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Factors associated to referral of tuberculosis suspects by private practitioners to community health centres in Bali Province, Indonesia

I Wayan Gede Artawan Eka Putra1*, Ni Wayan Arya Utami1, I Ketut Suarjana1, I Made Kerta Duana1, Cok Istri Darma Astiti2, IW Putra3, Ari Probandari4, Edine W Tiemersma5 and Chatarina Umbul Wahyuni6

Author Affiliations

1 School of Public Health, Faculty of Medicine, Udayana University, Bali, Indonesia

2 NTP of Bali Province Health Office, Bali, Indonesia

3 NTP of Tabanan District, Health Office, Bali, Indonesia

4 Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia

5 KNCV Tuberculosis Foundation, The Hague, The Netherlands

6 Faculty of Public Health, Airlangga University, Surabaya, Indonesia

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BMC Health Services Research 2013, 13:445  doi:10.1186/1472-6963-13-445

Published: 28 October 2013



The contrast between the low proportion of tuberculosis (TB) suspects referred from private practitioners in Bali province and the high volume of TB suspects seeking care at private practices suggests problems with TB suspect referral from private practitioners to the public health sector. We aimed to identify key factors associated with the referral of TB suspects by private practitioners.


We conducted a case-control study conducted in Bali province, Indonesia. The cases were private practitioners who had referred at least one TB suspect to a community health centre between 1 January 2007 and the start of data collection, while the controls were private practitioners who had not referred a single TB suspect in the same time.


The following factors were independently associated with referral of TB suspects by private practitioners: having received information about the directly observed treatment short-course (DOTS) strategy (OR 2.0; 95% CI 1.1 – 3.8), ever having been visited by a district TB program officer (OR 2.1; 95% CI 1.0 – 4.5), availability of TB suspect referral forms in the practice (OR 2.8; 95% CI 1.5-5.2), and less than 5 km distance between the private practice and the laboratory for smear examination (OR 2.2; 95% CI 1.2-4.0).


Education and exposure of private practitioners to the TB program improves referral of TB suspects from private practitioners to the national TB program. We recommend that the TB program provides all private practitioners with information about the DOTS strategy and TB suspect referral forms, and organizes regular visits to private practitioners.

Tuberculosis; Private practitioners; Operational research; Indonesia