Tuberculosis in Leeds the United Kingdom - Essay Example

? EPIDEMIOLOGICAL REPORT ON TUBERCULOSIS IN LEEDS UK due: Table of Contents Table of Contents 2 Abstract 3 Introduction 3 Tuberculosis latent and active 4 Response and treatment 4 Risk factors 5 Overview of the epidemiological situation 6 Health protection and health improvement solutions 7 Results- Summary of clinical findings 8 Discussion 9 Recommendations 10 Conclusion 11 Bibliography 13 Abstract Tuberculosis lingers as a significant public health threat in Leeds west, Yorkshire. Findings support the hypothesis that tuberculosis infection was introduced into Leeds west, Yorkshire by airborne transmission from the sputum of an infected individual. These findings also examine the effect of ethnicity and deprivation in regard to the prevalence rate of tuberculosis in the city of Leeds. The rising prevalence of tuberculosis in Leeds west, Yorkshire, UK in the last decade has been mainly due to the high tuberculosis rates among ethnic minority groups. The epidemiology of the ethnic minority groups has not well been understood. From the research conducted, there is a connection between tuberculosis and poverty in ethnic minority groups residing in Leeds west, Yorkshire. In the last decade, tuberculosis cases have progressively increased among the ethnic minority groups who come from places where tuberculosis is widespread. It is evident that many efforts have to be implemented on primary and secondary care, in order to control and maintain the spread of tuberculosis. Introduction This report aspires to give a general idea of the situation of tuberculosis in Leeds west Yorkshire, UK. Data obtained is based on tuberculosis respiratory latent and active, as well as the health issues associated with this communicable disease. This analysis is grounded on data collected from various studies, scientific reports, and publications related to the epidemiological situation of tuberculosis in the specific geographical location (Leeds west, Yorkshire, UK). Tuberculosis persists as an important public health issue in the United Kingdom despite control of this disease being made a priority at government level. Studies on the disease epidemiology have been conducted service provision was produced with proposals for future planning, yet despite these efforts, Leeds west, Yorkshire continues to have a high incidence of tuberculosis. Tuberculosis is a respiratory tract infection brought about by the bacterium Mycobacterium tuberculosis. Mycobacterium tuberculosis is a thin, large, slow growing bacilli. This bacterium contains a cell wall prepared of a waxy material called mycolic acid, which facilitates the cell less permeable. This infection affects the lungs mostly; other organs may also be affected. Tuberculosis is an airborne disease spread when an individual with active pathogens coughs or sneezes and sprays the bacteria into the air. Typical symptoms of tuberculosis include, weight loss, loss of appetite, fever, fatigue, and a persistent cough lasting for more than three weeks with the production of bloody sputum. Tuberculosis latent and active There are two states of Tuberculosis, latent TB infection and active TB disease. According to statistics, not everyone who inhales the pathogens develops active tuberculosis condition; this is due to the immunity status. Roughly, 10% of the infected individuals develop active diseases in their lifespan. Latent tuberculosis occurs when the bacterium Mycobacterium tuberculosis is inhaled, but the body stops the bacteria from growing. As a substitute, the bacterium stays in the body as a latent tuberculosis infection; which cannot be spread to other people. Active tuberculosis is present in an infected person in situations whereby the body’s resistance is low or if the individual is exposed to the pathogens for a prolonged period, defeating the immune system. Active tuberculosis response leads to inflammation that can damage the lungs (Warrell; et al 2003: 570). Response and treatment Chest x-ray, Mantoux test, and blood tests can be carried out to determine tuberculosis diagnosis if the patient was in close contact with a tuberculosis victim. Treatment of tuberculosis is an itinerary of antibiotics lasting for six months. Different antibiotics are used as some strains of Mycobacterium tuberculosis are resistant to specific antibodies. Treatment of