The Prevalence of Tuberculosis amongst Asians in London Borough of New Ham - Essay Example

THE PREVALENCE OF TUBERCULOSIS AMONGST ASIANS IN LONDON BOROUGH OF NEW HAM By Introduction Tuberculosis is an infectious disease that often spreads by coughing and sneezing and every year leaves more than a million dead. Most often, it attacks the lungs but responds very well to treatment. Over 95 % of cases occur in developing countries and experts are increasingly concerned about the rise of antibiotic -resistant strains, which then require treatment with more toxic drugs. The number of tuberculosis patients has been increasing rapidly in the UK. In fact UK in general and London in Particular, has more tuberculosis cases than Holland, Belgium, Greece and Norway combined. The number of cases also exceeds to countries like Eritrea and Gambia (Abernethy 2013, n.p.).According to these mentioned statistics, tuberculosis is an urban health issue which has to be prevented. To elaborate on the effect of TB and why it has grown into an urban health issue, this study text will highlight the emerging TB issue in Europe, particularly the United Kingdom. The discussion will argue on the perspective that immigrant populations contribute to its increase, as is observed in the New Ham region of the London Borough. Tuberculosis in Newham is at an alarmingly high rate (Howes 2013, p.136). The following study text will critically examine the prevalence of tuberculosis within Newham in comparison to other boroughs within the UK. The paper will discuss the situation of the area of New Ham, East London and see that are the causes of increasing number of tuberculosis cases. In its conclusion, the study will also provide some potential recommendations to deal with the issue which will help in the fight against tuberculosis in the said region. Rationale According to Centers for Disease Control and Prevention (2014, n.p.),Tuberculosis is caused by the Mycobacterium tuberculosis bacteria. As is popularly known, it affects mostly the lungs and other organs such as the lymphatic system, the circulatory system and to an extent the central nervous system (NHS 2014, n.p.). The lymph nodes surrounding the lungs and heart become enlarged, as is the case with all other lymph nodes in an effort to curb the spread of the disease to the entire body (On Health 2014, n.p.). Upon realizing this threat, the body’s immune system reacts by forming scar fibrosis or tissue around the bacteria. If by any chance the bacteria bypass the fibrosis, the disease is reactivated and the pneumonia re-emerges. What follows is damage to bones, kidneys, and the meninges lining the brain and spinal cord. There are two categories of TB. Latent tuberculosis means that the bacteria are present in the body but are inactive, that is, they do not show any symptoms (Acton 2012, p.6). Latent TB does not present any activity (Minnesota Department of Health 2009, n.p.) At a worldwide scope, tuberculosis causes the most deaths in Africa and Asia, killing approximately 2 million people every year. According to the WHO, 95% of the deaths originate from countries ranked as low or middle-income economies, thus the trends in Asia, Africa, and South America (Sandhu 2011, p.144). As Coomson (2013, n.p.) reveals, after HIV/AIDS, tuberculosis follows in terms of the greatest killer originating from a single infection. In the year 2012, approximately 8.6 million people were infected with TB, and of this total, about 1.3 died from it. In addition, TB ranks amongst the top 3 killers of females aged between 15 to 44 years. In the context of children, in 2012 about 530, 000 were infected with active TB, and of this total, about 74,000 who also had HIV/AIDS died of it (WHO 2013, p.1). This in turn brings up the issue of deaths related to the HIV/AIDS-TB relationship. The observed trends indicate that of the entire population which succumbs to HIV/AIDS; about a fifth of them originate from Tuberculosis illness. Finally, the recent past has seen a new challenge emerge; a new breed of Multi-drug resistant TB, otherwise known as MDR-TB (Davies P 1999, n.p.). MDR-TB is referred to as drug resistant if it resists the two first-line anti-TB cures; isoniazid and rifampicin. It will be most likely to occur if a patient suffering from treatable TB and is under medication makes a mistake of allowing the antibiotic treatment