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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

Centenary medals awarded
2004-10-15

Speech, Rector and Vice-Chancellor: Prof. Frederick Fourie

Op 28 Januarie 2004 het ons die honderdste herdenking van die geboorte van hier­die hoër onderwys instelling gevier met ‘n groot partytjie voor die Hoofgebou. Dit was ‘n wonderlike en vreugdevolle aand.

Die historiese prosessie tydens die amptelike opening van 6 Februarie 2004, in kleurvolle akademiese togas, vanaf ons wortels in Grey-Kollege tot by die Hoof­gebou, het die reistog vanaf die verlede na die hede treffend ge­simbo­liseer.

Talle ander eeufeesgeleenthede het gedurende hierdie jaar plaasgevind. Woensdagaand het ons die premiêre van ‘n dokumentêre film oor koning Moshoeshoe beleef – ‘n belangrike eeufeesprojek van die UV wat onder meer gemik is op die ontwikkeling van ‘ n gedeede geskiedenisbesef – a shared sense of history – and the celebration of a very special leadership, of a spirit of nation-building and reconciliation, in somebody like king Moshoeshoe (also MT Steyn and others…)

Last night we experienced a wonderful and moving honorary doctorary ceremony, with a wonderful group of South Africans like Khotso Mokhele, Antjie Krog, Jakes Gerwel, Van Zyl Slabbert, Jaap Steyn, Saleem Badat, and others - giving so much food for thought.

This evening, where we honour outstanding contributors to the development of this University, is a suitable moment to reflect on the course of the first 100 years of the University of the Free State.

1. ‘n Voëlvlug oor die geskiedenis: die vyf fases

1.1 Eerste fase: 1904 – 1927 (Eerste kwarteeu)

Eerste wankelende treë in die totstandkoming van die
Grey Universiteitskollege

Gedurende 1904 – 1920 word die eerste en mees basiese vakke in geestes- en natuurweten­skappe ingestel, eerste Senaat en eerste Raad saamgestel, en eerste geboue opgerig (hoofgebou en manskoshuis). Teen 1920 was daar egter slegs ongeveer 100 studente, die instelling was finansieel in die knyp, met geen vooruitgang en groei, en ook nie ‘n vaste rektor nie – klaar­blyk­lik was die GUK nog geen lewensvatbare instelling nie. Vrystaatse kinders word steeds eerder na ander universiteite gestuur.

Hierna maak ds JD Kestell, rektor 1920 – 1927, ‘n reuse bydrae om ‘n versukkelde, arm, klein universiteitskollege lewensvatbaat te kry. Hy slaag met fonds­insameling en oortuig Afrikaanse én Engelse ouers om hulle kinders na die GUK te stuur. Teen 1927, met 420 studente, word die eerste nederige mylpale van kritiese massa bereik te midde van ‘n steeds armoedige Vrystaat­se gemeenskap en ‘n studentekorps met gelapte klere. [Maar ook die tyd waarin die Reitz-saal, waarin hierdie plegtigheid plaasvind, gebou is.]

1.2 Second phase: 1927 – 1950 (Tweede kwarteeu)

The Grey University College becomes a fully fledged university

By 1950 the establishment of main basic and career-oriented faculties were completed – Faculty of Commerce in 1937; Faculty of Law as wel as the Faculty of Education in 1945. Student numbers reached 1000 in 1950.

Die UKOVS beleef en oorleef die Groot Depressie, die armblankevraagstuk, die Tweede Wêreldoorlog, taal- en politieke stryd onder Afrikaners, en die stryd van Nat vs Sap, ook op die kampus. Die tydperk word veral gestempel deur die taalstryd met DF Malherbe (rektor 1929 – 1934) as sterk kampvegter vir Afrikaans. Veral na 1948 volg rektor Van der Merwe Scholtz ‘n doelbewuste enkel­talige Afrikaanse rigting (Christelik-nasionaal).

1.3 Derde fase: 1950 – 1976 (Derde kwarteeu)

Ongekompliseerde groei ná onafhanklikheid

Hierdie periode word gestempel deur verkryging van onafhanklikheid as universiteit op 18 Maart 1950. Daarna beleef die UOVS onder rektore Scholtz, Flippie Groene­woud en Benedictus Kok stelselmatige groei sonder beduidende finansiële kommer. Die UV is duidelik ‘n Afrikaanse ‘volksuniversiteit’ op Christelik-nasionale grondslag, onlosmaaklik in­gebed in die dominante politieke bedeling van apartheid en afsonder­like ontwikke­ling. Dit is die hooggety van Afrikaner (en blanke) self­vertroue en heerskappy. Vir personeel sowel as studente is dit ‘n relatief onge­kom­­pliseerde tyd getipeer deur groeiende voor­spoed in die blanke en Afrikaanse gemeenskap, goeie werksvooruitsigte vir studente, kommer­lose studentepret, en min spanning op die kampus.

