Tuberculosis in China
Introduction
The selected chapter of interest is chapter 13, which deals with communicable diseases. The case study selected is titled Controlling Tuberculosis in China. Tuberculosis (TB) is one of many communicable diseases. The occurrence of TB is attributed to Mycobacterium tuberculosis. Even though there are different types of TB, the most typical and infectious is pulmonary TB. The disease is ranked among the leading causes of death in the world. TB is curable but global efforts to eradicate it have not been successful. Notwithstanding the failures, control efforts have managed to reduce mortality rates. The disease still causes a high burden in the health sector.
China is one of the countries faced by the TB health issue. The country has struggled for many years with the disease. TB is a significant public health issue in China. The struggle to contain TB in China can be traced back to the 1980s when the National Tuberculosis program was established to control TB and enhance reporting systems. The efforts to eradicate TB in China gained momentum in 1989 when the project adopted a TB DOTS strategy developed by the World Health Organization. The project targeted to increase TB diagnosis rates and reduce mortality by 100, 000 annually.
Populations
TB in China affects almost all people. Since the disease is infectious, it can infect almost all people in the population regardless of their age. The most affected group of people is those living in poor conditions. The poor living conditions increase the exposure to TB pathogens. Poor living standards are associated with a lack of access to good healthcare, poor nutrition, poor housing with no or limited ventilation, and overcrowding. All these factors make the population susceptible to TB infections. TB cases in China are spread across all its provinces.
Nature and Magnitude of TB
The control and treatment of TB in China are hindered by the emergence of drug-resistant TB. Again, a large proportion of TB cases go undetected for a long time. The lack of systems to diagnose TB at the early stages makes the control of the spread of TB hard. The prevalence of TB in China is high. Based on a 2015 report on TB, China accounted for 15.32% of new cases in the world. There were 1.56 million new TB cases in China in 2015 alone. Furthermore, around fifty-two thousand deaths were reported in the same year. TB burden in China was ranked third in 2015. It causes many deaths than any other infectious disease in the country. Annually, an average of 1.4 million people in China develops active TB.
The main gap in controlling TB in China is the lack of better systems to diagnose TB. Without a proper health system that increases diagnosis levels, it is hard to control TB. The first step towards controlling TB is to detect the disease. Another gap is the lack of sufficient financing towards TB eradication programs.
Sustainable Development Goals
The sustainable development goals that relate to TB include the reduction of maternal mortality rate to below 70 deaths in every 100,000 live births. TB is among the risk factors leading to high maternal mortality. Hence, reducing TB prevalence will help to reduce maternal deaths. The second SDG related to TB is target 3.3, which aims to end the epidemics of TB, AIDS, and Malaria by 2030. Lastly, the achievement of universal health coverage is part of the SDG related to RB. The SDG aims to promote access to quality health services and affordable medicine.
Determinants and Social Determinant of Health
The occurrence of TB is influenced by several factors. They are conditions that expose individuals to TB infections. The social determinants of TB in China are socioeconomic status, physical environment, level of education, and access to healthcare. Socioeconomic status is a significant determinant of TB prevalence. In China, a large proportion of TB prevalence is reported among people with low income living in poor environments. As a determinant of TB, the physical environment determines the chances of one getting TB when they are exposed. The spread of TB is facilitated by overcrowding in places with no proper ventilation.
Key Health Indicators
The control of TB requires some measures that will show the progress of intervention programs. Indicators establish a basis to understand the health status of the population. One of the key indicators that show the status of the affected population is TB mortality rates. TB mortality rates reveal the number of deaths occurring as a result of TB infection in every 100,000 population in China. Since the implementation of the China Tuberculosis Control Project in 2002, TB mortality rates have been declining, signifying some significant success. A reduction in TB mortality rates can be used to measure the success of intervention measures.
Another health indicator is the TB prevalence rate. The indicator shows the number of cases in the population. An increase in prevalence rates signifies that the spread of TB is increasing, while a decrease in prevalence rate shows that the spread of the disease is reducing. The indicator can also be used to measure the success of TB control interventions.
