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.

Awareness of symptoms of pulmonary TB and promptness of action taken to seek the treatment by the sufferers in an urban area, Madras, was studied. A total of 796 patients were administered questionnaires, out of whom, 600 were men and 196 were women. The mean age for men and women were 37 years and 32 years respectively. The proportion of patients drawn from all the 3 selected areas who took action within a month was 40 percent, within 3 months 65 percent and within 6 months 84 percent. The proximity of the medical facility in the city enabled a sizable proportion (53%) to take action within a month. Among symptomatics reporting within a month, the bacillary cases were proportionately low which tended to increase as time elapsed. Regarding the psychological impact of the disease on the patients, there was a sense of optimism in a large proportion of patients due to a very favourable response to good treatment. Varied attitudes of the relatives towards the patients, consistent with Indian stereotypes were elicited.

The study group constitutes 86 ‘cases’ and 341 ‘suspects’ diagnosed in a TB prevalence survey. The area of the survey was under cover of the NTP for more than 20 years. The observed fate of these cases after five year was: dead 58.3%, culture negative 30% and culture positive 11.7%. Comparison of these rates with age standardised rates of ‘cases’ followed up after 5 years in an adjacent area, where control measures were not undertaken revealed that both these rates were not statistically different. The findings suggest that the same natural dynamics of TB as observed under the non-intervention situation, obtained in the study area as well, despite the latter being under the cover of NTP for so long.

Suspects, epidemiologically, proved to be a low priority group as the breakdown rate observed among them over five years was as low as 3.3%, again similar to the findings in the non-intervention area of a longitudinal survey.

A sociological enquiry revealed that cardinal symptoms of TB persisted even after five years in 65% of cases and 55% of suspects. Action taking behaviour indicated that more than half the patients, reported to GHS for remedial measures, while none of the ‘asymptomatics’ approached any health centre. These findings suggest that ‘symptoms’ are the driving force for patients to seek medical advice and the NTP still has the potential to bring these self-reporting cases within its network.