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KNOWLEDGE, ATTITUDES, AND PRACTICES OF PRIVATE MEDICAL PRACTITIONERS ON TUBERCULOSIS AMONG HIV/AIDS PATIENTS IN ELDORET, KENYA
Abstract
ABSTRACT
Background: Tuberculosis (TB) is one of the major communicable diseases afflicting
mankind today. Its prevalence is increasing with increase in HIV infection. It is
important that doctors be able to correctly diagnose and institute proper management
of patients with TB.
Objectives: To determine the knowledge, attitudes, and practices (KAP) of private
medical practitioners in Eldoret on the management of TB.
Design: Cross-sectional descriptive qualitative study.
Setting: Private medical practitioners’ clinics and the outpatient departments of private
hospitals in Eldoret town, western, Kenya. Eldoret is a cosmopolitan town 350-km north
west of Nairobi. It is the main town in the north Rift Valley with such infrastructure
as roads, international airport, and banks.
Subjects: Private medical practitioners in Eldoret.
Results: Fifty three out of 70 private doctors were interviewed. Of these 84.9% were
male. Only 5.7% knew that sputum for AAFBs is collected on spot, early morning,
and spot, whereas 69.8% and 13.2% said it should be collected on three and six
consecutive early mornings respectively. Sputum and chest X-ray were the most common
investigations used to diagnose TB. Few doctors knew that the clinical features
considered as suspicious for TB in children were failure to thrive (FTT) (20.6%), contact
with open TB case (12.8%), and cough for more than two or more weeks (7.8%). Others
wrongly considered cough for four or more weeks (9.2%). Features correctly considered
of diagnostic value by a few of the private doctors in paediatric TB were: chest Xray
(19.8%), FTT (8.7%), positive sputum for AAFBs (8.7%), and history of contact
with TB case (8.7%). A small number of doctors based their diagnosis on chest Xray
(38%), AAFBs (19%), and Keith-Jones criteria (6.3%). There were 16 regimes
mentioned and used for the treatment of TB. The NLTP recommended regimes such
as 2RHZ/4RH, 2RHZE/6HE, 2RHZ/6HE and 2SHRZE/1RHZE/5HRE, were used by
9(19.6%), 2(4.3%), 0% and 0% of the doctors respectively. The rest used unrecommended
regimes and no doctor used the re-treatment regime of 2SHRZE/1 RHZE/5RHE. Similar
regimes were used for the HIV as for the non-HIV-infected patients. None of the
interviewees had appropriate knowledge on all the areas of diagnosis, treatment, case
recording, and follow up.
Conclusion: Most doctors were not aware of the correct diagnosis and treatment of
TB and many used unrecommended treatment regimes. They were generally unfamiliar
with the recording system of TB cases. Most doctors did not know the definitions of
the various re-treatment cases. Continuing medical education on clinical management
of TB patients is needed for doctors in private practice.
Background: Tuberculosis (TB) is one of the major communicable diseases afflicting
mankind today. Its prevalence is increasing with increase in HIV infection. It is
important that doctors be able to correctly diagnose and institute proper management
of patients with TB.
Objectives: To determine the knowledge, attitudes, and practices (KAP) of private
medical practitioners in Eldoret on the management of TB.
Design: Cross-sectional descriptive qualitative study.
Setting: Private medical practitioners’ clinics and the outpatient departments of private
hospitals in Eldoret town, western, Kenya. Eldoret is a cosmopolitan town 350-km north
west of Nairobi. It is the main town in the north Rift Valley with such infrastructure
as roads, international airport, and banks.
Subjects: Private medical practitioners in Eldoret.
Results: Fifty three out of 70 private doctors were interviewed. Of these 84.9% were
male. Only 5.7% knew that sputum for AAFBs is collected on spot, early morning,
and spot, whereas 69.8% and 13.2% said it should be collected on three and six
consecutive early mornings respectively. Sputum and chest X-ray were the most common
investigations used to diagnose TB. Few doctors knew that the clinical features
considered as suspicious for TB in children were failure to thrive (FTT) (20.6%), contact
with open TB case (12.8%), and cough for more than two or more weeks (7.8%). Others
wrongly considered cough for four or more weeks (9.2%). Features correctly considered
of diagnostic value by a few of the private doctors in paediatric TB were: chest Xray
(19.8%), FTT (8.7%), positive sputum for AAFBs (8.7%), and history of contact
with TB case (8.7%). A small number of doctors based their diagnosis on chest Xray
(38%), AAFBs (19%), and Keith-Jones criteria (6.3%). There were 16 regimes
mentioned and used for the treatment of TB. The NLTP recommended regimes such
as 2RHZ/4RH, 2RHZE/6HE, 2RHZ/6HE and 2SHRZE/1RHZE/5HRE, were used by
9(19.6%), 2(4.3%), 0% and 0% of the doctors respectively. The rest used unrecommended
regimes and no doctor used the re-treatment regime of 2SHRZE/1 RHZE/5RHE. Similar
regimes were used for the HIV as for the non-HIV-infected patients. None of the
interviewees had appropriate knowledge on all the areas of diagnosis, treatment, case
recording, and follow up.
Conclusion: Most doctors were not aware of the correct diagnosis and treatment of
TB and many used unrecommended treatment regimes. They were generally unfamiliar
with the recording system of TB cases. Most doctors did not know the definitions of
the various re-treatment cases. Continuing medical education on clinical management
of TB patients is needed for doctors in private practice.
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