An Intervention Program for Strengthening Tuberculosis Control in Alexandria Part I: Training of Physicians

Document Type : Original Article

Authors

1 Primary Health Care Division, High Institute of Public Health, Alexandria University, Egypt

2 Health Education Division, High Institute of Public Health, Alexandria University, Egypt

3 Tropical Health Division, High Institute of Public Health, Alexandria University, Egypt

4 Parasitology and Medical Entomology Division, High Institute of Public Health, Alexandria University, Egypt

Abstract

Background: The year 2005 targets for tuberculosis [TB] control ratified by WHO were to detect 70% of smear positive pulmonary TB cases and to treat successfully 85% of such cases. To improve the effectiveness of passive case finding, health personnel have to be motivated to consider the diagnosis of TB.
Objective: The aim of the present study was to train physicians working in Alexandria health centers on early detection and management of TB cases according to "Directly Observed Treatment with Short Course Chemotherapy" [DOTS] strategy and to assess effectiveness of the training program by measuring their knowledge about TB control before and after the training workshops and three months later.
Methods: Ten training workshops were organized in coordination with Alexandria Health Directorate to cover the seven health districts of Alexandria. The training coverage reached 31.5% of the physicians. A self-administered questionnaire was designed to assess the physicians' knowledge about their role in TB control before and after the workshops and three months later [pre-test, post-test and final test]. Handouts were prepared according to the TB control guide of National TB Control Program [NTP]and the guide for primary health care workers. They were distributed on the physicians at the end of workshops.
Results: revealed a long lasting improvement in knowledge after the training program, as the physicians' mean % of knowledge score was only 35.2% before the workshops, but increased to 65.8% after the workshops and remained high three months later [61.5%]. The improvement in knowledge was evident concerning diagnosis and treatment of TB cases. For example, about 60% of the physicians considered sputum examination essential for diagnosis of pulmonary TB in the pre-test, compared to 97.5% in the post-test. Only 3.1% of them knew about the DOTS strategy before the training workshops, but this percentage increased to about 80% after the workshops. Only 1.3% knew the drug regimen recommended by the NTP for treatment of pulmonary TB in the pre-test, compared to 66% in the post-test. However, one third of the physicians knew the duration of treatment in the pre-test and increased to about 90% in the post-test. Moreover, more than half of the physicians recognized the importance of patients' compliance with their drug regimens before the workshops, compared to about 90% in the post-test. 

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