Initial default from tuberculosis treatment: how often does it happen and what are the reasons?

A study in 11 primary health care facilities in and around Cape Town determined the proportion of bacteriologically confirmed tuberculosis (TB) cases who did not start treatment (initial default) and identified reasons for it. Databases from centralised laboratories were compared with electronic TB treatment registers. Fourteen per cent (373/2758) of TB suspects were TB cases. Of the 58 (16%) initial defaulters, 14 (24%) died, while 26 (45%) could not be interviewed for address-related reasons. The 18 subjects who were interviewed indicated reasons for initial default that were (56%) or were not (44%) directly linked to services. High initial default rates require improvement in the quality of health services.

Evaluation of a peri-urban community health worker project in the western Cape.

The South African Christian Leadership Assembly (SACLA) Health Project is a non-governmental organisation that runs a community health worker (CHW) programme in 4 peri-urban townships of Cape Town. A cross-sectional descriptive community survey was conducted in April 1990 to evaluate coverage and health education on oral rehydration solution (ORS) and to plan future preventive, promotive and development programmes. Research concepts and methods were made accessible to the CHWs through a training process designed to facilitate participation in every stage of the research. A multi-stage cluster sampling scheme was used, and the CHWs interviewed 822 residents. Coverage indicators showed that over 80% of all respondents had previously known about or consulted the CHW. The most common community problems related to water, filth and refuse, toilets, housing, unemployment and lack of community facilities. The most common health problems were generalised aches and pains, chest problems, skin problems, worms, and diarrhoea. An index developed to measure knowledge of ORS showed very few respondents had 'complete knowledge'. The community's expectations of the CHW included health education, attending to sanitation problems, providing a clean environment, organising community facilities, and helping with employment.

AIDS in South Africa: potential decimation on the eve of liberation.

PIP: With a government that lacks political credibility among its black population, grassroots organizations in South Africa have taken the lead in facing the mounting threat of AIDS. Although no comprehensive data on rate of HIV infection in South Africa exists, one study suggests that the rate of infection is doubling every 8.5 months. Initially a disease among white male gay community, HIV has now begun to spread among the black heterosexual population. One estimate indicates that the number of HIV-positive blacks ranges somewhere between 1/4 and 1/2 million people. Some believe that the current massive tuberculosis epidemic currently affecting the black population is related to the AIDS epidemic. What little the government has done to combat AIDS has been ineffective. The gay community has been shunned. And as AIDS has spread through the black community, the government has done little more than dispense free condoms through family planning clinics. But these clinics are distrusted by blacks, since the government's family planning program has attempted to limit the growth of the black population while encouraging the growth of the white population. Only the community- based health sector possess the political credibility necessary to lead the fight against AIDS. The National Progressive Primary Health Care Network has begun devising an AIDS prevention strategy. Regional AIDS committees have begun disseminating information and training community health workers. The author notes that a determined campaign will be needed to end the association of condoms with the government's racist family planning policy. Although South Africa currently faces political turmoil, the author fears that AIDS could turn out to be the bigger threat.^ieng