Global Health Problem


Global health is a collective goal of nations as there exist a great number of health problems that threaten humanity, like tuberculosis. Tuberculosis is one of the deadliest respiratory infections that have led to significant loss of lives all over the world. The condition can result in debility and also be traced among individuals with normal health but exposed to causative organisms. The infectious disease is highly communicable and poses great threats to the individuals whom it attacks. The infectious disease is airborne and can easily spread through the respiratory fluids released into the air during coughing, sneezing or talking. The disease has a tendency of progressing to latent stages, which makes individuals asymptomatic. Many studies in nursing have been done about the deadly disease, and the paper analyzes four nursing research, which investigate tuberculosis as a global health problem.

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Global Health Problem

Part A

Tuberculosis, normally abbreviated as TB, is an ancient disease which has been affecting human beings for more than 1000 years. It has become a global health problem as it kills 1.7 million people annually with each year having over 9.4 million cases. Tuberculosis is an infectious airborne communicable disease of respiratory system. It typically invades the lungs of an individual but also has a tendency of affecting other parts of the body. The disease is caused by a lethal Mycobacterium tuberculum, which is a bacillus. The condition is spread when an infected person releases the respiratory fluids through sneezing, coughing or through spitting the saliva containing the bacilli. Tuberculosis is infectious and spreads faster in overcrowded conditions that have accelerated air flow.

The bacilli usually cause asymptomatic infections in individuals; however, the condition can also progress to a more complicated symptomatic type. The infectious tuberculosis should be treated as soon as it is detected to prevent its effects on the body systems. If left untreated, it can infect a large number of individuals within short time duration, since it spreads easily in air. Preventive approaches have been taught to individuals to reduce chances of spreading the infection. However, late detection of the disease leads to more unprecedented deaths related to TB.

Studies on TB cases have revealed that it is an infectious disease that is mostly connected with poverty. TB is prevalent in populations with low socio-economic status. Poverty and low socio-economic status cause the spread of conditions to higher extents. Many articles that have been written on TB indicate how the developed countries dispute the fact of low socio-economic status. It was found that even in the developed countries with poor urban areas the disease spread scale was higher than in regions with high and moderate socio-economic statuses. It was clearly seen among the poor population where the disease caused deaths of many people. The main focus was placed by the researchers on the tuberculosis in the form of respiratory defects. During latter interventions, it was noticed that the condition can affect any part of the body except the integuments. The condition was also seen more among immune-compromised individuals. The effect of TB in immune-compromised individuals led to great concerns where certain individuals used its diagnosis for HIV.

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How Tuberculosis is Viewed in the US

Even from the perspectives of developed countries like the US, tuberculosis is viewed in a global context. Though the incidence of tuberculosis is low as compared to many world countries, the US has developed strategies for controlling it as it is a global health problem. In the US, nurses play an active role in the identification of potential health risks at the US borders. The proportion of foreign-born tuberculosis patients in the US has been steadily increasing. In the 19th century, the condition affected a large number of people mainly from the poor groups. As a result, research later revealed the effects of the disease in respect to reducing socio-economic status and poverty. Therefore, it benefits the United States to help strengthen tuberculosis control programs globally. Such policy is particularly implemented in the countries that are the source of most tuberculosis cases imported into the United States. The US understands that tuberculosis will not be eliminated in the country until the world-wide epidemic is brought under control. The authorities of the country have, thus, contributed to the global tuberculosis control efforts through targeted use of financial, technical, research and human resources. They have also participated in all initiatives aimed at stopping TB globally.

How India Views Tuberculosis

Tuberculosis has been and continues to be a terrible threat for the Indian population. A report by WHO in 20006 had indicated that India has more TB cases annually than any other country. TB has remained one of the most leading infectious causes of mortality in the country in the last decade as it causes approximately 364,000 deaths per year. India has been very keen on the global control of the disease, and it views it as a global health problem.

Why I chose the Topic

Tuberculosis is a leading cause of death worldwide even though it is a treatable and preventable disease. The first cases of TB have been indicated long time ago. The condition has different forms like the pulmonary TB, Scrofula and Lupus, TB of the bones and spine, tuberculosis meningitis. The disease can stay in human system for longer periods of time. It has a complex pathologic process that affects the human systems in a lethal way. Today, TB is one of the most feared infectious diseases in the modern world. TB presents a global health problem of escalating proportions as the epidemic spreads and becomes more dangerous every year. One-third of the world population today is under threat of the bacillus. The disease is expected to kill approximately 30 million people globally in the next ten years, and such fact makes it a global health problem.

