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Bhalla BB, Chadha V, Gupta J, Nagendra N, Praseeja P, Anjinappa S, Ahmed J, Srivastava R, Kumar P. Knowledge of private practitioners of Bangalore city in diagnosis, treatment of pulmonary tuberculosis and compliance with case notification. ACTA ACUST UNITED AC 2018; 65:124-129. [DOI: 10.1016/j.ijtb.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 09/28/2017] [Accepted: 01/05/2018] [Indexed: 12/01/2022]
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Javaid A, Ahmad N, Khan AH, Shaheen Z. Applicability of the World Health Organization recommended new shorter regimen in a multidrug-resistant tuberculosis high burden country. Eur Respir J 2016; 49:13993003.01967-2016. [DOI: 10.1183/13993003.01967-2016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/06/2016] [Indexed: 11/05/2022]
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Hoffman SJ, Guindon GE, Lavis JN, Randhawa H, Becerra-Posada F, Dejman M, Falahat K, Malek-Afzali H, Ramachandran P, Shi G, Yesudian CAK. Surveying the Knowledge and Practices of Health Professionals in China, India, Iran, and Mexico on Treating Tuberculosis. Am J Trop Med Hyg 2016; 94:959-970. [PMID: 26903613 PMCID: PMC4856627 DOI: 10.4269/ajtmh.15-0538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/04/2016] [Indexed: 01/05/2023] Open
Abstract
Research evidence continues to reveal findings important for health professionals' clinical practices, yet it is not consistently disseminated to those who can use it. The resulting deficits in knowledge and service provision may be especially pronounced in low- and middle-income countries that have greater resource constraints. Tuberculosis treatment is an important area for assessing professionals' knowledge and practices because of the effectiveness of existing treatments and recognized gaps in professionals' knowledge about treatment. This study surveyed 384 health professionals in China, India, Iran, and Mexico on their knowledge and practices related to tuberculosis treatment. Few respondents correctly answered all five knowledge questions (12%) or self-reported performing all five recommended clinical practices "often or very often" (3%). Factors associated with higher knowledge scores included clinical specialization and working with researchers. Factors associated with better practices included training in the care of tuberculosis patients, being based in a hospital, trusting systematic reviews of randomized controlled double-blind trials, and reading summaries of articles, reports, and reviews. This study highlights several strategies that may prove effective in improving health professionals' knowledge and practices related to tuberculosis treatment. Facilitating interactions with researchers and training in acquiring systematic reviews may be especially helpful.
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Affiliation(s)
- Steven J. Hoffman
- Global Strategy Lab, Faculty of Law, University of Ottawa, Ottawa, Ontario, Canada; Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada; Pan American Health Organization, Washington, DC; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Valmar International, Mumbai, India; Department of Policy Research, Chinese Peasants' and Workers' Democratic Party, Beijing, China; Health Systems Consultant and Trainer, Mumbai, India
| | | | | | | | | | | | | | | | - Parasurama Ramachandran
- Global Strategy Lab, Faculty of Law, University of Ottawa, Ottawa, Ontario, Canada; Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada; Pan American Health Organization, Washington, DC; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Valmar International, Mumbai, India; Department of Policy Research, Chinese Peasants' and Workers' Democratic Party, Beijing, China; Health Systems Consultant and Trainer, Mumbai, India
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Ahmad N, Javaid A, Sulaiman SAS, Ming LC, Ahmad I, Khan AH. Resistance patterns, prevalence, and predictors of fluoroquinolones resistance in multidrug resistant tuberculosis patients. Braz J Infect Dis 2016; 20:41-7. [PMID: 26626164 PMCID: PMC9425347 DOI: 10.1016/j.bjid.2015.09.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/30/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Fluoroquinolones are the backbone of multidrug resistant tuberculosis treatment regimens. Despite the high burden of multidrug resistant tuberculosis in the country, little is known about drug resistance patterns, prevalence, and predictors of fluoroquinolones resistance among multidrug resistant tuberculosis patients from Pakistan. OBJECTIVE To evaluate drug resistance patterns, prevalence, and predictors of fluoroquinolones resistance in multidrug resistant tuberculosis patients. METHODS This was a cross-sectional study conducted at a programmatic management unit of drug resistant tuberculosis, Lady Reading Hospital Peshawar, Pakistan. Two hundred and forty-three newly diagnosed multidrug resistant tuberculosis patients consecutively enrolled for treatment at study site from January 1, 2012 to July 28, 2013 were included in the study. A standardized data collection form was used to collect patients' socio-demographic, microbiological, and clinical data. SPSS 16 was used for data analysis. RESULTS High degree of drug resistance (median 5 drugs, range 2-8) was observed. High proportion of patients was resistant to all five first-line anti-tuberculosis drugs (62.6%), and more than half were resistant to second line drugs (55.1%). The majority of the patients were ofloxacin resistant (52.7%). Upon multivariate analysis previous tuberculosis treatment at private (OR=1.953, p=0.034) and public private mix (OR=2.824, p=0.046) sectors were predictors of ofloxacin resistance. CONCLUSION The high degree of drug resistance observed, particularly to fluoroquinolones, is alarming. We recommend the adoption of more restrictive policies to control non-prescription sale of fluoroquinolones, its rational use by physicians, and training doctors in both private and public-private mix sectors to prevent further increase in fluoroquinolones resistant Mycobacterium tuberculosis strains.
