Early case identification and adherence to treatment regimens are two remaining barriers to successful TB control. In many nations, however, fewer than half of those with active disease receive a diagnosis and fewer than half of those beginning treatment, complete it. These twin problems derive from complex factors. People's confusion as to the implications of the TB symptoms, cost of transportation to clinic services, the social stigma that attaches to TB, the high cost of medication, organizational problems in providing adequate follow-up services and patients' perception of clinic facilities as inhospitable all contribute to the complexity. Socio-cultural factors such as the cultural understanding that people with symptoms apply to their disease, staff reluctance to adapt their work environments to patients' daily activities and the socio-political organisation of health delivery services have been emphasised. The importance of studies carried out on three specific subtopics: a) Perception and interpretation of chest symptoms, b) Influence of social stigma on help-seeking and adherence to therapy and, c) Adherence to treatment recommendations are discussed in detail.

A knowledge of the health culture of their patients must become a critical tool for health care providers if TB programmes are to be successful. Several anthropological procedures such as adopting focus group sessions are recommended to help uncover the health culture of TB patients. Thus, a comprehensive analysis of the health culture of groups at high risk for TB, as it interacts with the availability of effective chemotherapy will provide the needed groundwork to eliminate remaining barriers to successful, enduring TB control.

Several case studies are presented in this paper to emphasize that the social and cultural dimensions of TB are of paramount importance from the management point of view. The conclusions drawn were: 1) The social stigma against TB was still dominant regardless of caste, social class, economic status, level of literacy and geographic location, 2) Maid servants appeared to be one of the most important transmitting agents of TB, 3) The perception of the patient towards his/her life and people (society) changed within moments of learning that they had contracted TB, 4) The physical recovery of the patient was faster than their psychological recovery. It is recommended that the NTCP take note of the behavioural dimensions of the TB patient from the management perspective.