Eswatini is showing encouraging progress in the treatment of multidrug-resistant tuberculosis, with new approaches helping more patients complete therapy successfully and recover. Health workers in the country say treatment failure often happens when patients miss doses, stop medication early, take medicines incorrectly, or receive the wrong regimen, which can lead to serious consequences such as drug resistance. Multidrug-resistant tuberculosis, or MDR-TB, develops when the bacteria become resistant to at least two of the most powerful first-line TB medicines, making the disease much harder and more expensive to treat. Like drug-sensitive TB, MDR-TB can also spread easily through the air, particularly in crowded or poorly ventilated environments.
The experience of Babazile Ngwenya from Manzini illustrates both the dangers of incomplete treatment and the benefits of newer treatment options. She first contracted tuberculosis in 2012 and stopped taking the standard first-line treatment after only two months. As a result, she later developed MDR-TB, likely due to incomplete treatment, and was hospitalized for seven months in an effort to ensure adherence. At that time, MDR-TB treatment involved a lengthy and demanding course of up to 18 months with a complex combination of daily oral medicines and injections, which she found overwhelming and difficult to complete.
A major turning point came when the World Health Organization recommended a shorter six-month, all-oral treatment regimen known as BPaL(M) in 2022. Eswatini adopted this regimen in 2023, making it the standard treatment for MDR-TB patients across the country. Health professionals in Eswatini say the shorter all-oral regimen is much more patient-friendly because it removes the need for painful daily injections and significantly reduces the overall treatment period. This makes it easier for patients to stay on treatment and complete the full course, which is essential for curing the disease and preventing further resistance.
When Ngwenya began experiencing persistent coughing, dizziness, and shortness of breath again in 2024, she was once more diagnosed with MDR-TB. This time, however, her treatment experience was different. She was hospitalized for three months due to her illness and anaemia and was placed on the six-month BPaL(M) regimen. With the shorter and easier treatment plan, she was able to adhere properly and was eventually cured. Her recovery highlights the importance of simpler treatment options in improving patient outcomes and giving people a second chance at recovery.
Tuberculosis remains a major public health challenge in Eswatini, which is one of the 30 high-burden TB countries globally. According to WHO estimates, the country recorded a TB incidence of 319 cases per 100,000 people in 2024, including an estimated MDR-TB incidence of 13 cases per 100,000 people. The burden of the disease is made even more serious by the country’s HIV epidemic and the growing number of drug-resistant TB cases, both of which complicate diagnosis, treatment, and long-term control efforts. Health authorities have described TB as an ongoing and significant threat to public health in the country.
In Eswatini, patients diagnosed with MDR-TB are admitted to health facilities when they are seriously ill or when their home environment does not allow proper infection prevention and control. Once they are stable and able to continue treatment safely, they are discharged to complete their care at home. Health workers stress that proper counselling is central to treatment success, with patients receiving education at the start of treatment about TB, the importance of adherence, and the need to complete the full course. For MDR-TB patients in particular, having a treatment supporter is considered essential.
The country has put in place a range of practical support measures to help patients stay on treatment. Patients and their treatment supporters receive monthly transport stipends to help them attend appointments, while food packages are provided each month to support households of four to six people. Treatment supporters, who are usually family members, monitor doses and record each observed medication intake. If a patient misses an appointment, the health facility follows up by phone, and if necessary, sends a treatment adherence supporter on a motorbike to visit the patient at home. These community-based systems are designed to reduce treatment interruptions and improve outcomes.
For Ngwenya, family and workplace support played an important role in her recovery. She credits her mother for caring for her during her hospitalization and helping her through the difficult period. Her story reflects how social support, along with accessible and manageable treatment, can make a critical difference for people living with MDR-TB. She has since returned to her job as a sales assistant at a boutique in Manzini, a position she had previously been forced to leave because of illness, and now speaks positively about the fact that TB can be treated and cured if people seek care early and follow treatment properly.
Eswatini has already achieved notable progress in its fight against MDR-TB. In 2022, 86 percent of people diagnosed with MDR-TB in the country were treated successfully, and TB-related deaths declined by 60 percent between 2015 and 2024. However, major challenges remain. In 2024, an estimated 54 percent of people with MDR-TB were either not diagnosed or not started on the correct treatment, showing that large gaps in detection and access still need to be addressed. Closing these gaps will require stronger targeted screening, better referral systems, improved data management, and deeper community involvement.
The World Health Organization continues to play a major role in supporting Eswatini’s national tuberculosis response. In 2024, WHO helped the country develop its new National TB Strategic Plan for 2024–2028 and supported the rollout of digital X-ray systems with computer-aided diagnostics to improve case finding. The organization also continues to provide technical support to strengthen the quality of TB services and improve programme management. WHO has said it will remain closely involved in helping Eswatini accelerate its TB response in line with the latest global guidelines, while also emphasizing the importance of working closely with communities and civil society to ensure equitable access to care.
