Introduction
Tuberculosis (TB) is a communicable disease caused by an etiological agent. TB is considered a major global problem, being a significant health threat mainly in developing countries, which suffer from limited resources and overloaded healthcare systems. The disease is transmitted through respiratory secretions, such as coughing and sneezing. Though TB is not restricted to particular groups, those who are immunocompromised, older people, and children are at higher risk. The increasing number of multidrug-resistant TB cases is posing significant challenges in diagnosis, treatment, and prevention, necessitating the development of innovative tools for diagnosis.
Description of the Disease
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. This disease has long been a debatable subject, and though there has been tremendous progress in its control, it remains a threat to public health. Primarily, TB is transmitted through the air, as when an infected person coughs, sneezes, or speaks, droplets laden with TB bacteria are propelled into the air (Addo et al., 2022). Thus, when others inhale these droplets, infection can occur. However, it is worth noting that prolonged exposure to an active TB patient is usually required for such an infection to occur.
TB symptoms may vary depending on the type and location of the disease. The most typical form of pulmonary TB often involves morning coughing (sometimes containing blood), pain in the chest, fever, night sweats, and significant weight loss (Addo et al., 2022). If the TB infection spreads beyond the lungs, it can cause additional symptoms depending on the organs affected.
Taking TB treatment requires committed adherence on the patient’s part. Generally, a combination of several antibiotics is prescribed, and therapy lasts 6 to 9 months. Incomplete treatment puts the risk of drug resistance, makes disease management worse, and might facilitate the spread of drug-resistant strains.
The complications of TB can be dire, especially when there is no treatment or the development of drug resistance. These problems may include pulmonary fibrosis, meningitis (inflammation of the membranes that protect the brain), bone/joint infections, and even the most fatal form of disseminated TB, in which the bacteria spread throughout the body. According to the WHO (World Health Organization), in 2021, more than 50% of the TB (tuberculosis) cases were reported in the WHO regions of South-East Asia, Africa, and the Western Pacific (World Health Organization, 2021).
TB is closely associated with poverty, malnutrition, overcrowding, and transmission, and mostly poor and middle-income countries are affected. The WHO estimated 10.6 million cases of TB globally in 2021 (World Health Organization, 2021). In 2020, around 13.7 million active cases were reported in a given period (World Health Organization, 2021). Global efforts to address socioeconomic determinants enabling TB’s persistence are crucial to alleviate its preventable burden on human health and wellbeing.
TB morbidity and mortality rates are still extremely high. A single infectious agent was responsible for the anticipated 1.6 million deaths from tuberculosis (TB) in 2021, placing the disease in the top 10 causes of mortality worldwide (World Health Organization, 2021). The World Health Organization (2021) reported that the global death rate from the previous year was 11.6%.
Significant progress has been made in eliminating tuberculosis despite the troubling trend in these data. The World Health Organization (2021) states that the End TB Strategy aims to reduce tuberculosis deaths by 95% and new cases by 90%. The incidence rate has been declining for the previous few decades. Despite high TB rates, global goals and declining cases suggest that coordinated efforts to address its multiple drivers and ensure equitable access to prevention, diagnosis, and treatment could potentially aid in reducing the burden of the disease.
Determinants of Health Affecting Tuberculosis
Tuberculosis is caused by socioeconomic factors such as poor diet, small living spaces, and limited access to medical treatment. As reported by the World Health Organization (WHO), a significant share of TB cases is found in low- and middle-income countries where there is poverty. In 2021, 95% of TB cases and deaths were among individuals in developing countries (World Health Organization, 2021). Education level is another crucial element because the knowledge about TB prevention, symptoms, and treatment options is reduced at lower education levels, which makes it hard to identify the symptoms early and, therefore, delays the required intervention.
Some of the significant environmental factors that help spread TB include overcrowding and poor ventilation. Based on WHO data, about one-fourth of the global burden of TB is caused by household air pollution in slums and informal settlements, which are usually characterized by crowded housing and insufficient sanitation (World Health Organization, 2021). Indoor pollution from using solid fuels for cooking and heating intensifies the danger of contracting TB.
Biological determinants, such as HIV/AIDS due to reduced immune function, malnutrition, and chronic diseases like diabetes, increase the risk of TB infection and the progression of the disease from latent to active form. By the year 2021, it is estimated that as many as 8.5% of the globe’s TB cases were among those living with HIV (World Health Organization, 2021). The matter of the co-epidemic of HIV and TB is highlighted because the risk of developing TB in people living with HIV is higher than that of an HIV-negative person.
Healthcare determinants also significantly contribute to the development of the TB environment. Inadequate and unequal access to high-level healthcare services, deficient healthcare infrastructure, and delays in diagnosis and treatment prevent the epidemic from being addressed effectively (Adhikari et al., 2022). In many resource-restricted settings, treatment centers lack diagnostic equipment, medicines, and trained personnel to provide appropriate care for TB patients. Additionally, the appearance and distribution of the drug-resistant TB variants have become a big problem since they usually require more and more complicated and expensive treatment courses that low-income countries cannot afford.
