Tuberculosis as a Communicable Disease
People have been confronted with many sicknesses and diseases throughout history, which pathogenic microorganisms have brought about. Diseases are categorized broadly into either infectious or communicable diseases. This paper focuses on communicable diseases, primarily caused by pathogens that are disseminated from one person to another directly or indirectly. Examples of communicable diseases include HIV, measles, malaria, tetanus, smallpox, tuberculosis, and hepatitis A, among many others.
This paper aims to describe tuberculosis (TB), which is particularly interesting in population health. TB mainly affects the lungs and is influenced by various determinants of health, including social, economic, and environmental factors. The public health nurse’s role in addressing TB involves prevention, early detection, treatment adherence, and community education to reduce the disease’s burden and improve the population’s overall health.
Disease Description
Causes
Tuberculosis (TB) is caused by a bacterium known as Mycobacterium tuberculosis. The disease commonly affects the lungs but can also infect the kidneys, brain, and spine, which may result in death if not treated. Clark (2015) states that there are two primary forms of TB: active TB and latent (quiescent) TB infection (LTBI). The forms of infections are also clustered based on their molecular aspects.
Transmission
TB is airborne; the germs are indirectly transferred from one person to another through the air. TB can also be easily spread through sputum transferred when singing, coughing, or talking. Clark (2015) states that TB is mainly spread in congested areas, such as long-term care facilities, homeless shelters, or correctional institutions. Governments and health agencies, including the Centers for Disease Control and Prevention (CDC), have implemented measures to contain its spread and impact. Latent TB can be described as an inactive form of TB whereby a person carries the disease pathogens in the body and cannot transmit them to another person.
Symptoms and Treatment
People infected with latent TB do not show symptoms, but the infection can be detected through a skin or blood test. Active TB may be marked by night sweats, fever, loss of weight, loss of appetite, tiredness, coughing up blood, or chest pain. Anyone with these symptoms should be tested for TB and start medication immediately.
TB was incurable, and many people died when it was first discovered. This led to extensive research and the development of antibiotics to cure the infection. Antibiotics include pyrazinamide, rifampin, isoniazid, streptomycin, and ethambutol (World Health Organization, 2021). The drugs are taken over six to nine months. However, an infected person can become drug-resistant, so medication would be ineffective in containing the disease-carrying bacteria.
Demographics Most Affected
Tuberculosis affects people of all ages, but it is much more pronounced among older people who are the most productive. Every part of the world is infected with TB. Still, the World Health Organization (2021) indicates that the disease mainly affects middle- and low-income countries, which account for 80 percent of the cases. In 2021, Southeast Asia, Africa, and the Western Pacific accounted for an incidence rate of 46 percent, 23 percent, and 18 percent, respectively.
During the year, 10.6 million people contracted TB globally; men were the most affected at six million. Women were more affected than children, with 3.4 million and 1.2 million cases, respectively. Global mortality due to TB accounted for 1.6 million deaths in 2021, second only to the COVID-19 pandemic (World Health Organization, 2021). The morbidity between TB and HIV caused the death of 187,000 people in 2021 (World Health Organization, 2021). Even as all countries and age groups remain at risk, TB can be cured and prevented, reducing incidence and mortality rates.
Determinants of Health Affecting TB
Determinants of health comprise the factors within which people live, are born, study, play, work, and worship that impact their health, quality of life, and functioning, according to HealthyPeople.gov. (2023), there are five main classes of the determinants of health, which are further broken down into several other categories. TB is affected by the determinants of health, including the biological factors, which include gender, race/ethnicity, age, gender, and physiologic health status.
In terms of age, Clark (2015) indicates that TB occurs mainly in older persons than in other age groups. The racial and ethnic factors affecting TB stem from the different levels of exposure and other sociocultural and behavioral factors. In the U.S., racial and ethnic disparities account for higher TB incidence among Asians and Pacific Islanders (APIs) and persons of Hispanic origin. The incidence is higher than in other racial groups due to poor living conditions, mainly overcrowding.
Furthermore, the development of TB can be influenced by psychological factors. For instance, TB stress contributes to the development of active TB in persons with LBTI. TB is also positively correlated with depression, which is propagated by stigmatization. The development of TB is also influenced by behavioral determinants connected to sexual activity, diet, and drug use.
Malnutrition also makes people more likely to contract TB, particularly among unimmunized populations, and may contribute to other complications. Urban and rural differences also influence the development of TB, with a higher incidence reported in urban areas (Clark, 2015). Urban areas have higher TB incidence rates due to overcrowding from a high population density, homelessness, immigration, and dwindling public health infrastructures to control the spread of TB.
Additionally, the development of TB is influenced by social and cultural factors. Social forces are rampant due to the congregation of large groups of people, such as in correctional facilities and people staying indoors during the cold winter season. Policy and legal issues also influence TB incidence and control, given that different jurisdictions have laws related to the control of TB. In the U.S., the CDC has tried to intervene by suggesting that the different states develop a set of standard provisions on critical areas of disease control and management (HealthyPeople.gov, 2023). Traveling from one region to another is a significant factor in the spread and development of TB, as people carry germs from one region to another.
Epidemiologic Triad for TB
The epidemiologic triad is a framework that enhances understanding of diseases, including their causes and transmission. It comprises three aspects: agent, host, and environmental factors. Their interplay helps to describe the nature of infection and influences applicable measures for prevention, cure, and control.
In the case of TB, the agent is the TB organism, which includes several factors, such as the genome, mutations, and drug resistance (Clark, 2015). The host carries the organisms and is characterized by malnutrition, a history of contact, co-morbidities, gender, age, poor immunity, and race. The disease is transmitted through the air, and the environmental factors that propagate its transmission include inadequate sanitation, overcrowding, and poor ventilation.
Role of the Public Health Nurse
Nursing is crucial in controlling, preventing, and treating communicable diseases in individuals and population groups, including TB. The population health nurse can be involved in finding TB by assessing the determinants of health contributing to the development of the disease. Further involvement includes developing the necessary population nursing diagnoses and planning, executing, and evaluating options to prevent or control the occurrence of TB (Clark, 2015).
The nursing diagnosis can uncover risk factors that affect the development of TB in individuals or population groups. The other processes of reporting, collecting, analyzing data, and follow-up can be undertaken mainly through contact investigation and notification. The process entails finding individuals and populations that could be exposed to a person carrying TB organisms. The reporting process entails making them aware that they have been exposed to TB germs that require analysis and the provision of treatment and screening for the disease.
Furthermore, the population health nurse can analyze TB by interviewing people with the disease and their relevant contacts. Follow-up procedures can be undertaken by notifying the contacts of their status and offering the necessary screening and treatment services. Clark (2015) states that the process can involve making home visits or approaching contacts at work or any other place where they can be found.
Coworkers, relatives, or school classmates may be prime contacts. They should be prioritized based on the infection, considering their age, immunization, and the intensity and duration of exposure. Some individuals can have latent TB, which can be controlled with treatment and prevented from progressing to the active disease.
References
Clark, M. J. (2015). Population and community health nursing (6th ed.). Pearson.
Healthy People.gov. (2023). Social Determinants of Health. Healthy People 2030; U.S. Department of Health and Human Services. Web.
World Health Organization. (2021). Tuberculosis (TB). Web.