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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

Research on cactus pear grabs attention of food, cosmetic and medical industry
2015-02-18

Cactus pear
Photo: Charl Devenish

The dedicated research and development programme at the UFS on spineless cactus pear (Opuntia ficus-indica) – also known as prickly pear – has grown steadily in both vision and dimension during the past 15 years. Formal cactus pear research at the UFS started with the formation of the Prickly Pear Working Group (PPWG) in June 2002. It has since gone from strength to strength with several MSc dissertations and a PhD thesis as well as popular and scientific publications flowing from this initiative.

According to Prof Wijnand Swart from the Department of Plant Sciences, the UFS is today recognised as a leading institution in the world conducting multi-disciplinary research on spineless cactus pear.

Cactus pear for animal feed

Increasing demands on already scarce water resources in South Africa require alternative sources of animal feed – specifically crops that are more efficient users of water. One alternative with the potential for widespread production is spineless cactus pear. It is 1.14 x more efficient in its use of water than Old man saltbush, 2.8 x more efficient than wheat, 3.75 x more efficient than lucerne and 7.5 x more efficient than rangeland vegetation.

“Studies on the use of sun-dried cactus pear cladodes suggest that it has the potential to provide some 25% of the basic feed resources required by South Africa’s commercial ruminant feed manufacturing sector,” says Prof HO de Waal of the Department of Animal, Wildlife and Grassland Sciences at the UFS.

Until recently, research has focused extensively on the use of cactus pear as drought fodder. However, this is now beginning to shift, with growing interest in the intensive production of spineless cactus pear for other types of animal feed. One example is the spineless cactus pear fruit, produced seasonal, yielding large quantities of fruit in a relatively short period of a few months in summer. Unless kept in cold storage, the fruit cannot be stored for a long period. Therefore, a procedure was developed to combine large volumes of mashed cactus pear fruit with dry hay and straw and preserve it for longer periods as high moisture livestock feed, kuilmoes – a high water content livestock feed similar to silage.

Cactus pear and Pineapple juice
Photo: Charl Devenish

Cactus pear for human consumption

“In addition to its use as a livestock feed, cactus pear is increasingly being cultivated for human consumption. Although the plant can be consumed fresh as a juice or vegetable, significant value can be added through processing. This potential is considerable: the plant can be pickled; preserved as a jam or marmalade; or dried and milled to produce baking flour. It can also serve as a replacement of egg and fat in mayonnaise,” said Dr Maryna de Wit from the Department of Microbial, Biochemical and Food Biotechnology.

The extraction of mucilage from fresh cladodes can form a gelling, emulsifier, and fat-replacing agent commonly found in food products such as mayonnaise and candy. During an information session to the media Dr De Wit and her team conducted a food demonstration to showcase the use of the cladodes in a juice, chicken stir-fry, biscuits and a salad.

The extrusion of cactus pear seed oil provides a further lucrative niche product to the array of uses. These include high-value organic oil for the cosmetic sector, such as soap, hair gel and sun screens.

The cladodes and the fruit also have medicinal uses. It has anti-viral, anti-inflammatory, pain killing and anti-diabetic agents. It is also high in fibre and can lower cholesterol. The fruit also prevents proliferation of cells and suppresses tumour growth and can even help to reduce a hangover.

In South Africa the outdated perception of cactus pears as thorny, alien invaders, is rapidly disappearing. Instead, farmers now recognise that cactus pear can play a vital role as a high yielding, water-efficient, multi-use crop, said Prof de Waal and the members of the Cactus Pear Team.

Facebook photo gallery
Dagbreek interview with Dr Maryna de Wit  

Research on cactus pear (read the full story)

For more information or enquiries contact news@ufs.ac.za

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