title: 'Multiple-test' approach to the laboratory diagnosis of tuberculosis -perception of medical doctors from Ujjain, India.
abstract: BACKGROUND
  Delay in diagnosis is one of the most important factors for the control of tuberculosis (TB) in endemic countries like India. As laboratory diagnosis is the mainstay for identification of active disease, we aim to explore and understand the opinions of medical doctors about the laboratory diagnosis of TB in Ujjain, India.
  
  
  METHODS
  Sixteen qualified specialist medical doctors from Ujjain were purposefully selected for the study. Individual interviews with the doctors (13 men and 3 women), were conducted. As one interview could not be completed, data from 15 interviews were analyzed using manifest and latent content analysis.
  
  
  RESULTS
  Based on perception of the doctors, the theme; 'challenges and need for the laboratory diagnosis of TB' emerged from the following subthemes: (i) Relationship between basic element of the TB diseases process such as 'Symptoms prior to diagnoses' and 'Clinical characteristics of TB', which were not specific enough to diagnose TB (ii) The prevailing conditions such as lack of explicit diagnostic tools, lead to the doctors using the 'multiple tests' or 'empiric treatment' approach (iii) The doctors proposed that there is a need for access to a rapid, single and simple diagnostic test, and a need for awareness and knowledge of the practitioners regarding specific TB investigations, and early referral to improve the situation at resource-limited settings.
  
  
  CONCLUSIONS
  The medical specialists use a 'multiple test' or 'empiric treatment' approach to diagnose TB. According to the participants, there is a low dependence and uptake of the available laboratory TB investigations by medical practitioners. There is an urgent need to have a specific, simple and reliable test, and a protocol, to improve diagnosis of TB and to prevent development of resistant TB.
authors.affiliation: Department of Pathology, R. D. Gardi Medical College, Ujjain, India. manjuraj.purohit64@gmail.com.|Central Clinical Laboratory, Ujjain Charitable Trust Hospital and Research Centre, Ujjain, India. manjuraj.purohit64@gmail.com.|Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. manjuraj.purohit64@gmail.com.
authors.forename: Manju Raj
authors.initials: MR
authors.lastname: Purohit
authors.affiliation: Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. megha.sharma@ki.se.|Department of Pharmacology, R.D. Gardi Medical College, Ujjain, India. megha.sharma@ki.se.
authors.forename: Megha
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. senia.rosales.1@ki.se.
authors.forename: Senia
authors.initials: S
authors.lastname: Rosales-Klintz
authors.affiliation: Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Cecilia.Stalsby.Lundborg@ki.se.
authors.forename: Cecilia Stålsby
authors.initials: CS
authors.lastname: Lundborg
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019411:Clinical Laboratory Techniques / Q000592:standards; D003955:Diagnostic Tests, Routine / Q000592:standards; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007194:India; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*