For decades, Tuberculosis has been a deadly disease finding its way in every corner of the world. An airborne disease caused by a mycobacterium is highly infectious and has killed millions of people over the years. Transmitted through droplets when someone coughs, sneezes or speaks, it is contagious and affects the lungs of an individual. Although some people are asymptomatic (TB Latent), those are not, end up requiring treatment for active TB, and some lose their lives. Hence, focusing on India, Nigeria, and the United States, the first two countries represent two of the thirty world-leading cases of TB. Although the world continues to experience improvement in the number of infections and lowered deaths, there is no doubt that it continues to infect millions of people. Although anyone is at risk of contracting TB, some populations tend to be more at risk of falling sick upon exposure.
People with a weak immune system due to underlying health conditions are more at risk of contracting it. According to the CDC (2016), persons with HIV are more at risk of getting TB than those with healthy immune systems. Such underlying immunocompromised diseases include diabetes, cancer, and hypertension are at risk. With lowered immunity, it gives the body a weak defense system that does not fight ailments as a person with a healthy immune would. For instance, with India having the highest infections in 2019, those highly infected were persons suffering from other diseases. Indeed, an estimated 63,000 HIV positive persons in Nigeria die each year from Tuberculosis, with over 300,000 cases undetected (WHO, 2019). However, for the United States, it forms one of the countries recording low occurrences of the disease, meaning their cases are manageable. Nonetheless, the majority of those infected are people with underlying conditions that make their bodies more susceptible to external attacks.
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Also, behavioral risk factors result in high cases of the disease. The behaviors include smoking, pollution, and living in poor ventilation areas that play a vital role in determining infection. Smoking affects the lungs, while pollution and poor ventilation present an unconducive environment for adequate air circulation. With the population of India, many people live in populated areas with inadequate ventilation systems. Also, streets are overcrowded, meaning that breathing in air contaminated by infected persons is highly likely. The reason for living in such areas is also contributed by poverty as populations prefer residing in slums, which are cheaper. World health organization (2019) outlines that 60% of patients with TB live under the poverty line in Nigeria. With such, affording basic needs and nutrition to keep healthy is difficult, increasing the chances of infections and re-infections. Also, with thousands of people dying every year due to smoking in the U.S., tobacco users increase the chances of the disease due to weakened lungs that Georgia has the highest cases of TB in the U.S, which can be accounted for due to smocking incidences (WHO, 2019).
Age is a significant factor as different age brackets are at risk of mixing social and biological factors. Young people are likely to engage in social circles where social contact increases the chances of overcrowding and new environments where risk is higher. Ideally, in old age, the risk of having low immunity is higher, and the possibility of underlying conditions is also high. In the U.S, WHO estimates that incidences peak at a young age between 15-40 years, and again cases are at 60% for persons aged 25-64 years. It is the same similar case with India, with the majority being young people of 20-64 years. However, in Nigeria, high cases are recorded for children under the age of 14, with an 85% prevalence due to biological immunodeficiency and malnutrition (Ogbudebe, 2018).
Nonetheless, there have been increased initiatives towards creating awareness. Despite globalization, stigmatization for patients with TB continues to be high, as some people affiliate it with HIV infections, which is not always the case. Collaborating with local communities and civil society organizations has proved vital in engaging communities in the fight. In 2015, the World Health Organization developed the End TB program to reduce cases by 95%. Together with Directly observed treatment short-course strategy (DOTS strategy) in India, they have proved impactful in TB reduction among young people. The United Nations has worked hard towards informing communities on how the importance of medication and preventative measures. Through community systems strengthening, health access in Nigeria and India has immensely improved with people becoming more willing to take drugs.
Increased funding has made it easy to access to treatment. According to the Global Fund (2019), over the past three years, 6 million lives have been saved and, 17 million treated of Tb due to bridging the $ 1.6 funding gap. In developing nations, making TB treatment free in public hospitals save the lives of people who would otherwise not afford medication. For places such as India and Nigeria and high insurance cost in the U.S., is high, funding has been a relief as patients can focus on nutrition with the amount they would have used for treatment.
