XXI Commonwealth Games 2018: Prevalence Of Communicable Diseases Among Participating Countries

Background and Rationale

Commonwealth games provide the most substantial and clear expression of the Commonwealth citizens to the meaning of belonging to the global family. These games thus build the potential manifestations with respect to Commonwealth (Groom & Taylor (Eds.), 2016). By spreading global awareness about Commonwealth along with its value, is important to advance the cumulative importance of respecting the diversity, development and democracy. Commonwealth Federation works in collaborate ways to bring out creative and imaginative ways through which the citizens are brought together by enhancing the profile of Commonwealth. These games display the hallmarks of participation and unity (Pamment, 2014). There are examples of witnessing the determination of human and their outstanding sporting spirits through these games. The citizens of the commonwealth watch the games with utmost keen and support their respective teams competing.  At present the modern technology has made the games easily accessible through news and covering images. In order to experience the excitement, uncountable spectators attend the games. Every sense of the participation let it be competitor, spectators, supporter or official authority should be treasured. With this mind, special tributes should be paid to the achievers with disability who are in athletics are completely integrated into the sports program.  This inclusion was first noted in 2002 Manchester Games within multi-sport events throughout the world. Standards of the games are set high by including the core values, humanity, equality and destiny that not only increase the perception and performance of the game but also of the Commonwealth (Horne & Whannel, 2016).

After successfully hosting the Commonwealth games in Glasgow and Scotland in 2014 and,  selling tickets more than 1.2 million with sporting records of more than 100, the next Commonwealth games are planned to be held on Gold Coast, Queensland, Australia in the year 2018 from 4 to 15^th April, commonly known as the XXI Commonwealth games.

Gold Coast is situated in the south Brisbane and north of New South Wales and is a popular destination of the tourists. It is also considered as the paradise for the Surfer’s (Dredge & Jamal, 2013). These games will be the largest cultural and sporting event ever to be held in the Gold Coast city. It has been recorded that more than 6500 athletes and team officials coming from 71 nations and territories will be competing in 18 sports including 7 para-sports during the duration of 11 days of spectacular event. Nearly 2 million spectators are estimated to attend the events. The athletic events will be conducted at the Carrara Stadium in Gold Coast, the swimming event will be held at the Aquatic Centre of the Gold Coast, a marathon or triathlon event at Southport Broadwater Parklands, or the road cycling event at hinterland region of Currumbin Valley in the Gold Coast. Other events such as shooting will be held in Brisbane, basketball event will be in the tropics of Townsville and Cairns.

All total 70 countries are listed to participate in the XXI commonwealth games in 2018 (Carlini  & O’Neil, 2017). Among the countries participating, we will consider some countries on the basis of communicable disease prevalence. The countries are selected from Africa, America, South East Asia, Europe, East Mediterranean and West Pacific. These countries are reported with number of reported cases of communicable diseases. The diseases that we will take into consideration are Influenza, Measles, Meningitis, Pertussis, Gastro infections, Malaria, Dengue and Zika virus.  The underlying causes behind the prevalence of the diseases can be the status of socio-economic condition of population in the countries mentioned. This status usually leads the environmental conditions to be conducive to the proliferations of the vector and thereby enhance the transmission of the disease (Fletcher, Fletcher & Fletcher, 2012). To cite an example, the rapid urbanizations build in Africa had led to the formation of water reservoirs that are unprotected with poor housing condition and improper sanitation that had impact on the transmission and epidemiology of various communicable diseases (Kumpel & Nelson, 2016).  But the urban regions were found to be less effected in comparison to its counterparts. Another reason for the prevalence of the communicable diseases can be the climatic variation in the countries due to their geographical variation. The climatic factors play a key role in the distribution spatially and seasonally based on inter-annual variation and potential of epidemics (Lowe, Chirombo & Tompkins, 2013). The climatic factors that influence are the rainfall affecting the breeding patterns of the vectors, followed by the distribution and the sites for resting (Dhimalet al., 2015). The varied temperature among the different countries influence the development rates of the immature and the survival rate of the adults, the frequency of biting  and the extrinsic periods of incubation also gets affected (Mordecai et al., 2017). Literacy levels in the different countries also affect the prevalence of the diseases. Usually the region with high levels of literacy gets more access to preventive interventions in comparison to the rural area (Bhutta et al., 2014). As the poor population do not get any interventional methods they are prone to get more affected to the various air-borne and water-borne diseases. The urban regions facilitated with advanced educational system are reported to be less influenced (Bisen & Raghuvanshi, 2013).  Education is one of the socio-economic components that might impact the disease prevalence. The status of education tends to influence the knowledge about the preventive measures and controlling the disease within the population of the regions. Thus, the different countries mentioned above with different geographical location and varied economic and climatic factors influence the active prevalence of the different communicable diseases. The major concern for the organisers of the commonwealth games to be held on 2018 at Gold Coast in Australia is that, some of the countries that will participate in the games had some history of communicable disease outbreaks and there can be high chances that the diseases can spread into the region where the commonwealth games will be held. Thus in order to build some appropriate preventive measures and to control the transmission of the diseases locally, study of the disease distribution reported from the different regions of the Commonwealth is important to assess the participants and the visitors who have high chances of carrying them. This required need was also warranted by the staffs of the Gold Coast Health that deals with the control of communicable disease and preventive measures to be taken in the Gold Coast Commonwealth games to be held in 2018.

