Survey of knowledge, attitudes, and practices regarding tuberculosis among general and private medical practitioners in Nigeria

Professor E A Dosumu, Department of Medicine, National Hospital, Abuja, Nigeria. Correspondence to: Professor E A Dosumu, PO Box 8683, Wise Post Office, Abuja, Nigeria. Email: [email protected] Introduction Tuberculosis (TB) is an endemic disease in Nigeria.1 The World Health Organization (WHO) declared TB as a global emergency in 1993.2 Since then, although there has been an intensification of global efforts to control this disease its incidence has been increasing. The incidence of TB increased from 8.8 million cases annually in 1995 to 11.9 million in 2005.3 The problem is largest in subSaharan Africa and South-East Asia.4 Current annual estimates suggest that 9 million TB deaths occur globally;5 Abstract The knowledge and practice regarding tuberculosis (TB) treatment was surveyed by analysing questionnaires distributed to 390 general and private medical practitioners in Nigeria. Of the 350 (89%) questionnaires returned, 305 (87.1%) practitioners had treated TB cases in their hospitals. The number of regimens recorded were 85 for newly diagnosed (ND) cases and for 45 re-treatment (RT) cases. The National Tuberculosis Control Programme (NTCP)-approved regimen were used in 61 (20%) ND cases and 60 (19.7%) RT cases. The number of inadequate regimens prescribed were 60 (70.6%) for ND cases and 36 (80%) for RT cases; 34 (40%) practitioners wrongly stated that streptomycin should be used for ND cases. In ND cases, regimens lasting less than 6 months were prescribed in 8 (9.4%) cases, and regiments lasting more than 12 months were prescribed in 10 cases (11.7%). Other aspects of poor knowledge were exhibited by a significant number of respondents who estimated seeing an average of 1525 TB patients each month. It was concluded that a significant number of physicians in private practice did not adhere to the standard norms for prescribing anti-TB treatment, did not know about the regimen recommended by the NTCP, and often prescribed wrong regimens. Intervention strategies in the form of continuing medical education in TB should be urgently organised for general and private medical practitioners if the disease is to be controlled in Nigeria. over 250 000 cases are in Nigeria.6 The National Tuberculosis Control Programme (NTCP) has published a booklet prescribing various regimens to be used for newly diagnoses (ND) and re-treatment (RT) cases of TB in Nigeria. Directly observed treatment, short course (DOTS) has also been advocated by the Federal Ministry of Health in Nigeria for the treatment of TB. Both the private and public sectors have been sensitised by the government to participate in the DOTS strategy. Anti-TB drugs are only made available free-of-charge by the government to the public sector. Thus, TB patients attending private hospitals have to pay for drugs and other investigations. However, the services of private medical practitioners are better in Nigeria than in the public hospitals and, therefore, about 70% of patients are seen in the private sector. Private physicians may be treating a large, yet undefined, number of TB patients. The treatment of TB is complex and there exist many recommended regimens.7,8 However, it requires adherence to these regimens with the correct combination of drugs and dosages, at regular intervals over an extended period, if the two aims of successful treatment and reduced level of anti-TB drug resistance are to be achieved.9 The aim of this study was to assess the knowledge and practices regarding TB among private and general medical practitioners in Nigeria to find out if they follow the recommended regimens of the NTCP. To date, no study of this nature had been carried out.