KNOWLEDGE, ATTITUDE AND PRACTICE OF PRIVATE PRACTITIONERS REGARDING TB-DOTS IN A RURAL DISTRICT OF SINDH, PAKISTAN
AbstractBackground: Tuberculosis is prevailing in both urban and rural areas of Pakistan. Knowledge,attitude and practice (KAP) of private practitioners (PPs) regarding tuberculosis management havebeen reported only in urban areas of Pakistan. This survey was conducted for the first time in a ruralarea of Sindh, Pakistan. Methods: This survey was conducted in January 2007 at Thatta, a ruraldistrict of Sindh, Pakistan. Study subjects were twenty-two allopathic qualified (MBBS) doctors ofdistrict Thatta, who were practicing in private setups for at least last one year. Before TB-DOTStraining PPs had filled the KAP questionnaire regarding tuberculosis (TB) diagnosis andmanagement through DOTS. Survey data was analysed through SPSS version 11.05 software.Results: On average, five TB suspects per month were seen by each PP. Only 14% of PPs advisedsputum microscopy solely for pulmonary TB diagnosis, while 86% of PPs used differentcombination of tests (chest x-ray/sputum microscopy/ESR/tuberculin test) for TB diagnosis. Over40% PPs did not prescribe TB treatment regimen according to TB-DOTS category. Majority PPs(85%) did not follow the treatment through sputum microscopy and instead relied on clinicalimprovement and x-ray clearance. Nearly 60% of TB patients at PPs clinic did not show complianceto the TB treatment and none of PPs were following the retrieval of default cases. Conclusions: Agross lack of PPs knowledge and right practice regarding TB diagnosis and management throughDOTS was identified and needed to be addressed through providing DOTS training.Keywords: Tuberculosis, DOTS, private practitioners, knowledge, practice
National TB Control Program Pakistan/About NTP. [On
line]. 2006 [cited 2007 March 24]. Available from:
WHO Report 2007/Global Tuberculosis Control/Key
Findings. [On line]. 2007 [cited 2007 March 24]. Available
WHO Report 2007/Country Profile/Pakistan. [On line]. 2007
[cited 2007 March 24]. Available from: http://www.who.int/
Marsh D, Hashim R, Hassany F, Hussain N, Iqbal Z,
Irfanullah A, et al. Front-line management of pulmonary
tuberculosis: an analysis of tuberculosis and treatment
practices in urban Sindh, Pakistan. Int J Tuberc Lung Dis
Uplekar M, Juvekar S, Morankar S, Rangan S, Nunn P.
Tuberculosis patients and practitioners in private clinics in
India. Int J Tuberc Lung Dis 1998;2(4):324–9.
Raman AV, Chadha VK, Shashidhara AN, Jaigopal MV,
Selvam. A study of knowledge, attitude and practices of
medical practitioners regarding tuberculosis and its control in a
backward area of South India. NTI Bulletin 2000;36(1-2):3–7.
Uplekar MW, Rangan S. Private doctors and tuberculosis
control in India. Tubercle Lung Dis 1993;74:332–7.
Uplekar MW, Juvekar SK, Parande SD, Dalal DB,
Khanvilkar SS, Vadair AS, et al. Tuberculosis management
in private practice and its implications. Indian J Tuberc
Singla N, Sharma PP, Singla R, Jain RC. Survey of
knowledge, attitude and practices for tuberculosis among
general practitioners in Delhi, India. Int J Tuberc Lung Dis
Khan JA, Akbani F, Malik A, Kazi GN, Aslam F, Hussain
SF. Effect of providing free sputum microscopy service to
private practitioners on case notification to national
tuberculosis control program. J Ayub Med Coll Abbottabad
Shah SK, Sadiq H, Khalil, Noor A, Rasheed G, Shah SM, et
al. Do private doctors follow national guidelines for
managing pulmonary tuberculosis in Pakistan? East Mediterr
Health J 2003;9(4):776–88.
Population Census, Sindh results. Bureau of statistics,
Planning and Development Department, Government of
Sindh, Kehkashan, Karachi-6. 1998.
Murty KJ, Frieden TR, Yazdani A, Hreshikesh P. Publicprivate partnership in tuberculosis: experience in Hyderabad,
India. Int J Tuberc Lung Dis 2001;5(4):354–9.