Management of tuberculosis by healthcare practitioners in Pakistan: A systematic review.

<h4<Objective</h4<To assess the quality of tuberculosis (TB) care in Pakistan, through determining comparison of healthcare practitioners' knowledge and practices to national and international TB care guidelines.<h4<Methods</h4<Studies reporting on knowledge, attitudes a...
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Autor*in:	Christy A Braham [verfasserIn] Peter J White [verfasserIn] Nimalan Arinaminpathy [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2018

Übergeordnetes Werk:	In: PLoS ONE - Public Library of Science (PLoS), 2007, 13(2018), 6, p e0199413
Übergeordnetes Werk:	volume:13 ; year:2018 ; number:6, p e0199413

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1371/journal.pone.0199413

Katalog-ID:	DOAJ076947556

Internformat


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publishDate	2018
allfields	10.1371/journal.pone.0199413 doi (DE-627)DOAJ076947556 (DE-599)DOAJ7edf7df304394ada93139323e0a9e7e4 DE-627 ger DE-627 rakwb eng Christy A Braham verfasserin aut Management of tuberculosis by healthcare practitioners in Pakistan: A systematic review. 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <h4<Objective</h4<To assess the quality of tuberculosis (TB) care in Pakistan, through determining comparison of healthcare practitioners' knowledge and practices to national and international TB care guidelines.<h4<Methods</h4<Studies reporting on knowledge, attitudes and practices of public and private practitioners with TB patients were selected through searching electronic databases and grey literature.<h4<Findings</h4<Of 1458 reports, 20 full-texts were assessed, of which 11 met the eligibility and quality criteria; all studies focused on private sector care. Heterogeneity precluded meta-analysis. In 3 of 4 studies, over 50% of practitioners correctly identified a cough as the main TB symptom. However, 4 out of 6 studies showed practitioners' compliance to be low (under 50%) for the use of sputum microscopy in diagnosis. The poorest quality care occurred in the later stages of treatment, with low compliance in prescribing practices for continuation-phase care and in monitoring and recording treatment progress, the latter of which is particularly critical for treatment success.<h4<Conclusion</h4<TB care was variable and generally inadequate, with both a lack of knowledge and a small 'know-do' gap evident-practitioners did not use methods that they know they should use. A lack of recent evidence found suggests that the quality of current practices may not be fully captured and further research is needed, especially on non-allopathic, rural and public-sector contexts. Improved training of practitioners, greater availability of recommended diagnostic tools and expansion of public-private partnerships are suggestions for improving the quality of TB care in Pakistan. Medicine R Science Q Peter J White verfasserin aut Nimalan Arinaminpathy verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 13(2018), 6, p e0199413 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:13 year:2018 number:6, p e0199413 https://doi.org/10.1371/journal.pone.0199413 kostenfrei https://doaj.org/article/7edf7df304394ada93139323e0a9e7e4 kostenfrei https://doi.org/10.1371/journal.pone.0199413 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2018 6, p e0199413
spelling	10.1371/journal.pone.0199413 doi (DE-627)DOAJ076947556 (DE-599)DOAJ7edf7df304394ada93139323e0a9e7e4 DE-627 ger DE-627 rakwb eng Christy A Braham verfasserin aut Management of tuberculosis by healthcare practitioners in Pakistan: A systematic review. 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <h4<Objective</h4<To assess the quality of tuberculosis (TB) care in Pakistan, through determining comparison of healthcare practitioners' knowledge and practices to national and international TB care guidelines.<h4<Methods</h4<Studies reporting on knowledge, attitudes and practices of public and private practitioners with TB patients were selected through searching electronic databases and grey literature.<h4<Findings</h4<Of 1458 reports, 20 full-texts were assessed, of which 11 met the eligibility and quality criteria; all studies focused on private sector care. Heterogeneity precluded meta-analysis. In 3 of 4 studies, over 50% of practitioners correctly identified a cough as the main TB symptom. However, 4 out of 6 studies showed practitioners' compliance to be low (under 50%) for the use of sputum microscopy in diagnosis. The poorest quality care occurred in the later stages of treatment, with low compliance in prescribing practices for continuation-phase care and in monitoring and recording treatment progress, the latter of which is particularly critical for treatment success.