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Undiagnosed depression in tuberculosis patients threatens control of the disease

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

A new dawn for student governance

2011-09-02

Our SRC presidents: Richard Chemaly (Bloemfontein Campus) and Bongani Ncgaca (Qwaqwa Campus)
Photo: Hannes Pieterse

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The successful and peaceful completion of the University of the Free State’s (UFS) Student Representative (SRC) elections 2011 herals a new dawn for student governance with the announcement of the results today (1 September 2011).

The SRC elections at the Qwaqwa Campus were completed on 25 August 2011, while the elections at our Bloemfontein Campus took place on 29 and 30 August 2011.

“A new dawn heralds a new day when Richard Chemaly, the son of Lebanese immigrants becomes President of an SRC, as elected by students from all racial backgrounds and from across the student body at large. A new day has arrived when candidates could have won voter support across racial lines; a new day is here when all SRC members are now recognised leaders on the basis of academic accountability,” the Dean of Student Affairs, Mr Rudi Buys, says.

A new dawn has arrived; firstly, insofar as student elections for the choice of student leaders at the UFS now proceed according to a non-racial and a non-party political basis.

Not only did the SRC elections at both the Bloemfontein and Qwaqwa Campuses achieve its required quorum, with 31% (4 729 votes) and 50% (2 112 votes) voter turnout, respectively, but the SRC elected by students at the Bloemfontein Campus is 55% black and 45% white, and 60% female and 40% male. The numbers of votes gained by successful candidates also indicate that voters from all racial backgrounds have voted for their candidates of choice.

Secondly, a new dawn has arrived insofar as student governance occupied by only some student groups claiming to speak on behalf of all students has made way for direct voting for candidates by the broad student body and the threefold increase of student governance structures on campus.

Not only did all students at our Bloemfontein and Qwaqwa Campuses (a total of 15 173 and 4 257, respectively) have the opportunity to participate in voting directly, but nine additional Student Councils were established at our Bloemfontein Campus that each holds an ex officio seat on the SRC and allows for student governance in all the major student sectors of the student body, such as for postgraduate students, international students and all categories of student associations.

The various councils now established include the Student Academic Affairs Council, the Student Associations Council, the Postgraduate Student Council, the International Student Council, the Student Media Council, the Residences Student Council, the Commuter Student Council and the Rag Community Service Fundraising and Service Councils. In addition, all faculties also introduced student representative structures at departmental and faculty level in 2011 to ensure student participation in faculty management and governance.

The SRC members at the Bloemfontein Campus are:

Elective portfolios:
President: Mr Richard Chemaly
Vice-President: Mr Lefata David Maklein
Secretary: Ms Matshepo Ramokgadi
Treasurer: Mr Werner Pretorius
Arts & Culture: Ms Alta Grobelaar
Accessibility & Student Support: Mr William Clayton
First-generation Students: Ms Petre du Plessis
Media, Marketing & Liaison: Ms Biejanka Calitz
Sport: Mr Bonolo Thebe
Student Development & Environmental Affairs: Ms Busisiwe Madikizela
Transformation: Ms Qaqamba Mhlauli

Ex officio portfolios:
Dialogue & Ex officio: Associations Student Council: Mr Anesu Ruswa
Academic Affairs & Ex officio: Academic Affairs Student Council: Mr Jean Vermaas
Residence Affairs & Ex officio: Campus Residences Student Council: Ms Mpho Mokaleng
City student Affairs & Ex officio: Commuter Student Council: Ms Annemieke Plekker
Postgraduate Affairs & Ex officio: Postgraduate Student Council: Ms Glancina Mokone
International Affairs & Ex officio: International Student Council: Mr Pitso Ramokoatsi
Student Media Affairs & Ex officio: Student Media Council: Ms Nicole Heyns
RAG Community Service & Ex officio: RAG Fundraising Council: Ms Iselma Parker
RAG Community Service & Ex officio: RAG Community Service Council: Ms Motheo Pooe

In the Qwaqwa elections, SASCO achieved 36,84% of the vote, with SADESMO, PASMA and NASMO each achieving 29,73% and 18,56% and 12,74%, respectively .

Mr Bongani Ncgaca was elected as the President of the SRC at our Qwaqwa Campus, while the names of the SRC members at the campus will be announced on 7 September 2011.

The Central SRC will be established on 8 September 2011 by a joint sitting of the two SRCs.

The successful completion of the SRC elections at the Bloemfontein Campus follows a yearlong review process of student governance by a Broad Student Transformation Forum (BSTF) that consists of 59 delegations from student organisations and residences. The BSTF adopted independent candidacy for elective portfolios and additional student councils to provide ex officio seats on the SRC as the template for student governance, following the consideration of a series of benchmarking reports on student governance nationally and internationally.

The UFS Council adopted the new SRC Constitution, as drafted and submitted by the BSTF, on 3 June 2011.

Media Release
1 September 2011
Issued by: Lacea Loader
Director: Strategic Communication
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: news@ufs.ac.za

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