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Int J Tuberc Lung Dis. 2015 Jul;19(7):751-63. doi: 10.5588/ijtld.15.0186.

Quality of tuberculosis care in India: a systematic review.

Author information

1
Department of Epidemiology, Biostatistics and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada; Center for Operations Research, International Union Against Tuberculosis and Lung Disease, Paris, France.
2
Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Partners for Urban Knowledge, Action and Research, Mumbai, India.
3
Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA; Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, California, USA.
4
Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, California, USA.
5
Life Sciences Library, McGill University, Montreal, Canada.
6
Development Economics Research Group, World Bank, Washington DC, USA.
7
The Fenway Institute and Beth Israel Deaconess Medical Center, Boston Massachusetts, USA.
8
Center for Operations Research, International Union Against Tuberculosis and Lung Disease, Paris, France; Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Canada.
9
Department of Epidemiology, Biostatistics and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada.

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.

PMID:
26056098
PMCID:
PMC4462173
DOI:
10.5588/ijtld.15.0186
[Indexed for MEDLINE]
Free PMC Article

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