<h4<Conclusion</h4<TB care was variable and generally inadequate, with both a lack of knowledge and a small 'know-do' gap evident-practitioners did not use methods that they know they should use. A lack of recent evidence found suggests that the quality of current practices may not be fully captured and further research is needed, especially on non-allopathic, rural and public-sector contexts. Improved training of practitioners, greater availability of recommended diagnostic tools and expansion of public-private partnerships are suggestions for improving the quality of TB care in Pakistan. Medicine R Science Q Peter J White verfasserin aut Nimalan Arinaminpathy verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 13(2018), 6, p e0199413 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:13 year:2018 number:6, p e0199413 https://doi.org/10.1371/journal.pone.0199413 kostenfrei https://doaj.org/article/7edf7df304394ada93139323e0a9e7e4 kostenfrei https://doi.org/10.1371/journal.pone.0199413 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2018 6, p e0199413
allfields_unstemmed	10.1371/journal.pone.0199413 doi (DE-627)DOAJ076947556 (DE-599)DOAJ7edf7df304394ada93139323e0a9e7e4 DE-627 ger DE-627 rakwb eng Christy A Braham verfasserin aut Management of tuberculosis by healthcare practitioners in Pakistan: A systematic review. 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <h4<Objective</h4<To assess the quality of tuberculosis (TB) care in Pakistan, through determining comparison of healthcare practitioners' knowledge and practices to national and international TB care guidelines.<h4<Methods</h4<Studies reporting on knowledge, attitudes and practices of public and private practitioners with TB patients were selected through searching electronic databases and grey literature.<h4<Findings</h4<Of 1458 reports, 20 full-texts were assessed, of which 11 met the eligibility and quality criteria; all studies focused on private sector care. Heterogeneity precluded meta-analysis. In 3 of 4 studies, over 50% of practitioners correctly identified a cough as the main TB symptom. However, 4 out of 6 studies showed practitioners' compliance to be low (under 50%) for the use of sputum microscopy in diagnosis. The poorest quality care occurred in the later stages of treatment, with low compliance in prescribing practices for continuation-phase care and in monitoring and recording treatment progress, the latter of which is particularly critical for treatment success.<h4<Conclusion</h4<TB care was variable and generally inadequate, with both a lack of knowledge and a small 'know-do' gap evident-practitioners did not use methods that they know they should use. A lack of recent evidence found suggests that the quality of current practices may not be fully captured and further research is needed, especially on non-allopathic, rural and public-sector contexts. Improved training of practitioners, greater availability of recommended diagnostic tools and expansion of public-private partnerships are suggestions for improving the quality of TB care in Pakistan. Medicine R Science Q Peter J White verfasserin aut Nimalan Arinaminpathy verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 13(2018), 6, p e0199413 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:13 year:2018 number:6, p e0199413 https://doi.org/10.1371/journal.pone.0199413 kostenfrei https://doaj.org/article/7edf7df304394ada93139323e0a9e7e4 kostenfrei https://doi.org/10.1371/journal.pone.0199413 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2018 6, p e0199413
allfieldsGer	10.1371/journal.pone.0199413 doi (DE-627)DOAJ076947556 (DE-599)DOAJ7edf7df304394ada93139323e0a9e7e4 DE-627 ger DE-627 rakwb eng Christy A Braham verfasserin aut Management of tuberculosis by healthcare practitioners in Pakistan: A systematic review. 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <h4<Objective</h4<To assess the quality of tuberculosis (TB) care in Pakistan, through determining comparison of healthcare practitioners' knowledge and practices to national and international TB care guidelines.<h4<Methods</h4<Studies reporting on knowledge, attitudes and practices of public and private practitioners with TB patients were selected through searching electronic databases and grey literature.<h4<Findings</h4<Of 1458 reports, 20 full-texts were assessed, of which 11 met the eligibility and quality criteria; all studies focused on private sector care. Heterogeneity precluded meta-analysis. In 3 of 4 studies, over 50% of practitioners correctly identified a cough as the main TB symptom. However, 4 out of 6 studies showed practitioners' compliance to be low (under 50%) for the use of sputum microscopy in diagnosis. The poorest quality care occurred in the later stages of treatment, with low compliance in prescribing practices for continuation-phase care and in monitoring and recording treatment progress, the latter of which is particularly critical for treatment success.