Culture and Disease, Essay Example

Tuberculosis is considered to be one of the leading causes of death for one third of the world’s population. South-East Asia and the Pacific region are one of the areas affected most by tuberculosis infections. According to the World Health Organization, 95% of tuberculosis cases reported occur in the countries of India, Bangladesh, Indonesia, Myanmar and Thailand (AsiaNews, 2005). India itself accounts for one-fifth of global Tuberculosis cases (WHO/India, 2009). Each year nearly two million people in India develop Tuberculosis, or TB. Of these cases, around 0.87 million are infectious cases. It is estimated that around 330,000 Indians die due to TB every year (WHO/India, 2009). A variety of influences contribute to the high rate of TB infection within India. Biological factors specific to the Indian population have an effect on contraction of the disease. These include age, gender, and genetics. There are also environmental factors that make Indian citizens vulnerable to the contraction of TB. Poverty and nutritional status along with livelihoods contribute to the chance of infection. Social and cultural factors such as the influence of education, religion, knowledge, and behavior on societies and individuals also contribute to India’s high vulnerability to TB infection (Bates, 2004, V4 (5)). In the following sections background information on the population of India and factors that contribute to the vulnerability of the population to TB, the modes of disease transmission and methods of control, and treatment options and the effect of the populations beliefs and values on treatment choice will be discussed.

India is located in the South Asia region and bordered on the southwest by the Indian Ocean. The country is home to over 967 million people and has an annual growth rate of 1.7 percent (Adlakha, 1997). This growth rate is about 70% higher than that of China and though the fertility rate in India is declining, there were still about 25 million babies born in India in 1997 (Adlakha, 1997). This high number of annual births means that India adds more people to the world population each year than any other country (Adlakha, 1997). India boasts sixteen official languages, five major religions, and a rigid caste system. Two of the world’s largest metropolitan areas are located in India, Mumbai, with a population of over 16 million people, and Calcutta, with a population of over 12 million people (Rosenberg, 1997). The extremely high number of people and the wide diversity within India results in chaotic living conditions for the country’s population. According to the United Nation’s Human Development Index, the living conditions in India are rated the third worst in all of Asia (Rosenberg, 1997). Poverty is widespread in India, with 42% of the population living below the international poverty line of US$1.25 a day (UNICEF, 2004). Poverty is one of the main environmental factors contributing to a vulnerability to tuberculosis within the Indian population. Statistics taken from 2000 to 2007 show that there is an overall lack of nutrition for children, with 43% of children under five reported as being moderately or severely underweight and 19% of children under five suffering from wasting (UNICEF, 2004). In the same time period, 77% of children aged 20-23 months were still breastfed as a way to replace general nutrition (UNICEF, 2004). Access to uncontaminated drinking water and healthy sanitation facilities is limited for a sizable portion of the population. In 2006, it was reported that only 89 percent of the total population, urban and rural combined, had access to improved drinking water sources and only 28 percent of the population had access to improved sanitation facilities (UNICEF, 2004). Poor standards of living contribute largely to disease susceptibility in general. Coupled with the low immunization rates in the country, the Indian population is being left open to widespread contraction and spreading of the TB disease. As of 2007 in India, the tuberculosis vaccination was the highest vaccination received for children aged 1 year old, at 85% vaccination rate (UNICEF, 2004). An 85% vaccination rate still leaves 15% of the population, or roughly 145 million people, completely unprotected against tuberculosis.

In addition to the poor standard of living for roughly half of the country, education and literacy rates are lacking. UNICEF reports on their website, that from 2000-2007, the literacy rate was found to be only 87 percent for males and even lower for females at 77 percent. Also noted, in 2006 only 15 out of every 100 people owned a telephone and just 11 out of every 100 people were regular internet users (UNICEF, 2004). These statistics are relevant in that the lack of ability to access and comprehend information about the disease leads to ignorance in general disease prevention techniques, such as covering the mouth and washing hands, knowledge of risk factors for the disease, and identification of symptoms for early treatment of tuberculosis.

It is interesting to note that recent research has found the Indian population may contain a natural advantage to resistance of the tuberculosis disease. Genetic studies by Niyaz Ahmed, Nasreen Z. Ehtesham and Seyed E. Hasnain have found a predominance of ancestral strains of tuberculosis in major parts of India (Niyaz Ahmed, 2009, V9 (1)). However, the “ancestral advantage” gained from ancestral strains is predicted to be low, since the current strains of tuberculosis are stronger and vary from the ancestral strains. Combined with the prevalence of diseases such as HIV and diabetes, any natural advantage to tuberculosis in the Indian population has been overwhelmed (Niyaz Ahmed, 2009, V9 (1)).

