Latest News Archive

Please select Category, Year, and then Month to display items
Previous Archive
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

Victory lies beyond the moment
2017-12-25


 Description: 2017 Victory lies beyond the moment Tags: 2017 Victory lies beyond the moment 

Mokoena learns a new skill at the Learning Festival arranged
by the Centre for Community Engagement.
Photo: Igno van Niekerk

For Mokoena it was just a regular day. Another day. Another rush. As a taxi driver you get used to the adrenaline, taking gaps, foot on the accelerator. Alert. Honking hooters. Angry drivers.

Then it came out of nowhere. A stroke. The one side of his body was going numb. What was happening? What about his job? His income? His life?

Fast-forward a few years.

I meet Mokoena at the Learning Festival arranged by the Centre for Community Engagement, in association with Bloemshelter on the University of the Free State’s Bloemfontein Campus. A reserved young man, Mokoena is busy at one of the stands where a range of people from rural communities come to learn new skills. At no cost. They then go back to teach the skills they learnt in their communities. Job creation, that’s the philosophy: as you develop, you need to develop others. 

When I talk to Karen Venter, Head of Service Learning at the Centre for Community Engagement, the stories are overwhelming. “There was the lady who attended 19 workshops in two days. She went back to her community, shared her knowledge and became an entrepreneur helping others take care of themselves.”

New skills
Mokoena is also here to acquire new skills. After his stroke he was told by occupational therapy students about a project that teaches you to build your own house with raw materials. He takes out his cellphone with a sense of pride. Scrolls through some pictures: “This is my house. I built it from all kinds of things, cow manure, bottles, clay, other people’s rubbish.” The pictures show a house in a neat environment. Solid. Proud. A lot of healing came with building the house. Karen explains: “The physical work he was doing, pushing a wheelbarrow and working, but more than that – the knowledge that he could take charge, make a difference, work on a dream – the healing power of a sense of purpose. He became stronger and more confident.”

Victory 
Mokoena walks back to the sewing workshop he was attending before sharing his story. The buzz continues inside the Equitas Building where artisans, entrepreneurs and UFS staff are sharing their skills. Sewing machines hum away and infrequent beeps sound from a table where an excited group of non-scientists have just completed the building of circuits. Faces light up with every beep. Hands raised. Fists clenched. Victory!

But the victory lies beyond the moment. It’s in the confidence, the learning, and the sharing that will be taking place when these people go back to their communities. Some will participate in research projects; others will benefit from curricular requirements leading students into distant communities, and others will be hosting workshops at the next Learning Festival. 

And there will be more great stories. Like Mokoena’s.

We use cookies to make interactions with our websites and services easy and meaningful. To better understand how they are used, read more about the UFS cookie policy. By continuing to use this site you are giving us your consent to do this.

Accept