DESCRIBE THE PREVENTION AND CONTROL MEASURES OF TUBERCULOSIS IN DEVELOPING COUNTRIES


DESCRIBE THE PREVENTION AND CONTROL MEASURES OF TUBERCULOSIS IN DEVELOPING COUNTRIES
INTRODUCTION
A developing country, also called a less developed country or underdeveloped country, is a nation with an underdeveloped industrial base, and a low Human Development Index (HDI) relative to other countries, thus Tuberculosis, MTB, or TB (short for tubercle bacillus), in the past also called phthisis, phthisis pulmonalis, or consumption, is a widespread, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis typically attacks the lungs, but can also affect other parts of the body. It is spread through the air when people who have an active TB infection cough, sneeze, or otherwise transmit respiratory fluids through the air. Most infections do not have symptoms, known as latent tuberculosis. About one in ten latent infections eventually progresses to active disease which, if left untreated, kills more than 50% of those so infected.
The classic symptoms of active TB infection are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss (the last of these giving rise to the formerly common term for the disease, “consumption”). Infection of other organs causes a wide range of symptoms. Diagnosis of active TB relies on radiology (commonly chest X-rays), as well as microscopic examination and microbiological culture of body fluids. Diagnosis of latent TB relies on the tuberculin skin test (TST) and/or blood tests. Treatment is difficult and requires administration of multiple antibiotics over a long period of time. Household, workplace and social contacts are also screened and treated if necessary. Antibiotic resistance is a growing problem in multiple drug-resistant tuberculosis (MDR-TB) infections. Prevention relies on early detection and treatment of cases and on screening programs and vaccination with the bacillus Calmette-Guérin vaccine.
PREVENTION AND CONTROL MEASURES OF TUBERCULOSIS IN DEVELOPING COUNTRIES
The principles of diagnosis and treatment of TB disease discussed in this section are guidelines and not meant to substitute for clinical experience and judgment. Medical providers not familiar with the management of TB disease should consult a person with expertise. All facilities’ local operations procedures should include plans for consultation with and referral to persons with expertise in TB and should include criteria delineating when consultation and referral are indicated.
Although the index of suspicion for TB disease varies by individual risk factors and prevalence of TB in the population served by the correctional facility, correctional facilities typically are considered higher-risk settings. A diagnosis of TB disease should be considered for any patient who has a persistent cough (i.e., one lasting >3 weeks) or other signs or symptoms compatible with TB disease (e.g., hemoptysis, night sweats, weight loss, anorexia, and fever). Diagnostic tests for TB include the TST, QFT-G, chest radiography, and laboratory examination of sputum samples or other body tissues and fluids.
Persons exposed to inmates with TB disease might become latently infected with M. tuberculosis depending on host immunity and the degree and duration of exposure. Therefore, the treatment of persons with TB disease plays a key role in TB control by stopping transmission and preventing potentially infectious cases from occurring (92). LTBI is an asymptomatic condition that can be diagnosed by the TST or QFT-G.
Diagnosis of tuberculosis
To check for TB, a health care provider will use a stethoscope to listen to the lungs and will check for swelling in the lymph nodes. They will also ask about symptoms and medical history as well as assessing a person’s risk of exposure to TB.
The most common diagnostic test for TB is a skin test where a small injection of PPD tuberculin, an extract of the TB bacterium, is made just below the inside forearm.
The injection site should be checked after 2-3 days, and if a hard, red bump has swollen up then it is likely that TB is present.

