There is a wide spread prejudice among the staff of health centres that patients invariably prefer injection and it was felt by many health workers that streptomycin containing intermittent regimens would be more acceptable to rural patients. A study was carried out to find out the acceptability and applicability of an intermittent supervised drug regimen containing streptomycin 1 gm and INH 650 mgm once a week in a rural area as well as the regularity with which the rural folk took this treatment. Association between the observed regularity and factors like age, sex etc., was also analysed. 107 rural patients of tuberculosis, diagnosed at 5 taluk hospitals in Ananthapur district of Andhra Pradesh on the basis of sputum examination by direct smear and/or X-ray examination with the help of mobile X-rays, consented to treatment with intermittent regimen mentioned above. About half of them were new patients and the rest were old patients who were mostly regular on an earlier oral regimen. 94 of the above were available for analysis.

The regimen was found quite practicable in the sense that at no centre the study was interrupted or discontinued because of the inability of the health centre staff to give injection. If regularity is expressed as a proportion of patients who at any given time had taken the optimal amount of treatment (no. of injections), then 40 patients (42%) were found regular on the intermittent regimen, 36 patients were classified as lost and the remaining had 3 or less injections due and had not yet had the chance to become lost according to the definition adopted. Thus, the regularity of those accepting the regimen was quite low. There was very steep fall in regularity during the first 10 weeks of treatment, nearly a half of the total cases became irregular during the first 6 weeks. Beyond 4 months of treatment, patients who continued to attend centres regularly for treatment became negligible, thus pointing that injection was not a key variable in the treatment regularity of tuberculosis.

In the formulation and evolution of a National Tuberculosis Programme some assumptions are made which require to be tested under the normal administrative set up with minimum interference by the investigating team. The objectives of the study were to understand some operational aspects of Case-finding in the Peripheral Health Institutions (PHIs) in an integrated programme. First, what is the frequency of persons showing symptoms suggestive of pulmonary tuberculosis among the normal out patients attendance (OPA), how many cases can be found by direct microscopy of sputum of those symptomatics, what will be the workload of TB Case-finding at a PHI and, what proportion of symptomatics will be willing to and will actually attend the District TB Centre (DTC) when referred there for X-ray examination. The study was conducted in a district with a population of 1.5 million having one DTC and 55 PHIs. 15 PHIs were selected on the basis of stratified random sampling. At each PHI an National Tuberculosis Institute (NTI) investigator worked for a period of one month. All new out patients were questioned for symptoms (non- suggestive and suggestive) and any patient with chest symptoms mainly cough for more than one week fever, chest pain and haemoptysis was subjected to a sputum examination and also referred for X-ray examination at the DTC.

It was found that 381 (2.5%) of the 14881 total new out patients of all age groups complained of cough for 2 weeks and more. From these chest symptomatics, 11% were new cases of pulmonary tuberculosis. When the symptomatics were referred for X-ray examination, although 66% agreed to go for X-ray to DTC but only 16% (of the total referred) actually went for X-ray. Each PHI had to examine only one or two sputum specimens per working day. As the study was conducted in a representative sample of PHIs for a representative duration of time, the material permits the estimation of the potential yield of cases in a District TB Programme (DTP) during a period of time (say one year). It was estimated that about 45% of the total estimated prevalence cases in a district can be diagnosed in a DTP during a period of one year, if all PHIs function according to the programme recommendations. The workload due to tuberculosis Case-finding is small and can be managed with the existing staff and Case-finding by direct smear examination of sputum at the PHI has to be relied upon.

A study was undertaken in Bangalore city, Karnataka, to find out whether people with chest symptoms, including tuberculosis patients, attend General Health Institutions or report directly to tuberculosis clinics. The objective was to investigate the proportion of persons with chest symptoms (cough, fever, pain in chest and haemoptysis) among out patients attending the general city dispensaries, and the proportion of pulmonary tuberculosis cases among them. The findings of this study are based on examination of one day's attendance at each of the 19 general dispensaries of Bangalore city, consisting of 2,506 persons aged 10 years or more who had attended the dispensaries for the relief of any ailment. The investigation consisted of symptom questioning, examination of spot sputum sample and 70 mm chest photofluorogram. Sputum specimens were examined by direct smear and culture. Study intake period of 19 days was spread over three months.

The study showed that of the 2506 out patients, 1170 (47%) had visited dispensaries primarily for relief of chest symptoms. Of these, 31 (2%) had evidence of active or probably active pulmonary tuberculosis and 20 (0.8%) were sputum positive cases. It is concluded that even though there are special tuberculosis institutions in the city, a fair number of new and old tuberculosis patients contact general dispensaries. These dispensaries can therefore contribute considerably to tuberculosis case-finding in the city.

This investigation was to find out the drug consumption among tuberculosis patients put on domiciliary self administered chemotherapy, in terms of proportion of patients that make various levels of drug collections and proportion among them that consume drugs at different points of time during the course of treatment. In all, 816 tuberculosis patients aged 5 years and above residing in Bangalore city were admitted to the study. They were randomly divided into 6 groups at the time of inclusion into the study, for examination of urine samples for the presence of INH and PAS. One surprise urine sample was collected from each patient at the pre determined time after the drug collection. The samples of urine were collected from one group at first month, another at second month, third at fourth month, fourth at sixth month, fifth at ninth month and sixth at twelfth month of treatment. Urine samples were collected within 33 days of drug collection for the month because the drugs were supplied at a time for the said period. Urine specimens were examined for the presence of drugs or their metabolites. For INH, NM test & acetyl INH test and for PAS, ferriechloride and case test were performed. The drug collection was judged on the basis of treatment record and its consumption on the basis of results of urine examination.

Of the total patients included in the study, 54% made 10 or more drug collections over a period of 15 months. The initial radiological or bacteriological status or severity of disease did not influence the drug collection; however smaller proportion of old persons in both sexes collected the drugs for 10 months or more. Urine specimens of 71% of patients who had collected drugs were positive for INH on any one day. Bacteriological quiescence was obtained among the 82% INH sensitive patients who had made 10 or more collections. The above findings suggest that the patients who collect drugs also consume with fair amount of regularity and achieve a high degree of bacteriological quiescence.