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Effective anti-tuberculosis chemotherapy was developed during the 1950's, yet four decades later the cure rates for tuberculosis (TB) worldwide remain unacceptably low. A major reason for the failure to eliminate TB is that many patients with active disease fail to take sufficient anti-tuberculosis medication to render a cure. This paper describes a project designed to involve clinic nurses in the process of exploring how TB patients experience their disease. Information obtained from the qualitative research process was used to develop a photonovel which can be used to supplement the education given to newly diagnosed TB patients.

Growth monitoring, oral rehydration, breast-feeding and immunisation--female education, family spacing and food supplementation (GOBI-FFF) are a selective package of World Health Organisation primary health care strategies recommended by UNICEF. Changes over a 1-year period in the implementation of the components of GOBI-FFF were investigated in a rural village in Ciskei to detect any changes associated with a newly modified village health-worker (VHW) programme. A baseline survey was conducted before the introduction of a modified VHW programme and a second survey took place a year later. The principles of GOBI-FFF were already familiar to and have since been increasingly practised by the community and health personnel. Breast-feeding is widespread, most carers know how to make oral rehydration solution and most children have a 'Road to Health' card and are being weighed regularly. However, malnutrition remains a major problem and the food supplementation programme is operating poorly. The high coverage of the community by the village health-workers and the clinic suggest that these two channels should be used more intensively to strengthen the GOBI-FFF programme in the area.

In the predominantly rural Hewu district of Ciskei 54% of infant deaths are diarrhoea-related. The aim of this study was to determine whether village health workers (VHWs) could teach mothers to safely prepare homemade sugar-salt solutions (SSS). VHWs from 11 villages were selected for training while 11 randomly selected villages acted as controls. VHWs selected for training were taught to prepare SSSs and to teach mothers with children under 5 years about the use of such solutions. A card illustrating the main points was given to all mothers. Six weeks after training, randomly selected mothers in control villages (n = 320) and experimental villages (n = 327) were interviewed and asked to prepare SSS. Experimental and control villages had similar children's diarrhoeal disease rates (using a 2 week recall period). In experimental villages 81.5% of mothers compared to 29.7% in control villages had received SSS cards (i.e. been visited). Of recently occurring diarrhoeal-episodes 76.6% were initially treated with a SSS (correct formula used in 81% of cases) in experimental villages compared to 50.5% (correct formula used in 48% of cases) in control villages (P less than 0.05 for SSS use). Greater use of enemas and home remedies occurred in control villages (P less than 0.05). Of solutions made in experimental villages 7% had sodium concentrations over 100 mmol/litre compared to 36% in control villages. Results show that VHWs can effectively train mothers to safely prepare SSS and the VHW program has been expanded to other areas.