<h4<Conclusion</h4<TB care was variable and generally inadequate, with both a lack of knowledge and a small 'know-do' gap evident-practitioners did not use methods that they know they should use. A lack of recent evidence found suggests that the quality of current practices may not be fully captured and further research is needed, especially on non-allopathic, rural and public-sector contexts. Improved training of practitioners, greater availability of recommended diagnostic tools and expansion of public-private partnerships are suggestions for improving the quality of TB care in Pakistan. Medicine R Science Q Peter J White verfasserin aut Nimalan Arinaminpathy verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 13(2018), 6, p e0199413 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:13 year:2018 number:6, p e0199413 https://doi.org/10.1371/journal.pone.0199413 kostenfrei https://doaj.org/article/7edf7df304394ada93139323e0a9e7e4 kostenfrei https://doi.org/10.1371/journal.pone.0199413 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2018 6, p e0199413
allfieldsSound	10.1371/journal.pone.0199413 doi (DE-627)DOAJ076947556 (DE-599)DOAJ7edf7df304394ada93139323e0a9e7e4 DE-627 ger DE-627 rakwb eng Christy A Braham verfasserin aut Management of tuberculosis by healthcare practitioners in Pakistan: A systematic review. 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <h4<Objective</h4<To assess the quality of tuberculosis (TB) care in Pakistan, through determining comparison of healthcare practitioners' knowledge and practices to national and international TB care guidelines.<h4<Methods</h4<Studies reporting on knowledge, attitudes and practices of public and private practitioners with TB patients were selected through searching electronic databases and grey literature.<h4<Findings</h4<Of 1458 reports, 20 full-texts were assessed, of which 11 met the eligibility and quality criteria; all studies focused on private sector care. Heterogeneity precluded meta-analysis. In 3 of 4 studies, over 50% of practitioners correctly identified a cough as the main TB symptom. However, 4 out of 6 studies showed practitioners' compliance to be low (under 50%) for the use of sputum microscopy in diagnosis. The poorest quality care occurred in the later stages of treatment, with low compliance in prescribing practices for continuation-phase care and in monitoring and recording treatment progress, the latter of which is particularly critical for treatment success.<h4<Conclusion</h4<TB care was variable and generally inadequate, with both a lack of knowledge and a small 'know-do' gap evident-practitioners did not use methods that they know they should use. A lack of recent evidence found suggests that the quality of current practices may not be fully captured and further research is needed, especially on non-allopathic, rural and public-sector contexts. Improved training of practitioners, greater availability of recommended diagnostic tools and expansion of public-private partnerships are suggestions for improving the quality of TB care in Pakistan. Medicine R Science Q Peter J White verfasserin aut Nimalan Arinaminpathy verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 13(2018), 6, p e0199413 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:13 year:2018 number:6, p e0199413 https://doi.org/10.1371/journal.pone.0199413 kostenfrei https://doaj.org/article/7edf7df304394ada93139323e0a9e7e4 kostenfrei https://doi.org/10.1371/journal.pone.0199413 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2018 6, p e0199413
language	English
source	In PLoS ONE 13(2018), 6, p e0199413 volume:13 year:2018 number:6, p e0199413
sourceStr	In PLoS ONE 13(2018), 6, p e0199413 volume:13 year:2018 number:6, p e0199413
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topic_facet	Medicine R Science Q
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container_title	PLoS ONE
authorswithroles_txt_mv	Christy A Braham @@aut@@ Peter J White @@aut@@ Nimalan Arinaminpathy @@aut@@
publishDateDaySort_date	2018-01-01T00:00:00Z
hierarchy_top_id	523574592
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language_de	englisch
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author	Christy A Braham
spellingShingle	Christy A Braham misc Medicine misc R misc Science misc Q Management of tuberculosis by healthcare practitioners in Pakistan: A systematic review.
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title	Management of tuberculosis by healthcare practitioners in Pakistan: A systematic review.
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title_full	Management of tuberculosis by healthcare practitioners in Pakistan: A systematic review
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title_sort	management of tuberculosis by healthcare practitioners in pakistan: a systematic review
title_auth	Management of tuberculosis by healthcare practitioners in Pakistan: A systematic review.
