Tuberculosis is a relatively widespread infectious disease that can be found in many countries around the world. Environmental and social factors significantly influence its incidence. Therefore, the roles of stakeholders must be clearly defined in order to improve community health outcomes.
Description
Tuberculosis (TB) is caused by Mycobacterium tuberculosis, a microorganism that is spread by an infected individual (Mayo Clinic Staff, 2016). Its mode of transmission is through airborne droplet nuclei containing the said bacteria. The nuclei are formed from the saliva of the infected person and become airborne during coughing, sneezing, and speaking. They can remain suspended in the air for several hours. However, skin contact does not cause infection – in order for the disease to be transmitted; these particles have to be inhaled (Mayo Clinic Staff, 2016). The symptoms of tuberculosis include prolonged coughing (more than three weeks), chest pain, and blood during a cough, fever, chills, night sweats, fatigue, and weakness accompanied by loss of appetite and weight.
Importantly, the symptoms are only observable after the bacteria become active. In the case of a healthy immune system, the bacteria remain inactive, do not produce symptoms, and are not contagious (this state is known as latent tuberculosis). Untreated tuberculosis can spread from the respiratory system to other organs, leading to serious complications. Depending on the affected areas, the complications may include liver and kidney damage, stiffness and pain in the spinal cord, joint damage and arthritis, and fluid collection around the heart leading to heart tamponade (Mayo Clinic Staff, 2016). Unless addressed in a timely manner, some of the complications can be fatal.
Tuberculosis can be treated with antibiotics. The most common medications include pyrazinamide, ethambutol, rifampin, and isoniazid (Mayo Clinic Staff, 2016). Most commonly, three or four antibiotics are taken during the initial months of the treatment, and the number is decreased to two for the rest of the process. For drug-resistant tuberculosis (i.e., MDRTB), the length of treatment and the number of medications is increased.
According to the latest report from the World Health Organization, the morbidity rate of tuberculosis on a global scale was 10.4 million incidents per year (WHO, 2016). The mortality rate among HIV-negative persons was 1.4 million deaths (WHO, 2016). It is worth mentioning that the incidence rate of the disease is currently decreasing on a global scale.
Determinants of Health
Several social determinants are associated with tuberculosis incidence. Poverty is the most notable one as it contributes to several factors that increase the risk of acquiring the disease. First, the poor population often has no access to adequate sanitary conditions. Specifically, poorly ventilated air increases the likelihood of infection. Inadequate nutrition and disrupted sleep patterns, which are common among the poor population segment, weaken the immune system and contribute to the transmission from latent to the active state of the disease. The same can be said about substance abuse, which is common among poor individuals (Millet et al., 2013).
Smoking also seriously weakens the immune response of the respiratory system and, by extension, increases the likelihood of infection and development of active TB. Finally, the social determinant of poverty is characterized by the increased incidence of HIV, which, in turn, greatly increases the mortality rate of tuberculosis (Millet et al., 2013). Certain environments, such as correctional facilities, have a negative impact on the immune system and thus increase TB incidence. Finally, poverty has a significant indirect effect resulting from the lack of possibilities to acquire the necessary help. The gaps include the financial barriers (inability to pay for treatment), infrastructural issues (scarcity of healthcare providers in the region), and insufficient education. The lack of awareness about the problem leads to the inability to recognize symptoms and seek professional assistance on time.
Epidemiologic Triangle
From the epidemiologic triangle perspective, the agent factor is the organism that causes the infection, Mycobacterium tuberculosis. The list of host factors includes the initial state of health of the individual, presence of other diseases in the system, habits that weaken the immune response (e.g., smoking and substance abuse), nutritional and sleep patterns, and, most importantly, the HIV presence, which seriously decreases the likelihood of successful treatment and increases the risk of a fatal result. The environment factors include the quality of ventilation in the building, the proximity to an infected individual, the frequency of communication with the ill person, the crowding of the residence, the quality of sanitary conditions, the fact of traveling to high-risk areas, the conditions in specific institutions (e.g., correctional facilities), state of healthcare in the region (e.g., presence of providers, availability of resources, and proficiency of the staff), cultural background (e.g., the existence of discriminatory behaviors among healthcare workers), social characteristics of the region (e.g., prevalent behavior of peers), and the available informational background (e.g., presence of education and awareness programs and availability of accessible media).
