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A SOCIOLOGICAL INQUIRY INTO AN URBAN TUBERCULOSIS
CONTROL PROGRAMME IN INDIA |
Stig Andersen & D Banerji: Bull WHO 1963, 29,
685-700. |
Tuberculosis control by mass domiciliary chemotherapy
is now being attempted on an increasingly large scale in the technically
underdeveloped countries. The National TB Institute (NTI), Bangalore
is an important centre for the development of such programmes and
a study reported in this paper is an enquiry into the working of
an urban tuberculosis programme which is operated under the auspices
of the Institute. The excellent results of controlled clinical trials
have lead to widespread belief that tuberculosis problem can be
reduced significantly and rapidly by use of mass chemotherapy. However,
the findings of such programmes elsewhere showed that by a long
term continuous effort year after year, the removal of infectious
cases can bring about a gradual reduction of the problem. Hence,
it was necessary to study the treatment organisation of domiciliary
chemotherapy on a large scale in respect of patients behaviour
towards the programme during the treatment period. Three types of
problems encountered in an urban tuberculosis programme are dealt
in this paper: (1) problems related to the patients who are under
treatment at the Lady Willingdon TB Demonstration & Training
Centre (LWTDTC); (2) patients who prefer to take treatment from
other institutions and (3) patients who come from outside the city.
Study population consisted of 784 radiologically positive patients
diagnosed at the LWTDTC from March 61 to May 61. All the outpatients
were submitted to a tuberculin test and examination by a 70 mm photofluorogram.
Those who were X-ray positive were given bacteriological examination
of a spot sample of sputum by both smear and culture on their second
visit scheduled on the third day. Of the 784 persons 318 (54%) were
found to excrete tubercle bacilli. All patients suffering from active
tuberculosis and sputum positive disease were put on a treatment
regimen of 300 mg of isoniazid per day for a period of one year.
During the course of the study a few of the sputum positive cases
were given 10 gms of PAS in addition. The study population was interviewed
by the Social Investigators of NTI: initially at the clinic immediately
after their diagnosis, defaulters at their homes within four weeks
of their defaulting and all patients after twelve months of treatment
period. The coverage was 100%, 65% and 76% respectively.
The major problems identified and quantified were:
Of the 784 patients under study, 84 (11%) did not even return to
learn the results, 46 (6%) patients houses could not be traced,
138 (17%) resided outside the city, 48 (6%) emigrated during the
treatment, 173 (22%) took treatment from outside sources, 156 (20%)
took treatment regularly from the clinic and 139 (18%) also took
treatment in the clinic but irregularly. Various reasons were given
for defaults in drug collection, a sizable proportion of which could
have been avoided through better organisation and administrative
procedures and good initial motivation at the clinic. Default is
a complex behaviour pattern and this study did not bring out any
correlation between default and the economic, social, educational
or other status of the patient. With changes in the system leading
to a good treatment organization, it should be possible to have
a higher percentage of regular patients than 20% as at present.
About 64% sputum conversion among regular patients and estimated
25% among defaulters was observed.
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KEY WORDS: URBAN CONTROL PROGRAMME, SOCIAL INQUIRY,
COMPLIANCE. |