Surveying the Knowledge and Practices of Health Professionals in China, India, Iran, and Mexico on Treating Tuberculosis

Development and validation of a health practitioner survey on ocular allergy

Survey studies have played a significant role in understanding the gaps in the knowledge and practices of health practitioners. However, there have been no such survey studies on Ocular Allergy (OA). Thus, the purpose of this study was to develop and validate a survey on OA to better understand the gaps in the diagnostic, treatment, and collaborative care approaches of health practitioners in OA. The survey is titled "Survey on Ocular Allergy for Health Practitioners (SOAHP)". SOAHP was developed in a five-stage process. First, item extraction via the use of a literature review, second, face and content validity, third, a pilot study, fourth, test-retest reliability, and fifth, finalisation of the survey. 65 items under 6 domains were initially generated in the item extraction phase. Content validity was conducted on 15 experts in the field. This was conducted twice to reach consensus whereby items and domains were added, edited, kept, or removed, resulting in 50 items under 7 domains. The pilot study was conducted on 15 participants from the five relevant health practitioner fields (Allergists/Immunologists, General Practitioners (GPs), Ophthalmologists, Optometrists and Pharmacists). This altered the survey further to 40 items under 7 domains. Test-retest reliability was conducted on 25 participants from the five health practitioner fields. Reliability was moderate to almost perfect for most (97%) investigated items. The finalised survey was 40 items under 7 domains. SOAHP is the first survey created to assess diagnostic, treatment and collaborative care approaches of Allergists/Immunologists, GPs, Ophthalmologists, Optometrists and Pharmacists on OA. SOAHP will be a useful tool in clinical research on OA.

Needs assessment of a pythiosis continuing professional development program

BACKGROUND

Pythiosis is a rare disease with high mortality, with over 94% of cases reported from Thailand and India. Prompt diagnosis and surgery improves patient outcomes. Therefore, continuing professional development (CPD) is essential for early recognition. However, a needs assessment related to a pythiosis CPD program has not been performed.

OBJECTIVES

We conducted a needs assessment to develop a pythiosis CPD program.

PATIENTS/METHODS

We conducted a survey study with 267 King Chulalongkorn Memorial Hospital residents (141 internal medicine (IM) residents and 126 surgery residents). A 30-item survey consisting of a knowledge assessment, demographic section, and an attitudes portion was distributed both electronically and via paper. The data was analyzed with descriptive and inferential statistics.

RESULTS

Sixty-seven percent completed the survey (110/141 IM residents, 70/126 surgery residents). The mean score [95% confidence interval] on the knowledge assessment was 41.67% [39.64%-43.69%] across all objectives. The three domains with the highest scores were pythiosis risk factors (67.22% correct), microbiologic characteristics (50.83%), and radiographic interpretation (50.56%). The three domains with the lowest scores were laboratory investigation (15.00%), epidemiology (29.17%), and symptomatology (30.83%). Most participants noted that the program should be online with both synchronous and asynchronous sessions, with a preferred length of 60-90 minutes per session.

CONCLUSION

The pythiosis CPD program should emphasize education regarding symptomatology, laboratory investigation, and epidemiology, all of which are critical for the early detection of pythiosis to decrease mortality from this devastating disease. Most respondents felt this program was necessary and should be implemented in a virtual blended format.

Bridging the Gap: A Strategic Approach to Upscale Knowledge Among Diverse Healthcare Providers for Effective Tuberculosis Management in Gujarat, India

INTRODUCTION

Tuberculosis (TB) remains a global health challenge, particularly in low- and middle-income countries. Knowledge gaps among healthcare providers (HCPs) significantly impact TB management, hindering timely care-seeking and effective interventions.

OBJECTIVE

The primary objective was to assess knowledge gaps among 3086 HCPs engaged in the National Tuberculosis Elimination Program (NTEP) implementation in Gujarat, India. The study provided a platform to develop and implement cadre-specific training modules to address identified knowledge deficiencies and enhance TB management.

METHODOLOGY

The study was conducted in two phases. Phase one was designed as a cross-sectional assessment to identify the knowledge gaps. Phase two involved the development of cadre-specific training modules based on identified deficiencies in the knowledge, crafted with collaboration from an expert panel. The training impact will be evaluated after completion of the training of all cadres through a comprehensive assessment.

