Survey of Health Professionals to Gauge Knowledge of TB & DOTS - India

Health and Development Initiative-India conducted a rapid survey (week of August 13-17 2001) to gauge the awareness level of health professionals in the Punjab State of India about DOTS and to gain an insight into the process they follow while treating TB patients. Thirty-three randomly selected health professional drawn from different sections of service delivery were requested to provide answers to a questionnaire.

The following questions were put to the respondents (and the answers follow):

1. Have you heard of DOTS as a treatment modality for TB?

• Yes: 67%
• No: 33%

2. What does DOTS stand for?

• Directly Observed Treatment Shortcourse: 9%
• Incorrect replies: 52%
• Do not know: 39%

3. In your opinion, which is the most, appropriate tool for diagnosing Pulmonary TB (PTB)?

• Sputum examination for AFB: 42%
• X-Ray Chest: 34%
• Clinical Examination: 12%
• ESR: 8%
• Mx test: 3%

4. In your practice what single factor determines choice of drug treatment regimen in a newly diagnosed case of PTB?

• Economic status of the patient: 22%
• Result of the sputum examination for AFB: 17%
• Extent of disease: 11%
• Severity of symptoms: 6%
• Age: 3%
• Nutritional status of the patient: 3%
• Not sure: 17%
• Misc.: 21%

5. In your opinion which is the best tool to monitor the progress of a case under treatment for PTB?

• X-Ray Chest: 27%
• Sputum examination for AFB: 23%
• Improvement in general condition of the patient: 16%
• ESR: 11%
• Weight gain: 7%
• Clinical judgment: 7%
• Screening Chest: 5%
• Rise in Hemoglobin: 2%
• ELISA: 2%

The following conclusions have been drawn from this survey:

a. The survey suggests that the knowledge of health professionals, working in various service providing sectors is woefully inadequate as regards technical guidelines of the Revised National Tuberculosis Control Programme (RNTCP)are concerned.

b. 33% respondents have not heard of DOTS as a treatment modality for treatment of Pulmonary TB.

c. Only 9% respondents know that DOTS stands for Directly Observed Treatment Short-course. 91% respondents do not even know full form of DOTS.

d. Only 42% respondents consider Sputum examination for AFB as an appropriate tool for diagnosis of PTB. 34% respondents consider X Ray examination of chest as an appropriate tool.

e. Only 17% respondents based their choice of drug treatment regimen on result of Sputum Examination for AFB. None of the respondents considered it essential to determine the HIV status of their patient before commencing treatment.

f. Only 23% respondents considered Sputum examination for AFB as best tool to monitor the progress of a case under treatment for PTB.

g. Most doctors are inclined to base their TB case management based on misbeliefs emerging out of a lack of standard sources of information.