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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

Professor launches his book, opposition parties attend
2011-03-22

Prof. Hussein Solomon
Photo: Stephen Collett

“We are good in opposing people, but we’re less good in opposing ideas.” This was how Prof. Jonathan Jansen, Vice-Chancellor and Rector of the University of the Free State (UFS) introduced the book launch of Against all Odds: Opposition Politics in Southern Africa.

The event was hosted in collaboration with the publisher under the title: Are opposition parties in South Africa in a crisis? This formed part of a series of dialogue sessions, organised by the Centre for Africa Studies, in the run up to the local elections.
 
Amongst those interested who attended the evening in the Senate Hall of the CR Swart Building on the Main Campus were various politicians, students, staff en a panel consisting of academics and the respective provincial representatives of the ANC and DA.
 
Dr Mcebisi Ndletyana from the Human Sciences Research Council (HSRC), acted as arbiter.
 
Proff. Hussein Solomon, author of Against all Odds: Opposition Politics in Southern Africa, also lecturer at the UFS, as well as Dirk Kotzé, Head of the Department of Political Science at Unisa, delivered enriching lectures on the stance and positioning of opposition parties.
 
Prof. Hussein, who spoke first, circumscribed the context of the political climate in the country, based on his book. “The problem that political science encounters is that everybody becomes experts on the internet, while they have no experience of what is happening in South Africa.” He said that when political parties in the country are under discussion, voters often allow myths and/or stereotyping to influence their concept of it. ‘’If there are no opposition parties, there is no democracy and people are deprived of their vote.”
 
Prof. Kotzé stated in his speech that it was not only opposition parties who had to make the government watch its step, but also the status that the country acquired, amongst others, from its connections, i.e. collaborative agreements such as BRICSA and the country’s inclusion in the G20. He left the audience with a question about how they were going to become involved in politics, and with his rhetoric question referred to options like social networks and movements.
 
Mr Sibongile Besani, the ANC'S secretary in the Free State, said the DA grew due to it’s swallowing of other parties; something he claims is taking the country backwards. He also described the use of personalities by opposition parties as means of association a weakness. He added that voters will continue voting for the ANC because they can associate themselves with the party’s vision.
 
In contrast, Mr Roy Jankielsohn, provincial leader of the DA, said voters and parties unite under their core vision for the country as like in the case of the ANC during the liberation struggles.
 
During the question-and-answer session, which followed after Mr Jankielson’s speech, Prof. Kwandiwe Kondlo, upon completion and summary of the discussions, stated firmly that the opposition parties are in a crisis. “The start of the solution is to recognise the problem. That is why our democracy finds itself in the state in which it is; because the opposition does not fulfil the role that they are supposed to fulfil.“ Prof. Kondlo is the head of the Centre of Africa Studies at the UFS.
 
He concluded by stating that the economic basis in the country was not transformed. “We cannot say that people determine their futures if they posses nothing. Opposition parties must start to communicate at this level in order to table something new. Our democracy must become more inclusive at political and material level.”

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