RESULTS

Out of 3086 assessed HCPs, 26% scored below the passing benchmark, revealing significant knowledge gaps. The variations were observed among and within the same cadres, with the accredited social health activists (ASHAs) and community health workers showing higher proficiency while pharmacists and medical officers showed lower proficiency. The cadre-specific training modules and training cascade were designed to address these gaps and improve TB-related knowledge and skills.

CONCLUSION

The study underscores the critical need for targeted interventions to address knowledge gaps among HCPs involved in TB control. The customized HCP-specific training programs are recommended to enhance knowledge, improve TB management, and contribute to national TB elimination goals.

Health Care Providers' Knowledge of Tuberculosis and Diabetes Mellitus Comorbidity in Lubumbashi, Democratic Republic of the Congo (DRC)

Background

Tuberculosis-Diabetes mellitus (TB-DM) co-morbidity is a growing scourge in the world. The new approaches and interventions for TB control implemented by the Tuberculosis National Control Program (TNCP) in DRC require the involvement of health care providers for their success.

Objective

The objective of this study is to assess the knowledge of health care provider on different aspects of the management of TB-DM co-morbidity and to compare this knowledge according to the health care system, the type of providers and the number of years of experience.

Methods

Cross-sectional and analytic study was conducted in 11 health care facilities in the Lubumbashi Health District, selected by reasoned choice, and an electronic questionnaire was administered to health care providers. These providers were interviewed on the different aspects of the management of the TB-DM comorbidity. The data were presented and compared in relation to knowledge about TB, DM, and TB-DM comorbidity.

Results

A total of 113 providers were interviewed, predominantly males and physicians. Questions related to knowledge about DM were better answered. Doctors compared to paramedics; tertiary-level providers compared to secondary-level providers had better responses to the different questions. There is a statistically significant correlation between the level of knowledge of TB, DM and the type of health care provider, the number of years of experience.

Conclusion

The present study shows that there are gaps in the knowledge of our health care providers and community members on the recommendations of the DRC TB guidelines (Programme AntiTuberculeux Intégré 5: PATI 5) in general and on the management of TB-DM. It is therefore important and necessary to put in place strategies to improve this level of knowledge, which will focus on the extension of the guidelines, the awareness and the training of the stakeholders involved in the control.

Eosinophilia attention, diagnosis, treatment, and awareness in physicians: a cross-sectional survey

Background

Patients with incidental eosinophilia is becoming increasingly common in clinical practice. But it remains challenging to diagnose and treat owing to its complex etiology. The awareness of physicians and the strategies of diagnosis and treatment toward eosinophilia are still unclear.

Objective

We aimed to evaluate attention, diagnosis, treatment, and awareness of eosinophilia among physicians, as well as factors influencing clinical practice, and to find ways to improve the efficacy of this disease.

Design

This is a cross-sectional survey.

Methods

A cross-sectional study was conducted from 1 to 4 June 2021 in a tertiary hospital. Self-administered and validated electronic questionnaire was used to investigate the attention toward eosinophilia, the strategies of diagnosis and treatment, and the awareness in physicians.

Results

A total of 607 valid questionnaires were collected, with a response rate of 84.5%. Among the responders, 65.4% of physicians claimed to be familiar with patients with eosinophilia but only 11.0% of them had read the relevant guidelines or expert consensus. Among 207 physicians who had ever diagnosed patients with eosinophilia, only 19.4% had performed detailed examinations. The accuracy of awareness questions was 1.6-53.5%, and only 26.5% of physicians had high levels of awareness. An increase in the awareness level of up to 2.82 folds was seen among physicians with factors such as job title, encountering patients with eosinophilia, linking patients' conditions to peripheral blood eosinophil count, and paying attention to guidelines.

Conclusion

This study highlighted the importance of raising awareness and knowledge of eosinophilia among physicians in China. More works on education about eosinophilia guideline are needed, which may help physicians make decision with more benefits to patients.

