Selected data from the Philippines TB Survey (1981-1983) are presented to study the relationship between epidemiological and social aspects of TB, specifically, awareness of certain symptoms and prevalence of TB. Qualified sociological interrogators were drilled for several weeks prior to the survey in setting interview situations, non-suggestive questioning followed by a few leading questions, anatomy of the questionnaire and the standard way of handling it, testing for consistency both prior to use and during the survey. Individuals 20 years and above were asked if they had any suggestive symptoms, namely, cough, fever, chest and/ or back pain, or haemoptysis during 4 weeks prior to an interview. Of 9,090 such persons interviewed, 2,515 (28%) had one or more of the stated symptoms. Of those with symptoms, 3.6% had positive smear results compared with 0.5% among the asymptomatics. For culture positivity, the corresponding proportions were 4.2% and 0.9% and, for radiographic TB, 11.4% and 4.1% respectively. These differences were highly significant and applicable to all age groups. There appears to be a fairly close relationship between the epidemiological parameters and suffering awareness of symptoms produced by TB. This conclusion was supported by the finding that, when both symptomatics and asymptomatics were equally pressed to attend for the investigations, the presence of symptoms appeared to have increased the suspects' likelihood to attend for the investigations (P<0.0001).

Further, the data suggested that eliciting suggestive symptoms in a manner to reflect suffering awareness had a reasonably high degree of sensitivity and specificity; the highest level of sensitivity (74%) was reached with respect to smear-positive cases. Thus, using the symptom suffering as a useful sociological parameter is feasible. Concerning action-taking, on analysis, the pattern varied with age, gender, urban/rural habitat, nature and duration of symptoms, whether a symptom occurred alone or in combination, etiology of the symptom and social perception of what needs to be done for a particular kind of symptom and how an individual/ family should proceed if an action taken was unsuccessful. Nevertheless, the choice of action was related to the TB/ non-specific etiology of symptoms. Based on these findings, there appears to be a good case to develop an objective measurement of cough, of a selected duration and action taking as a sociological parameter of suffering to go along with the epidemiological measurement of TB in a community.