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The Concepts of Epidemiology and Nursing Research to Tuberculosis (TB)
TB is considered as one of the major threats to public health globally. The WHO classifies TB among the top 10 causes of death all over the world (WHO, 2018). Generally, the disease is communicable as its causative bacteria that mainly attacks the lungs can be transmitted from one person to another through the air. Initially, the prevalence of TB was low in the developed world but the rapid spread and of HIV consequently led to an increase in the number of TB infections as of 1985. This is because HIV destroys the immune system when it enters the body making it challenging for the TB germs to be suppressed. Nevertheless, the development of effective TB prevention programs led to a decline in the number of TB cases since 1993 but the disease is still a problem. This paper utilizes the concepts of epidemiology and nursing research to explain TB in details.
Causes and Mode of transmission
TB is caused by a Mycobacterium tuberculosis, a bacterium that mainly invades the lungs. This microorganism is transmitted among individuals through tiny droplets released into the air by an infected person when they cough, sneeze, laugh, or spit and inhaled by an uninfected individual (Churchyard, et al. 2017). Only small amounts of the germs are needed to contract TB. Nevertheless, individuals with latent TV cannot infect others. As for active TB, taking drugs as instructed by the physician for the past two weeks cannot spread the disease to others. The presence of HIV is also considered as an indirect cause of TB as its emergence is largely responsible for the increase in the number of individuals who get TB (WHO, 2018). HIV infected individuals are at a higher risk of getting TB since they have a weak immune system which is cannot fight M tuberculosis adequately.
Symptoms
The latent or inactive form of TB is often asymptomatic. The bacteria is still in the body but does not cause any signs or symptoms and is also not contagious. However, it is important for individuals in this phase to receive treatment so that the disease does not progress into active TB. Active TB makes the condition’s indicators to show up and is also transmittable. Sickness can manifest after a few weeks, months, or even years after an invasion by the TB pathogen. The most common symptoms of TB include coughing persistently for 3 or more weeks, presence of blood in the sputum, chest pain, general body weakness, and significant loss of weight and appetite (WHO, 2018). Fever, night sweats, and chills are also common among TB patients. If the disease manifests in other parts of the body, the symptoms vary depending on the organ affected. For instance, kidney TB can lead to bloody urine.
Treatment and complications
TB can be treated or cured through a proper administration of the correct medications. Nevertheless, unlike other bacterial infections, managing TB can take long. Various factors including whether an individual has latent or active TB, age, general health status, the infection site, and a likelihood of drug resistance determine the period of antibiotic treatment. For patients with active TB, they are required to take 4 types of antimicrobial drugs for 6-9 months and under the supervision and the assistance of a healthcare worker (WHO, 2018). This support is necessary to ensure that a patient adheres to treatment and also mitigate the spread of the disease. On the other hand, latent TB can be managed using one or two kinds of antibiotics. Rifampin, isoniazid, pyrazinamide, and ethambutol are the drugs used commonly to treat TB. In the event of drug-resistant TB, physicians often prescribe fluoroquinolones and injectable medications.
Untreated TB can have adverse effects including death. Failure to manage the active form of the disease can make it spread to other body parts through the bloodstream and cause various complications. Some of the TB compilations are meningitis, liver or kidney damage, spinal pain, and damage to the joints. In some cases, TB can lead to heart problems such as cardiac tamponade.
