THE NUMBER OF TUBERCULOSIS CASES IN ADULT 25-45 YRS.

OLD RECORDED IN KAUSWAGAN, TALAMBAN CEBU CITY: A GUIDE TO PREVENTION AND TREATMENT THIS FEBRUARY 2006

A Thesis Proposal Presented to Ms. Florecar Arco Cebu Doctors University College of Arts and Sciences Department ______________________________________________ In Partial Fulfillment Of the Requirements for the Subject English 12 (Introduction to Research)

By: Naomi Colleen Balugo Vanessa Cagas Donna Martz Lua Jeanette Mangle Jaine Lorraine Ong Rona May Sta. Cruz Kathleen Tac-an Richildine Jumao-as Micheal Kenichi Fumoto Rayland Del Mar Mark Cyril Salo John Kylle Pesquira

(BSN 1-H)

December 2006 ACKNOWLEDGMENT

The making of this research wouldnt have been made possible without the generous support of the following people who the researchers sincerely would like to thank: Their classmates, for all their contributions and suggestions so that the researcher could catch up to the lesson they were not able to absorb while doing the research, Leuterio family, of the undying support and through guidance all throughout the research process, Ms. Florecar Arco, for the unfailing motivation and for helping them build a foundation for our research, Their parents, for their unceasing financial and moral support so that they could buy all the necessary things they needed. Most importantly, the Almighty One for all His goodness to the group so that they could push through with the work despite all the challenges they met along the way.

THE RESEARCHERS

ii ABSTRACT

THE NUMBER OF TUBERCULOSIS CASES IN ADULT 25-45 YRS. OLD RECORDED IN KAUSWAGAN, TALAMBAN CEBU CITY: A GUIDE TO PREVENTION AND TREATMENT THIS FEBRUARY 2006, Naomi Colleen Balugo, Vanessa Cagas, Rayland Del Mar, Michael Kenichi Fumoto, RIchildine Jumao-as, Donna Martz Lua, Jeanette Mangle, Jaine Lorraine Ong, John Kylle Pesquira, Mark Cyril Salo, Rona May Sta. Cruz, and Kathleen Tac-an, Cebu Doctors University, Cebu City, 6000, Cebu, Philippines, 2006, Adviser: Ms. Florecar Arco. This study aimed to find out the number of tuberculosis cases in adult 2545 yrs. old recorded in Kauswagan, Talamban Cebu City: A Guide to Prevention and Treatment this February 2006. Specifically, it sought to determine the actual cases of Tuberculosis that would prevent the increasing rate of Tuberculosis infection. This study used the non-experimental type of research which employed actual non-experiment in gathering data. Books, Journals, Articles and Periodicals about Tuberculosis and Questionnaires were prepared. The data gathered were applied on the research of Tuberculosis cases which are obtained from the Library and Internet. The result revealed that the number of Tuberculosis cases were moderate in adult 25-45 yrs. old, for there were health centers within the vicinity, immunization of BCG were available, and the environment is properly maintained. It is highly recommended that parents should let their children have an immunization of BCG to prevent Tuberculosis in the near future. Also to the adult, they should have physical examination annually and good general care.

iii TABLE OF CONTENTS

Page Title Page Acknowledgment Abstract Table of Contents.. i ii iii iv

Chapter 1 THE PROBLEM AND ITS SCOPE INTRODUCTION Rationale of the Study.. Theoretical Background .. 1 1 2

THE PROBLEM.

10

Statement of the Problem... Statement of Hypothesis. Significance of the Study.

10 10 11

iv

SCOPE AND LIMITATIONS

13

Scope. Limitations..

13 13

RESEARCH METHODOLOGY ..

14

Research Design... Research Locale

14 14

DEFINITION OF TERMS..

15

BIBLIOGRAPHY.

