The Role Of Public Health Workers In Tuberculosis Management And Prevention

INTRODUCTION

1.1 Background to the study

Tuberculosis or TB is a common and often deadly infectious disease caused by various strains of Mycobacteria, usually Mycobacterium tuberculosis in humans. Tuberculosis usually attacksthe lungs but can also affect other parts of the body. It is spread when the bacteria get into the air, and when people who have the disease cough, sneeze, or spit. A person can become infected with tuberculosis bacteria when he or she inhales minute particles of infected sputum from the air. People who are close to the infected person, are more likely to be infected when they breathe the bacteria into their lungs. Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease, which, if left untreated, kills more than 50% of its victims. (Mims, 1993)

Persons with latent TB infection do not feel sick and do not have any symptoms, but usually have a positive reaction to the tuberculin skin test. They are infected with Mycobacterium

tuberculosis, but do not have active TB disease. Those with latent TB infection are not infectious

and cannot spread TB infection to others. However, persons with latent TB infection may develop active TB disease at some time in the future. About 10% of infected persons will develop active TB disease at some time in their lives, but the risk is considerably higher in the first two years of infection particularly for persons whose immune systems have been weakened by HIV infection. Persons with latent TB infection should be treated in good time, in order to prevent the infection from progressing to active disease. Those with active TB disease are considered infectious and can spread TB bacteria to others. The classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss. Infection of other organs causes a wide range of symptoms. Tuberculosis is diagnosed definitively by identifying thecausative organism (Mycobacterium tuberculosis) for example in sputum or pus. When this is not possible, a probable - although sometimes inconclusive diagnosis may be made using imaging such as X-rays or scans and/or a tuberculin skin test (Mantoux test).Treatment is difficult and requires long courses of multiple antibiotics. Contacts are also screened and treated if necessary. Antibiotic resistance is a growing problem in (extensively) multi-drug-resistant tuberculosis. Prevention relies on screening programs and vaccination, usually with Bacillus Calmette-Guérin vaccine

With the discovery of chemotherapy in the 1940s and adoption of the standardized short course in the 1980s, it was believed that TB would decline globally. Although a declining trend was observed in most developed countries, this was not evident in many developing countries (Chadha, 2009). In developing countries; about 7% of all deaths are attributed to TB which is the most common cause of death from a single source of infection among adults. (Kaye et al., 1996).

The end TB Strategy target is to accelerate the annual decline of TB incidence rates from 2% in 2015 to 10% per year by 2025, WHO (2016). This strategy addresses the challenges facing many countries with high tuberculosis (TB) burden including Nigeria, which remains one of the worst TB affected countries in the world, Onyedum CC (2017). Evidence suggests that the TB prevalence and mortality rates in Nigeria were previous underestimated.Adamu AL (2017). Despite being ranked the 4th TB affected country in the world in 2009, it was estimated that 590,000 new TB cases were reported in 2015.WHO (2013). In order to stop the spread of TB in the country, the government of Nigeria has implemented various interventions aimed at early detection of TB and overall TB control.Pathmanathan I (2017). Although these initiatives contribute greatly to the management of TB, several studies carried out in Nigeria and other countries have presented TB related challenges.Kigozi G (2017), This includes patients’ related factors such as inadequate TB knowledge as well as perceptions and attitude towards treatment. Consistently, inadequate knowledge of TB treatment especially treatment duration has been associated with treatment interruption. Sub- optimal patients’ compliance is a practical implication of poor TB knowledge. In real terms, when patients observe improvement in their health arising from the effective use of TB-medications within few weeks of treatment at the DOT centres, they stop taking medication. Patients whose treatment is interrupted remain infectious for longer period. They are more likely to relapse or succumb to tuberculosis as a result of treatment failure, hence foster the emergence of drug-resistant tuberculosis.

1.2 Statment of the Problem

The World Health Organization (WHO) in 1993 declared TB a global emergency in recognition of its growing importance as a public health problem. In 2009, WHO revised TB Infection Prevention Control policy, guidelines and implementation strategies. The WHO stipulated guidelines adopted by Nigeria were to ensure safe practices among health care workers, patients and families. This was disseminated in all the states in 2010 to ensure that TB control strategies are implemented in all health institutions throughout the country including the ability to control nosocomial infections as part of quality health care service to the people (WHO, 2006). TB Infection Prevention Control is one of the major strategies to prevent and control TB disease in patients and healthcare workers (HCWs) in the health care setting (Federal MinistryofHealth, 2010). However, tuberculosis transmission among HCWs, patients and families is still a threat especially to nurses who have the closest and longest contact with patients than other care givers (Lopez, 2008).

In the state where the current study was conducted, there was no available official data on students infected with TB. The TB coordinator of the school clinic indicated that this was so because the TB reporting format does not include the patients‘ occupation (personal communication).The researcher, a student has observed that some practices among students were contrary to the recommended standard guidelines and strategies on TB infection control despite the adoption and dissemination of TB infection prevention control in Nigeria two years ago.However, the question is what is the role of public health workers in tuberculosis management and prevention?.