title: How well can physicians manage tuberculosis? A public-private sector comparison from Karachi, Pakistan.
abstract: BACKGROUND
  Tuberculosis (TB) is endemic in Pakistan which ranks fifth amongst the twenty two countries designated to be highly burdened by TB according to the World Health Organization. However, there is paucity of data regarding the knowledge of diagnosis of TB and its management amongst public and private practitioners. In this study, we endeavor to identify this gap in knowledge regarding the diagnosis and management of TB between public and private doctors and the factors affecting these knowledge scores in urban Pakistan.
  
  
  METHODS
  This cross sectional survey was conducted between June and December 2011. Doctors from public hospitals, private hospitals and private clinics scattered in all eighteen towns of Karachi were included in the study. Qualified MBBS doctors working in any specialty were eligible to participate whereas doctors working in both the public and private sectors were excluded from the study. Vignette based clinical scenarios were given to assess the knowledge score regarding the diagnosis and management of TB.
  
  
  RESULTS
  A total of 196 doctors participated in the study. There was a significant difference between private and public physicians in terms of age and years of practice (p-value <0.05). Significant differences in the proportion of knowledge scores were observed between the public and private doctors and National TB Control Program trained and untrained doctors in Karachi. Factors associated with inadequate knowledge scores were being female gender [OR: 2.76 (95% CI: 1.418-5.384)], private employment status [OR: 1.50 (95% CI: 1.258-2.439)], and not trained by NTP [OR: 2.98 (95% CI: 1.286-3.225)] on multivariate logistic regression analysis.
  
  
  CONCLUSIONS
  It is concluded that a knowledge gap exists between the public and private doctors in Karachi. Strengthening of currently implemented public private mix model along with improvement in the trainings of public and private practitioners is highly recommended to control TB in Pakistan.
authors.affiliation: Division of Environmental Health Sciences, Department of Community Health, Sciences, The Aga Khan University Hospital, Stadium Road, P,O, Box-3500, Karachi (74800), Pakistan. maliha.naseer@gmail.com.
authors.forename: Maliha
authors.initials: M
authors.lastname: Naseer
authors.forename: Ali
authors.initials: A
authors.lastname: Khawaja
authors.forename: Amin S
authors.initials: AS
authors.lastname: Pethani
authors.forename: Salik
authors.initials: S
authors.lastname: Aleem
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D010820:Physicians / Q000592:standards / Q000706:statistics & numerical data*; D017149:Private Sector / Q000706:statistics & numerical data*; D017150:Public Sector / Q000592:standards*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents