Africans immigrants are increasingly flooding the USA. It is approximated that in 2018 one billion people were on the move. The immigrants are faced with a myriad of challenges ranging from economic, political, cultural and health problems. The health challenges are not purely stereotypes that Africans are prone to most medical illnesses, but it is strictly environmental predisposition. The barriers have reduced or slowed public health effort to respond to health challenges. The Africans in this scenario are chosen due to the highest number of health challenges facing them. Tuberculosis (TB) is selected in this case as one on the health problem facing the immigrants. The TB both active and latent form is one of the health concern facing the immigrants.
In the USA, the epidemiological information associated with new cases of TB from 1992 to 2002 was estimated to be 5% and 7%. In the consecutive years, the disease dropped to an estimated 1.4% in 2003. The reason for the decline was associated with a decrease in the number of immigrants entering the USA. It was estimated that in 2009, 1545 new cases of TB were reported, the consecutive year reported 11,181 new cases were reported (Liu et al., 2015). The new cases of TB in 2011 in the USA were spontaneously related to the increasing number of immigrants entering the country. The highest number of TB were Africans and Hispanics. The reason a
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Despite the well-grounded prevention measures of TB, the condition remains one of the global burdens of public health. In 2017 only, it was estimated that 1.3 million deaths were associated with the disease. Immigrants are more predisposed to TB due to the poverty, poor access to health services, myths and misconceptions related to the disease, inadequate housing standards, poor access to vaccinations and civil wars. The conditions are also dependent on the country of origin, the mode of transport the implicated cases use as well as the level of contact they had with the TB patients. Though TB is common among the immigrants, the conditions have not been completely eradicated and still affects the citizens.
The disease surveillance at the points of entry finds it difficult to diagnose TB as some immigrants might have relapses with might not be detected as active cases of tuberculosis. The disease screening tools at the country of origin might be compromised, or the disease might be prevalent in the country. The immigrants also might have received poor treatment regiments hence creating an avenue for relapses
Tuberculosis is caused by Mycobacterium tuberculosis. The clinicians have arrived at a clinical decision that the disease should be suspected in cases one has unexplained weight loss, fatigue, fever, night sweats and loss of appetite. The most clinical disease reported in a hospital set up is pulmonary tuberculosis. The pulmonary tuberculosis is confined to the lungs. Extra-pulmonary tuberculosis is TB affecting the other anatomical parts of the body (Howley et al., 2015). The disease is transmitted from human-human via breathing air droplets containing the Mycobacterium bacilli. The infectious agents can persist in the air for several hours in the air. The other recorded modes of transmission of the disease are cutaneous inoculation. The mode of transmission is usually very rare but may occur in a laboratory set up.
The clinical judgment for tuberculosis disease is a tough entity and needs a lot of diagnostic procedures as it might mimic other conditions that present with the same clinical history. The clinicians should make a complete medical history, request for a chest x-ray and even request for gene expert for resistant forms of TB (Campbell et al., 2015). The chest x-ray might not be a definitive diagnosis for TB. This is attributed to other conditions that present with the same clinical symptoms. Sputum microscopy should be used to test for the bacilli. Patients with a history of TB are challenging to diagnose the disease because the chest x-ray films are indicative of an active type of opacities.
Treatment and management of TB should be done diligently. The patients clinically suspected to be having the disease should be isolated in private rooms with negative pressure. High precautions should be taken by clinicians while handling the cases. The ventilation of the room should be mechanically supported with exhaustion to outside especially with high-efficiency particulate air filter (Zammarchi et al., 2015). To manage the disease effectively, it is essential to treat the affected effectively with the WHO recommended treatments regiments. Poor treatments regiments have been linked with relapses and Multi-Drug Resistant Tuberculosis (MDRTB). The disease should be treated from 6-9 months depending on the response to the first line drug regiments. Treatment of TB has two phases, the intense phase of two months and the other continuous phase of six months. The drugs of choice and which are approved by the U.S. Food and Drug Administration (FDA) are Isoniazid (INH), rifampicin (RIF), ethambutol (EMB), and pyrazinamide (PZA). The drugs of choice are prescribed in combination for a specified period (Zammarchi et al., 2015).
According to the World Health Organization, in the intensive phase of Tuberculosis, the drugs of choice to be used are; Isoniazid with rifampicin, pyrazinamide, and ethambutol. The treatment in this phase should go for two months. In the continuation phase, the drugs of choice are Isoniazid with rifampicin. The duration of treatment is usually four months. The drugs are generally taken together. The drugs are taken daily for six months. The dosage of each medication must be computed. The isoniazid must have a maximum of 300 milligrams per body weight. Rifampicin, pyrazinamide, and ethambutol come with 10, 25 and 15 milligrams per body weight. The drugs cannot be effective if one drug is taken off or if the treatment plans are stopped. Rifampicin has been known to develop some form of resistance.
The case of retreatment, the World Health Organization, has developed a treatment regimen. WHO does not recommend the prescription of streptomycin not unless it was one of the drug regimens. The new recommendation by WHO indicates that, for the case of retreatment, category (ii) should be considered and drug sensitivity test carried to identify the resistant drug. The treatment success for relapses of TB is very low as patients cannot complete the recommended duration of treatment. The nine months period is very long for some impatient patients. The loss to follow up for TB patients predisposes the clients to drug resistance.
