CHAPTER III - ILLNESS PERCEPTION & UTILIZATION OF HEALTH FACILITIES <<Back
 
a) Community Survey Based
 
190
AU : Sophia Vijay, Krishna Murthy MS & Srikantaramu N
TI : Fate of pulmonary tuberculosis patients diagnosed in a prevalence survey – A socio- epidemiological follow up after five years
SO : INDIAN J TB 1998, 45, 199-205.
DT : Per
AB :

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.

KEY WORDS: SOCIAL ACTION; SOCIO-EPIDEMIOLOGY; SOCIAL INQUIRY; INDIA
 

 
     CHAPTER IV - TREATMENT BEHAVIOUR OF TB PATIENTS  
 
a) Treatment Failure & The Problem of Non Adherence
 
230
AU : Sophia Vijay, Balasangameshwara VH & Srikantaramu N
TI : Treatment dynamics and profile of tuberculosis patients under the District Tuberculosis Programme (DTP) – A prospective cohort study
SO : INDIAN J TB 1999, 46, 239-249
DT : Per
AB :

A prospective cohort study among new smear positive pulmonary TB cases initiated on SCC was undertaken in Kolar district of Karnataka. The objective was to study the treatment outcome and patient profile of treatment adherent (completed) and non-adherent (lost) patients. Data collection was done through interviews based on pre-tested structured schedules, soon after diagnosis and at the end of treatment. Of the 224 available patients in the cohort, 120 (53.6%) completed treatment, 68 (30.4%) were lost, 29 (12.9%) died and 7 (3.1%) migrated outside the district.

Persistence of cough at the end of treatment was significantly more among lost patients. The general profile of the patients, relating to socio-economic, demographic, literacy and employment details did not differ significantly between the 2 subgroups. However, the treatment related factors like distance from health centre, knowledge of treatment duration, advice on treatment given after diagnosis, payments made to staff and for tonics were significantly more among patients lost to treatment. Raising of money to meet the expenditure, particularly through selling of valuables too was proportionately more among lost patients. Defaulter retrieval action was not taken for more than 85% of all eligibles, both among completed and lost groups. The reasons for non-adherence to treatment as emerged from the study are mainly related to the treatment organization.

The study results emphasize the need to strengthen the treatment organization to achieve the desired treatment outcome. This would also be essential for a successful implementation of DOTS strategy.

KEY WORDS: COMPLIANCE; COHORT STUDY; CASE HOLDING; INDIA.
 
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