Epidemiology forms the foundation of public health and nursing in its entirety. As such, understanding the demographic patterns, causes as well as effects of a disease enables the nurses to make appropriate decisions, identify the risk factors and subsequently come up with evidence-based intervention strategies to mitigate the effects of the disease. The purpose of this paper is to identify a communicable illness in Ghana and describe its history as well as its pathophysiology. Additionally, the paper will discuss the demographic patterns of the illness, risk factors of the illness and the evidence-based approaches that have been used to mitigate the effects of the illness in the country.
HIV/AIDS is one of the most widespread communicable diseases in Ghana that affects a significant number of persons in the country. The first HIV case in the country was diagnosed in 1986 (Abrefa-Gyan et al., 2015). However, HIV cases have escalated to epidemic levels over the years creating serious health problems among the infected persons, general population and the healthcare system of the country in its entirety. According to HSS (HIV Sentinel Survey), the prevalence rate of HIV in 2013 was 1.3% whereby this represented an estimate of about 224,448 people who were HIV positive in Ghana (GAC, 2013). The disease was highly prevalent among the adult population as compared to children with statistics indicating that 189,931 adults were HIV positive while 34,557 children living with the disease. The survey also indicated the adult population recorded the most number of new infections and about 10,074 deaths were recorded in 2013 due to HIV and HIV related illness. In relation to prevalence of the illness among the age group, persons aged between 45 to 49 years had the highest prevalence rate (3.3%)followed by those aged between 35 to 39 years (3.2%) while those aged between 15 to 19 had the lowest prevalence of about 0.8%. Moreover, the prevalence rate of the illness varied depending on the geographic locations whereby the disease was more prevalent in the urban areas as compared to the rural areas.
Inherently, the transmission of the HIV virus occurs through various methods such as blood transfusions that involve infected blood, engaging in unprotected sex with infected persons and mother-child transmissions. Once an individual acquires the HIV virus, the HIV virus is replicated within the body thereby killing the T-helper cells that are necessary in the enhancement of one’s immunity level. Decrease of the T-helper cells lowers the immunity of an individual whereby this predisposes one to numerous opportunistic illnesses that are the main cause of HIV/ AIDS related deaths ( LeVasseur, Goldstein, & Welles, 2014).
Typically, HIV progresses in different stages before turning to AIDS. The first HIV stage is seroconversion stage that is characterized by influenza like symptoms followed by asymptomatic infection stage that is characterized by low replication of the virus and thus no symptoms are present at this stage. The third stage is known as the PGL (Persistent generalized lymphadenopathy) that is characterized by the swelling of the lymph nodes. Subsequently, HIV progresses to symptomatic stage whereby one begins to develop the symptoms associated to the disease. AIDS is the last stage of the disease that is characterized by a low count of the CD4 cells of less than 200 cells per blood ml leading to a severe deficiency of the immune system that predisposes one to life-threatening health conditions (LeVasseur, Goldstein, & Welles, 2014). HIV/AIDS present a number of symptoms that depend on the stage of the disease.
During the primary infection or acute HIV stage individuals’ present symptoms such as fever, rashes, headaches and sore throats. As the disease progresses to asymptomatic stage there are no symptoms present. However, the virus continues to replicate killing the T-helper cells. Subsequently, as the disease progresses to symptomatic stage, an individual presents a wide range of symptoms due to serious destruction of the immune cells. Some of the common symptoms present at this stage include; fever, weight loss, shingles, fatigue and diarrhea. Eventually, an individual presents serious symptoms such as chronic diarrhea, recurring fever, persistent fatigue and loss of weight as the disease progresses to AIDS due to serious destruction of the immune cells (LeVasseur, Goldstein, & Welles, 2014).
