Epidemiology and Nursing Research to Tuberculosis
Tuberculosis is one of the deadliest infectious diseases in the world (Kenrad & Williams, 2005). Although there has been a significant effort towards reducing the incidences, prevalence and mortality of the disease, it remains a major public health threat all over the world.
Mode of Transmission
Tuberculosis is a bacterial infection that spread from one individual to the other through microscopic droplets of saliva or mucus expunged into the air when an infected person coughs, sneezes, speaks or spits. These infectious droplets find their way into the lungs. When they reach the alveoli, the TB bacteria are engulfed by macrophage and then transported to the lymphatic system and the bloodstream. Thereafter, they are transported all over the body into various organs. They multiply fast in organs with rich oxygen supply such as the upper lobes of the lungs, meninges, kidneys, bone marrow and the spinal cord. The bacteria multiply until they reach numbers that can clinically cause a disease. (Sismanidis, Glazion, & Floyd, 2014)
Causes of Tuberculosis
A bacterial agent causes tuberculosis. The bacterium is called Mycobacterium tuberculosis. (Kenrad & Williams, 2005). They are transmitted from an individual to another and majorly attacks the lungs, although they can also attack other organs of the body. This attack manifest as symptoms recognized as tuberculosis.
Symptoms of Tuberculosis
It is possible for an individual to harbor Mycobacterium tuberculosis and the disease fails to manifest because the immune system of such an individual fights off the bacteria preventing the individual from falling sick. There are two categories of tuberculosis. Latent TB occurs when an individual is infected, but the bacteria remains inactive in the body. Consequently, the individual does not manifest symptoms and lives a normal life. At this stage, the TB cannot be passed from person to person. However, treatment is necessary to prevent progression into active TB (Stella, Killewo, & Haggenhougen, 2012). Active TB manifests as a disease and is highly contagious. Symptoms of the active form of tuberculosis include the following;
- A persistent cough that may progress into increased production of mucus and cough up blood.
- Pain around the chest region
- Fatigue and lethargy all the time
- Excessive sweating at night that often lead to drenching of the bedding
- Loss of appetite
- Weight loss
Tuberculosis bacteria can also infect places other than the lungs, and the symptoms manifest depending on the site of infection. For example, a spinal cord infection will manifest with symptoms such as severe back pains and headache. Tuberculosis in the kidney may manifest with symptoms such as blood in urine or acidosis in the body. (Roggi, Sulis, Mateelli, & Raviglione, 2014)
A failure in the management of tuberculosis can cause life-threatening situations. In most scenarios, the complications are fatal and swift action should be taken to avert any deaths. These complications include Meningeal TB that occurs when Mycobacterium tuberculosis infects the brain and the central nervous system, which causes severe back pains and stiffness of the neck and is particularly a serious condition that should be treated immediately by a qualified physician. Miliary TB occurs when the bacteria infects the body in its entirety. It spreads throughout the body causing a life-threatening disease condition. It leads to malfunction of various vital organs such as the liver and kidney. In rare cases, the bacteria can infect tissues surrounding the heart leading to a fatal condition called cardiac tamponade. It impairs the functioning of the heart. Children are at a higher risk of being infected with this form of TB. (Sismanidis, Glazion, & Floyd, 2014). Pulmonary TB is the most common form or rather type of TB that can be treated. However, it can cause severe damage to the lung if not diagnosed and treated in time. The disease can also very easily spread to other parts of the body leading to serious complications.Re- infection with Mycobacterium tuberculosis points out the possibility of the individual harboring drug-resistant Mycobacterium tuberculosis strains.
Drug- resistant strains is another complication. In most cases, different TB bacteria resist the treatment. Worse is when these strains resist the anti-tuberculosis drugs such as isoniazid and rifampin, which leads to multidrug-resistant tuberculosis which is difficult to treat and can easily spread from one individual to another (Sismanidis, Glazion, & Floyd, 2014).
Treatment of Tuberculosis
The treatment depends on whether the disease is in its active form or at a latent stage. Individuals who are infected but do not show symptoms are given a preventive course. Often physicians recommend a daily intake of an inexpensive drug called isoniazid, which takes approximately nine months. Active TB requires a more effective drug regimen including isoniazid, ethambutol, rifampin and pyrazinamide. It involves an initial two months regimen followed by continuous therapy for a total of nine months. These drugs must be taken religiously to prevent developing resistance. A directly observed therapy has been introduced to improve compliance and thus prevent multi-drug resistance. (Kenrad & Williams, 2005)
There has been a global decrease in mortality rates by 45% since 1990.Approximately 1.2 million people died from tuberculosis in 2012 with 75% of the total deaths happening in Africa and South East Asia. This includes the deaths of HIV-infected people. Countries in Western Europe, America, Australia and New Zealand recorded as low as 1 death in 100000 people in 2012.On the other hand, most of the African countries, Cambodia and Bangladesh recorded high death rates of 40 and above in every 100000 people. (Roggi, Sulis, Mateelli, & Raviglione, 2014)
Incidence of Tuberculosis
The number of tuberculosis cases reported is declining slowly. In 2012, 8.6 million cases of tuberculosis were reported. These cases were majorly reported in Africa (27%) and Southeast Asia (58%).Other regions had low incidences; America (3%), Europe (4%) and Mediterranean region (8%). India had the highest incidences at approximately 2.2 million infections. (Kenrad & Williams, 2005).