20

v INTRODUCTION

Rationale of the Study

Tuberculosis usually affects the lungs. Although it can attack almost any organ in the body. In some people, it can lead to serious complications and even death, especially if the body is weakened by other health problems. Tuberculosis has been a serious public health problem since 1800 that caused more than 30% of the death in Europe. With the advent of anti-tuberculosis antibiotics in the 1940s, the battle against tuberculosis seemed to be won. Unfortunately, because of factors such as inadequate public health resources, reduced immune response due to AIDS, the development of drug resistance and extreme poverty in many parts of the world, tuberculosis continues to be a deadly disease.

World Health Organization (WHO) estimates the a third of the worlds population (1.5 billion people) is infected with dormant (latent) tuberculosis infection, of these cases 45% are in low and middle income countries particularly in Africa and Asia. Tuberculosis kills 3 million people every year, most of these deaths are in poor countries.

Tuberculosis is caught by breathing-in droplets containing the bacteria, for example, when an infected person caught on sneezes. Anyone can get Tuberculosis, but it is more likely if you already have another disease, dont eat well, or live in very crowded or 1 substandard housing.

In many people who become infected with Tuberculosis, the immune system (The bodys defense mechanism) successfully fights off the infection. The bacteria are still in the body, but there are no symptoms and it can be passed on Except for very young children, few people become sick immediately after tuberculosis bacteria enter their body. In 90% to 95% of cases, the bacteria never caused any further problems, but in about 5 to 10% of infected people they start to multiply It is in this active phase known that an infected person actually becomes sick and can spread the disease, it often occurs when the persons immune system becomes impaired due to a very advanced age.

Theoretical Background

Today, tuberculosis (TB) tends to be concentrated among inner city dwellers, ethnic minorities and recent immigrants from areas of the world where the disease is still common. Alcoholics, who are often malnourished, are at high risk of developing the disease, as are people infected with HIV. It can occur anywhere, and no one is exempt from the threat of infection. (Kozier,et

al,Fundamentals of Nursing Concept and Procedure, 3rd Edition,Addison Wesey 1979, pp. 935-939)

Tuberculosis (TB), chronic or

acute infectious disease caused by

the bacillus Mycobacterium tuberculosis, which may affect any tissue of the body but is usually found in the lungs. The name tuberculosis is derived from the formation by the body of characteristic cellular structures called tubercles, in which the bacilli are trapped and walled off. Other alternative names are TB, Tuberculosis pulmonary, consumption. ((Kozier,et al,Fundamentals of Nursing Concept and Procedure, 3rd Edition,Addison Wesey 1979, pp. 935-939)

There are two types of TB infection these are the latent TB infection and active TB infection. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is called latent TB infection. People with latent TB infection have no symptoms, dont feel sick, cant spread TB to others usually have a positive skin test reaction and can develop active TB disease if they do not receive treatment for latent TB infection. Many people who have latent TB infection never develop active TB disease for the TB bacteria remain inactive for a lifetime without causing disease. But TB bacteria become active if the immune system is weak and cant stop them from growing. These active bacteria begin to multiply in the body and cause active TB disease. The bacteria attack the body and

destroy tissue. It will create a hole in the lungs. People with active TB infection have symptoms like pain in chest, coughing, weight loss, fever and etc., may spread TB to others, usually has a positive skin test and may have an abnormal chest x-ray, or positive sputum, smear or culture.(Smith, Alice Loranie, Microbiology and Pathology, 9th Edition, St. Louis,The C.V. Mosby Company 1968.)

