SURVEY OF PHYSICIAN USE OF RADIOGRAPHY AND SPUTUM SMEAR MICROSCOPY FOR TUBERCULOSIS DIAGNOSIS AND FOLLOW-UP IN BOTSWANA

SETTING: National survey of physician knowledge, attitudes, and practi ces for tuberculosis (TB) diagnosis and monitoring in Botswana. OBJECT IVE: To assess adherence to national guidelines for TB diagnosis and m onitoring. DESIGN: Questionnaires were mailed to all physicians regist ered with the Ministry of Health. RESULTS: The response rate was 69%. Diagnostic and follow-up practices differed substantially from nationa l recommendations. Senior District Medical Officers (SDMOs) were the m ost likely to adhere to guidelines on use of sputum examination for di agnosis (87%) and follow-up (50%); private practitioners were the leas t likely to follow the same guidelines (53% and 10%, respectively). SD MOs were also less likely to use radiographs for diagnosis (27%); the greatest use was seen in government hospital-based physicians (86%). W hile mast SDMOs had received an introduction to the TB programme and h ad access to the programme manual and recent information on TB, the ma jority of other practising physicians in the country did not. CONCLUSI ON: Recommended diagnostic procedures for TB were not being followed b y a substantial percentage of physicians. Efforts are being made to in form hospital-based physicians and private practitioners about TB prog ramme policies. Adherence to programme recommendations is vital to str engthen TB control efforts.