SETTING: National survey of physician knowledge, attitudes, and practices for tuberculosis (TB) diagnosis and monitoring in Botswana. OBJECTIVE: To assess adherence to national guidelines for TB diagnosis and monitoring. DESIGN: Questionnaires were mailed to all physicians registered with the Ministry of Health. RESULTS: The response rate was 69%. Diagnostic and follow-up practices differed substantially from national recommendations. Senior District Medical Officers (SDMOs) were the most likely to adhere to guidelines on use of sputum examination for diagnosis (87%) and follow-up (50%); private practitioners were the least likely to follow the same guidelines (53% and 10%, respectively). SDMOs were also less likely to use radiographs for diagnosis (27%); the greatest use was seen in government hospital-based physicians (86%). While most SDMOs had received an introduction to the TB programme and had access to the programme manual and recent information on TB, the majority of other practising physicians in the country did not. CONCLUSION: Recommended diagnostic procedures for TB were not being followed by a substantial percentage of physicians. Efforts are being made to inform hospital-based physicians and private practitioners about TB programme policies. Adherence to programme recommendations is vital to strengthen TB control efforts.
SETTING: National survey of physician knowledge, attitudes, and practices for tuberculosis (TB) diagnosis and monitoring in Botswana. OBJECTIVE: To assess adherence to national guidelines for TB diagnosis and monitoring. DESIGN: Questionnaires were mailed to all physicians registered with the Ministry of Health. RESULTS: The response rate was 69%. Diagnostic and follow-up practices differed substantially from national recommendations. Senior District Medical Officers (SDMOs) were the most likely to adhere to guidelines on use of sputum examination for diagnosis (87%) and follow-up (50%); private practitioners were the least likely to follow the same guidelines (53% and 10%, respectively). SDMOs were also less likely to use radiographs for diagnosis (27%); the greatest use was seen in government hospital-based physicians (86%). While most SDMOs had received an introduction to the TB programme and had access to the programme manual and recent information on TB, the majority of other practising physicians in the country did not. CONCLUSION: Recommended diagnostic procedures for TB were not being followed by a substantial percentage of physicians. Efforts are being made to inform hospital-based physicians and private practitioners about TB programme policies. Adherence to programme recommendations is vital to strengthen TB control efforts.