Dep tu Asest T 1
Tuberculosis
Disease: Tuberculosis
INQUIRY PLATFORM: THE PREVALENCE OF DISEASES HAS CHANGED OVER TIME.
1. Focusing on your allocated disease, design two possible research questions
to address the statement above.
Possible research questions:
● How has treatment such as antibiotics helped stop the spread of
infectious diseases such as tuberculosis globally over time?
● How have preventative measures helped stop the spread of tuberculosis
over time?
Final research question:
How have treatments such as antibiotics helped stop the spread of infectious
diseases such as tuberculosis globally over time?
2. Create a hypothesis based on your final research question.
Question - How have treatments such as antibiotics helped stop the spread
of infectious diseases such as tuberculosis?
Hypothesis - Antibiotics have been effective in helping to reduce the number of
people affected by tuberculosis over time.
3. Research your answer
a. What terms will you need to look up? What smaller questions will you enter into
a search?
Some terms that need to be looked up: infection rate, tuberculosis, causes,
symptoms, trends, prevalence, incidence, cases, age groups affected.
Smaller questions:
➔ What is the name of the antibiotic which helps cure tuberculosis?
➔ How is tuberculosis spread?
➔ What is the prevalence of tuberculosis over the last 50-100 years?
➔ What are the trends in tuberculosis for different age groups?
➔ How is tuberculosis spread across different people?
➔ Which regions have higher chances of contracting tuberculosis?
b. What sources will you accept as credible? Justify your answer
Credible sources are those that are unbiased and are backed up with evidence.
Many sources can be considered credible by looking at other factors such as
the author, purpose of the source, date of publication as well as the depth of
the information that is being provided by the source. Sources that are written
by qualified people and are recent from the last 2-3 years are unbiased and
recent, which means that they are credible.
c. How will you ensure your information is reliable?
To ensure that information is reliable, sources should be well-reasoned and
based on strong evidence. Any information that is obtained and that is reliable,
can be considered as credible. The accuracy of the source can be used to
determine the reliability of information that is being obtained. When looking
for the accuracy of sources, it should be known that some content can be
misleading when dealing with technical terminologies. To ensure this does not
happen, information can be double checked against another source that is
known to be trustworthy. Another way to determine if information obtained is
reliable, is by looking at the coverage and currency of the content being
researched. For any information that is medical-based, information in recent
years is far more reliable than those found in previous older years. Similarly,
information that is reliable also needs to be covering content that is relevant to
the topic that is being studied.
d. Locate statistical data on the incidence (number of new cases for a specified
population in a given period) AND prevalence (total number of cases for a
specified population in a given period) of this disease.
● Identify key trends in the
data
World Health Organisation - Global TB report 2021
The prevalence of a disease is generally considered to be the prevalence rate, which is
the proportion of people in a population in a particular given time period who have a
specific disease or attribute which can at a specific given time period. The incidence of
a disease is generally considered to be the occurrence of new cases of a disease for a
population in a given period. The global trend of the prevalence of tuberculosis is
seeming to decrease from the time of 2016 to 2020. The total number of cases from
2016 was approximately 6.4 million per year with the number of cases increasing in the
time between 2016 to 2019. It can be seen that the global trend in case notifications
has significantly decreased between 2019 and 2020. The substantial reduction in TB
case detection and reporting between 2019 and 2020 reflects both the supply and
demand-side disruptions to tuberculosis diagnostic and treatment services including
the increase in antibiotics to cure tuberculosis. This data is evident through all six of
the World Health Organisation regions including the African Region, Region of the
America, South-East Asia, the European region, Eastern Mediterranean region as well
as the Western Pacific Region.
World Health Organisation - Global TB report 2021
The estimated number of tuberculosis incidence rates worldwide show the incidence
per 100000 population per year. It is evident from the map that approximately most
of Africa and Asia as well as Western South America are majorly affected by new
incidents. These new cases provide evidence for the lack of resources available for
these countries in these particular areas as well as the quality of life associated with
the living conditions for people.
