The Challenge of Drug-Resistant Tuberculosis
The Concepts of Epidemiology and Nursing Research to a Communicable Disease: Tuberculosis
Tuberculosis (TB) is a tropical infectious disease that is among the leading cause of death among infectious diseases. According to Sousa et al (2019), in 2016 there were approximately 10.4 million new TB cases globally, and 6.9% of the cases were among children aged below 15 years. TB is poverty-related and thus the most vulnerable group, the poorest, and the most marginalized population groups are disproportionately affected by the disease (Duarte et al., 2018). Therefore, improving access to TB diagnosis and treatment is among the most effective strategies in combating TB, especially among the most susceptible population groups. Additionally, effective control of TB requires the implementation of an effective surveillance system to determine the epidemiology of the disease and evaluate the impact of the control measures (Sousa et al., 2019). For example, the multidrug-resistant TB strains require routine surveillance to effectively assess and monitor the course of disease epidemiology. This paper will discuss and apply the concepts of epidemiology and nursing research to tuberculosis.The Challenge of Drug-Resistant Tuberculosis
Description of the Communicable Disease
TB is an infectious disease caused by a bacterium known as Mycobacterium tuberculosis. The bacterium normally attacks the lungs, although it can attack any body part such as the brain, spine, and kidneys. There are two types of TB-related conditions and they include TB disease and TB infection (LTBI) (Gupta-Wright et al., 2018). If left untreated, TB disease is fatal. TB is an airborne disease and this means it is spread through the air from one individual to another. The TB bacterium gets in the air after an individual with TB disease coughs, sneezes, or talks. Adjacent people can breathe the bacteria and become infected when the bacteria settle in the lungs and starts growing. From there, the bacteria can move via blood to other body parts such as the spine, brain, and kidney. Symptoms of TB disease in the lungs include a severe cough that lasts for about three weeks or longer, chest pain, fatigue, weight loss, night sweats, and coughing up sputum or blood. People at high risk of developing TB disease include people who had a recent TB infection and people with weak immune systems Gupta-Wright et al., 2018).
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TB is a highly contagious and infectious disease. Once a TB infection has occurred, the disease susceptibility is attributable to comorbidities such as diabetes, HIV, rheumatoid arthritis, cancer, and other chronic diseases or immunosuppressive treatments. Additionally, malnutrition, alcohol intake, and smoking increase the susceptibility to TB infection. Healthcare costs allied to TB disease include the direct user fees from the healthcare facilities and indirect costs associated with visiting the healthcare facilities. The finances spend on transportation, loss of work due to sickness or medical appointments, and co-payments for drugs are all the indirect costs allied to the utilization of healthcare services. Therefore, TB poses a big economic burden to the patients and families affected by the disease Gupta-Wright et al., 2018). The successful TB treatment includes taking the anti-TB medications for at least 6 months.
Determinants of Health and How Determinants Contribute to Disease Development
Determinants of health include various factors that affect and influence the health status of populations or individuals. Health is determined by complex interactions between economic and social factors, individual behavior, and the physical environment. The main determinants of health include income and social status; education; social support networks, the physical and social environment; individual behavior; and access to healthcare services (Duarte et al., 2018).
The main determinants of health that influence the development of TB include socioeconomic status, physical environment, and individual behavior. Socioeconomic status influences the pathogenesis of TB at all stages. The risk of exposure to TB is allied to the environment people live in and the underlying disease burden. The environmental characteristics, the number of individuals sharing space, and airflow also influence the risk of exposure to TB.The Challenge of Drug-Resistant Tuberculosis
Socioeconomic factors include education, level of income, employment, overcrowding, among other factors. The conditions people live in and the structural determinants influence health inequalities and the risk of TB. Evidence shows that factors such as overcrowding, poor living conditions, malnutrition, lack of employment, and lack of access to healthcare increase the risk of TB (Duarte et al., 2018).
Homelessness is associated with an increased risk of TB and a reduced treatment success rate. Overcrowding is also attributed to the increased risk of exposure to tuberculosis. This is because housing conditions can influence the risk of TB exposure through the quality of indoor air and poor ventilation (Singh et al., 2018). Individuals from low socioeconomic status have an increased risk of contact with individuals with tuberculosis, increased likelihood of working and living in crowded and poorly ventilated places, less healthy behaviors such as smoking and alcohol abuse, increased risk of malnutrition, and also face barriers to healthcare access.
Poor nutrition is also associated with an increased risk of TB. According to Duarte et al (2018), there is a dose-response link between the level of malnutrition and the risk of tuberculosis incidence. Malnutrition is also a result of TB, while malnutrition during diagnosis is also allied to an increased risk of death from TB disease. Additionally, injection drug users have an increased risk for tuberculosis because of socioeconomic and risky personal behaviors like imprisonment, malnutrition, homelessness, and HIV infection (Miandad et al., 2019). Additionally, people from low socioeconomic status face obstacles to healthcare because of ill perception towards TB disease and lack of access to the proper treatment.
Epidemiologic Triangle and Environmental Factors
The “epidemiological triad” is a tool including a disease agent, host, and the environment that explain how the disease is spread in a community setting, and to identify intervention points, prevent transmission, and to assist in epidemiologic investigations (Jia et al., 2020). The agent of TB is a bacterium known as Mycobacterium tuberculosis; the agent is an acid-fast aerobic rod that is hyper-sensitive to ultraviolet light and health and reproduces slowly. TB typically affects the respiratory system, but can also affect the kidneys, brain, bones, lymph nodes, and reproductive organs. The transmission of the Mycobacterium tuberculosis occurs from one individual to another through airborne droplets with vehicles being talking, sneezing, and coughing.