abstract	<h4<Objective</h4<To assess the quality of tuberculosis (TB) care in Pakistan, through determining comparison of healthcare practitioners' knowledge and practices to national and international TB care guidelines.<h4<Methods</h4<Studies reporting on knowledge, attitudes and practices of public and private practitioners with TB patients were selected through searching electronic databases and grey literature.<h4<Findings</h4<Of 1458 reports, 20 full-texts were assessed, of which 11 met the eligibility and quality criteria; all studies focused on private sector care. Heterogeneity precluded meta-analysis. In 3 of 4 studies, over 50% of practitioners correctly identified a cough as the main TB symptom. However, 4 out of 6 studies showed practitioners' compliance to be low (under 50%) for the use of sputum microscopy in diagnosis. The poorest quality care occurred in the later stages of treatment, with low compliance in prescribing practices for continuation-phase care and in monitoring and recording treatment progress, the latter of which is particularly critical for treatment success.<h4<Conclusion</h4<TB care was variable and generally inadequate, with both a lack of knowledge and a small 'know-do' gap evident-practitioners did not use methods that they know they should use. A lack of recent evidence found suggests that the quality of current practices may not be fully captured and further research is needed, especially on non-allopathic, rural and public-sector contexts. Improved training of practitioners, greater availability of recommended diagnostic tools and expansion of public-private partnerships are suggestions for improving the quality of TB care in Pakistan.
abstractGer	<h4<Objective</h4<To assess the quality of tuberculosis (TB) care in Pakistan, through determining comparison of healthcare practitioners' knowledge and practices to national and international TB care guidelines.<h4<Methods</h4<Studies reporting on knowledge, attitudes and practices of public and private practitioners with TB patients were selected through searching electronic databases and grey literature.<h4<Findings</h4<Of 1458 reports, 20 full-texts were assessed, of which 11 met the eligibility and quality criteria; all studies focused on private sector care. Heterogeneity precluded meta-analysis. In 3 of 4 studies, over 50% of practitioners correctly identified a cough as the main TB symptom. However, 4 out of 6 studies showed practitioners' compliance to be low (under 50%) for the use of sputum microscopy in diagnosis. The poorest quality care occurred in the later stages of treatment, with low compliance in prescribing practices for continuation-phase care and in monitoring and recording treatment progress, the latter of which is particularly critical for treatment success.<h4<Conclusion</h4<TB care was variable and generally inadequate, with both a lack of knowledge and a small 'know-do' gap evident-practitioners did not use methods that they know they should use. A lack of recent evidence found suggests that the quality of current practices may not be fully captured and further research is needed, especially on non-allopathic, rural and public-sector contexts. Improved training of practitioners, greater availability of recommended diagnostic tools and expansion of public-private partnerships are suggestions for improving the quality of TB care in Pakistan.
abstract_unstemmed	<h4<Objective</h4<To assess the quality of tuberculosis (TB) care in Pakistan, through determining comparison of healthcare practitioners' knowledge and practices to national and international TB care guidelines.<h4<Methods</h4<Studies reporting on knowledge, attitudes and practices of public and private practitioners with TB patients were selected through searching electronic databases and grey literature.<h4<Findings</h4<Of 1458 reports, 20 full-texts were assessed, of which 11 met the eligibility and quality criteria; all studies focused on private sector care. Heterogeneity precluded meta-analysis. In 3 of 4 studies, over 50% of practitioners correctly identified a cough as the main TB symptom. However, 4 out of 6 studies showed practitioners' compliance to be low (under 50%) for the use of sputum microscopy in diagnosis. The poorest quality care occurred in the later stages of treatment, with low compliance in prescribing practices for continuation-phase care and in monitoring and recording treatment progress, the latter of which is particularly critical for treatment success.<h4<Conclusion</h4<TB care was variable and generally inadequate, with both a lack of knowledge and a small 'know-do' gap evident-practitioners did not use methods that they know they should use. A lack of recent evidence found suggests that the quality of current practices may not be fully captured and further research is needed, especially on non-allopathic, rural and public-sector contexts. Improved training of practitioners, greater availability of recommended diagnostic tools and expansion of public-private partnerships are suggestions for improving the quality of TB care in Pakistan.
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Management of tuberculosis by healthcare practitioners in Pakistan: A systematic review.

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