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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

Lessons of The Spear
2012-08-14

 Discussing weighty issues at the UFS were from left: Prof. Jonathan Jansen; Vice-Chancellor and Rector; Nic Dawes, Editor-in-Chief, Mail & Guardian; Max du Preez: Investigative journalist and political columnist; Ferial Haffajee: Editor, City Press; and Justice Malala: Political commentator and newspaper columnist.
Photo: Johan Roux
14 August 2012

What were South Africans left with after The Spear? More importantly, what did we learn from The Spear?

These were the issues discussed at a seminar, Beyond the Spear, on the controversial Brett Murray painting at the Bloemfontein Campus of the University of the Free State (UFS) on Monday 13 August 2012.

The university hosted this seminar, Beyond the Spear, in conjunction with acclaimed journalists, to look deeper into the lessons that South Africans learnt from this painting and the reaction from the public and politicians following soon after it went on display at the Goodman Gallery in Johannesburg.

The four panellists, Mr Justice Malala (political analyst, journalist and host of the news show, The Justice Factor), Mr Nic Dawes (editor in chief of Mail & Guardian), Mr Max du Preez (investigative journalist and political columnist) and Ms Ferial Haffajee (editor of City Press), all presented their views and experiences on the public’s perceptions of this artwork.

In his opening remarks, Prof. Jonathan Jansen, Vice-Chancellor and Rector, said the purpose of the seminar was to help us make sense of what happened. Prof. Jansen also chaired this seminar.

“This being South Africa, there will be more ‘Spears’. More public crises will unfold that divide the nation and that will stir the emotions. We need to understand what happened so that we are better prepared to deal with the coming ‘Spears’.”

Issues on leadership, South Africa’s hurtful past and the freedom of expression were some of the topics raised by the panellists.

“This has taught us that South Africans – especially the older generation – still need to vent their anger… White South Africa must be patient and allow black citizens to shout at them,” said Mr Du Preez. He warned that this anger should serve a constructive purpose. In reaction to a question if Brett Murray did not disrespect Pres. Jacob Zuma’s dignity with his controversial painting, he said that this painting was “…rude and disrespectful.”

“It was meant to be. It was not honouring him.” He said that politicians will do anything, including messing with the country’s stability, to further their own interests. “From now on we need to be far more alert, far more cynical about our politicians.”

Mr Dawes shared his experience and said that the debates around The Spear were very painful considering where the nation has come from. He said the painting opened up painful pasts and difficult spaces. “It is up to the media to open up these difficult spaces.” He said the painting also brought up questions of how South Africans deal and live with pain. “South Africa must live with its past. The debate should now be how to preserve space for the country’s ghosts and how its citizens could get the resilience to deal with it.”

Ms Haffajee, who was caught in the crossfire between freedom of expression and human dignity and who refused to remove a picture of the painting from the City Press website, said that the media was viciously played by politicians.

“This had shown that achieving freedom took many lives, but it took very little to kill it.” She said The Spear is art that it is part of a rich cultural heritage of protest art.

Mr Malala said with the debates around The Spear painting, something died in South Africa. “The debate was taken away from us. We let politicians get to us.”

After the panellists delivered their presentations, Prof. Jansen led a discussion session between the audience and the panellists.
 

 

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