Population health and tuberculosis
Population health can be defined as a field that is concerned with the outcomes of health of a given group of individuals. It tends to approach the issue of health with the sole objective of improving the health of a whole population through reducing health discrimination in population groupings. Population health goes beyond individual level focus of conventional medicine and public and focuses on addressing a myriad of factors that affect the health of the population as a whole for instance the environment, social structure and distribution of resources. The vital idea behind population health is the social determinants of health and the relative negligible effect, medicine and healthcare have in improving the health generally,
From population health point of view, health is not only defined as a situation free from infirmity, but the aptitude of a populace to acclimatize to, respond to, or manage life’s challenges and changes.
Tuberculosis or TB is a contagious disease attributable to bacteria called Mycobacterium tuberculosis. It can affect any part of the body though the lungs are the most affected. It can cause serious illness if left untreated. When an infected person sneezes or coughs, the germs can spread to another person by breathing in the bacteria. When the bacteria enter the lungs of a healthy person, they multiply causing lung infection (pneumonia). Some bacteria remain dormant in the body for years but cannot be spread. If left untreated, the infection can develop to disease.
At first TB may show no symptoms. It can take many months after infection for the infected person to start showing signs of fatigue, weakness, fever, weight loss and night sweats accompanied by cough. As the lungs get worse, the cough contains blood or sputum (material from the lungs), shortness of breath and chest pain. These symptoms go on for more that two weeks. The bacteria can also spread to other parts of the body but it is fought by the immune system, stopping it from spreading by forming scar tissue (fibrosis) around the bacteria separating it from the rest of the body. This way the bacteria are paralyzed and cannot be spread to other people.
People with HIV virus are the most prone to TB. It is also known to many that tuberculosis has no cure. But the fact is that everyone is at risk of infection, especially those living with a person who has TB, refugees, people with immune systems weakened by diseases like diabetes, immunosuppressive therapy, silicosis or HIV?AIDS and also those living in overcrowded places like residential institutions and prisons. Tuberculosis is be cured especially if detected early. With proper treatment, chances for full recovery are very high. The commencement stage of treatment is crucial to prevent the appearance of drug resistance to ensure good results. The minimum satisfactory duration for treatment of tuberculosis is 6 months for both adults and children.
Tuberculosis contributes enormously to poverty
Tuberculosis plays a big role in encouraging poverty. Poverty stricken nations have a higher population of TB than developed countries. It is spreading at an alarming rate leaving a weak labor force. Children who are viewed as the leaders of tomorrow are force to drop out of school to take care of their ailing parents. Feeble labor force means more poverty. Poverty accompanied by poor housing, congestion, malnutrition, encourages the spread of TB and the cycle goes on and on.
Tuberculosis and children
Children are very sensitive to infection because their immune system is not fully developed compared to that of adults. When a child is diagnosed with tuberculosis it means that there is a person to them mostly an adult has TB (Nelson and Moore 2001).
Research conducted by World health Organization in 2005, indicated that over 250,000 children develop tuberculosis annually and 100,000 children continue to die from TB each year. BCG (Bacillus Camille Guerin) vaccination of infants does not guarantee prevention of active TB in adulthood. It only prevents dissemination forms of tuberculosis for instance TB meningitis in children.
The direct and indirect impacts children are exposed to from family members with TB puts them at greater risks of infection. Malnutrition increases vulnerability to TB and it brings with it venomous effects on both education and health since children with TB are sent home to prevent transmission. Even when a parent is sick with TB, most children especially in developing nations, end up discontinuing their education to cater for their sick parents. In India alone it is estimated that 300,000 children drop out of school every year to take care of parents with TB. Children one way of the other fall victim to directly or indirectly. Since children are more vulnerable to tuberculosis infection, it is important to cure it and prevent it from spreading in the community.
Tuberculosis and poverty
The relationship between TB and poverty is well established. In the developed countries, TB is common in the most deprived parts of the community. The number of people living below poverty line increases with the increasing world population. Increasing population causes congestion especially for the less fortunate. Tuberculosis spreads at an alarming rate in these overcrowded areas. The poor, plagued by hunger and living in crowded and unhygienic places fall victim to TB. Poor health facilities in these places also play a big role in the spread of TB.
Lack of quality drugs always results to premature treatment since TB requires at least six months to ensure it is totally cured (Hughes 2009).
