Determinants of Health and how they contribute to the Development of Tuberculosis

Tuberculosis: A Fatal Disease


Tuberculosis is a fatal disease that affects the human anatomy's airways, with the lungs being the organs most affected. Coughs and sneezes are means of transmission in which minute atomized droplets move through the air to create illnesses. In the mid-nineteenth century, TB had reached historically low levels in affluent countries (Lawn & Zumla, 2011). Yet, following the emergence of the Human Immunodeficiency Virus (HIV), patients' impaired immunity resulted in a rise in the frequency and prevalence of HIV during full-blown Acquired Immune Deficiency Syndrome (AIDS). The human immune system has been compromised beyond its ability to combat antigenic materials. Hence the tuberculosis bacteriae persist and prevail against one’s health following HIV. Nevertheless, in countries with well-established clinical systems, like the US, the spread of tuberculosis was brought to relatively low rates, beginning the early 1990s, even though the disease remains to be a factor of concern in the health segment. Nevertheless, it is unfortunate that most strains of tuberculosis are resistant to the available drugs. Consequently, cases of infection usually prompt those infected to take a couple of drugs, and the dosage is carefully prescribed by qualified health professionals to avoid drug resistance.


Symptoms


Many people could be harboring the bacterium that causes tuberculosis. However, the ability of their respective immune systems to resist the infection might observe symptoms not expressly evident. Consequently, there are categories of infection, based on the scientific classifications of the manifestation of disease (Lawn & Zumla, 2011). One of the segments if the latent form of tuberculosis, whereby the infectious organisms are in the body, but they remain inactive. This kind of tuberculosis which is inactive usually is not contentious. Nevertheless, treatment is a necessity, considering that latent form of the disease could graduate into the active form, hence causing illness. It is estimated that apparently, one billion people are latently infected (Lawn & Zumla, 2011). Secondly is the active form of tuberculosis, which is infectious and makes those affected to be sick. Nevertheless, sickness could set in immediately following the infection, or disease would surface later in life. He signs, and symptoms of tuberculosis include night sweats, loss of appetite, chills, unintentional weight loss, coughing that lasts two to three weeks, chest pain accompanied with coughing or breathing, as well as coughing blood-stained sputum. In cases where tuberculosis becomes systemic, it could as well affect the brain, spinal cord, and the kidneys. Consequently, the anatomical location of the disease would vary the presentation of symptoms, for instance, kidney and spinal tuberculosis would result in blood stains in urine and back pain respectively.


Causes


Mycobacterium tuberculosis is the bacterial organism that causes disease (WHO, 2013). The aerosols released into the air are the ones that transmit the infectious microorganisms from one person to another. The transmission is highly active when an individual with active and untreated disease spits, speaks, laughs, coughs, sings, or sneezes. However, it should be noted that the disease is not easily passed from an infected person to one that is not, despite the fact that it remains to be highly contentious. As such, it explains why people get infections from people they leave with more than those who get the disease from strangers. Fortunately, persons infected with tuberculosis, and have been on medication for the last two weeks cannot pass the disease to those uninfected, as they are no longer contagious.


Mode of Transmission


Typically, tuberculosis is transmitted through air aerosols; the nuclei created as droplets normally when the infected person coughs. Indeed, coughing is the most probable mode of transmission because the most substantial number of droplet nuclei are created, and they are normally fresh enough to carry across the mycobacterium that would cause the infection. Nevertheless, external factors like the nature of ventilation, the rigor of a cough and the frequency of coughs largely influences the probability transmission (WHO, 2013). However, as it is an assumption in the public domain, tuberculosis is never transmitted through fomites, including dishes or cups among other tools used by those infected.