Considering the extended treatment regiments of TB, it is evident that the disease can be treated effectively. Among the immigrants, the disease treatment success rate is low as compared to the other population. The transient nature of immigrants can deter immigrants from accessing the drugs of TB. Poor drug regiments among the immigrants predispose them to relapses. The immigration also might also interrupt the treatment plan for the cases and hence compromise the population health (Zammarchi et al., 2015).
The African culture associated the Tuberculosis to witchcraft. Culture has been linked to low treatment success for TB. The people who have the disease feel shy to seek for treatment since the condition has been stereotyped. The public health efforts and professionals have had a tough time trying to address the stigma associated with the disease. The immigrants with tuberculosis live in isolated informal settlements (Zammarchi et al., 2015). The settlements are characterized by perpetual poverty with poor access to healthcare services. The immunization coverage is very low with some reporting that their children have not received BCG vaccination. The informal settlements have poor educational initiatives on TB. The issue is also coupled with high illiteracy which makes the strategy not appropriate.
Some traditional practices in African set up put up stringent measures whereby people with Tuberculosis were isolated and stigmatized. The people with TB could not be welcomed in big family meetings, and their belongings could not be shared with other people. At some instant, the patients were referred to the outcast and were left to vent for themselves.
Some traditions despised the use of conventional drugs and opted for the use of traditional medicines. Traditional cultures and practices prevented some patients from accessing healthcare services. The impact of the use of traditional medicine in the management of all forms of TB resulted in unexplained cases of relapse and deaths. In some cultures, the use of conventional drugs attracts punitive measures like expulsion from the community.
Poor structural houses characterize the informal settlements of the immigrants. Some immigrants are living in camps with the highest number of family members. Also, the structural aspects of the houses or camps give an ambient environment for the spread of TB (Nuzzo et al., 2015). The status of ventilation of the same houses is compromised. The defects in the structural aspects of the building for example lack of adequate permanent vents in the building gives an ambient environment for the spread of the infection.
African immigrants perceive that the treatment regimens for TB are experimental and perceive they are being tested by giving them the drugs. Cultural perception about treatment regimen for tuberculosis is putting public health interventions to futility (Nuzzo et al., 2015). Drugs pharmacovigilance have recorded that some immigrants are disposing of drugs. Health education should be commenced to educate the public about the importance of taking anti-tubular drugs.
An organization should carry out an educational program on any therapeutic drug regimens before the organization can disperse the drug. It is evident from the literature that TB drugs are not assimilated to some Christian's institutions and some affiliated organizations. The reason being that God treats and if one takes the medication they contradicts the Christians believes. It is, therefore, necessary for pharmaceutical companies to educate and incorporate these beliefs in their production and distribution programs.
Behavior change and communication strategies should be used by pharmaceutical industries to help the industries remove fears associated with TB drugs. The approach must first identify the problem associated with TB (Khan et al., 2015). Then the organization analyzes the issues to distinguish well the precipitators. A well-analyzed problem will not pose challenges when solving it.
Nurses should be agents of change in the population. The nurses are the real picture of the society and lead all aspects of health. The prime work includes behavior change communication. The nurses are in the forefront advocating for increased access to health services in the community. Among the issues, the nurses should be deliberating are access to anti-tubercular drugs. In line duty, the nurses also must address the stigma associated with TB among immigrants.
In conclusion, nurses play a significant role in maintaining the health of immigrants. The nurses must incorporate some of the aspects of community culture in maintaining the health of the population. It is also vital for nurses and all the healthcare workers to appreciate the role of community members of the immigrant population. Tuberculosis is one of the communicable disease affecting African immigrants. Nurses should be in the forefront fighting for resources to help combat this condition.
References
Howley, M. M., Painter, J. A., Katz, D. J., Graviss, E. A., Reves, R., Beavers, S. F., & Garrett, D. O. (2015). Evaluation of QuantiFERON-TB gold in-tube and tuberculin skin tests among immigrant children being screened for latent tuberculosis infection. The Pediatric infectious disease journal , 34 (1), 35.
Khan, K., Hirji, M. M., Miniota, J., Hu, W., Wang, J., Gardam, M., ... & Rea, E. (2015). Domestic impact of tuberculosis screening among new immigrants to Ontario, Canada. Cmaj , 187 (16), E473-E481.
Liu, Y., Posey, D. L., Cetron, M. S., & Painter, J. A. (2015). Effect of a culture-based screening algorithm on tuberculosis incidence in immigrants and refugees bound for the United States: a population-based cross-sectional study. Annals of internal medicine , 162 (6), 420-428.
Campbell, J. R., Krot, J., Elwood, K., Cook, V., & Marra, F. (2015). A systematic review on TST and IGRA tests used for the diagnosis of LTBI in immigrants. Molecular diagnosis & therapy , 19 (1), 9-24.population-based Cross-Sectional study. Annals of internal medicine , 162 (6), 420-428.
Nuzzo, J. B., Golub, J. E., Chaulk, P., & Shah, M. (2015). Postarrival tuberculosis screening of high-risk immigrants at a local health department. American journal of public health , 105 (7), 1432-1438.
Zammarchi, L., Casadei, G., Strohmeyer, M., Bartalesi, F., Liendo, C., Matteelli, A., ... & Bartoloni, A. (2015). A scoping review of cost-effectiveness of screening and treatment for latent tuberculosis infection in migrants from high-incidence countries. BMC health services research , 15 (1), 412.
