Tetanus in Poor Communities - Term Paper Example

Tetanus in poor communities Geographical and ecological context According to CDC (1), tetanus is a common disease in the developing countries with a high mortality rate. However, the rate is low in developed countries such as the US, Australia and South America. Africa and Asia are the continents affected the most. Lack of education, economic constraints and political instability are the main factors frustrating WHO, UNICEF and other non-governmental and governmental organizations in attempting to eradicate the two most common forms of tetanus: neonatal and maternal tetanus. At the beginning of the century, global estimates of deaths caused by tetanus totaled 309,000 yearly. Among the 309,000 close to 200,000 deaths were caused by neonatal tetanus. Fifty-seven developing countries across Africa and Asia were marked as the disease’s prevalence regions. Out of the 57 countries, 27 countries were identifiable where 90 per cent of the cases were neonatal tetanus. The efforts that begun at the time to eradicate the disease defined MTN (Maternal and Neonatal Tetanus) eradication as less than one case in 1000 live births at the lowest administration level, the district. The strategies employed in fighting the MTN included Tetanus Toxoid immunization of pregnant mother, promotion of hygienic, clean delivery procedures and surveillance. Additional strategies required women of childbearing age in the affected regions to undergo a three-dose immunization process by vaccines containing Tetanus Toxoid (TT). In order to avoid other forms of tetanus that develop later in life, children received vaccines at strategic ages as they developed through infantry and early childhood. According to 2010 statistics, deaths by tetanus were about 61,000. Though improvement is clear, neonatal tetanus remained as the leading cause of death. Out of the 61,000, only 31 cases were from United States despite its vast population. This indicates that there is a big margin between death reports from developing countries and developed countries. Current reports of 2013 indicate that tetanus cases are rare. Majority of the reported cases are still from Africa and Asia. Biology of tetanus Etiology Clostridium tetani is the disease-causing agent of tetanus. It is a motile, anaerobic gram-positive bacterium. It forms spores that survive for many years under adverse conditions including disinfection and boiling of water for more than 20 minutes. The bacterium thrives in saliva, manure, dust and soil. A person may acquire tetanus from both indoor and outdoor environments. The etiologic agents mostly enter the body through a wound, which accounts for more than 65 per cent of the cases. Once the bacterium enters the body, incubation period begins in which the disease is undetectable. The incubation period ranges from a few days to several months but usually takes 8 to 10 days. Studies indicate that incubation period is dependent on how far the point of entry is from the central nervous system. There are four main types of tetanus namely generalized, neonatal, local and cephalic tetanus (WHO 1). Generalized tetanus is the most popular because it covers about 80% of all tetanus cases. Trismus and facial spasms are the first signs. Neck stiffness, swallowing difficulties and rigidity in calf and pectoral muscles follow. The spasms are frequent lasting for a couple of minutes and shape the body into a bow-like appearance. This persists for several weeks with full recovery taking months. Additional symptoms include elevated B.P and temperature, occasional increase in heart rate and sweating (WHO 1). Neonatal tetanus occurs in infants and risk factors include home delivery, unhygienic delivery practices and failure to vaccinate the mother during pregnancy, which would offer partial protection to the infant (WHO 1). Local tetanus affects a localized part of the body around an injury point. Symptoms include spasms around the area, which subside after several weeks. It is mild and non-fatal though it can lead to generalized tetanus. Cephalic tetanus occur mostly following head trauma, but is rare (WHO 1). Immunization reduces the chances of contracting tetanus significantly. A person that observes periodic dosage is unlikely to fall victim to tetanus whereas an under-immunized has high chances of falling ill, if his blood or muscle tissue are exposed to the bacteria. Long-term skin ulceration disorders account for 5% of tetanus infections (WHO 2). Transmission Tetanus is infectious but not contagious. There are various modes of transmission. The bacteria may gain entry into body tissue when there is contact between broken skin and contaminated soil. Penetrating injuries caused by contaminated objects such as rusty nails or contaminated splinters transmit the disease as well. Burns, dead tissue and crush injuries also avail a route of entry. Rare modes of transmission include chronic skin infections, insect bites, intravenous medication and entry of the pathogens through a clean wound in which only the superficial skin layer is affected (CDC 1). Role of the immune system Vaccination prompts the body’s immune system to develop a mechanism of fighting the disease following exposure of an immunized person to the tetanus agents. It assists the body actively fight the infection for a period of ten years after full immunization. There are two types of immune response systems: cellular immune response system and humoral immunity response. The cellular system responds to tetanus antigen by fighting off the disease causing bacteria. The system relies on the initial exposure through immunization, which generates immunological memory to the system. However, research indicates that with increasing age, anti-tetanus antibodies concentration declines leaving individuals at higher risk of falling ill to the disease (CDC 2). Impacts of tetanus Human cost Tetanus causes death eventually reducing the labor force. Studies have employed several strategies to determine the human cost resulting from tetanus. Governmental and world health groups incur substantial costs in lowering tetanus mortality. Individual victims spend substantial funds obtaining vaccination or managing tetanus (Campbell, Hinfey and Cunha 4). Economic cost A significant proportion of funds are consumed yearly to control the disease. Cost categories incurred include personnel, consumables, antibiotics, gases for respiration purposes and vaccines. Each country incurs different costs depending on the size of its population. US use about $6 million yearly in control of the disease. An economic evaluation carried out in the country in 2006 on the vaccination routine indicated that in absence of an immunization program, there would be about 153 reported cases of tetanus and 23 deaths, which collectively would cost $29 million under indirect and direct costs related to control, treatment and burial expenditure. This study monitored 3.9 million neonates from time of birth to time of death (Campbell, Hinfey and Cunha 4). Social burdens of the disease The disease affects all categories of people in the society especially the poor. It directly affects children, women and men of varying ages. Family members are forced to part with significant amounts of funds to