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Affiliation(s)
- Nafees Ahmad
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
| | - Arshad Javaid
- Department of Pulmonology, Postgraduate Medical Institute, Peshawar, Pakistan
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Long Chiau Ming
- Unit for Medication Outcomes Research and Education, School of Medicine, Division of Pharmacy, University of Tasmania, Australia
| | - Izaz Ahmad
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Theory-Informed Interventions to Improve the Quality of Tuberculosis Evaluation at Ugandan Health Centers: A Quasi-Experimental Study. PLoS One 2015; 10:e0132573. [PMID: 26172948 PMCID: PMC4501843 DOI: 10.1371/journal.pone.0132573] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 06/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) remains under-diagnosed in many countries, in part due to poor evaluation practices at health facilities. Theory-informed strategies are needed to improve implementation of TB evaluation guidelines. We aimed to evaluate the impact of performance feedback and same-day smear microscopy on the quality of TB evaluation at 6 health centers in rural Uganda. METHODS We tested components of a multi-faceted intervention to improve adherence to the International Standards for Tuberculosis Care (ISTC): performance feedback and same-day smear microscopy. The strategies were selected based on a qualitative assessment guided by the Theory of Planned Behavior and the PRECEDE model. We collected patient data 6 months before and after the introduction of each intervention component, and compared ISTC adherence in the pre- and post-intervention periods for adults with cough ≥ 2 weeks' duration. RESULTS The performance feedback evaluation included 1,446 adults; 838 (58%) were evaluated during the pre-intervention period and 608 (42%) during the post-intervention period. Performance feedback resulted in a 15% (95%CI +10% to +20%, p<0.001) increase in the proportion of patients receiving ISTC-adherent care. The same-day microscopy evaluation included 1,950 adults; 907 (47%) were evaluated during the pre-intervention period and 1,043 (53%) during the post-intervention period. Same-day microscopy was associated with a 14% (95%CI +10% to +18%, p<0.001) increase in the proportion of patients receiving ISTC-adherent care. CONCLUSIONS Performance feedback and same-day microscopy should be considered along with ISTC training as part of a multi-faceted intervention to improve the quality of TB evaluation in other high TB burden countries.
