Transcript The burden of tuberculosis in costa rica

THE BURDEN OF TUBERCULOSIS IN COSTA RICA
KIMMY HOGUE
NURS 445: SUMMER 2014
SAN JOSE, COSTA RICA
COSTA RICA
▪ 4.805 million (2012)
▪ Spanish is the official language
▪ GDP per capita 9,386.30 USD (2012)
▪ Ranked 63rd in 2012
▪ United States of America: GDP 51,748.56 USD
(2012)
▪ San Jose is the capital of Costa Rica & the
largest city
▪ 315,909 live in the city
▪ Universal health care provided to all citizens
▪ Mix of both private and public hospitals
▪ Average life expectancy is 79.07 years
http://data.worldbank.org/indicator/NY.GDP.PCAP.CD
Artwork is commonly found throughout
San Jose, Costa Rica
LEARNING OBJECTIVES
(1) (1) TO LEARN ABOUT THE EPIDEMIOLOGY OF
TUBERCULOSIS IN COSTA RICA
(2) (2) TO UNDERSTAND THE ROUTINE TREATMENT
OF TUBERCULOSIS WITHIN THE MEDICAL
ORGANIZATION OF COSTA RICA
(3) (3) IDENTIFY PREVENTATIVE MEASURES THAT
ARE IN PLACE TO DECREASE THE SPREAD OF
TUBERCULOSIS
(4) (4) COMPARE INCIDENCE OF DISEASE-RESISTANT
TUBERCULOSIS BETWEEN COUNTRIES
The wheel of an ox cart which is commonly used
by local farmers in the mountainous regions of
Costa Rica
(5) (5) TO STUDY THE PREVALENCE OF
TUBERCULOSIS IN CHILDREN AND
ADOLESCENCE AND THE LONG-TERM EFFECTS
OF THE DISEASE.
TUBERCULOSIS BACKGROUND
▪ Tuberculosis (TB) is the second leading cause of deaths
due to an infectious agent
▪ In 2012, 1.3 million deaths occured due to TB
▪ 11 per 100,000 people contracted TB in Costa Rica (2013)
▪ Approximately 530,000 children contracted TB
worldwide
▪ Majority of TB deaths happen in low & middle income
countries (over 95%)
▪ From 1990-2012, the TB death rate has declined by 46%
▪ In 2009, 16 per 100,000 people were infected with TB in
Costa Rica
▪ TB is caused by Mycobacterium tuberculosis & spread
from person to person contact
▪ TB is preventable & curable
World Health Organization, 2014
HOSPITAL CLINICA SANTA RITA
▪ Private hospital specializes in
Plastics, Obstetrics, Pediatrics,
and Orthopedics
▪ The clinic can service approximately 30
patients
▪ Connected with medical tourism
▪ Established in 1965 & expanding
▪ Recently using electronic
documentation for surgical procedures
▪ Additional services: public
pharmacy, blood bank, and
nutritional programs
http://hospitalclinicasantaritacr.com/about-us.shtml
Currently the front entrance of Clinica
Santa Rita & the future expansion
PRIVATE VS. PUBLIC FACILITIES
HOSPITAL CLINICA SANTA RITA
HOSPITAL NACIONAL DE NINOS
▪ Two operating room (OR) suites & a single
delivery room
▪ Approximately, ten patients to every
nurse
▪ More than 20 nurses & care assistants
▪ Hospital began purely on donations
in 1942
▪ One patient for the entire nursing staff for two days
▪ Private rooms for patients & family
▪ High burn out rate
Mural
from the
public
hospital
Private hospital room in Hospital Clinica Santa
Rita
TUBERCULOSIS
 MYCOBACTERIUM TUBERCULOSIS AFFECTS THE LUNGS &
IS SPREAD BY A SNEEZE, COUGH, OR SPIT IN THE AIR
 OVER A YEAR, TB PATIENTS CAN INFECT 10-15 PEOPLE BY
CLOSE ENCOUNTERS
 Isolation rooms are limited in public hospitals
 Personal protective equipment is required
RISK FACTORS
 INFECTED PATIENTS WILL HAVE A CONSTANT RISK OF
DEVELOPING TB AGAIN
 YOUNG ADULTS & IMMUNO-COMPROMISED
INDIVIDUALS ARE MOST AT RISK TO DEVELOPING TB
 OVER 20% OF TB CASES ARE CAUSED BY SMOKING IN
COSTA RICA
(MacPherson et al., 2014)
Before & after the pharmacy of Hospital Clinica
Santa Rita was opened to the public
RECOGNIZING & DIAGNOSING TB

TB SYMPTOMS: COUGH, FATIGUE, FEVER, CHEST PAIN, & NIGHT SWEATS


DIAGNOSING TB IN CHILDREN IS ESPECIALLY CHALLENGING


Latent tuberculosis infection (LTBI) poses new threat
SPUTUM SMEAR MICROSCOPY IS USED TO DIAGNOSE MAJORITY OF TB
CASES




