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Andreea Stanescu

Audrey Ragsac

Honors 221 B

03/14/2022

Caused by Tuberculosis in Developing Nations

Globally, Tuberculosis (TB) is responsible for 1.5 million deaths each year (World

Health Organization, 2021.) This infectious disease is the 13th leading cause of death across the

world as well as the second most lethal infectious disease, following Human Immunodeficiency

Virus (HIV.) Tuberculosis is caused by Mycobacterium tuberculosis (Mtb), which typically

enters the body through the respiratory tract to the lung alveoli following the inhalation of

infected droplets which infects the respiratory system. Within developed nations, such as the

United States of America, there have been numerous measures implemented to prevent and treat

TB, including vaccination and quarantine programs, and increasing access to treatments, such as

antibiotics. However, developing nations continue to face high cases of TB, and TB connected

death. Some qualities of the standard of life in developing nations that aid in the propagation of

Tuberculosis include residential overcrowding, diagnosis and treatment availability, as well food

insecurity and malnutrition in these populations.

Developing nations have a higher percentage of citizens with increased poverty levels,

which inflates a correlation between residential overcrowding as a product of a large population

with a demand for housing, and TB infection. Housing overcrowding is where “the number of

occupants exceeds the capacity of the dwelling space available… [and] the effects of crowding

can be broadly defined as the hazards associated with inadequate space within the dwelling for

living, sleeping and household activities” (WHO, 2008). Ecological associations with the
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“transmission of Mycobacterium tuberculosis, [is seen] primarily through its influence on living

conditions, such as people living in overcrowded and poor ventilated homes” (Marais et al.,

2009). When looking at access to housing, individuals in the working class are more financially

restricted and are often times confined to overcrowded and low standards of living. Thus,

“overcrowded housing conditions can increase exposure of susceptible people to those with

infectious respiratory disease, and in doing so may increase the probability of transmission…

[and] major housing problems have been identified in First Nations communities in Canada, and

analyses have shown TB incidence is higher in communities isolated from health services”

(Clark et al., 2002). This high demand for housing and increase in the population density is

condensed locations, which are often times far from medical facilities, creates the environment

for TB to propagate and affect large numbers of the population in developing nations. This

concept has been seen in other settings as well, including prisons, which have been found to have

higher rates of tuberculosis transmission due to how tightly compacted prisoner populations

living within these facilities (Pelissari, 2017.) Thus, we see that “the importance of living

conditions rather than the exact level of poverty is support by the rural/urban discrepancy in TB

incidence rates” (Marais et al., 2009). There is a strong a correlation between the propagation of

tuberculosis and overcrowded housing that is most prevalently found in association with

developing nations and lower income demographics, making TB more common in nations where

poverty rates are higher.

The populous of developing countries also experience decreased access to advanced

healthcare services in comparison to those of developed countries, and often times lack timely

diagnosis and treatment of tuberculosis. In developing nations, the general population often

resides far from medical facilities and/or cannot afford the expenses of medical services and
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transportation means to get to these treatment facilities. When looking at the scope of

tuberculosis “the main strategies to control TB are early diagnosis and prompt treatment

initiation” (Getnet et al., 2017). In developing nations, the time interval between the onset of

symptoms and the confirmation of tuberculosis is especially long, and access to healthcare and

treatment is limited. There is a wide range of factors affecting patient delay in tuberculosis

diagnosis and treatment such as “poor literacy, first care seeking from informal providers, self-

medication sex (mostly female), wrong perceptions and rural residence among others” which all

are interwoven with lower income and education access in developing nations (Getnet et al.,

2017). When one individual in a community becomes infected with TB and cannot get proper

treatment or diagnosis, the likelihood of that individual spreading the disease to others around

them is very high (Lienhardt & Ogden, 2004.) This delay in diagnosis of tuberculosis in low-

income regions has been found to intensify transmission of the disease (Getnet et al., 2017.) Yet,

in more developed nations, a primary method for reducing the spread of tuberculosis is breaking

the cycle of transmission. In countries such as the United States of America, tuberculosis cases

are able to be identified early, and infected individuals are isolated and given appropriate

treatment so as to stop the spread of the infectious disease. The resources for diagnosis and

treatment, as well as isolation are far more accessible in developed nations due to more highly

developed healthcare system infrastructure. Yet, resources scarce areas do not have the ability to

diagnose individuals quickly and efficiently, and as a result the spread of tuberculosis within

these regions is relatively high (Lienhardt & Ogden, 2004.) Furthermore, antibiotics are the main

course of treatment utilized against TB, however a lack of education or money on how they work

has resulted in individuals taking the antibiotics for less time than their full dosage, which

increases the probability of mutated strains of TB with resistance to these antibiotics to increase
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in frequency. This is particularly dangerous because there is a limited array of antibiotics that we

have access to for treatment of tuberculosis, so with increased numbers of resistant strains

becoming larger, there is a decrease in the methods we as a world have to treat TB. This strain on

diagnosis, treatment and the overall lack of education on these processes creates an environment

where TB thrives.