Games Overview

According to LaMorte (2017), descriptive epidemiology for infectious disease outbreaks is mainly divided in to person, place, and time. Let us discuss about the person, information about the cases is regularly recorded in a "line posting," a matrix on which data for each case is compressed with a different segment for every factor. Statistic data is constantly significant, e.g., age, sex, and address, since they are frequently the qualities most unequivocally identified with presentation and to the danger of ailment. In the start of an examination few cases will be met to search for some normal connection. These are alluded to as "speculation producing interviews." Depending on the methods by which the sickness is for the most part transmitted, the specialist may likewise need to think about other individual attributes, for example, travel, occupation, relaxation exercises, utilization of prescriptions, tobacco, drugs. What did these casualties have in like manner? Where did they do their shopping for food? What eateries had they gone to in the previous month or thereabouts? Had they voyaged? Had they been presented to other individuals who had been sick? Different qualities will be more particular to the malady under scrutiny and the setting of the episode. For instance, in the event that you were researching a flare-up of Influenza, meningitis, pertussis, measles, malaria, dengue, zika, and chikunguniya. you ought to consider the typical high-chance exposures for that contamination, for example, intravenous medication utilize, sexual contacts, transmission from infected person to non-infected person.. Obviously, it is critical to pose numerous inquiries about conceivable communicable diseases. Theory producing meetings may rapidly uncover a few shared characteristics that give pieces of information about the conceivable sources. Let us discuss about place, evaluation of an episode by giving data on the geographic degree of an issue and may likewise demonstrate groups or examples that give hints to the character and inceptions of the issue. A straightforward and valuable system for taking a gander at geographic examples is to plot, on a "spot delineate" the territory, where the influenced individuals live, work, play, or may have been uncovered. A spot guide of cases may indicate bunches or examples that reflect communicable diseases. Now, this project is discussed the time, when researching the wellspring of an episode of irresistible illness, Investigators record the date of beginning of sickness for each of the casualties and afterward plot the beginning of new cases over the long run to make what is alluded to as a pandemic bend. The scourge bends for a flare-up of communicable diseases.  This project will hypothesize the importation and local transmission of the communicable diseases that are endemic in the participating countries but are not so common in Australia. According to embracing 2018 (2017), there may be participating of 6600 officials from 70 nations in Gold Coast city Australia in April (2018).  We may also hypothesize to understand the temporal trend of disease occurrence within the countries participating in the month of March and April based on the last few years starting from 2012 to 2016. This study may provide the Australian health system about their underlying importation and local transmission during the Commonwealth games and thus assist them to prepare the preventive and control measures against communicable diseases like influenza, pertussis, meningitis, measles, malaria, dengue, zika, and chikunguniya. There is a big question, which is arising in mind that why health ministry of Gold coast Australia takes preventive measures against these type of communicable diseases. The answer is that these are contagious diseases, which may be transferred from one person to another person. This project will discuss the transmission of communicable diseases.  