Global Burden of TB
Globally, TB has a high disease burden. TB accounted for 4.9% of all deaths among people aged fifteen years and forty-nine years in 2016. It ranks among the top ten causes of death worldwide. It can also be noted that a significant proportion of TB deaths occur in low and middle-income countries. The proportion of TB deaths in low-income countries is 5.6%, while the proportion in high-income countries is 0.1%.
Risk Factors
Although everyone can get TB, several factors increase the risk of infection. Many people have latent TB, but some factors can hasten the development of latent TB to active TB. The risk factors for TB in China are as follows. First, poor housing and poor ventilation increase the chances of contracting TB. People living in poorly ventilated buildings are more likely to become infected if one of the occupants is infected. Secondly, people living with HIV/AIDS are at risk of infection. HIV positive people have low immunity and can easily be infected by TB. Thirdly, smoking, and alcohol consumption increases the possibility of TB infections. Lastly, caregivers are at high risk of contracting TB. If proper measures to protect caregivers are not put in place, they are exposed to a greater risk of infection.
Health Disparities
China is a big country with a large geographical area. People are spread across different provinces with different economic levels. TB control measures vary significantly from province to province. Since TB is associated with low-income settings, the rural and poor provinces of China are the most affected as compared to urban provinces. In rural areas, proper surveillance systems are missing. There is also limited access to better healthcare, which hinders the treatment process for TB. The disparity in TB prevalence among provinces is also influenced by the education levels of the residents. Most rural areas report high cases of TB since people have low education levels.
Current Public Health Interventions
TB is curable and can be controlled. China has been optimistic to end the TB epidemic. Various health interventions have been successful in reducing mortality and prevalence rates but it has not eradicated TB completely. The country is adopting the directly observed treatment, short-course (DOTS) approach to counter TB endemic. The health intervention strives to diagnose TB, treating the patients, and caring for the patients. The implementation of the DOTS in various provinces in China is done by the Chinese National Health Commission in collaboration with the Chinese CDC. The program ensures that patients receive quality and affordable TB care. Again, hospitals across China are offering TB-testing services. A large bulk of TB treatment and care happens in designated hospitals.
Health, Social, and Economic Outcomes
The efforts put forward to control and reduce the impacts of TB have a significant influence on the health, social, and economic status of individuals and the country. The health outcomes of TB control interventions include reduced mortality and prevalence. Few TB cases improve the health status of people and can reduce pressure on the health sector. Socially, TB control interventions are crucial in restoring family ties. In China, families living under the same roof can be separated when some family members are diagnosed with TB. This negatively affects family integration. If the interventions succeed in treating patients effectively, they can resume their normal lives with families. Finally, economic outcomes can be realized through reduced money spend in treating TB patients. The money can be used for other development around the country.
Human Rights and Ethical Concerns
Most of the risk factors that increase the chances of a person getting TB to have some elements of human rights. The lack of realization of human rights accounts for increased vulnerability to infections. A human-rights approach to TB control can lead to greater success levels. Everyone is entitled to the right to access health facilities and good health services. Healthcare service providers who care for TB patients have a right to healthy occupational conditions. Since most TB cases are reported in low-income areas, guaranteeing the right to good housing, nutrition, and education can go a long way to reducing the prevalence of TB in rural China.
The ethical issues surrounding the control of TB include equitable distribution of resources. In a typical society in China, some people have a lot of wealth, while others have limited wealth. The part of the population with limited access to resources is more vulnerable to TB infections. Thus, ensuring that resources are equitably distributed will reduce the chances of infections among low-income citizens. Again, the choice of TB treatment selected by patients needs to be respected. Finally, the protection of vulnerable groups in the community increases the success of TB control measures.
Levels of Care and Health Services
Currently, numerous efforts are in place to control and treat TB across China. The initiatives to control TB in China include the China TB Control Project which employs the DOTS approach in dealing with TB. The initiative has increased the detection rate for new cases to above 80% and the treatment rate to above 90%. It has increased the number of diagnoses. The treatment cycle for TB takes at least six months to complete. Due to a long time, it takes to cure TB, most patients drop out of the process on the way. Without effective follow-up systems, many patients go uncured and end up developing drug-resistant TB. There is no vaccine for TB, which makes its prevention process complicated. Moving TB treatment processes to CDC improved the national scale for TB treatment. But there are still some treatments taking place in the hospitals. TB treatment in hospitals is prone to low outcomes and is the main driver for the MDR-TB problem.
