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Active Tuberculosis

Dr. Joseph Costa, DHSc., PA-C

Health Policy and Management

MPH 525

Adaku Otuonye

April 2014

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Table of Contents

Chapter Page

1. Introduction................................................................................................................................3

General overview…………………………………………………………………………..3

Brief Statistics……………………………………………………………………………...4

2. Communication...........................................................................................................................6

Communication on TB infection.........................................................................................6

Approaches to TB communication Messages......................................................................6

Avoiding Risk Communication…………………………………………………………8

3. Ensuring Successful Communication.......................................................................................10

Available Resources…………………………………………………………………….10

Stakeholders in communication……………………………………………………….11

Community Partnership………………………………………………………………..12

Relating to the Media.........................................................................................................12

Follow up and Monitoring of Reported Tb Cases……………………………………..12

4. Communication Theory............................................................................................................14

Communication for persuasion Theory.............................................................................14

Cultivating Theory of Mass Media....................................................................................14

Mass Communication Theory…………………………………………………………15

5. Conclusion…………………………………………………………………………………..18

Summary………………………………………………………………………………..18

Recommendation…………………………………………………………………………18

References.....................................................................................................................................20

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Chapter 1

Introduction

General Overview

Tuberculosis (TB), is a common, usually cases fatal, infectious disease caused by various

strains of bacteria in the mycobacterium family specially mycobacterium tuberculosis.

Tuberculosis typically attacks the lungs but can also affect other parts of the body mainly

spreading through the air when people who have an active TB infection cough, sneeze, or

otherwise transmit respiratory fluids through the air. When the infection do not have symptoms,

it identified as the latent tuberculosis. About one in ten latent infections eventually progresses to

active disease which, if left untreated, kills more than 50% of those so infected.

According to Koo (2009), when someone gets infected with TB, the immune system cells

will usually wall off the infection and cause the TB bacteria to go into an inactive form that

causes no symptoms and is not contagious. When eventually the immune system is weakened,

however, the infection becomes active, causing symptoms and contagious disease. About 3% to

5% of people develop active TB within a year of receiving positive diagnosis in a TB skin test or

having evidence of a new infection.

The symptoms of latent and active TB are summarized in Table 1 below. A person with active

TB may spread TB infection to others.

Latent TB Active TB

A person has:

No symptoms of TB

Does not feel unwell

Symptoms may include:

A bad cough that lasts 3 weeks or longer

Pain in the chest

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Cannot spread TB to others

Usually has a positive skin test or TB

blood test

Has a normal chest x-ray and sputum

test

May convert to active TB later in life if

Individual’s immune system declines

Coughing up blood or sputum

Weakness or fatigue

Weight loss

No appetite

Chills

Fever

Sweating at night

Note. Adapted from “A TB action plan for Scotland,” by Scotland Government, 2011, P.5.

Infection of other organs causes a wide range of symptoms. Proper diagnosis of active TB relies

on radiology and its findings, as well as microscopic examination and microbiological culture of

body fluids while the diagnosis of latent TB relies on the tuberculin skin test (TST) and/or blood

tests. 

Brief statistics

Tuberculosis (TB) is a global issue and it is estimated that TB continues to kill

approximately 1.8 million people worldwide each year. One third of the world's population is

thought to have been infected with M. tuberculosis, with new infections occurring in about 1% of

the population each year. In 2007, there were an estimated 13.7 million chronic active cases

globally, while in 2010, there were an estimated 8.8 million new cases and 1.5 million associated

deaths, mostly occurring in developing countries. 

  The rates of tuberculosis in different areas varies across the globe; about 80% of the

population in many Asian and African countries tests positive in tuberculin tests, while only 5–

10% of the United States population tests positive. While more people in the developing world

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contract tuberculosis because of a poor immune system, in most cases, it is largely due to high

rates of HIV infection and the corresponding development of AIDS.

TB has been a disease of significant public health importance. Being a communicable

disease that if undiagnosed and unchecked can spread amongst populations and, particularly,

amongst those who are vulnerable or have other serious conditions that has weakened the

immune system such as HIV. While it seems that TB is not necessarily a disease that will spread

very easily from person to person, the potential for transmission remains in the increase and there

is a sufficient cultural memory of TB that the risk of transmission can in itself cause fear and

alarm. Not to mention the associated concerns around drug-resistant strains of the disease also

support the need to limit the spread of disease wherever possible. The role of public health

services in reducing TB transmission at a population level and in responding to TB incidents is

therefore crucial. These issues were considered by the Public Health Services Subgroup.

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Chapter 2

Communication

Communication on Tuberculosis Infection

Communication and mobilization programmes ensuring patient education, combined with

broader community support and empowerment initiatives, are essential and helps to address four

key challenges:

• Improving case detection and treatment adherence

• Combating stigma and discrimination

• Empowering people affected by TB

• Mobilizing political commitment and resources for TB.

