Are Informal Healthcare Providers Knowledgeable in Tuberculosis Care? A Cross-sectional Survey Using Vignettes in West Bengal, India

Overview

Journal Int Health

Publisher Oxford University Press

Specialty Health Services

Date 2022 Jul 30

PMID 35907263

Authors

Poshan Thapa

Rohan Jayasuriya

John J Hall

Partha Sarathi Mukherjee

Kristen Beek

Nancy Briggs

Dipesh Kr Das

Tushar Mandal

Padmanesan Narasimhan

Affiliations

Soon will be listed here.

Abstract

Background: India accounts for one-quarter of the world's TB cases. Despite efforts to engage the private sector in India's National TB Elimination Program, informal healthcare providers (IPs), who serve as the first contact for a significant TB patients, remain grossly underutilised. However, considering the substantial evidence establishing IPs' role in patients' care pathway, it is essential to expand the evidence base regarding their knowledge in TB care.

Methods: We conducted a cross-sectional study in the Birbhum district of West Bengal, India. The data were collected using the TB vignette among 331 IPs (165 trained and 166 untrained). The correct case management was defined following India's Technical and Operational Guidelines for TB Control.

Results: Overall, IPs demonstrated a suboptimal level of knowledge in TB care. IPs exhibited the lowest knowledge in asking essential history questions (all four: 5.4% and at least two: 21.7%) compared with ordering sputum test (76.1%), making a correct diagnosis (83.3%) and appropriate referrals (100%). Nonetheless, a statistically significant difference in knowledge (in most domains of TB care) was observed between trained and untrained IPs.

Conclusions: This study identifies gaps in IPs' knowledge in TB care. However, the observed significant difference between the trained and untrained groups indicates a positive impact of training in improving IPs' knowledge in TB care.

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References

Das J, Chowdhury A, Hussam R, Banerjee A . The impact of training informal health care providers in India: A randomized controlled trial. Science. 2016; 354(6308). DOI: 10.1126/science.aaf7384. View

Subbaraman R, Nathavitharana R, Mayer K, Satyanarayana S, Chadha V, Arinaminpathy N . Constructing care cascades for active tuberculosis: A strategy for program monitoring and identifying gaps in quality of care. PLoS Med. 2019; 16(2):e1002754. PMC: 6392267. DOI: 10.1371/journal.pmed.1002754. View

Samal J . Health Seeking Behaviour among Tuberculosis Patients in India: A Systematic Review. J Clin Diagn Res. 2016; 10(10):LE01-LE06. PMC: 5121700. DOI: 10.7860/JCDR/2016/19678.8598. View

Stallworthy G, Dias H, Pai M . Quality of tuberculosis care in the private health sector. J Clin Tuberc Other Mycobact Dis. 2020; 20:100171. PMC: 7332523. DOI: 10.1016/j.jctube.2020.100171. View

Guo W, Sylvia S, Umble K, Chen Y, Zhang X, Yi H . The competence of village clinicians in the diagnosis and treatment of heart disease in rural China: A nationally representative assessment. Lancet Reg Health West Pac. 2021; 2:100026. PMC: 8315592. DOI: 10.1016/j.lanwpc.2020.100026. View

Delgado-Rodriguez M, Llorca J . Bias. J Epidemiol Community Health. 2004; 58(8):635-41. PMC: 1732856. DOI: 10.1136/jech.2003.008466. View

Sreeramareddy C, Qin Z, Satyanarayana S, Subbaraman R, Pai M . Delays in diagnosis and treatment of pulmonary tuberculosis in India: a systematic review. Int J Tuberc Lung Dis. 2014; 18(3):255-266. PMC: 4070850. DOI: 10.5588/ijtld.13.0585. View

Anandhi C, Nagaraj V, Kumar R . Knowledge and practice pattern of non-allopathic indigenous medical practitioners regarding tuberculosis in a rural area of India. Int J Tuberc Lung Dis. 2002; 6(6):553-5. DOI: 10.5588/09640569513093. View

Thapa P, Jayasuriya R, Hall J, Beek K, Mukherjee P, Gudi N . Role of informal healthcare providers in tuberculosis care in low- and middle-income countries: A systematic scoping review. PLoS One. 2021; 16(9):e0256795. PMC: 8412253. DOI: 10.1371/journal.pone.0256795. View

10.

Pulla P . Are India's quacks the answer to its shortage of doctors?. BMJ. 2016; 352:i291. DOI: 10.1136/bmj.i291. View

11.

Satyanarayana S, Subbaraman R, Shete P, Gore G, Das J, Cattamanchi A . Quality of tuberculosis care in India: a systematic review. Int J Tuberc Lung Dis. 2015; 19(7):751-63. PMC: 4462173. DOI: 10.5588/ijtld.15.0186. View

12.

Bronner Murrison L, Ananthakrishnan R, Swaminathan A, Auguesteen S, Krishnan N, Pai M . How do patients access the private sector in Chennai, India? An evaluation of delays in tuberculosis diagnosis. Int J Tuberc Lung Dis. 2016; 20(4):544-51. DOI: 10.5588/ijtld.15.0423. View

13.

Mackintosh M, Channon A, Karan A, Selvaraj S, Cavagnero E, Zhao H . What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries. Lancet. 2016; 388(10044):596-605. DOI: 10.1016/S0140-6736(16)00342-1. View

14.

Kapoor S, Venkat Raman A, Sachdeva K, Satyanarayana S . How did the TB patients reach DOTS services in Delhi? A study of patient treatment seeking behavior. PLoS One. 2012; 7(8):e42458. PMC: 3412865. DOI: 10.1371/journal.pone.0042458. View

15.

Mohanan M, Goldhaber-Fiebert J, Giardili S, Vera-Hernandez M . Providers' knowledge of diagnosis and treatment of tuberculosis using vignettes: evidence from rural Bihar, India. BMJ Glob Health. 2017; 1(4):e000155. PMC: 5321391. DOI: 10.1136/bmjgh-2016-000155. View

16.

Das J, Holla A, Das V, Mohanan M, Tabak D, Chan B . In urban and rural India, a standardized patient study showed low levels of provider training and huge quality gaps. Health Aff (Millwood). 2012; 31(12):2774-84. PMC: 3730274. DOI: 10.1377/hlthaff.2011.1356. View

17.

Reid M, Arinaminpathy N, Bloom A, Bloom B, Boehme C, Chaisson R . Building a tuberculosis-free world: The Lancet Commission on tuberculosis. Lancet. 2019; 393(10178):1331-1384. DOI: 10.1016/S0140-6736(19)30024-8. View

18.

Kwan A, Daniels B, Bergkvist S, Das V, Pai M, Das J . Use of standardised patients for healthcare quality research in low- and middle-income countries. BMJ Glob Health. 2019; 4(5):e001669. PMC: 6747906. DOI: 10.1136/bmjgh-2019-001669. View

19.

Banerjee A, Deaton A, Duflo E . HEALTH, HEALTH CARE, AND ECONOMIC DEVELOPMENT: Wealth, Health, and Health Services in Rural Rajasthan. Am Econ Rev. 2011; 94(2):326-330. PMC: 2658609. DOI: 10.1257/0002828041301902. View

20.

Rao K, Bhatnagar A, Berman P . So many, yet few: Human resources for health in India. Hum Resour Health. 2012; 10:19. PMC: 3541981. DOI: 10.1186/1478-4491-10-19. View