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16 Apr 2012
The association of housing density, isolation and tuberculosis in Canadian
First Nations communities
Michael Clark, a Peter Ribena and Earl Nowgesicb
First nation communities experience high levels of overcrowded housing, degree of
isolation and rates of tuberculosis (TB).
The purpose of this study was to examine the association between community housing
density, isolation the incidence and occurrence of TB in Canadian First Nations
Overall findings /results
TB incidence is higher in communities located in isolated areas, and in
communities with higher average housing densities.
It is possible that communities with such cases experienced higher transmission
rates and were more likely to be influenced by factors such as overcrowded
Although an increase in community income was associated with a decreased risk
of TB,income levels were higher in isolated communities where TB incidence is
higher this may be due to higher wages given to employees in isolated areas
where the cost of living is elevated.
It is also possible that people in non isolated communities are more likely to move
to the reserves and break down the disease to the isolated places where they do
not provide such services
Overcrowded living conditions and isolations from health services are associated
with an increased risk of developing TB.
Neighbourhood poverty is also associated with an increased risk of acquiring TB.
Therefore TB is more common in isolated communities where unique challenges
exist in transporting patients, equipments, drugs and staff.
Overcrowded housing conditions can increase the occurrence of
tuberculosis(TB) transmission from infectious to susceptible individuals
Isolation from health services may lead to patient and provider delays in
TB diagnosis, increasing the risk of transmission
The Canadian first nations population experiences higher housing
densities and higher TB rates than the overall Canadian population
Increased housing densities and geographical isolation have been
associated with an increased risk of TB in Canadian First Nations
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Infections and Inequalities: the Modern Plagues.
Despite the importance of Haiti to the French economy, their investment in health care
infrastructure had been negligible.
Only a few miserable military hospitals were in operation
Members of the white minority were treated at home; members of the black majority if
they were treated received care in the plantation sick bays of varying qualities.
the major causes of childhood deaths in Haiti are diarrhea, pneumonia and tetanus and
tuberculosis is the leading cause of death among adults
the high prevalence of TB has been linked to HIV
most of the TB patients are co-infected with HIV therefore HIV is a major factor for
pulmonary tuberculosis among young Adult Haitians
it would also be preventable if the spread of HIV was controlled
Proje Veye Santé was effective in identifying and referring patients with pulmonary
tuberculosis to the clinic it became clear that detection of new cases did not necessarily
lead to cure
Some health workers felt that TB patients who had poor outcomes were the most
economically impoverished and thus the sickest
Others including physicians present attributed poor compliance to wide spread beliefs
that TB was a disorder inflicted through sorcery, which led patients to abandon
biomedical therapy
Others hypothesized that patients lost interest in chemotherapy after ridding themselves
of the symptoms that had caused them to seek medical advice
The Proje veye Santé project
The new program was designed to be aggressive and community based
Relying heavily on community health workers for close follow-up
It was also designed to respond to patients appeals for nutritional assistance
All residents of Sector 1-diagnosed with pulmonary tuberculosis would be eligible to
participate in a treatment program featuring ;
During the first months following diagnosis daily visits from their village health worker,
they would also receive financial support of $30 per months for the first three months and
they would also be eligible for nutritional supplements
Patients from sector 2-were the control group in the sense that they did not benefit from
the community based services and the financial aid
Patients from sector 1 were able to return to work compared to patients from sector 2
Explaining treatment outcomes
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