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Cattamanchi A, Miller CR, Tapley A, Haguma P, Ochom E, Ackerman S, Davis JL, Katamba A, Handley MA. Health worker perspectives on barriers to delivery of routine tuberculosis diagnostic evaluation services in Uganda: a qualitative study to guide clinic-based interventions. BMC Health Serv Res 2015; 15:10. [PMID: 25609495 PMCID: PMC4307676 DOI: 10.1186/s12913-014-0668-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 12/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies of the quality of tuberculosis (TB) diagnostic evaluation of patients in high burden countries have generally shown poor adherence to international or national guidelines. Health worker perspectives on barriers to improving TB diagnostic evaluation are critical for developing clinic-level interventions to improve guideline implementation. METHODS We conducted structured, in-depth interviews with staff at six district-level health centers in Uganda to elicit their perceptions regarding barriers to TB evaluation. Interviews were transcribed, coded with a standardized framework, and analyzed to identify emergent themes. We used thematic analysis to develop a logic model depicting health system and contextual barriers to recommended TB evaluation practices. To identify possible clinic-level interventions to improve TB evaluation, we categorized findings into predisposing, enabling, and reinforcing factors as described by the PRECEDE model, focusing on potentially modifiable behaviors at the clinic-level. RESULTS We interviewed 22 health center staff between February 2010 and November 2011. Participants identified key health system barriers hindering TB evaluation, including: stock-outs of drugs/supplies, inadequate space and infrastructure, lack of training, high workload, low staff motivation, and poor coordination of health center services. Contextual barrier challenges to TB evaluation were also reported, including the time and costs borne by patients to seek and complete TB evaluation, poor health literacy, and stigma against patients with TB. These contextual barriers interacted with health system barriers to contribute to sub-standard TB evaluation. Examples of intervention strategies that could address these barriers and are related to PRECEDE model components include: assigned mentors/peer coaching for new staff (targets predisposing factor of low motivation and need for support to conduct job duties); facilitated workshops to implement same day microscopy (targets enabling factor of patient barriers to completing TB evaluation), and recognition/incentives for good TB screening practices (targets low motivation and self-efficacy). CONCLUSIONS Our findings suggest that health system and contextual barriers work together to impede TB diagnosis at health centers and, if not addressed, could hinder TB case detection efforts. Qualitative research that improves understanding of the barriers facing TB providers is critical to developing targeted interventions to improve TB care.
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Affiliation(s)
- Adithya Cattamanchi
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, Room 5K1, 1001 Potrero Avenue, San Francisco, California, 94110, USA.
- Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA.
- School of Medicine, University of California San Francisco, San Francisco, California, USA.
- Infectious Diseases Research Collaboration, Kampala, Uganda.
| | - Cecily R Miller
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, Room 5K1, 1001 Potrero Avenue, San Francisco, California, 94110, USA.
- Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
| | - Asa Tapley
- School of Medicine, University of California San Francisco, San Francisco, California, USA.
| | | | - Emmanuel Ochom
- Infectious Diseases Research Collaboration, Kampala, Uganda.
| | - Sara Ackerman
- Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA.
| | - J Lucian Davis
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, Room 5K1, 1001 Potrero Avenue, San Francisco, California, 94110, USA.
- Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA.
- School of Medicine, University of California San Francisco, San Francisco, California, USA.
- Infectious Diseases Research Collaboration, Kampala, Uganda.
| | - Achilles Katamba
- School of MedicineMakerere University College of Health Sciences, Kampala, Uganda.
- Infectious Diseases Research Collaboration, Kampala, Uganda.
| | - Margaret A Handley
- School of Medicine, University of California San Francisco, San Francisco, California, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, California, USA.
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Affiliation(s)
- Mishal S Khan
- Communicable Diseases Policy Research Group, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117597.
| | - Richard J Coker
- Communicable Diseases Policy Research Group, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117597
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Zheng X, Zhong F, Zhang X. Doctors' compliance with national guidelines and clinical pathway on the treatment of tuberculosis inpatients in Hubei, China. J Eval Clin Pract 2014; 20:288-93. [PMID: 24690026 DOI: 10.1111/jep.12127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2014] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The Ministry of Health in China has enacted a revised National Tuberculosis Control Program (NTP) guidelines and clinical pathway (CP) on new smear-positive pulmonary tuberculosis (TB) inpatients to improve the quality of TB care and asked doctors' compliance to them on the treatment of TB inpatients. However, it remains unknown whether doctors adhere to them well. So this study focuses on evaluating the doctors' compliance with them in one representative TB hospital for medical quality improvement. METHODS A hospital-based retrospective study involving all medical records of newly diagnosed smear-positive pulmonary TB inpatients from July 2011 to July 2013. Analysis indicators including adequate drug regimens rate, adequate drug dosages rate and adequate length of hospital stay rate were chosen to assess doctors' compliance with NTP guidelines and CP on the treatment of new smear-positive pulmonary TB inpatients. The optimal value of these indicators is 100%. RESULTS Of the 334 inpatients selected, the rate of adequate drug regimens prescribed is 26.95% (90/334), and the rate of adequate drug dosages is 0% (0/90). For the dosage of single drug, the rates of adequate dosage of isoniazid, rifampicin, pyrazinamide and ethambutol are 24.44% (22/90), 85.56% (77/90), 70% (63/90) and 13.33% (12/90). Moreover, 75.56% (68/90) of isoniazid was prescribed too high and 83.34% (75/90) of ethambutol was prescribed too low. The rate of adequate length of hospital stay provided is 28.44% (95/334). CONCLUSION Doctors' compliance with NTP guidelines and CP on new smear-positive pulmonary TB inpatients is depressed and needs improvement.
