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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

New multi-purpose residences open in January 2015

2014-06-18

The UFS is currently busy with exciting new accommodation developments on both the Bloemfontein and Qwaqwa Campuses.

This includes a new residence with a hotel and a conference/lecture hall on the western part of the Bloemfontein Campus and the building of another residence on the Qwaqwa Campus.

“We have done what was possible in our quest to maximise the number of beds available in the older residences on the Bloemfontein Campus,” says Quintin Koetaan, Senior Director: Housing and Residence Affairs at the UFS. “This we achieved by converting underutilised and unutilised dining halls and kitchens into bedrooms, which was totally insufficient to address the dire need for beds.”

“The new residence building will have different types of accommodation. I am very excited and look forward to the completion of this project. And this particular residence also brings a very exciting architectural design to the university environment.”

The residence, with multiple blocks for different accommodation, will be wheelchair friendly and numbering and signage will also be in braille. This futuristic-designed building will stand the test of time and will be provide student accommodation until 2030.The R60 million project is funded by the UFS and the Department of Higher Education and Training.

In step with international university accommodation trends – as with Yale's residential college system – this residence will house female first-years who will be mentored by postgraduate students. Postgraduates will be headhunted with the support of the Student Representative Council’s (SRC) postgraduate committee. These postgraduate students will represent all the faculties. Block A and B will accommodate 184 female first-years.

Each floor in this residence will have a study room, two lounges, a kitchen and a laundry for 25 students. Security will be very tight, with three levels of security: entrance to residence, corridor and individual bedroom door. There will also be perimeter camera surveillance and a security officer outside and inside the residence.

Block C will accommodate postgraduate students. The ground floor will house eight single-bed roomed flats. The first floor will have 16 single rooms sharing a bathroom, kitchen and living room, as well as one double room with its own bathroom. The second floor will have 21 single rooms sharing a bathroom, kitchen and living room.

Block D will house 18 hotel-like en suites, with a dining room where breakfast will be served. The target market here will be visiting academics and other university-affiliated visitors. Prices will be competitive to those of local guesthouses and hotels.

Bookings have already opened. Guests will be able to book in and access the hotel desk 24/7. The dining room, accommodating up to 60 people, will not only be open for hotel guests, but also for postgraduate students and UFS staff. Bookings will therefore be essential.

The expansion of bed spaces also took place at the Qwaqwa Campus. In 2012 a 200-bed residence with a state of the art computer room was completed. As a follow-up to this development, another 248-bed residence is now being built. In this particular residence, there will be designated post-graduate accommodation for 48 students.

The project will be handed over at the end of October 2014, with the first intake planned for January 2015.

Another development at the Qwaqwa Campus is the Chancellor’s House Bed & Breakfast. This B&B, with its 5 en suite rooms, is open for business for all UFS staff.

For enquiries or bookings at this new accommodation facility, contact:

- Undergraduate (first-year ladies’ residence):
Monica Naidoo at +27(0)51 401 3455 or NaidooM@ufs.ac.za

- Postgraduate:
Hein Badenhorst at +27(0)51 401 2602 or BadenH@ufs.ac.za

- Hotel:
Ilze Nikolova at +27(0)51 401 9689 or NikolovaI@ufs.ac.za

- Chancellor’s House Bed & Breakfast on Qwaqwa Campus:
Olga Molaudzi at +27(0)58 718 5030 or molaudziOD@qwa.ufs.ac.za

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