a drug resistant tuberculosis strain usually lasts for as long as 18 months. Moreover, drug susceptibility investigations are carried out to perceive resistance to the antibiotics used in the management of tuberculosis (Royal College of Physicians 2006: 113). Risk factors The epidemiological triangle is useful in comprehending infectious disorders, in this case tuberculosis infection (Mausner & Kramer 1985: 217). According to the epidemiologic triangle, tuberculosis causation is as an interaction among agent, host, and the environment (Bhopal 2008: 256). Risk factors for tuberculosis infection include the following: 1. Age: Potential victims of this bacterium include young children and adults. Young children are more prone to infection from a tuberculosis patient; this is due to their developing immune system, which is not yet strong. Young adults are also susceptible to tuberculosis especially in their most productive years. The elderly individuals, who were once infected with tuberculosis, pose the greatest risk of reactivation of the disease (Schaaf et al 2009: 18). 2. Close contact of a tuberculosis patient: Tuberculosis infection risk is most likely when around individuals with active pathogens who are coughing. Infection is dependent on the nature and duration of exposure. 3. Ethnic minority groups: Most tuberculosis cases occur from ethnic minorities; Africa and Asia. Individuals originating from such locations with a high incidence of tuberculosis pose a greater risk to their children and close relations born in the UK. 4. Immuno-compromised patients: An excellent example of such patients includes HIV victims. HIV restrains the immune system, making it difficult for the body to destroy the Mycobacterium tuberculosis bacterium once it is infected. Thus, HIV patients are more liable to develop tuberculosis as compared to the individuals who do not have HIV (Kaufmann & Walker 2009: 192). 5. Lifestyle: Drug and alcohol abuse can also lead to tuberculosis infection. Drug and alcohol addicts have a weakened immune system, thus are more prone to infection. Such individuals are less likely to have time to access health care services, especially during the early stages of infection. This factor leads to an increase of morbidity rates among this group due to tuberculosis infection, and a greater risk of spreading the infection to non-infected vulnerable individuals. Smoking attributes to tuberculosis infection. According to statistics, more than 20% of tuberculosis cases contribute to smoking (World Health Organization 2008: 72). 6. Living conditions: Crowded and unsanitary accommodation is a major contributing factor to tuberculosis infection. The homeless, prisoners, and poor individuals fall into this risk factor. Poverty, poor housing, overcrowding, lack of ventilation, and malnutrition encourage the spread of tuberculosis. Overview of the epidemiological situation Epidemiological studies carried out in Leeds west Yorkshire aim to identify the current burden of tuberculosis, this is inclusive of latent tuberculosis within the population. Data comparisons of the previous years with regional and national levels are inclusive components of these studies. The methods based on collecting the required data in this report included descriptive epidemiology and ecological analysis of the study population diagnosed with tuberculosis. In the year 2011, 8,963 cases of tuberculosis infection were reported in the UK (Pawson & Tilley: 1997: 527-529). Tuberculosis is more common among migrants, the homeless, poor people in inner cities, people living with HIV, drug users, and prisoners (Cundall & Pearson 1988:964–966.). Poor living conditions are associated with the selected tuberculosis victims. Tuberculosis is mostly associated with poverty (Spence et al 1993:759–761). More than 6,000 of these cases affected inhabitants who were born outside the UK (migrants). These individuals originate from locations where tuberculosis is widespread. Tuberculosis prevalence is greater than before within the UK; due to this threat, targets for tuberculosis control have been put in place and interventions proposed. Health protection and improvement solutions have been implemented so as to deal with the current nature of tuberculosis which is a threat problem in the UK. Tuberculosis was a major killer in Leeds west, Yorkshire. It became a notifiable condition