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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

Middle East activists speak about peace on the Bloemfontein Campus
2012-03-15

 

Bassem Eid (left) and Benjamin Pogrund discuss the situation in the Middle East.
Photo: Johan Roux
15 March 2012

Peace is a big word in the Middle East, particularly amongst Israelis and Palestinians. After years of conflict, people yearn for peace; they want an end to the killings and the uncertainty. The problem is that both sides are actively doing things that undermine the prospect of peace. There is also double talk, lies and evasion with each side pointing fingers. This was the word from Benjamin Pogrund, an Israeli peace activist, addressing staff and students on the Bloemfontein Campus of the University of the Free State. He and fellow peace activist Bassem Eid, a Palestinian, visited the campus to speak about the situation in the Middle East.

Both men agreed that peace efforts were hindered by the Israeli and the Palestinian leaders. According to Pogrund, neither the Palestinians, nor the Israelis are leading the way in accepting that the conflict must end.
 
“Both Israeli and Palestinian leaders say let us get together with no pre-conditions. Then the Israeli leaders say, Jerusalem we cannot share, that is not for negotiation. And, they say to the Palestinians you must recognise Israel as a Jewish state. So, what they say is unless you agree to these pre-conditions there can be no talks without pre-conditions.
 
“And the Palestinians in turn say the settlement construction must cease immediately, and unless that happened, there is no point in meeting. And they say we will never acknowledge you as a Jewish state so do not even bother talking about it. And we insist on the right of return of Palestinian refugees. So they also say unless you acknowledge these pre-conditions there is no point in meeting with our pre-conditions. So as you can gather each side blames the other side, each side points the finger and says you are responsible for the lack of progress.”
 
Pogrund said both the Israelis and the Palestinians could demand legitimacy in that part of the world.
 
“Both Jewish and Arabs can say we have history on our side. We have religion on our side, culture.”
 
To compare Israel to Apartheid South Africa is wrong, he said.
 
“It is an occupation, it is repression, but it is not Apartheid.”
 
Eid, who is the director of the Palestinian Human Rights Monitoring Group, said the Palestinians were close to having a complete independent Palestinian state from 1994 to 1999.
 
“But in one rocket former Israeli Prime minister Ariel Sharon destroyed it.”
 
He said Israel’s disengagement from the Gaza Strip in 2005 did not bring political unity.
 
“We, the Palestinians, were supposed to start building the infrastructure of the Gaza Strip but unfortunately Hamas started dancing on that Israeli disengagement and considered it as their own success because of their military resistance against the occupation.” He also said Hamas is satisfied with its hold in the Gaza Strip and Fatah is also very satisfied with its hold in the West Bank. According to Eid, it is convenient for the Israelis that the Palestinians are separated.

 

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