Running head: GLOBAL HEALTH CASE STUDY 1

NRSE 3510: Population, Community, and Public Health

Global Health Case Study

Courtney Harmon

East Tennessee State University College of Nursing

GLOBAL HEALTH CASE STUDY 2

Global Health Case Study

Diagnosis of Tuberculosis

Tuberculosis(TB) can be diagnosed through chest x-ray, TB skin test, and TB blood test. In

addition to the chest x-ray that was already performed, the father should have a TB blood test.

Tuberculosis has been conformed via chest x-ray, but determining if it is active or latent is

crucial to treatment. A TB blood test can determine if the patient is positive or negative for TB.

This is the appropriate test for someone who has received the TB vaccine called bacilli

Chalmette-Guerin (BCG) (CDC, 2018c). The mother and children have been around the father;

Therefore, they are at risk for having TB.

The mother and two children should be evaluated by having a TB skin test. The test is

simplistic in nature, consisting of a small amount of fluid (tuberculin) being injected underneath

the skin. This creates a small bump under the skin. The patient should return in 48-72 hours to

have a health care professional assess the area. A positive result is when the injected area

measures at a width of at least 5mm (CDC, 2018c). If the patient’s skin test was positive,

additional tests will need to be performed to determine the active state/ latent state of the disease

(CDC,2018c). The mother and 4-year-old’s skin test results of 0 mm and 2mm are considered

negative, so no further intervention is required. The 2-year-old’s reading of 6 mm means that

they are positive for TB. If a reading is more than 5mm, it is a positive result.

Treatment of Tuberculosis

Along with being placed in a negative pressure room to help prevent the spread of TB,

there are four main FDA approved medications prescribed for TB treatment: Isoniazid, Rifampin,

Ethambutol, and Pyrazinamide (CDC, 2018a). These are all first line-treatments for non-drug

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resistant TB. Isoniazid should be taken daily at a dosage of 5mg/kg, or weekly at a dosage of 15

mg/kg (CDC, 2018b). Isoniazid can be given via tablets and intramuscular injection (Jones &

Bartlett, 2017). Rifampin should be taken daily at a dosage of 10mg/kg, or twice weekly at a

dosage of 20-30 mg/kg (CDC, 2018b). This medication can be given by capsules, oral

suspension, or intravenous infusion (Jones & Bartlett, 2017). Pyrazinamide should be taken daily

at varying dosages of 18.2-26.3 depending on the patient’s weight (CDC, 2018b). According to

Jones & Bartlett (2017), the route of administration are tablets. Lastly, Ethambutol should be

taken daily at varying dosage of 14.5-21.1 mg/kg depending on the patient’s weight (CDC,

2018b). This medication can be taken via tablets (Jones & Bartlett, 2017). These medications

will only be effective if taken completely through the regime.

Tuberculosis is spread through air droplets, so complete resolution of the infection should

be ensured before discontinuing any medication. However, the patient is Nigerian, which will

change up the treatment. Nigeria has an extremely high incidence rate of TB, with the prevalence

rate of drug resistance being 32%, as discussed in the article “Prevalence of drug-resistant

tuberculosis in Nigeria” (Onyedum, C. C., Alobu, I., & Ukwaja, K. N., 2017). Due to the higher

prevalence rate of drug-resistant Tuberculosis (DR TB) in areas like Nigeria, the father is at a

higher risk of possessing this resistance; Therefore, a DR TB medication should be given.

Normally, patients who possess drug-resistant Tuberculosis will be prescribed on a strict

fluoroquinolone medication regime.

Resources for Tuberculosis and Global Burden

Follow-ups with community agencies is crucial to the treatment and prevention of further

TB infection. Direct Observed Therapy (DOT) is a great way to ensure that patients are abiding

by the strict regimen of therapy prescribed. DOT is extremely successful in reducing the

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development of drug resistant TB by its’ persistent monitoring of patients. According to the CDC

(2016b), drug resistant-TB disease should always be treated with a daily regimen while under

direct observation. DOT should be applied in TB disease that involves children and adolescents,

because family members should not be the providers of DOT (CDC, 2016b). DOT providers can

also help educate the patient and answer any questions about the disease and treatment plan.

TB is a problem worldwide, having taken the lives of 1.6 million people (World Health

Organization {WHO}, 2018). That is a devastating number, and will only increase with time due

to the increasing prevalence of drug resistant TB. Tuberculosis is becoming drug resistant for a

few reasons: the same medications have been used for years to treat the disease. This will cause

the disease to mutate and become resistant to those medications. Many people diagnosed with

TB have a lack of education on the importance of takng all of their medication as prescribed.

This can cause the strongest TB bacteria to survive, and mutate. This will result in stronger,

harder to treat TB. It can also lead to the “new and improved’ TB to spread to another person

simply by breathing it in. All of these challenges in treating TB result in a larger challenge of

treating TB as a whole. Many of the counties that TB is prevalent in are smaller, developing

countries. They may not have the means to treat TB the way it needs to be treated. High poverty

rates, low access to health care supplies/facilities, and other major diseases are affecting these

countries’ efforts to treat and stop the rapid spread of TB.

Conclusion

In conclusion, Tuberculosis is an overwhelmingly prominent problem worldwide. There are

plenty of treatments for this disease, but they are not for everyone. The treatments require

appropriate means to treat, such as money and time devotion. This puts a strain on many of the

people who need treatment. TB requires the patient and provider to work togwther and to have a

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complete understanding of the diagnosis and treatment. This can be a problem, since many TB

cases are popping up in developing countries with limited resources to assign to health care.

Together, as health care professionals, we can combine forces and help treat Tuberculosis.

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Resources

Centers for Disease Control and Prevention (2016a). Treatment. Retrieved from

https://www.cdc.gov/tb/topic/treatment/tbdisease.htm

Centers for Disease Control and Prevention (2016b). Treatment. Retrieved from

https://www.cdc.gov/tb/education/corecurr/pdf/chapter6.pdf

Centers for Disease Control and Prevention (2016c). Testing for TB Infection. Retrieved from

https://www.cdc.gov/tb/topic/testing/default.htm

Onyedum, C. C., Alobu, I., & Ukwaja, K. N. (2017). Prevalence of drug-resistant tuberculosis in
Nigeria: A systematic review and meta-analysis. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509256/

Tuberculosis. (n.d.). Retrieved from http://www.who.int/news-room/fact-

sheets/detail/tuberculosis