Sociological Analysis of Tuberculosis - Free Essay Example

Tuberculosis (TB) is an extensive global health problem. Approximately one third of the entire population is infected with tuberculosis (Riegelman 2016). Tuberculosis is the second leading cause for high mortality rates across the world, following HIV/AIDS. In 2011, there were 8.7 million new cases of tuberculosis and 1.4 million related deaths. In 2013, mortality rose to 1.5 million deaths and those infected rose to 9 million (Fogel 2015). The disease is deadlier than the plague or cholera (Fogel 2015:528). Mycobacterium tuberculosis is the bacteria that is responsible for the disease. It is spread from person to person through aerosol droplets. People breathe in these aerosol particles and contract the disease. Tuberculosis mainly affects the lungs; however, it can also target other organs in the body. One infected individual has the potential of infecting 10 to 15 persons annually and two thirds of those infected with active TB will die. Symptoms of tuberculosis may include a cough lastly more than 3 weeks, weakness, night sweats, decreased appetite and body weakness (Riegelman 2016). Tuberculosis can also lead to severe coughing, fever, and chest pains according to Fogel (2015). TB infection and mortality rates are of a concern to g lobal health, because tuberculosis is mostly a preventable and curable disease. A vaccine known as Bacillus-Calmette-Guerin (BCG) can be given to children to reduce their risk of obtaining tuberculosis. The vaccine is normally provided to newborns and is not all that effective in adults. However, children are not significant transmitters of tuberculosis and therefore, vaccination rates of children have little impact on the prevalence and incidence rates of TB. Those who contract tuberculosis are recommended a six-month regimen by the World Health Organization in which the patient must be carefully monitored to ensure adherence. The regimen is a drug cocktail that begins with an intense two-month phase and then followed by a less intense four-month continuation phase. Depending on the situation of TB, the regimen can be complex and difficult to follow. Tuberculosis has a fast mutation rate and not adhering to this regimen can lead to drug resistance (Fogel 2015). If the disease is re sistant to one or more tuberculosis drugs, this is known as multidrug-resistant TB (MDR-TB). Nonadherence can also lead to extensively drug-resistant TB (XDR-TB) that is difficult to treat. In 2013, approximately 5% of all TB cases were multidrug-resistant and this rate continues to increase (Riegelman 2016). Tuberculosis causes extensive costs to individuals affected and to a countrys economy overall. For instance, in India, TB causes an individual to lose three months worth of wages. In Bangladesh, TB causes a loss of 4 months of wages. In Thai, more than 15% of an individuals income is spent to treat tuberculosis (Riegelman 2016). Lower productivity of individuals causes a strain on the economys productivity and the amount of GDP spent on healthcare treating tuberculosis. The likelihood of contracting tuberculosis is increased by certain risk factors and social forces. Individuals with a compromised immune system, including those with HIV, AIDS, Diabetes, malnutrition, or even certain cancers, are at higher risks of contracting TB. Smoking can also compromise the immune system and lead to a higher risk for tuberculosis (Riegelman 2016). Specific populations are also at greater risk for contracting TB. These individuals include young male adults living in developing countries, healthcare workers who are around those infected, and foreign-born individuals according to Fogel (2015). The organization of tuberculosis healthcare services also impacts the rate of TB. TB services are not structured with the needs of patients in mind. Healthcare professionals operating TB services have been found to be authoritative, disrespectful, and nonempathetic. Healthcare has a traditionally manly, authoritative approach that does not fit the needs of men or women. Men a re reluctant to see a male physician with this mentality and it makes women feel inferior and also reluctant to seek care (Mason et al. 2017). Young men from migrant and refugee backgrounds are known to face various barriers to accessing primary care in Australia and New Zealand, while young women in the Asia-Pacific region, particularly on the Indian subcontinent, frequently face financial and social barriers to accessing primary health care services, including TB services (Mason et al. 2017:227). The homeless, HIV-positive persons, prisoners, and those living in poverty and crowded areas also have higher risks for TB. Gender also plays a role in tuberculosis rates. Sixty percent of all TB cases fall among men (Riegelman 2016). Worldwide, TB cases among men exceed those found in women, with a male to female ratio of 1.7:1 (Mason et al. 2017:227). Prisons are known as hot spots for tuberculosis due to their overcrowding of people in small spaces and since prisoners are mainly males, TB rates are shown to impact males more than females (Mason et al. 2017). Despite this, TB is also a leading killer of women causing 500,000 deaths (Riegelman 2016). According to Mason et al. (2017), men and women differ in their patterns of seeking healthcare, including diagnosis and treatment of TB. Men are constricted by social gender roles that impact their health-seeking behaviors and this can postpone the diagnosis of their TB. Women are more likely to seek care from a health professional than are men. Women