Community Health Nursing
Tuberculosis is among one of the deadliest and chronic communicable diseases in the globe. It is a zoonotic disease too, in that it affects both man and animals and is transmissible to either sex (Fogel, 2015). It is projected that almost of the world’s inhabitants are ill in its dormant form (World Health Organization, 2016).
Cause of tuberculosis
The disease is caused by different strains of the bacteria Mycobacterium most commonly Mycobacterium tuberculosis (Glaziou, Sismanidis, Floyd & Raviglione, 2015). The bacteria invade the respiratory system mainly the lungs, but it can also distress other body parts where it is referred to as extra-pulmonary tuberculosis.
Modes of transmission
The disease is transmitted mainly through the aerosol route but can also occur via the gastrointestinal path (Glaziou et al., 2015). Sneezing, spitting and coughing are the channels that spread it. They release germ nuclei through droplets known as bacilli into the air. They remain suspended in the air for several hours. Inhaling the droplets causes infection (Fogel, 2015).
Symptoms include chest pains, prolonged coughing blood with the production of sputum, unexplained weight loss, fever, fatigue, chills, anorexia and night sweats.
Treatment depends on whether the patient is in the active or latent stage. It usually involves administration of a cocktail of drugs in phases. Main medications used include isoniazid, pyrazinamide, rifampin, streptomycin, and ethambutol (World Health Organization, 2016). Treatment can last for six to nine months. The Bacillus Calmette Guerin (BCG) vaccine is also administered for a natural immune response (Fogel, 2015).
Disease resistance is a major deterrence to eradicating the disease. The bacteria have developed multiple drug resistance (MDR) due to evolution. This evolution has been brought about by not complying with drug regimens and incomplete treatments. Extensively drug resistance (XDR-TB) is another complication where there is resistance to the first line and at least second line of anti-tuberculosis drugs (Lönnroth, Glaziou, Weil, Floyd, Uplekar & Raviglione, 2014).
Every year approximately 2 million people develop tuberculosis of which eighty percent are diagnosed with highly infectious positive cases (World Health Organization, 2016). The annual risk of being infected is 1.6%, and on infection, there is 10% risk of developing the disease (Fogel, 2015. It is the leading killer of people who are HIV positive. Adults especially males are the most affected especially with HIV than females. The risk of infection increases with age. It is most prevalent in Africa, India, China, Indonesia, and Pakistan among other developing nations. Mortality rates stand at 1.3 million among individuals who are not HIV infected. Globally it is projected that 10.5 million cases of tuberculosis inclusive of new ones (Lönnroth et al., 2014).
Determinants affecting tuberculosis
Tuberculosis has been known to be a social disease with aspects of health. They can include poor quality of life, overcrowding, poor housing, lack of education, malnutrition and lacking awareness in the causes of the disease. All these elements are interrelated and play a role in the spread and occurrence of the disease (Glaziou et al., 2015).
Most individuals in the developing countries where there are more incidences of the disease do not have access to proper medical care. Hospitals are few or undeveloped with limited staff and lack drugs (Glaziou et al., 2015). Communication challenges also occur since some of the community members have little or no education. Some of the medicine to treat tuberculosis such as first-line medicines is costly and therefore not many patients can afford.
The causative agent is a facultative intracellular pathogen and can be resistant to intracellular killing (Glaziou et al., 2015). The source of infection is also a crucial factor. In case of humans, they acquire the disease via various modes of transmission such as spitting whereas for bovines it can be through infected milk. Patients remain infective if not treated. This can include age, and it is shown that it is more prevalent in adults than young ones. It is also more prevalent in males than females (Glaziou et al., 2015).
The epidemiologic triad as related to tuberculosis
The causative agent, Mycobacterium tuberculosis is an acid-fast bacteria impervious to gram staining due to their waxy coating (Glaziou et al., 2015). It is an aerobic rod bacteria that is slow in reproduction. It is also hypersensitive to ultraviolet light and heat. Tuberculosis primarily affects the respiratory system, but it can also attack the lymphatic system, pericardium, meninges, gastrointestinal system, gonads, and joints (Fogel, 2015). Transmission is via airborne droplets through coughing, spitting and sneezing. The smaller the droplet, the more it can stay in the air increasing the probability of infecting another person.
The bacteria is quickly spread to susceptible individuals via the respiratory tract in public or communal environs. People at higher risk of contracting the disease include those suffering from diabetes mellitus, HIV, and cancer (World Health Organization, 2016). People with healthy immune systems are also predisposed to the bacteria if exposed for a long time. Healthcare personnel are also continuously at the risk of exposure to infection in the hospitals. External factors such as the environs influence the pathogen. Many environmental factors induce the risk of tuberculosis such as poverty, overcrowding in houses, prisons, and camps (World Health Organization, 2016).
Role of public health concerning tuberculosis
They help in spreading and increasing awareness of the disease in the rural and urban settings. They are also actively and passively involved in gathering information about the condition for statistical purposes. They educate the community at large about tuberculosis. This helps in mapping out potential risk areas and people that help in controlling the disease (World Health Organization, 2016). They ensure that medication regimens are adequately followed to reduce cases of drug resistance.
They also implement control activities according to local, national and international standards (World Health Organization, 2016). They also report definite and suspected cases to the relevant authorities. They are also involved in policy making to ensure that tuberculosis is eradicated. Public health promotes prompt, appropriate diagnosis and treatment of infected individuals. Public health also help in submission of the affected, exposed and recovered patients’ data for analysis and reporting to the government and other agencies for use in preventing disease spread and following it up (Fogel, 2015).
Fogel, N. (2015). Tuberculosis: a disease without boundaries. Tuberculosis, 95(5), 527-531.
Glaziou, P., Sismanidis, C., Floyd, K., & Raviglione, M. (2015). Global epidemiology of tuberculosis. Cold Spring Harbor perspectives in medicine, 5(2), a017798.
Lönnroth, K., Glaziou, P., Weil, D., Floyd, K., Uplekar, M., & Raviglione, M. (2014). Beyond UHC: monitoring health and social protection coverage in the context of tuberculosis care and prevention. PLoS medicine, 11(9), e1001693.