The estimated tuberculosis incidence for countries around the world with at least
100000 incident cases show the common regions of the world that are severely
affected by this infectious disease. From the map, it can be seen that approximately
India is responsible for the 2,000,000 new cases in 2020 while other Asian countries
such as China, Philippines and
Indonesia seem to be
responsible for 1,000,000 of
new cases with finally Southern
African countries responsible
for approximately less than
500,000 new cases during the
year of 2020. These countries
accounted for approximately
two thirds of the global cases
in the year of 2020. However,
these number of incident cases
compared much lower to the
number of incident cases in
2015 with most of the
cumulative incidence reduced
by 11% just over the 2020 milestone. World Health Organisation - Global TB report 2021
● Identify factors that affect the incidence AND prevalence of this disease
e.g. location
➢ Socio-economic factors:
Tuberculosis patients tend to have a poor quality of life and a high risk of
experiencing depression. This in turn is also affected by a patient's adherence to
treatment. These poor living conditions are related to the social relationships of those
patients as well as physical conditions. Gender also plays a significant role in the
amount of people affected by tuberculosis. These global estimates of tuberculosis
incidence as well as prevalence show the majority of males most affected by this
disease when compared to females. The age groups also represent the majority of
males affected are in the range of between 25 and 54. Majority of females
mainly affected include those between the ages of 15 to 34 with cases decreasing as
age increases. According to the Global Burden of Disease, the majority of tuberculosis
related deaths occurred among people over the age of 45. Older adults are more
likely to contract extra-pulmonary and
atypical forms of disease that are often
harder to diagnose than conventional
sputum smear-positive pulmonary
tuberculosis. Health systems are more
inclined to confront the challenge of an
ageing global population as well as the
integrated services required to address
their health needs.
← World Health Organisation - Global TB report
2021
➢ Environmental factors:
Environmental factors such as pollution
as well as access to good ventilation
are important to notice the increase in
the incidence and prevalence of
tuberculosis. Even though the nature of
tuberculosis cases and environmental factors have not been much in focus, about 26%
of these cases are due to indoor pollution. Indoor pollution can include excess smoke
inside the house due to no exhaust when cooking, the type of fuel used for cooking,
number of people sleeping in a single room as well as sharing of toilet facilities.
Prevalence of tuberculosis was found to be higher in households using solid fuel for
cooking in most Asian countries, as well as those that did not have a separate area for
cooking. As well as indoor pollution, it has been revealed that air pollution from
passive smoking and biomass fuel combustion is related to the increased risk of
tuberculosis. Broad evidence has also shown that exposure to particles with
aerodynamic diameters less than 10 micrometres, carbon monoxide, nitrogen oxides as
well as nitrogen dioxide are associated with the high risks of the incidence of
tuberculosis.
➢ Economic factors:
Economic factors such as unemployment as well as those with low incomes are greatly
associated with the increased possibility of contracting tuberculosis. This risk of
tuberculosis is highly popular amongst those who are living in poverty, lower
socioeconomic groups, low income as well as immunosuppressed individuals. For
example, Ethiopia is home to the second most populous country in Africa with only
16% of the country living in urban areas with approximately a literacy rate of 42.7%. It
is one of the most high burden countries in the world with an estimated prevalence
and incidence rate of 394 and 296 cases per 100,000 inhabitants respectively. Low
level of knowledge can also lead to the increased transmission of TB and delayed
health seeking behaviour, disease complication and eventually death.
e. Using the data, discuss the change(s) in the incidence AND prevalence of the
disease over time with reference to your research question.
Since 1992 it has been shown that there has been a decline in the number of cases
accumulated over a year as well as the total number of cases. Due to the introduction
of antibiotics, this disease has been deemed curable. Current antibiotic regimes
include six to nine months of daily doses of four drugs with the sole purpose of
eradicating Mycobacterium tuberculosis to stop the drug-resistant development of the
bacterium. Though antibiotics have helped to see a decrease in the prevalence of
tuberculosis, new acquired antibiotic resistant bacteria have started to develop in
which the antibiotic that is provided is no longer effective for this new strain. The
multi-drug resistant bacteria currently requires treatment for up to 2 years with
several antibiotics that pose possible side effects. This extensively drug-resistant
tuberculosis has thus been reported across 92 countries around the world with some
strains resistant to all available drugs. In this decline of cases, it can be seen that the
majority of those affected by TB are largely male compared to females in relatively
low to medium income countries. This is due to the fact that men are disadvantaged in
seeking or accessing proper healthcare in many settings. Similarly factors such as
economic factors as well as environmental factors also play a role in determining who
is affected by tuberculosis. However these factors are gradually decreasing as the
total number of cases from 2016 to 2020 had a significant drop between 2019 and
2020. This may have been due to the CoronaVirus pandemic giving less importance to
those affected by tuberculosis. However, the incidence of these cases has reduced by
20%. Most regions around the world show that the rate per 100,000 population per
year has gone from approximately 1000 per 100,000 population to significantly less
than 500 per 100,000 population. However, the World Health Organisation has
projected that the negative impacts of tuberculosis mortality and incidence in 2020
will become much worse in 2021 and beyond. Earlier modelling projections also show
that the incidence is projected to be much higher in 2022. Thus it can be seen that
there has been a significant reduction in tuberculosis incidence and prevalence across
the world however these changes in case numbers are not the direct result of
antibiotics but also from other preventative measures as well as the increased use of
technology to account for anti-tuberculosis tablets and long-term medications which
has become available worldwide.