Incidence, prevalence, morbidity, and mortality
Given that TB is classified as a major killer disease globally, eradicating the epidemic is one of the health-based goals by 2030. Over the past decade, the incidence of TB has reduced but at a slow pace. Experts say that the worldwide incidence rate of TB is declining by 2 percent each year. To achieve the 2020 strategy which is focused on ending TB, a 4-5 percent acceleration is needed (WHO, 2018). On the other hand, the disease’s prevalence is still a concern as it has made the elimination of the disease on universal and national levels difficult which means that more efforts should be made. It is projected that a quarter of the world’s populace, that is approximately 2 billion individuals have TB. Moreover, over 9 million people get TB every year. In 2017, about 10.1 million new cases of TB disease were reported. 90 percent of those cases were adults aged 15 years and above and the majority of them were male (WHO, 2018). Also, among those new incidences, 9 percent were people who had HIV. Also during the same year, statistics show that the number of children who were ailing from TB was about 1.1 million globally. In the U.S, 9,093 new TB infections were recorded in 2017 which represented a 1.8 percentage decline from the former year (Stewart, et al. 2018). Also, there were 1.6 million deaths associated with TB in 2017 including 0.3 million who had HIV. Moreover, a total of 230, 000 children with TB had died in the same year.
The determinant of health affecting TB
Determinants of health encompass a wide range of socioeconomic, personal, and environmental aspects that impact individuals’ health statuses. Socioeconomic factors are the main determinants of health influencing TB infection and prevalence. To be specific, TB is widely associated with poverty and is common in communities where there are scarce resources. People who live in crowded and inadequately ventilated environments are at a higher risk of transmitting the disease which can then quickly spread in an entire location (WHO, 2019). More so, lack of finances to seek medical attention in addition to inadequate healthcare facilities means that when infected with TB it can progress and eventually causing death. This is one of the main reasons why TB is widespread among poor countries. Lack of proper nutrition which is an element of poverty also plays a significant role in the progression of the disease to its active form. Destitution also deprives individuals of accessing education which would enable then avoid various risks of exposure to TB, for instance, smoking and HIV.
The epidemiologic triad of TB
Agent
Mycobacterium tuberculosis (Mtb) is the agent that causes TB. It is released in the air in the form of aerosols. Inhalation of 1-10 bacilli increases the risk of infection (Churchyard, et al. 2017).
Host
Human beings are the host of Mtb. Inhalation of 1-10 bacilli increases the risk of infection. Once in the body, it attacks the macrophages and utilizes its core machinery of carbon metabolism’s elasticity to familiarize with the hostile environment. The diseased macrophages then move via the lymphatic or the blood system to the lungs or other parts of the body.
Environmental factors
Poverty can cause the prevalence of TB in a population. This is due to living in crowded areas, inaccessibility to healthcare, undernutrition, and lack of education. Smoking also leads to clogging up of macrophages, rendering them incapable of fighting Mtb.
Role of a public health nurse in managing TB
A public health nurse is an important resource in preventing and alleviating TB. They engage in research which involves identifying new and existing cases of TB and administering immediate treatment. This helps the disease not to spread to many people and not to progress to active TB. Public health nurses also engage in collection and data analysis to determine the prevalence, the incidence, morbidity as well as mortality of the disease (Shimamura, et al. 2013). This information is used by policymakers to come up with measures that can help eradicate the disease and reduce the number of deaths caused by TB. More so, as a public health care worker, the nurses are often involved in follow-ups for patients who are taking medications at home to see whether they are adhering to the prescriptions and report whether there are improvements.
 
 
References
Churchyard, G., Kim, P., Shah, N. S., Rustomjee, R., Gandhi, N., Mathema, B., … & Cardenas, V. (2017). What we know about tuberculosis transmission: an overview. The Journal of infectious diseases216(suppl_6), S629-S635.
Shimamura, T., Taguchi, A., Kobayashi, S., Nagata, S., Magilvy, J. K., & Murashima, S. (2013). The Strategies of Japanese Public Health Nurses in Medication Support for High‐Risk Tuberculosis Patients. Public Health Nursing30(4), 370-378.
Stewart, R. J., Tsang, C. A., Pratt, R. H., Price, S. F., & Langer, A. J. (2018). Tuberculosis—United States, 2017. Morbidity and Mortality Weekly Report67(11), 317.
WHO. (2018). Global tuberculosis report 2018. World Health Organization.
WHO. (2019). Addressing the social determinants of TB.