Survey of physician use of radiography and sputum smear microscopy for tuberculosis diagnosis and follow-up in Botswana.
METHODS
National survey of physician knowledge, attitudes, and practices for tuberculosis (TB) diagnosis and monitoring in Botswana.


OBJECTIVE
To assess adherence to national guidelines for TB diagnosis and monitoring.


METHODS
Questionnaires were mailed to all physicians registered with the Ministry of Health.


RESULTS
The response rate was 69%. Diagnostic and follow-up practices differed substantially from national recommendations. Senior District Medical Officers (SDMOs) were the most likely to adhere to guidelines on use of sputum examination for diagnosis (87%) and follow-up (50%); private practitioners were the least likely to follow the same guidelines (53% and 10%, respectively). SDMOs were also less likely to use radiographs for diagnosis (27%); the greatest use was seen in government hospital-based physicians (86%). While most SDMOs had received an introduction to the TB programme and had access to the programme manual and recent information on TB, the majority of other practising physicians in the country did not.


CONCLUSIONS
Recommended diagnostic procedures for TB were not being followed by a substantial percentage of physicians. Efforts are being made to inform hospital-based physicians and private practitioners about TB programme policies. Adherence to programme recommendations is vital to strengthen TB control efforts.
Huebner
R E
RE
Botswana National Tuberculosis Programme, Gaborone, Botswana, South Africa.
Moeti
T L
TL
Binkin
N J
NJ
Rumisha
D W
DW
D000328:Adult; D000368:Aged; D001431:Bacteriological Techniques / Q000706:statistics & numerical data*; D001902:Botswana / Q000453:epidemiology; D003906:Developing Countries; D004502:Education, Medical, Continuing / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008400:Mass Chest X-Ray / Q000706:statistics & numerical data*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D014600:Utilization Review