Health System
The success of TB control interventions can be increased significantly if the health system is aligned with the demands of the populations. The process of aligning TB interventions with population demands includes increasing diagnosis activities in places with low diagnosis levels. The focus of the health system should be on testing people who are perceived to be at higher risks of infections. On the other side, the health system should focus on treating patients in places where many cases have been identified. The Chinese health system needs to incorporate the private sector in the fight against TB. Collaboration with the private sector will improve funding for TB control initiatives, which is currently a major problem. Apart from using Xpert MTB/RIF to improve care for TB, it is also necessary to improve the whole health system.
Key Health Sector Issues and Public Health Policies
TB diagnosis and treatment is currently decentralized in China. Although the China CDC is responsible for the diagnosis and implementation of other TB control measures, a significant proportion of diagnosis still happens in the hospitals. To improve diagnosis and treatment, the quality of care should be elevated across all levels of care. Harmonizing care procedures in CDC, hospitals, and community levels will go a long way in increasing success in TB control. TB care providers need to be linked to TB control programs. Public health policies should foster community care and public-private partnerships. WHO advises nations to incorporate tuberculosis care into universal health coverage and strengthen community-based care.
Importance of Culture
Culture is enormously important to health. There is a strong link between the two concepts as culture is a critical influencer of an individual’s health. Most of the health decisions are made based on cultural beliefs, especially in low and middle-income communities in China. For example, the decision to seek treatment in hospitals practicing western medicine is greatly guided by culture. China has a well-defined system of indigenous medicine. Most people in China practice the culture of using indigenous medicine, which negatively impacts the treatment of TB. In this case, people seek traditional medicine first before resorting to hospitals dealing in western medicine when it is too late. Traditional medicine systems result in a poor diagnosis and poor treatment outcomes.
Health Believes and Practices
Believes and practices concerning health issues vary between communities. For example, in China, sick people would first seek the intervention of an acupuncturist or herbalist. When their condition does not improve, they would eventually visit a hospital that practices western medicine. It is also common to find people taking herbal and western medicine at the same time to treat TB. A combination of the two forms of treatment may lead to the development of drug-resistant TB. Drug-resistant TB has significantly increased TB burden in China.
Recommendations
The fight against TB has lasted for many years across the world and particularly in China. The past few decades have seen China adopt a raft of measures to eliminate TB. Among the recognized measures to cab the prevalence of TB is the 10-year infectious and endemic disease control initiative that was rolled out in 1991. The project adopted the DOTS approach and only succeeded in reducing TB cases by 37%. In this view, it can be recommended that the use of DOTS should be scaled up in all the provinces of China reporting a high prevalence of TB. It is also recommended that the whole health system needs to be strengthened. Better policies need to be formulated and implemented to ensure that there is a rapid diagnosis of TB and effective treatment is available for everyone.
Health Behavior and Behavior Change
There is a common belief in China that TB can be cured using traditional medicine. They depend on herbalists to provide treatment and only visit hospitals when their conditions worsen. This tradition encourages the spread of TB since patients continue to infect others while they are visiting herbalist. The traditional practitioners are also exposed to the risk of getting TB. Such practices increase the rate of spreading TB which consequently increases the number of cases and deaths. Such behaviors will be changed through the implementation of educational programs. Communities need to be educated on the importance of seeking TB treatment in hospitals that practice western medicine. Increasing the knowledge on the effectiveness of hospital treatments encourages more patients to seek treatment is such hospitals.
Public Health Activities
China is partly successful in meeting old global targets of reducing TB prevalence and deaths. But there are still some problems that hinder a complete eradication of the disease. One of the major challenges is the shifting of TB treatment from the Chinese CDC to designated hospitals. Although the initiative to shift treatment to designated hospitals will increase the number of patients that are treated, it poses an important quality issue. The lack of adequate health personnel in the designated hospitals will negatively affect the quality of treatment. Additionally, both primary and secondary cares are important in TB control. Since secondary care of TB happens within the communities, it increases treatment uptake and increases the number of patients receiving TB treatment.