b) Health Centre Based
AU : Nagpaul DR, Vishwanath MK & Dwarakanath G
TI : A socio-epidemiological study of out-patients attending a city tuberculosis clinic in India to judge the place of specialised centres in a tuberculosis control programme.
SO : BULL WHO 1970, 43, 17-34.
DT : Per
AB :

The study was carried out at LWTDTC, 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 percent random sample of 2,658 out-patients during 61 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 of age.

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 TB 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. Upon 4.8 km the number of new out-patients 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 showed 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 TB 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 that urban and rural patients behave in almost the same way in that their first contact for symptoms suggestive of TB, is initially at the general medical services and they should be strengthened with adequate means for diagnosis and treatment of TB.