• The first objective of the study would be to determine various communicable diseases that are not common in Australia but are prevalent in different Commonwealth countries and have substantial amount of risk of local transmission followed by significant consequences to the health system in Australia.
  
  
• The second objective of the study would be to summarize and represent the temporal trend of the selected communicable diseases in between the month of March and April from 2012-2016 in Commonwealth countries.

Prevalence of Communicable Diseases

Methods:

The selection of the different communicable diseases has been done by risk assessment. After scoping the literatures searches in the initial stage, the authors framed their experiences of working on both the theory and review practice within multifarious guises in order to examine the used vocabulary in the literature published along with unpublished documents and added source material. The method followed in this review was through meta-analysis.  All the quantitative results were statistically combined in order to produce more précised outcomes of the results. For validating the meta-analysis it was required that all the incorporated studies were similar in sufficient manner.  All the studies that were included comprised of the population that were studied, the interventions explored and the comparison that was made. The most important part of the analysis was that it required the same type of measures or measurement of the outcomes within the same intervals of time.

The meta-analysis is found to be popular as it facilitates individual studies in the preliminary stage. Although, some inclusive studies were small and lacked statistical significance, contributed to larger picture. Additionally, compilations of such studies were time efficient to decision makers particularly when compared with the duration taken in order to review the studies of scattered individuals. On the other hand, the meta-analysis was critically argued based on the inappropriate compilation of the studies which was not that much similar. Nevertheless, one of the essential facts that remained was that a meta-analysis could not be better than the allowance of the included studies (Grant & Booth, 2009).

In this following review, the communicable disease that will be discussed are given below:

Communicable diseases spread from person to person through different ways such as direct contact with blood and body fluids, through breathing in an airborne virus, and bitten by any insect. Thus the reported cases of communicable diseases play an important part in planning and analysing prevention and control programs of disease (Evans, 2013). 

Air-borne diseases: Among the communicable diseases, some of the air borne diseases will be discussed in this review. Disease through air spreads through breathing of an infected person while coughing, sneezing, talking and throat secretions in air (Tatem et al., 2012).  As these disease travels through air, is hard to control. The air borne diseases mentioned here are influenza, measles, meningitis and pertussis.

Influenza: Seasonal influenza virus circulates and produces disease among the humans every year. In temperate climates the disease occurs seasonally during the winter months and spreads to individuals through sneezing, touching the surface contaminated and coughing. The severity of influenza viruses ranges from mild to severe and at extreme cases cause death in some individuals with high risk (Farhad Memarzadeh , 2012). Extreme young and extreme old along with pregnant women, people who are immune-compromised and the individuals with chronic conditions are at increased risk to influenza virus disease. This virus evolves spontaneously which implies that individuals can get affected multiple times in their whole life. Thus the vaccines components of seasonal influenza should be frequently reviewed and must be updated in order to ensure the continuous efficacy of the vaccines (Wong & Webby, 2013).

Factors that Influence Disease Prevalence

Measles: Measles is one of the highly contagious diseases that are vaccine-preventable caused by measles virus. It spreads through droplets or through direct contamination with nasal or infected person’s throat secretions and sometimes through air. Measles is recorded as of the readily transmitted communicable diseases and most dreadful of all childhood fever illness (World Health Organization, 2012).

Meningitis: This disease infects the meninges which is the membrane that covers the brain. Bacterial meningitis is detrimental as it onset rapidly and the infection is linked with significant death risk and also causes mental retardation, epilepsy, deafness (Vyse et al., 2013).

Pertussis: Pertussis or in other term whooping cough is a respiratory tract disease caused by bacterial microorganism that resides inside the mouth, throat and nose. The children contracted with Pertussis shows coughing spells that extends for 4 to 8 weeks. The disease is most detrimental among the infants (Mossad, 2013). 

Vector-borne disease: The infections that are transmitted though bites of infected arthropods such as ticks, sandflies, blackflies, mosquitoes and triatomine bugs. These vectors of the disease are usually ectothermic (cold-blooded) which are usually sensitive to climatic factors (Khormi & Kumar, 2015). Some of the vector-borne diseases that will be discussed in this review are as follows:

1. Chikungunya-It is a viral disease caused due to Alphavirus. Aedes aegypti and Aedes albopictus act as vectors. The incubation period is between 4-7 days after a mosquito bite. Most common symptoms are high fever accompanied by swelling in the joints, rashes, headache, joint pain, nausea and fatigue. It becomes fatal if not treated on time. Diagnosis is done by serological tests (Weaver & Forrester, 2015).
   