Evaluación de una estrategia educativa sobre tuberculosis y diabetes mellitus para personal de salud de atención primaria en México

Antecedentes. En la literatura se ha identificado una asociación fuerte entre la tuberculosis y la diabetes mellitus, asimismo, algunos estudios han reportado un nivel bajo de conocimiento de esta relación por parte del personal de salud. Objetivos. Explorar el cambio en los conocimientos y actitudes del personal de salud de atención primaria sobre epidemiología y políticas públicas de la asociación de Tuberculosis (TB) y Diabetes (DM) después de una sesión de entrenamiento. Material y Métodos. Diseño de medición pre-post intervención de un solo grupo de 31 participantes, mediante un cuestionario estructurado autodiligenciado construido ad hoc. Se utilizaron las pruebas de rangos signados de Wilcoxon para estimar diferencias entre las evaluaciones pre y post, análisis de correlaciones y la prueba Chi cuadrada. Se consideró un conocimiento adecuado a puntajes mayores a 70%. Resultados.El 12,9% de los participantes tuvieron conocimientos adecuados en la evaluación previa, mientras que el 16,1% en la evaluación post. Hubo un aumento porcentual en el nivel de conocimientos (pre= 53,43% versus post= 58,27%) y actitudes (pre=89,56% versus post=96,29%); sin embargo, fue estadísticamente significativo sólo para las actitudes (p= 0.000). Conclusión. La evaluación inicial (pre) muestra la importancia y necesidad de entrenar al personal de salud para lograr el abordaje integral de un paciente con la  asociación TB-DM.

'We are not aware of notification of tuberculosis': A mixed-methods study among private practitioners from western India

BACKGROUND

Implementing the Standards for tuberculosis care in India (STCI) guidelines in the private sector is vital. This study attempted to estimate the knowledge and practices regarding STCI guidelines among private practitioners and to explore the reasons and solutions for low tuberculosis (TB) notification rates.

METHODS

We conducted a cross-sectional study for assessing the knowledge and practices of the STCI guidelines among 100 full-time allopathic private practitioners in Bhavnagar (in western part of India) from September 2018 to January 2019. Knowledge and practice were categorised as good or poor by assigning scores to the responses to a questionnaire based on the STCI guidelines. It was followed by two focus group discussions to explore the reasons and solutions for low notification rates of TB as perceived by private practitioners.

RESULTS

Among the 100 private practitioners, 55% had good knowledge, and 41% had good practice regarding the STCI guidelines; 69% knew about the gazette notification of mandatory notification of TB, and 58% were notifying TB cases to the government. Lack of awareness about the process as well as incentives for notification, time constraints and infrequent visits by health workers were the main reasons perceived by private practitioners for not notifying TB cases to the government. The critical solutions suggested by them were creating awareness regarding the notification process as well as incentives, increasing health worker visits and use of social media for notification.

CONCLUSION

Only about half of private practitioners follow the STCI guidelines for TB care, and the notification rates are low in our setting. Regular sensitisation programs need to be arranged for private practitioners to create awareness on TB notification.

Self-reported tuberculosis in India: evidence from NFHS-4

This paper reports self-reported levels and socioeconomic patterns in the distribution of tuberculosis (TB) cases in India, based on information collected under the National Family Health Survey-Round 4 (NFHS-4, 2014-2015). Based on a nationally representative sample of over 600 000 households comprising of about 2.9 million individuals, we estimate a self-reported point prevalence of 304 TB cases per 100 000 population, with a higher burden evident among households with poorer wealth status and among individuals with low educational levels. About 55% of the reported TB cases sought treatment from public services, with higher public service use observed in West Bengal, Kerala and Tamil Nadu. However, more than a third of the patients from poorest groups sought treatment from private sources. Results indicate a significant proportion of the general population, including those with completed school-level education continue to have incomplete knowledge on the routes of the spread of TB infection. Social stigma, such as reluctance to disclose about a family member being infected with the disease to others, also remains high. Imminent need for appropriate policy mechanisms for involving the private sector and raising consciousness through suitable advocacy measures is re-emphasised.

