The author addresses some typical questions of overseas societies concerning the various roles and activities and the factors to be considered in constituting a voluntary organisation. It is concluded that while it is impossible to foresee every combination of circumstances which may surround the birth of a voluntary TB association, personal enthusiasm, patience, and mental flexibility can overcome every obstacle. In creating a voluntary society, the first step to educate the community as a whole, is being taken. Such a voluntary association can be thought of as a working model which reflects the state of general enlightenment. For this slow process of education, there is no substitute. No hygiene or medical services will be really effective unless the will-power and interest of a significant number of ordinary people are aroused.

The Aga Khan University Hospital, in Karachi, Pakistan, is a 650-bed university teaching hospital. There is little data from Pakistan on the awareness and application of the WHO’s TB treatment guidelines among physicians. This study evaluates physician compliance with these guidelines. A questionnaire to measure physician compliance was developed, pilot tested and standardised. Case records of all patients hospitalized with TB were reviewed (January-December 1995, n = 229), and were classified into WHO Category 1(n = 191), Category 2 (n = 9) and Category 3 (n = 29).

A total of 53 (23%) patients had a diagnostic bacteriological sputum smear examination, of which 38% were smear positive and 47% culture positive. Of 25 cerebrospinal fluid cultures 12% were positive. No sputum smear tests were conducted during treatment. Of 58 patients in Category 1 who completed therapy 74% received a 2-month intensive phase consisting of HRZE (isoniazid, rifampicin, pyrazinamide, ethambutol) (n = 43), while 41% received a 6 month continuation phase with HE (n = 24). Over 70% patients were lost to follow up, more than half of these during the intensive phase.

The study reflects poor awareness of the WHO guidelines and low compliance among physicians, and a high loss to follow-up. Efforts are needed to create physician awareness about the WHO guidelines and their use. This study can be used to assess the effectiveness of any future physician education and to identify areas of weakness in health care.