Part B

Research 1: Noyes, J., & Popay, J. Directly observed therapy and tuberculosis: how can a systematic review of qualitative research contribute to improving services? A qualitative meta-synthesis. Journal of Advanced Nursing.

The aim of the research was to report findings from a meta-synthesis qualitative study, which concerned people who had or were at risk of being infected with tuberculosis, the service providers and the policymakers. The research sought to understand their experiences and perceptions regarding the treatment of tuberculosis. The research had proposed directly observed therapy as an intervention package in improving treatment and adherence of tuberculosis.

The study used systematic review methods in searching, screening, appraising and extracting. Thematic analysis of data was used in synthesizing data from 1990-2002 and literature update to 2005. The methodology addressed tow questions: what does qualitative research state about the facilitators and barriers when one is accessing or complying with treatment of tuberculosis? And what did qualitative research state about the diverse results and effect of the controlled randomized trials that are included in the Cochrane review?

The research findings represented five themes from the data that was synthesized: socio-economic circumstances, individual agency and material resources, knowledge systems and explanatory models relating to TB and its treatment, stigma experiences regarding tuberculosis and the social relationships of care and social organization. The research concluded that the findings had a contribution to developing a theory concerning global WHO tuberculosis control and stated how useful it can be for local implementation.

Research 2: Reilley, B., Bloss, E., Byrd, K. K., Iralu, J., Neel, L., & Cheek, J.  Death rates from human immunodeficiency virus and tuberculosis among American Indians/Alaska natives in the United States, 1990-2009. American Journal of Public Health.

The main objective of the study was to compare HIV and TB mortality from 1999 till 2009 between people of American Indian natives (mainly from Alaska) and the whites. In the methodology, national vital statistics surveillance systems of mortality data were adjusted to receive the racial misclassification. It was done through linkage with Indian health service records of registration. They compared annual death rates from TB and HIV for approximately ten years. The results showed that death rates from TB were higher than from HIV among both the native Indians and the whites. The research showed that the death rates were higher among the Indians as opposed to the whites and that TB caused more deaths as opposed to HIV, thus, becoming a global health problem. The study concluded that public health interventions have to be prioritized to reduce TB mortality among the population.

Research 3: Marks, S. M., Flood, J., Seaworth, B., Hirsch-Moverman, Y., Armstrong, L., Mase, S., & Sheeran, K. Treatment practices, outcomes, and costs of multidrug-resistant and extensively drug-resistant tuberculosis, United States, 2005-2007. Emerging Infectious Diseases.

The research background argued that studies about TB in the US have been limited due to small sample sizes, limited study periods, minimal outcome information and cost or relying solely on surveillance data. The study analyzed the characteristics that are associated with drug resistance, treatment, timely diagnosis, outcomes and the costs associated with MDR-TB. It was done for the cases reported to the Center for Disease Control and Prevention by New York, California, Texas in the period ranging from 2005-2007. The research used qualitative and quantitative methods with 75% simple random sample of MDR-TB cases from New York and California and 50% sample from Texas.

The results showed that out of a sample of 135 patients, representing 36% of MDR-TB and 56% of XDR-TB cases reported in the US, 87% were foreign-born, while 36% had prior TB disease. The participants who were foreigners were mainly from India, Mexico, Philippines and Vietnam. 7% were homeless before being diagnosed and during treatment. The quantity of homeless in the US is much bigger as compared to other groups of people. The research concluded that stable rise in the number of homeless in the country is a potential risk factor. It causes the situation when TB detection occurs with delay among such people, exposing larger number of citizens to the infection. In addition, homeless individuals were found reluctant to going to the hospital to seek medical attention. It exposes them to many threats in cases of acute infections.
Since TB infection may take longer time to be detected, the homeless individuals do not detect the infection in time. It leads to worsening of the condition, which may then spread to other larger numbers of healthier individuals. The general health condition of homeless individuals is always poor due to inappropriate nutrition and lack of food. Such situation results in lowering their immunity, making them susceptible to infectious conditions like TB.

Research 4: Gupta, A., Kulkarni, S., Rastogi, N., & Anupurba, S. A study of Mycobacterium tuberculosis genotypic diversity & drug resistance mutations in Varanasi, North India. Indian Journal of Medical Research.

The study was aimed at investigating the molecular epidemiology of Mycobacterium tuberculosis genotypes in Varanasi, northern India, and how they are associated with clinical presentations of patients with pulmonary TB. In the methodology, 104 TB patients attending a tertiary referral hospital in northern India were selected for screening. They were screened for susceptibility to isoniazid, ethambutol rifampicin and streptomycin using proportion method. The results showed that 83 of 104 isolates had Mycobacterium tuberculosis genotype. The study gave an insight into the genetic biodiversity of the Mycobacterium tuberculosis in Varanasi, northern India. It concluded that TB is caused by a wide diversity of spoligotypes with genotype lineages that are predominant. The findings of the study are very vital in the control and prevention of TB in the given area.

