The study was undertaken among 22,957 persons belonging to 55 randomly selected villages of Nelamangala taluk of Bangalore district in 1975, to find out precise estimates of prevalence of bacillary disease. Symptom screening was done by well experienced social investigators, according to a brief interview schedule. Sputum was collected from all above the age of 5 years reporting chest symptoms for seven or more number of days during the previous two months. Within two weeks after symptom questioning, all were tuberculin tested and all 5 years and above were X-rayed. Additional sputum collection was done for those asymptomatics who had abnormal shadows in their chest X-rays.

The overall prevalence rate of culture confirmed bacillary cases by symptom and/or X-ray screening was 0.32 percent. Same prevalence was seen with X-ray alone also. But the overall prevalence rate based on symptom screening alone was 0.21 percent which is significantly lower than that of symptom and/or X-ray screening, or X-ray screening alone. The prevalence rates by age and sex based on symptom screening were about two-thirds that of rate based on X-ray and/or symptom screening. Hence to obtain prevalence rate according to X-ray and/or symptom screening, a correction factor of 1.52 should be applied to the prevalence rates obtained by symptom screening alone. This correction factor is fairly good for most of the age groups. It was also estimated that the cost of surveying the population by symptom screening alone is about half that of surveying the population by X-ray screening.

A study was conducted in 55 randomly selected villages of Nelamangala taluk, Bangalore district in 1975 (1) to estimate the prevalence of symptoms in the general population during the two months prior to the epidemiological survey, (2) to study the nature of action taken by these symptomatics and, (3) to find out through sputum examination as to how many of them suffer from pulmonary tuberculosis. The entire population was interviewed and sputum was collected from those aged five years and above having symptoms continuously for seven days and more. A coverage of 98.8% was obtained. Symptomatics among the directly interviewed were almost double (32.3%) of those who had to be interviewed by proxy (16.8%). Proportion of symptomatics were higher in the age groups twenty years and above. 24.8% were symptomatic during the reference period of two months and 16.7% had symptoms on the day of interview. ll.1% were found to have chest symptoms. The prevalence rate of tuberculosis was found to be 21 per 1000, (for males 28 and females 14). Cough was the most prevalent and the symptom of longest duration.

The findings suggest that symptoms questioning should focus more on cough and its combination with other symptoms. Symptoms questioning as a tool to detect cases has less potential than X-ray, but data reveal that leading questions can elicit more information on symptoms and action taking. The manner of action taking was the same for chest symptoms as for other symptoms and the proportion taking action is also the same for males and females. Government health facilities are found to be the most important source of relief, indigenous medicine having some importance marked second and the private practitioners ranking only third.

Persons suffering from pulmonary tuberculosis generally experience symptoms such as cough, chest pain, fever and haemoptysis. It is possible to identify the symptomatics by interviewing them during community health surveys. The symptom survey was carried out in 62 villages and 4 town blocks of Tumkur district in Karnataka as a sequel to an epidemiological survey undertaken to estimate the prevalence of tuberculosis. The data was collected through structured schedule. The interviewers were given the identification details of individuals having X-ray shadows suggestive of tuberculosis and an equal number of matched controls within 4 weeks of the survey. A total of 1752 persons were taken into the study of whom 875 had x ray shadows and 877 were normals. Of the total persons under study 89.7% were satisfactorily interviewed. It was observed that 42.6% of the total symptomatics gave history of one symptom at the first general question, 13% responded having symptoms after being asked specific questions. In conclusion a 42.6% affirmative response to the initial question of 'How is your health' is noteworthy that an investigator is acceptable health agency as the interviewee is willing to confide in him regarding his health problems. Additional number of persons responded to direct specific questions.

