| Abstract: | A study in rural South India revealed that more than half of infectious TB cases sought treatment, one-fourth were worried, and the rest were conscious about the symptoms. Most of these patients were not diagnosed as having TB and were not treated. These findings induced the National Tuberculosis Program (NTP) to give priority to those who have a felt need and to propose that TB service be an integral part of general health services. Operations research conducted about the felt-need component indicated the following: at least 1 out of every 24 persons reporting a chronic cough is a sputum-positive case of pulmonary TB; domiciliary treatment is reasonably satisfactory; in rural facilities, marginal investment can provide diagnosis and treatment of TB; referral is feasible to specialized TB services; a District TB Center (DTC) can cover a population of 1.5 million; BCG teams can be attached to DTCs to further integration; and a state TB center could cover a population of 30 million. An integrated TB program would cost much less than a specialized TB program in rural areas. The integrated TB program could also grow with the general health services, while a specialized program deprives the general health services from sorely needed funds. Organizational efficiency is another advantage, as TB work results in mobilization of unutilized resources of the organization. Some of the sociological consequences are: 1) the investment of efforts for TB work conforms to the importance attached to the disease in the community; 2) taking care of those with a felt need assures better acceptance of treatment; and 3) provision of efficacious services has the potential of reaching 95% of infectious cases by inspiring confidence in the community. Epidemiologically, factors other than treatment can also reduce TB, such as the rise in living standards and the weeding out of the susceptible population over time. |
