What do primary care clinicians know about the management and control of Tuberculosis?

Abstract

Objectives To investigate primary care clinicians' knowledge of tuberculosis (TB) management and control. Methods: A cross-sectional survey of primary care clinicians in public service, attending the TB symposium organised for the 1999 WorldTB Day in Mpumalanga Province,South Africa. One hundred and sixty-eight primary clinicians completed the questionnaire. Respondents included 36 doctors (21%),94 nurses (58%) and 34 (21%) allied health professionals. The response rate was 100%. Results The mean questionnaire score was 58% (range: 0-97%) but there was profound heterogeneity in answers to specific questions. Certain deficiencies found could seriously compromise TB management, for example the finding that only 55% of respondents knew the correct duration of continuation phase therapy for new pulmonary TB patients. Doctors performed better on the questionnaire, with 64% (23/ 36) scoring greater than 75% compared to 20% (20/98) of nurse practitioners, but doctors were, weaker in questions relating to TB control. Nurse practitioners who had attended TB training programmes scored considerably better than their colleagues, with 47% (14/30) scoring greater than 75% compared to 8% (5/64) of their colleagues (Xt= 19.12; p=0.000;. Respondents demonstrated limited knowledge of managing childhood TB. Only 17% (28/ | 68) could provide the rationale for BCG immunisation, 33% (55/168) provided the indication for tuberculin skin testing and 21% (35/ 168) named the correct prophylactic TB therapy for children under two years. Conclusions Nurse clinicians in Mpumalanga Province who had attended TB training programs demonstrated superior knowledge on TB management and control com-pared to their colleagues who had received no training. Primary care doctors appear to be an under-utilised resource in theTB Control Program in Mpumalanga Province and require orientation on control program priorities. In general,the knowledge of primary care clinicians on managing TB in children is inadequate and must become a focus for future training.