It must be pointed out that interview is a generic term applied to a tool that may be used for obtaining information through verbal communication. As a tool in surveys for screening for tuberculosis it is amenable to divese techniques and has great potentialities of being applied to different situations and various categories of respondents. Hence, it is necessary to identify the nature of data to be obtained and to decide on the technique that would be most suitable. Proper training, skill and supervision of the interviewer can obviate any possible bias and subjectivity that could vitiate an interview. As compared to many of the tools of social science research, the interview is simple, easy and amenable to being used in live situations. It is also of prime importance among populations for whom vocalisation is the most important medium of communication. Hence, in a community survey for the estimation of the prevalence of chest symptomatics the interview can be a valuable tool. It also shows that the interview is adequate as a tool of community survey in tuberculosis.

A study on awareness of symptoms of pulmonary tuberculosis and action taking was repeated in the 62 villages and 4 town blocks of Tumkur district of Karnataka after an interval of 12 years. In the earlier study, 2106 persons formed the study population. In the present study, 1752 were intaken to obtain a comparison of these 1752 intaken persons who were eligible for interview, 875 were X-ray positive and 877 X-ray normal (matched control).

The study showed that 95% of patients having radiologically active tuberculosis by both X-ray readers, 70% by one reader, 49.5% inactive by both readers, were aware of symptoms. According to the bacteriological status 79.5% had symptoms among those who were sputum positive by both microscopy and culture, 62.2% among those positive by culture alone and 73.7% among patients sputum positive by any method. Regarding action taking it was observed that 49.5% of the bacteriologically positive patients took some action compared by 70% of those found to have radiologically active disease by both X-ray readers. Thus action taking was higher among the latter category in both the studies. It may be due to the fact that extent of lesions are less advanced among those bacteriologically positive than among those who were in radiologically positive stage.

The findings of the study are similar to the earlier awareness study carried out in 1963 in the same area (Tumkur). This also indicates that in spite of having advantage of DTP for a decade actual and total benefits have not reached the people.

A longitudinal epidemiologic survey was carried out in Nelamangala taluk of Bangalore district since 1961, to find out prevalence of infection and disease of tuberculosis. During V round of the survey 1977, after 16 years of the first round, it was planned to study the awareness of symptoms and action taking of persons in the community where repeated surveys consisting of tuberculin, X-ray and sputum examinations had been carried out since 1961 and facilities for diagnosis and treatment were available since 1974. Fifty one persons aged 20 years and above, referred as X-ray positives were interviewed by social investigators on a structured questionnaire to elicit the awareness of symptoms and details of action taken to seek relief.

Of the 51 satisfactorily interviewed, 41 (80.4%) had symptoms suggestive of tuberculosis, of the 20 bacteriologically positive cases 19 (95%) were aware of symptoms suggestive of tuberculosis, thus registering a higher percentage of awareness than the X-ray positives. Of those with symptoms, 58.8% sought relief, many of them at multiple agencies such as Govt. hospitals and private practitioners, and some at tuberculosis hospitals, on being referred there. Most had obtained services free of cost and appreciated the available intrinsic benefits. Prior personal or family associations were the main reasons for seeking the services of private practitioners. Only 23% had gone to the nearest health facilities. Lack of proper facilities for good treatment and preference to be treated at urban centres, were the main reasons for not availing of the services at the nearest health facilities.

This study based on an individualistic model examines the significance of factors such as symptom awareness, knowledge about the disease, recall of clinic instructions, economic problems and social interaction in the treatment regularity of patients with pulmonary tuberculosis through a multi dimensional comparison of regular patients, irregular patients and their households. There was no difference in the symptom awareness of the two groups of patients. Thus frequency of medical visits is to adopt the sick role than of stress. In NTP patients are denied the sick role has “rest” and “special diet” the vital elements of traditional treatment are not recommended as part of treatment. Yet, three of the four cardinal symptoms of pulmonary tuberculosis, cough fever and haemoptysis being of a nature observable by others, have been observed by the households to the extent similar to patients awareness. Most of the patients who take treatment from non- paying centres such as the LWTDTC live in overcrowded areas where there is generally a high degree of neighbourhood interaction not only social but in sharing common utilities such as courtyard, water tap, bath room, toilet etc. It is therefore not surprising that nearly half of the patients and households said that the neighbours knew about the patient's illness.

