• Javaid Ahmad Khan
  • Farooq Akbani
  • Amyn Malik
  • Ghulam Nabi Kazi
  • Fawad Aslam
  • Syed Fayyaz Hussain


Background: This study was undertaken to see whether providing free sputum microscopyservices to private practitioners helps in case notification to the national tuberculosis controlprogram. The knowledge, attitudes and practices of these practitioners regarding tuberculosis werealso evaluated. Methods: A questionnaire was administered to all the private practitionerspracticing in a densely populated area of Karachi. They were asked to fill tuberculosis notificationcards for the first three months and then for another three months when an incentive in the form offree sputum microscopy was provided to the practitioners. Results: Although the majority of thepractitioners knew that cough, fever and weight loss are the main symptoms of tuberculosis, lessthan half knew that blood in sputum, poor appetite and chest pain could also be associated withtuberculosis. Only 66% of the practitioners indicated sputum microscopy as the preferreddiagnostic method for tuberculosis. Only 50% of the practitioners self treated the patients, whilethe remaining half referred their patients to specialists. Around 80% of the practitioners wereaware of the four first-line anti-tuberculosis drugs. Less than half of the practitioners consideredsputum microscopy as the most useful follow-up investigation in a patient with pulmonarytuberculosis. Generally, there was a poor response in case notification by private practitioners onprovision of free sputum microscopy. Conclusion: An overwhelming majority of the practitionershad poor knowledge concerning the correct treatment practices in Tuberculosis. Providing sputumfree microscopy does not significantly help in improving tuberculosis case notification. Strategiesfor public-private collaboration in tuberculosis control are needed.Keywords: tuberculosis, private practice, sputum, microscopy, knowledge, attitude, behaviour,Pakistan.


De Muynck A, Siddiqi S, Ghaffar A, Sadiq H. Tuberculosis

control in Pakistan. Critical analysis and its implementation.

J Pak Med Assoc 2001;51:41-7.

Country Profile: Pakistan; Global Tuberculosis Control.

WHO Report 2003, pp 99-101.

Introduction; National Guidelines for TB Control in Pakistan,

, pp 1-3.

Marsh D, Hashim R, Hassany F, Hussain N, Iqbal Z,

Irfanullah A et al. Frontline management of tuberculosis and

treatment practices in urban Sindh, Pakistan. Tuber Lung Dis


Bennet, S., McPake, B., Mills, A. The public/private mixed

debate in health care. In:Benet, S., McPake, B., Mills, A.

(eds). Private Health Providers in Developing Countries.

Serving the Public Interest? Zed Books Ltd 1997; London:

pp. 1-18.

Hurtig AK, Pande SB, Baral SC, Porter JD, Bam DS.

Tuberculosis treatment and private practioners in Kathmandu

Valley. Int J Tuberc Lung Dis 2000;4:730-6.

Uplekar MW, Shepard DS. Treatment of tuberculosis by

private practitioners in India. Tuberculosis 1991;72:284-290.

Uplekar MW, Rangan S. Tackling TB – the search for

solutions. The Foundation for Research in Community

Health. 1996; Pune/ Mumbai, India.

Hong YP, Kwon DW, Kim SJ, Chang SC, Kang MK, Lee EP

et al. Survey of knowledge, attitudes and practices for

tuberculosis among general practitioners. Tuber Lung Dis


Uplekar MW, Rangan S. Private doctors and tuberculosis

control in India. Tuber Lung Dis 1993;74:332-7.

Dolin PJ, Raviglione MC, Kochi A. Global TB incidence and

mortality during 1990-2000. Bull World Health Organ


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


Hussain R, Hasan R, Khurshid M, Sturm AW, Ellner JJ,

Dawood G. Pulmonary TB in a BCG vaccinated area:

Relationship of disease and drug with immunological and

hematological parameters and drug resistance. Southeast

Asian J Trop Med Public Health 1996;27:257-62.

Grzybowski A. Tuberculosis, a look at the world situation.

In: Pathan AJ, Illyas eds. Jan’s treatise on epidemiology and

control on tuberculosis, Karachi: Time Traders,1988;pp 62

Hossain S. TB: A public health threat as NATAB sees it.

Presented at 28th World Conference of IUTALD/UICTMR

Mainz, Germany, June 14-17, 1994.