   
2. Malaria-It is one of the most life threatening diseases that causes more than 90% deaths globally.  Malaria is prevalent in more than 91 countries and is curable. The WHO African region reported cases of more than 92% deaths due to malaria in the year 2015. Plasmodium falciparum is the most common protozoan pathogen. vivax is also responsible for its transmission. Female Anopheles mosquito acts as the vector. It has an incubation period of 10-15 days. Fever, chills, headache are the common symptoms (Baird, 2013). 

• Zika virus-It is caused due to Flavivirus that is transmitted by Aedes Most common symptoms are dengue, skin rash, fever, joint and muscle pain, heache and malaise. Zika virus is prevalent among the African countries and Brazil. Microcephaly is often associated with zika virus infection (Ioos et al., 2014).

1. Dengue-It is a viral infection borne by the Aedes aegypti Dengue virus belongs to the Flavivirus genus and is of 4 types (DEN-1, DEN-2, DEN-3 and DEN-4). It is a pandemic disease, found predominantly in urban and suburban areas. It affects more than 50 million people annually. Symptoms appear after 4-7 days (Idrees & Ashfaq, 2012).

Following communicable diseases are further discussed below in table.

Disease	Incubation period	Period of infectivity	Clinical signs and Symptoms	Transmission	Case fatality Rate
Influenza	2 days (WHO, 2016)	1 day before onset of symptoms and until 5 to 7 days after onset of symptoms (WHO, 2016)	Fever, myalgia, headache, malaise, non productive cough, sore throat, and rhinitis (WHO, 2016)	Droplets via close contact between source and recipient person. Contaminated hands by influenza virus (WHO, 2016)	25000-500000/ year (WHO, 2016)
Measles	4 days Centre For Disease Control and Prevention, 2017)	4 days before and 4 days after rash onsets (Centre For Disease Control and Prevention, 2017)	Fever, conjunctivitis, coryza cough, koplik spots (main diagnostic point), maculopapular rashes (Centre For Disease Control and Prevention, 2017)	Droplets via close contact between source and recipient person. Contaminated hands by measles virus (Centre For Disease Control and Prevention, 2017)	146000/ year (Centre For Disease Control and Prevention, 2016)
Meningitis	4 days (WHO, 2015)	24 hours (WHO, 2015)	Stiff neck, high-grade fever, sensitivity to light, confusion, headache, and vomiting (WHO, 2015)	Droplets via close contact between source and recipient person. Contaminated hands by causative agent of this infection (WHO, 2015).	10000/year (WHO, 2015).
Pertussis	5 to 10 days (Centre For Disease Control and Prevention, 2017)	From 8 days (Centre For Disease Control and Prevention, 2017)	Whooping cough, dysnea, fever, vomiting, and fatigue (Centre For Disease Control and Prevention, 2017)	Droplets via close contact between source and recipient. Contaminated hands by pertussis bacteria (Centre For Disease Control and Prevention, 2017)	30000/year (Centre For Disease Control and Prevention, 2017)
Malaria	10 to 15 days (WHO, 2017)	24 hours after 1st symptom (WHO, 2017)	Fever, chills, headache, respiratory distress, and anaemia (WHO, 2017)	Anopheles mosquitoes WHO, 2017)	400000/year (WHO, 2017)
Dengue	3 to 14 days (WHO and TDR, 2009).	From the day before fever upto 12 days after bleeding	Fever, hematemesis, hair loss, skin rashes, arthralgia, myalgia, nausea, vomiting and confusion (WHO and TDR, 2009)	Aedes Aegypti (WHO and TDR, 2009)	20000/ year (WHO and TDR, 2009)
Zika	3 to 12 days (Centre For Disease Control and Prevention, 2017)	7days  ( Centre For Disease Control and Prevention, 2017)	Fever, red itchy eyes, muscle pain, joint pain, headache and skin rashes (Centre For Disease Control and Prevention, 2017)	Aedes Aegypti and Aedes Albopictus mosquitoes (Centre For Disease Control and Prevention, 2017)	0.1 percent (Centre For Disease Control and Prevention, 2017)
Chikunguniya	3 to 7 days (Centre For Disease Control and Prevention, 2017)	2 to 6 days (Centre For Disease Control and Prevention, 2017)	Fever, arthralgia, myalgia, maculopapular rashes, vomiting and red itchy eye (Centre For Disease Control and Prevention, 2017).	Aedes Aegypti (Centre For Disease Control and Prevention, 2017)	1000/year (Centre For Disease Control and Prevention, 2017)

