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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

Mellon Foundation awards R10 million research grant to Trauma, Forgiveness and Reconciliation Studies
2015-02-20

Prof Pumla Gobodo-Madikizela, Senior Research Professor in Trauma, Forgiveness and Reconciliation Studies, and Dr Saleem Badat, Programme Director at the Mellon Foundation.
Photo: Johan Roux

Through her profound insight, vast experience, and unfaltering belief in humanity, Prof Pumla Gobodo-Madikizela, has secured a R10 million grant from one of the world’s most prestigious foundations funding human sciences research.

“This is one of the biggest grants that the Andrew W. Mellon Foundation has awarded to a university”, said Dr Saleem Badat, Program Director: International Higher Education and Strategic Projects at the Mellon Foundation. Prof Badat attended the press event that took place on 16 February 2015 on our Bloemfontein Campus.

UFS Trauma, Forgiveness, and Reconciliation Studies, spearheaded by Prof Gobodo-Madikizela, will manage the research project.

Prof Jonathan Jansen, Vice-Chancellor and Rector of the UFS, expressed great excitement “about this particular grant and the subject on which it focuses is so incredibly timely and germane to our own situation.”

Trauma, Memory and Representations of the Past: Transforming Scholarship in the Humanities and Arts

This new-found partnership between the Mellon Foundation and the UFS will enable a five-year research programme. The focus area of this initiative will be ‘Trauma, Memory and Representations of the Past: Transforming Scholarship in the Humanities and Arts’.

The research will pivot specifically around the question of how trauma is transmitted from one generation to the next. “South Africa lends itself to these questions,” Prof Gobodo-Madikizela said, “because we are now dealing with a generation of young people who were born after the traumas of the past.” These past experiences, though, are “passed on to the younger generation and become their own stories and narratives as if they themselves experienced the traumas directly.”

“This is an investment in how we can in fact create a different kind of community,” Prof Jansen said, “in which we eventually recognise each other – not by the accident of our skin, but by that elusive sense of a common humanity.”

Arts and theatre

Other aspects critical to this study are the inclusion of the arts and theatre. Many people have great difficulty in expressing their experiences of trauma in the spoken word. The arts and theatre provide an ideal platform to engage the public and stimulate conversation. As an example of the power these platforms possess, Prof Gobodo-Madikizela highlighted the success of the Johannes Stegmann Art Gallery – situated on the Bloemfontein Campus and curated by Angela de Jesus – in engaging the public in very productive ways.

Participants

Some of the artists, directors and scholars who will join in this project include:

• Lara Foot-Newton, Director/Playwright
• Sue Williamson, Activist Artist
• Angela de Jesus, Visual Artist/Curator
• Dr Buhle Zuma, Social Psychology Research
• Dr Shose Khessi, Social Psychology Research
• Prof Tamara Shefer, Women’s and Gender Studies
• Prof Kopano Ratele, Gender/Men and Masculinities
• Prof Jan Coetzee, Sociology of Developing Societies
• Prof Helene Strauss, Literary and Cultural Studies

New intellectual frontiers

“There is an aspiration in this proposal,” Dr Saleem Badat said. “We were born through this pain of colonialism and apartheid; we even went through the TRC. Our scholars in this country, our universities, should be at the forefront of this research. This is not research we can leave to the institutions in the north.”

Prof Gobodo-Madikizela agreed. “The overarching theme of this work is new knowledge production, focusing on the experiences in South Africa as experiences that can teach us something new.”

This will serve not only South Africa, but can also establish support for, and inform, countries facing similar dilemmas. In fact, “any part of the world in which genocide and murder and racism remains as legacies from the past,” Dr Badat said.

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