Also, initiatives to reduce treatment duration continues to yield hopeful results. The treatment takes 6-9 months, where patients have to adhere to antibiotics dosage. According to TB Alliance (2018), TB is the most infectious disease, killing 1.5 million people yearly and a person within every 21 seconds. Hence, in the last five years, the focus on keeping phase 3 of TB trials continue with improved execution of non-inferior tests. Such takes on a route of creativeness and the use of technology for the improvement of drugs. Over 500,000 patients with drug-resistant issues have benefitted from adjustments to TB treatment (Philips et al. 2019). Still, each trial results in different merits that are useful in establishing new changes to the next test for a better outcome.
For management, there should be frequent screening for the disease. Targeting hospitals, homeless persons, and the borders make it possible to use medical practitioners within the named areas to help treat the infection before it progresses. For persons with active TB cases, such screenings would help increase follow up on treatment and establishing better ways of helping patients with psychological strains that come with the diagnosis. With having enough resources within hospitals, the staff is well equipped with handling cases while monitoring treatment. TB Strategy (2019) asserts that to attain 95% of treatment success, focusing on increasing screening capacity is mandatory if we intend to see results.
It is also vital for governments to be more committed to funding set initiatives and strategies. The Global Fund (2019) outlines that there is a $1.6 billion deficit in financing TB services annually. For people who depend on free drugs, such a gap could prove costly as most people, especially in developing nations, cannot afford insurance or funds to support their treatment. Engaging policymakers towards taking steps that increase funding of local TB projects is also essential. World collaboration towards funding national TB centers which help ensure effective and efficient resources for dealing with the disease.
Through an analysis tool, data collection, and evaluation can help measure the effectiveness of initiatives and funding. Such benefits analysts know whether the targeted objectives are met over some time. For instance, the cohort analysis tool has been very efficient in indicating the quarterly and annual rates. Similarly, the tool can establish the populations within countries that are more susceptible to the disease. Recording and evaluating data allows for efficient reporting to indicate persons who have reacted to treatment and those who have recovered with no complications.
In conclusion, with a focus on the United States, Nigeria, and India, each having populations with infections, risk factors include persons with weak immune, behavioral factors, and age. Indeed, persons with vulnerable immune systems such as those with underlying conditions, including diabetes, HIV, and hypertension, are more at risk (THE GLOBAL FUND, 2015). Also, behavioral changes such as smoking and living conditions increase the chances of infection. Still, research indicates that certain age groups have a higher chance due to biological and social factors. Nonetheless, world organizations have made progress in establishing programs, increasing funding, and carrying out successful drug trials to reduce the treatment period and side effects of drugs. To ensure that effectiveness thrives, there is a need to increase TB screening to determine active cases and help them towards recovery. Government involvement in funding international organizations and local programs is also vital to ensure all patients get treatment on time. To measure that effectiveness, analysis through data collection, record, and interpretation is critical to measure progress between different periods.
References
TB is a Pandemic . (2018). Retrieved from TB Alliance: https://www.tballiance.org/why-new-tb-drugs/global-pandemic
TB Risk Factors . (2016, March 18). Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/tb/topic/basics/risk.htm
THE GLOBAL FUND STRATEGY 2017-2022. (2015). Retrieved from The Global Fund: https://www.theglobalfund.org/media/2531/core_globalfundstrategy2017-2022_strategy_en.pdf
WHO. (2019). Implementing the Stop TB Strategy . Retrieved from the World Health Organization.
Ogbudebe, C. L., Adepoju, V., Ekerete-Udofia, C., Abu, E., Egesemba, G., Chukwueme, N., & Gidado, M. (2018). Childhood Tuberculosis in Nigeria: Disease Presentation and Treatment Outcomes. Health services insights, 11, https://doi.org/10.1177/1178632918757490
Phillips, P., Mitnick, C. D., Neaton, J. D., Nahid, P., Lienhardt, C., & Nunn, A. J. (2019). Keeping phase III tuberculosis trials relevant: Adapting to a rapidly changing landscape. PLoS medicine, 16(3), e1002767. https://doi.org/10.1371/journal.pmed.1002767
The Global Fund (2019). Tuberculosis financing and support gaps in 118 countries eligible for global fund support.
World Health Organization (2018). Tuberculosis. https://www.who.int/news-room/fact-sheets/detail/tuberculosis .