course of curing TB to be interrupted. These mistakes might range from non-adherence to dosage, lack of sufficient drugs, lack of access to the drugs, or laxity in adhering to the treatment instructions. These combined, the infected persons develop more complex TB, and are likely to die from it than they would from normal TB (CDC 2014, n.p.). All the above facts combined; there emerges the fact that TB is indeed an urban health issue which requires intervention before it goes on to result in more harm. However, the most startling observation calling for the intervention is the fact that in the recent past, tuberculosis emergence has been increasing in Europe, particularly the west (Public Health England 2013, n.p.). According to research, UK is the only country in Western Europe that is dramatically increasing rates of disease. The number of tuberculosis cases in London has increased over 50 % since 1999 among which 40% occurs in the British capital. Tuberculosis ravaged last the UK. In 1660, rates of the disease in London came to be 1,000 per 100,000 individuals (Abernethy 2013, n.p.). During the 19thcentury, in Victorian times, it was dubbed "the white plague" due to loss of skin colour experienced by a TB patient. Mortality rates from tuberculosis in the UK began to decline in the early 20th century as living standards improved with better housing, nutrition, and the introduction of anti-tuberculosis drugs (Lawn& Zumla 2011, p.1). In early 1980 the experts considered that the disease had been "conquered" in the country and care services against the disease were significantly reduced (James 2010, n.p.). However, in the past 10 years tuberculosis has been diagnosed among 9,000 patients and experts also believe that this number could be higher because current diagnostic tests are only able to detect 70% of active cases. According to the BBC (2013, n.p.), the largest increase in TB cases has been mainly between groups of people not born in the UK. This disease is more common in districts experiencing "relatively more deprivation" because Areas like New Ham, East London have more cases of tuberculosis because such areas have more homelessness, drug addiction, high number of immigrants who live in small, overcrowded spaces, making them susceptible to infections. Thus, we can say with certainty, that by all means, that Tuberculosis is an urban health issue which has to be discussed frequently to disseminate knowledge of its prevention and treatment. Urban Context The area which will be taken for this study is New Ham, East London. This is one of the most densely populated areas of London having a total population of around 254,000 (London Borough of Newham n.d., p.17). This borough is one of those boroughs where the population of immigrants is much larger than the local population. According to the census of 2001, Newham is the area where 62% of the population belongs to ethnic minorities. Being the members of minority groups, most of the residents of New Ham have poor social conditions. There are significant health inequalities which are measured through life expectancy, mortality, disability, incidence or prevalence of certain diseases (McEvan 1990, n.p.). These health disparities are related to social, economic and cultural, as in most modern societies, the establishment of public health systems has facilitated access to health services and their use. One of the main reasons of increasing rate of tuberculosis cases as Bernan (2008, p.547) states is the increasing number of immigrants in UK and the poor social and living conditions which is often associated with immigrants. Determinant is not strictly a case as a sequence of events that result in a specific effect. Rather, they are risk factors or protection that was statistically associated with certain health or social problems. In addition, given that these factors act in interaction, it becomes difficult to assess the respective contribution of each factor in causing a health problem. The often non-specific and multi-factorial aetiology complicates the task when estimating accurately the impact of various factors affecting the health and well-being. Whether these factors act synergistically, one must also consider that their effects are multiple and often occur after long periods of exposure (Mackenbach& Bakker 2003, n.p.). The demographic data of New Ham area revealed that