A Review of Tuberculosis management from five private clinics in Multan

Muhammad Azam Mushtaq, Syed Sarmad Ali, Muhammad Wajahat Tariq, Tahir Khan, Humayoun Ghulam Murtaza, Syed Junaid Awais

Abstract


Background:  Tuberculosis (TB) is a major concern worldwide and the world's second most common cause of death from infectious disease after HIV/AIDS and poses a serious threat to public health throughout the world. With emergence of its resistant strains, clinicians must be familiar with the clinical presentation of this deadly infection.

Objective:  To review the management of tuberculosis in private clinics/ Hospitals in Multan, city of south Punjab to observe the contribution of private sector in the management of this commonest diseases especially in this part of Punjab as many patients of TB are still being treated privately.

Material and methods:  This study was carried out from December 2015 to January 2017. A total of 05 leading private clinics were included after informed consent. All newly diagnosed tuberculosis patients were included in the study and those with doubtful history, defaulted as well as treated previously for TB were excluded. 200 patients fulfilled the above inclusion criteria and were included in the study. Baseline demographic data, co morbidities, treatment outcome and default rate were enter into special designed proforma and was analyzed.

Results:  Age of the study population ranged from 16-70 years, 61% were in the age range of 30- 40 years or younger and 57% were females. Pulmonary disease diagnosed in 80% patients and extra-pulmonary tuberculosis in 20% patients (mainly pleural effusion). 31 patients had side effects from antituberculous drugs. Hepatitis/deranged LFT's were the commonest side effect which was observed in 15 patients. Other side effects were mild skin irritation (5 cases), skin rashes (03) gastrointestinal disturbance ( 06) and joint pains (02). 30 patients were diabetics (16 male and 14 female). Diabetes was associated with 21 pulmonary tuberculosis cases and 9 cases of extra-pulmonary tuberculosis. 27 were using insulin and 03 were on oral hypoglycemic agents among 40 cases 0f extra pulmonary disease, 25 were having unilateral pleural effusion , 02 bilateral pleural effusion, 09 were diagnosed cervical TB lymph adenitis, 01 empyema and 03 with spinal TB. Out of all pulmonary cases that were treated, sputum smear examination was positive only in 60% of cases rest 40% were smear negative and were diagnosed on clinical grounds. The overall cure rate was 52% The mortality was 2% whereas default rate was 27%. 0ut of these 05 clinics, only 01 clinic was obtaining the opinion from a pulmonologist, 04 that of a medical specialist and/or run by the GPs. None of the clinics were using DOTS strategy.

Conclusion:  For the best management of TB DOTS strategies must be implemented in private sector in an attempt to reduce the default rate and achieve successful outcome according to WHO target. Private setup should be encouraged to maintain and follow national TB guidelines for the treatment of TB patients for timely treatment and good outcomes.


Keywords


Tuberculosis; Private sector; Outcome

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