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Introduction
India accounts for nearly one-third of the global burden of
tuberculosis and two-third of the total cases in South-East
Asia. Nearly 40% of Indians are infected with Mycobacterium
tuberculosis and everyday about 5,000 people develop TB
disease while over 1,000 die of the disease. Every year 1.8
million new cases occur in the country of which 0.8 million
are highly infectious sputum positive. Unless properly
treated, infectious pulmonary TB patients can infect 10 - 15
persons in a year. Control of TB has come a long way since
the initiation of the National Tuberculosis Control
Programme (1962) in India. By the end of March 2006, the
whole country had been covered under the Revised
National Tuberculosis Control Programme (RNTCP) with a
focus on Directly Observed Treatment Short-course (DOTS)
and annual reports suggest that we are maintaining 85%
cure rate and 70% case detection rates; however, with 1,000
TB deaths per day. According to the WHO, around 73,000
of the notified new TB cases in 2010 were already multidrug resistant. Of these, less than 3,000 were detected1.
More than half of tuberculosis patients in India seek care
initially in the private healthcare sector where diagnostics,
treatment, and reporting practices often do not meet
national or international standards for tuberculosis and still
have remained alienated from DOTS implementation. For
national programmers to broaden its reach and to have
maximum impact, involvement of private practitioners
assumes greater significance and also poses as one of the
greatest challenges to ensure their participation which is
intimately linked with the success of programme. To
maximise the outcome of programme objectives, it is
imperative to gauge the knowledge status of human
resources at regular intervals so as to fine-tune educational
activities and instill good practices. With this background, a
study was undertaken to determine the knowledge of
doctors (government and private), post-graduate students,
interns, and final year medical students about TB and RNTCP
on selected parameters.
Results
Overall awareness on DOTS-plus (6.3%) and perception on
efficacy of intermittent therapy to daily regime (31.5%)
was low (Table I). Still, private practitioners have a high (74%)
impression of X-ray being the first modality for diagnosing
PTB while only 26% correctly mentioned sputum as first
investigation (Table II).
Table III, provides summary findings of incorrect responses.
DOTS categories were not correctly enumerated by 58%,
30%, and 17.7% of private practitioners, undergraduate and
PG students respectively.Treatment regimen for both adult
and paediatric patients was wrongly described by 68.4%
and 51.7% of respondents; life prolongation with DOTS in
patients with HIV with PTB was wrongly mentioned by 69.6%
and stopping ATT criteria was not correctly mentioned by
44% study participants.
Discussion
The present cross-sectional descriptive study was
conducted among randomly selected private practitioners,
in-service doctors working in the district, final year medical
students, interns, post-graduate students associated with
PGIMS, Rohtak. Textbooks emerged as the most common
*Departments of Tuberculosis and Respiratory Medicine, and Community Medicine, Pandit B. D. Sharma PGIMS,
Rohtak - 124 001, Haryana.
Table I: Correct knowledge and perception of doctors on selected parameters of tuberculosis and RNTCP.
Study participants
(n)
DOTS
RNTCP
DOTS-Plus
Observed treatment of
DOTS is more effective
than self administered
therapy (yes)
Is DOTS the
right approach
to tuberculosis
(yes)
Efficacy of intermittent
therapy is similar to
daily regime
(yes)
113 (98.2%)
113 (98.2%)
02 (1.7%)
112 (97.3%)
115 (100%)
29 (25.2%)
Interns (115)
112 (97.5%)
112 (97.5%)
03 (2.6%)
115 (100%)
115 (100%)
06 (5.2%)
PG students (164)
157 (95.7%)
157 (95.7%)
11 (6.8%)
141 (85.9%)
162 (98.8%)
74 (45.2%)
HCMS (60)
59 (98.4%)
59 (98.4%)
06 (10%)
57 (85.2%)
59 (98.4%)
45 (75%)
09 (18%)
08 (16%)
10 (20%)
13 (26%)
05 (10%)
450 (89.2%)
449 (89%)
32 (6.3%)
438 (86.9%)
451 (89.4%)
159 (31.5%)
Total (504)
Chest X-ray
PCR
ELISA
ESR
Tuberculin test
110 (95.6%)
02 (1.7%)
03 (2.6%)
Interns (115)
112 (97.3%)
03 (2.7%)
PG students (164)
118 (71.9%)
04 (2.4%)
06 (3.6%)
01 (0.6%)
HCMS (60)
60 (100%)
13 (26%)
37 (74%)
413 (81.9%)
46 (9.1%)
9 (1.7%)
1 (0.1%)
Total (504)
Medical students
Interns
PG students
HCMS
Pvt. practitioners
Total
2.6%
1.5%
1.7%
2.5%
4.3%
1.6%
82%
10.7%
98.3%
97.4%
93.2%
90%
80%
93.6%
DOTS categories
30.1%
2.6%
17.7%
58%
19.6%
MC route of TB spread
3.5%
0.86%
3.7%
2%
2.3%
MC symptom of PTB
2.5%
2.5%
7.4%
8%
4.3%
93.9%
58.3%
65.2%
68%
54%
68.4%
16.5%
56.5%
65.2%
71.7%
54%
51.7%
31.3%
6%
42%
11.7%
84%
31.9%
20%
1.7%
9.2%
30
10.9
30.4%
8.7%
71.3%
21.7%
94%
44%
6%
0.9%
1.6%
44%
6.1%
Emphasis in RNTCP
20.9%
2.5
40.2
23.3
80%
29.1%
2.5%
1.7%
4.9%
1.6%
40%
6.7%
4.4%
2.5%
28.1%
26%
18%
66%
70.7%
63.3%
30%
66.6%
60.9%
67%
68.3%
74%
69.6%
Current TB programme
80.9%
July-September, 2016
199
200
References
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