TB is primarily the problem of human suffering.
The author, in 1967, presented some ways of measuring suffering.
Eleven thousand, three hundred and fifteen persons from 2,135 rural
Bangalore (Karnataka) families were questioned for the presence
of TB symptoms two months preceding an interview. Four thousand,
six hundred and ninety persons (41.4%) with symptoms were identified.
Suffering was measured in terms of death, sick man-days, absence
from work and loss of wages, hiring alternative labor, cost of treatment
etc. Sick man-days were categorized as completely bed-ridden, partially
bed-ridden and ambulatory days. The calculated rough specific mortality
of 17.6% compared poorly with the overall crude mortality of 2.2%,
without adjustment for age and sex. The overall economic penalty
inflicted was about five times more for TB patients compared to
other sick persons.
From a review of longitudinal surveys conducted
in Singapore and Korea (1975) and in the Philippines (1981-1983),
it was shown that the duration of symptoms (suffering man-days),
before diagnosis in a fresh case, could be developed into a sociological
parameter with cough, the most frequent symptom, being taken as
the index symptom. For reliability, information on the duration
of cough should be elicited in homes in the presence of the entire
family by trained health workers. Specific mortality could also
be used as a sociological yardstick. If information on TB deaths
cannot be related to the entire community, the yardstick should
be applied to patients placed on treatment by NTP. Effective NTPs
should be able to bring down specific mortality fairly close to
crude mortality. Finally, if the estimate of epidemiological prevalence
of the bacteriologically confirmed cases in the community is available,
it is desirable to calculate the proportion of the prevalence cases
under the current treatment of NTP, from time to time.