Management of tuberculosis by healthcare practitioners in Pakistan: A systematic review

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Title: Management of tuberculosis by healthcare practitioners in Pakistan: A systematic review
Author(s): Braham, C
White, P
Arinaminpathy, N
Item Type: Journal Article
Abstract: Objective: To assess the quality of tuberculosis (TB) care in Pakistan, through determining comparison of healthcare practitioners’ knowledge and practices to national and international TB care guidelines. Methods: Studies reporting on knowledge, attitudes and practices of public and private practitioners with TB patients were selected through searching electronic databases and grey literature. Findings: Of 1458 reports, 20 full-texts were assessed, of which 11 met the eligibility and quality criteria; all studies focused on private sector care. Heterogeneity precluded meta-analysis. In 3 of 4 studies, over 50% of practitioners correctly identified a cough as the main TB symptom. However, 4 out of 6 studies showed practitioners’ compliance to be low (under 50%) for the use of sputum microscopy in diagnosis. The poorest quality care occurred in the later stages of treatment, with low compliance in prescribing practices for continuation-phase care and in monitoring and recording treatment progress, the latter of which is particularly critical for treatment success. Conclusion: TB care was variable and generally inadequate, with both a lack of knowledge and a small ‘know-do’ gap evident—practitioners did not use methods that they know they should use. A lack of recent evidence found suggests that the quality of current practices may not be fully captured and further research is needed, especially on non-allopathic, rural and public-sector contexts. Improved training of practitioners, greater availability of recommended diagnostic tools and expansion of public-private partnerships are suggestions for improving the quality of TB care in Pakistan.
Publication Date: 21-Jun-2018
Date of Acceptance: 24-May-2018
URI: http://hdl.handle.net/10044/1/60320
DOI: https://dx.doi.org/10.1371/journal.pone.0199413
ISSN: 1932-6203
Publisher: Public Library of Science (PLoS)
Journal / Book Title: PLoS ONE
Volume: 13
Issue: 6
Sponsor/Funder: Medical Research Council (MRC)
Funder's Grant Number: MR/K010174/1B
Copyright Statement: © 2018 Braham et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: MD Multidisciplinary
General Science & Technology
Publication Status: Published
Article Number: e0199413
Online Publication Date: 2018-06-21
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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