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Epidemiology and Communicable Diseases: Tuberculosis
Introduction
Communicable diseases represent an almost inescapable phenomenon, especially in the modern setting of the global community where members of different social classes and economic background can converse. With the advent of tuberculosis and the threats that it has created, the global panic seems to have reached its peak, the world is in desperate need for guidelines in increasing health levels and developing an understanding of the tuberculosis infection, the threats that it poses to average citizens, and the ways of avoiding tuberculosis contraction.
Disease Description
Tuberculosis as a potentially fatal disease has been known for a while, gaining an extraordinarily poor reputation as one of the leading causes of death at some point. Therefore, knowing the factors that trigger the development of tuberculosis, as well as the symptoms that allow diagnosing the disease and the existing treatment options that allow fighting it is essential. According to Öhd et al. (2019), tuberculosis may come in two forms, namely, active and latent TB. The latter is particularly dangerous since it remains formant for a certain period of time until it is activated and begins its destructive activity (Öhd et al., 2019). While the dormant TB does not have any specific symptoms and is extraordinarily rate to spot, the active one can be identified by noticing the symptoms such as the cough that lasts up to three weeks and results in a patient spitting blood; chest pain and fatigue; night sweats and loss of appetite. When observing at least two of the listed issues simultaneously, on should visit a doctor and ensure that the latter immediately runs the necessary tests to establish whether a patient has tuberculosis.
Being a respiratory disease in the first place, tuberculosis is transferred as a droplet infection, namely, as people inhale the air that contains the virus. The specified method of disease contraction is particularly difficult to control for obvious reasons, which is why tuberculosis is quite hard to spot at its early stage and, thus, very difficult to manage. However, treatments against tuberculosis exist and can be considered quite effective.
Although tuberculosis used to be very difficult to treat not so long ago, it is currently quite manageable as long as patients address healthcare services before the disease progresses to the point where it can no longer be handled. As a rule, tuberculosis requires immediate and rather harsh actions, which include antimicrobial drugs such as isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA) (Zhang, Shi, Feng, Zhang, & Zhang, 2017). The specified four medications constitute the core of the approved treatment options for tuberculosis. The current mortality rates for tuberculosis make 3%, which is a slight improvement compared to previous years (World Health Organization, 2020). In turn, the levels of morbidity have dropped to 12% (World Health Organization, 2020). The current incidence among the target groups makes 169 cases per 100,000 people, whereas the prevalence constitutes 57% (World Health Organization, 2020). The specified trend can be considered as a positive shift in the spreading of the disease, yet the speed of progress needs to be increased.
Due to the high contagion levels and the effects that tuberculosis has on patients immune system, children and aging people are under particularly high threat. Moreover, underprivileged members of society, which may include homeless people and people living in poverty, are also under significant danger as far as the development of the disease is concerned (Alffenaar et al., 2017). Each of the specified populations has its unique characteristics, yet they share the one of being exposed to the threat of tuberculosis to the greatest extent due to the weaknesses in their immune systems (Alffenaar et al., 2017). Therefore, the specified members of local communities should be seen as the main target of the campaign aimed at preventing and fighting tuberculosis.
Social Determinants of Health
Although the risk of contracting the tuberculosis virus cannot be obliterated completely, there are several crucial social determinants of health that lead to minimizing the threat of tuberculosis in most vulnerable groups. First and most obvious, the focus on financing the healthcare support for the said populations needs to be mentioned among the key determinants of health. The specified factor belongs to the range of political ones due to the necessity to establish a statewide chain of healthcare services that offer free testing and diagnosis. In addition, the presence of equipment that allows for high-quality bacteriology testing is also on the list of key health determinants. Another important factor that leads to effective management of public health is the well-developed treatment framework paired with patient support. Consequently, regular drug supply and systems for monitoring the target audiences are the remaining two social determinants of health, which hinge upon the extent of technological development within the target community, as well as the presence of decent financing in it.
Epidemiologic Triangle
The concept of the epidemiologic triangle was introduced into the contemporary medicine in order to study the development of a disease and the manner in which it spreads within a specific community. Therefore, a traditional epidemiologic triangle contains three main elements, which are the agent the host, and the environment. In the specified framework, the agent represents the virus or bacterium that causes the disease, whereas the host includes the types of organisms that can contract the specified agent (Khan, 2017). In turn, the environment incorporates the factors that contribute to the spread of the virus and the development of the epidemiologic outbreak within a specific community (Onuka et al., 2018). However, since there are several types of tuberculosis, applying the specified model to the disease may be quite difficult.
