title: Quality of diagnostic and treatment practices of pulmonary tuberculosis management amongst health practitioners in Haryana, north India.
abstract: BACKGROUND
  Early diagnosis and supervised treatment remains the mainstay for tuberculosis (TB) control in India.
  
  
  METHODS
  A facility-based cross-sectional study was conducted to assess diagnostic and treatment practices of tuberculosis management as per the Revised National Tuberculosis Control Programme at a secondary level health facility in north India. This hospital mostly caters to rural and peri-urban populations in the Ballabgarh block of Faridabad district, Haryana. A sample size of 244 was calculated. Consecutive chest symptomatic patients were recruited in the study. Information about socio-demographic characteristics and treatment was obtained from a routine history-taking process in the outpatient clinic. Results were expressed as mean, standard deviation (SD) and odds ratio (OR) with 95% confidence interval (CI).
  
  
  RESULTS
  A total of 250 pulmonary TB suspects were recruited, out of which 55.4% were males and mean age of study participants was 35.4 years (SD 14.6). Almost half (47.1%) of the participants had sought treatment from government hospitals, followed by 46.7% from private hospitals. Those who had visited a private facility were significantly more likely not to receive sputum acid-fast bacillus (AFB) diagnostic testing (OR=7.26, 95% CI 4.04-13.08), likely to be taking a second-line anti-TB drug as an antibiotic trial (OR=3.65, 95% CI 1.17-11.30), be empirically taking anti-TB drugs (OR=5.28, 95% CI 1.50-118.64) and getting a serological test done (OR=9.58, 95% CI 1.20-76.0) than those who went to a government health facility. Those who made at least three visits to a private facility were significantly more likely to have taken a second-line anti-TB drug as an antibiotic trial (OR=3.56, 95% CI 1.36- 9.28) and be empirically taking anti-TB drugs (OR=5.75, 95% CI 2.18-15.20) than those that made fewer than three visits.
  
  
  CONCLUSIONS
  This study documented inappropriate diagnostic and treatment practices in TB management and highlights the need to generate awareness about it among health practitioners in north India.
authors.affiliation: Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India. arvind28aug@gmail.com.
authors.forename: Arvind K
authors.initials: AK
authors.lastname: Singh
authors.affiliation: Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India. harshalsalve@ymail.com.
authors.forename: Harshal
authors.initials: H
authors.lastname: Salve
authors.affiliation: Department of Preventive and Social Medicine, Jawaharlal Nehru Institute of Postgraduate Medical Education & Research, Pondicherry, India. kalaiselvi.dr@gmail.com.
authors.forename: Kalaiselvi
authors.initials: K
authors.lastname: Selvaraj
authors.affiliation: Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India. drsanjay.aiims@gmail.com.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Rai
authors.affiliation: Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India. skant76@gmail.com.
authors.forename: Shashi
authors.initials: S
authors.lastname: Kant
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D019035:Rural Health Services; D013183:Sputum / Q000382:microbiology; D014374:Tuberculin Test / Q000706:statistics & numerical data; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Asia; Epidemiology; Health Service reform; Infectious Disease; Management/Administration; Medical; Public Health; Tropical Health