Tuberculosis Treatment and Private Practitioners, Kathmandu Valley

Abstract

SETTING: An urban municipality of 150,000 citizens
in Kathmandu valley where approximately
650 TB patients annually start treatment in the
public sector.
OBJECTIVE: To determine the caseload of TB
patients, treatment practices used in the private
sector and professional characteristics of private
practitioners involved in TB care.
DESIGN: A self-administered questionnaire was
distributed to private practitioners in the area.
RESULTS: Forty-three (73%) of 59 private practitioners
returned the questionnaire, and form the
base for the analysis. Twenty-eight (65%) were
working also in government clinics. Thirty-nine
(93%) were treating tuberculosis patients. during
the previous month, 68 suspected cases of pulmonary
tuberculosis and 78 suspected extrapulmonary
cases had been seen. A total of 97 patients were
started on anti-TB treatment, 24 (25%) of those
managed by surgical specialists. Twenty (51%) of
the doctors prescribed internationally or nationally
recommended regimens (i.e. 2 EHRZ/4HR or
2 EHRZ/6HE) to new pulmonary TB patients.
Thirty-three (85%) reported referral of certain categories
of TB patients to governmental or non-governmental
facilities. Twenty-six (79%) referred
their patients primarily to the National Tuberculosis
Centre. The main reason for referral mentioned
by doctors (61%) was the patient’s inability to afford
treatment in the prevate sector.

CONCLUSION: There quarters of the private
practitioners used sputum smears for diagnosis, but
only about half prescribed appropriate treatment
regimens. Extrapulmonary TB cases form a substantial
part of the case-load and approximately
one fourth of all TB patients are being treated by
surgical specialists. The cost of TB treatment in
the private sector is too high for many patients.
Informal links are already evident between the
public and private sector but collaborative efforts
need to be increased.