Tuberculosis Treatment in Developing Nations

To the Editor.  —The recent article by Dr Raviglione and colleagues¹ strikingly reveals the severe consequences of inadequate and misguided funding for the global management of tuberculosis. One critical barrier to controlling this pandemic is still our relative ignorance of how different cultural structures and beliefs shape patterns of noncompliance. With few exceptions, most of what we know about noncompliance with tuberculosis treatment protocols comes from studies of the most industrialized nations, which in 1990 collectively accounted for only 2.6% of new cases of tuberculosis in the world.² This imbalance of studies persists even though we have data to support that noncompliance is a serious problem in many less industrialized countries and may be as high as 40% in some areas.³ Thus, for those places that bear most of the momentum for continued tuberculosis morbidity and mortality, we are all too often left assuming that the reasons