) whereas both age (P < 0.05) and sex (P < 0.05) were significantly associated with patient registration category (old/new cases). The results highlight inadequacy in the availability of social stratifiers in the routine HMIS. This limitation hampers the NTP’s ability to conduct intersectional analyses, crucial for unveiling the roles of other social determinants of TB. Such limitation underscores the need for more disaggregated data in routine NTP to better inform policies and plans contributing to the development of a more responsive and equitable TB programme and effectively addressing disparities.

中文翻译：

---

评估尼泊尔卫生管理信息系统中的跨部门性别分析：包容性卫生系统的结核病案例研究

结核病 (TB) 仍然是尼泊尔的一个主要公共卫生问题，在性别和社会不平等现象普遍存在的地区，结核病发病率很高。各种社会阶层相互交叉，根据个人的特征和背景给予个人特权或压迫，从而增加了与结核病相关的风险、脆弱性和边缘化。本研究旨在通过对国家结核病规划（NTP）的健康管理信息系统（HMIS）记录的结核病病例进行交叉分析，评估性别和其他社会分层因素在关键卫生相关国家政策和国家结核病规划（NTP）健康管理信息系统（HMIS）中的包容性。对关键政策和 NTP 的 HMIS 进行了案头审查。回顾性交叉分析利用了两个二手数据源：年度结核病防治报告（2017-2021）和两个结核病中心通过 HMIS 6.5 记录的 628 例结核病病例（2017/18-2018/19）。卡方检验和多变量分析用于评估社会阶层与结核病类型、登记类别和治疗结果之间的关联。性别、社会包容和交叉概念被纳入各种卫生政策和战略，但缺乏有效实施。自 2014/2015 年以来，NTP 已开始通过 HMIS 收集年龄、性别、种族和位置数据。然而，通常只报告按年龄和性别分类的数据，使记录的结核病患者的社会分层保持静态，没有进行分析和传播。此外，使用结核病二级数据进行交叉分析的结果表明，25 岁​​以上的男性表现出更高的几率 [调整后的比值比 (aOR) = 4.95，95% 置信区间 (CI)：1.60–19.06，P = 0.01）]与 25 岁以下的男性结核病患者相比，取得了成功的结果。同样，性别与结核病类型显着相关（P < 0.05），而年龄（P < 0.05）和性别（P < 0.05）与患者登记类别（老/新病例）显着相关。结果凸显了常规 HMIS 中社会分层的可用性不足。这一限制阻碍了 NTP 进行交叉分析的能力，这对于揭示结核病其他社会决定因素的作用至关重要。这种限制凸显了常规国家结核病防治计划中需要更多分类数据，以便更好地为政策和计划提供信息，从而有助于制定更具响应性和公平的结核病规划并有效解决差异。