Educational Needs Assessment of General Practitioners in Tuberculosis Control and Management

BACKGROUND

Tuberculosis is one of the top 10 causes of mortality worldwide. It is also the leading cause of death in HIV-positive patients. In this study, we aimed to assess the educational needs of general practitioners regarding tuberculosis in the North Health Center of Tehran, Iran.

MATERIALS AND METHODS

This quantitative and qualitative study was conducted in 2017. In the quantitative phase, 31 general practitioners from the North Health Center of Tehran were included. The educational needs assessment was performed using the knowledge assessment and self-assessment scales. Data were entered in SPSS version 21 and analyzed using descriptive tests and Pearson's correlation coefficient test. In the qualitative phase, data were collected by interviewing six managers of tuberculosis monitoring program and analyzed using the content analysis method.

RESULTS

The mean score of the knowledge assessment scale was 22.8±6.4. The most and the least important educational needs were related to treatment and general information about tuberculosis, respectively. Moreover, tuberculosis treatment and general information about tuberculosis were the most and the least important educational needs in the self-assessment scale, respectively. There was a poor correlation between the mean scores of self-assessment scale and knowledge assessment scale regarding tuberculosis prevention (P=0.01, r=0.27). Also, a moderate correlation was found regarding tuberculosis screening (P=0.001, r=0.56). However, no significant correlation was found in terms of general information (P=0.31), diagnosis (P=0.43), and treatment (P=0.29) of tuberculosis. Five major themes were extracted in the qualitative phase of the study, including "training time", "educational content", "educational references", "teaching method", and "organizational factors".

CONCLUSION

An appropriate educational program should be developed for general practitioners in form of continuing education and educational reform.

Tuberculosis knowledge, attitude and practice among healthcare workers during the 2016 Hajj

BACKGROUND

Given the inherent characteristics of the Hajj pilgrimage, the event is a risk for tuberculosis (TB) infection. Early diagnosis and appropriate management of TB cases by knowledgeable and skilled healthcare workers (HCWs) are key in improving patients' outcome and preventing transmission during the Hajj mass gathering and globally.

METHOD

We conducted a cross-sectional study to assess knowledge, attitude and practice (KAP) of HCWs deployed during the 2016 Hajj regarding TB and its management using an anonymous self-administered questionnaire.

RESULTS

Data was collected from 540 HCWs from 13 hospitals. HCWs originated from 17 countries and included physicians, nurses and other non-administrative HCWs. Nearly half of HCWs declared having experience dealing with TB patients. In general, HCWs had average knowledge (mean knowledge score of 52%), above average attitude (mean attitude score of 73%) and good practice (mean practice score of 85%) regarding TB, based on our scoring system and cut-off points. Knowledge gaps were identified in relation to the definition of MDR-/XDR-TB and LTBI, smear microscopy results, length of standard TB treatment for drug-sensitive TB, 2nd line anti-TB drugs, BCG vaccination, and appropriate PPE to be used with active PTB patients. Poor attitudes were found in relation to willingness to work in TB clinic/ward and to the management and treatment of TB patients. Poor practices were reported for commencing anti-TB treatment on suspected TB cases before laboratory confirmation and not increasing natural ventilation in TB patients' rooms. Age, gender, nationality, occupation, length of work experience and experience dealing with TB patients were associated with knowledge scores. Age and occupation were associated with attitude scores while length of work experience and occupation were associated with practice scores. There was a weak but statistically significant positive correlation between score for knowledge and attitude (rs = 0.11, p = 0.009) and attitude and practice (rs = 0.13, p = 0.002).

CONCLUSIONS

While the results of the study are encouraging, important knowledge gaps and some poor attitudes and practices regarding TB were identified among HCWs during Hajj. This calls for multifaceted interventions to improve HCWs KAP regarding TB including tailored, periodic TB education and training aimed at boosting knowledge and improving behaviour.

Knowledge and determinants regarding tuberculosis among medical students in Hunan, China: a cross-sectional study

Background

Tuberculosis (TB) is one of the most common infectious diseases worldwide. Insufficient TB knowledge may increase the risk of contracting the disease among medical students. The purpose of this study was to assess the level of TB knowledge and analyse related determinants among medical students.