4. Based on the data you have gathered, review your hypothesis and provide
justification for amending (if required) your hypothesis.
The hypothesis states that due to the use of antibiotics, the prevalence and incidence
of tuberculosis has significantly decreased around the world. However, the potential
mutating nature of the bacterium shows that there is no single cure for this disease
and preventative measures allow for the gradual improvement of an individual's
health. This hypothesis cannot be supported as the decrease in tuberculosis has not
only been from the excessive use of antibiotics. Human behaviours also play a major
role determining the reason for the debate regarding antibiotics as the more
non-compliance an individual had, the more easily the bacterium would undergo
mutations making it resistant. The everlasting nature of this disease means that it will
always be present in this world and inventions such as technology can help to identify
the disease at earlier stages but medications such as antibiotics cannot be fully used
to eradicate this disease. Thus, the hypothesis made is incorrect as antibiotics are not
the sole reason why the incidence and prevalence of tuberculosis has decreased but is
a contributor to the decrease in the number of cases.
FACT SHEET - TUBERCULOSIS
IDENTIFY THE NAME OF THE DISEASE RISK FACTORS
Name of disease - Tuberculosis Risk factors for tuberculosis may include
close-contact situations where people have
BRIEFLY OUTLINE THE DISEASE been in contact with those affected by
Tuberculosis is an infectious disease, tuberculosis, alcohol and IV drug abuse etc.
primarily in the lungs and is a type of Those at risk mainly include people who have
Pneumonia, caused by the bacteria spent long periods in close contact with
Mycobacterium tuberculosis. This bacteria infectious Tuberculosis. Others include people
was first isolated by Robert Koch, a who take medication that affects the immune
German physician who received the Nobel system such as chemotherapy or
prize for discovering the bacterium. corticosteroids as well as those who have a
chronic illness which affects their immune
OUTLINE THE CAUSE/TRANSMISSION system.
Tuberculosis is an infectious disease most
commonly transmitted through the air. PREVENTATIVE MEASURES
When those that are affected by Some preventative measures that helps reduce
Tuberculosis cough, sneeze or spit, germs the spread of tuberculosis is always covering
are propelled into the atmosphere. Anyone the mouth with a tissue when coughing or
who inhales this air is affected. However, sneezing and throwing away the tissue after
the bacteria can also remain in a dormant use, washing hands with antibacterial soap
state for many years without causing any after coughing or sneezing, use a fan or open
symptoms or spreading from one person to windows to let fresh air circulate through the
another. It is also not spread by households room, avoid using public transportation, stay at
items such as cutlery, sheets, clothes and home from work or school. This also includes
phone so it is not necessary to separate keeping those infected isolated. The BCG
household items. vaccination also gives protection against the
life-threatening forms of TB in young children
IDENTIFY THE SIGNS/SYMPTOMS who travel to countries where Tuberculosis is
The main symptoms of tuberculosis include common. However this vaccine is not routinely
cough with sputum and sometimes blood, given in NSW.
chest pains, weakness, weight loss, night
sweats as well as fevers. Can also cause loss MANAGEMENT/TREATMENT
of appetite as well as pain and swelling Tuberculosis is a treatable and curable disease.
in the affected area, 3 week cough and fatigue. It can be treated through a Standard 6-month
course of four antimicrobial drugs that are
METHODS OF DIAGNOSIS given along with information support for the
The World Health Organisation patient by a healthcare worker or trained
recommends the use of rapid molecular volunteer. Inactive tuberculosis may also be
diagnostic tests as the initial diagnostic in treated with antibiotics such as isoniazid
everyone with signs and symptoms as this preventing it from becoming active. For
will lead to the early detection of Tuberculosis infection the doctor may prescribe
tuberculosis as well as drug-resistant a course of tablets or follow up with regular
tuberculosis. This disease can also be diagnosed chest x-rays. Tuberculosis disease is treated with
through various skin tests, chest x-rays, sputum a combination of antibiotics. A chest clinic nurse
analysis (chest and culture) as well as PCR will supervise the treatment to provide support
tests to detect the genetic material of the and will check for any side effects to ensure
bacteria. TB diagnosed outside the lungs can be treatment of the disease is successfully
done through fine needle biopsy or urine completed.
Samples.
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