The epidemiologic triangle is an appropriate model that can be used to effectively understand the spread of a communicable disease and develop evidence-based approaches to mitigate the effects of the said disease. The epidemiological triangle of HIV/AIDS is annotated by the human beings as the host, the human immunodeficiency virus as the agent and cultural, behavioral and social factors as environments or vectors through which the disease finds ample avenues or catalysts to spread. The agent for HIV/AIDS is the human immunodeficiency virus. The host for the disease is human beings. The disease has different avenues through which it can spread. The most common mode of HIV/AIDS transmission is through unprotected sexual intercourse with an infected person. This mode, involves exchange of body fluids (semen) constitutes the biggest cause of the disease. Other major avenues include mother-to-child infection through breast milk (mother-to-child). Blood transfusion and sharing of needles (especially among drug users) are also examples of avenues through which the disease can spread. There are a myriad of factors that promote the spread of the disease. These factors range from cultural, social to behavioral. There are various cultural factors that have evidently been proven to promote the prevalence of HIV/AIDS in Ghana. Examples of these cultural factors include; traditional circumcision practices and wife-inheritance. For instance, HIV/AIDS prevalence in Ghana is comparatively high in areas where these cultural practices are predominant. On the other hand, social issues such as illiteracy play a major role in promoting the spread of HIV/AIDS in this West African country (Abrefa-Gyan et al., 2015). Coupled with cultural beliefs, illiteracy plays a leading role in sensitizing people on HIV/AIDS prevention. For instance, mother to child infection of HIV/AIDS through breast-feeding are among the areas where illiteracy and traditional beliefs continue to hamper the fight against the disease. Behavioral factors that have been associated with HIV/AIDS across the world also apply in the Ghanaian situation. Irresponsible sexual behaviors such as having more than sexual partners and promiscuity are example of factors that continue to promote the spread of the disease
Despite the continued efforts by the government as well as the non-governmental agencies to combat the HIV epidemic in Ghana, HIV prevalence in the country is relatively high. This can be attributed to various factors that exacerbate the spread of the HIV in the country. Some of the major factors include poverty, cultural practices such as wife inheritance and social practices such as prostitution. In relation to this, wife inheritance, polygamy and use of traditional circumcision methods are some of the widespread cultural practices that foster the spread of HIV in the country. For instance, sharing of the circumcision instruments predisposes an individual to the disease because of the blood contacts involved in the practice. Additionally, the level of education is a key contributor to HIV spread in Ghana since an individual’s education level influences their social behavior such as sexual activities. Moreover, poverty has a great impact on the HIV spread since the financial status of an individual influence their access to healthcare services such as screening. For example, in Ghana a significant number of the citizens are poor whereby this affects limits their HIV screening leading and thus most of the people are not aware of their HIV status resulting to HIV spread. Furthermore, poverty predisposes one to unhealthy practices such as prostitution that is one of the major factors that promotes the spread of the HIV. For example, the number of new infections is higher in urban areas of the eastern region of the country where prostitution is rampant.
Ghana has made huge strides in trying to curb the spread of the disease as well as mitigate the effects of HIV. The country utilizes various evidence-based approaches in the management of the illness. Sensitization of people is one of the major evidence-based strategies that has been used to in creating awareness on the causes, risk factors and the effects of the disease and educate them on the appropriate prevention measures. For instance, the Ghanaian government works in collaboration with various non-governmental agencies to sensitize people on the preventive measures of HIV/AIDS. HIV Screening through the provision of VCT (voluntary counseling and testing) services is another evidence-based strategy that enables people know their status and take proactive action in the prevention or management of the disease. For example, HIV screening helps in preventing mother to child transmission by providing PMTCT services to HIV pregnant women. The provision of adequate resources to the health sector is another strategy that helps the healthcare workers to effectively control the spread of the disease. In regard to this, Ghana has set up a commission (Ghana Aids Commission) that coordinates the activities relating to HIV and mobilizes resources to curb it’s spread.
According to the Healthy People 2020, it is core to its objective to reduce HIV/AIDS prevalence and promote better health outcomes for people living with the disease (U.S. Department of Health and Human Services, 2016). In line with Healthy People 2020, Ghana has made appreciable strides in meeting this mandate notably through modifying various HIV/AIDS health determinants such as social economic and cultural factors in order to prevent the spread of the disease and promote better quality of life for HIV/AIDS patients. The tremendous efforts of the Ghanaian government, non-governmental organizations and the international bodies such as CDC and WHO have born fruits and the reduction in prevalence rates of the disease is a testament to this fact. In conclusion, epidemiology is an essential component in nursing that helps nurses understanding the demographic patterns, causes as well as effects of a disease and subsequently makes appropriate decisions, identify the risk factors and come up with evidence-based intervention strategies to mitigate the effects of the disease.
Abrefa-Gyan, T., Cornelius, L. J., & Okundaye, J. (2015). Socio-Demographic Factors, Social Support, Quality of Life, and HIV/AIDS in Ghana. Journal of evidence-informed social work, (ahead-of-print), 1-11.
GHANA AIDS COMMISSION. (2013). SUMMARY OF THE 2013 HIV SENTINEL SURVEY REPORT. Retrieved from http://ghanaids.gov.gh/gac1/aids_info.php
LeVasseur, M. T., Goldstein, N. D., & Welles, S. L. (2014). A public health perspective on HIV/AIDS in Africa: Victories and unmet challenges. Pathophysiology, 21(3), 237-256. doi:10.1016/j.pathophys.2014.07.001
U.S. Department of Health and Human Services. (2016). HIV | Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/hiv/objectives