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Sample essay topic, essay writing: Tuberculosis - Everything U Need To Know (htis Is An Entire Report On - 3486 words
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.. up with many different preventive measures and cures, ranging from the surprisingly insightful to the silly. The common measures were: . Avoiding garbage form which `miasmas' emanated. . No spitting, covering mouth when coughing.
. Isolation of diseased. . Burning possessions of deceased patients. . Pasteurization of cow's milk.
Legislation designed to prevent spread. Other treatments include Artificial Pneumothorax (compression of the affected lung by the introduction of gas or filtered air into the pleural cavity, which was to be continued for a period of from two to four or more years) and Thoracoplastly (removal of the ribs on one side of the thorax to accomplish a permanent collapse of the affected). Some physicians instructed patients to eat only `animal foods' or to drink the warm milk of a goat, donkey and cow. In 1821 the `Nantucket Inquirer' encouraged drinking strange concoctions and inhaling the smoke from burning rosin or the steam of boiling tar to strengthen one's lungs. Many early physicians felt that southern climates and sunshine were key elements in the treatment of a TB patient and in the 1880's in the United States hundreds of people moved to Arizona with the belief that this climate might cure their TB.
In some countries in the Middle Ages, kings were considered to posses miraculous powers of healing. For many centuries the kings of France and England used to 'touch for Scrofula' - that is, they claimed to be able, simply by their touch, to cure people suffering from this disease, and their subjects shared a common belief in their powers.'The picture shows Charles II 'touching for Scrofula'. Famous people afflicted with T.B include : John Keats ,poet John Harvard, founder Harvard University. Robert Louis Stevenson ,writer Max Lurie ,TB researcher who developed immune and susceptible inbred rabbits Charlotte and Emily Bronte ,writers. Another famous T.B victim is Katherine Mansfield , whose personal journal included the following entry: 'August .
I cough and cough, and at each breath a dragging, boiling, bubbling sound is heard. I feel that my whole chest is boiling. I sip water, spit, sip, spit. I feel I must break my heart. And I can't expand my chest; it's is though the chest had collapsed...Life is--getting a new breath. Nothing else counts.'Re-emergence of T.B:While TB has long been a major problem in developing countries, by the 1960's it was widely thought to have been eliminated in the developed world as a result of improved social conditions, mass screening, and the effective use of antibiotics and the BCG vaccine.
After the 1960's, the perception was that Tuberculosis will automatically be eliminated from industrialized countries and would steadily decline in developing countries with the discovery of effective chemotherapy. But, many countries have had no strategy, no sharply focused plan and few resources to combat TB for the last two decades. Migration, international travel and tourism are increasingly allowing TB to penetrate borders. As a result, Tuberculosis has had a major rebirth in the 1990's. Improper detection and misdiagnosis caused less than half the estimated 8 million cased in 1990 to be detected, and of those detected less than half were successfully treated. According to the World Health Organization, the worldwide increase in TB is such that in 1996 more people were infected with the disease than at any other time. Each year, more people are dying of TB.
New outbreaks have occurred in Eastern Europe, where TB deaths are increasing after almost 40 years of steady decline. In terms of numbers of cases, the biggest burden of TB is in south-east Asia. TB kills about 2 million people each year. . Around 8 million people become sick with TB each year. Over 1.5 million TB cases per year occur in sub-Saharan Africa.
This number is rising rapidly as a result of the HIV/AIDS epidemic. . Nearly 3 million TB cases per year occur in south-east Asia. . Over a quarter of a million TB cases per year occur in Eastern Europe.
Factors Contributing to the Rise in TB . The global resurgence of TB is being accelerated by the spread of human immunodeficiency virus (HIV), the causative agent of AIDS. Of the 14 million people in the world who were HIV positive in 1994, some 5.6 million were believed to be infected with TB as well. TB and HIV form a deadly combination, each multiplying the impact of the other. When people are infected with both TB and HIV, TB is much more likely to become active because of the person's weakened immune system.
As more TB cases become infectious, it means that larger numbers of people carry and spread TB to healthy populations. TB is already the leading cause of death among people who are HIV-positive, accounting for almost one third of fatalities worldwide and about 40% in Africa. Preliminary studies show that it is the leading opportunistic disease in 50-70% of AIDS patients in parts of Asia, where the HIV virus is spreading more rapidly than anywhere else in the world. . Poorly managed TB programs are threatening to make TB incurable Until 50 years ago, there were no drugs to cure TB. Now, strains that are resistant to a single drug have been documented in every country surveyed and, what is more, strains of TB resistant to all major anti-TB drugs have emerged. A particularly dangerous form of drug-resistant TB is multidrug-resistant TB (MDR-TB), which is defined as the disease due to TB bacilli resistant to at least Isoniazid and Rifampicin---the two most powerful anti-TB drugs. MDR-TB is rising at alarming rates in some countries, especially in the former Soviet Union, and threatens global TB control efforts.
