Knowledge and attitude of private practitioners about operational component of tuberculosis under RNTCP

Received 31 October 2018 Revised 25 December 2018 Accepted 31 December 2018 Early online 05 January 2019 Print 31 January 2019 India is a high burden country for tuberculosis (TB). The Stop TB strategy 2006-2015 of Revised National Tuberculosis Control Programme (RNTCP) aimed to engage directly with private healthcare sector to ensure patients have access to high quality DOTS. A cross-sectional study was conducted using a self-administered questionnaire to assess the knowledge and attitude of private practitioners regarding the operational component of RNTCP. Though majority of study subjects had correct knowledge and good attitude about diagnostic aspects of TB, but there were clear gaps in between. Sensitization of private practitioners regarding RNTCP needs to be intensified. Corresponding author

India is a high burden country for tuberculosis (TB). The Stop TB strategy 2006-2015 of Revised National Tuberculosis Control Programme (RNTCP) aimed to engage directly with private healthcare sector to ensure patients have access to high quality DOTS. A cross-sectional study was conducted using a self-administered questionnaire to assess the knowledge and attitude of private practitioners regarding the operational component of RNTCP. Though majority of study subjects had correct knowledge and good attitude about diagnostic aspects of TB, but there were clear gaps in between. Sensitization of private practitioners regarding RNTCP needs to be intensified. ndia is one of the countries that were designated as high burden countries for tuberculosis (TB) by the World Health Organization (WHO This study was done to assess the knowledge, attitude of private practitioners in relation to diag-nosis, treatment and management of TB. This information is important in assessing the loopholes in private sector which can be thereafter addressed to improve implementation of DOTS in private sector as well in the larger interest of public health.

Materials and methods
The study was done in Kashmir Province of Jammu & Kashmir state of India. It was a crosssectional study and study subjects were 25 private practitioners whose minimum qualification was Bachelor of Medicine and Bachelor of Surgery (MBBS). Allopathic private practitioners working in government sector as well were excluded. In Kashmir private sector is not so much developed and majority of doctors preferably work in government sector. Besides there is also ban on private practice in the major tertiary care hospitals. For this reason only 25 practitioners could be approached I using convenience sampling. Self administered, pre-tested, structured questionnaire was administered to the study subjects. Written consent was taken from all the study subjects prior to administration of questionnaire.
Statistical analysis: Data was analyzed using SPSS 20.  Contacts of sputum positives 20 80

Results
As per the observations in Table 1, 76% (19/25) of private practitioners were MBBS graduates and rest was post-graduates. 52% (13/25) had received RNTCP training for a period of 6 days but without any succeeding refresher training. All the recipients were satisfied with the training.

Discussion
India continues to remain one of the highest TB burden countries. Inadequate treatment practices and implementation are the major contributing factors for this high burden of disease [3][4][5] . 76 % (19/25) of study subjects in our study were MBBS graduates; hence this group mainly needs to be roped in for trainings under RNTCP. 52% (13/25) of Private practitioners had received training which is higher than that seen in two other studies 6,7 .
Majority of study subjects had correct knowledge about diagnosis of a case of TB which is consistent with yet another study 7 . And 56% (14/25) knew rightly about number of sputum samples to be collected for diagnosis. Likewise, only 40% (10/25) correctly knew about the number of sputum samples to be examined during DOTS. This shows the evident gaps in the knowledge of private practitioners regarding management of TB under RNTCP.
Overall the attitude towards the operational control of RNTCP was fairly good. 80% (20/25) of study subjects reported that they send chest symptomatic patients for sputum examination to DMC and a sputum positive patient to DOTS facility. This good attitude is consistent with another study 6 . 88% (22) agreed that DOTS is a viable method to tackle the menace of TB. At the same time majority of private practitioners were unaware of nearest DMC or DOTS facility. This shows a mismatch between knowledge, attitude and practices (KAP) of these private practitioners. 66.6% of practitioners who had not received any RNTCP training were interested in receiving trainings.

Conclusion and Recommendations
The present study shows that there are apparent gaps between knowledge, attitude and practices of private health care providers. These gaps need to be addressed. It is recommended that all private health care providers should be sensitized and trained under RNTCP at war footing in order to improve the implementation of RNTCP in private sector as well.