Knowledge of Private Practitioners in Diagnosis and Management of Tuberculosis in Context of National Tuberculosis Elimination Program: A Cross-sectional Study from Gujarat, India

Abstract

Introduction: According to the World Health Organisation (WHO) global Tuberculosis (TB) report in 2019, 10 million new cases of Tuberculosis were detected worldwide, with India being one of the significant contributors. After achieving some milestones in TB control, the Government of India launched the National Tuberculosis Elimination Program (NTEP) to end TB by 2025. The role of private practitioners in the success of national health programs in India cannot be overemphasised, considering they cater to three times more population than the public sector. Aim: To understand the knowledge and perceived bottlenecks of private practitioners in achieving the goals of NTEP. Materials and Methods: A web-based cross-sectional survey was conducted by Community Medicine Department of Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India, using a semi-structured questionnaire among randomly selected 110 doctors affiliated with the Indian Medical Association (IMA) from October 2020 to December 2020. The survey questionnaire was prepared by an experienced TB Chest expert and consensually validated. It covered all aspects of the Revised National TB Control Program (RNTCP) training modules. Descriptive statistics (Mean, SD, Frequency (%), etc.,) along with independent t-test and Analysis of Variance (ANOVA) were used to present the profile of the participants as well as associated factors with the knowledge score. A p-value of less than 0.05 was considered statistically significant. Results: Out of 110 invitations, 97 (88%) doctors responded. Most of the respondents were males 71 (73%), specialists (81, 83.5%), and had been practicing for more than 20 years (66, 68%). The mean (SD) score was 3.31±1.27 out of six for Multiple Choice Questions and 8.05±3.77 out of 15 for True/False questions. Only 37 (38%) participants scored above the passing benchmark of 60%, indicating a substantial knowledge gap. A higher Outpatient Department (OPD) strength (>50 patients per day) and attending a TB training program by the Government were associated with a higher total score (p=0.018). Conclusion: The knowledge of private practitioners about the diagnosis and management of Tuberculosis was found to be suboptimal. Participants also expressed a few systemic challenges like poor communication and the complexity of the system in the notification of Tuberculosis cases. Innovative training programs, proper communication, and supportive supervision will help in engaging the private practitioners to achieve TB elimination goals.