Cape Town — Weaknesses in South Africa's public health system have been cited as being among the reasons tuberculosis has increased four-fold in the last 15 years.
Addressing the country's failure to control and cure TB, Veloshnee Govender of the University of Cape Town's Health Economics Unit told a conference that there has been a 400 percent increase in TB incidence in the last decade and a half.
In line with recommendations of the World Health Organisation (WHO), treatment of TB follows the DOTS (Directly Observed Treatment Short course) protocol, which requires that TB patients take medication daily in front of a health worker who administers and "observes" that this is done correctly.
Treatment of TB usually requires a daily dose of drugs for six months, but in more severe cases it may require a longer period. Given the long distances some patients have to travel to get to clinics, or the inconvenience of fitting in daily visit to a clinic, many patients do not take their medication as diligently as they should.
However, the WHO protocol also states that the "whole purpose of treatment observation would be defeated were it to limit access to care, turn patients away from treatment or add to their hardships".
From a study of 1,200 patients in four health sub-districts in South Africa, researchers have investigated the barriers that patients face in taking their treatment regularly and consistently. Excluding those receiving their treatment through injections, Govender said that "more than half of those who reported missing treatment doses were being observed at clinics".