Knowledge and practice of qualified physicians regarding management of tuberculosis in Bangladesh: are they following the national guidelines?

  From a forthcoming paper

This study explored current knowledge and practice of in-service trainee physicians (interns) and general practice physicians (GPs) regarding management of tuberculosis cases according to the TB DOTS (Directly Observed Treatment, Short course) guidelines of the National TB control Programme (NTP). The study was conducted during first quarter of 2013 in conveniently selected 20 public and private medical college hospitals. Relevant data were collected from interns working in these hospitals (n=1,474) and GPs (n=539) practicing within half kilometer distance of these hospitals, using a self-administered questionnaire. About 75% physicians were  knowing about community based DOTS programme, but only 36% knew the details. Around 40-60% of the physicians treated TB suspects with non-specific antibiotics, 39-44% advised for further tests and a 37-50% did not refer TB patients and suspects to the nearest DOTS corner. Around 39% of the physicians perceived that current curriculum was not conducive for managing TB suspects and patients, and 75% reported that they sought TB information beyond classroom. 

A score was constructed with 17 variables pertaining to knowledge on TB and its management. Sixty-one percent of interns had adequate knowledge (mean scores≥ 10.82) as against 44% of GPs (p<0.01). Logistic regression analysis found physicians more likely to be knowledgeable when they were aware of NTP guidelines (AOR 2.16, 95% CI: 1.36, 3.44), had access to multiple sources of TB information (AOR 1.43, 95%CI: 1.10, 2.36), and longer hours of exposure to TB information (for>6 hours, AOR 3.10, 95% CI: 2.37, .07).  Thus, there exists a wide gap between NTP guidelines and practices of the physicians outside the purview of NTP. To improve TB case detection and management by DOTS approach, NTP should take appropriate measures to raise awareness on, and ensure commitment of these physicians to follow, the DOTS guidelines including measures to update the under-graduate TB curriculum.