Knowledge of Tuberculosis Diagnosis and its Management Strategies among Private Practitioners
INTRODUCTION
1) Tuberculosis (TB) continues to be one of the most important public health threats.
2) Lack of proper diagnostic skills and irrational prescriptions are among major contributing factors for increasing burden of drug resistance TB
World Health Organization. WHO Global Strategy for Containment of Antimicrobial Resistance. Geneva, 2001 (WHO/CDS/CSR/DRS/2001.2)
OBJECTIVE
The objective of the study was to assess and document the knowledge of TB and its management practices among private practitioners and there adherence to National TB control guidelines.
METHODS
We reviewed the records of pulmonary and extrapulmonary TB patients reporting in Dept. Of Chest and TB, Govt. Medical College Patiala who were already on anti tubercular treatment from outside. We determined the general information (including age, sex, address etc), anti TB regimen, dose and duration of therapy.
1) Tuberculosis (TB) continues to be one of the most important public health threats.
2) Lack of proper diagnostic skills and irrational prescriptions are among major contributing factors for increasing burden of drug resistance TB
World Health Organization. WHO Global Strategy for Containment of Antimicrobial Resistance. Geneva, 2001 (WHO/CDS/CSR/DRS/2001.2)
OBJECTIVE
The objective of the study was to assess and document the knowledge of TB and its management practices among private practitioners and there adherence to National TB control guidelines.
METHODS
We reviewed the records of pulmonary and extrapulmonary TB patients reporting in Dept. Of Chest and TB, Govt. Medical College Patiala who were already on anti tubercular treatment from outside. We determined the general information (including age, sex, address etc), anti TB regimen, dose and duration of therapy.
CONCLUSION
RESULTS
- Treatment of 24 cases including 18 pulmonary TB and 6 extrapulmonary TB was reviewed
- Only 3(12.5%) used sputum smear examination as the diagnostic mode.
- 10(41.6%) started ATT on the basis of chest xray.
- 5(20.8%) used Mantoux and ESR as the diagnostic modality
- 5(20.8%) considered serology to be diagnostic of TB
- Only 7(29.1%) prescribed DOTS .
- 20(83.3%) had errors in treatment prescription.
- 13(50%)of doctors could not resort to the recommended regimen ,
- 7(29.1%)could not write the correct dosage according to the weight
- 5(20.8%) were wrong both in terms of dosage and regimen.
CONCLUSIONS
The study reflects lack of knowledge about standardized TB diagnosis and treatment protocols among private practitioners and also shows lack of effective collaboration between private sector and National TB control programme.
The overall goals for treatment of tuberculosis are
1) to cure the individual patient
2) to minimize the transmission of Mycobacterium tuberculosis to other persons
TUBERCULOSIS Serodiagnostic Tests Policy Statement 2011 clearly states
•that serological tests not be used for the diagnosis of pulmonary and extra-pulmonary TB.
• Currently available serological tests provide inconsistent and imprecise findings.
• There is no evidence that existing commercial serological assays improve patient outcomes
•A blood test can cost up to $30 per patient
•In a country like India, it is estimated that serological testing would result in 121,000 additional false-positive diagnoses.
•For each additional smear-negative TB case found by serology, more than six additional false-positive cases would be inappropriately diagnosed.
•125 year-old sputum smear microscopy test, is still the gold standard for diagnosis of pulmonary tuberculosis followed by Bactec culture sensitivity in paucibacillary disease.
•In Extrapulmonary tuberculosis clinical picture along with mantoux, ESR, cytology may help at reaching the diagnosis.
Cost-effectiveness of TB Serology in India, by Dowdy et al, in press in PLoS Medicine 2011
TUBERCULOSIS Serodiagnostic Tests Policy Statement 2011 available at http://www.who.int/tb
For this reason the prescribing physician, be he/she in the public or private sector, is carrying out a public health function with responsibility not only for prescribing an appropriate regimen but also for successful completion of therapy. However, starting of ATT only on basis of serology or chest xray particularly in already treated cases of tuberculosis in past is leading to overtreatment of the disease.
American Thoracic Society, Centers for Disease Control and Prevention. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit Care Med 1994;149:1359--1374. Available at http://www.thoracic.org/adobe/statements/tbchild1-16.pdf