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Affiliation(s)
- Xiaofei Zheng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Naseer M, Khawaja A, Pethani AS, Aleem S. How well can physicians manage tuberculosis? A public-private sector comparison from Karachi, Pakistan. BMC Health Serv Res 2013; 13:439. [PMID: 24156568 PMCID: PMC3816786 DOI: 10.1186/1472-6963-13-439] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 10/09/2013] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis (TB) is endemic in Pakistan which ranks fifth amongst the twenty two countries designated to be highly burdened by TB according to the World Health Organization. However, there is paucity of data regarding the knowledge of diagnosis of TB and its management amongst public and private practitioners. In this study, we endeavor to identify this gap in knowledge regarding the diagnosis and management of TB between public and private doctors and the factors affecting these knowledge scores in urban Pakistan. Methods This cross sectional survey was conducted between June and December 2011. Doctors from public hospitals, private hospitals and private clinics scattered in all eighteen towns of Karachi were included in the study. Qualified MBBS doctors working in any specialty were eligible to participate whereas doctors working in both the public and private sectors were excluded from the study. Vignette based clinical scenarios were given to assess the knowledge score regarding the diagnosis and management of TB. Results A total of 196 doctors participated in the study. There was a significant difference between private and public physicians in terms of age and years of practice (p-value <0.05). Significant differences in the proportion of knowledge scores were observed between the public and private doctors and National TB Control Program trained and untrained doctors in Karachi. Factors associated with inadequate knowledge scores were being female gender [OR: 2.76 (95% CI: 1.418-5.384)], private employment status [OR: 1.50 (95% CI: 1.258-2.439)], and not trained by NTP [OR: 2.98 (95% CI: 1.286-3.225)] on multivariate logistic regression analysis. Conclusion It is concluded that a knowledge gap exists between the public and private doctors in Karachi. Strengthening of currently implemented public private mix model along with improvement in the trainings of public and private practitioners is highly recommended to control TB in Pakistan.
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Affiliation(s)
- Maliha Naseer
- Division of Environmental Health Sciences, Department of Community Health, Sciences, The Aga Khan University Hospital, Stadium Road, P,O, Box-3500, Karachi (74800), Pakistan.
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Baloch NA, Pai M. Tuberculosis control: business models for the private sector. THE LANCET. INFECTIOUS DISEASES 2012; 12:579-80. [PMID: 22704777 DOI: 10.1016/s1473-3099(12)70122-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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McQuade Billingsley K, Smith N, Shirley R, Achieng L, Keiser P. A quality assessment tool for tuberculosis control activities in resource limited settings. Tuberculosis (Edinb) 2011; 91 Suppl 1:S49-53. [PMID: 22088324 DOI: 10.1016/j.tube.2011.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tuberculosis (TB) is a significant problem, infecting nearly 9 million new patients per year and killing about 2 million a year. The primary means with which to affect TB globally are to decrease transmission locally, mainly by effective identification, diagnosis, and treatment of infectious TB patients. Therefore, quality assurance of TB control efforts at the local level is essential. This study describes the creation of a data extraction tool for retrospective chart review based on the International Standards for TB Care, 2009 for the assessment of TB control programs located in resource limited settings. The tool was field tested at a rural mission hospital in central Kenya. Results were used by host site staff to develop a quality improvement plan. The process prompted revision of the tool to clarify questions and answers. This is a tool that can be used in resource limited settings for data collection to assess the quality of TB care and to inform the design, implementation, and further assessment of future quality improvement initiatives.
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Knowledge and Attitude of General Practitioners Regarding Autism in Karachi, Pakistan. J Autism Dev Disord 2010; 41:465-74. [DOI: 10.1007/s10803-010-1068-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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