These challenges cannot be met without far greater prioritization and improvement in TB-related

communication activities.

The link between a lack of communication and poor case detection has been of great concern to

public health officials. It has been severally demonstrated in different studied that

Generally patients with low knowledge about the symptoms of TB are more likely to

Postpone seeking care and getting tested.

In some communities, patients with low knowledge are more likely to visit traditional

healers and pharmacists,

Strategic and intensive deployment of communication is increasingly acknowledged as necessary

to encourage and support the at risk populations and positively affect a social change in society

to tackle stigma and marginalization of people with TB.

Approaches to TB communication messages

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The term communication means the process people use to exchange information about

TB making use of some form of media or channel of communication (e.g. mass media,

community media, interpersonal communication etc). While much of the communication effort

on TB is concerned with communicating a series of messages to people affected by TB, effective

communication should be understood as a two-way process, with 'participation' and 'dialogue' as

key elements.

With the current situation of TB cases, messages are created and transmitted as fast as possible to

improve tuberculosis literacy,Improve the identification and screening of contacts of infectious c

ases curtail avoidable predisposing factors.

Target Audience Participation: The entire community are notified through the local radio

channels, churches, community based organizations, local neighborhood schools and vocational

training centers and the community leaders. Engaging the leaders to aid in the public

announcement describing the situation while encouraging community members to be actively

involved at recognizing and reporting every case found. Here the developed key messages meet

the needs of the audience and benefit the audience in acquiring preventive strategies from

contacting tuberculosis.

Interdisciplinary Approach: Working with people from different disciplines and backgrounds,

including nurses, social health workers, auxiliary health personnel, physicians, pharmacists,

epidemiologists, and communication specialists (town criers) engaging them to help in notifying

the masses on the TB case development and the need for constant monitoring of cases.

Encourage communication experts including the town criers to engage on house to house

notification and highlighting the role of good providers in this approach, the messages are

disseminated through different people with different mode though having the same meaning and

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also acts as a reinforcement approach since the likelihood of meeting different people with the

same message.

Networks with Community Groups: Optimal TB prevention and control activities require a

multidisciplinary approach. Thus, TB control programs in communities having a high prevalence

of TB should form networks and coalitions with local groups (e.g., cultural and ethnic

organizations, community clinics, places of worship, professional societies, lung associations,

and medical and nursing schools). In collaborating with these community groups, the TB

Messages should ensure that community leaders, health-care providers, and policymakers are

knowledgeable about the current situation of TB case surveillance and help educate the public

about what should be expected.

These approaches aid in faster spreading of the TB situation in the community reaching at all

levels and different sectors of the population, who may be more receptive to one form of

communication over the other.

Avoiding risk communication

Two basic tenets of risk communication are first, people and communities have a right to

participate in decisions that affect their lives, their property, and the things they value and

second, the goal of communication should not be to diffuse public concerns or avoid action but

to produce an informed public. Being an unavoidable and often prominent feature,

communicating with individuals and communities at risk, should be done in ways that build,

maintain or restore trust. This is best done by communicating rapidly and transparently by means

and methods that acknowledge the public's preexisting mental models. If done effectively,

communication will foster public resilience and guide appropriate public participation to support

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the rapid containment of the outbreak, thus limiting morbidity and mortality (World Health

Organization (WHO), 2005).

Communication strategies to avoid panic are aimed for transparency and candour while

building and supporting the domestic public’s confidence in its leaders, and to building trust

between the communities and the health officials. According to WHO (2005), these strategies

are:

Inform and involve the public as early as possible

Acknowledge uncertainty

Message content issues: communicating with compassion contributes to the credibility

and trustworthiness of sources

Being responsive to reporters' needs.

Listening and responding to public concerns.

Aiming for message consistency, clarity and simplicity.

Working with external sources, especially local influential’s, to help maintain

consistency and build credibility.

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Chapter 3

Ensuring Successful Communication

Available Resources 

In the event of active TBcases, the following resources can be utilized to help 

control the TB cases and prevent the further spread of TB infection in a timely mannerThe State 

TB Program Manager, and any individuals that are directly allocated by the program manager, ar

e responsible for contacting additional resources as required (Wyoming Department of Health,

2008). 

