A medico-social study was conducted at the New Delhi TB Center to determine the factors involved in late diagnosis. A total of 400 new patients attending the Center from three different territories, were interviewed for information on the duration of symptoms and remedial action taken by them before reporting at the Center. The resulting data were then correlated with the clinical and bacteriological status of each patient to ascertain the consequences of late diagnosis for the patient. The results, based entirely on patients' narrations, indicated that patients' late visit to the Center was because of late diagnosis or referral. A concerted effort is necessary to promote awareness of TB among the general public and to ensure that GPs and General Health Institutions suspect TB early and diagnose or make referrals early.

The panel included two GPs, an administrator and specialists in private practice and in government clinics and the Technical adviser of the TAI. The panel discussed the problem in great detail and the following is the consensus of the discussion.

The necessity for this study arose due to our desire to learn first hand the reactions and reasons for irregularity and non-cooperation of the party i.e the patients. No doubt health visitors on repeated visits try to find out the main cause of irregularity; yet we felt that since health visitors are known to be a part of this institution, the patients may not tell them the real behind their non-cooperation. We felt that the students of the Delhi school of social work being unconnected with the centre and also by possessing proper attitude for this work would be able to bring out the real reasons.

The study was conducted in 1965-66 to ascertain whether an additional visit by a senior member of the domiciliary service staff at the NDTC, such as a Medical Officer or the Chief Public Health Nurse, could help retrieve defaulting patients, after three visits by the Health Visitor during a period of 2-3 weeks had failed. Of the 786 non-cooperators, 531 were visited by the Chief Public Health Nurse. The results showed that more than half (58%) of the non-cooperators could be retrieved by the senior staff member, while 24% completed the treatment thereafter and, 8% were still continuing. Only partial success was achieved with the remaining 16%. Counting those who did not attend at all (331) and those who did not complete treatment after being called (73), the experiment was successful in nearly half the cases (382 out of 786). Therefore, it is recommended that the health visitors’ attempts to retrieve the defaulters must be supplemented by at least one visit from a senior staff member for maximum effort.

The study was conducted to determine if homevisiting made any difference in the regularity of drug-taking, in the domiciliary treatment area of the NDTC. All cases of pulmonary TB in this area were included in the study. Every patient’s home was visited once, within one week of starting treatment, to give routine advice, motivate and confirm that the patient was a bonafide resident of the area. Thereafter, the patients were randomly allocated to three groups based on certain criteria. The regularity in drug collection was defined as:

             Drugs collected any period
-------------------------------------------------------       X   100
Drugs which should have been collected

The interim analysis of the data shows that home visiting definitely helps to reduce default and increase the regularity of drug collection. Whether the policy of “Preventive” visiting pays better dividends than retrieving defaulters still remains to be seen.