TB also contributes to poverty in the sense that once a patient is taken ill with tuberculosis, their ability to work lessens intensifying poverty. It decreases the output of a nation’s work force reducing its gross household product. Human and economic impacts of TB are greater in poor nations and households than in developed nations. The high rate of TB observed in nations plagued by poverty means a sick labor force and handcuffed economic growth. Studies imply that a TB patient looses 3-4 months of work time. Total lost earnings add up to 30% of household income yearly. Lack of awareness about free treatment often leads to other alternatives like traditional medicine which in most cases doesn’t help. Even when there is availability of free treatment the patient may have to walk or travel long distances to get access.
Pollution and tuberculosis.
Air pollution subjects a person to tuberculosis more than any other form of pollution since it mostly affects the lungs. Exposure to combustion derived air enumerates the risks of TB. Other related sources of exposure are environmental tobacco smoke, tobacco smoking or enclosed burning of solid fuels. Outdoor air pollution from vehicles, industries and solid waste burning also have similar impact on tuberculosis infection. Settlers in urban areas are more exposed to air pollution compared to their counterparts in rural areas. Urban centers have a bigger population of people infected with TB yet they are more exposed to unclean air. (Samet, Maynard and Koren 1999)
Research by US centers for Disease Control and Prevention (CDC) states that smokers are at a greater risk developing TB than nonsmokers. Researchers also found that outdoor pollution may increase risk of TB infection, illness and even death. Being a highly infectious disease that affects that lungs and caused by airborne bacteria, polluted air is the last thing an infected person needs. More than half of the world’s population depends on coal wood, crop residues and charcoal as heating fuel especially in Asia and Africa where TB is common and on the increase (Ezzati and Murray 2004).These environmental factors pose a great risk to people infected with TB. Passive smoking also contributes to the spread of TB as the infected person can pass the bacteria to the next through a cigarette.
Treatment is a preferable prevention measure by use of safe and effective vaccine. BCG (Bacillus Camille Guerin) vaccine helps prevent certain types of tuberculosis although its effectiveness varies. Many countries vaccinate infants with BCG as part of their control programs. Countries around the world have taken it upon themselves to improve standards for ventilation, air filtration and segregation methods in hospitals, prisons, and nursing homes. Creating awareness in third world communities on tuberculosis, how to prevent and treat it should be considered. (Ezzati and Murray 2004) This has been made possible by offering door to door TB services to remote areas where access to medical care is just as remote. Most nations are taking education and also TB treatment to homes and places of work, involving the government, community and private health providers and employers in the practice. This way every one plays a part.
Most governments in developing countries especially in Africa and Asia provide free treatment for TB to ensure everyone receives treatment.
For tuberculosis to be considered fully cured, it is give a minimum of 6 months treatment. The average tuberculosis treatment is an amalgamation of three to four antibiotics prescribed for a period of two months followed by two antibiotics taken for the remaining four months.
This combination of antibiotics helps reduce chances for the bacteria to resist to drugs. In cases of TB meningitis or bacteria resistance to one or more antibiotics, longer courses of treatment are needed and different drugs are also used. Two weeks in treatment the patients begin to feel better though cure can only be guaranteed after six months.
Treatment for pregnant women is different and more sensitive (Hughes 2009). There are drugs that are known to unsafe while there are those that are considered safe for pregnant women.
Many of us have the wrong assumption about tuberculosis including beliefs that people with HIV and AIDS are the ones prone to infection whereas everyone is at risk. Ignorance is the key reason why TB is spreading at an alarming rate. We assume it is the responsibility of other bodies but everyone is affected worldwide. Going near an infected person only provoked fear yet the bacteria is airborne. Touching an infected person cannot get one transmit tuberculosis. Tuberculosis has a cure provided it is detected early and given the right treatment.
Nelson J, and Moore M. 2001. “Epidemiology of Childhood Tuberculosis”
Ezzati M, Murray M 2004. ‘The Need for Continued Vigilance”.
Samet M, Maynard R, and Koren H 1999: “Air pollution and health.”
W.H.O Communicable Disease, 2008: “TB and Children Fact Sheet” Accessed on: 19 April 2009 from URL: http://www.searo.who.int
Hughes P: 2009 “symptoms and treatment of TB in pregnancy”
Phelan.J, 1995. “Social conditions as fundamental causes of diseases”