Latest News Archive

Please select Category, Year, and then Month to display items

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

Getting out of the dark

2015-04-28

Photo: Leonie Bolleurs

Since 2008, the University of the Free State has been busy with the planning and implementation of projects to reduce the impact of load shedding. To date, the cost of these projects has run to R6 million. They have been done primarily to ensure that the academic programme does not suffer damage as a result of the increasing interruptions in the power supply that are continuing this year.

The university’s greatest concern has been the provision of emergency power to the lecture halls and laboratories.

Thus far, 35 generators are servicing 55 buildings on the three campuses of the UFS. This includes 26 generators on the Bloemfontein Campus, eight on the Qwaqwa Campus in the Eastern Free State, and one generator on the South Campus in Bloemfontein. The generators are already in service, and are maintained in working order.

Since 2010, the university has also ensured that all newly-built academic buildings are equipped with emergency power supplies.

On the South Campus in Bloemfontein, the new lecture-hall building and the computer laboratory are equipped with emergency power, while the installation of emergency generators in other buildings is under way. The majority of the buildings on the Qwaqwa Campus in the Eastern Free State are equipped with emergency power supplies.

In the meantime, the UFS management has approved a further R11 million for the installation of additional generators on the three campuses. A further R1.5 million has also been approved for the purchase of two mobile generators.

To extend the work already done, the main task will be the installation of more generators on the Bloemfontein Campus to ensure that lecture halls with emergency power will be available for the centrally-arranged timetables, and to ensure that more of the critical laboratories will be provided with emergency power.

There are still some important buildings and halls on the Bloemfontein Campus that must be supplied with emergency power. However, it is a costly process and must be brought into operation gradually. The further implementation of emergency power depends on the delivery of equipment. The university is also investigating alternative solutions for power provisioning, including solar power.

Generators with spare capacity are optimally deployed to satisfy the lower needs of the campus, including the Odeion, the ANNEX at Microbiology, the Stabilis ANNEX, the Agriculture Building, the UV-Sasol library, and the Francois Retief Building.

In addition, the UFS is busy on all campuses, coupling area lighting, including

street lights and pedestrian walkways, to existing generators. Procedures for the operation of mechanical equipment, such as entrance gates, lifts, and so on, are currently being dealt with on all campuses. Continuous power sources for certain ICT equipment will be installed on all campuses to protect it against power surges.

Staff and students can also equip themselves with the necessary knowledge to manage load shedding in their specific areas of work and study. It is always helpful to know who to contact. The following list with guidelines and contact numbers has been compiled to assist you:

1. In an emergency, call Protection Services. This line will continue to operate, regardless of whether the power is on or off.
2. Avoid using lifts just before planned load shedding. Some lifts have emergency power packs which will bring the lift to the nearest floor and open the doors. If you still get stuck in a lift during a power outage, use your cellphone to call Protection Services. While you're waiting, stay calm and be patient.
3. If the access control systems in your building stop working after load shedding, contact Protection Services.
4. The students and staff members who are most at risk during load shedding are those in wheelchairs or with other mobility limitations. As far as possible, plan ahead to avoid being stuck on a floor or in a room that is difficult to access when load shedding is imminent. Please contact Protection Services if you need assistance.
5. During a fire, alarms WILL go off. Alarms are not power driven, but battery driven. For assistance, contact Protection Services.
6. The main UFS Switchboard (Bloemfontein Campus +27(0)51 401 9111 and Qwaqwa Campus +27(0)58 718 5000) will continue to operate during load shedding.

Contact details of Protection Services:

Bloemfontein Campus: +27(0)51 401 2634/2911
Qwaqwa Campus: +27(0)58 508 5460/5175
South Campus: +27(0)51 5051217

Communication and Brand Management will make information available on the UFS web, Facebook page, Twitter, Blackboard and the intranet. Get the load shedding schedule from Eskom’s webpage (http://loadshedding.eskom.co.za/). The Bloemfontein Campus falls in group 4 and the South Campus falls in group 2 in Centlec’s load shedding schedule.

Back

Economic and Management Sciences

Education

Health Sciences

The Humanities

Law

Natural and Agricultural Sciences

Theology and Religion

Open Distance Learning

Business School

We use cookies to make interactions with our websites and services easy and meaningful. To better understand how they are used, read more about the UFS cookie policy. By continuing to use this site you are giving us your consent to do this.

Accept