Complications


Tuberculosis is normally a fatal disease if medical intervention and clinical management are not given priority. Active tuberculosis typically affected the lungs of those infected. However, the infection becomes typically systemic and hence affects other organisms in the body including the kidneys and the spine (WHO, 2013). There are many complications of tuberculosis. The stiffness of the back and the pain associated with such signs is ordinarily spinal pain caused by tuberculosis. Joint pain as well manifests as tuberculosis arthritis, and usually, it affects the big joints; the knees and the hips. The swelling of the pia and the dura matter, hence meningitis is a common form of the tuberculosis complications, and this could lead to intermittent or permanent head damage. Liver and kidney complications commonly occur in extreme cases, which could be fatal since the purification of blood by filtering impurities would be rendered void (WHO, 2013). Cardiac tamponade is the last resort to occur but which is deadly when it happens, following the accumulation of the fluid around the heart muscles following tuberculosis infection which causes cardiac inflammation.


Treatment


Medical intervention is the only reliable remedy for containing tuberculosis, accompanied by minimal clinical, managerial approaches. Drugs are normally dispensed by qualified physicians limited to the patient`s age, the possibility of drug resistance, overall health, the location of disease in the body, as well as the form of ailment; whether active or latent. Treatments usually last in months, up to nine months on average, though specialist argues that the time could be reduced to 4 months when combined medication is engaged. Moreover, latent tuberculosis could be prevented from degenerating into the active form when earlier medical intervention is launched. Multidrug-resistant tuberculosis meets typically more than one prescription of drugs, as opposed to the latent form of the disease. Pyrazinamide, Isoniazid, Ethambutol (Myambutol), and Rifampin (Rifadin, Rimactane) are the regimens typically used in the treatment of the disease. Multidrug-resistant tuberculosis would require medication through 20 to 30 months, and drugs like kanamycin or capreomycin, and amikacin are used, despite the growing resistance apparently. Nevertheless, scientific efforts have been staged to counter the resistance, and drugs under development yet to enter the market are Linezolid and Bedaquiline.


Mortality, Morbidity, Incidence, Prevalence and Global Implication of the Disease


Of the making infectious organisms causing death globally, Mycobacterium tuberculosis is the ninth. Hence tuberculosis is higher on the scale of motility rate than HIV/AIDS. It is estimated that in 2006 alone 1.3 million individuals died of tuberculosis exclusively. The total rises to 1674000 million people who succumbed to the disease worldwide, after adding 374 thousand of those who had been immunocompromised by AIDS but died of tuberculosis. In total, 250 thousand children lost their lives to tuberculosis, a combination of those infected with HIV and those who died exclusively from tuberculosis (Gagneux & Small, 2007). On average, the year 2016 data confirms that 40 percent of those who succumbed to the disease had tuberculosis infections. The incidence of tuberculosis among children was estimated at one million infections. The incidence across the board was 10.4 million, and 10 percent of the infections were among HIV cases. Of the total, 74 and 65 percent lived in Africa and were adults respectfully, whereas 90 percent of the total were adults. South Africa, China, Indonesia, India, Pakistan, and Philistines, as well as Nigeria, formed 60 percent of the incidents in 2016. Because of the HIV infections, the prevalence of tuberculosis remains escalated across the globe (Gagneux & Small, 2007).


Determinants of Health and how they contribute to the Development of Tuberculosis


The biological, environmental, economic, and behavioral factors are the primary determinants of health, and they significantly influence the health status of both individuals and the community as a whole (García, Bayer, & Cárcamo, 2014). For the case of tuberculosis, the determinants of health are very diverse across the world, with many variables in the above-aforementioned parameters entailed. Human behavior is to a significant extent determined by the environment and the nature of the community as both the molecular and biological as well as the social and environmental elements. Behavior most associated with tuberculosis infections include crowding in social and poorly ventilated places, critical for tuberculosis epidemiology. A lot of factors including untreated psychiatric conditions, lack of education, poverty, sexual abuse, violence, stigma, homelessness, addiction, powerlessness, lack of independence and decision making, lack of legal residence as well as the lack of employment opportunities all play critical roles in the epidemiology of tuberculosis (Gagneux & Small, 2007). Therefore, the economic, organizational, legal policy, cultural, social, and physical factors all can help prevent or escalate the incidence, morbidity, mortality, and prevalence of tuberculosis in society. Unfortunately, the structural elements that could help in the mitigation of tuberculosis are intrinsically bound to the conservational, social, economic, and political fabric of society, making it cumbersome to attain remedies.


