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Community Health Nursing: Medical

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Question:

Describe about the Community Health Nursing for Medical?
 
 

Answer:

TB Outbreak in Haiti

Evidence-based research literature reveals the event of tuberculosis outbreak across Haiti under the influence of tubercular strain that resulted in the low level rpoB Mutation attributing to the multidrug resistant nature of this contagious condition (Ocheretina, et al., 2015). CDC statistics describe Haiti in terms of the highest burden of tuberculosis across the American subcontinent (CDC, 2012). The findings also state that 40% of the TB cases remain overlooked and undiagnosed in Haiti by the local authorities.  The earthquake disaster in 2010 in Haiti disrupted its tuberculosis surveillance mechanism in entirety that resulted in the rapid progression of drug resistant tuberculosis across the international borders.

TB Outbreak that Crossed International Borders

Clinical studies by (Mitruka, et al., 2014) reveal the events of tuberculosis outbreak across the international borders facilitated by cross border traveling of the infected patients. For example, the tuberculosis outbreak across the Hispanic community in Southern Nevada Health District resulted due to inappropriate treatment of tuberculosis cases across the region. Infected patients from Nevada travelled to the region of Arizona that became the preliminary cause of the transmission of tubercle bacilli from Nevada to Arizona. Similar reasons attribute to the widespread international transmission of tuberculosis infection following its origin across Haiti. The TB pandemic occurred due to the poor sanitation, overcrowding, and international traveling of the TB patients, immigration, inappropriate utilization of antibiotics and nutritional inadequacies across the Haitian region (Denham, Eggenberger, Young, & Krumwiede, 2015, p. 5). The predominance of the risk factors attributing to the broken roads, unclosed gutters, infected food and water sources influenced the transfer of tuberculosis infection from Haiti to the neighboring countries. Furthermore, lack of appropriate laboratory testing systems, healthcare facilities and medical interventions across international borders failed to cease the transmission of tuberculosis infection from Haiti to the international borders.   

 

Epidemiological Determinants of TB Outbreak

The statistical findings by (Glaziou, Falzon, Floyd, & Raviglione, 2013) reveal 8.7 million newly reported cases of tuberculosis attributing to its elevated epidemiological burden across the global societies. The clinical literature describes children as the significant source of tuberculosis progression across the community environment. Infants exposed to the source of tuberculosis infection remain predisposed to develop this disease at a risk of 50% among communities (Seddon & Shingadia, 2014). Events of HIV pandemic facilitate the progression of Mycobacterium tuberculosis between individuals and the clinical manifestations further intensify under the influence of psychosocial determinants leading to the reported cases of mortalities of the infected individuals (Migliori & Lange, 2012, pp. 14-16). The length and density of tuberculosis exposure and state of the immune system of the infected patients attribute to the intensification of tuberculosis patterns across the community environment.     

The epidemiological determinants of tuberculosis pandemic across Haiti attribute to the undetermined contacts between the tuberculosis patients due to lack of TB awareness among the local residents. Unchecked visits of tourists to Haiti resulted in the transmission of droplet infection to the healthy individuals that reciprocally added to the burden of the disease. Furthermore, international healthcare workers experienced a high risk of transmission of tubercle bacilli in the absence of acquiring protective measures for mitigating the clinical manifestations of tuberculosis infection. The direct exposure of the infants to the infected adults increased the pace of tuberculosis transmission across the community environment in Haiti.   

Routes of Disease Transmission

The preliminary source of tuberculosis infections attributes to the infected patients carrying M. tuberculosis bacterium; however, Mycobacterium-avium progresses through soil and water resources leading to the epidemic outbreak across the community environment (Gangadharam & Jenkins, 1998, pp. 179-180). The most common mode of M. tuberculosis infection attributes to the transfer of infectious bacterium through airborne droplets that travel between the individuals through coughing, shouting or sneezing. Infected droplets invade the alveoli of the exposed individuals and release tubercle bacilli leading to the onset of bacterial infection (CDC, Transmission and Pathogenesis of Tuberculosis, 2012). 

Risk Factors Attributing to TB Outbreak

Environmental risk factors of tuberculosis progression attribute to the pattern of smoking, administration of injectable drugs and alcohol dependence. Furthermore, disease conditions including malignancies, silicosis, measles, renal disorders, gastrectomy-status, HIV, diabetes and corticosteroid interventions increase the risk of developing tuberculosis among the predisposed individuals (Schaaf & Zumla, 2009). 