poverty is one of the major causes of TB. People with social, cultural and physical problems were excluded from the minimum accepted lifestyle because of poverty. Thus, poverty is not only limited to less monetary income but also the poor living conditions which are one of the major causes of problems like tuberculosis (Whitehead 1998, n.p.). Public Health Consequences TB is passed on from person to person through inhalation of infected persons meaning that it is an airborne disease. It does not however necessarily mean that inhaling the particles develops TB (Wilson 2006, p.40). This because the bacterium can result in any of these three scenarios; the immune system can destroy it, the bacterium may assume a latent (inactive) status, or in the unfortunate situation, the person becomes ill with TB.TB upon becoming active shows symptoms such as persistent coughing which lasts over three weeks, a pain in the chest area, coughing up bloody sputum, extreme sweating at night, fever, chills, lack of appetite, fatigue, weight loss, and fever amongst others (Dunphy & Brown 2011, p.376). There are also symptoms which are specific to the lungs; painful coughs, painful breathing, and a sharp pain in the chest (both lungs). The tubercle bacillus destroys lung tissue; so that the patient is suffering from a prolonged cough (over two weeks) often accompanied by expectoration of sputum and sometimes blood (Timby & Smith 2005, p.327). Many people are suffering a range of these symptoms or interpret them as a different ailment altogether. This is dangerous because without treatment, death can occur within a few months or a few years.If treatment is given very late, the patient may never fully recover fully intact lungs or reconstitute its forces. In addition, patients can contaminate other people around during the period when not treated (Division of Health Promotion and Disease Prevention 2001, p.46). Any person with a cough that persists for more than two weeks should therefore go to health services for an analysis of sputum. There is a significant association with pulmonary TB, disseminated, genitourinary, intra-abdominal and mediastinal musculoskeletal as well as with an increased risk of death. Pawlowski, et al, (2012, n.p.) states that the tuberculosis-HIV co-infection remains one of the major urban health threats owing to the fact that upon this occurrence, the chances of the patient dying are more. In addition, the co-infection is most prevalent in regions with limited resources, and in this particular context, the immigrant populations in London can fit in this margin. When these two diseases coexist, the immunological functioning of the body deteriorates faster, and premature death is likely to occur. This happens in that HIV and TB have great capabilities of weakening the immune system (Diedrich & Flynn 2011, n.p.). The interplay occurs in that when AIDS has totally weakened the immune system, TB easily colonizes the body, resulting in adverse health effects and eventual death. In the most recent studies, it was discovered that about 14 million people are dually infected. This is alarming considering the fact that TB is the leading killer of HIV patients. This means that with the statistics recorded in 2012 indicating that of every 1,000 London dwellers, 5 were diagnosed with HIV (Ho 2004, p.18), then there was more danger than meets the eye to this problem. It is also furthered by the fact that of the total population living with HIV, only 42% receive medical attention. In translation, the other 58% remains at a risk of succumbing to HIV-TB co-infection if they get the exposure. Tuberculosis Interventions Despite the discovery of TB-curing drugs around the 1940’s, TB remains a major cause of death resulting from infectious agents. It is for such reasons that TB control remains a top agenda with regards to the international health context (Zaman 2010, n.p.). The intervention measures available for TB include preventing new infections, stopping development of latent TB to active TB, preventing co-infection between TB and HIV/AIDS, and finally treating the disease in its active state. One means of preventing TB infection is through vaccination. Vaccination as an immunization against TB is administered as a live attenuated BCG. There are more vaccines being tested but so far, this has proven to be the most effective. BCG vaccination