The following communicable diseases were studied according to the number of cases reported from 2012 to 2016 in the countries that are about to participate in the Commonwealth games to be held at Gold Coast of Australia in 2018. The following countries that were chosen are Ghana, Brazil, Pakistan, Nigeria, Thailand, and Philippines. All the communicable diseases mentioned above were reported from all these countries and the data were collected from the month of April. All the data were statistically analysed and were recorded from the WHO website.

• Ghana: From the above graphical data it has been found that the number of reported cases of measles got gradually decreased from 2012 to 2016 but on the other hand the reported cases of pertussis increased at high rate at 2016. Prevalence of malaria is reported from Ghana which was reported to be more in 2012 which got slightly reduced followed by significant increase in 2016.
  
  
• South Africa: All the three communicable diseases were reported from South Africa with highest reported cases in 2014.
  
  
• Malaysia: The reported cases of measles in Malaysia were highest in the year 2012 which decreased in the consecutive years but was found to increase in the year 2016. Pertussis was reported to be low in the year 2012 which increased in the year 2015 with subsequent decline in 2016. Malaria was reported to be high throughout the five years recording highest in the year 2012.
  
  
• Pakistan: Both the reported cases of measles and pertussis were reported to be highest in the year 2013 and the malarial cases were significantly reported to be high throughout the following 5 years.
  
  
• Nigeria: The reported cases of measles was highest in the year 2013 whereas the reported cases of pertussis in Nigeria was found to be high in the earlier year which gradually decreased with no reported cases in 2016.
  
  
• New Zealand: Measles was reported to be highest in the year 2015 which decreased in the following next year but was found to increase in 2016. Whereas pertussis was reported to be highest in the year 2012 which gradually decreased in the following coming years till 2016.

Thus from all the statistical data graphically represented shows the reported cases of several communicable diseases that were reported to be prevalent in the countries such as Ghana, South Africa, Malaysia Pakistan, Nigeria, New Zealand which will be participating in the Commonwealth games in 2018. Thus, by studying the number of reported cases of the different communicable diseases from the different countries of the Commonwealth would be helpful in providing information to the health system of Australia to implement appropriate measures in order to prevent and control the local transmission of the diseases that could be carried by the participants and participants attending the Gold Coast, 2018. 

