Tuberculosis Treatment and Private Practitioners, Kathmandu Valley

Abstract

SETTING: An urban municipality of 150,000 citizensin Kathmandu valley where approximately650 TB patients annually start treatment in thepublic sector.OBJECTIVE: To determine the caseload of TBpatients, treatment practices used in the privatesector and professional characteristics of privatepractitioners involved in TB care.DESIGN: A self-administered questionnaire wasdistributed to private practitioners in the area.RESULTS: Forty-three (73%) of 59 private practitionersreturned the questionnaire, and form thebase for the analysis. Twenty-eight (65%) wereworking also in government clinics. Thirty-nine(93%) were treating tuberculosis patients. duringthe previous month, 68 suspected cases of pulmonarytuberculosis and 78 suspected extrapulmonarycases had been seen. A total of 97 patients werestarted on anti-TB treatment, 24 (25%) of thosemanaged by surgical specialists. Twenty (51%) ofthe doctors prescribed internationally or nationallyrecommended regimens (i.e. 2 EHRZ/4HR or2 EHRZ/6HE) to new pulmonary TB patients.Thirty-three (85%) reported referral of certain categoriesof TB patients to governmental or non-governmentalfacilities. Twenty-six (79%) referredtheir patients primarily to the National TuberculosisCentre. The main reason for referral mentionedby doctors (61%) was the patient’s inability to affordtreatment in the prevate sector.CONCLUSION: There quarters of the privatepractitioners used sputum smears for diagnosis, butonly about half prescribed appropriate treatmentregimens. Extrapulmonary TB cases form a substantialpart of the case-load and approximatelyone fourth of all TB patients are being treated bysurgical specialists. The cost of TB treatment inthe private sector is too high for many patients.Informal links are already evident between thepublic and private sector but collaborative effortsneed to be increased.