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.

The annual incidence of TB cases among Singapore residents fell steadily from 306 per 100,000 population in 1960 to 56/100,000 in 1987 but has since remained at between 50 and 55/100,000. One of the possible reasons for this non-decline may be persistence of transmission of TB in the community due to delayed diagnosis, treatment and ineffective case holding.

Compared to non-defaulting patients as controls, defaulters were mostly non-Chinese, and those live on their own or with friends. There was no significant association of defaulting with age, sex, marital or employment status, disease characteristics, or treatment-related factors. Seventy per cent defaulted during the continuation phase of treatment.

The study was a retrospective patient record based case control study conducted in the TB Control Unit (TBCU), Singapore. This being the main treatment centre, which treats about 50% of the cases was the venue of the study. The objectives were to: (i) identify any demographic, social, disease or treatment-related characteristics which may be predictive of patients defaulting from treatment; (ii) assess the effectiveness of home visits as a means of defaulter recall; and (iii) ascertain outcome in these patients. TB treatment defaulters were defined as the patients who missed their scheduled appointments and required a home visit to recall for treatment. Equal number of controls were randomly selected from non-defaulting patients who started treatment on the same dates as the defaulters. Majority of the patients were supplied drugs for self-administration at home and there were about 10% of the patients who were on DOTS during the study period.

Of the 44 treatment defaulters, 6 (13.6%) were contacted directly, 20 (45.5%) through a person at home during the visit and for 18 (40.9%) a recall letter was slipped through the door due to no contact with patient or any other person at home. Following home visits, 20 (45.5%) returned within 7 days. The treatment outcome was not very encouraging as only 19 (43.2%) completed treatment, 21 (47.7%) were not traceable, 1 was dead and 3 were hospitalized. However, of the 21 patients who were lost to follow-up, all except one had culture negative results. The study identifies the future prediction of default as those who were non-Chinese, living alone, male and had a previous history of treatment.