in the West Riding in 1912, when the provisions of Lloyd George’s National Insurance Act of 1911 helped in diagnosis and treatment. Ten tuberculosis districts were made, each containing a dispensary and branch dispensaries. This led to the development of a tuberculosis sanatorium in Leeds west, Yorkshire (Rychetnick et al, 2002: 119-127). Health protection and health improvement solutions The aim of the health protection and improvement solutions is to improve prevention and treatment of tuberculosis with recommendations from key national guidance documents. This is a long term aim of eliminating tuberculosis from the population of Leeds west, Yorkshire. Because of the high tuberculosis prevalence rate, proper studies have been conducted on this disease presentation and management (Coggan et al 1997: 17). Currently, Bacillus Calmette-Guerin vaccine is administered to the populace who are at an elevated risk of developing tuberculosis. This includes children residing in areas with high prevalence rates of tuberculosis, health care workers, and migrants (phru.nhs.uk). Community health protection and improvement solution involve community awareness. This is raising awareness about tuberculosis in the community and primary care services; educating the community members on issues related to tuberculosis (Green & Tones, 2010: 86). The aim of community awareness is to reduce delayed diagnosis of tuberculosis. Community awareness program brings together primary care trusts, local authorities, and voluntary members to raise awareness about tuberculosis among the people most vulnerable to tuberculosis (Aceijas 2011: 26). Concerning service development, the number of tuberculosis nursing staff has to be ensured to be adequate. This is essential to control tuberculosis as the roles of the nursing staff will be contact tracing and offering support to the tuberculosis patients undergoing treatment. Ensuring proper service development is critical for tuberculosis management, prevention, and control. In regard to service development, the improvement of access to tuberculosis specialist services in medical facilities is vital (Eraut 2002: 26). This will help in the improvement of the timeliness of diagnosis and ensuring effective treatment. Medical practitioners should implement the service specifications as described in the department of health tuberculosis toolkit. The public health department has provided supplementary tools necessary in the management of tuberculosis cases (Dixey et al, 2013: 107-142). Results- Summary of clinical findings The incidence rate of tuberculosis in Leeds west, Yorkshire goes on to remain elevated. Despite a fall in the incidence tempo in 2011 compared with the past years, Leeds west still contains the highest rate of tuberculosis infection this region marks one of the highest prevalence rates nationally. Data analysis at the subgroup level reveals that the incidence of tuberculosis in Leeds west is highest in young adults and migrants, especially from African and Asian origins. Moreover, non- UK born residents comprise of the highest population containing tuberculosis; with a staggering rate of 12 times higher as compared to the UK born residents. Tuberculosis cases among migrants are increasing; this is a clear indication of poor control of tuberculosis in the region (phru.nhs.uk). Pulmonary tuberculosis remains the most common type of tuberculosis infection occurring in Leeds west. This respiratory tract infection develops in the winter in most cases. This type of tuberculosis is the most infectious form thus; early diagnosis and treatment is essential. Bacillus Calmette-Guerin vaccination among neonates is high but low in older children. Issues of understaffed tuberculosis services prove as the key factor in poor tuberculosis management and control programs (Rychetnick et al, 2002: 119-127). Another pressing matter is that the reporting mechanisms of tuberculosis cases, contacts and screened individuals are independent of each other. This has potential of difficulty in linking cases to obtain complete information for each patient; this is a contributing factor of disjointed services. Discussion Findings from the ecological analysis reveal that the risk of tuberculosis infection is linked to deprivation, population density, and ethnicity. Ethnicity factor was independent of both population density and