Talk about TB, and most people will probably say, “Are we still talking about tuberculosis in this day and age? Yet we grew up knowing to keep windows open, even at school”.
The answer is a big YES with an emphasis that we need society to partner and lead in the campaign to end TB.
The World Health Organisation reports that TB remains the world’s leading cause of death from a single infectious agent and remains in the leading top 10 causes of death.
Reflecting only on 2024 statistics, the WHO recorded 10.7 million people being ill from TB, with 1.23 million succumbing to death. Importantly, TB is in all countries and across all age groups. The prevalence of TB based on 2024 infections was 5.8 million men, 3.7 million women and 1.2 million children.
SA’s contribution to global statistics shows a decline — infections being at 249,000 and deaths dropping to 54,000 — which is attributed to the successful HIV treatment programme’s expansion. However, there are still concerns regarding underdiagnosis, with reports of 65,000 undetected cases in 2024.
The department of health acknowledges “TB remains the most pressing public health challenge in South Africa”.
Furthermore, it declares that SA remains on the list of 30 high-burden TB countries, with HIV-associated TB and drug-resistant TB contributing significantly to the global epidemic.
What we know
WHO defines TB as “an infectious disease caused by bacteria that most often affects the lungs. It spreads through the air when people with TB cough, sneeze or spit. In general, people with TB don’t feel sick and are not contagious. About 5–10% of people infected with TB will eventually get symptoms and develop TB disease. Babies and children are at higher risk of developing the disease if they are infected.”
Progression of infection to TB disease occurs when bacteria multiply in the body and affect different organs. TB symptoms may be mild for many months, so it is easy to spread TB to others without knowing it. Symptoms depend on which part of the body is affected. While TB usually affects the lungs, it can also affect the kidneys, brain, and spine, commonly referred to as “extrapulmonary TB”.
Help us be on high alert
Despite TB transmission being airborne in the main, there are factors that influence its prevalence. These social determinants of TB transmission include poverty, unequal access to healthcare, stigma, racism and lack of education. Certain conditions can increase a person’s risk for TB disease. These include:
- Diabetes (high blood sugar)
- Weakened immune system (for example, from HIV)
- Undernutrition
- Tobacco use
- Harmful use of alcohol
It is important to note that some people with TB do not have any symptoms but can still spread the disease. Common symptoms of TB are:
- Prolonged cough (sometimes with blood)
- Chest pain
- Weakness
- Fatigue
- Weight loss
- Fever
- Night sweats
Society’s role
TB has become part of society, as reflected by the incidence profile and the social determinants above. We cannot run away from a reality in which we all have a role to play.
The role of society in the fight against TB is crucial and multi-pronged for the success of control efforts and prevention. Among the opportunities of impact for societies is advocating for and supporting TB interventions. Communities’ or civil societies’ impact can be felt through some of the following actions:
- Advocacy for policies and funding towards TB programmes;
- Community engagements promoting screening, treatment and prevention;
- Monitoring and evaluation of implementation of programmes;
- Support for research related to TB, especially on effectiveness of programmes; and
- Education and information, including how to prevent and treat TB.
Joint efforts by society will lead to the improved implementation of other preventative measures. The continuous screening of communities, especially those in contact or at high risk, is needed, as well as the uptake of preventative TB treatment.
More voices are needed, with one message — to encourage patients to maintain hygiene, use masks and cover their mouths and noses when coughing or sneezing. Research still confirms that well-ventilated rooms and the provision of respirators in areas with overcrowding play a crucial role in preventing further infections.
Where are we now
The global End TB Strategy 2035 aims to eliminate tuberculosis as a public health threat, targeting zero deaths, disease, and catastrophic costs through integrated care, supportive policies, and intensified research.
The strategy adopted by the World Health Assembly in 2014 provides a global blueprint to end the TB epidemic by 2035.
Its overarching goals are to reduce TB incidence by 80%, TB deaths by 90%, and eliminate catastrophic costs for TB-affected households by 2030, with continued progress toward 2035 targets.
Ending TB is also a development challenge, requiring multisectoral action and adaptation to country-specific contexts.
The strategy is built on pillars that ensure integrated, patient-centred care and prevention — ensuring early diagnosis, effective treatment, and preventive measures for all populations, including high-risk groups.
Furthermore, there also needs to be implementation of bold policies and supportive systems — engaging governments, communities, and private stakeholders to strengthen health systems, financing, and social protection.
Lastly, there is intensified research and innovation — developing new diagnostics, vaccines, and treatments to accelerate progress and break the TB epidemic trajectory.
These pillars are underpinned by four key principles: government stewardship, strong civil society and community coalitions, promotion of human rights and equity, and country-level adaptation of interventions.
Call for action
The department of health acknowledges that “despite these efforts, South Africa is not yet on track to meet the full End TB targets, highlighting the need for intensified action”. However, with the support of communities, we can help the country end TB.
- Dr Bayeni is a medical doctor and host of DR B Talks, a weekly health conversation platform focused on empowering communities through accessible health education.
Sowetan
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