 

Influence of TB Outbreak at Community Level

The progression of tuberculosis across community environment influences functionality of schools that become the centers of infection during the tenure of an epidemic. The school premises provides several opportunities for the spread of tubercle bacilli to a wide range of subjects including the children as well as the adolescent individuals, as evidenced by the clinical studies (Smallman-Raynor & Cliff, 2012, p. 110). The tuberculosis outbreak adversely influences the functionality of local governmental agencies while increasing their economic burden in the context of extending social welfare programs for mitigating the adverse socioeconomic outcomes (Sharp, 2012, p. 38). The tuberculosis outbreak proves to be a potential epidemiological burden for the developing nations of the world and leads to their economic decline while affecting the business activities (Jamison, Breman, & Measham, 2006). Hospitals across the community environment become the source of nosocomial infections following the tuberculosis outbreak. Furthermore, the increased burden of tuberculosis leads to an acute shortage of medicines and healthcare interventions that reciprocally decrease the wellness patterns of the predisposed individuals until the progression of the outbreak. 

Reporting Protocol of TB Outbreak

The reporting protocol for tuberculosis outbreak follows the appropriate investigation of TB transmission and corresponding mortalities across the community environment (Davies, Gordon, & Davies, 2014, p. 66). The identification of high incidence rates of TB infection following the efficient retrieval of epidemiological information by executing routine surveillance studies and utilizing social networking tools gives an insight regarding the possible modes of TB transmission across the community environment. Adequate reporting of the outbreak statistics assists healthcare professionals in developing mitigating strategies for controlling the adverse epidemiological manifestations of tuberculosis.  

The protocol for reporting the tuberculosis cases to the local community attributes to the submission of detailed reports for the patients confirmed with TB infection while specifying their demographics, laboratory findings, and nationality and treatment interventions. Furthermore, the reporting of cases of latent TB infection requires execution within three days of determining progression of the disease. The laboratory findings attributing to tuberculosis culture require reporting the appropriate genotype of the infectious organism to the local communities in the context of devising appropriate therapeutic interventions for reducing the progression of tuberculosis across the region of the outbreak. Furthermore, reporting of patient’s occupation, ethnicity, chest X ray findings, HIV status, history of alcoholism and residential status require execution in the context of updating this relevant information to the local health communities. Discharge of any TB patient in the absence of correctional measures by the healthcare facility requires prompt reporting to the local community in the context of determining the predisposition of the healthy individuals toward developing tuberculosis manifestations. Events of non-adherence to prescribed medicines by the TB patients require prompt reporting to the local community for evaluating the burden of the disease across the community environment. Furthermore, the cessation of TB treatment or development of co-morbid states by the affected patients requires reporting to the local state agencies in the context of devising mitigating strategies for reducing the progression of disease across the community environment. Structured reports with the above-mentioned information require submission to the local communities for timely reporting the progression of TB outbreak and its deterministic factors to the local health authorities.   

 

Plan of Action

Tuberculosis outbreak requires timely reporting to the healthcare authorities as well as the key stakeholders of the state health agencies in the context of challenging infectious manifestations across the community environment. The healthcare professionals need to retrieve the details of immigrants, patterns of transmission of tuberculosis across the hospital settings and the extent of infrastructure disintegration during the TB outbreak for reporting these findings to the stakeholders to facilitate the administration of appropriate healthcare interventions for the affected patients. Health professionals also need to evaluate the population groups at high risk of infection for their prompt reporting to the healthcare agencies for implementing effective quarantine measures in the context of reducing the progression of tuberculosis following the epidemic outbreak.  

 

Mitigating Strategies for Preventing the TB Outbreak

The mitigating strategies for reducing the progression of tuberculosis across the community environment attribute to the organization of training sessions for patients in the context of increasing their patterns of compliance to the prescribed medication (Woo & Robinson, 2015, p. 1251). Healthcare professionals need to facilitate the effective dissemination of significant information regarding pathophysiology of tuberculosis to increase their awareness regarding the prognostic outcomes (of tuberculosis) following its progression across the region of the outbreak.     