Causes of Tuberculosis

Tubercle bacilli are transmitted through sputum, mainly in airborne droplets, or by dust particles of dried sputum. They are rarely spread by excreta or food products. Unlike other infectious diseases, tuberculosis has no specific incubation period. A single attack does not confer lasting immunity; rather, the bacilli may remain latent in the body for a long period, until a weakening of the body's resistance affords them the opportunity to multiply and produce symptoms of the disease. The usual site of the disease is the lungs, but other organs may be involved. Pulmonary TB develops in the minority of people whose immune systems do not successfully contain the primary infection. The disease may occur within weeks after the primary infection, or it may lie dormant for years before causing disease. (Wolf,Weitzel,et. al., Fundamentals of Nursing, 17th Edition,Philadelpia, J.B. Lippincott 1979, pp. 58-92)

Symptoms of Tuberculosis

The onset of pulmonary tuberculosis is not alike in any two cases, but it is usually either sudden or else protracted. Some patients develop a cough, have fever, loss weight due to loss of 4 appetite, suffer from extreme

fatigue, night sweats, blood spitting and show an early tuberculosis lesion upon careful x-ray or physical examination. Other patients, for no apparent reason whatever, suddenly expectorate small amounts of blood or have a severe pulmonary hemorrhage. Others develop a cough or what appears to be a severe cold, which continues over an unusually long time, the patients finally begin to raise sputum which upon examination contains tubercle bacilli. Still other cases, following exposure to wet or cold, suddenly develop acute pain in the chest with high fever, and thus usher in a pleurisy which marks the onset of pulmonary tuberculosis. (Frobisher and Fuest, Microbiology in the Health and Diseases, 13th Edition, Reprinted under authority of presidential decree no.285 by National Book store 701 Rizal Avenue Corner St.)

Source of Infection

Tuberculosis is nearly always contracted from persons with open tuberculosis lesions, usually pulmonary, and it is occasionally contracted from tuberculous cattle. It is spread by direct or indirect contact with infected persons, usually by discharges from the respiratory tract by means of coughing, sneezing or kissing; less easily proven with certainty, by droplet infection, or by contact

with contaminated eating or drinking utensils, flies or dust. Casual contact is rarely a source of infection: it usually results from continuous and intimate exposure to infected individuals within the family circle or institutions. (Halsey,et. al., Colliers Encyclopedia, Volume IV, New York:Macmilla Educational Company, 1989 & www.healthproblems.com/tuberculosis)

Diagnosis

A diagnosis of pulmonary tuberculosis is established by development of a data base derived from the patients interview: specific inquiries should be made to document if the patient has a previous history of tuberculosis, the presence of tb infection or disease among family members or close associates. Response to tuberculin skin testing (Mantoux Test) : procedure for the diagnosis of tuberculosis infection by the introduction into the skin, usually by injection on the front surface of the forearm, of a minute amount of purified protein derivative (PPD) tuberculin. This is a substance made from dead tubercle bacilli. When the test is positive, a region of swelling 10 mm (0.4 inch) or greater in diameter, usually accompanied by redness, occurs within 48 hours at the site of injection it indicates a positive reaction. The test is a help to the physician in determining the source and time of an infection and in distinguishing tuberculosis from other pulmonary conditions. A chest x-ray examination: An X ray of the lungs may show typical shadows caused by tubercular nodules or lesions. (Bannster,et. al., Grays Anatomy, New York: Churchill Livingstone, 1989 , Smith,) , (Alice Loranie,

Microbiology and Pathology, 9th Edition, St. Louis,The C.V. Mosby Company 1968.) & (www.healthproblems.com/tuberculosis)

Treatment

The treatment of tuberculosis now consists of drug therapy and good general care. Nowadays antimicrobial drugs were discovered that revolutionized the treatment of patients with tuberculosis. Isoniazid, rifampicin, and streptomycin are the three main drugs used to treat tuberculosis; all three are capable of virtually eradicating the tubercle bacillus from the human body. Other such drugs are ethambutol, para-aminosalicylic acid, thiacetazone, and pyrazinamide. Before these drugs were available, treatment consisted of long periods, often years, of bed rest and often surgical removal of useless lung tissue. With early drug treatment, surgery is now rarely needed. One problem with drug therapies, however, is that the bacilli may become resistant to some of the drugs. This is avoided mainly by giving combinations of the drugs. The patient is usually made noninfectious quite quickly, but complete cure requires treatment for several months at least. If the patient does not continue treatment for the required time or is treated with only one drug, the resistant bacilli multiply and the patient becomes sick again. If subsequent treatment is also incomplete, the surviving bacilli may become resistant to several drugs. These multidrug-resistant (MDR) strains of bacilli cause an acute form of the disease that is extremely difficult to cure and in most cases proves fatal. (Small PM,Fujiwara PI(2001). Management

of tuberculosis in the United States. New England Journal of Medicine, 345(3): 189-200.) & (www.healthproblems.com/tuberculosis)