 The State TB Program: (307) 777‐5658 

The State Epidemiologist: (307) 777‐7716 

The State Health Officer: (307) 777‐7643 

The State Public Health Laboratory: (307) 777‐6066 

The County Health Officer (from the affected and/or surrounding counties) 

The Communicable Disease Section Chief: (307) 777‐ 7529 

The Regional Disease Intervention Specialist 

Southeast Region: (307) 777‐ 8939 

Southwest and Central Region: (307) 777‐ 2434 

Northeast Region: (307) 777‐ 3562 

The Public Health Nurses (at both the County and/or State level) 

The State Public Information Officer (PIO): (307) 777‐ 6420 

If necessary, several outside resources may be utilized as well, including: 

Division of Tuberculosis Elimination at CDC 

National Jewish Center Tuberculosis Laboratory 

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Francis J. Curry National Tuberculosis Center 

Tuberculosis Program Managers in other states 

Stakeholders in communication

The Public Health Nurse is usually the primary contact with the infected

individual and in most situations will have a direct role in the investigation of TB 

cases.  Public Health Nurses provide communication within the community that

cannot be easily carried out by higher officials. They are also responsible to

contact the State TB Program Managersignificant role in detection and preventing the spread of 

TB. 

Trained nurses, community outreach workers with the same cultural and linguistic

background as the patients should help drive home current information on TB case, and assist the

community to fully understand and be able to identify earliest signs and symptoms of

tuberculosis, while helping them to identify and overcome obstacles to adherence to health

information.

Outreach workers should be recruited and hired from the areas and communities being

identified for service. They should have knowledge of and be sensitive to the culture and

language of the population to be served. This enable them to act as extensions of the clinician

and nurse by locating patients, resolving basic confusions, encouraging adherence, delivering of

messages, and identifying, tracing, and examining contacts. They should also serve as a liaison

between the public health officials and the patient by helping to bridge cultural and linguistic

gaps. Such employees can greatly enhance TB control efforts among at-risk populations.

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Public events are often an inexpensive way to get press coverage and generate interest.

Events like the World Tuberculosis Day become essential to remind the public about TB

situation in the area, pointing out different strategies to ensure and improve preventive measures.

Community Partnerships 

It is important that the State TB Control Program has access to other public

health staff, community providers and laboratory professionals in the area. 

PartnershipWithcommunity groups are essential in outreach efforts to find those who may have b

een exposed to active TB in the event of an outbreak. It is important that

efforts are made when initiating Contact Investigations and those partnerships are forged to war

d‐off potential problems such as language barriers, transportation and other barriers which may 

prevent contacts from reaching proper healthcare. 

Relating to the Media 

Communication with the media should be coordinated with the State Health Department; 

specifically, the State Epidemiologist, the TB Program Manager and the Public Information Offi

cer before the release of any information. 

Communication with the media should be conducted at the State level as directed

by the State Epidemiologist and Public Information Officer.State Health Officer should always b

e kept informed, as necessary, as the outbreak response proceeds. The TB 

Program Manager will keep members of the Preventive Health and Safety Division 

Administration apprised of the status of the outbreak and our response to the outbreak. 

Follow‐up and Monitoring of Reported TB Outbreak 

The State TB Program Manager will work with all individuals and resources involved 

with case management activities for cases of TB involved in the outbreak. It is

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the State TB Program Manager’s duty to ensure that all intervention activities and prevention eff

orts are occurring in a timely manner and that possible linking of cases is not over‐looked. The 

TB  Program Manager will provide weekly updates to the State Epidemiologist and the

Preventive Health and Safety Division (PHSD) Administration during the response efforts. If

necessary, the State TB Program Manager will 

schedule additional meetings with resource personnel and determine if additional resources are 

needed.  

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Chapter 4

Communication Theories

Communication for Persuasion Theory

This is a mass communication theory that deals with messages aimed at changing the

altitudes of receivers. The persuasive messages are able to activate an altitude change that can

modify individuals’ behaviors.

Values, beliefs and motivation are key generators of peoples’ attitudes, while altitudes influence

behaviors. Value + Beliefs + Motives = Altitudes and Behavior.

According to Kapeleris (2010), Persuasive communication is the process of guiding people

towards adoption of an idea, attitude, or action by rational and emotional means. The key

elements of persuasive communication are:

1. Establish credibility and rapport

2. Connect emotionally with your target audience

3. Communicate the compelling value proposition for the audience

4. Reinforce your position with compelling evidence and expressive, vivid language

Messages aimed at informing the community of the TB case were a bit persuasive since creating

awareness was of great target. Evidence to convince the community to be seriously involved in

surveillance could be reinenforced applying the persuasion theory.

