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In every part of the world, certain health challenges seriously affect the people who live there. If health challenges require resources to be addressed, they usually affect many countries' economies. Despite the negative impacts of health challenges on the country's economy, necessary steps must be taken to deal with the challenges of improving people's way of living and the general health of the public. If a country does not address its health challenges, then the people's general health will deteriorate, leading to a reduced life expectancy. Therefore, there is a need for necessary interventions to be taken by states to deal with any health challenges that may be threatening the existence of its citizens. The purpose of this paper is to identify and analyze the current global health challenge of Tuberculosis (TB) in Malawi -Africa, and its impact internationally and critically discuss the contemporary initiatives employed to tackle the identified challenge and evaluate the associated role of the future nurses. The prevalence of TB in Malawi will be compared to the prevalence of the disease in the UK, as well as the initiatives that have been taken in both countries to deal with the global health challenge.
LO1: TB in Malawi
TB is a serious and, indeed, a big public health issue in Malawi. It affects all the people regardless of their age. However, surveys indicate that the number of people living with TB in the country continued to decrease every year since 2003 when the number of TB cases in the country was more than 28,000 (Sommerland, Wouters, Mitchell, Ngicho, Redwood, Masquillier, van Hoorn, van den Hof and Van Rie, 2017 pg. 82). This is due to several interventions being taken to deal with the disease in the country. However, this does not mean that the number of TB cases has been decreasing as there are other years when the number of TB cases in the country has increased. For instance, according to the survey, the number increased from 18,567 TB cases in 2017 to more than 30,000 cases in 2018, which then decreased to 17,000 cases in 2019 (Sommerland et al. 2017 pg.83). In 2019, the prevalence of TB cases in the country was 1012 in every 100,000 people, according to the National TB Control Program (NTCP). Among the 17000 cases reported in 2019, 1135 were children aged below five years, while 736 were children below one year (Sommerland et al. 2017 pg.83). The number of deaths related to TB has also been high in Malawi as the 2019 data shows that 1700 people died due to TB. The mortality trend of all adults has been decreasing in the last five years. However, the mortality trend for children below one year and below five years has increased every year in the last five years. The number of deaths for children aged below five years was 233 in 2018, but that number increased to 277 cases in 2019. Similarly, the mortality rate of children below one also increased from 85 cases in 2018 to 103 cases in 2019 (Sommerland et al. 2017 pg.83). This shows that the children are seriously affected by the disease, and therefore, there is a need to take necessary actions to take care of children living with TB in the country.
According to surveys done, HIV/AIDS in Malawi remains the most significant risk factor for developing TB infection in Malawi. According to Gupta-Wright, Fielding, Wilson, van Oosterhout, Grint, Mwandumba, Alufandika-Moyo, Peters, Chiume, Lawn and Corbett (2019), 52% of those people living with TB are also infected with HIV/AIDS (71). As a result, it has been compulsory for those who have TB to be tested for HIV infection to establish if, indeed, the person is not infected. This has led to 95% of the registered TB cases to be aware of their HIV status. The survey showed that 92% of those infected with HIV were on antiretroviral therapy during the time they were receiving TB medications. Further research has shown that TB is the major killer of the people living with HIV due to the development of multidrug-resistant TB. The study shows that multidrug-resistant TB prevalence in Malawi is 0.4% for new cases and 4.8% for the previously treated TB patients (Henderson and Howard, 2017 pg.643). Apart from HIV, other drivers of TB cases in Malawi include cancer, malnutrition, and high poverty levels.
The quality of health care in Malawi is not one of the best. Malawi is one of the poorest countries in the world, and therefore, it lacks the resources to establish standard health care facilities all over the country to deal with different kinds of diseases. As a result, many world non-governmental organisations have come to aid people to help people suffering from various infections, including TB and HIV. The cost of providing TB treatment in the country is high, and that is why the World Health Organisation (WHO) is now providing TB treatments to the people at only $13. Therefore, WHO has enhanced the personal healthcare access and the quality of healthcare, which would have been impossible for the Malawian government to guarantee its citizens.