has passed tests to prove that it protected against serious forms of TB in children and because of that, the vaccination is recommended worldwide for children immediately at childbirth, that is, at first contact with medical services (Parikh 2009, p.139). The last 25 years have seen an increase in BCG vaccination in the world. The estimated numbers as at 2002 were standing at around 100 million children, which represent about 86% of all the children born. In Europe only, 92% of the infant population was vaccinated. However, the vaccine is not 100% effective since of the total vaccine numbers, the number that was overly protected from TB in 2002 only was about 29,700, not forgetting that the protection is valid only for the first 5 years of life (Hessling, et al., 2007, p.1376). The second intervention measure of intervening is by preventing latent TB infection to active TB. The idea is to protect the inactive (latent) TB from being activated to become TB disease, which is the one with symptoms and causes illness (Fong 2013, p.109). The treatment of the latent TB is initiated once it has been established that there is no active TB infection. Once this has been diagnosed, a healthcare provider is met with the option of using rifampin, rifapentine, or isoniazid drugs where the treatment time might be between 4 to 9 months (Sharma,et al, 2013, n.p.). Owing to the long treatment durations, the poor population remains at risks of contracting active TB because the drug acquisition may become too expensive for them over time. The third measure, though a little far-fetched, is by preventing HIV positive people from contracting Tuberculosis and vice-versa. This measure is derived from the fact that these two co-exist, resulting in higher chances of fatality from immune depletion. As such, preventing the issue of co-infection is an effective counter-measure of fatalities (Granich, et al, 2010, n.p.). Overall, there are about 2 billion people living with Tuberculosis, and another 33 million living with HIV/AIDS. When a HIV positive person contracts TB, it becomes a source of suffering, mortality, and morbidity to both them and the people close to them. The alarm is furthered by the relating ratios that people infected with HIV face 20 to 37 times more risks than healthy persons (WHO n.d., p.3). As such, global health bodies such as the WHO advocate for measures to counter the dual infection by the two diseases. The final and collective measured suggested by the WHO (2014, n,p.) is application of the DOTS and Stop TB strategies. The DOTS strategy has five main elements to it. The first element dictates that there should be more political commitment and increased financing by governments to all campaigns against TB. The political aspect calls for amongst others, national legislation through partnerships with local advocators of stopping TB. Legislation in this case refers to improving quality, equity, and the access of TB care. The aspect of funding simply means that all the activities involved in the fight against TB receive sufficient resources to run the advocacy (Dyer 2010, p.67). The second element is about advanced case detection of TB bacteria. This is supported by the fact that bacteriology is still the most recommended means of detecting TB. The two methods included in this are one, using a sputum smear, and two, using a DST test. These two therefore call for the strengthening of the laboratory network. This entails the provision of labs with all the required equipment in addition to properly-trained staff. In short, there should be functioning laboratories based on standards which adhere to internationally-set guidelines (Schaaf & Zumla 2009, p.59). The third element demands for better patient support, better treatment services, and finally, consistent supervision. Better treatment means that the processes involved in the diagnosis, treatment, and administration of all curing measures is of standardized levels. In supervision and patient support, these are measures aimed at discovering the factors behind dose or treatment interruption and devising means of preventing their occurrence (Raviglione 2006, p.1234). The fourth element encircles about effective drug supply and management systems. This can be better put as having a sustainable and uninterruptible supply of quality and approved anti-TB drugs. In addition to the availability