Seeking multiple sources of treatment is a common behaviour pattern of patients. Yet, it is disconcerting to find that tuberculosis patients who can ill afford to pay and who need to be under treatment for a long period should 'shop around' for treatment. It is the irregular patients who have sought treatment at other agencies more often. The study shows that patients showing regular drug collection have had help from household members in collecting the drugs. They have also had help from household members in remembering to consume the drugs. More of the households of the regulars mentioned LWTDTC as the place of treatment while in the in case of the households of the irregulars mentioned several places of treatment.

No significant differences were seen between the regular and irregular patients in their social interactions within the households or in the behaviour of households towards the patients. To the household, economic difficulties were the most important, perhaps for the reason that the patients were men in the working age group. Though economic difficulties were important to patients also the predominant aspect was pain and discomfort the physical dimensions of suffering. A treatment agency that can pay adequate attention to the relief of physical suffering and non- relapse of symptoms can perhaps help to improve treatment regularity of tuberculosis patients appreciably.

National tuberculosis programme reaches people through PHCs and sub centres. A study was conducted to find out the perception of illness and utilisation of health facilities by the community. This study was conducted in a random sample of 48 villages selected according to Probability Proportioned to Size within 5 Kms of the selected PHIs in Kolar District using a Multi stage sampling technique. Information on socio economic status, availability of health services and their utilisation was collected. 13,323 individuals were interviewed. 706 were ill in a period of two months prior to survey. 71.3% had taken allopathic system of treatment. 69.1% had approached government hospital or PHC. 34 patients reported to have TB. All had attended either DTC or PHC.

The study indicated that morbidity was perceived much early and also followed by an action. Data indicates a high percentage of preferring allopathic system in general and from peripheral health centres and other Government hospitals in particular. Data indicates that in spite of overall backwardness of the study area and very limited economic resources people have utilised the PHC to the maximum. The reason could be either high acceptance of PHC or inevitability. But, there is an evidence of higher utilisation of family welfare and MCH services. The data shows all tuberculosis patients have had exposure to standard regimens, all of them have approached either PHC or DTC for treatment. This confirms the felt need oriented concept of National Tuberculosis Programme. Also high level morbidity among children below 4 years of age and action taken indicate an enhanced level of demand for health services.

A study on acceptability of BCG vaccination, through specialised technicians in a population of 8350 residing in 8 villages of Channapatna taluk of Bangalore district, was carried out by National Tuberculosis Institute. Of the 1106 households satisfactorily interviewed, 956 (86.4%) had at least one child eligible for vaccination. For the purpose of analysis they were classified into three groups. Group I consisted of 312 (32.6%) households in which all children were vaccinated, Group II 270 (28.2%) where non-e of the children were vaccinated and Group III 374 (39.2%) households where only some of their children were vaccinated. Overall vaccination coverage was 52.7% with a range of 33.9% to 79.3%.

The reasons for refusing vaccination were studied. The caste, occupation, education etc., of the household did not have any influence on the refusals. When analysed according to the knowledge and opinion about vaccination it was observed that 55.9% of the children were not vaccinated because of the lack of knowledge in the group where no child was vaccinated. Even when 42% had favourable opinion about vaccination, 52% of the households did not vaccinate any of their children. The refusals were mainly due to (i) absence from the village on the day of vaccination, (ii) fear of prick. Among households where there was unfavourable opinion, all had refused due to fear. The reasons for accepting BCG vaccination were (i) the vaccination was done in the school and hence there was no option for the parents to accept or refuse, (ii) parents felt that the vaccination was good for children, (iii) parents knew that it would prevent TB.

