Known as the second deadliest disease in the world, tuberculosis remains a high rated disease with remarkable fatal rates. As earlier stated it is caused by a small aerobic, non motile bacterium known as Mycobacterium tuberculosis which in most cases lives in the lungs. This pathogen has a high lipid content, which confers to its unique characteristics.
Tuberculosis is a worldwide disease that can be contacted by anybody so long as they are in contact with this bacterium. However, there is a population which is at risk of contacting this disease known as the target population. The target population is associated with risk factors. First, the HIV infected people. Estimates have it that individuals who are HIV positive are likely to be infected by tuberculosis 20-37 times more than those who are HIV negative (Engel, 2013). This is evidenced by the weak immune system among the victims hence the body cannot adequately sense and fight the foreign particle introduced in the body.
Secondly, crowded population is a major risk factor in the spread of tuberculosis. One of the major transmission agents of tuberculosis is air. Congestion within a small place accelerates transmission of this bacterium from one person to another through the air. Study in American prisons showed that the incidence of tuberculosis in prisoners is relatively high than the general population, this is due to their congested population within the prison (Engel, 2013).
Nutrition subjects a certain group to high risk of tuberculosis. People with low body weight approximately less than 18.5 body mass index have poor drug response possibly because of poor drug absorption in the body hence it is quite cumbersome to treat them(Wouk, 2009). This suggests that, increase in weight is important in tuberculosis prevention and treatment. Globally, poor nutrition and severe malnutrition in developing countries has been the major factor behind high incident rates due its damaging effects on the immune system.
Flor de Lima & Tavares (2014) anthropologists argue that it is morally insufficient only to associate the target group of tuberculosis by their parameters of biomedical association while living the structural violence in certain parts of the globe. Discourses of some structural violence explain how religious, economic, hegemonic, social, and legal structures have seriously subjected certain groups to infection by tuberculosis. For example in Haiti, the high prevalence cases are correlated to the exploitative historical and political narratives, which were based on poor sanitation, poverty, and hunger. Lastly, the other high-risk groups include those who are drinking alcohol, smoking, and people in pathetic hygienic conditions.
Tuberculosis was discovered several years ago and up to now it is still a threat to the whole universe. The major problem of this fatal disease lies in the methods of treatment and the ability of Mycobacterium tuberculosis to mutate hence enhancing resistance to certain drugs. Several problems are associated with TB treatment. First, complexity and duration for the treatment result in nonadherence to treatment hence resulting into suboptimal response, resistance and spread of this bacterium (Flor de Lima & Tavares, 2014).
Second, which is a major problem is the incidence of regular and increasing of multidrug-resistance. This problem is facilitated by the fact that the bacterium is able to mutate and change the drug receptors to a friendly and non foreign to the immune system. It includes two types of resistance; MDR that is resistance to at least rifampin and ioziniazid, XDR resistant, which is an MDR resistant and resists to floroquinolone and amynoglycocoside (Engel, 2013).
This resistance occurs in the presence of partially suppressive drug concentrations, which enables bacterial replication, mutant formation, and too much growth of wild types strains by selective pressure (Flor de Lima & Tavares, 2014.) Drug resistant patients require second-line drugs that are very toxic, nowhere to be found, less effective, and require longer time than first line drugs. This complicates treatment of this disease.
Another major problem of tuberculosis treatment is co infection with HIV. This requires high pill count which is associated with adherence problems, overlapping toxicity between anti-TB and anti retroviral and also risk of having immune reconstitution syndrome (Wouk, 2009). Lastly, prophylactic therapy of Tb with izoniazid drugs has continuous complications of non-adherence; conversely, attempts to use alternative drugs still results to severe adverse events.
In attempt to curb all these problems in TB treatment, the World Health Organization developed a system of Directly Observed Therapy (DOTs) method to look at the response and adherence to TB treatment (Engel, 2013). Nonetheless, DOTs is expensive and labor intensive which is causing a lot of burden to the public health program especially in developing countries where resources are scarce.
Other problems that are associated with pharmacological medication includes; inadequate and diagnostic treatment. Following the poverty in the developing countries there are still outdated methods of diagnosis of this disease. Sputum-smear cannot detect extra-pulmonary or smear negative TB and it is less effective in children (Flor de Lima & Tavares, 2014). Moreover, partial treatment has resulted in resistant of TB by drugs such as izoniazid.
Engel N. (2013). The making of a public health problem: mult-drug resistant tuberculosis in India. Health Policy & Planning, 28(4), 375-385.
Flor de Lima B. & Tavares M. (2014.) rias factors for extensively drug-resistant tuberculosis: a review. Clinical Respiratory Journal, 8(1) 11-23
Wouk H (2009). Tuberculosis. Marshall Cavendish Corporation, Malaysia.