Do Doctors Know Enough on Tuberculosis? a Survey among Government Medical Officers in the Curative Health Sector

Background: Tuberculosis (TB) is a global epidemic with over 2 billion people, equal to one-third of the world’s population, are currently estimated to be infected. In Sri Lanka, despite an effective national programme for TB control and mass scale immunoprophylaxis, TB still remains a growing public health issue with over 9000 new cases being detected annually. Studies conducted in many high prevalent settings had clearly shown that the knowledge and practices among many general practitioners and family physicians do not conform to WHO guidelines or expectations. A survey among government medical offi cers in the curative health sector was carried out with the objective to assess the basic knowledge on tuberculosis (TB) among non-specialist medical offi cers (MOs). Methodology: We assessed the basic knowledge on TB in fi ve main fi elds, namely clinical pathology, diagnostic methods, treatment regimens, Direct Observed Treatment Short course (DOTS) and Bacillus of Calmette-Guerin (BCG) vaccination in 355 randomly selected MOs. According to the individual performance, marks were allocated and a grading of poor, average or good was offered for each component. An overall fi nal rank was given to each subject according to the total marks achieved. Results: Only 27% had good (marks >66%) overall knowledge. 67% had average, while 6% had poor (marks <33%) overall knowledge. Majority had good understanding on clinical pathology and DOTS, but the knowledge was most inadequate with regard to BCG and treatment regimens. Post-intern MOs had a lower understanding on anti-TB medications and different regimens, when compared to intern MOs (x2=8.8047,p=0.012), and their knowledge did not improve with service experience. MOs attached to out-patient departments and surgical units seem to be in need of extra attention. Conclusion: The knowledge on basic aspects of TB is not satisfactory among most of the MOs. Applicability of targeted awareness and continuation of medical education programmes, assessment schemes, appraisal systems and antibiotic regulation and prescription policies for the local setup should be explored.