Tuberculosis and Epidemiologic Triangle

Introduction and background information

Tuberculosis is one of the communicable diseases that pose critical health concerns globally. Although there have been slight declines in tuberculosis prevalence over the last ten years, the disease is still a major cause of deaths with approximately 1.3 million fatalities and almost 9 million new infections reported in 2012 (Sulis, Roggi, Matteelli, & Raviglione, 2014).

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Tuberculosis (TB)

Cause and symptoms of TB

TB is a microbial disease caused by the bacterium Mycobacterium tuberculosis, which infects the respiratory system and other body parts, including the kidney, spine, and brain (Centers for Disease Control and Prevention, 2016). The M. tuberculosis infections manifest through multiple symptoms depending on the organ affected. The infection on lungs manifests through prolonged cough, chest pains, and blood coughs. Moreover, TB infection may manifest through weakness/fatigue weight loss, lack of appetite, fever, chills, and sweating at night (Centers for Disease Control and Prevention, 2016).

The transmission of the M. tuberculosis bacteria

The air is the medium of transmission of the M. tuberculosis bacteria. Coughing, speaking, or singing let out the bacteria from an infected person to the air and the bacteria spread to people nearby. It is worth noting that only the bacteria in the lungs/throats can be transmitted from a person to another. Bacteria in other body organs like the kidney/spine are oftentimes non-infectious (Centers for Disease Control and Prevention, 2016).

Complications and treatment of TB

Once the M. tuberculosis bacteria are in a new host, they become active and multiply drastically. The multiplication’s severity prevent the immune system of the infected person from fighting the bacteria. The drastic complication consequently result in what is commonly referred to as the TB disease making the newly infected person sick and able to spread the bacteria to other susceptible hosts.

TB should be treated promptly and with acute medical adherence. Noncompliance to medications/prescriptions may result in reinfection and drug resistance. Some of the treatment regiments adopted in the US include isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA). It is also worth to note that the immunity of susceptible hosts can be improved by immunization (Centers for Disease Control and Prevention, 2016).

Demographics of interests

As seen earlier, TB is a major cause of mortality and morbidity in the world. The prevalence of the disease had registered some drops in the last ten years. However, annual mortalities rates go beyond 1.5 million with new cases of infection each year (Srivanitchapoom & Sittitrai, 2016)

Major incidences are reported in populous regions in developing countries, especially in Africa and Asia (Jassal & Bishai, 2010).

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The determinants of health in TB

TB is highly dependent on socio-economic and environmental factors. Key determinants of health in TB are economic development levels and living conditions. The prevalence of TB is extremely higher in poor countries (Kolifarhoode, Khorasani-Zavareh, Salarilak, Shoghli, & Khosravi, 2015; Hargreaves, et al., 2011).

Therefore, TB is considered a poverty-related ailment with people in poor economies and living in impoverished environments registering highest mortalities and morbidities. In the poor economies, it is likely to experience other determinants of TB, which include poor dieting/food insecurity, low literacy levels, and unfavourable psychosocial circumstances (Sulis et al., 2014).

Vulnerability and susceptibility to TB infections are high among HIV patients, asylum seekers, inmates, drug/substance addicts, and people without homes.

The TB determinants facilitate the development of the disease in various ways. First, they increase the exposure of susceptible hosts to the M. tuberculosis. Second, they prevent timely and effective intervention and treatment of the diseases. Third, TB determinants inhibit early diagnosis and therefore facilitate widespread infections (Sulis et al., 2014).

The epidemiologic triangle as it relates to TB

Three factors, including hosts, agents, and environmental factors are a key component of infectious diseases. The interlinking relationship among the three components constitutes to what is referred to as the epidemiologic triangle (Venkatraman, Morris, & Wiselka, 2013).

In the spread of TB, there exists a strong linkage among the bacterial, the human host and environmental factors. Environmental factors (the settings in which transmissions occur) such as poor housing/poor living conditions (prisoners/immigrants), poverty, inaccessibility to medical services, and proximity to infected persons are some of the environmental factors that link the bacteria with the human host.

Similarly, the host may facilitate the spread and development of TB bacteria. However, research has revealed that modification of host factors is theoretically possible. Some of the host factors that highly influence transmission include the immunosuppression resulting from other diseases (diabetes/HIV), drug and substance abuse, insufficient Vitamin D, and the use of steroids and other immunosuppressant.

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The role of community health nurse in TB management

Community health nurses play significant roles in the management of TB (Ahmed, Soliman, & Awad, 2012). Proper/appropriate nurse performances and nursing competencies have been linked to patients’ adherence to medication and augmented outcomes.