deprivation. Findings reveal that disease aetiology and the risk profile vary with ethnicity. The study population (Leeds west, Yorkshire) was considered as complete as possible, but the basis of cases were not autonomous so the ascertainment could not be properly tested. Respiratory tuberculosis (82.2%) was much more widespread than the non-respiratory disease (15.9%). The lack of multi drug resistance tuberculosis risk factors in a proportion of patients, underscores the importance of trying to obtain microbiological samples, and utilisation of resistance mutation analysis; in the treatment and analysis of tuberculosis disease. Despite the numerous programs and efforts laid out in tuberculosis prevention and management, very little help is available for the homeless individuals, who are an additional vulnerable group to tuberculosis infection. Recommendations From these findings, future analysis of overall trends and incidence rates in regard to ethnicity is recommended. This will lead to a better perception of the dynamics of tuberculosis infection in the Leeds west, Yorkshire population. A lot has to be done on the improvement of tuberculosis services across the region. Implementing the service standards and ensuring its maintenance must be a priority especially in regions where tuberculosis incidence rate is alarming. The provision of additional tuberculosis nurses has to be done in agreement with the necessities provided by the national Institute for health and Clinical Excellence (Judge & Bald 2001: 19-38). District wide commissioning of tuberculosis services has to be undertaken by one individual from the clinical commissioning group within Leeds west, Yorkshire; this is essential in the prevention of disjointed services (farmtoschool.org). In addition, tuberculosis services have to be commissioned as a separate entity, as opposed to it being within other services like respiratory services; this will ensure transparency of service provision (Green & South. (2010: 36). Transparency of service provision will also be achieved via the creation of existing tuberculosis databases onto one database, provision of active case finding service for vulnerable groups, and formation of an outpatient clinic within secondary care that is specific to tuberculosis cases. In addition to improving of clinical services and organisation, community education concerning tuberculosis is paramount. Recommendations for community education can be done by the development of a multi-disciplinary team that will involve all organisations that provide tuberculosis service (Petticrew & Roberts, 2003: 527-529). This team will increase an awareness of tuberculosis among primary care, secondary care, and third sector professionals involved in tuberculosis management. The multi-disciplinary team is also expected to encourage the community to attend tuberculosis care services (Green & South, 2006: 15). In regard to new developments concerning the diagnosis of active tuberculosis and drug resistance, at least three sputum specimens should be collected and tested with microscopy as well as culture. This is essential in the reduction of patient dropout, making rapid analysis on tuberculosis infection and control (Marks 2002: 26). Diagnosis of latent tuberculosis infection is best done carried out with advanced tests. This necessary in the detection of hidden Mycobacterium tuberculosis strains (ncbi.nlm.nih.gov). The knowledge of bacterial metabolism is still on-going, but it is known that Mycobacterium tuberculosis can acclimatize their metabolism to the existing sources within the host’s tissues; causing the bacteria to turn out to be firmly planted within the host (Fritz et al, 2002: 286-291). Further research has to be conducted on the metabolism of Mycobacterium tuberculosis, both aerobic and anaerobic metabolism (Nieva et al, 2005: 9). Conclusion Tuberculosis is a preventable infectious disease that can lead to significant morbidity and mortality if left untreated. Multi-drug resistance tuberculosis remains a threat to the Leeds west Yorkshire population. Poverty conditions are associated with tuberculosis in Leeds west, Yorkshire population. Poverty conditions play a significant role in Leeds west. There is an increase in the rate of tuberculosis infection among individuals who have multi-drug resistance, and HIV with tuberculosis. HIV trend is increasing, results