of the drugs, there should be means of ensuring that there are reliable channels of distributing and acquiring the anti-TB drugs. As is set internationally, the TB drugs should be given at no costs to the patients. Drug management procedures should be strict, and can be inflicted by training all the practitioners included in the TB drugs handling (Nelson & Williams 2014, p.533). The final element is all about monitoring and evaluating the entire systems implemented in fighting the TB issue, and in doing so, measure the impact achieved. The monitoring and evaluation can be conducted by capturing patient data, patient outcomes, problem evaluations, and other methods that can assist in the measurement of the Stop TB advocacy (Tulchinsky & Varavikova 2014, p.197). Recommendations and conclusions As the study highlighted, the spread of TB is heightened by the existence of people in poor living conditions. As such, TB spread can be curbed by improving the conditions of living and working in order to foster a full and rich life at all stages of life. Again, there should be better or fairer distribution of power of money and resources within and between societies. This will ensure that drugs and healthcare measures have the required resources to prevent and fight TB. It is also important to measure and understand the problem as well as assess the impacts of actions taken to reduce those (Marmot et al. 2008, n.p.). The association between tuberculosis and poverty is well demonstrated, and for that reason, governments should implement means of reversing poverty and its effects. This is attributed to the fact that tuberculosis infection is transmitted more rapidly at ambient conditions related to poverty like overcrowding, poor ventilation and malnutrition. Therefore, as Dye & Floyd (2006, n.p.) suggest, improving the socioeconomic conditions will favour the reduction in the incidence of tuberculosis It will also increase access to care and their rational use and quality; and in it prevent further emergence of atrocities attributed to TB. Bibliography Abernethy, D.A. et al (2013). Bovine tuberculosis trends in the UK and the Republic of Ireland, 1995-2010. Vet. Rec. 172, 312.  Acton, Q 2012, Latent Tuberculosis: New Insights for the Healthcare Professional, Scholarly Editions. BBC 2013, “London Tuberculosis Rates Worst in Western Europe”, BBC.com, available at http://www.bbc.com/news/uk-england-london-23777685 [20 May, 2014]. Bernan 2008, Diseases Know No Frontiers: How Effective Are Intergovernmental Organisations in Controlling Their Spread? The Stationery Office. Centers for Disease Control and Prevention 2014, “Drug Resistant TB” CDC available at http://www.cdc.gov/tb/topic/drtb/default.htm [20 May, 2014]. Centers for Disease Control and Prevention 2014, “Tuberculosis (TB)”, available at http://www.cdc.gov/tb/ [20 May, 2014]. Coomson, E 2013, “Tuberculosis, The Second Killer after AIDS” The Chronicle, available at http://thechronicle.com.gh/tuberculosis-the-second-killer-after-aids/ [20 May, 2014]. Davies, P 1999, “Multi-Drug Resistant Tuberculosis” Priory.com, available at http://priory.com/cmol/tbmultid.htm [20 May, 2014]. Diedrich, C & Flynn, J 2011, “HIV-1/ Mycobacterium tuberculosis Coinfection Immunology: How Does HIV-1 Exacerbate Tuberculosis?”, Infection and Immunity, available at http://iai.asm.org/content/79/4/1407.long [20 May, 2014]. Division of Health Promotion and Disease Prevention 2001, Tuberculosis in the Workplace, National Academies Press. Dunphy, L, & Brown, J 2011, Primary Care: The Art and Science of Advanced Practice Nursing, F.A. Davis. Dye, C, & Floyd, K 2006, “Disease Control Priorities in Developing Countries” NCBI, available at http://www.ncbi.nlm.nih.gov/books/NBK11724/ [20 May, 2014]. Dyer, C 2010, Tuberculosis, ABC- CLIO. Fong, I 2013, Challenges in Infectious Diseases, Springer: New York. Granich, R, Akolo, C, Gunneberg, C, Getahun, H, Williams, P, & Williams, B 2010, “Prevention of Tuberculosis in People Living with HIV”, Oxford Journals, available at http://cid.oxfordjournals.org/content/50/Supplement_3/S215.full [20 May, 2014]. Hessling, A, Cotton, M, Reyn, C, Graham, S, Gie, R & Hussey, G 2007, “Consensus Statement on the Revised World Health Organizatio Reccomendations for BCG Vaccination in HIV-Infected Infants”, The Union, 1376-1379. Ho, T 2004, “Prevalence of Tb in Healthcare Workers in