The academic focus is on teaching, especially to provide staff for the growing public service and education sectors. Research has a low profile. More career-oriented or professional faculties are established: agriculture in 1958 and the medical faculty in 1970. Student numbers reach 2000 in 1960, 4000 in 1970 en 7000 in 1975. Many new residences and academic buildings are erected, especially in the Kok-era.

Teen 1976 was die vernaamste boustene van ‘n medium-grootte universiteit in posisie: onafhanklikheid, genoeg fakulteite, genoeg koshuise en akademiese geboue, goeie sport en kultuur. Op die oog af is die ideaal van volwaardige, onaf­hanklike universiteit verwesenlik.

1.4 Vierde fase: 1976 – 1989

Op koers na die jaar 2000: van die statiese na vernuwing

Politieke onstabiliteit en oorgang in die land begin met die Soweto-onluste, die drie-kamer parlement, PW Botha se Rubicon-toespraak, noodtoestande, die ‘struggle’ en opkoms van UDF, en so meer. Die UOVS is swaar onder die indruk van die ‘totale aanslag’ en die regering se totale teen-strategie. Die Universiteit word polities en akade­mies geïsoleer en intellektueel gemarginaliseer. Ekonomies is dit moeiliker tye na die oliekrisis en die begin van hoë inflasie, en die Staat se finansies wat begin knyp.

Academically this period is distinguished by the strong stimulation and support of the research capacity and orientation by rector Wynand Mouton, which leads to a significant growth in research, especially in the natural sciences. The faculty of Theology is establishyed, the Sasol-UFS library erected. Student numbers continue to grow, but at a much slower rate then before.

Twee ander fasette kenmerk hierdie tydperk: eerstens die toelating van die eerste swart studente (nagraadse 1978, voorgraads 1988) en die begin van die era van multikulturaliteit; tweedens, die begin van subsidie- en finansiële probleme en die eerste rasionalisasie van personeel. Albei hierdie is voortekens van ingewikkelde jare wat sou volg vanaf 1990.

1.5 Fifth phase: 1990 – 2004: The turn of the century brings winds of change

(a) 1990 – 1996:

Die Francois Retief era word gedomineer deur die gevolge van die politieke verande­ringe deur president FW de Klerk en die vrylating van Nelson Mandela. Die UV ontwaak tot die realiteit van die oorgang na ‘n post-apartheid samelewing en komende ANC regering. Die eerste versigtige trans­for­ma­sie­stappe word ingestel, multikulturaliteit word die groot uitdaging, en die eerste fasiliterende strukture (bv. die Multikulturele Komitee) word gevestig. Die eerste senior swart personeel word aangestel.

The dramatic decision about the introduction of parallel-medium teaching in 1993 signals the start of multilingualism as well as a significant growth in the admission of black students. Total student numbers are stable at approximately 9000, but black student numbers grow to 36% in 1995. Initially the change to parallel-medium impact negatively on staff teaching load and hence onresearch outputs.

Die inkrimping in staatsubsidie lei tot ernstige finansiële probleme, besparings­pogings, grootskaalse rasionalisasie van personeel in veral die fakulteit Lettere en Wysbegeerte, spanning tussen Senaat en rektoraat oor finansies – en mismoedig­heid onder personeel.

(b) 1997 – 2004:

The time of rector Stef Coetzee and his successor is the era of the new democracy and transformation. At the beginning of this phase Afrikaans parents start sending their children to other Afrikaans universities; residence become half full. Tensions arise between student groups. This is followed by the large breakthroughs in student transformation in 1997, which normalises the situation. The University becomes a leader in transformation. This leads to the acceptance of the multicultural and multilingual character, on a Christian foundation, of the University. The name changes to the University of the Free State (UFS).

Met ‘n finansiële krisis en verdere rasionalisasie van personeel op hande word die akade­miese en finansiële ‘draaistrategie’ in Januarie 2000 geloods. ‘n Drama­tiese finansiële ommekeer lei tot herinvestering in kampus­fasiliteite en toerusting, ‘n toename in personeel en beduidende verhoging in vergoeding bokant inflasie. Terselfdertyd is daar ‘n opbloei in die akademie: innoverende onderrig­programme, e-leer, ‘n fokus op programgehalte. Konsolidering van fakulteite vind plaas, die Bestuurskool word gestig, daar is sterk internasio­na­lisering en groei in navorsing. Profes­sionele bemarking en strategiese kommunikasie verander die beeld van die UV.