Dissemination plan: The key objective of the project involved providing information to the health system of Australia to adopt effective strategies that would be helpful in preventing and controlling the local transmission of the diseases that have high risks among participants attending the Gold Coast, 2018. The dissemination plan is based on sharing the findings of the study with Gold Coast Health which significantly helps in establishing effective interventions as well as monitoring the situation to reduce the chances of infections. Sharing the findings is also encouraged due to the idea of adopting a collaborative approach to care and ensuring involvement in health care policies and decisions. On the other sharing, the findings with Gold Coast Health is based on ensuring effective preparation and expertise required in delivering patient-centered care as well as promoting positive outcomes to the patients. Sharing information with Gold Coast Health is also based on exploring effective intervention measures and promote positive outcomes.  Sharing the information plays a significant role in understanding the risk factors, how to identify them and the most effective interventions for the diseases identified as the high risk among participants attending Gold Coast, 2018. Additionally, the rationale for sharing information with Gold Coast Health is based on early preparation and the selection of effective health care professionals tasked with the responsibility of serving high-risk participants from different backgrounds. The dissemination plan will also include sharing the findings with the broader audience after GC2018. The aspect is effective in determining the level of preparedness, expectations and the actual happening. Additionally, sharing the information after GC2018 helps in reducing negative perception and unnecessary fear and sensation on Gold Coast Health during the event. Besides, it promotes the chances of making a comparison with the actual happening. According to research, the findings of the study is based on the expected risk factors to different diseases presenting the notion that it has not been proven thus presenting the findings after the actual happening is effective in evaluating the management's ability to address different health conditions.The sharing of the findings after the GC2018 also promotes the chances of effective monitoring of the risk factors before and during the events in order to promote positive outcomes as well as help in reducing the overall number of people affected. The risk factors and the target population helps the healthcare providers to effectively monitor the participant's condition and deliver the timely intervention. However, sharing the findings of the study after GC2018 promotes the chances of determining the healthcare settings ability to identify the risk factors and deliver effective solutions as well as saving on key resources which and the overall image of the event (Dredge & Jamal, 2013). It also offers a good opportunity for the healthcare providers to effectively monitor individual needs or the participants identified the risk factors thus providing patient-centered and evidence-based practice which promotes positive outcomes. The dissemination plan is also based on ensuring effective in influencing the participants on the credibility and expertise of the medical team through the ability to effectively manage the conditions as well as aligning their needs with the healthcare organizations goals and values.The dissemination plan will also involve the key partners in the study in order to effectively identify participants at risk as well as establish the effective solutions to address the health issues. The inclusion of partners in the dissemination plan plays a significant role in enhancing the overall reach and effectiveness of the selected intervention. Besides, it offers an easier comparison with the actual happening and the expectations based on the identified risk conditions. The success of the dissemination plan promotes the ability of the organization to achieve positive outcomes as well as enhance the participant's safety by reducing the risk of infections while attending the event.Collaboration: This is also a key part of the study and involves incorporating several key stakeholders in the process to enhance the success of the project such as identifying the participants at risk of the health condition identified. The collaboration will include two key partners which involve Gold Coast Health and Griffith University. Collaboration is critical and enhances the dissemination efforts in order to reach other users or share information in both formal and informal ways. Collaboration efforts using the two partners helps gain a large number of the workforce who can help in identifying the participants at risk and provide the right medication to reduce negative outcomes. Besides, the participants enhance the chances of research and training programs on ways to identify the disease symptoms or better management of the identified diseases likely to affect the participants from different regions. Researchers such as Weaver & Forrester (2015) acknowledge the positive impact of collaboration in healthcare as a means to ensure effective assessment or diagnosis process as well as the delivery of quality and reliable healthcare services. Collaboration also serves as a key step for implementing innovations or new care plans as well as aligning them with the organizational goals and values. Additionally, it provides the basis for the research to select the appropriate participants for the study as well as determining the effectiveness of the solutions provided to reduce the chances of negative outcomes during the event. Collaboration plan involving the two partners is also based on improving the communication process in order to convey the study outcomes after the event. According to research effective dissemination is based on using varied channels such as the collaborating partners which enhances the organization's consistency in ensuring effective change. The collaboration aspect further helps to influence the behaviour as well as reduce the complexity of the study by identifying different ways in which the partners can get the participants information for improved analysis and risk assessment process. Additionally, collaboration enhances the success of the evaluation process which determines the ultimate measure of success in patient care or reducing the risk factors of different health issues possible in the event.The inclusion of Griffith University in the collaboration stage serves as an important aspect of ensuring the process has enough personnel to assess the participants and effectively engage them to understand the risk factors as well as reduce the possibilities of negative outcomes. Collaboration helps increase active participation in the study which has positive health impacts to the participants such as reducing the infection rates or the risk factors as well as improving access to quality and safe healthcare practices (Bhutta et al., 2014). It also helps align the existing resources with the participant's health needs in order to reduce the risks of the diseases among other negative outcomes.  The ultimate success of the program involves reduced chances of the health conditions identified which can be determined by the number of cases reported. The collaborative approach effectively helps in determining what worked in the process or measure the success of the process since it's an iterative process that demands continuous feedback. The collaboration with the university ensures continuous feedback during the process which further helps determine the effectiveness of the measures taken as well as how best to improve the dissemination plan as well as improving the chances of mitigating potential barriers such as the participant's perception or resource needed for the success of the plan. From a research perspective, the success of the dissemination plan significantly depends on the collaborative approach adopted as well as the dissemination planning tools.                                                         

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