Role of Community Health Nurse
The most important issue to understand about tuberculosis is that it is largely preventable and curable. The likelihood of developing an active form of the disease is relatively low in a well-established environment. Therefore, a range of responsibilities can be identified for community health nurses that are expected to improve the situation. First, despite the significant progress made in recent years, the demographics of tuberculosis are still incomplete in some areas due to the scarcity of the possibilities of the population at risk. Therefore, nurses are expected to assist the data collection on morbidity and mortality of the disease in order to assess the causes and adjust the interventions. The assistance can be both direct (through participation in data collection) and indirect (by communicating the importance of reporting to the population at risk).
Next, public health nurses can provide useful insights by analyzing the existing data. While the overall picture on causes and social determinants of health is relatively clear, the situation may vary significantly for each specific area. A better understanding of the issue can result in more effective intervention and could decrease the number of necessary resources. In addition to data collection, nurses are expected to assist in the development of evaluation and monitoring techniques and ensure their effective execution. The appropriate level of control ensures the timely detection of inconsistencies and allows adjusting the process. Next, the knowledge generated during data collection and analysis should be utilized in assisting the development of effective policies by the authorities.
Community health nurses are closely familiar with issues pertinent to specific communities and can provide insights on relevant resources and assist in establishing communication and collaboration between the organizations pursuing the same goal. Most importantly, the nurses can increase awareness of the characteristics of the disease, which, by extension, will empower the people to self-diagnose and seek medical help, thus contributing to the progress. Finally, the nurses can promote collaboration between the patients, their families, and the healthcare providers, which will eliminate some social and cultural barriers to treatment. Once reliable communication channels are established between key stakeholders, the patient outcomes are expected to improve, and the community, on the whole, would be able to prevent the infection in a larger number of cases.
Contribution of National Organizations
One of the most notable national organizations that target the issue of tuberculosis is the National Tuberculosis Controllers Association (NTCA). The organization identifies the advancing of tuberculosis as its mission and aims at a tuberculosis-free world as its ultimate goal (NTCA, n.d.). The organization works primarily through policymaking in order to meet its objectives. Specifically, it coordinates the efforts of individual activist groups that advocate for the elimination and control of tuberculosis in the United States (NTCA, n.d.). Next, NTCA informs and counsels external organizations, agencies, task forces, and committees on effective means of prevention and control of the disease.
In other words, it establishes information exchange and ensures the availability of the relevant data to the stakeholders. The organization also provides support to the entities which indirectly contribute to the resolution of the issue. For example, the agencies which specialize in substance abuse and smoking minimization create an environment where the spread of infection is less likely. Finally, NTCA provides support and advocacy for laws, regulations, and policies that contribute to the understanding, control, and eventual prevention of the disease. The NTCA is responsible for the organization of the National TB conference, which gathers the specialists in the field and allows them to exchange knowledge and experience. The scope of the organization includes the territorial, local, and national levels.
Conclusion
Tuberculosis incidence depends on the large part of the environmental and social factors. Therefore, active involvement of community health nurses, activist groups, educational agencies, and advocacy organizations has great potential for improving the issue. The fulfillment of the described roles is expected to assist the identified trend of decreasing the mortality and incidence of the disease.
References
Mayo Clinic Staff. (2016). Tuberculosis. Web.
Millet, J. P., Moreno, A., Fina, L., Del Baño, L., Orcau, A., de Olalla, P. G., & Caylà , J. A. (2013). Factors that influence current tuberculosis epidemiology. European Spine Journal, 22(4), 539-548.
NTCA. (n.d.). NTCA. Web.
WHO. (2016). Global Health Observatory (GHO) data. Web.