Studentegetalle groei dramaties van 10 000 in 2000 na meer as
23 000 in 2003/4; groei moet nou beperk word. Afrikaanse studente keer terug; koshuise kry lang waglyste. Die verhou­ding tussen wit en swart studente op die hoofkampus is rondom 50:50.

The period ends with the incorporation of the Qwaqwa en Vista Bloemfontein campuses, the approval of a new language policy which also established multilingualism in management and administration, and purposeful efforts to consolidate the foundations of an institutional culture of multiculturalism, multilingualism, non-racialism and non-sexism – a culture of tolerance, embracement and justice in diversity. The Centenary is celebrated with harmony and prosperity on the campus in 2004 (although always with a good sprinkling of unexpected challenges and problems).

2. Vanaand bring ons hulde, en sê ons dankie aan, die bouers van die UV

Oor ‘n honderd jaar het honderde, duisende mense ‘n bydrae gelewer tot die UV se ontwikkeling.

Kom ons eer en dank diegene wat, 100 jaar gelede in a baie arm gemeen­skap wat bykans verwoes is deur die Anglo-Boere oorlog, nooit opgehou droom het oor ‘n eie universiteit om die jongmense te dien, om die mense te dien – die arm Vrystaatse mense van daardie tyd.

Let us honour and thank all those who painstaking built this university from very humble beginnings, from the first fragments and embrio of a university – through a hundred years of various wars, of the struggle, of poverty, of bad times but also good times.

In elke dekade, in elke een van die honderd jaar, is hierdie instelling gebou deur die harde werk, idealisme en verbintenis (“commitment”) van leiers, akademiese personeel, steundiens­personeel, dienswerkers. Laat ons hulle eer en dank.

Let us honour the spirit of commitment and ‘vasbyt’, of ‘never let go’, the determination to overcome obstacles, of timely and pre-emptive adjustment to new challenges and new needs, which made that possible.

Kom ons vier en eer die duisende studente wat in die 100 jaar hier was, wat die spesiale tradisies en spesiale gees geskep het van Kovsiekampus, van Kovsie studentelewe – en wat gedurig nuwe tradisies en gebruike geskep (en gepleeg) het, soos net studente dit kan doen.

Let us celebrate the way this University has, in the last 20 years, once again taken up the challenge of transformation and adjusting to new needs, serving all the people, especially those most in need at this time of our history – thereby closing the circle, going fully “from post Anglo-Boer War to Post-Apartheid”.

Kom ons vier, en wees innig dankbaar vir, die wyse waarop hierdie Universiteit in die laaste 5 jaar gedraai het, finansieel sowel as akademies, en die wonderlike periode van akademiese groei en ontwikkeling en verdieping waarin ons nou staan – tesame met die geleenthede wat QwaQwa en Vista Bfn vir ons bied. Hierdie voorspoed sien ons in die nuwe fisiese aangesig van die kampus, insluitend hierdie wonderlike Eeufeeskompleks.

Let us thank God, the Almighty, who has guided this university through a tumultuous century, for always being there for us, for blessing us in so many ways. In Deo Sapientiae Lux

* * *

So: vanaand is ons hier om erkenning te gee en dankie te sê…

Soveel mense het veel vroeër hul fondament-leggende bydraes gelewer, en alles wat ons vandag hier sien, moontlik gemaak. Selfs mense uit meer onlangse jare is reeds oorlede – enkeles terwyl hulle nog in diens van die UV was, ander na hul aftrede.

‘n Bepaalde groep was bevoorreg en geseend om in die laaste ongeveer 30 jaar by die UV betrokke te kon wees, én om vandag nog in die lewe te wees. Dit is van hulle wat vanaand hier is, en wat vanaand Eeufeesmedaljes ontvang.

Geweldige moeite is gedoen om hierdie proses van seleksie en keuring so billik en deeglik as moontlik te doen. Uiteraard is so ‘n proses nie volmaak nie en sal almal nie saamstem met die uitkomste van die proses nie. Groot moeite is egter gedoen in hierdie fase om mense nie verkeerdelik uit te laat uit of in te sluit in die toekenningslys nie, in volle bewustheid dat daar waarskynlik steeds foute gemaak sal word. Onvermydelik sal daar foute wees, of mense wat uitgelaat is. Ons vra daarvoor nederig om verskoning en begrip.

Billikheid, so ‘n belangrike rigsnoer vir hierdie Universiteit, veral in hierdie tye, lei ons ook dat ons oë oop is vir die bydraes vir mense uit alle afdelings van die Universiteit, wat lei tot ‘n bepaalde balans tussen fakulteite, tussen fakulteite en steundienste, tussen poskategorieë, tussen geslag en ras, en individue soveel as mense in spanverband.

In Deo Sapientiae Lux

God bless this university / Modimo o thlonolofatse yunivesithi ena

Khotso Pula Nala

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