Annals of Tropical Medicine and Public Health

ORIGINAL ARTICLE
Year
: 2012  |  Volume : 5  |  Issue : 3  |  Page : 206--208

To study the knowledge about tuberculosis management and national tuberculosis program among medical students and aspiring doctors in a high tubercular endemic country


Dinesh Mehta1, Rishabh Bassi2, Manjeet Singh3, Chavi Mehta4,  
1 Department of Pulmonary Medicine, MMIMSR, Ambala, India
2 Department of Anaesthesiology, LNJP, Delhi, India
3 Department of Physiology, PGIMS, Rohtak, Haryana, India
4 Department of ENT, Mehta Hospital, Yamunanagar, Haryana, India

Correspondence Address:
Dinesh Mehta
406, Model Colony, Yamunanagar, Haryana - 135001
India

Abstract

Background : More than eight million people develop active tuberculosis annually and most of the cases are detected in the developing world. This study aims to describe the knowledge about tuberculosis management and knowledge about national tuberculosis control program among medical students and young doctors in a developing country. Materials and Methods : A questionnaire based survey was conducted among 112 interns and post graduate students of a tertiary care hospital to study the knowledge about tuberculosis and national tuberculosis control program among these doctors. Results : Of the 112 respondents to the questionnaire The number of sputum specimens required for diagnosis under RNTCP was responded correctly by only 57%, the time duration in which sputum specimen should be processed was told correctly by only 42.5%, while the sputum examination guidelines for extra-pulmonary tuberculosis was responded correctly by only 27%. The awareness of serious forms of sputum-negative pulmonary tuberculosis was 21%, while serious form of extra pulmonary tuberculosis was known to be only 33%. The correct categorization of tuberculosis patients was done by only 56% of the respondents, while treatment of tubercular meningitis was marked correctly by 69% of the respondents. Conclusions : This study indicates a low level of knowledge among participants despite DOTS covering the entire country at present. This study indicates an enormous challenge and an urgent need to revamp and reform undergraduate medical education and change in medical curriculum with need instituting practical training at Directly Observed treatment Short Course (DOTS) centers in the curriculum of medical students in India.



How to cite this article:
Mehta D, Bassi R, Singh M, Mehta C. To study the knowledge about tuberculosis management and national tuberculosis program among medical students and aspiring doctors in a high tubercular endemic country.Ann Trop Med Public Health 2012;5:206-208


How to cite this URL:
Mehta D, Bassi R, Singh M, Mehta C. To study the knowledge about tuberculosis management and national tuberculosis program among medical students and aspiring doctors in a high tubercular endemic country. Ann Trop Med Public Health [serial online] 2012 [cited 2020 Sep 19 ];5:206-208
Available from: http://www.atmph.org/text.asp?2012/5/3/206/98620


Full Text

 Introduction



About one-third of the global population is infected with Mycobacterium tuberculosis and at risk of developing the disease. [1],[2] More than eight million people develop active tuberculosis annually, with more than 90% of deaths occurring in the developing world. [3],[4],[5] making tuberculosis still one of the most important global public health threats. Early detection and adequate treatment are critical measures for disease control. The World Health Organization (WHO) has published guidelines for tuberculosis control in low-income countries. [6],[7] However, inadequate case detection and poor treatment continue to be some of the major factors for the increasing burden of tuberculosis globally. [8],[9] Since the inception of Directly Observed Treatment Short Course (DOTS), the awareness, diagnosis, and treatment of tuberculosis have improved considerably. Some studies have documented inadequate tuberculosis knowledge and poor compliance with tuberculosis treatment guidelines among practicing physicians, [10],[11],[12],[13] Such studies need to be conducted regularly to check the compliance about Revised National Tuberculosis Control Programme (RNTCP) and the need for modifying the tuberculosis control program. The objective of the study was to assess and document the knowledge of tuberculosis and its management practices and their adherence among medical interns and post graduate students of all specialities, except tuberculosis and respiratory medicine since their inclusion will lead to bias of the results.

 Materials and Methods



The survey was conducted among 112 interns and post graduate students of a tertiary care hospital. The authors distributed pre-tested questionnaires, which were completed under supervision without allowance for discussions. The anonymity and confidentiality of the respondents were guaranteed. The questionnaire contained a set of multiple choice questions that assessed the knowledge of pulmonary and extra-pulmonary tuberculosis, its methods of diagnosis and management practices in light of the national tuberculosis control programme and the side effects of anti-tubercular drugs.