In case of tuberculosis, the agent is represented by the TB organism, namely, the virus that incites the process of tuberculosis development. However, since there are several strains of tuberculosis, several variations of the epidemiologic triangle exist, each being represented by a specific type of an agent (Rachlis et al., 2016). Approaching the issue from a generalized perspective, one may represent the agent by the tuberculosis organism as a generic concept of a virus that causes the disease (Meehan et al., 2018). As far as the host is concerned, nearly every community member falls under the category of a possible victim of tuberculosis (Rachlis et al., 2016). Indeed, the disease is highly contagious and will not spare anyone once it reaches the scale of an epidemic (Meehan et al., 2018). One could argue that homeless people, children, and aging people, as well as those that represent the underserviced population are at the higher risk of contagion (Meehan et al., 2018). Moreover, people with low immunity, patients with comorbid diseases, and undernourished people are especially vulnerable to the virus (Rachlis et al., 2016). Finally, the environment in which tuberculosis becomes rampant can be described as that one with bad sanitation and poor ventilation. In addition, the density of the place, namely, the presence of multiple people and the lack of space, is a huge factor in contracting tuberculosis (Meehan et al., 2018). As shown in Figure 1, these are the main elements of the epidemiological triangle for tuberculosis. Although there are several types of tuberculosis, the specified ones are the most common elements of the triangle, which one is likely to come across in most cases.
Given the fact that the epidemiologic triage depicted above points specifically to poor living conditions and economic concerns, namely, the presence of poverty and the lack of resources, the specific issues should be central to the development of the program that will allow addressing the needs of the target population. While the age issue mentioned above should also be taken into account as a critical characteristic of the vulnerable groups, one should also ensure that people from disadvantaged communities and remote areas receive the maximum support. Providing assistance to the specified population will require offering extensive social support and financing, which is why it will be necessary to locate investors.
Role of the Community Health Nurse
When addressing the issue of tuberculosis, a community health nurse needs to assume several roles, including the one f an educator, the role of a leader, and the one of healthcare services provider. Namely, a nurse will have to provide the target population with an opportunity to test for the possibility of tuberculosis, as well as offer exhaustive, detailed information about the symptoms o the disease and the methods of managing it. Since the problem of literacy stands particularly prominently in the target demographic, mostly due to the lack of enthusiasm and access to learning, it is the responsibility of a nurse to ensure that the required knowledge is cemented in vulnerable populations. Moreover, as a nurse, one has to offer an unlimited access to testing options, including X-raying, sputum samples, the TB skin test, and the TB blood test.
The latter two tests represent a particularly important part of addressing tuberculosis and determining the extent of the disease progress. However, a nurse has to remember that both of the tests above do not allow confirming exactly whether a patient has tuberculosis o not; instead, they show the presence of TB bacteria in a patients body (Rachlis et al., 2016). Therefore, in case the skin or blood test delivers the results that may imply the presence of the disease in the patient, it is essential to continue testing by offering them X-raying or sampling the patients sputum in order to state with certainty that the observed issues a case of tuberculosis.
National Agency
As a global concern, tuberculosis has been the focus of attention and research of multiple global and national health organizations. The National Tuberculosis Controllers Association (NTCA) is one of the best-known agencies that deal with the problem of tuberculosis on the nationwide scale (The National Tuberculosis Controllers Association, n.d.).Being a part of the Centers of Disease Control and Prevention (CDC), NTCA follows a coherent and homogenous framework for managing the issue of tuberculosis and increasing awareness concerning the disease among vulnerable groups. However, given the current rates of tuberculosis contraction, the undertaken measures do not seem to be enough (Zhang et al., 2018). Indeed, according to the WHO report, tuberculosis has not become any less of a problem despite the efforts to educate communities (World Health Organization, 2020). Specifically, while there has been a 2% change in the global rates of tuberculosis contagion, the expected 4% drop set in the Healthy People 2020 project has not been achieved, which means that more efforts have to be put to attaining the goal of global public health improvement.
