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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

Full week of graduation ceremonies at UFS in April

2015-04-10

Autumn always sees the UFS’s first graduation ceremony of the year on the Bloemfontein Campus.

From 14 – 17 April 2015, graduates will once again be rewarded for their hard work while top speakers will address them in the Callie Human Centre. There will be a ceremony at 09:00 and at 14:30 each day on all four days of the graduation.

The programme for the 2015 April Graduation is as follows:

Tuesday 14 April 2015:

Professor Himla Soodyall will be the speaker at both ceremonies on this day. Prof Soodyall is a Medical Scientist for the South African Institute for Medical Research. She is also a Principal Medical Scientist for the National Health Laboratory Service, and a Director for the Human Genome Diversity and Disease Research Unit at the University of Witwatersrand.

During the first ceremony of the day at 09:00, all diplomas/certificates and B degrees in the Faculty of Natural and Agricultural Sciences will be awarded. Only Honours degrees in the Faculty of Natural and Agricultural Sciences will be awarded at the 14:30 ceremony.

Wednesday 15 April 2015:

Wednesday will see Ndumiso Hadebe take the stage to address graduates at both ceremonies.

At the age of 23, Hadebe is the Founder and Managing Director of Master Frontiers Consulting, a firm that capacitates leaders and managers to achieve business goals through their people. He worked previously as a Researcher at Shanduka Black Umbrellas, a flagship enterprise and supplier development programme of the Shanduka Foundation.

He has been received numerous awards for excellence in leadership, such as the Sedibeng District Municipal Mayor’s Award for Service and Leadership. He is a Brand South Africa Ambassador and Read Educational Trust Ambassador.

All diplomas/certificates, B and Honours degrees in the Faculty of Economic and Management Sciences, except B Com degrees, will be awarded during the morning ceremony at 09:00. Later, at the 14:30 ceremony, only B Com degrees in the Faculty of Economic and Management Sciences will be awarded.

Thursday 16 April 2015:

Multiple award winning South African TV presenter, Leanne Manas, will be the speaker at both Thursday ceremonies.

Manas has graced our screens for over a decade. Not many broadcasters can boast having had live TV experience, 5 days a week for 12 years. She is currently the anchor of SABC 2’s flagship breakfast programme, Morning Live. Leanne is a qualified Speech and Drama teacher. having studied at London Trinity College. She also has an Honours degree in English.
Diplomas/certificates up to and including Honours degrees in the Faculty of the Humanities, Social Sciences, and Communication Sciences will be awarded during the ceremony at 09:00. The 14:30 ceremony will have diplomas/certificates up to and including Honours degrees in the Faculty of the Humanities’ other qualifications except for Social Sciences and Communication Sciences.

Friday 17 April 2015:

Dr Maria Phalime will be the speaker at both ceremonies on Friday.

Phalime is a medical doctor and award-winning author. She practiced for a brief period as a general practitioner in South Africa and the United Kingdom, before leaving medical practice to pursue non-clinical interests. She has worked in trade and investment promotion, and has undertaken research and consulting in the areas of economic development and business facilitation.

Diplomas/certificates up to and including Honours degrees in the Faculty of Education (CE, NPDE and ACE excluded) will be awarded during the ceremony at 09:00. Diplomas/certificates up to and including Honours degrees in the Faculties of Health Sciences, Law, and Theology will be awarded at the 14:30 ceremony.

Click here for the simple layout of the 2015 April Graduation programme:
http://www.ufs.ac.za/adhoc-pages/2014-graduation-ceremony/graduation-ceremony

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