chemotherapy for Mseleni Health Ward Six-month intermittent tuberculosis in the of KwaZulu

Isoniazid (mg) Pyrazinamide (g) Rifampicin (mg) Streptomycin (g) Ethambutol (g) (for outpatients) Three hundred and seventy-three tuberculosis patients in a rural African setting were treated with a 6-month twice­ weekly chemotherapy course. The recurrence rate for those with caseating pulmonary tuberculosis was 7,3% overall. In the second stage of the study, a modified form of supervised ambulatory therapy was used and compliance rates and recurrence rates assessed; 84,8% achieved 90% or more compliance and the recurrence rate was 8,7%. S AIr Med J 1990; 77: 405-407. 'Drugs all given twice weekly, Mondays and Fridays. Tuberculosis remains a serious community problem in South Africa, and its incidence is estimated to be highest among the rural black population - possibly as high as 370/100 OOO/yr.' Mseleni Hospital serves a rural population of 40000 people, and a study of compliance with outpatient therapy from 1978 to 1981 showed that, despite intense health education pro­ grammes, 88% of patients were collecting less than 50% of their medication from the clinics, and the rate for 100% compliance actually dropped from 20% to 8% during that period (unpublished report). These figures were somewhat similar to the findings of Yeats,2 where only 28% of patients from rural clinics in Estcourt collected 80% or more of their medication. There was adequate evidence to show that modern four­ drug therapy had made short-course therapy very effective,3-6 and so it was decided to admit all patients for 6 months of interminent four-drug therapy. This proved effective but unpopular. Relatively healthy people were being kept in hospital, straining accommodation resources and losing valuable time at home or work. In 1983, semi-supervised home therapy was devised to continue interminent four-drug therapy but to make it available in the home or place of work.