Survey of physician use of radiography and sputum smear microscopy for tuberculosis diagnosis and follow-up in Botswana.

The Botswana National Tuberculosis Program (BNTP) was created in 1975 and focuses upon BCG vaccination case-finding case-holding and treatment health education and staff training. The current strategy of short-course directly-observed chemotherapy was implemented in 1986. Botswanas 320 physicians registered with the Ministry of Health were mailed questionnaires in a national survey of physician knowledge attitudes and practices for tuberculosis (TB) diagnosis and monitoring. The survey was conducted to measure the levels of adherence to national guidelines for TB diagnosis and monitoring. 69% of the registered physicians still working in Botswana responded to the survey. 16 respondents were senior district medical officers (SDMOs) 111 were government hospital-based physicians (GHPs) 31 private hospital-based physicians (PHPs) and 40 private practitioners (PPs). The respondents diagnostic and follow-up practices differed substantially from national recommendations. 87% and 50% of SDMOs followed guidelines on the use of sputum examination for diagnosis and follow-up respectively. However only 53% and 10% of PPs followed the same guidelines respectively. 27% of SDMOs used radiographs for diagnosis compared to 86% of GHPs. While most SDMOs had been introduced to the TB program and had access to the program manual and recent information on TB the majority of other practicing physicians in the country had no such introduction or access. It is important that physicians adhere to program recommendations in order to control TB.