Illness is mostly a subjective awareness of an individual, the relief of which may be sought within or outside medical or health facilities. Perception of illness vary from people to people depending upon cultural, ethnic and socio-economic differences. Perception of symptoms by persons suffering from TB is very high yet only half of them approach modern medical facility for alleviation of their suffering. A survey was carried out in rural area of Hoskote taluk, Bangalore district to determine perceived morbidity and accessible medical relief in 1433 households belonging to 18 villages; of them, 1393 (97%) were successfully interviewed. Selected households belonged to three types of villages i.e., those being within 3 kms of a i) PHC, ii) taluk headquarters hospital and iii) non governmental health centre.

Of the 9286 individuals belonging to 1393 households satisfactorily interviewed regarding health, 1201 (12.9%) were found to be ill at some point of time during the reference period of one month. No differences were observed in the perception of morbidity or in the health seeking behaviour in the three groups of villages. Persons with symptoms/disease accounted for 88.8% of the total sickness, 3.4% for injuries and 9.3% for disabilities, while action taking was 61.6%, 90% and 13.5% respectively. Age sex distribution showed no difference in illness occurrence. Sputum was collected from 147 chest symptomatics and seven were found to be sputum positive. Government health facilities were utilized by 37.6% of the sick persons, private doctors by 36.4%, nature medicine by 10.6% and home remedies by only 9.9%. In conclusion, the services at the government health facilities were acceptable and were utilized if accessible. Prompt and adequate relief for injuries and acute indispositions ensures confidence of the people and better utilization.

NTP reaches people through PHCs and sub centres. A study was conducted to find out the perception of illness and utilisation of health facilities by the community. This study was conducted in a random sample of 48 villages selected according to Probability Proportioned to Size within 5 kms. of the selected PHIs in Kolar district using a multi stage sampling technique. Information on socio-economic status, availability of health services and their utilisation was collected. 13,323 individuals were interviewed. 706 were ill in a period of two months prior to survey. 71.3% had taken allopathic system of treatment. 69.1% had approached government hospital or PHC. 34 patients reported to have TB. All had attended either DTC or PHC.

The study indicated that morbidity was perceived much early and also followed by an action. Data indicates a high percentage of preferring allopathic system in general and from peripheral health centres and other government hospitals in particular. Data indicates that in spite of overall backwardness of the study area and very limited economic resources people have utilised the PHC to the maximum. The reason could be either high acceptance of PHC or inevitability. But, there is an evidence of higher utilisation of family welfare and MCH services. The data shows all TB patients have had exposure to standard regimens, all of them have approached either PHC or DTC for treatment. This confirms the felt need oriented concept of NTP. Also high level of morbidity among children below 4 years of age and action taken indicate an enhanced level of demand for health services.

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.

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.

A controlled study was conducted at LWTDTC, Bangalore, among 250 randomly selected urban patients of pulmonary TB of whom 155 were in the ‘motivation’ group and 95 were in the ‘control’ group. In the motivation group, patients were interviewed by NTI Health Visitor and motivated by LWC staff; a month of drugs (TH) were given. Within 3 days of initiation of treatment they were motivated along with their household members during home visit by NTI staff every month for a period of three months. Control group patients were motivated at the clinic as per the programme guidelines.

In the motivation group, 59.9% of patients had made all the three collections during the first three months compared to 27.8% in the ‘control’ group. During the remaining months also the drug collection was 47% and 35.6% respectively. The drug collection pattern among the patients in the motivation group was found to be better than among the patients in control group who did not have the benefit of home visiting. Sputum conversion was also found accordingly better among the motivation group as compared to control group.