|A SOCIO-EPIDEMIOLOGICAL STUDY OF OUT-PATIENTS ATTENDING
A CITY TUBERCULOSIS CLINIC IN INDIA TO JUDGE THE PLACE OF SPECIALIZED
CENTRES IN TUBERCULOSIS CONTROL PROGRAMME
|DR Nagpaul, MK Vishwanath & G Dwarakanath: Bull
WHO 1970, 43, 17-34.
The study was carried out at Lady Willingdon Tuberculosis
Demonstration & Training Centre, Bangalore to inquire into the
epidemiological and sociological characteristics of patients attending
a city TB clinic for the first time, to ascertain the reason for
attendance and the nature of previous treatment if any. It was also
to see whether there was a preference for seeking specialists and
specialised services for alleviation of the symptoms experienced
and whether there were any differences amongst the urban and rural
attenders. A fifty per cent random sample of 2,658 out patients
during 6l working days, formed the study population. They were interviewed
by using a questionnaire based on the above mentioned objectives.
247 were not eligible due to incomplete record and below 5 years
Majority of the out patients were in 20 30 years
of age and were wage earners. Nearly 80% were aware of their symptoms
and contained 95% of the tuberculosis cases detected at the clinic.
Most of them were having 2 3 symptoms. No difference in time of
reporting was observed among urban or rural patients; 61% of the
urban and 42% of the rural patients attended the clinic within 3
months from the onset of their symptoms. Distance is a major obstacle.
Upto 4.8 km the number of new outpatients was large but the case
yield was poor. As the distance increased the out patients decreased
but the case yield was more, suggesting a selective process influenced
by distance. It was also found that 20% of the out patients came
of their own without any prior contact with any other source of
treatment, 32% had previous contact with other health institutions,
31% were actually referred by them and 17% were advised by BCG workers.
Further analysis that of the 1,642 patients who had previous contact
with health institutions, 84% were at general health institutions,
10% at specialised TB clinics and 6% were others. Of the remaining
eligible 2,403 patients, 83% were from urban and 17% from rural
areas. Sputum was collected from 2,308 patients. Of them, 179 (7.8%)
were found to be positive by direct microscopy or culture or both
and 169 were positive by culture (91% confirmation by culture).
131 (80%) were sensitive to isoniazid and 32 were isoniazid resistant.
The data obtained suggests that attendance at a
specialized tuberculosis centre is not necessarily a function of
awareness of symptoms and of the knowledge that such specialised
services exist. It also does not support the theory that people
prefer specialized institutions in cities. It is also seen than
urban and rural patients behave in almost the same way in that their
first contact for symptoms suggestive of tuberculosis, is initially
at the general medical services and they should be strengthened
with adequate means for diagnosis and treatment of tuberculosis.
|KEY WORDS: CONTROL PROGRAMME, SOCIO EPIDEMIOLOGY,