#WorldTBDay2023: "Contracting TB isn't a choice because we all breathe"
How do you deal with a disease as old as the pharaohs? Try teaching TB at schools, says MSF
How are we going to end the ancient disease of tuberculosis (TB) in a country where more than 150,000* people with active TB are "missing", in the sense that they have not been screened, diagnosed and started on treatment, and can therefore potentially transmit the disease in communities, leading to increased suffering and death?
YouTube Research shows that increasing awareness about TB transmission and prevention among school learners can help reduce the disease's prevalence. In 2018, Doctors Without Borders (MSF) Southern Africa and OneVoice South Africa developed a TB curriculum for grades 8 to 12 and piloted the teaching of these lessons in 22 high schools.
"The aim was to impart more comprehensive TB information in schools to achieve better retention of that TB information. We tested 521 learners before and after receiving TB education. Encouragingly, the pass rate rose from 22.78 per cent to 77.22 among those that had gone through 5 modules," said Liesbet Ohler, MSF medical coordinator in Eshowe.
MSF has run a successful school health programme in Eshowe and Mbongolwane since 2012, taking inspiration from the Department of Basic Education's National Policy on HIV, STIs and TB, which stipulates that "Comprehensive Sexuality Education (CSE) will be a compulsory and timetabled subject in the curriculum, supported by appropriate Learner and Teacher Support Material and teacher training, development and support."
The MSF school programme initially focused on HIV, aiming to reduce new HIV infections and promote prevention methods among high-school students by training teachers to impart health education. The programme was successful - over 80,000 learners were reached, and 28,551 HIV counselling and testing sessions were conducted, contributing to the project area corresponding to the UNAIDS 90-90-90 targets two years before the deadline.
Yet, the MSF Eshowe team came to feel that TB was being neglected.
"The CSE curriculum, which is taught in school life orientation lessons, includes some TB information, but it is quite limited, even though TB is one of the leading causes of death among people with HIV," said Ohler.
MSF decided to shift the focus of its school health programme from HIV to TB 76; high school teachers and learner support agents received training on MSF's TB curriculum, and these educators, together with MSF mobilizers, delivered TB education to thousands of learners between 2018 and 2021. In the last year of the programme, MSF added a peer education component – learners with leadership qualities in each grade were given advanced TB education to capacitate them to assist their peers and their community. Learners who persisted with the curriculum tested well.
"Encouragingly, educators and learners reported that their involvement in the programme enabled them to share TB information with their families and neighbours, and thereby do their part in combating TB stigma in communities," said Ntombi Gcwensa, MSF's TB in Schools Programme Manager.
According to Bhekumuzi Nzuza, the life orientation educator in rural Phindulimi High School outside Eshowe, "our older generations believe that if you cough chronically and lose weight, both known TB symptoms, it is because of witchcraft.
Others believe that it is because the individual has HIV. In other words, TB is misunderstood and stigmatised, resulting in many people who have TB symptoms not going to the clinic to test, and those who start TB treatment often do not complete the course due to a lack of support from their family."
Nzuza believes that the TB in Schools programme has made a difference in his and his learners' lives.
"The training I received has enabled me to provide TB education inside and outside the walls of our classrooms. I was able to help a friend with TB symptoms to get help, and I convinced his entire family to get tested. Now they are all on TB treatment," said Nzuza.
*South Africa's first national TB prevalence survey, published in 2021, found an estimated 154,348 "missing TB cases in South Africa.
About Us
Doctors Without Borders (MSF) is a global network of principled medical and other professionals who specialise in medical humanitarian work, driven by our common humanity and guided by medical ethics. We strive to bring emergency medical care to people caught in conflicts, crises, and disasters in more than 70 countries worldwide.
In South Africa, the organisation is recognised as one of the pioneers of providing Antiretroviral Treatment (ART) in the public sector and started the first HIV programmes in South Africa in 1999. Until today, the focus of MSF’s interventions in the country has primarily been on developing new testing and treatment strategies for HIV/AIDS and TB in Eshowe (Kwa-Zulu Natal) and Khayelitsha (Western Cape).
In Tshwane, we run a migration project, and we offer medical and psychosocial care to migrants, refugees, and asylum seekers, who struggle to access public health services under South Africa’s increasingly restrictive.
Previously we offered free, high-quality, confidential medical care to survivors of SGBV in Rustenburg.
To learn more about our work in South Africa, please visit this page on our website (www.msf.org.za).
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