Knowledge of tuberculosis and its management practices among medical interns in a resource-poor setting: implications for disease control in sub-Saharan Africa

摘要

Of 118 medical interns, none could correctly state the estimated number of new TB cases per year in Nigeria. 88.1% knew that droplet infection was the usual mode of TB transmission. Only 27.1 % could state correctly the definition of MDR-TB while none new the definition of XDR-TB. 62.7% identified Zeihl Neelsen staining for acid fast bacilli as the best diagnostic procedure for pulmonary TB. Only 46.6% recognized that streptomycin should not be used in pregnancy while 22.9% would isolate a child from a mother with smear positive pulmonary TB to prevent transmission. The recommended 4-drug antiTB regimen was prescribed by 56.8% in the initiation phase and the recommended 2-drug combination in the continuation phase by 62.7%. The study reveals gross inadequacies in TB knowledge and management practices among Nigerian medical interns. There is urgent need for whole sale reform of undergraduate medical education curriculum with focal emphasis on tuberculosis and other infectious and tropical diseases. Introduction Tuberculosis (TB) continues to be one of the most important global public health threats. 1 About one-third of the global population is infected with Mycobacterium tuberculosis and at risk of developing the disease. 2,3 More than eight million people develop active TB annually with more than 90% of deaths occurring in the developing world. 4,5 Early detection and adequate treatment are critical measures for disease control. The World Health Organization (WHO) has published guidelines for TB control in low income countries.6,7 But inadequate case detection and poor treatment continue to be some of the major factors for the increasing burden of TB globally. 8,9 Although some studies have documented inadequate TB knowledge and poor compliance with TB treatment guidelines among practicing physicians, 10,11,12,13 such data are lacking in Nigeria. The objective of the study was to assess and document the knowledge of TB and its management practices among medical interns, and their adherence to the National TB Control (NTC) guidelines in Nigeria. Materials and Methods The survey was conducted among 118 medical interns between December 2004 and May 2007 at Federal Medical Centre, Ido-Ekiti, Nigeria. This is a tertiary hospital and a referral centre in the southwestern Nigeria. These medical interns, employed at various times in the above hospital, graduated within the previous 12 months before participation in the study. The authors distributed pre-tested questionnaire which were completed under supervision without allowance for discussions or cheatings. The anonymity and confidentiality of the respondents were guaranteed. The questionnaire contained a set of multiple choice questions that assessed knowledge of TB, its methods of diagnosis and management practices. It also had two subjective questions on prescription writing skills for a new case of smear positive pulmonary TB (PTB). The data were entered and analysed using Epi Info 6.04. Results Of the 118 interns surveyed, 90 (76.3%) and 28 (23.7%) had graduated from federal- and state-owned universities respectively. At the time of the study, 30 (25.4%), 30 (25.4%), 28 (23.7%) and 30 (25.4%) interns were rotating through the departments of internal medicine, paediatrics,, surgery and obstetrics, and gynaecology respectively.Knowledge assessmentNone of the interns could correctly state the estimated number of new cases of TB per year in Nigeria (about 80,000 14). Droplet infection was selected as the usual mode of transmission of PTB by 104 (88.1%). Overcrowding was chosen by the remaining 14 (11.9%). Only 32 (27.1%) interns could state correctly the definition of multidrug resistant TB (MDR-TB) (resistance to isoniazid (INH) and rifampicin (RIF) with or without resistance to other first-line drugs15) while none of them was aware of the definition of extensively drug resistant TB (XDR-TB) (resistance to isoniazid and rifampicin in addition to any fluoroquinolone and at least o