Knowledge and Practice of Private Medical Practitioners Regarding Diagnosis and Treatment of Paediatric Tuberculosis in Mogadishu

Abstract

Background: Tuberculosis (TB) remains one of the major health problems and the second leading infectious cause of mortality around the world. According to WHO estimates in 2011, there were 0.5 million new cases of TB and 64 000 deaths due to TB diseases in children. Somalia has been at civil war for the last two decades and the health system was virtually collapsed. The majority of the community seeks care from the private health sector. Objectives: To assess the knowledge and practice of private medical practitioners concerning paediatric tuberculosis diagnosis and treatment in Mogadishu and their level of adherence to the National or International guidelines. Methods: A cross-sectional study was conducted among 39 private medical practitioners from Mogadishu. Pre-tested questionnaire was used to collect the information. The researcher also collected 48 different prescriptions written by different clinicians to determine the practice of clinicians toward paediatric TB and to the adherence of the National or International guidelines. Results: The majority of the private medical practitioners expressed that fever for more than 2 week (87.19%), cough for more than 2 week (89.74%) and loss of weight (92.31%) will led them to suspect TB disease in children. But few of them 5 (12.82%) mentioned that they use history of TB contact as a suspicion of paediatric TB. More than half of the practitioners 21(53.85%) relied on CXR and ESR for the diagnosis of tuberculosis in children. None of the clinicians considered Mantoux test as a tool for investigation of TB in children. About 60% of the clinicians did not knew or not recommended the appropriate regimens for extra-pulmonary TB, while 79.49% did not know the recommended treatment of TB/HIV co-infection. Of the 48 prescriptions collected, only one prescription was correctly prescribed according to the weight of the child. Only 18 (39 %) of the anti-TB drugs prescribed were Fixed Dose Combination approved by the WHO. Conclusions: Private medical practitioners in Mogadishu have significant gaps in their knowledge and practice in regards to management of paediatric tuberculosis. Significant omissions are failure to consider history of TB contact as an important symptom by 80% of the practitioners, lack of utilization of Mantoux test as an investigative tool for TB in children and almost universal (98%) incorrectly prescribed TB drug doses according to the weight of the child. Recommendation: The Ministry of Health in Somalia should establish continues medical education to the private medical practitioners in Mogadishu.