Supervised out-patient treatment of tuberculosis: evaluation of a South African rural programme

We investigated a supervised out-patient treatment programme, operating in a predominantly rural area of KwaZulu, South Africa, for black tuberculosis patients. In particular, we evaluated treatment outcomes over a 3-year period (July 1987 to December 1989) and community involvement in the programme. In 1987 there were 118 patients (67 males, 31 females and 20 children) on the programme; 188 patients (106 males, 46 females and 36 children) in 1988; and 230 patients (112 males, 49 females and 69 children) in 1989. Analysis of treatment outcomes showed that 88% completed treatment, 8.5% defaulted and 3.4% died in 1987; 93% completed treatment, 4% defaulted and 3% died in 1988; 94% completed treatment, 3% defaulted and 3% died in 1989. The majority of patients were supervised by Voluntary Health Workers (68% in 1987, 82% in 1988 and 83% in 1989). Only four patients were readmitted to the hospital due to an unreliable health worker in this 3-year period. These findings suggest that the supervised out-patient treatment programme is meeting the ultimate aims of control; namely, holding and curing patients through community involvement and responsible participation.