The Epidemiologic Triangle as it Relates to Tuberculosis


The epidemiological triangle has three vertices. One corner represents the Agent, hence the microbe that causes the disease, and answers the What of the triangle which is Mycobacterium tuberculosis. The second corner presents the Who segment, and it defines the organism harboring the disease. In this case, the human person is the one affected by tuberculosis. The last vertex is the where question, which seeks to establish the environment in which the disease-causing microorganism thrives. Furthermore, the external environment is as well considered, and in this case, tuberculosis is a global epidemic, which thrives in the human body and is transmissible through aerosol nuclei from coughing (Gagneux & Small, 2007).


Role of Health Community Nurse


The community health nurse does a lot when it comes to tuberculosis infection cases, including the promotion of health, treatment, rehabilitation, care and evaluation of the health of the community as well as the prevention of infection and wellness advocacy. In collaboration with other health officials and the community at large (Getahun et al., 2010). The community nurse could go in the field to establish the cases of incidence prevalence, morbidity, and mortality due to tuberculosis, report the data to relevant stakeholders, and the data can be analyzed accordingly to project evidence-based outcomes that are instrumental in decision making and hence the mitigation follow-up processes (Getahun et al., 2010).


The Pan American Health Organization


(The Aids Institute, 2016)


The Pan American Health Organization is an American-based national organization that has a concern with tuberculosis patients, especially those in the aging bracket and within the Mexican American border zones. This organization seeks to create awareness, insist on the need for tuberculosis testing, care, treatment, and management. Furthermore, there is a critical program inculcated with the focus of dealing with the emerging challenges in the treatment of the elderly who are tuberculosis infected, hence the need for more research, drug prescription, and the management conveniences desirable to help their coping (The Aids Institute, 2016). The campaign advocated for by The Pan American Health Organization primarily entails a couple of functions. People living with tuberculosis and are 50 years of age or beyond are a primary target, to tailor patient-specific attention in the guest to mitigating the disease. The need to enlighten the aged about how they should use medical treatment regimens, as well as adhere to physician clinical pieces of advice to better their respective prognosis (The Aids Institute, 2016). On the other hand, the organization offers care and advice to the parents who are increasingly becoming the central guardians to children and orphans left behind by their parents who succumb to tuberculosis. Therefore, in either way, elderly people are very instrumental in the American society about the tuberculosis infection issue. All these objectives by The Pan American Health Organization have been very helpful in curbing down tuberculosis in the American society.

References


Gagneux, S., & Small, P. M. (2007). Global phylogeography of Mycobacterium tuberculosis and implications for tuberculosis product development. Lancet Infectious Diseases. https://doi.org/10.1016/S1473-3099(07)70108-1


García, P. J., Bayer, A., & Cárcamo, C. P. (2014). The changing face of HIV in Latin America and the Caribbean. Current HIV/AIDS Reports, 11(2), 146–157. https://doi.org/10.1007/s11904-014-0204-1


Getahun, H., Gunneberg, C., Granich, R., & Nunn, P. (2010). HIV infection-associated tuberculosis: the epidemiology and the response. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 50 Suppl 3, S201–S207. https://doi.org/10.1086/651492


Lawn, S. D., & Zumla, A. I. (2011). Tuberculosis. In The Lancet (Vol. 378, pp. 57–72). https://doi.org/10.1016/S0140-6736(10)62173-3


The Aids Institute. (2016). The AIDS Institute | To Promote Action for Social Change Through Public Policy Research, Advocacy and Education. Retrieved from http://www.theaidsinstitute.org/programs/education/national-hivaids-and-aging-awareness-nhaaa


WHO. (2013). Global Tuberculosis Report 2013. World Health Organization, 306. https://doi.org/10.3917/spub.092.0139

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