The “host” for TB are human beings. Mycobacterium tuberculosis is readily spread to vulnerable hosts via respiratory exposure in the environment, for example, in community settings or public gatherings. The hosts (human beings) with weak immune systems are at the highest risk for being affected by Mycobacterium tuberculosis and thus acquiring TB (Álvaro-Meca et al., 2016). For example, people with cancer, HIV/AIDs, diabetes, and those taking corticosteroid therapy are at higher risk of acquiring the bacterium infection. However, hosts with healthy immunity may also be vulnerable if exposed for a long time to the Mycobacterium tuberculosis. For example, healthcare providers are continuously exposed to the bacterium within the hospital settings, and this places them at a risk for contracting TB. Early detection, diagnosis, and treatment of TB is the main preventative strategy to the transmission of TB within healthcare settings.
The environment affects the transmission of Mycobacterium tuberculosis from one host to another. Numerous environmental factors trigger the susceptibility of the host’s body to TB. For example, prisons, overcrowded housing, malnourishment, and geographical locations in poor regions are the environments associated with increased transmission of Mycobacterium tuberculosis and TB disease (Miandad et al., 2019). The density of Mycobacterium tuberculosis within the air also influence the risk of acquiring TB. The Challenge of Drug-Resistant Tuberculosis
The Role of the Community Health Nurse and the Importance of Demographic Data
Nurses are the pillars of the prevention and management of TB. Community nurses, therefore, have the role of assessing, diagnosing, treating, and referring patients with tuberculosis for further care and treatment (McCollum et al., 2017).
Community health nurses are actively involved in health promotion and disease prevention activities. Therefore, in TB community health nurses have the role to educate the community members and individual populations about TB infection and the required measures to prevent TB. For example, the community health nurse should educate community members about the risk factors for TB and the behaviors and actions people should avoid to prevent TB disease (McCollum et al., 2017). For example, community health nurses conduct campaigns that educate people to avoid overcrowded places and to seek immediate medical attention when they start to experience symptoms associated with TB.
Screening is an important element of disease prevention. The community health nurse, therefore, has the role of conducting patient-focused activities such as performing screening programs to identify patients with tuberculosis and those at higher risk of getting TB. People diagnosed with TB should then be referred for further tests to come up with the appropriate treatment plan. Community health nurses also have the role of assessing patients before starting and during treatment to assess the suitability of the treatment regimen and the patient’s response to the treatment. The nurses also have the role of managing emergencies associated with the disease. According to Swanson et al (2020) community, health nurses have the role of coordinating healthcare activities related to the disease, including overseeing healthcare workers and communications amongst team members.
Community health nurses (CHNs) play an important role in combating multi-drug resistant TB (MDR-TB). As Swanson et al (2020) provide, nurses are actively involved in ensuring the low incidence of MDR-TB and high treatment rates for TB are sustained. Community health nurses work with community volunteers and NGOs to improve treatment adherence, decrease treatment failure rates, and prevent the development of MDR-TB.
CHNs also play the role of collecting data that allows effective surveillance and monitoring of the disease. The demographic data collected allows the identification of TB in high-risk groups, screening, and managing comorbidities, and risk behaviors that lead to poor TB outcomes to optimize clinical care (Swanson et al., 2020). Moreover, demographic data is useful in surveilling and monitoring the prevalence and incidence of TB to facilitate the implementation of the appropriate measures to counter the disease.
National Agency or Organization
The organization that works to address tuberculosis is the Centers for Disease Control and Prevention (CDC). CDC’s Division of Global HIV & TB (DGHT) partners with the American government to research, treat, and prevent tuberculosis in the country, and help sustain the country’s efforts to ensure a safe America and a safer world. CDC has been actively involved in conducting comprehensive research to identify the treatment and ensure the elimination of TB. For instance, the organization is actively involved in researching combating MDR-TB in the country. Moreover, the organization plays an important role in serving the populations at an increased risk of TB disease and plays an important role in TB elimination. The CD also plays a critical role in the prompt and accurate detection and diagnosis of TB and facilitating appropriate reporting of the disease and thus allows timely initiation and completion of treatment. The surveillance and monitoring systems implemented by CDC have allowed the organization to monitor the incidence and prevalence of TB in the country, and globally as well. The organization also develops innovative approaches to find and treat TB disease and establish best practices to end the transmission of TB in healthcare organizations and community settings.
Global Implication
Tuberculosis is the leading killer disease worldwide, causing about 1.5 million deaths annually. In 2018, approximately 1.7 billion people worldwide had TB infection. There has been the development of Multidrug-resistant tuberculosis (MDR-TB) due to lack of proper adherence to treatment, poor quality drugs, and the administration of wrong treatment. Additionally, people with HIV infection or other conditions weakening immunity are at increased risk of developing TB disease and have an increased risk of death after developing TB. TB is also among the leading causes of death globally (Kyu et al., 2018). The disease is also associated with a significant financial burden due to high healthcare costs associated with the treatment and monitoring of the disease condition. The Challenge of Drug-Resistant Tuberculosis
Conclusion
The selected infectious disease is tuberculosis. Even though there has been a decline in TB prevalence, incidence, and mortality, the disease has not been eliminated and it requires massive efforts and investment to eliminate the disease. The agent for TB is Mycobacterium tuberculosis while the host includes human beings. Community health nurses play an important role in the prevention and treatment of TB, for example through health promotion and disease prevention activities.
References
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