South West London” BMJ, 1-24. Howes, H. 2013. Strategic planning for water. London: Taylor & Francis. James, K 2010, “Tuberculosis Makes a Comeback in London” Deutsche Welle, available at http://www.dw.de/tuberculosis-makes-a-comeback-in-london/a-6352486 [20 May, 2014]. Lawn, S, & Izumla A 2011, “Tuberculosis” The Lancet.com, available at http://www.ucl.ac.uk/infection-immunity/research/res_ccm/zum_lancmarch11 [20 May, 2014]. London Borough of Newham n.d., “East Ham Community Forum Profile”, 1-17. Mackenbach, J. P. & Bakker, M.J. (2003). For the European Network on Interventions and Policies to Reduce Inequalities in Health, Tackling socioeconomic inequalities in health: analysis of European experiences.The Lancet, vol. 362, 9393: p. 1409-1414. Marmot, M., Friel ,S., Bell, R., Houweling, T.A.J. & Taylor S. (2008). Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health.The Lancet, vol. 372, 9650: p. 1661–166. McEvan, P.J.M.,1990, Special Issue, Health Inequities in Europe,Social Science and Medicine, vol. 31, n° 3, p. 221-420. Minnesota Department of Health 2009, “Active TB Disease”, available at http://www.health.state.mn.us/divs/idepc/diseases/tb/factsheets/activetb.html [20 May, 2014]. Nelson, K, & Williams C 2014, Infectious Disease Epidemiology, Jones & Bartlett Publishers. NHS 2014, “Tuberculosis”, available at http://www.nhs.uk/Conditions/Tuberculosis/Pages/Symptoms.aspx [20 May, 2014]. On Health 2014, Medicine Net, available at http://www.onhealth.com/tuberculosis/page3.htm [20 May, 2014]. Parikh, D 2009, Pediatric thoracic surgery. London, Springer. Pawlowski, A, Jansson, M, Skold, M, Rottenberg, M, & Kallenius, G 2012, “Tuberculosis and HIV Co-Infection”, NCBI, available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280977/ [20 May, 2014]. Public Health England 2013, “Tuberculosis Rates Remain Among Highest in Western Europe”, available at https://www.gov.uk/government/news/tuberculosis-rates-remain-among-highest-in-western-europe [20 May, 2014]. Raviglione, M 2006, Reichman and Hershfield’s Tuberculosis: A Comprehensive, International Approach, CRC Press. Sandhu, G 2011, “Tuberculosis: Current Situation, Challenges and Overview of its Control Programs in India”, Journal of Global Infectious Diseases, 3 (2), 143-150. Schaaf, H, & Zumla, A 2009, Tuberculosis: A Compreehensive Clinical ReferenceI. Elsevier Health Sciences. Sharma, S, Sharma, A, Kadhiravan, T, & Tharyan, P 2013, “Alternatives to Isoniazid Monotherapy for Preventing Active Tuberculosis in HIV-Negative Persons” Cochrane Summaries, available at http://summaries.cochrane.org/CD007545/alternatives-to-isoniazid-monotherapy-for-preventing-active-tuberculosis-in-hiv-negative-persons [20 May, 2014]. Timby, B, & Smith, N 2005, Essentials of Nursing: Care of Adults and Children, Lippincott Williams & Wilkins. Tulchinsky, T, & Varavikova, E 2014, The New Public Health: An Introduction for the 21st Century, Academic Press. Whitehead, M. (1998). Diffusion of Ideas on Social Inequalities in Health: A European Perspective.The Milbank Quarterly, vol. 76, 3: p. 469–92. WHO 2013, “Global Tuberculosis Report”, 1-97. WHO 2014, “The Five Elements of DOTS” WHO, available at http://www.who.int/tb/dots/whatisdots/en/ [20 May, 2014]. WHO n.d., “ART in Prevention of HIV and TB: Frequently Asked Questions”, WHO, 4-40. Wilson, J 2006, Infection Control in Clinical Practice, Elsevier Health Sciences. Zaman, K 2010, “Tuberculosis: A Global Health Problem”, NCBI, available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2980871/ [20 May, 2014]. Appendices 1. Aral, S & Douglas, J. M 2008, Behavioral interventions for prevention and control of sexually transmitted diseases. New York, Springer. 2. Brackemyre, T 2012, “Immigrants, Cities, and Disease: Immigration and Health Concerns in Late Nineteenth Century America,” UsHistory, available at http://www.ushistoryscene.com/uncategorized/immigrantscitiesdisease/ [20 May, 2014]. 3. Centers for Disease Control and Prevention, “Tuberculosis: The Connection Between TB and HIV (the AIDS virus)”, Department of Health and Human Services. 1-2. 4. Impact of Migration on Infectious Diseases in Europe 2007, “Impact of Migration on Infectious Diseases in Europe”, Europen Academics Science Advisory Council. 1-8. 5. Weston, D 2008, Infection Prevention and Control: Theory and Practice for Healthcare Professionals, John Wiley & Sons. Read More