to an increase in tuberculosis prevalence. The risk factors for tuberculosis indicate that this disease is linked to the lack of appropriate structure and implantation of health service delivery. As a health protection and improvement solution, tuberculosis control programs have been implemented. These programs are dependent on adequate numbers of professional medical practitioners, to enable early detection and case handling of the disease in the earlier stage. Now more than ever, a multi-disciplinary step involving primary health care, secondary health care, and third sector organisations are of the essence in achieving tuberculosis control. Bibliography ACEIJAS, C. (2011). Assessing evidence to improve population health and wellbeing. Exeter, Learning Matters. BHOPAL, R. S. (2008). Concepts of epidemiology: integrating the ideas, theories, principles, and methods of epidemiology. Oxford, Oxford University Press. COGGAN, D., ROSE, G. & BARKER, D.J.P. (1997). Epidemiology for the uninitiated (4thedition) London. British Medical Journal. CUNDALL DB, PEARSON SB. Inner city tuberculosis and immunisation policy. Arch Dis Child 1988;63:964–6. DIXEY, R., WOODALL, J. & LOWCOCK, D. (2013) Practicing Health and Promotion. In: R.Dixey(ed.) Health Promotion: Global Principles and Practice. Wallingford: CABI, pp.107-142. ERAUT, M. (2002) Developing Professional Knowledge and Competence. (2nd Ed.). London: Routledge. FARMTOSCHOOL, No. Date. Feasibility analysis. Strategies. [Online] Available at: http://www.farmtoschool.org/publications.php . [Accessed on 27th September 2013] FRITZ, C., S. MAASS, A. KREFT, AND F. BANGE. January 2002. Dependence of Mycobacterium bovis BCG on Anaerobic Nitrate Reductase for Persistence is Tissue Specific. Infection and Immunity: 286-291. GREEN, J. & SOUTH, J., (2006). Evaluation. Assessment process. Maidenhead, Open University Press. GREEN, J. & SOUTH. (2010). Health promotion. Planning and strategies (2nd Ed.). London, Sage. GREEN, J. & TONES, K. (2010) Health Promotion. Planning and Strategies. (2nd Ed.). London: Sage (Ch.10). JUDGE, K. & BALD, L. (2001) Strong Theory, Flexible Methods: Evaluating complex community-based initiatives, Critical Public Health, 1(1),pp. 19-38. KAUFMANN, S. H. E., & WALKER, B. D. (2009). AIDS and tuberculosis: a deadly liaison. Weinheim, Wiley-VCH. LONDON : ROYAL COLLEGE OF PHYSICIANS (2006). Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. London, Royal College of Physicians. MARKS, D.F. (2002) Perspectives on Evidence-based Practice. London: Health Development Agency. MAUSNER, JUDITH S., SHIRA KRAMER, AND ANITA K. BAHN. Epidemiology: an introductory text. 2nd ed. Philadelphia: Saunders, 1985. Print. NIEVA, V., MURPHY, R., RILEY, N. ET AL. (2005) Advances in Patient Safety: From research to implementation. Rockville, MD: Agency for Healthcare Research and Quality. O’HAIRE, C., MCPHEETERS, M. & NAKAMOTO, E. (2011) Engaging Stakeholders to Identify and Prioritise Future Research Needs. Online. Accessed 08th October 2013. http://www.ncbi.nlm.nih.gov/books/NBK62575/ . PAWSON, R. & TILLEY, N., 1997. Realistic Evaluation. Evaluation strategy. London, Sage. Petticrew, M. & Roberts, H., 2003. Evidence, hierarchies, and typologies: horses for courses. J Epidemiol Community Health 57 (7) 527-529. PETTICREW, M. & ROBERTS, H. (2003) Evidence, Hierarchies and Typologies: Horses for Courses. Journal of Epidemiology and Community Health, 57(7), pp. 527 – 529. PUBLIC HEALTH RESOURCES UNIT, (2013). Public health services. Critical solutions. [Online] Available at: http://www/phru.nhs.uk/casp/critical%20appraisal%20tools.htm . [Accessed on 27th September 2013]. RYCHETNICK, L., FROMEER, M., HAWE, P. & SHIEL, A. (2002) Criteria for Evaluating Evidence on Public Health Interventions. Journal of Epidemiology and Community Health, 56, pp. 119 – 127 SCHAAF, H. S., ZUMLA, A., & GRANGE, J. M. (2009). Tuberculosis a comprehensive clinical reference. Edinburgh, Saunders. http://www.engineeringvillage.com/controller/servlet/OpenURL?genre=book&isbn=9781437711066. SPENCE DPS, HOTCHKISS J, WILLIAMS CSD, DAVIES PDO. Tuberculosis and poverty.BMJ 1993;307:759–61. WARRELL, D. A. (2003). Oxford textbook of medicine. Oxford, Oxford University Press. WORLD HEALTH ORGANIZATION. (2008). Implementing the WHO Stop TB Strategy: a handbook for national TB control programmes. Geneva, World Health Organization. Read More