also face negative experiences and stigma associated with TB and this harmfully impacts a womens adherence to treatment of TB and their health-seeking behaviors (Mason et al. 2017). Age also plays a crucial role in who obtains the disease. Seventy-five percent of all TB infections occur within the age range of 15 to 54 years old (Riegelman 2016). Women between the age of 20 to 30 for generations born between 1820 to 1900, demonstrates a peak in TB infection rates (Mason e t al. 2017). Pregnancy is suspected to play a role in the early peak of female TB mortality in late adolescence and early childhood (Mason et al. 2017:227). Compared to women in the same generations, men between the age of 30 to 40 are at greater risk of death from TB. Occupational hazards and smoking are risk factors for men later in life (Mason et al. 2017). Men are also at more risk for developing multidrug-resistant tuberculosis, because they are more likely to be interrupted during treatment (Mason et al. 2017). The majority of cases of TB occur in particular areas of the world. Eighty percent of all TB cases occur mainly in 22 countries. Eighty-five percent of all multidrug-resistant TB cases occur in 27 countries, which includes Russia, India, and China (Fogel 2015). More than half of all tuberculosis cases occur in South-East Asia and the Western Pacific. The remaining high rates of TB occur in Africa- with an incidence rate of 280 new cases per 100,000 population each year, India- with 24% of new cases, and China- with 11% of all new cases (Riegelman 2016). Multiple issues must be addressed in order to reduce the prevalence, incidence, and mortality rates of tuberculosis. Poverty needs to be alleviated to allow for less crowded housing and better nutrition. Better diagnosis of TB needs to be available specifically in Eastern Europe and Central Asia. Those who are diagnosed need to be provided with adequate treatment. Diagnosis and treatment of TB also needs to be globally standardized, specifically in the private sector relating to drug regimen, cheaper TB treatment, and patient follow-up. This also calls for more funding. Overall health systems and healthcare coverage need to be improved. Lab services need to be cheaper and more readily available, infection control needs to be secured, TB care should be incorporated in the primary care level, and the community needs to be provided with more education about tuberculosis. Most importantly, a new regimen of vaccine must be created in order to treat tuberculosis in a more manageable manner . This would reduce the number of noncompliant patients with the current six-month regimen. This would also lead to a reduction in the number of multidrug-resistant and extensively drug-resistant TB. In order for this to be feasible, more research funds need to be provided (Riegelman 2016). Policy is needed that takes into consideration the gender class and ethnicity of those infected as the central analysis. There is a complex interplay of biological, social, and cultural variables and risk factors rather than being about either biological or social factors (Mason et al. 2017:228). Another issue with TB is the number of cases that are not reported. The World Health Organization estimates that three million individuals are still being missed by the healthcare system each year. These individuals are either not diagnosed or are not being notified of their positive TB status. Missing cases, high death rates, and drug-resistance all point to one critical underlying problem- that high bu rden countries are unable to guarantee an acceptable quality of TB care to all patients, regardless of whether they seek care in the public or the private sector (Pai and Memish 2015:1). Patients with known TB symptoms who are not diagnosed signifies the need for standardized international diagnosis, as mentioned above. Patients who develop multidrug-resistant and extensively drug-resistant TB demonstrates poor adherence to treatment standards, therefore a new system for monitoring individuals with TB must be established. Patients infected with tuberculosis who are not notified of their status shows the lack of engagement from health providers, specifically in the private sector. The World Health Organization has recently announced their ambitious End TB Strategy. This strategy aims to put an end to the worldwide TB epidemic and reduce TB deaths by 95%. The End TB Strategy also aims to reduce the incidence rates of TB by 90% from 2015 to 2035. It also aims to ensure families are not burdened by shattering expenses due to TB. The End TB Strategy may convince country governments to invest more in their tuberculosis control programs. For example, the Indian government is aiming to end TB by 2020 and has established a goal to provide universal access to tuberculosis treatment to all patients of acceptable quality. In order for this to be effective, the Indian government must provide more resources and money to this since their current TB expenditure is low. China on the other hand, has made major investments in their TB control and have successfully lowered their TB prevalence by more than half in the last 10 years. There is also an overall global funding gap for TB. Eight billion U.S. dollars are needed to respond to the TB epidemic, however there is a shortfall of two billion U.S. dollars (Pai and Memish 2015). These solutions will take political leaders and policy makers to provide adequate resources. If these solutions were implemented, the cost of healthcare expenditure on TB would decrease and lives would be saved.