Drug-resistant TB is caused by inconsistent or partial treatment, when patients do not take all their drugs regularly for the required period because they start to feel better, doctors and health workers prescribe the wrong treatment regimens or the drug supply is unreliable. While drug-resistant TB is treatable, it requires extensive chemotherapy (up to two years of treatment) that is often prohibitively expensive (often more than 100 times more expensive than treatment of drug-susceptible TB), and is also more toxic to patients. Treating patients with drug resistant TB is also beyond the pocket of many developing countries. The cost of treatment can rise from $2000 per patient with non-resistant TB to $250,000 for multi-drug resistant TB. Movement of people is helping the spread of TB.
Global trade and the number of people traveling in airplanes have increased dramatically over the last forty years. In many industrialized countries, at least one-half of TB cases are among foreign-born people. The number of refugees and displaced people in the world is also increasing. Untreated TB spreads quickly in crowded refugee camps and shelters. It is difficult to treat mobile populations, as treatment takes at least six months.
As many as 50 percent of the world's refugees may be infected with TB. As they move, they may spread TB. Other displaced people such as homeless people in industrialized countries are at risk. In 1995, approximately 30 percent of San Francisco's homeless population and 25 percent of London's homeless were reported to be infected with TB. These figures compare to overall prevalence of 7 percent in the United States and 13 percent in the United Kingdom. The prevalence of infection in prisons can be even higher.
A majority of the world's health care systems are doing a poor job of curing TB patients. The World Health Organization (WHO) estimates that fewer than 30% of all countries are beginning to follow the control policies recommended by WHO. Without question, lack of effective TB programs around the world is the primary reason that the TB epidemic is out of control. In many countries, particularly southern Asia, patients are diagnosed only on the basis of X-ray shadows. As a result, many people with other lung diseased or who have had TB in the past but who are now cured have shadows on their X-ray and are incorrectly diagnosed with tuberculosis.
Many countries are still not properly using short-course chemotherapy to treat their patients. They often adhere to a 12-month 'long-course' treatment that is initially less expensive until one adds the cost increased treatment failures. The situation is even worse in some parts of the world, where treatment practices are accomplishing nothing other than creating drug-resistant TB. For example, in a survey of 100 doctors in Bombay, it was found that up to 80 different drug combinations were being used, most of which were inappropriate.WHO Tuberculosis: Strategy and Operations Goals: .To reduce TB morbidity and deaths by promoting the world-wide use of DOTS and other effective TB control strategies to assess existing strategies, and develop new strategies for the prevention and control of TB through operational, epidemiological, and economic research Objectives: . to develop a global plan for the control and prevention of TB, and to assist countries in its implementation .
to promote the wide-spread use of DOTS; the potential of this cheap and effective strategy to reduce TB morbidity and deaths has not yet been realized in all settings . to assess the impact of DOTS in specific settings and globally . to design new approaches to TB control addressing the specific problems of TB/HIV, drug resistance and inequalities in access to health services The WHO-recommended treatment strategy for detection, cure and effective TB control is DOTS (Directly Observed Treatment). DOTS combine five elements: political commitment, microscopy services, drug supplies, surveillance and monitoring systems and use of highly efficacious regimes with direct observation of treatment. Once patients with infectious TB have been identified using microscopy services, health and community workers and trained volunteers observe and record patients swallowing the full course of the correct dosage of anti-TB medicines (treatment lasts six to eight months). Sputum smear testing is repeated after two months, to check progress, and again at the end of treatment.
A recording and reporting system documents patients' progress throughout, and the final outcome of treatment. . DOTS produces cure rates of up to 95 percent even in the poorest countries. . DOTS prevents new infections by curing infectious patients.
. DOTS prevents the development of MDR-TB by ensuring the full course of treatment is followed. . A six-month supply of drugs for DOTS costs US $11 per patient in some parts of the world. The World Bank has ranked the DOTS strategy as one of the 'most cost-effective of all health interventions.' Since DOTS was introduced on a global scale, millions of infectious patients have received effective DOTS treatment.
In half of China, cure rates among new cases are 96 percent. In Peru, widespread use of DOTS for more than five years has led to the successful treatment of 91 percent of cases. By the end of 1998, all 22 of the high burden countries which bear 80% of the estimated incident cases had adopted DOTS. 43 percent of the global population had access to DOTS, double the fraction reported in 1995. In the same year, 21 percent of estimated TB patients received treatment under DOTS, also double the fraction reported in 1995. WHO targets are to detect 70 percent of new infectious TB cases and to cure 85 percent of those detected.
