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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

Twee broers lewer intreerede
2004-06-10

‘n Unieke geleentheid sal homself môre, 9 Junie 2004, voordoen wanneer twee broers - proff Francois en Janse Tolmie - tydens dieselfde geleentheid hul intreeredes aan die Universiteit van die Vrystaat (UV) sal lewer.

Prof Francois Tolmie is verbonde aan die UV se Departement Nuwe Testament en die onderwerp van sy lesing is Die impak van die metodologie op die verstaan van die Nuwe Testament. Prof Janse Tolmie, sy jonger broer, is verbonde aan die UV se Departement Rekenaarwetenskap en Informatika en die onderwerp van sy lesing is Die rol van inligtingstegnologie in kennisbestuur.

Hoewel die studievelde vér verwyderd staan, klop die twee broers se missies wat betref die terugploeg van die verworwe vakkennis ten bate van die gemeenskap. Prof Francois Tolmie is nóú betrokke by dowes en Prof Janse Tolmie tap weer kunsmatige intelligensie ten bate van die mediese wetenskap en geestesgesondheid.

Prof Francois Tolmie verwerf die grade BA, BA Honneurs (Grieks), MA (Grieks), B Th en M Th almal cum laude aan die UV. In 1992 verwerf hy 'n D Th (Nuwe Testament) en in 2004 'n Ph D (Grieks) aan dieselfde universiteit. Na sy militêre diens as kapelaan in Walvisbaai aanvaar hy 'n beroep na die NG-gemeente Walvisbaai. Hy begin sy akademiese loopbaan op 1 April 1990 as senior lektor in die Departement Nuwe Testament en word in 1999 tot medeprofessor en in 2003 tot professor bevorder.

Sy navorsingspesialiteit is die Johannesevangelie en die Brief aan die Galasiërs. Hy is tesourier van die Nuwe Testamentiese Werksgemeenskap van Suid-Afrika, lid van die Society of Biblical Literature en die Studiorum Novi Testamenti Societas, redakteur van Acta Theologica en assistent-redakteur van Neotestamentica. Hy het reeds 34 artikels in geakkrediteerde tydskrifte gepubliseer, asook drie populêr-wetenskaplike boeke en talle bydraes in populêr-wetenskaplike boeke. Hy het twee akademiese boeke in die buiteland gepubliseer - onderskeidelik in Nederland en in die VSA. Later vanjaar verskyn 'n derde akademiese boek in Duitsland. Hy is ook een van die vertalers van die Afrikaanse Bybel vir Dowes.

Prof Janse Tolmie verwerf die grade B Sc, B Sc (Hons) en M Sc (Cum Laude) in Rekenaarwetenskap aan die UV.

Hy is vanaf 1989 betrokke by die UV en was ook ’n dosent aan die Militêre Akademie in Saldanhabaai in 1990/91 en het klas gegee by DePaul Universiteit in Chicago in 2002.

In 1992 is hy vir ses maande gesekondeer na ’n patologiese firma, Van Drimmelen en Vennote, in Johannesburg vir die ontwikkeling van kennisgebaseerde sagteware. Met hierdie projek word hy een van slegs ’n handjievol navorsers in die wêreld wat daarin kon slaag om ’n mediese kundigheidstelsel te ontwikkel wat werklik gebruik word.

Hy verwerf sy Ph D in 1994 en in 1994/95 doen hy navorsing aan die Besigheidskool van Carleton Universiteit in Ottawa, Kanada. Hy word in 1997 bevorder tot mede-professor en in 2003 tot volprofessor. Vanaf 2003 tree hy op as departementele voorsitter van die UV se Departement Rekenaarwetenskap en Informatika.

Hy het meer as 30 publikasies al die lig laat sien, insluitend verskeie internasionale kongresbydraes en artikels in geakkrediteerde joernale. Hy was ook vir 2 siklusse geëvalueer by die NRF. Sy portfolio sluit in die ontwikkeling van sagteware of prototipes vir groot maatskappye soos Van Drimmelen en Vennote en Bayer Diagnostics (VSA). Sy privaatbesigheid fokus op die ontwikkeling van nismarksagteware vir tersiêre instellings. Die sagteware word tans gebruik deur afdelings aan verskeie universiteite in Suid-Afrika.

Die geleentheid vind om 19:00 in die CR Swart-ouditorium op die kampus plaas.

MEDIAVERKLARING

Uitgereik deur: Lacea Loader
Mediaverteenwoordiger
Tel: (051) 401-2584
Sel: 083 645 2454
E-pos: loaderl.stg@mail.uovs.ac.za
 

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