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24 March 2023 | Story Profs Gladys Kigozi-Male, Christo Heunis, and Michelle Engelbrecht | Photo Supplied
Prof Christo Heunis, Prof Michelle Engelbrecht, Prof Gladys Kigozi-Male
From the left, Prof Christo, Prof Michelle Engelbrecht, and Prof Gladys Kigozi-Male.

 Opinion article by Profs Gladys Kigozi-Male, Christo Heunis, and Michelle Engelbrecht, Centre for Health Systems Research and Development, University of the Free State.


Each year on 24 March, the world commemorates World TB (Tuberculosis) Day. This date coincides with the day in 1882 when Robert Koch announced his discovery of the Mycobacterium Tuberculosis, the germ that causes TB. This infectious disease is transmitted through airborne droplets when an infected person coughs, sings, shouts, or sneezes. TB primarily affects the lungs (i.e., pulmonary TB), but other organs in the body such as the pleura, lymph nodes, abdomen, genitourinary tract, skin, joints and bones, or meninges (i.e., extra-pulmonary TB) can also be affected. TB can be cured; effective anti-TB drugs have been available for almost eight decades. Despite this, TB continues to wreak havoc across the world and in South Africa. According to a report released by the World Health Organisation (WHO), an estimated 304 000 new TB cases were reported in South Africa in 2021 and 56 000 people succumbed to the disease in the same year

A world without TB

In 2014, the sixty-seventh World Health Assembly endorsed a global strategy and targets for TB prevention, care, and control. The strategy envisions a world without TB, aiming to end the epidemic by 2035. By this target date, a reduction in TB deaths of 95% and new infections of 90% – compared to the respective levels in 2015 – are anticipated. Further to this, the United Nations’ Stop TB Partnership was mandated to drive activities to end the global TB epidemic. In 2015, the partnership launched the 90-(90)-90 targets; to reach at least 90% of people with TB and place them on appropriate treatment, including at least 90% of vulnerable populations such as people living with HIV, and to ensure that at least 90% of people with TB are successfully treated. Despite commendable progress, persisting high TB infection and death rates are adversely affecting global and national efforts to end the TB epidemic. With a treatment success rate of only 78% in 2020, South Africa is sorely challenged to attain the global target of 95%.

TB with mental health illness

One of the challenges confronting TB control is the frequent comorbidity of TB with mental health illness. There is compelling evidence linking TB to common mental health problems such as depression, anxiety, and alcohol misuse. Research indicates that TB patients can experience mental health problems at any time during the course of their TB treatment. Undiagnosed mental illness among TB patients may result in poor health-seeking behaviour and non-adherence to treatment, subpar quality of life, and negative treatment outcomes. The WHO's Global End TB Strategy thus recommends integrated patient-centred TB care. This implies that TB care should be provided in close collaboration with other primary health-care (PHC) programmes such as mental health. However, in many countries – South Africa included – efforts to integrate mental health and TB care are confronted by challenges such as limited capacity, nonrecognition of mental health as a problem, insufficient resources, and TB-related social stigma. Consequently, mental health conditions in TB patients are often un-/under-/mis-diagnosed.

Taking depression as a compelling example, a scoping review reported the prevalence of depression as high as 84% among people with TB in studies conducted internationally. However, little is known about the prevalence of depression among TB patients in South Africa. Using a nine-item Patient Health Questionnaire, we assessed probable depression among a sample of TB patients attending PHC facilities in the Free State. We found that almost half (46,1%) of the 208 patients interviewed had probable depression, with 22,6%, 18,8%, and 4,8% having mild, moderate, and severe symptoms, respectively. Probable depression was almost four times more likely among patients diagnosed with extra-pulmonary TB compared to pulmonary TB patients. HIV-infected TB patients undergoing antiretroviral therapy were more than twice as likely to experience symptoms of depression compared to their counterparts who were not undergoing such therapy. This could possibly be attributed to non-adherence to antiretroviral therapy. Studies elsewhere have established a significant association between depression and ART non-adherence. We further found that the longer patients were retained on TB treatment, the less likely they were to display symptoms of depression.

Important to monitor TB patients for depression

Based on these findings, it is important to monitor TB patients for symptoms of depression – particularly those with comorbid HIV – in PHC settings. At the same time, ensuring that patients stay on treatment by providing adequate support for treatment adherence may help to mitigate depression during TB treatment. 

The theme for this year’s World TB Day is ‘Yes! We can end TB’. It is a call for concerted multi-sectoral collaboration between governments, civil society, communities, academia and technical partners, international aid and scientific organisations, the private sector, and disease control programmes in the country to eliminate the TB epidemic. To this end, TB patients attending PHC facilities in South Africa need to be routinely screened for mental health illness. Given the critical shortage of mental health specialists, screening for mental illnesses could be undertaken by trained and well-supervised non-specialist healthcare cadres such as community health workers.

News Archive

UFS hosts sign language workshop to educate parents
2017-05-22

Description: Sign language workshop to educate parents Tags: Sign language workshop to educate parents

Back row; from left; John Keitsemore from
Bartimea School for the Deaf; Philip Cook,
the headmaster at De la Bat School for the
Deaf in Worcester; Jeannie Cook, De la Bat School
for the Deaf; front, from left; Marisa Vermeulen, mother
of two deaf children and teacher at Bartimea
School for the Deaf in Thaba Nchu; Marianne Kühn,
audiologist, and Susan Lombaard, acting Head of the
Department of South African Sign Language.
Photo: Rulanzen Martin

“Ninety percent of deaf children are born into hearing families. When parents first receive the news, they are shocked, angry and confused,” says Susan Lombaard, Acting head of the Department of South African Sign Language at the University of the Free State (UFS).

The department hosted a workshop, “Early intervention options for the child with a hearing loss”, on Friday 12 May 2017 on the Bloemfontein Campus. “It is the first time a sign language workshop of this kind was hosted by the Department of South African Sign Language at the UFS,” says Lombaard, who facilitated the workshop. They hope to make it an annual event.

Parents of deaf children do not always know how they will communicate with their children or where the child must attend school. The workshop aimed to provide parents with the necessary information on different communication options and also touched on school placement.

Support group for parents established
A support group for parents was also established, the first of its kind in the province. It will provide much-needed support, information and guidance for parents of deaf children.

Some of the speakers at the workshop included Anri Esterhuizen, an audiologist; Marianne Kühn from the Carel du Toit Centre, Marisa Vermeulen, who is a mother of two deaf children, and Phillip Cook, the headmaster at De la Bat School for the Deaf in Worcester, in the Western Cape. Jeannie Cook, also a presenter, provided information on sign language acquisition of the small deaf child, which is done through creative play.

Professionals have responsibility
South African Sign Language is a language in its own right and is not international. “Sign language is a visual language with its own grammar and syntax different from spoken language,” Lombaard said.

There has been much controversy surrounding teaching deaf children to speak and teaching them to sign. “We as professionals have the responsibility to provide information on all options. This is to help the parent make informed decisions about communication and school placement.”

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