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Tuberculosis is the leading cause of death in South Africa. A more dangerous form of the disease, multi-drug resistant tuberculosis is gaining ground in the country. The World Health Organization reports an estimated 440,000 MDR-TB infections occurred around the world in 2008 and one-third of those infected died. Lisa Schlein has this report for VOA from the King George Hospital in Kwazulu Natal, a leading center of MDR-TB expertise.

Sister Flora Nsubane shows a group of visitors around the King George Hospital in Kwazulu Natal, a world leader in the treatment of tuberculosis. They wear masks to protect them from getting infected with multi-drug resistant tuberculosis, or MDR-TB.

"This is a 32-bedded ward…It is always full because it is the only TB ward that we have," said Nsubane.

Patients who are sick with more virulent strains of MDR-TB and extensively drug-resistant tuberculosis or XDR-TB, stay in separate wards.

The children's ward is spotlessly clean but largely empty because most of the children are at a school run for them by the hospital. A couple of toddlers are quietly playing on the floor.

A baby girl in a highchair fixes her big dark eyes on Sister Suminthra Sukmandam, the nurse who is feeding her.

"The baby is having a soft diet, which is prepared from the kitchen. It is pureed butter nut, pureed chicken and also mashed potato," she said.

Sister Sukmandam says the baby is four months old and was admitted to the hospital two weeks ago. "She's got multi-drug resistant TB and she has been the same. Her appetite is improving," she added.

Sister Flora says the survival rate for children with MDR-TB is about 80 percent because they are kept in the hospital up to a year where their treatment is closely supervised. She says adults are admitted for six months and once their sputum is negative they are sent home.

"Then they continue with out patient treatment. And, at home, we have discovered that family members are not good support teams. Why? If the patient says I am tired of taking eight tablets a day and maybe the family member says no, it is O.K., you can take it tomorrow," she said. "And then that increases resistance and they take long to be cured. "

Tuberculosis is an infectious bacterial disease, which affects the lungs. It is associated with poverty and spreads widely among people living in overcrowded, dirty places. It is treatable with a six-month course of antibiotics. MDR-TB strains are increasing because people do not always take the drugs properly. MDR-TB and the more severe form of extensively drug-resistant tuberculosis do not respond to the standard six-month treatment with first-line anti-TB drugs. It can take two or more years to treat these diseases with drugs that are less effective and more expensive than the drugs used to treat ordinary TB.

Thirty-six-year old Samkelisiwe is a single mother of a 17-year old boy. She says she took treatment for ordinary TB last year. On April 26 she was admitted to the hospital and found to have XDR-TB

Samkelisiwe says that in September, 2009, she went to the clinic because of severe weight loss. She says she was coughing up sputum, which was diagnosed as TB. She says she did not respond to the TB treatment and later learned she had XDR.

People living with HIV are at great risk of developing tuberculosis. WHO reports TB has tripled in the past 15 years in countries, such as South Africa, with high HIV prevalence.

Sister Flora says at one time, TB and HIV were treated in isolation. But now, she says, all patients admitted to King George's hospital are treated for both HIV and drug resistance at the same time.

"So, if the patient comes here for TB, the following day we do counseling for HIV and 27…we initiate treatment," she said.

The World Health Organization reports MDR-TB threatens to become the dominant strain of TB over the next few decades. It says significant investment into research and development of new drugs and possible vaccines is needed. Yet, relatively little money is allocated for TB control and research. The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria is one of the few international agencies that funds multi-drug resistant TB. Currently, it provides money for treatment for 30,000 people with MDR-TB though there are nearly half a million people infected and in need of treatment.

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