A : Problem Definition
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.