Nurses play key roles in diagnosis and case finding. They are tasked with the evaluation of patients’ needs, understanding patients’ situations/status. As such, they carry out assessments to facilitate active case finding.

Further, community health nurses are tasked with assessing TB patients regarding various issues such as progress, intervention, visit schedules, responses to treatment among other pertinent information. It is highly recommended that the nurses make accurate and clear recording of patient information. Using special formats, nurses should then make reports to relevant physicians and other pertinent stakeholders (Ahmed et al., 2012).

Patient assessment involves collecting data pertaining each case of TB. The data is then analysed to come up with a nursing care plan. Data analysis should be done meticulously to allow proper and effective planning on care provision (Ahmed et al., 2012).

Community health nurse is responsible for TB patients’ follow-ups and referrals. It is highly recommended that follow-ups are done regularly and frequently to check on treatment adherence, possible medication side effects, and general progress of the TB patients. Where possible home visits should be done in outpatient to ensure treatment continuity. Depending on the conditions, the community nurse should make referrals (Ahmed et al., 2012).

The National Tuberculosis Controllers Association (NTCA) and its role in addressing TB

The National Tuberculosis Controllers Association is national agency in the US that deals with TB issues. From the agency’s aim, it is evident that NTCA is committed to aiding the elimination of TB from local to national levels. NTCA has sub-agencies that include the NTNC, the NSTC, and the SETC. Each of the sub-agencies has specific roles that they play in addressing TB (National Tuberculosis Controllers Association, 2015).

In the efforts to reduce the impacts of TB, NTCA has objectives that include providing a collective voice for all pertinent stakeholders in the fight to reduce infections, pushing for enactment of laws and policies that advance TB control and other TB reducing endeavours.

Moreover, NTCA holds periodical events in different cities and states throughout America where it sensitizes, trains, and carries out testing for TB among the US citizens. In the course of facilitating public awareness through training, NTCA works with other organisations like the RTMCs and the American Thoracic Society among others (National Tuberculosis Controllers Association, 2015).

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TB is a communicable disease that has high morbidity and mortality prevalence. M. tuberculosis bacteria cause the disease and it is transmitted through direct exposure (with the portal of exit/ re-entry being the respiratory system). Three factors, including the host, the environment, and the bacterial play significant role in enhancing TB transmission.

TB is treatable but needs strict medication adherence. National agencies, community health nurses, and other stakeholders play significant roles it the treating of TB. In addition, the stakeholders make efforts of reducing the spread/prevalence and the effects of TB.


Ahmed, A. I., Soliman, S. M., & Awad, L. A. (2012). Validation of Evidence-based Clinical Practice Guideline: Nursing intervention for newly diagnosed pulmonary tuberculosis patients at community setting. Alexandria Journal of Medicine, 48(2), 155–165. Web.

Centers for Disease Control and Prevention. (2016). Tuberculosis. Web.

Hargreaves, J. R., Boccia, D., Evans, C. A., Adato, M., Petticrew, M., & Porter, J. D. (2011). The Social Determinants of Tuberculosis: From Evidence to Action. American Journal of Public Health, 101(4), 654–662. Web.

Jassal, M. S., & Bishai, W. R. (2010). Epidemiology and Challenges to the Elimination of Global Tuberculosis. Clinical Infectious Diseases, 50(3), S156-S164. Web.

Kolifarhoode, G., Khorasani-Zavareh, D., Salarilak, S., Shoghli, A., & Khosravi, N. (2015). Spatial and non-spatial determinants of successful tuberculosis treatment outcomes: An implication of Geographical Information Systems in health policy-making in a developing country. Journal of Epidemiology and Global Health, 5(3), 221–230. Web.

National Tuberculosis Controllers Association. (2015). National Tuberculosis Controllers Association. Web.

Srivanitchapoom, C., & Sittitrai, P. (2016). Nasopharyngeal Tuberculosis: Epidemiology, Mechanism of Infection, Clinical Manifestations, and Management. International Journal of Otolaryngology, 2016(4817429), 1-6. Web.

Sulis, G., Roggi, A., Matteelli, A., & Raviglione, M. C. (2014). Tuberculosis: Epidemiology and Control. Mediterranean Journal Hematology and Infectious Diseases, 6(1), e2014070. Web.

Venkatraman, N., Morris, T., & Wiselka, M. (2013). Current Approaches to the Management of Tuberculosis. Wiley Online, 24(18), 47-50.

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