EFFECT OF PROVIDING FREE SPUTUM MICROSCOPY SERVICE TO PRIVATE PRACTITIONERS ON CASE NOTIFICATION TO NATIONAL TUBERCULOSIS CONTROL PROGRAM
Abstract
Background: This study was undertaken to see whether providing free sputum microscopyservices to private practitioners helps in case notification to the national tuberculosis control
program. The knowledge, attitudes and practices of these practitioners regarding tuberculosis were
also evaluated. Methods: A questionnaire was administered to all the private practitioners
practicing in a densely populated area of Karachi. They were asked to fill tuberculosis notification
cards for the first three months and then for another three months when an incentive in the form of
free sputum microscopy was provided to the practitioners. Results: Although the majority of the
practitioners knew that cough, fever and weight loss are the main symptoms of tuberculosis, less
than half knew that blood in sputum, poor appetite and chest pain could also be associated with
tuberculosis. Only 66% of the practitioners indicated sputum microscopy as the preferred
diagnostic method for tuberculosis. Only 50% of the practitioners self treated the patients, while
the remaining half referred their patients to specialists. Around 80% of the practitioners were
aware of the four first-line anti-tuberculosis drugs. Less than half of the practitioners considered
sputum microscopy as the most useful follow-up investigation in a patient with pulmonary
tuberculosis. Generally, there was a poor response in case notification by private practitioners on
provision of free sputum microscopy. Conclusion: An overwhelming majority of the practitioners
had poor knowledge concerning the correct treatment practices in Tuberculosis. Providing sputum
free microscopy does not significantly help in improving tuberculosis case notification. Strategies
for public-private collaboration in tuberculosis control are needed.
Keywords: tuberculosis, private practice, sputum, microscopy, knowledge, attitude, behaviour,
Pakistan.
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