High rates of HIV present in India plays a major part in the number of tuberculosis deaths in India. In 1996, India had an estimated population of 2 to 5 million HIV infected people (Adlakha, 1997). That statistic means that India has the highest number of adults living with HIV than any other country, worldwide. Studies show high risk populations, such as commercial sex workers, intravenous drug users, and sexually transmitted disease patients, are mostly to blame for the high rate of HIV infection, that exceeded 50% in some areas of the country in 1996 (Adlakha, 1997). Though HIV transforms into the fatal virus AIDS, tuberculosis is the leading cause of death for HIV patients in India (Bates, 2004, V4 (5)). This is due to the increased vulnerability of HIV infected patients resulting from a lowered immune system and high susceptibility to disease. HIV and TB are working hand-in-hand to cause infection and death within the population of India. Hopes for controlling tuberculosis within India depend largely on the ability to stop the increasing spread of HIV within the country.

To control tuberculosis, it is first necessary to know what it is and how the disease is spread. According to Dr. George Schiffman, “Tuberculosis (TB) is an infectious disease caused by bacteria whose scientific name is Mycobacterium tuberculosis” (Shiffman, 2009). Tuberculosis is a respiratory disease that is transmitted through the air, by inhaling infected particles. Infected particles are transmitted when someone infected with tuberculosis coughs, sneezes, shouts, or spits (Shiffman, 2009). Air transmission of a disease is especially problematic in highly populated areas, where people are packed together in busy streets, buildings, stores, and public transit systems. The highly concentrated populations of India, for example Calcutta and Mumbai among other Indian locations, are prime examples of breeding grounds for diseases transmitted by air, such as tuberculosis. In people with a strong, healthy immune system, the body can sometimes manage to contain the tuberculosis infection to the initial site of infection, usually the upper part of the lungs (Shiffman, 2009). However, in the case of a weakened immune system, due to lowered standards of health or immune deficiency, the tuberculosis virus will reproduce and spread throughout the lungs and body (Shiffman, 2009). It can take months for a person infected with TB to show symptoms. When symptoms appear, the first associated with an active TB infection are a general tiredness, weakness, weight loss, fever, and night sweats (Shiffman, 2009). Advanced symptoms include coughing with blood or sputum (material from the lungs) present, chest pain and shortness of breath (Shiffman, 2009). An antibiotic is used to treat tuberculosis, along with other oral medications. The antibiotic used to treat TB is called isoniazid and is taken for six to twelve months. Depending on the stage and severity of the infection, the antibiotic isoniazid may be taken in combination with any or all of the following medications:  rifampin (Rifadin), ethambutol (Myambutol), and pyrazinamide (Shiffman, 2009). In previous years, a lack of availability of these drugs in India, or parts of India have hindered treatment of tuberculosis (Tribune News Service , 2005). Also, ensuring that medications are taken consistently and as directed is a problem for doctors in India (Bates, 2004, V4 (5)). The low literacy rate and lack of easy access to medication promotes improper use of medication and inhibits individual recovery from tuberculosis.

The World Health Organization has initiated a plan for control of tuberculosis within India. This information and outline for this plan can be found at the WHO’s India webpage:   http://www.whoindia.org/en/Section3/Section123.htm. India implements the WHO’s method of control plan through their government program, the Revised National Tuberculosis Control Programme (RNTCP) (WHO/India, 2009). The Revised National Tuberculosis Control Programme has been in effect since 2006. RNTCP assists medical units throughout India by helping with quality screenings, providing access to higher quantities of medicine effective in treating tuberculosis, educating Indian citizens on the symptoms and methods of transmission of the disease, providing technical support to research centers, data management, and financial support. Initiatives to educate citizens about HIV infection risk factors are also supported by the RNTCP (WHO/India, 2009).

References

Adlakha, A. (1997, April). Population Trends: India. Retrieved November 28, 2009, from Census.gov: http://www.census.gov/ipc/prod/ib-9701.pdf

AsiaNews. (2005, March 23). WHO: 1/3 of the world population affected by tuberculosis. Retrieved November 28, 2009, from AsiaNews.it: http://www.asianews.it/index.php?l=en&art=2843

Bates, D. F. (2004, V4 (5)). Vulnerability to malaria, tuberculosis, and HIV/AIDS infection and disease. Part 1: determinants operating at individual and household level. The Lancet , 267-277.

Niyaz Ahmed, N. Z. (2009, V9 (1)). Ancestral Mycobacterium tuberculosis genotypes in India: Implications for TB control programmes. Infection, Genetics and Evolution , 142-146.

Rosenberg, M. (1997, August 18). About.com: Geography: India. Retrieved November 28, 2009, from About.com: http://geography.about.com/library/weekly/aa081897.htm#

Shiffman, G. (2009, November 28). Tuberculosis. Retrieved November 28, 2009, from MedicineNet.com: http://www.medicinenet.com/tuberculosis/article.htm

Tribune News Service . (2005, February). TB News from India. Retrieved November 28, 2009, from Health and Development Initiative India: http://www.healthinitiative.org/html/tbnews/archives/marapril2k5.htm

UNICEF. (2004, February 26). India: Statistics. Retrieved November 28, 2009, from UNICEF: http://www.unicef.org/infobycountry/india_statistics.html

WHO/India. (2009). Communicable Diseases and Disease Surveillance. Retrieved November 28, 2009, from World Health Organization: Country Office for India: http://www.whoindia.org/en/Section3/Section123.htm