Quality of tuberculosis care in India: a systematic review
Abstract:
BACKGROUND:
While Indian studies
have assessed care providers’ knowledge and practices,
there is no systematic review on the quality of tuberculosis
(TB) care.
METHODS:
We searched multiple
sources to identify studies (2000–2014) on
providers’ knowledge and practices. We used the
International Standards for TB Care to benchmark quality of
care.
RESULTS:
Of the 47 studies included,
35 were questionnaire surveys and 12 used chart abstraction.
None assessed actual practice using standardised patients.
Heterogeneity in the findings precluded meta-analysis. Of 22
studies evaluating provider knowledge about using sputum smears
for diagnosis, 10 found that less than half of providers had
correct knowledge; 3 of 4 studies assessing self-reported
practices by providers found that less than a quarter reported
ordering smears for patients with chest symptoms. In 11 of 14
studies that assessed treatment, less than one third of
providers knew the standard regimen for drug-susceptible TB.
Adherence to standards in practice was generally lower than
correct knowledge of those standards. Eleven studies with both
public and private providers found higher levels of appropriate
knowledge/practice in the public sector.
CONCLUSIONS:
Available evidence
suggests suboptimal quality of TB care, particularly in the
private sector. Improvement of quality of care should be a
priority for India.
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Source:
The International Journal of Tuberculosis and Lung
Disease