7 If you miss doses of medication or you stop treatment

too soon, your treatment may go on longer or you may have to start over. This can also cause the infection to get worse or lead to antibiotic-resistant infections that are much harder to treat. Resistance arises when patients fail to complete their drug therapy, lasting six months or longer. (Small PM,Fujiwara PI(2001). Management of tuberculosis in the United States. New England Journal of Medicine, 345(3): 189-200.) & (www.healthproblems.com/tuberculosis). Preventions and Control of Tuberculosis

The methods of control and prevention of tuberculosis are as follows: the health personnel should recognize the disease and report it. This is done by medical examination and the use of X-rays. Another method is to isolate the patient. This is preferably done in a sanatorium or hospital. The principles of medical aseptic technique should be applied in the handling of tuberculosis patients. Needless to say that this kind of method and precaution cannot be maintained at home; therefore, such patients should be removed from the home in order to prevent spread of the disease to other members of the family circle. The management of many tuberculosis sanitoria prefer all members of their personnel either to be inactive cases or to have positive tuberculin skin reactions,

since such personnel is relatively immune. The next method is through education of the public concerning the methods of diagnosing tuberculosis, its spread its danger, and the methods of its control. Next thing to do is to safely engineer the removal from industry the dangers of inhaling highly abrasive substances which produce such precursors to tuberculosis as silicosis in miners and stonemasons. We also have to sterilize milk and milk products by pasteurization and other methods. We also have to separate the babies from tuberculosis mothers at birth. There should also be improvement in nutritional intake and of housing conditions in the underprivileged. And lastly, BCG vaccination in highly susceptible racial groups or in individuals whose occupation or living conditions produce unusual or continuous exposure to active cases. (Fritzgerald D, Haas DW(2005). Mycobacterium tuberculosis. In GL Mandell et al., ed., Principles and Practice of Infectious Diseases, 6th ed., pp.2852-2886. Philadelphia: Elsavier.) , (www.healthproblems.com/tuberculosis) &

(www.tuberculosis_org.com)

THE PROBLEM

Statement of the problem

The study was intended to identify the number of Tuberculosis cases in adults 25-45 yrs. old recorded in Kauswagan, Talamban Cebu City this: A guide to prevention and treatment this February 2006.

The findings will be used as basis for counseling and teaching. The study aimed to answer the following specific questions:

1. Is there a high or low number of Tuberculosis present? 2. Why there is such a number? 3. What causes the spread of Tuberculosis infectious disease? 4. What are the ways in preventing tuberculosis? 5. Which areas in Kauswagan, Talamban these diseases often occur?

Statement of Hypothesis

The environment is well-sanitary and hospitals are easily access, our hypothesis states that there shall be less number of Tuberculosis cases in adult 25-45 yrs. old.

Significance of the study

10

The people themselves are the once who will benefit in this study. They will benefit in a sense that they can apply various preventions and treatments presented. This study can also be an aid in knowing which age level is most commonly affected.

The study was made possible in the hope that the following recipients will benefit the findings of the study:

Nursing Practices

The outcome of the study would yield additional information regarding the usefulness of the neonatal vaccination in relation to the reduction of Tuberculosis cases among preschoolers. Also, this knowledge may serve as a guide, especially for community health nurses, in there venture to serve the public through health education and immunization, as means of promoting health and preventing diseases. This would also enable them to be more knowledgeable conversant about Tuberculosis and maybe a resource for community health

education programs and a tool to advice parents about the BCG vaccine. Findings of the study can be use as basis for health teachings or as a care guide.