PART C: Conclusion

What I have learned from the journal articles

Risk Factors Associated with TB

There are many considerations regarding the condition. Susceptibility to the tuberculosis infection is related to the immunity of an individual. Reduced immunity is connected with most infections of TB. It is estimated that about 13% of people diagnosed with TB suffer from HIV. The disease is common where cases of HIV are so increased making it the commonest infectious disease among the poor people. It is also associated with poor nutrition and overcrowding of individuals suffering from the disease.

Stephen and Alimuddin illustrate other potential risk factors as the prisons, homeless shelters like camps for the refugees and displaced persons. It is highly spread in schools with low socioeconomic status where other children can easily pass the infection to their peers. It can also be acquired in the hospitals and other healthcare institutions where individuals with the infections are openly exposed to other healthy individuals. Other conditions like chronic lung illnesses increase the chances of developing the disease. Diabetes mellitus may also lead to the propagation of the condition due to debility and compromised immunity. Drug abuse, e.g. chronic alcohol consumption, predisposes individuals to the disease to higher extents. Some medications have also been found associated with the condition, e.g. the corticosteroids.

Signs and Symptoms of TB

Depending on the immunity status, the condition can be described by evident signs and symptoms. Estimated 5-10% of the individuals who do not have HIV acquire the condition before they die. Most people with the active form of the disease either have HIV or compromised immunity. The disease can affect any part of the body causing many symptoms related to the sites affected. Main descriptive features used in sites affected include the lungs (pulmonary type) or any other part of the body (extra-pulmonary type). As aforementioned, it causes intense fever, body chills, night sweats, anorexia, fatigue due to compromised respiration and weight loss.

In pulmonary infections, the disease causes productive cough, which is persistent over longer periods of time. The persistent cough can cause serious chest pain resulting from serious lung involvement. In cases of serious infections, the pulmonary artery may be affected and eventually impacted leading to bleeding during coughs. On the other hand, the condition can lead to inflammatory processes in the lobes of the lungs affected leading to occurrence of purulent secretions during cough. Extra-pulmonary effects may influence pleura, central nervous system, lymphatic system, genitor-urinary systems, skeletal system and many other systems that might be susceptible during the time of infections. The symptoms related to the extra-pulmonary type of infection include bone pain (osseous tuberculosis), tuberculosis ulcers, which affects the skin, and other types, which account for other forms of extra-pulmonary tuberculosis.

Mechanism of Transmission

In many studies, it has been found that the condition is mainly airborne. Any process that can lead to release of infectious respiratory fluids can cause transmission of the bacilli responsible for the condition. When an infected individual coughs, sneezes or spits onto an open surface, the respiratory fluid containing the tuberculosis bacilli can be inhaled by the healthy individuals. Through such process, the healthy individual acquires the bacilli, which start to develop in his/her body.


The infectious condition is lethal especially in cases of compromised immunity. Healthy individuals are only susceptible to the Mycobacterium tuberculosis, which then causes latent infections. Fewer cases of latent type of infection progress to the active type of TB. Individuals with HIV have increased susceptibility to the bacilli, causing numerous health issues in their body systems. With proper management, the disease has minimal chances of leading individuals to death.


Diagnosis of TB depends on the stage of the infection. Latent stage has a different diagnostic approach as the active phase. The conditions can only be suspected by use of signs and symptoms but might not be diagnosed through them. However, the signs and symptoms can be used to suggest the diagnosis, especially if they last for longer than two weeks. Chest X-ray shows the involvement of the condition in the lung tissue defining the extent of the disease involvement. The chest X-ray gives results, which are indicative of TB infection influence on the lung tissue.

Solution to the Homeless

One of the major achievements that can be made in preventing the spread of TB among the homeless individuals is identifying the individuals with the infection as early as possible. It will allow for early treatment of the condition, preventing the rest of the population from infection. To ensure that the infectious individuals are properly treated, treatment, as well as follow-up must be ensured. It will enable the individuals to terminate the spread to other healthier individuals, as well as to completely heal the patients form the infection.


Prevention starts with vaccination and identification of cases and treatment. Vaccination of children with BCG is protective against the bacilli. It has helped a number of children, thus, reducing the number of TB cases in the healthcare institutions. Effective treatment regimens for the identified cases help in the reduction of newer cases propagation. The preventive measures have been developed by numerous researchers for many years to help reduce the spread of the disease.

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