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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

First-year students encouraged to attend UFS welcoming function
2005-01-12

The University of the Free State (UFS) will host a welcoming function for all new first-year students and their parents on Saturday 15 January 2005 in the Callie Human Centre on the main campus in Bloemfontein.

The function starts at 11.00 and will be addressed by the Rector and Vice-Chancellor of the UFS, Prof Frederick Fourie. UFS staff will also be available to provide vital information to first-year students on academic matters.

According to UFS Registrar, Mr Vernon Collett, Saturday’s welcoming function can assist students and parents by providing vital information on the many high quality academic learning programmes on offer at the UFS in six faculties.

“If students and parents have this information it will make the registration process which starts next week Monday 17 January much smoother,” Mr Collett said.

The UFS has split the registration process into various categories of students and Mr Collett appealed to all students to adhere to the dates and times which apply to them as a one-stop service will be available so as to avoid unnecessary delays in the registration process.

The registration of first-time entering first-year students who applied before 30 November 2004 to study at the Bloemfontein campus will take place from Monday 17 January 2005 to 21 January 2005 at the Callie Human Centre.

Senior undergraduate students (that is, students entering their second or later year of study) may register from 22 to 29 January 2005.

Postgraduate students, first time entering first year students and other students who applied for admission to the main campus after 30 November 2004 must register at the Callie Human from 31 January 2005 to 4 February 2005.

Due to the limitations placed by government on student numbers, the applications of students who applied late will be regarded as pending and will be processed as places became available.

Vista campus

The Vista campus in Bloemfontein – which was incorporated into the UFS in January 2004 – no longer accepts applications from first-year students. Such prospective students had to apply to the UFS main campus.

Students who had been registered as Vista students last year must register at the Vista campus on the same dates as applicable on the main campus.

Qwaqwa Campus

At the Qwaqwa campus of the UFS, all first-time entering first-year students must report on 17 January 2005, after which the registration of these students will take place according to a specific programme.

The official welcoming functioning for new first-years at the Qwaqwa campus of the UFS will take place on Saturday 22 January 2005 at 11am in the Rolihlahla Mandela Hall on the Qwaqwa campus. As on the main campus, this function will also be addressed by the Rector and Vice-Chancellor, Prof Fourie.

Mr Collett appealed to first-year students who have applied to study at the Qwaqwa campus and their parents to attend this function which fulfills the same role as the one held on the Bloemfontein campus.

Detailed information on the dates and times of registration for the various faculties and academic learning programmes is available on the UFS website: http://www.uovs.ac.za/content.php?cid=9

Prospective students may also call 051-401-3000 for more information.

    Media release
Issued by: Anton Fisher
Media Representative
Cell: 072-207-8334

 


12 January 2005

 

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