Cultivation Theory of Mass Media

  Cultivation theory in its most basic form, suggests that television is responsible for

shaping, or ‘cultivating’ viewers’ conceptions of social reality. The combined effect of massive

television exposure by viewers over time subtly shapes the perception of social reality for

individuals and, ultimately, for our culture as a whole

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Cultivation Theory

Source: Hawkins and Pingree (1983)

Mass Communication Theory

Mass communication is a means of transmitting messages to a large segment of a

population. Electronic and print media are commonly used for this. The word ‘media’ is

currently used to refer not only to broadcast media such as radio, the internet and television —

but also to print media such as papers, magazines, leaflets and wall posters. The local folk media

such as local art, songs, plays, puppet shows and dance are also important. The powerful

advantage of mass media over face-to-face contact is the rapid spread of simple facts to a large

population at a low cost. The main effects of mass communication are the increased knowledge

or awareness of an issue, the potential influence on behaviors at the early stages and the

possibility to communicate new ideas to early adopters (opinion leaders).

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Figure 1.  Sometimes getting children to make songs about current TB cases can help you get

information to a wider audience. (Photo: Henk van Stokkom)

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Applying the Communication for Persuasion Theory, Cultivation Theory of Mass Media

and the Mass Communication Theory, approach helped emphasize and reinforce messages

enabling the messages to reach different sectors of the population. Consistent messages through

were disseminated through television, radio, local radio stations, print materials, billboards,

community gatherings, theater shows, video spots in clinics, and home visits. Mass media was

used to reach large numbers of people and to help create a conducive environment for change

Community-based media such as local theater brought messages directly to hard-to-reach

Audiences, even still ensuring all messages were consistent. As a result of this, a great number of

the community knew TB was a communicable and could be prevented too

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Chapter 5

Conclusion

Summary

With increasing number of active cases and yet no identified source, it is better classified

as an outbreak and its investigation involves several overlapping contact investigations with a

surge in the need for public health resources with more emphasis on the acute case finding.

The importance of communication in investigation and management of acute active tuberculosis

case cannot be over emphasized. The communication activities that contribute to overall success

in TB control included advocacy, mass media, interpersonal communication and counseling

training, and community mobilization. All of these approaches integrated into the overall

program strategy produce an overwhelming success in surveillance, investigation and control of

TB cases. Communication activities reinforced the TB program activities as needed at all levels

with an overall goal to:

Increasing community awareness of tuberculosis

Encouraging people to practice healthier behaviors related to TB

Raising awareness about the burden of TB and making the fight against TB a priority for

local leaders at all levels, the ministries, social organizations, and the community.

Strengthening individual and community involvement in TB-related activities.

Generally focusing the Health communication on providing information about the

causes, sources, effects and the preventive measure of TB.

Recommendations

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There are great importance of appropriate use of communication means to reach out to

individuals and the community as whole with any slightest suspect of TB case and to achieve a

great deal of this, it is recommended that communication means should involve:

Mass Media: This can reach large number of people disseminating the same message. This

helps reduce stigma by sending out the actual message about TB.

Community mobilization: The effects of the community mobilization and involvement

cannot be over emphasized. It helps to reach out to the hard to get areas and increase the

knowledge and awareness of TB

There is need to initiate, mobilize and promote the improved use of resources for community

bases active TB cases to enable access to the marginalized populations.

The use of persuasive messages, should be adopted to improve behavioural change on the TB

and improve mobilization to accept preventive measures.

Partnership with the community as whole goes a long way to changing the cultural ideas and

norms they had accepted, and empowers them with better knowledge.

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References

augustusjohnston. (2011). the cultivation theory of mass media. Retrieved from

http://augustusjohnston.wordpress.com/2011/11/02/the-cultivation-theory-of-mass-media

Centers for Disease Control.(1992). Prevention and control of tuberculosis in U.S.

communities with at-risk minority populations. MMWR 1992; 41(RR-5). Retrieved from

http://www.cdc.gov/mmwr/preview/mmwrhtml/00019899.htm.

Church-Balin, C., Huong, N.T.M., Llanos-Zavalga, F., Poppe, P., Tawfik, Y., Thuy,

D.O. (2004). The Role of Health Communication in Achieving Global TB

http://www.stoptb.org/assets/documents/countries/acsm/Summary.pdf.

Country level strategic framework for Advocacy, communication and social

Mobilization (ACSM) to support TB global plan 2

Hawkins, R.P & Pingree, S. (1983). Televisions influence on social reality. In: Wartella, E

Kapeleris, J. (2010). Tips on persuasive communication. Retrieved from

http://johnkapeleris.com/blog/?p=514

Koo, I. (2009). Active tuberculosis. Retrieved from

http://infectiousdiseases.about.com/od/respiratoryinfections/a/active_tb.htm.

Media Studies. (2010). Persuasion theory definition and description.

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World Health Organization. (2005). Outbreak communication. Retrieved from

http://www.psandman.com/articles/OCBD-1.pdf.

Wyoming Department of Health.(2008). Tuberculosis Outbreak Response Plan. Retrieved from

file:///C:/Users/ada/Downloads/TBOutbreakResponsePlan2008%20 (1).pdf.

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