Global Implication
Although tuberculosis cannot be considered a new threat to the well-being of the community, its persistence, especially in impoverished areas, is a rather troubling sign. Therefore, the global implications of introducing services with a greater extent of access for disadvantaged members of the community are likely to be quite positive and substantial. Moreover, the focus on education and the promotion of health literacy among target audiences will allow detecting the cases of tuberculosis comparatively early and address them appropriately before the disease spins out of control and takes the size of an epidemic. Additional options for free or, at the very least, cheaper screenings will lead to a drop in the extent of disease contagion, which, in turn, will help to reduce the levels of mortality and allow to
Conclusion
Although tuberculosis has gained massive notoriety within the first several months of is premiere, a lot of people remain unaware or uncertain of the effects that the disease produces, the symptoms with which it manifests itself, and the changes that it causes to a patient, including the challenges and multiple complications that it means for an individuals health (Zhang et al., 2018). Among the key dangers that the tuberculosis virus represents, the fact that it is prone to mutations and, therefore, may not be identified as such during the first stages of its development represents the greatest threat to the promotion of public health and the management of the disease.
Therefore, there is an urgent need in providing the target audience with health education and key information so that they could improve the levels of their health literacy. With the focus on promoting awareness, people will develop the behaviors that will allow reducing the rates of the disease contagion and, thus, help to fight tuberculosis effectively.
Moreover, a well-developed testing system that will allow determining the cases of tuberculosis fast and with high degree of trustworthiness needs to be established so that vulnerable groups could use it accordingly. Presently, people from disadvantaged backgrounds, mainly homeless people, as well as those living in poverty, are particularly susceptible to the contraction of the disease. Therefore, opportunities for people with low financial resources have to be provided so that tuberculosis could be eradicated from local communities.
In addition, the fact that the disease affects children and aging people particularly strongly needs to be brought up as an important piece of information that should shape the framework for patient education. Namely, parents and legal guardians should be provided with clear and accurate information about the factors leading to the contraction of tuberculosis, as well as the key symptoms and the sources of support that parents with TB children can use. Similarly, information and support services have to be established of aging people so that they could access it freely. Given the difficulties with mobility of the target demographic, introducing digital services such as online consultations, as well as the opportunities for contacting healthcare representatives by phone has to be offered. The latter may be needed in the scenarios in which aging people may have difficulties using digital tools to access the required assistance.
References
Alffenaar, J. W. C., Akkerman, O. W., Anthony, R. M., Tiberi, S., Heysell, S., Grobusch, M. P.,& Van Soolingen, D. (2017). Individualizing management of extensively drug-resistant tuberculosis: diagnostics, treatment, and biomarkers. Expert Review of Anti-Infective Therapy, 15(1), pp. 11-21.
Khan, A. H. (2017). Tuberculosis control in Sindh, Pakistan: Critical analysis of its implementation. Journal of Infection and Public Health, 10(1), pp. 1-7.
Meehan, C. J., Moris, P., Kohl, T. A., Pe
erska, J., Akter, S., Merker, M.,& Stadler, T. (2018). The relationship between transmission time and clustering methods in Mycobacterium tuberculosis epidemiology. EBioMedicine, 37, pp. 410-416.
Öhd, J. N., Lönnroth, K., Abubakar, I., Aldridge, R. W., Erkens, C., Jonsson, J.,& Hergens, M. P. (2019). Building a European database to gather multi-country evidence on active and latent TB screening for migrants. International Journal of Infectious Diseases, 80, pp. 45-49.
Onuka, O., Okezie, I., Ahukanna, J., Okebaram, C., Dakum, P., Agbaje, A.,& Okorie, A. (2018). Effectiveness of contact tracing of index tuberculosis cases in Nigeria. Advances in Infectious Diseases, 8(4), pp. 173-199.
Rachlis, B., Naanyu, V., Wachira, J., Genberg, B., Koech, B., Kamene, R.,& Braitstein, P. (2016). Community perceptions of community health workers (CHWs) and their roles in management for HIV, tuberculosis and hypertension in Western Kenya. PloS One, 11(2), pp. 1-13. Web.
The National Tuberculosis Controllers Association. (n.d.). Tuberculosis.
World Health Organization. (2020). Tuberculosis.
Zhang, S., Shi, W., Feng, J., Zhang, W., & Zhang, Y. (2017). Varying effects of common tuberculosis drugs on enhancing clofazimine activity in vitro: Effect of tuberculosis drugs on clofazimine activity. Emerging Microbes & Infections, 6(1), pp. 1-3.
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