A case has been made out for developing some selected sociological parameters of assessing NTPs.

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.

The decline of mortality in the more developed nations has been related to two major influences, economic development and the introduction of medical measures. The contribution of medical measures has been a source of continuing controversy. Most previous studies employed either a birth cohort or calendar year arrangement of mortality data to address this controversy. The present study applies an age-period-cohort model to mortality from respiratory TB in England & Wales, Italy, and New Zealand, in an attempt to separate economic influences from that of medical measures. The results of the analysis indicate that while the overall contribution of medical measures is small, when examined by calendar year, specific birth cohorts both in Italy and England and Wales benefited substantially from these measures. The environmental conditions in New Zealand, however, were such that the introduction of medical measures barely affected declining mortality levels from respiratory TB.

The article decries the concept of an episodic assessment of the NTP, done in an ad-hoc manner, with the definite potential of changing the very course of programme development, thereby, weakening rather than strengthening it. Instead, it is recommended that the NTP’s existing in-built monitoring be revamped, reactivated and strengthened.

The relative importance of within-household and community transmission of infection among children aged 6 months to 14 years living in a Peruvian Shanty-town, was investigated. The prevalence of mycobacterium TB exposure among 175 contact children (sharing a household with a person who had confirmed pulmonary TB) and 382 control children (living in nearby households free of active TB) was defined as the proportion of children with a positive purified protein derivative (PPD) skin test.

Ninety-seven (55 percent) contact children and 129 (34 percent) controls were PPD positive. Living in a contact household (odds ratio 1. 74, 95 percent CI 1.11-2.73) and age (1, 11, 1.06-1.18) were significant risk factors for PPD positivity. The community infection ratio (CIR) was calculated as the odds ratio of PPD positive controls to PPD-positive contacts:

              Prevalence in controls/ (1-prevalence in controls)
 CIR =   ------------------------------------------------------------------
             (Prevalence in contacts/ (1- prevalence in contacts).

A low CIR therefore suggests mainly household spread of infection, whereas a high value suggests frequent transmission outside the household. The adjusted odds ratio (for age, sex, within -household correlation, and household size) was 0.40 (95 percent CI 0.26-0.64), compared with values of 0.18-0.37 in studies elsewhere. Currently recommended TB control strategies are suitable for areas with low CIR`s. Different strategies may be needed for areas such as the one studied here, with high values.