Ranges from mild to severe
Chest x-ray confirms the presence of TB bacteria
Test takes 48 hours to process
The US commonly uses TB skin tests (Mantoux tuberculin skin test) or
TB blood tests
MDR-TB AND HIV-TB DIAGNOSING IS MORE DETAILED & A SEPARATE
TEST IS NECESSARY

Trained lab technicians read the test results
Centers for Disease Control and Prevention, 2014
Malorie Schuler lending a
helping hand by checking the
expiration dates of medications
COMMUNITY-LEVEL PREVENTION
 VACCINATIONS HAVE DRASTICALLY DECREASED THE RATE
OF TB
 HOSPITAL CLINICA SANTA RITA REQUIRES ALL NEWBORNS
TO RECEIVE THE VACCINATIONS
 Community strategy: Educational pamphlets are given
to parents
 Pharmacists and nurses work together to convince
parents of the benefits of vaccinations
 Government strategy: All citizens are required by law to
receive vaccinations
 VACCINATIONS ARE REFRIGERATED & CLOSELY
MONITORED
 Pharmacy checks all TB vaccinations daily
Stocking and organizing medications to
help prepare for the grand opening of the
pharmacy
GOVERNMENT- LEVEL PREVENTION
 COSTA RICAN GOVERNMENT REQUIRES ALL CITIZENS
TO RECEIVE TB VACCINATION
 Government employees go door-to-door to check
for vaccinated residents
 If unvaccinated, trained professionals will provide
immunization immediately
 VACCINATIONS ARE ACCESSIBLE TO ALL POPULATIONS
 DIRECT OBSERVATION OF TREATMENT
 Trained professionals will monitor TB patients to
ensure compliance
World Health Organization, 2014
San Jose is a considered the central hub
of health care for Costa Ricans due to its
accessibility
TREATMENT
Pharmacists provide patient education and
encourage Costa Ricans to consider the use of
medications and vaccinations to improve
overall health

TB IS TREATED WITH ANTIMICROBIAL DRUGS (RIFAMPIN &
ISONIAZID)
 Comparable to the US

COMPLIANCE OF MEDICATION IS NECESSARY FOR AROUND SIX
MONTHS

CERTIFIED VOLUNTEERS OR HEALTH PROFESSIONALS ENSURE
COMPLIANCE
 Can be monitored inside or outside of a health facility
 Meant to prevent MDR-TB

MULTIDRUG-RESISTANT TUBERCULOSIS (MDR-TB) IS TREATED WITH
SECOND-LINE DEFENSE

CHEMOTHERAPY TREATMENT CAN LAST UP TO TWO YEARS FOR
MDR-TB
 Severe adverse effects are common with second line treatment
Anowar et al., 2013
CONCLUSIONS & SUGGESTIONS
▪ Patient education is key
▪ Introducing pharmacological
interventions to patients
▪ Costa Rican culture strongly believes in
natural remedies
▪ Inter-professional team work to
strengthen staff knowledge
▪ Monitoring TB treatment closely to
ensure proper compliance
▪ DOT training (World Health
Organization, 2012)
▪ Increase number of health care
professionals in the public setting
Vaccinations were performed in the nursery at the
Hospital Clinica Santa Rita during the first bath of
the newborn
CLINICAL EXPERIENCE
▪ Inter-professional team work affects
patients and staff
▪ Having a strong relationship with coworkers strengthens commitment to
the health profession
▪ Learning and teaching is continuous
with a trusting environment
▪ Inter-professionalism allows open
communication that influences all
facets of the team
Working & learning from Diana & Carolina,
the pharmacists of the clinic. We were able
to open up the pharmacy to the public.
CULTURAL
EXPERIENCE
 Finding ways to communicate with
others through verbal or body language
 The importance of trying to learn
another language or cultural customs
 Adapting to cultural nuances

My
supportive
friends and
mentors.
Like having a tree frog on your face!
REFERENCES
Anowar, M., Petpichetchian, W., Isaramalai, S., & Klainin-Yobas, P. (2013). Using nursing
practice guidelines for the prevention of multidrug-resistant tuberculosis among
hospitalized adult patients in Bangladesh. International Journal Of Nursing
Practice, 1981-88.
Cegielski, J., Griffith, D. E., McGaha, P. K., Wolfgang, M., Robinson, C. B., Clark, P. A., &
Wallace, C. (2013). Eliminating Tuberculosis One Neighborhood at a Time. American
Journal Of Public Health, 103(7), 1292-1300.
Furlow, B. (2010). Tuberculosis: A Review and Update. Radiologic Technology, 82(1), 33-56.
Jaganath, D., & Mupere, E. (2012). Childhood tuberculosis and malnutrition. Journal of
Infectious Diseases, 206(12), 1809-1815.
MacPherson, P., Houben, R. J., Glynn, J. R., Corbett, E. L., & Kranzer, K. (2014). Pre-treatment
loss to follow-up in tuberculosis patients in low- and lower-middle-income countries and
high-burden countries: a systematic review and meta-analysis. Bulletin Of The World
Health Organization,92(2), 126-138.
World Health Statistics retrieved from http://www.who.int/tb/dots/treatment/en/
Statistic retrieved from http://www.cdc.gov/TB/TOPIC/testing/default.htm