Pediatric tuberculosis in rural South Africa--value of directly observed therapy.

Tuberculosis is a major cause of mortality and morbidity among children in resource-poor settings. A strategy of community-based, directly observed therapy employed in a rural health district in South Africa since 1991 is described. Most children (75 per cent) diagnosed with tuberculosis were treated in the community and most of them (85 per cent) completed treatment. Supervision was either by clinic-based health workers (26 per cent), community health workers (20 per cent), or volunteer lay people (46 per cent). Among children diagnosed with tuberculosis who were also HIV infected, the case-fatality rate was higher than among the HIV uninfected, and a larger proportion of the HIV infected failed to complete treatment.