Table 2 Domains of challenges and need for the laboratory diagnosis of tuberculosis from study conducted among medical doctors in Ujjain, Central India

Challenges and need for the laboratory diagnosis of TB^a

Relationship between the basic elements of TB and the diagnostic process

Symptoms prior to diagnosis

Cough, Low-grade fever, on –specific symptoms

Clinical characteristics of TB

Non-specific clinical signs, importance of clinical examination, many clinical signs together need to be interpreted

Inter-relationship between beliefs, knowledge and practice

TB stigma associated with socioeconomic status, traditional beliefs, Utilization of traditional health services, TB related illiteracy

Contextual and prevailing conditions for TB diagnosis

Laboratory system in action

Improper knowledge of laboratory test, low knowledge of newer TB test, poor adherence to protocol, self made protocols, non-availability of TB specific tests, multiple tests prescription, empiric treatment is considered as diagnosis test, wrong notion for the TB tests

Lack of explicit and reliable diagnostic tool

No definitive laboratory tests, laboratory test are considered supportive, multiple test result help diagnosis, sputum for AFB^b is unreliable, PCR^c and culture not useful in routine practice

Consumerism and the diagnostic process

Private practice, choice of tests, diagnostic algorithm

Extra-pulmonary tuberculosis and the diagnostic process

Importance of clinical history, Importance of clinical examination, difficult laboratory diagnosis, use of various modalities, invasive procedure

Context relevant need and intervention

Organizational changes and education of health care providers and improving referral

Early referral, easy accessibility, availability of infrastructure, education, use of common modes of communication

Formulation of simple and effective diagnostic protocol for all kind of TB

Simple test, reliable diagnostic tool, guidelines