TB is most commonly diagnosed via a skin test involving an injection into the forearm.
Unfortunately, the skin test is not 100% accurate and has been known to give incorrect positive and negative readings.
However, there are other tests that are available to diagnose TB. Blood tests, chest X-rays and sputum tests can all be used to test for the presence of TB bacteria, and may be used alongside a skin test. MDR-TB is more difficult to diagnose than regular TB. It is also difficult to diagnose regular TB in children.
Treatments for tuberculosis
The majority of TB cases can be cured when the right medication is available and administered correctly.
The precise type and length of antibiotic treatment depends on a person’s age, overall health, potential resistance to drugs, whether the TB is latent or active, and the location of infection (i.e. the lungs, brain, kidneys).
People with latent TB may need just one kind of TB antibiotics, whereas people with active TB (particularly MDR-TB) will often require a prescription of multiple drugs.
Antibiotics are usually required to be taken for a relatively long time. The standard length of time for a course of TB antibiotics is about 6 months.
All TB medication is toxic to the liver, and although side effects are uncommon, when they do occur, they can be quite serious. Potential side effects should be reported to a health care provider and include:
• Dark urine
• Fever
• Jaundice
• Loss of appetite
• Nausea and vomiting.
It is important for any course of treatment to be completed fully, even if the TB symptoms have gone away. Any bacteria that have survived the treatment could become resistant to the medication that has been prescribed, and could lead to developing MDR-TB in the future.
Directly observed therapy (DOT) can be recommended. It involves a health care worker administering the TB medication to ensure that the course of treatment is completed.

Prevention of tuberculosis

If you have active TB, a face mask can help lower the risk of the disease spreading to other people.

A few general measures can be taken to prevent the spread of active TB. Avoiding other people by not going to school or work, or sleeping in the same room as someone, will help to minimize the risk of germs from reaching anyone else. Wearing a mask, covering the mouth and ventilating rooms can also limit the spread of bacteria.
In some countries, BCG injections are given to children in order to vaccinate them against tuberculosis. It is not recommended for general use in the US because it is not effective in adults, and it can adversely influence the results of skin testing diagnoses.
The most important thing to do is to finish entire courses of medication when they are prescribed. MDR-TB bacteria are far deadlier than regular TB bacteria. Some cases of MDR-TB require extensive courses of chemotherapy, which can be expensive and cause severe adverse drug reactions in patients.

CONCLUSION
Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body.
TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes, or talks. If you have been exposed, you should go to your doctor for tests. You are more likely to get TB if you have a weak immune system.
Symptoms of TB in the lungs may include
• A bad cough that lasts 3 weeks or longer
• Weight loss
• Loss of appetite
• Coughing up blood or mucus
• Weakness or fatigue
• Fever
• Night sweats
Skin tests, blood tests, x-rays, and other tests can tell if you have TB. If not treated properly, TB can be deadly. You can usually cure active TB by taking several medicines for a long period of time.
One-third of the world’s population is thought to have been infected with M. tuberculosis, and new infections occur in about 1% of the population each year. In 2007, an estimated 13.7 million chronic cases were active globally, while in 2013, an estimated 9 million new cases occurred. In 2013 there were between 1.3 and 1.5 million associated deaths, most of which occurred in developing countries.The total number of tuberculosis cases has been decreasing since 2006, and new cases have decreased since 2002. The rate of tuberculosis in different areas varies across the globe; about 80% of the population in many Asian and African countries tests positive in tuberculin tests, while only 5–10% of the United States population tests positive. More people in the developing world contract tuberculosis because of a poor immune system, largely due to high rates of HIV infection and the corresponding development of AIDS.

REFERENCES
1. Elzinga G, Raviglione MC, Maher D. Scale up: meeting targets in global tuberculosis control. Lancet 2004;363:814–9.
2. MacNeil J, Lobato MN, Moore M. An unanswered health disparity: tuberculosis among correctional inmates, 1993 through 2003. Am J Public Health 2005;95:1800–5.
3. CDC. Prevention and control of tuberculosis in correctional facilities: recommendations of the Advisory Council for the Elimination of Tuberculosis. MMWR 1996;45(No. RR-8):1–27.
4. Bureau of Justice Statistics. Adult correctional populations, 1980–2004. Washington, DC: US Department of Justice, Office of Justice Programs; 2005. Available at http://www.ojp.usdoj.gov/bjs/glance/corr2.htm.
5. US Department of Justice. Prison and jail inmates at midyear 2003. Bureau of Justice Statistics Bulletin; 2004. NCJ 203947.
6. CDC. Reported tuberculosis in the United States, 2003. Atlanta, GA: US Department of Health and Human Services, CDC; 2004.
7. CDC. Probable transmission of multidrug-resistant tuberculosis in a correctional facility—California. MMWR 1993;42:48–51.
8. Braun MM, Truman BI, Maguire B, et al. Increasing incidence of tuberculosis in a prison inmate population: association with HIV infection. JAMA 1989;261:393–7.

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