 Results



This study involved a tertiary care teaching hospital in which post graduate medical trainees and interns were surveyed regarding the level of basic knowledge about tuberculosis. The results showed significant lack of basic knowledge [Table 1]. The number of sputum specimens required for diagnosis under RNTCP was responded correctly by only 57%, the time duration in which sputum specimen should be processed was told correctly by only 42.5%, while the sputum examination guidelines for extra-pulmonary tuberculosis was responded correctly by only 27%. The awareness of serious forms of sputum-negative pulmonary tuberculosis was 21%, while serious form of extra pulmonary tuberculosis was known to be only 33%. The correct categorization of tuberculosis patients was done by only 56% of the respondents, while treatment of tubercular meningitis was marked correctly by 69% of the respondents indicating comparative high level of knowledge about drugs involved in various categories of DOTS. The side effects of drugs, however, were responded correctly by only 37% of the participants, thus indicating a low level of knowledge among participants despite DOTS covering the entire country at present. However, similar trends are likely to exist in most of the developing and under developed countries across the globe, which ironically carries the highest burden of tuberculosis including drug-resistant tuberculosis.{Table 1}

 Discussion



The study revealed gross inadequacies in the knowledge of tuberculosis among medical interns and post graduate medical students. In a study from Pakistan, poor recognition of the burden of tuberculosis and its public health significance was equally identified among medical interns in that country. [12]

Adequate knowledge regarding diagnosis and a proper prescription written by a practicing physician is as important as treatment compliance by the patient, which has been shown to reduce the emergence of drug-resistant tuberculosis. A number of studies have highlighted the gaps in the knowledge and practice of physicians treating patients with tuberculosis.

The essential services needed to control tuberculosis were developed and packaged as the DOTS strategy in the early 1990s, and which has been promoted as a global strategy since the mid-1990s. With the widespread acceptance of the principles of DOTS, India has achieved the global target of detecting 70% of infectious cases and curing 85% of those detected. [14]

Despite such a successful program, gross lacunae have been observed in the knowledge of future budding doctors. The government must enforce the establishment of strict and dedicated DOTS clinic in all tertiary hospitals in which medical students must rotate during the course of their studies and practically participate in all its activities, including performance of ZN staining for sputum smear microscopy. All medical interns must also rotate through a DOTS clinic during their training. The revision of existing medical education curriculum in India should focus on incorporating national tuberculosis guidelines in the school curriculum. The appropriate authority should ensure the circulation and availability of tuberculosis guidelines to every practicing medical doctor in the country. This will encourage medical practitioners to inculcate diagnostic and prescription practices that are in accordance with the national tuberculosis guidelines. [15],[16] As a country heavily burdened with tuberculosis, India cannot afford to be negligent in providing proper medical education on tuberculosis and training of medical doctors for its management.

 Conclusion



The study has shown gross deficiencies in medical education in India, one of the countries with the largest numbers of tuberculosis cases. This is, no doubt, an enormous challenge to the effective control of tuberculosis in India. There is an urgent need to revamp and reform undergraduate medical education curriculum with focal emphasis on tuberculosis and other infections along with practical training. This will also have a significant impact on the management of patients with drug-sensitive tuberculosis as well as preventing the emergence and spread of Multidrug-Resistant/Extensively Resistant (MDR/XDR) tuberculosis.

References

1Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC. Consensus statement. Global burden of tuberculosis: Estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project. JAMA 1999;282:677-86.
2Frieden TR, Sterling TR, Munsiff SS, Watt CJ, Dye C. Tuberculosis. Lancet 2003;362:887-99.
3Ahlburg D. The economic impact of tuberculosis. Geneva: World Health Organization; 2000.
4Maher D, Raviglione M. Global epidemiology of tuberculosis. Clin Chest Med 2005;26:167-82.
5Gupta R, Espinal MA, Ravigilone MC. Tuberculosis as a major global health problem in the 21st century: A WHO perspective. Semin Respir Crit Care Med 2004;25:245-53.
6Enarson DA, Rieder HL, Arnaothr T, Trebucq A. Management of tuberculosis: A guide for low-income countries. 5 th ed. Paris: International Union Against Tuberculosis and Lung Disease; 2000.
7Treatment of tuberculosis: Guidelines for national programmes, 3 rd ed. Geneva: World Health Organization; 2003.
8Espinal MA, Laszlo A, Simonsen L. Global trends in resistance to antituberculosis drugs. N Eng J Med 2001;184:473-8.
9Mahmoudi A, Iseman MD. Pitfalls in the care of patients with tuberculosis: Common errors and their association with the acquisition of drug resistance. JAMA 1993;270:65-8.
10Arif K, Ali SA, Amanullah S. Physician compliance with national tuberculosis treatment guidelines: A university hospital study. Int J Tuberc Lung Dis 1997;2:2225-30.
11LoBue PA, Moser K, Catanzaro A. Management of tuberculosis in San Diego County: A survey of physicians' knowledge, attitudes and practices. Int J Tuberc Lung Dis 2001;5:933-8.
12Khan JA, Zahid S, Khan R, Hussain SF, Rizvi N, Rab A, et al. Medical interns knowledge of TB in Pakistan. Trop Doct 2005;35:144-7.
13World Health Organization. Antituberculosis drug resistance in the world. The WHO/IUATLD global project on antituberculosis drug resistance surveillance. Geneva: WHO; 1997. p. 1-227.
14World Health Organization. Treatment of tuberculosis: Guidelines for national programmes. 3 rd ed. Geneva: WHO; 2003.
15Khan JA, Hussain SF. Antituberculous drug prescribing doctors, compliance at a private teaching hospital in Pakistan. Trop Doc 2003;33:94-6.
16Prasad R, Nautiyal RG, Mukherji PK. Treatment of new pulmonary tuberculosis patients: What do allopathic doctors do in Indian? Int J Tuberc Lung Dis 2002;6:895-902.