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Methodology:
A cross-sectional once-off, assessment was conducted in the Hlanganani Health District to rapidly assess the situation regarding TB control and management. Data was obtained from primary and secondary sources. In addition to looking at district-wide data, five primary level facilities were purposively sampled for more detailed research. Interviews were conducted with TB managers, health care workers providing TB services, a pharmacist, a lab technician, DOTS supporters and TB patients.

Key findings:
One district TB coordinator oversees the provision of TB services in 19 primary level facilities. There is a district TB task team in Hlanganani, and each primary level facility has a official clinic TB coordinator. Various training workshops and sessions are ongoing within the district. Unfortunately, it is usually only the TB coordinator who attends such training. The TB incidence rate is approximately 300/100 000. A fairly large proportion of PTB cases are re-treatment cases. Collecting two sputum samples from patients visiting mobile clinics is a problem.

In 1999, 99,3% of the PTB cases were diagnosed with a sputum test. The health care providers were not familiar with the score sheet method of diagnosing TB in children. The district employs both a clinic-based and community-based DOTS system. A DOTS supporter reported not supplying patients who go away with any medication. Defaulting was not reported to be a serious problem. Patient education needs to receive attention in light of the fact that patients still believe that TB is caused by witchcraft. The hospitals have not identified specific beds for TB patients.

The use of fast queues for patients on treatment seems to be common practice. The TB register is a difficult register to maintain and keep accurate. The official figures for 1998 need to be treated with caution: overall cure rate of 52,5% successful treatment rate of 78,4% treatment failure rate of 1,9% and treatment interruption rate of 10,5%.

In search of solutions:
Attention must be given to the training of all clinic staff, general assistants and TB volunteers in TB management. In particular, professional nurses need to receive in-service training on diagnosis and the TB register. A policy guiding the management of TB patients on farms will assist with the diagnosis and treatment of TB patients. The diagnosis of TB in children needs to receive attention. The community-based DOTS system must be extended to all clinics in Hlanganani. In order for this to be achieved, more volunteer DOTS supporters will have to be trained. A well functioning community-based DOTS system will also help with the tracing of defaulters. Traditional healers can play an important role in encouraging TB patients to seek medical care. Both communities and patients would benefit from: 1) community campaigns on TB awareness 2) peer education and group health education and 3) professional nurses spending more time on patient education. A clear policy for the registration of patients diagnosed with TB at hospitals needs to be established. HIV/AIDS in TB patients should be further investigated.