title: Front-line management of pulmonary tuberculosis: an analysis of tuberculosis and treatment practices in urban Sindh, Pakistan.
abstract: METHODS
  Karachi and Hyderabad, Pakistan.
  
  
  OBJECTIVE
  To describe the level and quality of tuberculosis (TB) case management by non-TB control program (TCP) physicians in urban Sindh, Pakistan.
  
  
  METHODS
  We interviewed 152 adults with pulmonary TB confirmed by Karachi's TB control program regarding the initial management of their TB symptoms before entering the TCP. We also surveyed 65 general practitioners (GPs) attending continuing education seminars with a multiple choice test to assess their management of suspected pulmonary TB. We compared both results to guidelines from the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD).
  
  
  RESULTS
  Eighty percent (122/152) of patients first sought GPs. Only 14% of GPs performed any sputum test. At most, 17 (40%) of the 42 patients recalling their GP's treatment, received the recommended 4-drug regimen. However, 68% (45/65) of surveyed GPs chose correct treatment from a multiple choice format. But their initial laboratory investigations, follow-up, and treatment cessation criteria (9%, 9-31%, and 11% correct, respectively) demonstrated under-utilization of sputum tests and over-reliance on unhelpful tests.
  
  
  CONCLUSIONS
  GPs first saw most of these TCP patients, but their weak management likely hinders TB control. A partnership between TB control programs and GPs could improve case management and hasten TB control.
authors: Department of Community Health Sciences, Aga Khan University, Pakistan.
authors: D
authors: D
authors: Marsh
authors: R
authors: R
authors: Hashim
authors: F
authors: F
authors: Hassany
authors: N
authors: N
authors: Hussain
authors: Z
authors: Z
authors: Iqbal
authors: A
authors: A
authors: Irfanullah
authors: N
authors: N
authors: Islam
authors: F
authors: F
authors: Jalisi
authors: J
authors: J
authors: Janoo
authors: K
authors: K
authors: Kamal
authors: A
authors: A
authors: Kara
authors: A
authors: A
authors: Khan
authors: R
authors: R
authors: Khan
authors: O
authors: O
authors: Mirza
authors: T
authors: T
authors: Mubin
authors: F
authors: F
authors: Pirzada
authors: N
authors: N
authors: Rizvi
authors: A
authors: A
authors: Hussain
authors: G
authors: G
authors: Ansari
authors: A
authors: A
authors: Siddiqui
authors: S
authors: S
authors: Luby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019090:Case Management / Q000592:standards; D002983:Clinical Competence; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D011364:Professional Practice / Q000592:standards*; D011787:Quality of Health Care; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy*; D019037:Urban Health Services / Q000592:standards*