Diagnosis and management of tuberculosis by private practitioners in Manila, Philippines.
METHODS
Private for-profit health care providers are prominent in the health system of the Philippines.


OBJECTIVE
To examine the practices of the private practitioners in Malabon, Metropolitan Manila, Philippines, concerning diagnosis and treatment of tuberculosis (TB).


METHODS
Forty-five private practitioners of Malabon who treat adult TB patients were interviewed.


RESULTS
For diagnosis, most private practitioners relied on the clinical presentation and result of an X-ray. Only 13% of the respondents routinely also asked for sputum examination. Ninety-six percent used X-ray as a tool to monitor treatment. Sixty percent of the respondents prescribed a regimen consisting of isoniazid, rifampicin, pyrazinamide, and ethambutol. Except for rifampicin, over-dosage was common. For re-treatment cases, none prescribed the WHO-recommended re-treatment regimen. The private practitioners perceived the main reasons for patient non-adherence to be the patients' lack of finances to buy drugs and patients' perceived well being after a certain period of treatment. Patients' lack of money was seen as the main obstacle to compliance. The only case holding mechanism mentioned was occasional clinic appointments of the TB patients.


CONCLUSIONS
Private practices for diagnosis and treatment of TB typically deviate from guidelines. The quality of care among private practitioners needs improvement. Innovative strategies are required.
Auer
Christian
C
Department of Public Health and Epidemiology, Swiss Tropical Institute, Socinstr. 57, CH-4002 Basel, Switzerland. Christian.Auer@unibas.ch
Lagahid
Jaime Y
JY
Tanner
Marcel
M
Weiss
Mitchell G
MG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D007255:Information Services; D008875:Middle Aged; D010353:Patient Education as Topic; D010679:Philippines / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011331:Private Practice / Q000592:standards*; D017064:Process Assessment, Health Care; D011859:Radiography; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014944:World Health Organization
D000995:Antitubercular Agents