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. 2018 Jun 21;13(6):e0199413.
doi: 10.1371/journal.pone.0199413. eCollection 2018.

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

Christy A Braham  1 , Peter J White  1   2   3 , Nimalan Arinaminpathy  1   2
Affiliations

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

Christy A Braham et al. PLoS One. .

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.

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Conflict of interest statement

PJW has received research funding from Otsuka SA for a retrospective study of multi-drug-resistant tuberculosis treatment in several eastern European countries. CB and NA have nothing to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. PRISMA flow chart.
PRISMA flow chart outlining the search procedure for selecting studies on knowledge and practices in relation to TB care for the systematic review.
Fig 2
Fig 2. Forest plot on cough.
Forest plot visualising data on practitioners’ knowledge of cough as a main symptom of tuberculosis (ISTC Standard 1). CL = 95% Confidence Level.
Fig 3
Fig 3. Forest plots on diagnosis knowledge and practice.
(a) Forest plot visualising data on practitioners’ knowledge of using sputum microscopy for the diagnosis of pulmonary tuberculosis (ISTC Standard 2). CL = 95% Confidence Level. (b) Forest plot visualising data on practitioners’ practice of using sputum microscopy for the diagnosis of pulmonary tuberculosis (ISTC Standard 2). Marsh et al. (1996) includes 4 sets of data for this ISTC Standard, reflecting 4 different practitioner groups. CL = 95% Confidence Level.
Fig 4
Fig 4. Forest plots on prescriptions for intensive and continuation phases.
(a) Forest plot visualizing data on practitioners’ compliance with prescribing drugs for the intensive phase of TB treatment (ISTC Standard 8). CL = 95% Confidence Level. (b) Forest plot visualizing data on practitioners’ compliance with prescribing drugs for the continuation phase of TB treatment (ISTC Standard 8). CL = 95% Confidence Level.
Fig 5
Fig 5. Forest plot on prescribing in fixed doses.
Forest plot visualizing data on practitioners’ compliance with prescribing treatments in fixed-dose combinations (ISTC Standard 8). CL = 95% Confidence Level.
Fig 6
Fig 6. Forest plot on assessing clinical progress.
Forest plot visualising data on practitioners’ knowledge of using sputum microscopy to monitor treatment progress (ISTC Standard 10). CL = 95% Confidence Level.
Fig 7
Fig 7. Forest plot on recording treatments.
Forest plot visualising data on practitioners’ practice of recording treatments and their outcomes (ISTC Standard 13). CL = 95% Confidence Level.
See this image and copyright information in PMC

References

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