Prevalence of Tuberculosis
In 2012, there were approximately 11 million prevalent cases of tuberculosis representing an estimated 68 in every 100000 people. This figure signifies a 37% decrease since 1990.According to WHO, there is an impressive decline in the prevalent cases in America, Western Pacific region, South East Asia and Europe. However, the decline is out of reach for Mediterranean and African countries. (Kenrad & Williams, 2005)
In 2015, there were approximately 1 million children infected with tuberculosis. Out of which an estimated 170000 children died from the disease. This number excludes children with HIV/AIDS. (Roggi, Sulis, Mateelli, & Raviglione, 2014)
This term refers to a tool that shows the relationship between the host, agent and environment and how the three contribute to the spread of a disease. They include the agent, host and the environment. The agent for tuberculosis is Mycobacterium tuberculosis; aerobic, rod-shaped bacteria. The agent is transmitted from one human being (host) to another majorly in environments of poor sanitation, poor ventilation and public gatherings. Individuals with compromised immune system, malnourished or having concurrent diseases are more susceptible to attack by the agent (Stella, Killewo, & Haggenhougen, 2012).
Determinants of Health
Many factors determine the health of people in the society. These factors are classified into three broad categories including the social-economic environment, physical environment and people’s behaviors. These factors contribute to development of tuberculosis in a series of ways. Social status is a major component. Individuals with higher social and economic status live in well-ventilated houses, and this significantly reduces the chance of them being infected. Another factor is physical environment. Individuals with safe and clean water and healthy workplaces have minimal chance of being infected compared to individuals with crowded workplaces and unsafe houses. Education is another major factor. An individual’s level of education determines how keen they are in preventing tuberculosis infections. Uneducated people will be ignorant of initial signs and symptoms risking development of complications.
Another factor is personal behavior. People who drink alcohol, smoke and eat unbalanced diet have compromised immunity that increases their susceptibility to attack by tuberculosis and other infectious diseases. Other factors include access to health facilities and support from the society. Individuals who have little or no access to health facilities are at a higher chance to develop complications from tuberculosis and even spread the disease further. Individuals who receive support from the society have a higher chance of recovering fast and living a healthier life than those facing rejection. (Kenrad & Williams, 2005)
Role of Community Health Nurses
Community health nurses play a significant role in the management of tuberculosis. These roles include identifying tuberculosis cases. The nurses carry out research in communities to determine the number of individuals affected by tuberculosis and to find out whether there are individuals in the community developing resistant strains. The nurses also report cases of tuberculosis for immediate medication. Data collecting and analysis helps to identify the number of people affected and the response of the people already under therapy. Follow-ups are the most important aspect of community nursing. They give moral support and ensure that the patients adhere to the medication to prevent multi-drug resistant tuberculosis. (Stella, Killewo, & Haggenhougen, 2012)
National Agencies in Control of Tuberculosis
Centre for Disease Control is an agency that is actively involved in research to eliminate the life-threatening multi- resistant strains of tuberculosis. They work tirelessly to implement the National Action Plan (NAP), which entails improving TB surveillance, strengthening prevention programs and ensuring that multi-drug-resistant TB patients receive the support needed until cured. The U.S. Agency for International Development (USAID) encourages quality diagnosis and treatment for the many people suffering from TB and multidrug-resistant tuberculosis. In 2015 alone, approximately 3.7 million TB cases were diagnosed, and more than 70000 people started on multi-drug resistant tuberculosis treatment. (Roggi, Sulis, Mateelli, & Raviglione, 2014)
Kenrad, N. E., & Williams, C. (2005). Infectious Disease Epidemiology. Oxford University Press.
Roggi, A., Sulis, G., Mateelli, A., & Raviglione, M. C. (2014). Tuberculosis: Epidemiology and Control. Mediterranean Journal of Hematology and Infectious Diseases.54-93
Sismanidis, C., Glazion, P., & Floyd, K. (2014). Global Epidemiology of Tuberculosis. Cold Spring Harbor Perspectives in Medicine.
Stella, Q. R., Killewo, J., & Haggenhougen, K. (2012). Epidemiology and Demography in Public Health. Harvard University Press.