Nursing Education

11

The information gained from this study is vital to aspiring nursing students, especially those who are on the verge of becoming professionals. The findings of the study would serve as reference in the classroom discussions on immunization programs and hoping that this study would motivate individuals to participate in prevention of Tuberculosis, considering some possible

improvements in the current program.

Nursing Research

The additional information that would be taken from this study may serve as a stepping stone for other researchers who wish to conduct further study in the prevention of Tuberculosis

The findings of this study may serve as an eye opener for the department of health personnel because this would enlighten their minds about the present health status among adults 25-45 years old. Especially those who are suffering from Tuberculosis. This would also give them a birds eye view of the

12

effectiveness of neonatal BCG vaccine and advice the community not only about the vaccine but also the primary prevention of Tuberculosis. This may also lead them to improve their immunization programs in order to decrease the incidence rate of Tuberculosis among those already vaccinated with BCG. SCOPE AND LIMITATIONS Scope

This study is aimed to preventing practices of Tuberculosis in adult 25-45 years old in Kauswagan, Talamban Cebu City.

Limitations

The number of the study subjects was limited due to the following reasons: 1. Location 2. Unavailable data on registered adult with Tuberculosis 3. Families and neighbors would not want to be bothered or hesitant to be surveyed. 4. Change of residence of adults with Tuberculosis 5. Limited time to interview and observe adults with Tuberculosis Being non-experimental descriptive survey study the validity of the data may be affected by the respondents range of memory recall as there may be chances of forgetting some needed information considering the time factor. The

13

validity of the data is also dependent upon the honesty, sincerity and accuracy of the respondents in answering the questions. The questionnaire-checklist used was also a researcher-made tool and thus is limited to the researchers capabilities. RESEARCH METHODOLOGY

This study was an applied type of research and used the nonexperimental Descriptive Survey Approach. In conducting the research, several factors were given high consideration. Some of these factors were the need, positive effect and applicability of the study. This study utilized research instruments which cost less. The survey questions were formulated carefully so that accurate and desirable results came out. These factors were cautiously reflected on, particularly in performing the survey since they may produce distinct effects to the research or even the weight of the research.

Research Design A questionnaire was made with all the necessary questions about Tuberculosis. Then it was distributed to the people in Brgy. Kauswagan. All data were tabulated in the Observation Table. From the data gathered the conclusion was based.

Research Locale

The research was done at Kauswagan, Talamban Cebu City.

DEFINITION OF TERMS

14

Adult - mature; having attained full size, strength and reproductive ability. - In human society and law making, having attained the ability to handle personal affairs, of full legal age or majority.

Guide - one who leads or directs another in his way. - one who exhibits and explains points of interest. - Something that provides a person with.

Prevention - the act of preventing or hindering.

Treatment - the act or manner or an instance of treating someone or something.

Tuberculosis - characterized by the development of tubercles in the body tissue and by fever, anorexia and loss of weight.

Dear Respondent,

15

We the students of Cebu Doctors University are conducting a survey on the number of tuberculosis cases for the month of February here in Kauswagan, Talamban, Cebu City. This is in line of our research paper for the completion of the requirements of our English 12 class. The rest is assured that any in formation obtained would be held strictly confidential to keep your right of privacy secured and safe. We are very please if you answer genuinely and honestly. Thank you for your full support and cooperation on this project.

Sincerely,

Michael Kenichi Fumoto Group Leader

TB History Early Detection of Tuberculosis This questionnaire gives guidance in 16 identifying individuals with

suspected or confirmed TB so that appropriate controls can be promptly initiated.

