Khan Javaid Ahmad, Akbani Farooq, Malik Amyn, Kazi Ghulam Nabi, Aslam Fawad, Hussain Syed Fayyaz
Pulmonary Section, Department of Medicine, The Aga Khan University Hospital, Karachi.
J Ayub Med Coll Abbottabad. 2005 Oct-Dec;17(4):31-5.
This study was undertaken to see whether providing free sputum microscopy services to private practitioners helps in case notification to the national tuberculosis control program. The knowledge, attitudes and practices of these practitioners regarding tuberculosis were also evaluated.
A questionnaire was administered to all the private practitioners practicing in a densely populated area of Karachi. They were asked to fill tuberculosis notification cards for the first three months and then for another three months when an incentive in the form of free sputum microscopy was provided to the practitioners.
Although the majority of the practitioners knew that cough, fever and weight loss are the main symptoms of tuberculosis, less than half knew that blood in sputum, poor appetite and chest pain could also be associated with tuberculosis. Only 66% of the practitioners indicated sputum microscopy as the preferred diagnostic method for tuberculosis. Only 50% of the practitioners self treated the patients, while the remaining half referred their patients to specialists. Around 80% of the practitioners were aware of the four first-line anti-tuberculosis drugs. Less than half of the practitioners considered sputum microscopy as the most useful follow-up investigation in a patient with pulmonary tuberculosis. Generally, there was a poor response in case notification by private practitioners on provision of free sputum microscopy.
An overwhelming majority of the practitioners had poor knowledge concerning the correct treatment practices in Tuberculosis. Providing sputum free microscopy does not significantly help in improving tuberculosis case notification. Strategies for public-private collaboration in tuberculosis control are needed.
本研究旨在探讨向私人执业医生提供免费痰涂片镜检服务是否有助于向国家结核病控制项目通报病例。同时还评估了这些执业医生对结核病的知识、态度和做法。
对在卡拉奇人口密集地区执业的所有私人执业医生进行问卷调查。要求他们在头三个月填写结核病通报卡，之后在向执业医生提供免费痰涂片镜检激励措施的另外三个月里继续填写。
虽然大多数执业医生知道咳嗽、发热和体重减轻是结核病的主要症状，但不到一半的人知道痰中带血、食欲不振和胸痛也可能与结核病有关。只有66%的执业医生将痰涂片镜检作为结核病的首选诊断方法。只有50%的执业医生自行治疗患者，其余一半则将患者转诊给专科医生。约80%的执业医生知道四种一线抗结核药物。不到一半的执业医生认为痰涂片镜检是肺结核患者最有用的随访检查。总体而言，在提供免费痰涂片镜检后，私人执业医生在病例通报方面的反应较差。
绝大多数执业医生对结核病的正确治疗方法了解不足。提供免费痰涂片镜检对改善结核病病例通报没有显著帮助。需要制定结核病控制公私合作的策略。
