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in class lecture note

Course Code

of 3
L10 Tuberculosis
- caused by mycobacterium, attacking the body but most commonly the lungs
- active tb - antibodies within body was unable to fight off virus, transmissible up to 10-
- inactive/latent tb - bacteria is in the body but there are no symptoms, not capable of
- 50% of people who are not cured die
- was widespread in last centuries - pale with red eyes coughing out blood (vampires)
- 19th century romanticism - infected were considered to be more creative
tuberculosis meningitis - infection of the brain or spinal cord (characterized by irritability and
restlessness) Æ stiff neck, headache, vomiting, changes in mental condition or behaviour, or
intestinal tuberculosis - infection of the intestinal tract
tuberculosis lymphadenitis - infection of lymph nodes (causing enlargement of nodes and
forming masses in the neck)
tuberculosis pericarditis - infection of the heart
- contracted via respiratory tract, inhaling infected droplets
- installed in lungs, trapped in the bloodstream, attacking other organs
- mainly in Asia, in 2008 - 55% of the global total
- Eastern Europe - 150 000 new cases in Russia in 2008
- 14 097 new cases in USA in 2005
- in UK, dubbed 'the disease that never went away' with 8113 new cases in 2005
Æ in parts of London, tb rates are 10 x the national rate
McCraig - tb linked to factors of poverty and ethnic belonging
- 9 million cases annually (1/3 in China and India)
- need to have high density/urbanization, poor hygienic conditions, long periods of contact
- Southern developing countries are most burdened by tb
- loss of healthy life - #10, 2.5%, less than traffic road accidents, heart disease, malaria,
- HIV & TB is interrelated - lowered resistance as tb is an opportunistic disease
- 80+ million patients since 1980, 17 million patients on DOTS (Directly Observed Therapy)
- according to different geographical areas, results of treatment vary - many within Europe
died and failed, Africa died, defaulted, and transferred
- after fall of Iron Curtain, difficulties for people increased and more people were burdened
with tb
- tb decreases life expectancies (Africa - excaberated by poverty and lack of social services)
- 2 million people infected with TB bacilli, someone in the world is newly infected with TB
every s
- disease of poverty, affecting mostly young adults in their most productive years
- 1.6 million people died from TB in 2005, estimated 4400 deaths/day
- leading killer among HIV-infected peoples, 200 000 people with HIV/AIDS die from
- 8.8 million new tb cases in 2005, 80% in 22 countries
- annual incidence rates are now stable or falling -
- worldwide pandemic - half of new cases are in 6 Asian countries (Bangladesh, China, India,
Indonesia, Pakistan, Philippines)
- multidrug-resistant tb - does not respond to standard treatments using first-line drugs
- 450 000 new mdr-tb estimated every year Æ highest in Russia and China
- extensively drug resistent tb (XDR-TB) - resistance to second-line drugs develops, difficult
to treat
* vicious cycle of tb and poverty
- more deaths among women than all cases of maternal mortality combined
- over 900 million women infected, 1 million will die and 2.5 million will get sick this year
from the disease (between 25-44)
- barriers for women to access health services - unable to leave family/work (need
- do not control own income and lack the money to travel to clinics or pay for treatment
- stigma Æ isolation, abandonment and divorce - 100 000 women rejected from families/year
Socioeconomic impact based on study from India
- 67% rural/75% urban patients borrow money (14% of their income) for treatment
- reduces chances for children to pursue education -- 11% discontinue schooling and 8% take
up employment to support the family on account of tb
- 300 000 leave school/year
- need to contribute to livelihoods of the family
Economic impact
- patient loses 3 - 4 months of working time (too weak to work)
- 20%-30% of earnings gone to treatment
- South Africa, tb lost earnings = 16% of GDP per capita
- 75% of tb infections/deaths amongst 15-54 years old, most economically productive
- TB costs contribute to lost household production & leaves impact on health and education
of family
- ~4-7% GDP loss due to TB in Asian countries will deplete worlds poorest by US$12
- estimated 500 000 of tuberculosis deaths were infected with HIV
- people with HIV and latent TB have 800 x risk of developing active TB & becoming
- TB is harder to diagnose in HIV+ people
- progresses faster in HIV+
- TB in HIV+ people are more likely to be fatal if undiagnosed or left untreated
- occurs earlier in the course of HIV infection than other opportunistic infections
- only major AIDS-related opportunistic infection that poses a risk to HIV- people
TB on its own
- active tb can almost always be cured with a combination of antibiotics
- vaccine against tuberculosis (BCG, first used in 1920s)
Æ variable in ability to protect people from infection - but only lasts 15 years
- concept of disease with background of social and ideological construction of disease
- TB was considered as remerging disease in UK
- rationalized disease - attributable to people coming from different countries (foreigners are
responsible for re-emergence or spread)
- stigmatization to 'polluters' of society with low socioeconomic/rational background from
developing countries
- in the past, disease of TB was attributed to alcoholics -- now more related to other forms of
drugs - characterized by morals
- not just biological connotation but increases stigmatization - creates imaginary spread
shared by people living in other countries
Æ tendency to screen people who are coming from developing countries
- people who are perceived as modern expert workforce/travellers are not considered to be
under the category of being risky -- not applying preventive measures to them
* marginalized because of background
- can also increase racist behaviours to immigrants (active host)
- we live in globalized world -- need to adopt measures to take into consideration economic
exchange/interaction with people
- the need to tackle problems efficiently
Community Empowerment
- increase: demand for monitory/proper care & participation in patients care
- in Indonesia - leading causes with 583 000 new cases/year, 100 000 deaths/year, 3rd in TB
burden globally (after India and China)
1. TB knowledge and awareness
a. how to be diagnosed b. how to take treatment c. choosing a
healthy facility
- used mass media available in the local area (radio, local leadership events, interactive
2. increased case detection - community participation
- health-care seeking behaviours
- targeting areas for community TB care
- measuring the impact by suspected evaluation rates
Æ involving all care providers (public and care with DOTS services and to endorse the
International Standards of TB Care (ISTC)
3. treatment adherence - increasing knowledge of TB patients/community
Æ 85% success rates since 2001, > 20% drop outs within 2 months of starting treatment
4. reduced stigma and discrimination
- fundamental violations of human dignity:
* stigma is a mark or blemish on someone or something, leading to a negative impression or
* discrimination is the taking of specific action towards the stigmatized
Support Program to Community based Organizations (National Program to fight against
HIV, Malaria, and TB)
- Build community-based organizations technical and financial capacity
- Empower them to deliver quality services complementing the health system
- Empower them to become recognized actors
- intervention by: sensitization, community support services, referral to health centre
- permanent presence in TB Tx/Dx centres to support patients with adherence-to-treatment-
related challenges & home visits
- Traditional healers’ associations, Patients Associations, PLWHA Associations