Evaluation of directly observed treatment for tuberculosis in the Bojanala health district, North West Province of South Africa

Background: Tuberculosis (TB) remains one of the top public health problems in South Africa. Approximately 150 000 new cases and 10 000 TB-related deaths are reported in South Africa annually. In declaring TB a global emergency in 1993, the World Health Organization developed control strategies that include active case finding, laboratory support, directly observed treatment (DOT), contact tracing, and prevention of multidrug-and extreme drug-resistant tuberculosis (MDR-TB and XDR-TB). High DOT rates reported in some countries have been discordant with 'low cure' and 'high MDR' rates. Objectives: The aim of the study was to evaluate the use of DOT for TB in the Bojanala health district, North West Province, South Africa, by estimating the proportion of DOT use (1) amongst all TB patients and (2) in the initial TB treatment regimen compared to retreatment regimens. Method: A cross-sectional, descriptive study was conducted in 2008. Data regarding implementation of DOT were collected from eight purposefully selected primary health care clinics and one prison clinic in the health district. Upon receiving their informed consent, a questionnaire was administered to patients receiving TB treatment at the selected facilities. Results: A total of 88 (of 90 selected) patients participated in the study, of whom 50 (56.8%) were on DOT and had DOT supporters. However, 35 (40%) had never heard of DOT. DOT was used mainly for patients on the retreatment regimen (87.5%), rather than for those on first-line treatment (48.6%). Conclusion: In this South African rural health district, the DOT utilisation rate for TB was 56.8%, mainly for patients on the TB retreatment regimen. Strict implementation of DOT in all patients undergoing TB treatment is a known strategy for improving TB cure rate and preventing recurrence and drug resistance.