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.

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.

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.

Mass miniature radiography (MMR) is the usual tool for population screening in tuberculosis case prevalence surveys. However, this facility is not available at most centres in India. An attempt was made to study the feasibility of carrying out sputum positive case prevalence survey in a population by introducing methodological variation in the screening, in order to select those eligible for sputum test without resorting to the customary use of MMR for the purpose. The study was carried out in Bangalore rural district during 1984-1986. The area was the same as for six earlier prevalence surveys conducted since 1961. The population aged up to 44 years was tuberculin tested. Persons with test induration size of = 10 mm were eligible for sputum examination, besides all those aged over 45 years were eligible. It was observed that 78.4% of the registered population (29400) in the age group 10 years and above were required to undergo sputum examination by the present method of screening leading to a very high work load of sputum examination necessitating deployment of additional sputum cultures. Thus, the purpose of pre selection for sputum examination was hardly fulfilled. Further, a high contamination rate was observed. The changed screening procedure in this survey made comparison with the earlier data difficult.

The overall prevalence rate of cases was 438/100,000 in persons aged 10 years and above, while smear positive prevalence rate was 68/100,000. The observed prevalence rate was similar to earlier surveys, while smear positive prevalence rate was much lower. In conclusion, the screening methodology was found to be operationally unfeasible, ineffective and counterproductive to complicate the survey procedure in the quest for simplicity.