The questionnaire has two parts: 1. Reviewing the individual's TB history 2. Assessing current symptoms

INSTRUCTIONS:

Circle each answer given by patient. Add your comments as the evaluator at the bottom of the page. Institute the facility's exposure control measures outlined in the facility's Exposure Control Plan, Respiratory Protection and Medical Surveillance Program and refer the individual for further evaluation if the individual has:

(1) A persistent cough lasting 3 or more weeks and two or more symptoms of active TB. (2) Had a positive TB test on mucous that he/she coughed up. (3) Been told that he/she had TB and was treated, but never finished the medication.

17 First Name: Last Name: Positive TB Skin Test (PPD) Date: Last Chest X-Ray Date: Middle Initial:

TB HISTORY 1. 2. Have you ever had a positive TB skin test? Yes No Don't know Have you ever had an abnormal chest x-ray? Yes No Don't know If yes, how long ago? Have you recently had the mucous you cough up tested for TB? Yes No Don't know If yes, were you told it was positive? Yes No Don't know Have you ever been told you have Infectious Tuberculosis? Yes No Don't know If yes, how long ago? Have you ever been treated with medication for Infectious TB? Yes No Don't know If yes, how may medications? One Two Over two Are you still taking TB medicine? Yes No Did you take all the TB medicine until the health care professional told you that you were finished? Yes No

3.

4.

5.

6.

7.

Do you live with or have you been in close contact with someone who was recently diagnosed with TB? (e.g. shelter roommate, close friend, relative). Yes No Don't know 18 CURRENT SYMPTOMS (Part Two)

1. 2. 3. 4.

5.

Do you have a chronic cough that has lasted longer than three weeks? Yes No Do you cough up blood, mucous or sputum? Yes No Have you lost your appetite? Aren't hungry? Yes No Have you lost weight (more than 10 pounds) in the last two months? without trying to? Yes No Do you have night sweats (need to change the sheets or your clothes because they are wet)? Yes No Do you have fever for three to four weeks already? Yes No Do you easily get tired or you feel fatigue? Yes No Do you feel shortness of breath? Yes No

6. 7. 8.

Evaluator Comments:____________________________________________________ Exposure Control Methods Implemented? Yes No Referred for Further Evaluation? Yes No Evaluator's Signature:______________________________

Date:_____________

19 BIBLIOGRAPHY

Books

Smith, Alice Loranie, Microbiology and Pathology, 9th Edition, St. Louis,The C.V. Mosby Company 1968.

Frobisher and Fuest, Microbiology in the Health and Diseases, 13th Edition, Reprinted under authority of presidential decree no.285 by National Book store 701 Rizal Avenue Corner St.

Kozier, et al,Fundamentals of Nursing Concept and Procedure, 3rd Edition,Addison Wesey 1979, pp. 935-939.

Wolf,Weitzel,et. al., Fundamentals of Nursing, 17th Edition,Philadelpia, J.B. Lippincott 1979, pp. 58-92.

Halsey,et. al., Colliers Encyclopedia, Volume IV, New York:Macmilla Educational Company, 1989.

Bannster,et. al., Grays Anatomy, New York: Churchill Livingstone, 1989. Fritzgerald D, Haas DW(2005). Mycobacterium tuberculosis. In GL Mandell et al., ed., Principles and Practice of Infectious Diseases, 6th ed., pp.2852-2886. Philadelphia: Elsavier.

Small PM,Fujiwara PI(2001). Management of tuberculosis in the United States. New England Journal of Medicine, 345(3): 189-200.

Periodicals

20

Al-Kassimi, Feisal Abdullah et al. Does the Protective Effect of Neo-natal BCG Correlate with Vaccine induced Tuberculin Reaction, American Journal of Respiratory and Critical Medicine, Vol. 154, No. 1575-1577, March 24, 1995.

Vijayalakshimi, V. et al. Optimum age of a child for BCG vaccinations, Indian Pediatrics, Vol.31, No. 1500, December 1994.

Websites www.healthproblems.com/tuberculosis www.tuberculosis_org.com

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