Moreover, research has also found that food insecurity and malnutrition, which are

particularly prolific in underdeveloped nations, are strongly associated with tuberculosis

transmission and infection. Research has shown that a significant portion of people diagnosed

with tuberculosis in Africa are food insecure, and only ten percent of those who test positive are

food secure (Belinda et al., 2019). Many aspects of malnutrition, including micronutrient

deficiency and undernutrition, are associated with tuberculosis and “in both human and animal

studies, protein-energy malnutrition has been associated with impaired cell-mediated immunity,

a principal defense against TB” (Belinda et al., 2019). This is because malnutrition often times

leads to immunodeficiency which in turn increases the likelihood of becoming infected with the

tuberculosis disease because the weakened immune system is less able to fight off TB (Gupta et

al., 2009). The relative health standards of resource-poor / developing countries creates a higher

risk of infection and more detrimental health effects from TB which is a causational factor to TB

spread.

Looking to the future there are numerous challenges in terms of funding for better

healthcare infrastructures, as well as raising the general quality of life in terms of access to clean

water, a stable supply to food, and hygienic living conditions. There is also “a high prevalence of

drug resistant tuberculosis, Multidrug Resistant Tuberculosis (MDR-TB) and extensively drug

resistant tuberculosis (XDR-TB), Human Immunodeficiency Virus (HIV) and TB co morbidity,

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local, social and structural factors (which are different from region to region), economic

constraints, poor diagnostic facilities, etc.” (Jain et al., 2012). Mitigation of these extensive

factors is difficult and convoluted because of their interwoven nature with basic societal

structures such as the healthcare and education system. A motion for better funding and

increasing the accessibility of these basic resources, as well as increasing education on how TB

is spread and treated, are first steps towards overall raising of the quality of life in developing

nations and likely needs to stem from internal and external sources in union. Comprehensive

plans that focus on “case management, maintaining high quality of care and preventing drug

resistance, building human resource capacity, improving diagnosis and fostering operation

research in the area of tuberculosis should be the health case priority in these countries” (Jain et

al., 2012). Implementation of these efforts will aid in alleviating the burden that third world

countries bear.

The main factors of tuberculosis prevalence in developing nations thus stems from

commonalities in terms of residential overcrowding, diagnostic delay, which hinders one’s

ability to break the cycle of transmission quickly, and is also strongly associated with inflated

transmission rates as well as malnutrition, which often leads to immunodeficiency. Overall,

future steps regarding healthcare infrastructure as well as raising the general standard of life in

developing nations is quintessential towards decreasing the prevalence and impact of TB.

Although it is easy to disconnect from nations and peoples that you are not geographically near,

it is essential as a global interest to work towards these goals to lessen these burdens on human

life.
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References

Balinda, I. G., Sugrue, D. D., & Ivers, L. C. (2019). More Than Malnutrition: A Review of the

Relationship Between Food Insecurity and Tuberculosis. Open forum infectious

diseases, 6(4), ofz102. https://doi.org/10.1093/ofid/ofz102

Getnet, F., Demissie, M., Assefa, N. et al. Delay in diagnosis of pulmonary tuberculosis in low-

and middle-income settings: systematic review and meta-analysis. BMC Pulm

Med 17, 202 (2017). https://doi.org/10.1186/s12890-017-0551-y

Gupta, K. B., Gupta, R., Atreja, A., Verma, M., & Vishvkarma, S. (2009). Tuberculosis and

nutrition. Lung India : official organ of Indian Chest Society, 26(1), 9–16.

https://doi.org/10.4103/0970-2113.45198

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10.1111/j.1365-3156.2004.01273.x. PMID: 15228495.

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simple inverse linear correlation? European Respiratory Journal, 33(4), 943–944.

https://doi.org/10.1183/09031936.00173608

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tuberculosis in Canadian First Nations communities, International Journal of

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Epidemiology, Volume 31, Issue 5, October 2002, Pages 940–

945, https://doi.org/10.1093/ije/31.5.940

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World Health Organization. (n.d.). Tuberculosis (TB). World Health Organization. Retrieved

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