The effective collaboration of healthcare professionals with the communities highly required to facilitate the implementation of hygiene and healthy life style measures for reducing the probability of infection transmission following the onset of TB outbreak (World Health Organization, 2008). Governmental agencies require undertaking financial measures for enhancing the healthcare resources in practicing preventive approaches for encountering challenges posed by tuberculosis invasion across the communities. Healthcare policies and guidelines require configuration with the intent of enhancing the capacity of the healthcare system to efficiently measure and evaluate the progression of tuberculosis manifestations to undertake their evidence-based treatment across the community environment. The concepts of advocacy and communication require implementation for evidently displaying the epidemiological state of tuberculosis, the corresponding healthcare measures and their advantages with the engagement of the common masses to facilitate the wellness outcomes. Effective communication requires utilization as an evidence-based tool for influencing the perceptions of communities in terms of enhancing their quality of life to reduce the scope of TB progression among the predisposed individuals.

 

References

CDC. (2012, September 14). CDC Home. Retrieved from CDC.Gov: https://www.cdc.gov/tb/topic/globaltb/haiti.htm

CDC. (2012). Transmission and Pathogenesis of Tuberculosis. In CDC, Transmission and Pathogenesis of Tuberculosis (pp. 19-44). Retrieved from https://www.cdc.gov/tb/education/corecurr/pdf/chapter2.pdf

Davies, P. D.-O., Gordon, S. B., & Davies, G. (2014). Clinical Tuberculosis (5th ed.). Florida: CRC.

Denham, S., Eggenberger, S., Young, P., & Krumwiede, N. (2015). Family-Focused Nursing Care. Philadelphia: F. A. Davis.

Gangadharam, P. R., & Jenkins, P. A. (1998). Mycobacteria: I Basic Aspects. USA: Springer.

Glaziou, P., Falzon, D., Floyd, K., & Raviglione, M. (2013). Global epidemiology of tuberculosis. Seminars in Respiratory and Critical Care Medicine, 34(1), 3-16. doi:10.1055/s-0032-1333467

Jamison, D. T., Breman, J. G., & Measham, A. R. (2006). Disease Control Priorities in Developing Countries. Washington, DC: The International Bank for Reconstruction and Development. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK11724/

Migliori, G. B., & Lange, C. (2012). European Respiratory Monograph 58: Tuberculosis. UK: ERS.

Mitruka, K., Blake, H., Ricks, P., Miramontes, R., Bamrah, S., Chee, C., & Hickstein, L. (2014). A Tuberculosis Outbreak Fueled by Cross-Border Travel and Illicit Substances: Nevada and Arizona. Public Health Reports, 78-85.

Ocheretina, O., Shen, L., Escuyer, V. E., Mabou, M. M., Royal-Mardi, G., Collins, S. E., . . . Fitzgerald, D. W. (2015). Whole Genome Sequencing Investigation of a Tuberculosis Outbreak in Port-au-Prince, Haiti Caused by a Strain with a "Low-Level" rpoB Mutation L511P - Insights into a Mechanism of Resistance Escalation. PLoS One, 10(6). doi:10.1371/journal.pone.0129207. eCollection 2015.

Schaaf, H. S., & Zumla, A. (2009). Tuberculosis: A Comprehensive Clinical Reference. USA: Saunders Elsevier. Retrieved from https://books.google.co.in/books?id=5wFM7Bu8FG0C&pg=PT1091&dq=tuberculosis+risk+factors&hl=en&sa=X&ved=0ahUKEwjAptWY4e_JAhWUA44KHRQqARAQ6AEIQTAI#v=onepage&q=tuberculosis%20risk%20factors&f=false

Seddon, J. A., & Shingadia, D. (2014). Epidemiology and disease burden of tuberculosis in children: a global perspective. Infection and Drug Resistance, 153-165. doi:10.2147/IDR.S45090

Sharp, E. B. (2012). Does Local Government Matter?: How Urban Policies Shape Civic Engagement. Minnesota: University of Minnesota.

Smallman-Raynor, M., & Cliff, A. (2012). Atlas of Epidemic Britain: A Twentieth Century Picture. New York: Oxford.

WHO. (2008). Community Involvement in Tuberculosis Care and Prevention: Towards Partnerships for Health: Guiding Principles and Recommendations Based on a WHO Review. Geneva: WHO.

Woo, T. M., & Robinson, M. V. (2015). Pharmacotherapeutics For Advanced Practice Nurse Prescribers (4th ed.). Philadelphia: F.A.Davis.

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