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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

UFS involved in project to light up the townships
2006-06-06

The parties involved with the project are from the left: Prof Hendrik Swart (Departmental Chairperson of the UFS Department of Physics), Dr Thembela Hillie (CSIR), Prof Neerich Revaprasadu (Department of Chemistry at the University of Zululand) and Dr Wynand Steyn (CSIR).

UFS involved in project that could light up the townships   

The University of the Free State’s (UFS) Department of Physics is involved with a project that could make life easier in the townships through the use of artificial light.

“The project is based on the use of sunlight to activate nano material in for example cement and paint during the day. At night the cement or paint can then radiate light,” said Prof Hendrik Swart, Departmental Chairperson of the UFS Department of Physics.

According to Prof Swart an amount of R3,9 million has been made available by the Council for Scientific and Industrial Research (CSIR) for the further development of the project.   

Prof Swart visited the University of Florida in America in 1995 for a year where he researched luminescent phosphor material that is suitable for flat panel television screens.  The red, green and blue spots on the television screens originate from these kinds of phosphor materials.  “At that stage plasma television screens were only a dream.  Today it is sold everywhere,” said Prof Swart. 

“Upon my return I started a research group at the UFS which investigated the degrading of phosphor material.  We also started to concentrate on the effectiveness of nano phosphors.  In the mean time our cooperation with the Americans was strengthened with follow-up visits to America of my colleagues, Prof Koos Terblans and Mr Martin Ntwaeaborwa,” said Prof Swart.

“Nano phosphors are basically luminescent powders that consist of particles that are 1 millionth of a millimetre.  These particles can provide light as soon as they are illuminated with, for instance, sunlight.  The amount of time these particles can provide light, is determined by the impurities in the material,” said Prof Swart.

According to Prof Swart nano particles are developed and linked to infrastructure materials in order for these materials to be excited during the day by sunlight and then it emits light during night time.

“The nano material is of such a nature that it can be mixed with materials, such as paint or cement. The yellow lines of roads can for example emit light in a natural way during night time,” said Prof Swart.

About a year ago Prof Swart and Dr Thembela Hillie, a former Ph D-student of the UFS Department of Physics, had discussions with Prof Neerich Revaprasadu from the University of Zululand and the CSIR about the possibility of mixing these nano phosphor particles with other materials that can be used as light sources in the building of roads and houses.

“Prof Revaprasadu is also actively involved in the research of nano materials.  Our efforts resulted in the CSIR approving the further extension of the project,” said Prof Swart.   

“The UFS and the University of Zululand are currently busy investigating ways to extend the light emitting time,” said Prof Swart.  

“There are eight M Sc and Ph D-students from the UFS and about five students from the University of Zululand working on this research project.  The Department of Physics at the Qwaqwa Campus of the UFS, with Francis Dejene as subject head, is also involved with the project,” said Prof Swart.

According to Prof Swart the further applications of nano materials are unlimited.  “Children whose parents cannot afford electricity can for instance leave any object such as a lamp, that is covered with these phosphor particles, in the sun during the day and use it at night as a light for study purposes,” said Prof Swart.

According to Prof Swart the further extension of the project will take about two years.  “During this time we want to determine how the effectiveness of the phosphors can be increased.  Discussions with the government and other role players for the possible implementation of the project are also part of our planning,” said Prof Swart.


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

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