Tamar Kahn
26 October 2007
Cape Town — The number of tuberculosis (TB) patients continues to grow, but a slightly greater portion of them are finishing treatment and getting cured, new figures from the health department show.
SA's TB epidemic has surged with the country's HIV/AIDS crisis, rising to 337309 new cases in 2005, the most recent year for which figures are available. This is an 8% rise on the previous year's figure of 312436.
While the 2005 cure rate of 57,7% was well short of the World Health Organisation's target of 85%, it was a marked improvement on the 50,8% cure rate for 2004.
The head of the national TB programme, Lindiwe Mvusi, attributed the improved cure rate to several factors, including better education and support for patients. The standard treatment for TB involves a six-month course of four antibiotics, taken daily.
Patients often stop taking their pills before they are completely cured because their symptoms disappear fairly quickly and they feel better. Health workers try to discourage this because failure to complete the course encourages the development of drug-resistant Mycobacterium tuberculosis, the bacterium that cause TB.
When patients relapse, they may have drug-resistant strains of TB, requiring even longer treatment.
SA's approach to treatment is based on the WHO-recommended Directly Observed Therapy Short-course (Dots) system, which requires a patient to be observed taking their daily medication by clinic staff, or someone designated from their community.
The health department had increased funding to nongovernmental organisations to provide care, and recruited more "treatment supporters" from communities, Mvusi said. Training for clinic staff had been improved, and community health workers had helped with tracing patients who had skipped treatment.
Figures provided by Mvusi show 29787 TB patients died in 2005, or 8,8% of those registered. The previous year, 25871 patients died, or 8,3% of those registered. TB is a notifiable disease, and health authorities keep detailed records of patients' treatment.
Mvusi cautioned against assuming HIV was the sole reason underlying the rising numbers of deaths.
"The increase in death rates could be attributed to a number of factors, (including) HIV," she said.
" Patients die from other causes, both natural and unnatural. If they died whilst on TB treatment we report them as TB deaths.
"Patients should not be dying from TB because it is curable (if diagnosed early )," she said.
The figures reveal marked differences in the ability of provinces to prevent patients from defaulting on treatment, and in their capacity to track patients.
KwaZulu-Natal fared worst, with 16,6% of its patients known to have defaulted, although the figure could in fact be higher as 9,1% of the 103642 patients registered in the province could not be evaluated.
Similarly, 11,1% of Mpumalanga's 14496 patients defaulted on treatment, while a further 10% fell off the authorities' radar.
Mvusi said KwaZulu-Natal had increased its TB budget and was recruiting extra staff to deal with the province's TB burden, which is the biggest in the country.
The overall defaulter rate for 2005 was 11,8%, slightly up on the 2004 rate of 11,3%.
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