A controlled study was conducted at Lady Willingdon Tuberculosis Demonstration and Training Centre (LWTDTC), Bangalore among 250 patients randomly selected urban patients of pulmonary tuberculosis of whom 155 were in the 'motivation' group and 95 were in the 'control' group. In the motivation group, patients were interviewed by National Tuberculosis Institute health visitor and motivated by LWC staff; a month of drugs (TH) were given. Within 3 days of initiation of treatment they were motivated along with their household members during home visit by NTI staff every month for a period of three months. Control group patients were motivated at the clinic as per the programme guidelines.

In the motivation group, 59.9% of patients had made all the three collections during the first three months compared to 27.8% in the 'control' group. During the remaining months also the drug collection was 47% and 35.6% respectively. The drug collection pattern among the patients in the motivation group was found to be better than among the patients in control group who did not have the benefit of home visiting. Sputum conversion was also found accordingly better among the motivation group as compared to control group.

During last two decades, the health care delivery system has undergone several changes. The implementation of the concept of Primary Health Care and of the Multi Purpose Health Workers (MPWs) Scheme can be utilised to improve both Case-finding and case holding activities of the District Tuberculosis Programme. A study was undertaken by National Tuberculosis Institute (NTI) to obtain a profile of work of MPWs, observe their work on time and motion analogy and to ascertain output of tuberculosis services and other works. The study was carried out in a contiguous area of 6 PHCs of a district. The work of 16 MPWs was observed by a Social Investigator of NTI who accompanied them during a day's work; one month period was selected as reference period. 160 MPWs were asked to give details of their activities through self administered questionnaire and records of the six PHCs were studied in terms of output of the services.

On an average a MPW travelled 15 kms, spent 4 hours in the village, visited 70 homes; Of them, 25% were locked. The time spent on different activities during home visits were 34% for minor ailments, 26% on malaria, 12% on family welfare and 11% on tuberculosis. Profile of activities carried out on a randomised day were, 77.5% did not perform any anti tuberculosis activities. Those who did anti tuberculosis work identified 4 symptomatics, prepared two smears and followed up 13 patients. The highest performance was with regard to Family Welfare (68%) and treatment of ailments (64%). As per the opinion of MPWs tuberculosis was 7th, 8th and 9th rank, malaria was lst and 3rd and family welfare was 1st and 2nd. As per the actual output of work from the PHC records, anti malaria (70%) and minor treatment had the maximum performance and family welfare averaged, as only 35 of the eligible couples were registered. Findings suggest that tuberculosis was given lower priority in terms of all the three points i.e., actual performance, profile of work of MPW, actual day's work of MPW and diverse health activities among rural population. Integration of tuberculosis at periphery needs more important considerations.

As a part of the supervised field training of the students of health education from Rural Health Training Centre, Gandhigram, Tamil Nadu, a pilot project of short term intensive health education was undertaken at 11 selected villages under Primary Health Centre (PHC), Hesarghatta. The objectives were to measure the impact of an intensive health education effort in increasing the attendance of patients with symptoms suggestive of pulmonary tuberculosis at a PHC and to study the impact of health education in terms of increase in knowledge and change of attitude of the people towards the PHC. For participation of the community all the three health education approaches viz., individual approach, group approach and mass approach were planned along with audio visual aids as and when required. Application of a specific approach depended on the level of awareness about tuberculosis and the availability of services which was measured by a base line survey conducted in the selected villages.

As expected this short term intensive health education has shown that the knowledge on tuberculosis in the population increased, following it. When it was measured by the yardstick of increase in the proportion of out patients with chest symptoms, attending the PHC, no significant change was noticed during the period of observation. The likely reason could be that it was too early to measure the effect of health education within a period of 6 weeks. In this project the intensive health education work was done almost continuously for a short time which was probably not appreciated by the people. Though in all the villages following the health education programme, the people had understood the importance of getting the chest symptoms examined to rule out tuberculosis, they have not approached the PHC for the same. The other possible reason could be that the people are not satisfied with the services provided by the PHC. It goes without saying that when the services provided by the PHC itself are not upto the expectation of the people, the outcome of health education could only be