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Rumbidzayi Zinyuke
Senior Health Reporter
Adolescents and young people infected by tuberculosis in Zimbabwe are at high risk of suffering from mental health problems, especially denial and depression, owing to the stigma and discrimination surrounding the disease.
Union Zimbabwe Trust executive director Dr Ronald Ncube said adolescents faced many challenges relating to their TB diagnosis. “Adolescents with TB are vulnerable to mental health challenges that are associated with potential stigma, denial, depression, anxiety compounded by peer influence.
“These result from the disclosure issues of a TB diagnosis in the first place, isolation in some instances post diagnosis, treatment duration and location such as at school while taking medication, emergence of adverse events due to treatment, potential for co-infection with HIV and associated consequence and the need to frequently visit the health facility for resupplies and support.
“Older adolescents usually develop the adult type TB but have psycho-social challenges associated with this age group, including heightened vulnerability to stigma, denial, peer influence and other exploratory behaviours that affect adherence and completion of treatment.”
The WHO says TB prevention and care strategies often overlook adolescents and young adults by grouping them with either children or adults, but studies have shown that the group has particular physiological, developmental, and social characteristics that require dedicated approaches.
In 2017, studies showed that the prevalence of mental health disorders such as depression and anxiety among people with TB, was between 40 percent and 70 percent.
Dr Ncube concurred, saying the actual burden of TB among adolescents in Zimbabwe was not known owing to the surveillance system that in the past was not able to split up the statistics by adolescent age-categories.
This meant that young adolescents aged 10-14 years were grouped with all other children while those of 15-19 years were grouped with adults.
Dr Ncube said Zimbabwe had noted this gap and the need to prioritise and track TB interventions targeting adolescents going into the future.
To curb the negative effects of TB among this group, he said, there was need for continuous counselling, timely detection and management of adverse events as well as deployment of appropriate differentiated service delivery models where there is TB-HIV co-infection.
Enrolment of the young people into treatment support groups and rewarding approaches could be strengthened to ensure retention in care among adolescents.
For young people affected by TB, peer support and counselling are some of the best ways to deal with mental health challenges that arise after a diagnosis.
Dr Tanaka Mukuhwa said it was difficult for him to accept it when he was diagnosed with both TB and HIV at the age of 13. “Life was not easy. I was discriminated against at school and people had all sorts of derogatory names for me.
“Even at home, some family members distanced themselves from me. What made it worse was that I went on to develop TB meningitis, which affected my right leg and caused a permanent disability. I kept asking myself what I had done to deserve getting HIV and TB. So the more this issue troubled me, the more health challenges I started to experience. It even affected my treatment journey.”
Dr Mukuhwa said he received 60 injections as part of his TB treatment and had to take so many pills, including his anti-retroviral medication. At one point, he was taking 16 tablets at one go, and he defaulted on more than one occasion.
“I was then referred to a support group where I got counselling and I went back to taking my medications. I am now healthy and living a happy life and advocating for the rights of young people living with HIV, disability inclusion and several other advocacy issues involving sexual and reproductive health and rights, child marriages and others,” he added.
He was awarded an honourary PhD by the University of London in partnership with the World Health Organisation for his work towards eradicating child marriages.
Another survivor, Mr Cosmas Muzanenhamo, said he had suffered depression after being diagnosed with TB.
“I was very young when I was diagnosed with TB and I did not understand what was happening to me. It took time for me to finally get diagnosed because my parents would make me take different herbs with the hope that they would treat whatever was causing my health problems.
“I was also diagnosed with HIV and had to start with TB treatment then moved on to ART,” he said. He found the treatment painful and had severe after effects, which led to the stigma he suffered at school and in the community.
“I stopped going to school for a full year because the treatment was painful and the discrimination I was facing was difficult to accept. No one wanted to play with me and in the community other children and even some adults would say bad things about me.
“I stayed indoors all the time and I even defaulted on my medication because I though the treatment was responsible for the way people were now treating me,” he said.
Joining a peer support group helped Mr Muzanenhamo to accept the situation and continue with his medication, leading to his recovery.
Online Reporter