Six countries had achieved these targets in 1998. Governments, non-governmental organizations and civil society must continue to act to improve TB control if we are to reach these targets worldwide.Prevalence of Tuberculosis Around the WorldPrevalence of Tuberculosis Around the World with Specific Case-Control Sites Global Epidemiology Tuberculosis (TB) is the leading cause of death from a single infectious disease, accounting for over a quarter of avoidable deaths among adults. This disease has affected all major regions of the world. The purpose of this report is to give the reader an idea of how dominating and debilitating this disease has proved to be. In addition, the need to control tuberculosis is evident throughout the world and various control programs have recently been implemented. Tuberculosis is a global epidemic that has reached staggering morbidity and mortality rates.Based on the results, the greatest concentration of reported TB infections occurred in Southeast Asia. This makes up almost half the total reported cases in the world.
Furthermore, the number of cases in American and European populations has decreased since 1986. Although the data from 1984-1991 suggests that the American rates of TB cases will continue to drop, there has been an unexpected 14% increase in TB cases in the United States from 1985-1993 (Raviglione, 1995). This means that a significant increase in the number of TB cases must have occurred between 1991-1993. Among those more susceptible to the disease were young (25 yrs. old) to middle-aged people.
Overall, non-US-born individuals accounted for 60% of the increase in cases from 1986 through 1992. HIV infected individuals also account for a high percentage of a recent rise in reported tuberculosis cases. In Canada, a rate of 0.5 per 100,000 individuals has been maintained in recent years (Raviglione, 1995). Tuberculosis has had varying trends of occurrence throughout European countries. Most recently, western European countries have case notification rates ranging from 7.0 in Denmark and Sweden to 55.7 in Portugal per 100,000 residents.
In Eastern Europe, the rates are higher than those of the west ranging from 20.2 in the Czech Republic to 79.6 in Romania per 100,000. Notification rates are also different in countries such as Australia, Japan, and New Zealand. TB cases from 1986 through 1992 have remained stable at an average of 5.7 in Australia. Almost three-fourths of the cases were due to non-Australian-born individuals (Raviglione, 1995). Japan, on the other hand, has noticed a decrease in both case notifications and mortality rates. The declining rates, however, have been gradually diminishing since the early 1980's. According to WHO, overall notification cases in Japan have declined at an average of 3.5% per year; mortality rates have declined at an average of 4.6% per year since 1980.
New Zealand has also experienced a decline in mortality rates due to TB from 0.9% to 0.5% per year since 1980. Underdeveloped or developing areas of the world have seen much higher rates of TB morbidity and mortality, due mainly to the high prevalence of HIV and AIDS. According to the Global Programme on AIDS of the World Health Organization, almost 90% of all HIV infections have occurred in developing countries. These areas include much of Africa, Asia, Central and South America, and parts of North America. It is estimated that the majority of people infected by both HIV and TB live in sub-Saharan Africa. In 1994, 3.8 million of the 5.6 million individuals infected with both diseases were reported here (Raviglione, 1995). Other estimates of HIV/TB infected individuals are as follows: Table 2: Estimates of HIV/TB co-infection in selected regions Region Number Infected North Africa and the Middle East 23,000 East Asia and the Pacific 20,000 Southeast Asia 1.15 millionEurope and the former Soviet Union 9,000 Western Europe 49,000 North America 80,000 Latin America and the Caribbean 450,000 Tuberculosis Prevalence and Control in Specific RegionsDue to the tremendous tuberculosis prevalence around the world, it is crucial that the disease be kept under control.
The current focus is to pay attention to specific examples of how particular countries or geographical sites have dealt with the struggle to control this deadly disease. It should be mentioned that methods for TB control are not specific to a particular country. Many countries have similarities in their treatment programs (i.e. drug use and administration). In some cases, focus will be placed on controlling TB in certain populations. Raviglione, Mario C.,et al.
'Global epidemiolgy of tuberculosis: morbidity and mortality of a worldwide epidemic.' JAMA. 273:220-6. Jan. 18, 1995. A. In Puerto Rico Puerto Rico, an island located in the Caribbean, had an estimated 1,500 TB cases per 100,000 individuals in 1985.
Various methods were used to try to cure patients and control tuberculosis spread. These include the use of drugs such as isoniazid, rifampin, streptomycin, pyrazinamide, ethambutol, para-aminosalicylic acid, ethionamide, cycloserine, capreomycin and kanamycin (Hunter, 1985). In addition, Hunter (1985) suggested that a rise in the general standard of living along with improvements in housing, nutrition and working conditions is followed by a decline in the incidence of tuberculosis. Hunter, John M. and Arbona, Sonia.