The Epidemiologic Triad
The host variables are the unique characteristics and environments of individuals who are more vulnerable to contracting M. tuberculosis infections. Immunity is the primary host parameter, and individuals with compromised immune systems, such as those with HIV/AIDS, malnutrition, or immunosuppressive treatment, are at a higher risk of tuberculosis activation (Frascella et al., 2020). The inability of the body’s defensive mechanisms to successfully combat the invasive bacteria exacerbating infection contributes to TB susceptibility. People become more vulnerable to the invasion of TB due to the reduced defenses their bodies have against the disease’s microorganisms.
Mycobacterium tuberculosis, a virulent bacterium, causes tuberculosis due to its ability to cause disease and evade the host’s immune system. Tuberculosis uses several strategies to evade the host’s defenses; it can remain in one area and spread throughout the body. Furthermore, a significant barrier to the fight against tuberculosis is the emergence and rapid spread of drug-resistant strains of M. tuberculosis (Addo et al., 2022). These strains resist the effects of common antimicrobial drugs; they necessitate longer, more complex treatment plans, which can burden healthcare resources and jeopardize patient adherence.
The intricate, multidimensional role of environmental variables in tuberculosis epidemiology is underpinned by numerous interactions among physical, social, and economic conditions that either facilitate or impede the spread of the disease. Slums, informal settlements, and jails are among the most profitable places for the airborne transmission of TB germs due to their large numbers of people living and working close to one another. Poverty and underprivileged areas typically have higher rates of tuberculosis (TB) because the impoverished have lower levels of health, education, and nutrition, rendering them more susceptible to developing the disease (Addo et al., 2022). Immune system impairment results from malnutrition, and infection occurs when timely diagnosis and treatment are unavailable.
Role of the Public Health Nurse
Public health nurses often provide the first degree of care when someone has symptoms or is at risk of becoming sick. They look for potential cases by working in healthcare institutions, conducting home visits, and engaging in community outreach activities. This is crucial because it promptly notifies health agencies of suspected cases, initiating epidemiological investigations and contact tracing (Adhikari et al., 2022). They also take steps to stop the spread of illness by gathering and documenting every detail about the patient, including clinical indications and symptoms, risk factors, and demographics.
Moreover, the nurses conclude that they have collected information and localized certain tendencies, risk groups, and opportunities for planning focused interventions and resource allocation. They ensure the cases are resolved by providing proper treatment. Patients on TB regimens should pay close attention to the length and complexity of their medication regimens and their doctor’s advice to achieve the desired treatment outcomes and prevent the emergence of drug resistance (Frascella et al., 2020). The nurses also engage patients regularly by reminding them, supporting and instructing them, and presenting the appropriate resources.
Besides providing clinical care, public health nurses are crucial to community education and sensitization programs. Locals’ knowledge of their culture, customs, and beliefs is used in culturally responsive academic programs. Stigma around tuberculosis is declining, and community involvement in TB control is growing through activities aimed at dispelling myths, encouraging diagnostics, and encouraging people to visit treatment facilities as early as possible (Frascella et al., 2018). Public health nurses work with multiple dedicated teams of physicians, epidemiologists, and community workers to control tuberculosis cases. They formulate public health policies, guidelines, and protocols to ensure they are based on scientific principles and address the unique needs of individual communities.
Conclusion
Tuberculosis is currently one of the most crucial health issues that is affected by environmental, cultural, and economic factors. TB transmission and recurrence are due to poverty, HIV/AIDS, urbanization, ecological issues, and healthcare system problems in areas where TB is likely to occur. A holistic, equity-centered approach to the root causes of this issue should be in place to help people eradicate this complex problem. Combating poverty, advancing living conditions, mitigating environmental damage, providing health care, and HIV/AIDS prevention solutions can help reduce the disease. Nevertheless, if individuals address this ailment in a multifaceted way, it can be cured, thereby ushering in greater equality and a livable future for everyone.
References
Addo, J., Pearce, D., Metcalf, M., Lundquist, C., Thomas, G., Barros-Aguirre, D., Koh, G. C. K. W., & Strange, M. (2022). Living with tuberculosis: A qualitative study of patients’ experiences with disease and treatment. BMC Public Health, 22(1).
Adhikari, N., Bhattarai, R. B., Basnet, R., Joshi, L. R., Tinkari, B. S., Thapa, A., & Joshi, B. (2022). Prevalence and associated risk factors for tuberculosis among people living with HIV in Nepal. PLoS ONE, 17(1).
Frascella, B., Richards, A. S., Sossen, B., Emery, J. C., Odone, A., Law, I., Onozaki, I., Esmail, H., & Houben, R. M. G. J. (2020). Subclinical tuberculosis disease – a review and analysis of prevalence surveys to inform definitions, burden, associations, and screening methodology. Clinical Infectious Diseases, 73(3).
World Health Organization. (2021). Global tuberculosis report.
