title: Factors Related to Non-Referral of Patients with Presumptive Pulmonary TB to Designated Microscopy Centers (DMCs) by Registered Private Practitioners in Urban Areas of Punjab, India.
abstract: BACKGROUND
  Early diagnosis and proper treatment under RNTCP guidelines, forms the mainstay of management of a TB patient. A large proportion of patients with presumptive tuberculosis (TB) visit a Private Practitioner (PP) in the first place. Studies have shown that PPs rely more on X-rays and other diagnostic tools rather than referring the patient to the nearest Designated Microscopy Centre (DMC) for sputum microscopy.
  
  
  OBJECTIVE
  The present study was planned to look in to factors responsible for non-referral of patients with presumptive pulmonary TB to the DMCs for diagnosis by PPs.
  
  
  METHODS
  Present study was a case-control study conducted over a period of one year among registered PPs in urban areas of Punjab. The study was carried out in five major cities which have approximately half of the urban population of Punjab. Forty three Private Practitioners per city for referral group and 43 matched PPs for non-referral group were selected.
  
  
  RESULTS
  Knowledge regarding RNTCP was low in both the referral (38.1%) as well as non-referral (25.6%) group of PPs. Allopathic doctors had significantly higher knowledge regarding TB as compared to ayurvedic and homeopathy doctors, and Registered Medical Practitioners (RMP). Both the knowledge of PPs regarding nearest DMC as well as perception about accessibility of the nearest DMC for the patients were found to be significantly higher in the referral group. Only 15.3% of practitioners in the non-referral group said that they had been contacted by RNTCP staff.
  
  
  CONCLUSIONS
  The main factors responsible for non-referral of pulmonary TB suspects to DMCs for diagnosis in the present study included low knowledge regarding RNTCP, lack of awareness regarding place and accessibility of nearest DMC, and inadequate sensitization of PPs by the RNTCP staff.
authors.affiliation: Professor, Department of Community Medicine, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .
authors.forename: Sarit
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Intensivist, Department of Critical Care Medicine, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .
authors.forename: Shruti
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Ex. Professor and Head, Department of Pulmonary Medicine, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .
authors.forename: Jagdeep
authors.initials: J
authors.lastname: Whig
authors.affiliation: Associate Professor, Department of Community Medicine, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .
authors.forename: Mahesh
authors.initials: M
authors.lastname: Satija
authors.affiliation: Professor and Head, Department of Community Medicine, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .
authors.forename: Anurag
authors.initials: A
authors.lastname: Chaudhary
keywords: Awareness; Knowledge; Revised National Tuberculosis Control Programme