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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 welcomes Constitutional Court’s ruling on its Language Policy
2017-12-29



The executive management of the University of the Free State (UFS) welcomes today’s judgement by the Constitutional Court in favour of the university’s Language Policy. The judgement follows an appeal lodged by AfriForum against the judgement and order delivered by the Supreme Court of Appeal (SCA) on the implementation of the UFS Language Policy on 28 March 2017. 
 
In a majority ruling, Chief Justice Mogoeng Mogoeng denied AfriForum’s application for leave to appeal the SCA’s ruling, and said the UFS Council’s approval of the Language Policy was lawful and constitutionally valid. The court found that the adoption of the Language Policy was neither inconsistent with the provisions of the Constitution, nor did it violate the Constitutional rights of any students and/or staff members of the UFS.
 
Today’s landmark judgement is not only paving the way for the UFS to continue with the implementation plan for its Language Policy as approved by the UFS Council on 11 March 2016, but it is also an indication of the value which the university’s decision to change its Language Policy to English as primary medium of instruction has on higher education in South Africa.
 
“The judgement by the Constitutional Court is not a victory against Afrikaans as language. The UFS will continue to develop Afrikaans as an academic language. A key feature of the UFS Language Policy is flexibility and the commitment to strive for a truly multilingual environment. Today’s judgement allows the UFS to proceed with the implementation of its progressive approach to a language-rich environment that is committed to multilingualism,” says Prof Francis Petersen, Rector and Vice-Chancellor of the UFS.
 
According to Prof Petersen, the UFS is dedicated to the commitments in the Language Policy and, in particular, to make sure that language development is made available to students in order to ensure their success as well as greater levels of academic literacy – especially in English. This includes contributing to the development of Sesotho and isiZulu as higher-education languages within the context of the needs of the different UFS campuses.
 
“We can now continue to ensure that language is not used or perceived as a tool for the social exclusion of staff and/or students on any of the three campuses, and continue to promote a pragmatic learning and administrative environment committed to and accommodative to linguistic diversity within the regional, national, and international environments in which the UFS operates,” says Prof Petersen.
 
The UFS is the first university in South Africa appearing before the Constitutional Court regarding its Language Policy. 
 
During 2017, the Faculties of Health Sciences, the Humanities, and Law started with the implementation of the new Language Policy at first-year level. This includes the presentation of tutorials in Afrikaans. The remaining faculties will start implementing the policy as from 2018.

Released by:
Lacea Loader (Director: Communication and Brand Management)
Telephone: +27 51 401 2584 | +27 83 645 2454
Email: news@ufs.ac.za | loaderl@ufs.ac.za
Fax: +27 51 444 6393

Related articles:
UFS welcomes unanimous judgement about its Language Policy in the Supreme Court of Appeal (28 March 2017)
Judgement in the Supreme Court of Appeal about UFS Language Policy (17 November 2016)
Implications of new Language Policy for first-year students in 2017 (17 October 2016)
UFS to proceed with appealing to Supreme Court of Appeal regarding new Language Policy (29 September 2016)
UFS to lodge application to appeal judgment about new Language Policy (22 July 2016)
High Court ruling about new UFS Language Policy (21 July 2016)
UFS Council approves a new Language Policy (11 March 2016)

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