Methods

A cross-sectional study was performed among final-year medical students from three main undergraduate medical universities in Hunan Province. TB knowledge, attitude and practice were assessed using a questionnaire. A t-test and multiple linear regression analysis were conducted to explore the association between TB knowledge and influencing factors.

Results

The total mean percentage of correct answers for TB knowledge was 44.4% (SD 13.5%), including 52.5% (SD 16.8%) for epidemiology and prevention, 35.7% (SD 16.1%) for diagnosis, and 47.5% (SD 22.7%) for treatment. Medical students who reported observing at least one TB case and an X-ray of a TB patient had a higher percentage of correct answers for epidemiology and prevention (54.4% vs 43.9%, p < 0.001; 54.3% vs 42.1%, p < 0.001), diagnosis (37.2% vs 29.0%, p < 0.001; 37.1% vs 27.5%, p < 0.001), treatment (50.0% vs 36.0%, p < 0.001; 49.5% vs 35.7%, p < 0.001) and total score (46.2% vs 36.2, p < 0.001; 46.0% vs 34.7%, p < 0.001). Older medical students (≥23 years) had greater knowledge than younger medical students (< 23 years) regarding diagnosis (37.2% vs 31.7%, p < 0.001). The multivariable linear regression analysis determined an association between observing at least one TB case and an X-ray of a TB patient and greater knowledge of epidemiology and prevention (β = 5.6, 95% CI: 2.3, 8.9; β = 8.2, 95% CI: 4.6, 11.8), diagnosis (β = 3.9, 95% CI: 0.8, 7.1; β = 5.7, 95% CI: 2.2, 9.2) and treatment (β = 10.1, 95% CI: 5.6, 14.5; β = 7.0, 95% CI: 2.2, 11.8) and a higher total score (β = 5.5, 95% CI: 2.9, 8.1; β = 6.6, 95% CI: 3.8, 9.5). Moreover, an older age (≥23 years) was associated with more accurate knowledge of diagnosis (β = 3.9, 95% CI: 1.8, 6.1) and a higher total score (β = 2.8, 95% CI: 1.1, 4.6).

Conclusion

Poor TB knowledge was observed among medical students, which implied a need to innovate our current infectious disease curriculum to promote TB knowledge and practices among medical students.

Clinicians' knowledge and practices regarding family planning and intrauterine devices in China, Kazakhstan, Laos and Mexico

BACKGROUND

It is widely agreed that the practices of clinicians should be based on the best available research evidence, but too often this evidence is not reliably disseminated to people who can make use of it. This "know-do" gap leads to ineffective resource use and suboptimal provision of services, which is especially problematic in low- and middle-income countries (LMICs) which face greater resource limitations. Family planning, including intrauterine device (IUD) use, represents an important area to evaluate clinicians' knowledge and practices in order to make improvements.

METHODS

A questionnaire was developed, tested and administered to 438 individuals in China (n = 115), Kazakhstan (n = 110), Laos (n = 105), and Mexico (n = 108). The participants responded to ten questions assessing knowledge and practices relating to contraception and IUDs, and a series of questions used to determine their individual characteristics and working context. Ordinal logistic regressions were conducted with knowledge and practices as dependent variables.

RESULTS

Overall, a 96 % response rate was achieved (n = 438/458). Only 2.8 % of respondents were able to correctly answer all five knowledge-testing questions, and only 0.9 % self-reported "often" undertaking all four recommended clinical practices and "never" performing the one practice that was contrary to recommendation. Statistically significant factors associated with knowledge scores included: 1) having a masters or doctorate degree; and 2) often reading scientific journals from high-income countries. Significant factors associated with recommended practices included: 1) training in critically appraising systematic reviews; 2) training in the care of patients with IUDs; 3) believing that research performed in their own country is above average or excellent in quality; 4) being based in a facility operated by an NGO; and 5) having the view that higher quality available research is important to improving their work.

CONCLUSIONS

This analysis supports previous work emphasizing the need for improved knowledge and practices among clinicians concerning the use of IUDs for family planning. It also identifies areas in which targeted interventions may prove effective. Assessing opportunities for increasing education and training programs for clinicians in research and IUD provision could prove to be particularly effective.