Characteristics of the medical status and living conditions of the homeless registered as tuberculosis patients in Nagoya City

An Investigation by questionnaire was conducted in 1996 to know the tuberculosis (TB) status and living conditions of 50 homeless people registered as TB patients at one of Nagoya city's 16 health centers. 1. All patients had one or more symptoms of TB, 64% of them showed positive TB bacilli on smear, and 35.3% of them had a previous history of TB treatment. However, only 15.2% suspected they had TB at the onset of symptoms. 2. Main reasons of seeking medical treatment: 28.6% arrived by ambulance after falling down from exhaustion, 25.7% had consulted with welfare agencies after the onset of symptoms, and 20.0% had been diagnosed during the treatment of other diseases. 3. When they were admitted to the hospital they had many concerns: 29.0% loss of income, 19.4% living expenses, 19.4% smoking prohibition, 12.9% admission fee, and 9.7% privacy. 4. They lived in the following: 42.9% construction camps, 20.0% parks or streets, 17.1% single room occupancy hotels, 17.1% daily or monthly paid apartments, and 11.4% sauna baths. 5. Past medical histories of the subjects included 40.6% injuries by labor accidents, and 25.0% stomach ulcers. Current diseases were 15.6% mental diseases, 15.6% liver diseases, 15.6% diabetes mellitus, and 9.4% alcoholic dependence. Seventy percent of them consumed alcohol daily (average pure ethanol 125 ml per day). 6. From the results outlined above, the following proposals relating to TB control of the homeless should be considered. 1) Educating the homeless as to the need for a health check when TB symptoms are present. 2) Opening a clinic for the homeless for easy access to consultation on TB. 3) Directly observed therapy short-course, for TB in the homeless. 4) Health examination of the employees of single-room occupancy hotels and sauna baths which are used frequently by the homeless. 5) A fundamental countermeasure to deal with alcoholic dependency among the homeless.