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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

Shortage of quantity surveyors discussed at UFS

2006-03-24

During the recent visit of the Association of South African Quantity Surveyors (ASAQS) to the University of the Free State (UFS) were from the left Mr Egon Wortmann (Director: ASAQS), Prof Basie Verster (representative of the Free State on the ASAQS and head of the Department of Quantity Surveying and Construction Management at the UFS), Mr Greyling Venter (Chairperson: Free State branch of the ASAQS), Prof DG Brümmer(Vice-President: ASAQS) and Mr Patrick Waterson (President: ASAQS).
Photo supplied

Shortage of quantity surveyors discussed at UFS

“The South African building industry is experiencing an unprecedented high level of economic growth and prosperity. This is causing a definite shortage of registered quantity surveyors,” said Mr Egon Wortmann, Director of the Association of South African Quantity Surveyors(ASAQS) during the association’s recent visit to the Department of Quantity Surveying and Construction Management at the University of the Free State (UFS).

“This shortage is especially noticeable in local and national governments where unqualified and inexperienced staff, consultants and/or facilitators are now appointed,” said Mr Wortmann.

In doing so, the authorities that have adopted this approach are according to Mr Wortmann actually acting illegally and are not in compliance with the legal and statutory requirements of South Africa. “These unprofessional practices are unproductive, it leads to frustration and is strongly condemned by the ASAQS,” he said.

“The service delivery of these unqualified and unregistered service providers is often sub standard and does not comply to the legal requirements of the profession. It may also result in the tarnishing of the image and high professional standards set by the quantity surveying profession,” said Mr Wortmann.

“Universities offering programmes in quantity-surveying and construction management are also negatively affected by the high levels of activity in the building environment. Suitable lecturing staff are leaving the academic institutions as they are attracted to better opportunities being offered in the building industry. The ability of the tertiary institutions to attract young academics, to train them and to keep them in the longer term, is therefore almost impossible”, said Prof Basie Verster, head of the Department of Quantity Surveying and Construction Management at the UFS and representative of the Free State on the ASAQS.

According to Prof Verster the UFS supplies more than its quota of qualified quantity surveyors to the South African building industry. “Although more than 460 students are registered in construction related programmes at the UFS, we are as the ASAQS’s concerned about the shortage of students that can enter the construction industry. In our case, we are experiencing a shortage in black female students,” he said.

“Of the 460 postgraduate students, 38% are black of which 20% are female students. Graduates do also not necessarily stay in the country. As the UFS’s programmes are accredited overseas, a lot of our students leave the country for working opportunities elsewhere,” said Prof Verster.

Mr Patrick Waterson, President of the ASAQS, appealed to quantity surveyors to, when they are approached, consider academic careers or to make themselves available to lecture on a part time basis. “I also appeal to quantity-surveying practices, construction companies and developers to consider taking part in training activities,” he said.

The ASAQS has over the years developed a proud tradition within the quantity-surveying profession. Consequently membership of this organisation is a sought after goal for many members within the building environment. International agreements with various countries are also in place whereby it is mutually agreed that local as well as overseas qualifications are mutually acceptable on a reciprocal basis.

A more recent addition to the list of agreements is the reciprocity agreement entered into with the Royal Institution of Chartered Surveyors which makes it possible for South African based quantity surveyors to practice in over 120 countries worldwide.

Media release
Issued by: Lacea Loader
Media Representative
Tel: (051) 401-2584
Cell: 083 645 2454
E-mail: loaderl.stg@mail.uovs.ac.za
23 March 2006

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