Tuberculosis in South Africa

Tuberculosis arrived in this country with colonialists, settlers and missionaries, many of whom were already infected from the massive epidemic, which had swept Europe and North America during the 17th century. Many sufferers came seeking a cure from the sun and fresh air. The previously unexposed, non-immune indigenous populations of South Africa rapidly developed tuberculosis.

When the gold mines started on the Reef in the later 1800s, workers were exposed to silica dust, overcrowded hostel living, poor nutritional status and stress, all of which were major contributors to the development of TB. When they became sick, they returned to their families in rural areas and spread the disease to them. By 1930, it was estimated that over 60% of the black population of South Africa was infected. In 1953 the rate of active disease was measured to be 780 per 100 000 of the population of the northern and eastern parts of the country.

Incidence rates measured from notifications since 1919 rose rapidly, and peaked during the 1960s. The rates appeared to decline in the early 1970s when certain sections of the country were declared independent states and were not included in reported figures. Apartheid policies were responsible for the much of the tuberculosis during this era, when rural poverty and rapid urbanisation created the living conditions conducive to the continuing epidemic, which was uncontrolled because health services were inadequate for the majority of the population. It has been well shown elsewhere that no TB control programme is better than a poor one, because a poor programme allows the disease to smolder. The development of resistance to drugs classically occurs with inadequate (stop-start) treatment. During apartheid, poorly funded and inadequate health services were directly responsible for under-treatment of patients. For many years the standard treatment was a 12 or 18 month period in hospital (on PAS, INH and Streptomycin). Then treatment was changed to ambulatory (out patient care) to save hospital costs and supposedly make it easier for patients. However services in the main were hospital-based, meaning that patients had to travel long distances to facilities, making treatment inaccessible and unaffordable. Drugs supplies in many areas were erratic.