Cost effectiveness of chemotherapy for pulmonary tuberculosis in three sub-Saharan African countries

The value of programmes to control pulmonary tuberculosis in developing countries remains the subject of debate. We have examined the cost-effectiveness of chemotherapy programmes for the control of pulmonary sputum-smear-positive tuberculosis in Malawi; Mozambique; and Tanzania. Effective cure rates of 86-90 percent were achieved with short-course chemotherapy and of 60-66 percent with standard chemotherapy. The average incremental costs per year of life saved were US $1.7-2.1 for short-course chemotherapy with hospital admission; $2.4-3.4 for standard chemotherapy with hospital admission; $0.9-1.1 for ambulatory short-course chemotherapy; and $0.9-1.3 for ambulatory standard chemotherapy. Chemotherapy for smear-positive tuberculosis is thus cheaper than other cost-effective health interventions such as immunisation against measles and oral rehydration therapy. Because the greatest benefit of chemotherapy is reduced transmission of the bacillus; treating HIV-seropositive; tuberculosis smear-positive patients would be only slightly less cost-effective than treating HIV-seronegative; tuberculosis-smear-positive patients

Tuberculosis and HIV infection

Infection with TB in Malawi continues to rise with about 9000 TB patients notified in 1989. It has been shown that immunodepression promotes the progression of latent TB infection to clinical disease. Widespread HIV infection would be expected to alter the dynamics of TB in the population and is being observed with the increase in TB patients mainly the young; sexually active age group where both HIV and TB infection prevalence are high

Factors contributing to a successful tuberculosis control programme in Malawi

A discription of the revised National Tuberculosis Programme [NTP] and the reasons for the continued improvement from year to year despite the relatively small number of core tuberculosis personnel. These factors include: political stability; pragmatic governmental policies; self-sufficiency in food; standardized tuberculosis control strategies; constant staff training and supervision; and community participation

Weight gain in African patients with pulmonary tuberculosis receiving short course chemotherapy

The weight of 100 adult African patients with a first time diagnosis of sputum-positive pulmonary tuberculosis; who received short course chemotherapy under hospital supervision; was measure at one week intervals to determine the extent of change and whether this was related to clinical features. Significant weight gain occurred at 4 weeks and again at 8 weeks and was unrelated to symptoms; duration of illness or smoking habits. In this group of patients weight gain in the first two months is a simple and useful parameter of response to chemotherapy