obtain treatment for infected family members. The money used in treatment and sometimes immunization would help improve other social aspects including living standards, obtaining better education and purchasing certain social amenities. Tetanus leads to death. Family members mourn for a while which directly affects the family social interaction and participation in social development duties. The most affected are poor people living in low hygiene and economically challenged regions. The regions have large families because parents struggle to feed several children. If a mother dies, she leaves the children with only one parent to cater for them. Loss of parents affects the development of the community because the children will not obtain education unless members of the extended family are financially capable to take them through education. A vicious cycle of poverty ensues and social evils such as prostitution, robbery and disregard of responsibilities follow (WHO 3). Technologies for preventing and treating the tetanus Creating awareness is one way of preventing diseases. People need to realize the fatality of tetanus. Several approaches can be used to tackle tetanus especially campaigns through social media, internet services, mobile crusades and incorporation of issues into the education system. Technologies employed here include broadcasting, public speaker systems and internet. Immunization involves high-tech laboratory research encompassing electronic microscopes, scientific testing of vaccines and other complicated laboratory methods. Specific technologies help develop the vaccines. One involves utilization of OMVs (outer membrane vesicles). This is a pathogenic bacterium whose actions resemble the natural phospholipids in human tissue. In developing the vaccine using OMV, pharmacists use recombinant DNA technology. Nanorobots are like to be used in the future to develop vaccines and treatment including tetanus. The technology allows the creation of cell-size robots that seek and destroy clostridium tetani. Certain tests help in establishing immunoprotection levels of an individual. The test is called Keul-o-test Tetanus and measures tetanus-specific antibody concentration in the human body. It is a form of immunoassay (CDC 3). Cost of prevention and treatment According to a UNICEF report 2011, an average adult cost of tetanus prevention in the private sector through booster vaccines estimated at $37.55. This includes an additional cost due to taxation. However, this varies with geographical location. The extra cost ranged from 1 %-2% of the initial cost. Other reports indicated that administration of booster vaccines in a periodic program 10 years apart would prevent monetary expenditure ranging from $160 to $31,000 in each pertussis case. There are two main treatment strategies, intramuscular immunoglobulin and intrathecal. Categories of cost include all treatment requirements under these procedures including respiratory gases, antibiotic, consumables and personnel. Estimated treatment costs averaged $503 to $1200 (CDC 3). Prevention and treatment programs Prevention programs involve assessment of pregnant women to determine their susceptibility considering that such women come from marginalized regions. The women’s immunization history is unknown. Women who completed the initial immunization series but did not receive any further tetanus vaccination for a period surpassing ten years must receive a booster dose during pregnancy. Those who did not receive the initial dosages must undertake the three-dose Tdap vaccine. ACIP made this official in 2011. The recommended time to administer the immunization on a pregnant woman is the late second trimester or the third trimester. Other susceptible women of childbearing age should receive a similar treatment; a booster for those that have not received a booster for more than ten years and a three-dose vaccination program for those that did not complete the initial immunization program (CDC 1). The primary vaccine series is administered in childhood as part of DPT dosages. It consists of five shots strategically placed in an infant’s early life. The first shot is after two months of life, the second at four months, third shot at six months, fourth at fifteen to eighteen months and the last one between fourth and sixth year of age (CDC 1). Treatment targets to clean the wound and destroy spores’ germination environment, cease toxin production, neutralize toxins, prevent onset of other secondary infections and diseases and manage any resultant complications. A patient of tetanus should be admitted in an ICU. In absence of one, referral to better-equipped hospital is the best option. Upon arrival, the doctor should administer passive immunization to help reduce the diseases severity and shorten its course. Other supportive strategies include supported ventilation, high-calorie diet and drugs administration for countering spasms, seizures, infections and rigidity (CDC 5). Obstacles to solution Illiteracy Areas with high tetanus prevalence are characterized by low literacy levels. The communities fail to understand the severity of the disease and need for completing the immunization program. Some still practice the traditional health care practices that are scientifically disapproved. A common factor with illiteracy is that the affected people do not believe published information (WHO 1). Political instability There are global organizations that dedicate their efforts in penetrating marginalized places to provide medical services including tetanus vaccination. However, political instability makes areas that need help inaccessible. Transportation of tetanus vaccination requires unique conditions and timely delivery. An example is the Al Shaabab war with Kenya 2012-2013. Several areas in Somalia were not accessible or were very dangerous to. Economic constraints Poverty is another characteristic of the marginalized locations. Although governments and non-governmental organizations pay for a substantial fraction of the vaccines cost, the consumer has to give a particular fee. The inhabitants within such regions lack the ability to pay for the vaccines. Similarly, women in poor communities do not deliver in hospitals or attend maternal clinics. As such, they deliver through unconventional means without prior vaccination that predisposes the mother and child to tetanus (WHO 1). Benefits of prevention and treatment Prevention of any disease reduces the funds required for management and treatment. Tetanus vaccination fees are relatively small compared to cost of treating the disease. Prevention avoids grief or social problems that face a family upon diagnosis. As reported earlier, tetanus kills many people every year. Prevention and treatment reduces the mortality rates. Consequently, there is minimal labor loss at the family, community and national level. Works Cited Campbell, K. Patrick, Hinfey and Burke, Cunha. National Business Group on Health. 11 November 2011. 2 December 2013 http://www.businessgrouphealth.org CDC. Centers for Disease Control and Prevention. 22 April 2012. 2 December 2013 http://www.cdc.gov/Vaccines/vpd-vac/tetanus/default.htm WHO. World Health Organization. 17 February 2010. 1 December 2013 http://www.who.int/topics/tetanus/en Read More