A socio-epidemiological study of out-patients attending a city tuberculosis clinic in India to judge the place of specialized centres in a tuberculosis control programme.

In India, specialized tuberculosis clinics exist mostly in cities. These clinics treat mainly persons with an awareness of symptoms who present themselves of their own accord. The few persons without symptoms are those who have been advised to have an examination. The urge to attend a specialized centre, presumably motivated by suffering or discomfort from symptoms and by awareness that specialized services exist, does not appear to be strong enough to overcome all the "obstacles" that lie between the patient and the tuberculosis clinic. A distance of 4 miles (6.4 km) or more is a major obstacle, irrespective of where the town limits lie. The socio-economic value of the patient to his family also appears to influence attendance. There is evidence that most patients first approach treatment sources, without regard to the nature of the service, whether specialized or general. It has been observed that if the quality of service rendered by a centre is unsatisfactory, the patient may constantly search for "better" treatment. Social considerations, other than suffering, which influence attendance could be termed "social preference". The justification for strengthening general health institutions (with adequate means for the diagnosis and treatment of tuberculosis), without taking urban or rural factors into consideration, is discussed in the light of the findings of this study.