1. Orientation of the district level health workers for TB and Tobacco integration and training on counselling for smoking cessation Kathmandu, April 7 – 8, 2014 Tobacco as a risk factor for TB and screening strategies Giampaolo Mezzabotta Medical Officer/Tuberculosis World Health Organization Nepal Country Office

2. How tobacco influences TB * = smoking-related cough can mask TB, thus delaying patients’ care seeking behaviour and making harder for clinicians to recognize TB. SMOKING?

3. Who should be screened for TB? TB prevalence in Nepal is estimated at 241/100,000.

4. Who is at higher risk of active TB? Setting

5. Published in 2007 but still the main source of information about TB and tobacco control

6. Estimated number of cases Estimated number of deaths 1.3 million* 74.000 in children 410.000 in women 8.6 million 0.5 m in children 2.9 m in women 450,000 All forms of TB Multidrug-resistant TB HIV-associated TB 1.1 million (13%) 320,000 Source: WHO Global Tuberculosis Report 2013 * Including deaths attributed to HIV/TB The global burden of TB -2012 170,000

7. The Tobacco epidemic

8. How and where the two epidemics merge ?