The management of pulmonary tuberculosis in the border sub-region, 1983

In order to study the management of pulmonary tuberculosis among black and coloured adults in the Border region of South Africa in 1983, a historical inception cohort representative of tuberculosis hospitals and local authority health services was followed up over 15 months to assess how efficiently the national responsibility is discharged in a region. About 75% of patients were sputum-positive, and 81% were judged to have had active pulmonary tuberculosis. The mean service delay after radiography was about 1 1/2 weeks. About 26% of patients were treated with a rifampicin regimen, 50% were frequent attenders and 41% completed treatment, although about 21% were still being treated after 15 months. There was a deficiency of laboratory information for diagnosis and monitoring of response to treatment. Periodic cohort evaluation and improvement of diagnostic efficiency, of peripheral use of laboratories, and of spending on community service infrastructure are essential for closing the gap between policies and implementation.