UK and Malawi are two different countries in terms of resources and health care facilities. That does not mean that the UK has no cases of TB infections. However, if the prevalence of the TB infections is compared in the two countries as at 2019, Malawi had a far high number of TB infection than UK. In 2019, Malawi's TB prevalence was 1013 people in every 100,000 people, while in the UK, the prevalence was 8.3 people per 100,000 individuals (Ghebrehiwet, 2016 pg. 640). The highest number of TB infections in the UK was recorded in 2011, which was 8,280 TB infections, which have since decreased to 4,655 in 2019, representing a decrease of 44% (Henderson and Howard, 2017 pg.642). Therefore, the incidence of TB infection in the UK is far lower compared to Malawi. The mortality rate is also very low in the UK, and the number of deaths of children aged under one year and five years has been insignificant in the UK. The number of TB related deaths are also low compared to those in Malawi. This can be attributed to improved personal healthcare access of UK citizens than those in Malawi. There has also been excellent multidrug-resistant TB management as those patients with MDR-TB are referred to the British Thoracic Society MDR-TB Clinical Advice Service to assist in their recovery. There is no health facility in Malawi that deals with TB cases of patients who develop MDR-TB, which explains why there has been a high TB related mortality rate in the country. Malawi also spends a lot of money on dealing with TB cases when compared to the UK. This can be explained by the number of cases that is in Malawi compared to that in UK. in 2019 alone, WHO reported that more than $2.2 million was spent to provide care to TB patients in Malawi, which too high compared to utmost $1 million used to treat TB patients in the UK (Davidson, Lalor, Mohiyuddin, Loutet, Khonyongwa, Uddin, Venugopalan, Quinn, Muzyamba, Zenner and Abubakar, 2015). Unlike the UK, which provides care to the TB patients from government-funded programs, Malawi has to rely on non-profit organisations to assist in providing care to TB patients and other illnesses as the country lack enough resources to deal with certain diseases affecting the people. Therefore, Malawi has more number of TB cases, higher TB related deaths, and spends much too high to treat TB cases when compared to the UK.
LO2: Global Health Initiatives to Address TB in Malawi
In the past, the role of nurses in preventing TB and providing care to patients has been minimal. The nursing's contribution to the prevention and treatment of TB infections has also not been recognized. The lack of nurses' voices in making major health decisions and policies has led to decreased quality and quantity of human resources to control and provide care to the patients. As a result, Malawi, with its many TB cases, resulting from increased HIV infections, has been having weak and ineffective health systems that have been unable to meet the ever-growing need for TB control and treatment services. However, in recent years, the role of nurses in TB control and treatment has been recognized. For instance, nurses' role has increased in Malawi through the Directly Observed Therapy Short Course (DOTS) strategy that aims at providing advocacy for political commitments, increasing TB case detections, training the community workers, providing referrals and making follow-ups of the TB patients discharged, as well as administering and monitoring of drug regimens for TB. The implementation of the International Council of Nurses (ICN) in Malawi has played a significant role in developing the nurses' capacity in TB prevention, care, and treatment. Through the trainers (TOT) programme, nurses in Malawi working in primary health care settings of TB patients have been provided with crucial knowledge and skills of how they should deal with the patients to help them recover. Nurses have also been provided with organisational support and supplies such as masks and other protective gear to help them avoid contracting TB when they are attending the TB patients. As a result, nurses in the country are now determined to strengthen the DOTS and TOT programmes to keep the levels of MDR-TB low and sustain the high rates of curing the disease by reducing treatment failures and preventing the development of MDR-TB.
LO3: Collaborative and Partnership Approaches
There are many organisations working in partnership to address tuberculosis in Malawi. Some of the main organisations working in collaboration to tackle the global health challenge include USAID, WHO, and the National Tuberculosis Control Programme. Of course, many other voluntary agencies are operating collaboratively in the country, but the most important ones are the three organisations that have been mentioned above. The three organisations mentioned above assist in creating awareness, funding TB treatment programs, and even providing healthcare services to different parts of the country that are medically underserved. For instance, USAID and WHO have been setting more TB registration and treatment centres worldwide. As a result, the number of TB registration and treatment centres has increased, which has led to a high rate of curing the patients and preventing them from developing MDR-TB. The two organisations have also been creating awareness of the dangers of TB, how it is spread, and how to live with patients who have contracted it by not being infected. The two organisations have been assisted by the National Tuberculosis Control Programme, which declared TB a national emergency in 2007, showing the people that it was a major health concern in the country (Flick, Kim, Simon, Munthali, Hosseinipour, Rosenberg, Kazembe, Mpunga and Ahmed, 2016 pg. 1047). The NTCP is adopting and WHO implementing Stop TB strategy and has incorporated the strategy in its development strategy. Some of the main pillars of the NTP's activities that aim to enhance WHO's Stop TB Strategy include pursuing and promoting high-quality DOTS enhancement and expansion, engaging all health care providers including nurses, and addressing the HIV/TB, MDR-TB and many other challenges that are facing the health care systems in Malawi. The primary objective of NTP is to increase the awareness of TB infections in the country and enhance the success rate of TB treatment, thus reducing the morbidity, death rate, and the spread of the disease to other people in the country until the disease is no longer a national health concern.
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