'Field Testing along a disease gradient: some geographical dimensions of Tuberculosis in Puerto Rico.' Social Science and Medicine. Volume 21, #9, 1985. Page 1023-42.B. In Canada The drugs mentioned above are not the only ones available which are effective in the control of TB. Canada, with a high incidence of TB infection among native Indian populations, has used a different drug in studies to treat newborns of natives.
Bacille Calmette-Gu'erin (BCG) has been used as a vaccine to prevent the development of tuberculosis in these babies. The effectiveness of the drug in protecting newborns has been estimated to be at least 60% (Young, 1986). Although this is not extremely high, when used in conjunction with other treatments, overall effectiveness may be greatly enhanced. Young, T. Kue. 'A Case-Control study to evaluate the effectiveness of mass neonatal BCG vaccination among Canadian Indians.' American Journal of Public Health. Volume 76, July 1986.
Page 783-6. C. Underdeveloped Countries Tuberculosis control teams, such as the French-based Association pour la Promotion de la M'edecine Pr'eventive (APMP), have been developed specifically to help TB infected children in underdeveloped third world countries. Because so much area in third world countries consist of rural development, vaccines against tuberculosis are often scarce. This occurs because the major hospitals and clinics are found in the more urban developed areas, which are often secluded from the rural world. As a result, the delivery of vaccines to proper TB infected areas or populations becomes a challenge.
However, there is hope. The APMP team was created to give health care to those rural populations (especially children) infected with disease. The four member team consists of the following: a paramedical experienced leader, who administers the one intradermal shot of BCG for tuberculosis and monitors any reactions; a nurse, who explains to the mothers why it is important for the children to return, as well as how to improve family health and nutrition; a driver-mechanic; and a scout who rides ahead to get the village chieftain to assemble the families (Englebardt, 1984). Each team was efficient in vaccinating hundreds of children per day. Later studies had confirmed that the vaccinated children had developed antibodies against the tuberculosis disease.
Englebardt, Stanley L. Saving the Third World's Children.' Reader's Digest. Vol 125, October 1984, pages 136-141.D. In China: China, which created a national tuberculosis control programme in the early 1990's, has had great success in controlling the infectious disease. The Chinese government proposed that village doctors directly supervise patients (i.e.
making sure they took their medication at the right time and with the correct dosage) in order to make sure that they successfully complete their treatment. In addition, the government significantly reduced the price of tuberculosis medicine, making it affordable for TB infected patients who were financially challenged. By consolidating the purchase of large quantities of TB medicines, the government was able to dramatically reduce the cost of six months' worth of medicine from as high as $80 to only $13 per person. The outcome of this project yielded some of the most successful results found in the world. Cure rates were found to be 94% by the end of 1991 and 91% by 1993.
E. In Tanzania: Tanzania has utilized a strategy similar to China's in the fight against tuberculosis. Immediate treatment involves the drugs isoniazid, rifampicin, pyrazinamide, and streptomycin. Patients are treated with these drugs each day for two months. Thereafter, treatments involve only the isoniazid and rifampicin every other day for three months. This treatment has given an increase in cure rate from 43% to 80% in preliminary projects.
Global Emergency AlertThe World Health Organization estimates that the annual number of new cases of tuberculosis will increase from 7.5 million in 1990 to 10.2 million in the year 2000, a global escalation that will produce almost 90 million new cases this decade. Deaths attributable to tuberculosis are likely to rise from 2.5 million in 1990 to 3.5 million by the year 2000, making a total of 30 million deaths during the 1990's (i.e. one quarter of all preventable adult deaths).IT'S A FACT THAT.... TB kills 1.7 million people every year. Of these, almost half a million people are co-infected with HIV. One in three of the global population-about 2 billion people-have latent TB infection, but only about 10% of them will go on to develop the disease.
TB is spread by infectious droplets-through coughing, sneezing, or spitting. It thrives in conditions of poverty and overcrowding. A person with active TB can infect an average of 15 people a year. Every year there are about 8 million new TB cases and the poorest and most vulnerable are at highest risk. The disease strikes people during their most productive years. Three out of four deaths occur between the ages of 15 and 54.
Millions of TB deaths could be prevented through the widespread use of DOTS , an inexpensive strategy for the detection and treatment of TB. In 1997 the average treatment success rate worldwide was almost 80%. Unfortunately, less than 25% of people who are sick with TB are treated through the DOTS strategy. A new strain of TB addressed as multi-drug-resistant tuberculosis (MDR-TB) as well as the co-epidemic TB/HIV. Two-thirds of the people living with HIV worldwide are in sub-Saharan Africa and over 90% do not know they are infected. This region accounts for 70% of all co-infections with TB/HIV.strategy.
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