Management of tuberculosis patients by grass root level practitioners
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20161391Keywords:
Grass Root level Practitioners, RNTCP, DOTS, TuberculosisAbstract
Background: The tuberculosis bacteria are the top most infectious killing agents in the world. 9.6 million is the number of people that developed tuberculosis globally in the year 2014. The objective was to evaluate the management of Tuberculosis patients by grass root level practitioners as a one of the cause behind slow progress in TB control and increasing resistance to anti-TB drugs.
Methods: Cross sectional, observational study with pretested, semi structured proforma with open and close ended questions.
Results: Very few practitioners are updated about the renewed RNTCP guidelines. Only 25.58% know about cough for more than two weeks as a prime symptom, and 48.71% know that two sputum samples have to be taken for diagnosis. Most of them are not taking the recommended morning and spot samples. There is an overdependence on X-Ray for diagnosis and follow up. 64% of the practitioners do not notify the DTC. Only 22% knew of the two categories of TB patients according to the RNTCP guidelines. Supervision of treatment and intermittent dosing, as advised by RNTCP, are not strictly followed by most practitioners, and only 20% were doing a sputum examination at the end of two months and 6 months. Overtreatment is commonly seen. Awareness about applicability of DOTS on children and contraindication of Streptomycin in pregnancy is inadequate.
Conclusion: The knowledge and practice of the grass root level practitioners is significantly below mark and may contribute to the static or slow decreasing burden of TB, and increasing drug resistance. The practitioners should be registered, adequately trained, and properly equipped to deal with the TB patients, to avoid the emergence of newer drug resistant tubercular cases.
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References
WHO. factsheet: tuberculosis N104, October 2015 available at http://www.who.int/ mediacentre/ factsheets/ FS104 accessed 2016-02-08.
Udwadia ZF, Pinto LM, Uplekar MW. Tuberculosis management by private practitioners in Mumbai, India.2010;5(8):e12023.
Hazarika I. Role of private sector in providing tuberculosis care: evidence from population based service in India. J Glob Infect Dis. 2011;3:19-24.
Achanta S, Jaju J, Kumar A, Nagaraja S, Sharma S, Bandi S et al. Tuberculosis management practices by private practitioners in Andhra Pradesh, India. 2013;8(8):e71119
Prasad R, Nautiyal RG, Mukherji PK, Jani A, Singh K, Ahuja RC. Diagnostic evaluation of pulmonary tuberculosis : what do doctors of modern medicine do in India? Int J Tuber Lung Dis. 2003;7:52-7.
TBFACTS.ORG, 2016. Available at www.tbfacts.org/. accessed 2016-02-08.
Portero JL, Rubio M. Private practitioners and tuberculosis control in Phillipines: strangers when they meet? Trop Med Int Health., 2003; 8:329-35.
Uplekar M, Pathania V, Raviglione M. Private practitioners and public health: weak links in TB control. 2001;9285:912-6.
Srinath S, Sreenivas AN, Chadha SS, Shivashankar R, Sharma G, Yadav S, et al. From where are TB patients accessing treatment in India? Results from a cross sectional country based survey of 30 districts. 2011;6(9):e24160.
WHO Geneva, 2012: Global Tuberculosis control 2012. Available at www.who.int/ tb/ publications/ global_report/. Accessed 2016-02-08.
NIKSHAY Online tool for monitoring TB control programme, 2016. Available at www.nikshay.gov.in accessed on 2016-02-08
CDC: get the facts about TB disease. Available at www.cdc.gov/ tb/ publications/ pamphlets/ default accessed on 2016-02-08.
WHO. Reduction of number of smears for the diagnosis of pulmonary TB, 2007. Available at http://www.who.int/ tb/ laboratory/ policy_diagnosis_pulmonary_tb/ en/. Accessed on 2016-02-08.
Davis JL, Cattamanchi A, Cuevas LE, Hopewell PC, Steingart KR. Diagnostic accuracy of same-day microscopy versus standard microscopy for pulmonary tuberculosis: a systematic review and meta-analysis. The Lancet Infectious Diseases Feb 2013;13(2):47-154.
Kirwan DE, Gilman RH. Same-day diagnosis and treatment of tuberculosis. The Lancet Infectious Diseases. 2013;13(2):102-4.
Government of India, Central Tuberculosis division: Annual status Report, 2014. Available at http://www.tbcindia.nic.in .accessed on 2016-02-08.
WHO. Treatment of Tuberculosis Guidelines, 4th Ed, 2010. Available at http://www.who.int/ tb/ publications/ 2010. Accessed on 2016-02-08.
WHO. Drug Resistant Tuberculosis, Jan 2012. Available at www.who.int/ tb/ challenges/ mdr/ tdr . Accessed on 2016-02-08.
CDC. Factsheets: Tuberculosis and pregnancy, 2012. Available at http://www.cdc.gov/ tb/ publications/ factsheets/ specpop/ pregnancy . Accessed at 2016-02-08.
CDC. Education and training: Tuberculosis. 2014. Available at www.cdc.gov/ tb /education . Accessed on 2016-02-08.
Yadav S, Patel A, Unadkat SV, Bhanuhali VV. Evaluation of Management of TB patients by General Practitoners of Jamnagar city. Indian Journal of Community Medicine. 2006;31:259-60.
Baxi R.K., Shah A.R. Management of Tuberculosis by the General Practitioners of Vadodara City 2006; 31;279-80.
Dasgupta A, Chattopadhyay A. A Study on the Perception of General Practitioners of a Locality in Kolkata Regarding RNTCP and DOTS. Indian Journal of Community Medicine. 2010;35:344-6.
Bharaswadkar S, Kanchar A, Thakur N, Shah S, Patnaik B, Click ES et al. Tuberculosis Management Practices of Private practitioners in Pune municipal Corporation, India. 2014;9(6):e9799.
Thakur J S, Kar SS , Sehgal A, Kumar R. Private Sector Involvement in Tuberculosis Controlin Chandigarh. Indian Journal of Tuberculosis 2005; 53(3):149-53.
Yadav A, Garg SK, Chopra H, Bajpai SK, Bano T, Jain S et al. Treatment Practices in Pulmonary Tuberculosis by Private Sector Physicians of Meerut, Uttar Pradesh. The Indian Journal of Chest Diseases & Allied Sciences. 2011;54:161-4.
Shehzadi R, Irfan M, Zohra T, Khan JA, Hussain SF. Knowledge regarding Management of Tuberculosis among General Practitioners in Northern Areas of Pakistan. J Pak Med Assoc. 2005;55(4):174-6.
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