Tuberculosis diagnostic practices among private medical practitioners of modern medicine in South India – A cross-sectional study

Abstract

Abstract Background: India has the highest tuberculosis (TB) burden in the world and account for nearly one-fourth of the global burden of TB. Although the Indian government provides a basic national health service, an increasingly large number of health-care interactions in India are with the physicians in the private sector. Objective: The objective is to study the TB diagnostic practices among private medical practitioners and to determine the association of diagnostic practices with socio-demographic factors, the Revised National Tuberculosis Control Programme (RNTCP) training status, and professional/academic qualification of private medical practitioners. Materials and Methods: The current study was a cross-sectional study conducted in the urban areas of Nalgonda district between October 2015 and September 2017. The study included all medical general practitioners (GP) and all specialists practicing internal medicine, chest medicine, and pediatrics, registered with the Indian Medical Association (IMA) branches and had a private practice in the study area. The study included 101 private medical practitioners from three IMA branches. The data on diagnostic practices of TB and RNTCP training status were collected by an interview using a pretested semi-structured questionnaire. The data analysis was done using Statistical Package for Social Sciences (SPSS) 19th version. Results: The majority of study participants in this study were GP, while specialists constituted a smaller portion. Most of these private medical practitioners opted sputum smear examination as their second preferred investigation after a chest X-ray. For the diagnosis of pulmonary TB, majority of the private practitioners preferred both sputum smears examination and chest X-ray. The private medical practitioners who had received the RNTCP training were employing sputum smear microscopy as a diagnostic tool and were also aware about notification of TB. Conclusions: Overreliance on chest X-ray as the investigation of choice to diagnose pulmonary TB and for follow-up. Training in RNTCP has a positive impact on practicing standard diagnostic practices, treatment, and referral practices on private medical practitioners.