||Arif K, Ali SA, Amanullah S, Siddiqui I, Khan JA &
||Physician compliance with national tuberculosis treatment
guidelines: a university hospital study
||INT J TB & LUNG DIS 1997, 2, 225-230
The Aga Khan University Hospital, in Karachi, Pakistan,
is a 650-bed university teaching hospital. There is little data
from Pakistan on the awareness and application of the WHOs
TB treatment guidelines among physicians. This study evaluates physician
compliance with these guidelines. A questionnaire to measure physician
compliance was developed, pilot tested and standardised. Case records
of all patients hospitalized with TB were reviewed (January-December
1995, n = 229), and were classified into WHO Category 1(n = 191),
Category 2 (n = 9) and Category 3 (n = 29).
A total of 53 (23%) patients had a diagnostic bacteriological
sputum smear examination, of which 38% were smear positive and 47%
culture positive. Of 25 cerebrospinal fluid cultures 12% were positive.
No sputum smear tests were conducted during treatment. Of 58 patients
in Category 1 who completed therapy 74% received a 2-month intensive
phase consisting of HRZE (isoniazid, rifampicin, pyrazinamide, ethambutol)
(n = 43), while 41% received a 6 month continuation phase with HE
(n = 24). Over 70% patients were lost to follow up, more than half
of these during the intensive phase.
The study reflects poor awareness of the WHO guidelines
and low compliance among physicians, and a high loss to follow-up.
Efforts are needed to create physician awareness about the WHO guidelines
and their use. This study can be used to assess the effectiveness
of any future physician education and to identify areas of weakness
in health care.
|KEY WORDS: TRADITIONAL HEALERS; HEALTH EDUCATION; KNOWLEDGE;
ATTITUDE; PRACTICE; PRIVATE SECTOR; PAKISTAN.