Paper Example on Infectious Diseases

Abstract

Objective

The objective of this master thesis is to investigate the association between the prevalence of infectious diseases and asylum intake in Saltdal municipality and to identify initiated measures of disease treatment, prevention and spreading. Individually, the aims are to:

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To describe the prevalence of HIV, TB, Hepatitis B and C, syphilis, and other sexually transmitted diseases in Saltdal municipality between 2007- 2016.

To examine whether the establishment of the Rognan Asylum Centre in 2002 had a significant effect on the incidence of these diseases.

To identify the reporting institutions, and whether or not the infected persons received personal protection advice and if there were any infection control measures initiated.

The findings are expected to:

Be used in the evaluation of infectious disease management, and of healthcare services for Norwegians, asylum seekers and refugees, in Saltdal municipality, and

To lay the foundation for further studies regarding healthcare services for asylum seekers and refugees in primary care.

Method

The MSIS reports that the Municipality consultant physician in Saltdal has collected data on prevalence and history of these infections between 2007 and 2016 to establish a foundation for the current study. Data about the incidence of TB, HIV, Hepatitis B and C and other sexually transmitted diseases were extracted and systematically presented. The study design was exploratory with asylum seekers living in Saltdal municipality and, who displayed symptoms of communicable diseases reported in the MSIS Register from 2007-2016, as the sample study.

Chapter One

1. Introduction

Historically, infectious diseases have been the most significant contributor to human morbidity and mortality until relatively recent times, when non-communicable diseases became the leading causes of death in industrialized countries. According to a research article published on the Public Library of Science revealed that the proportion of deaths due to non-communicable disease is projected to rise from 59% in 2002 to 69% in 2030(1). However, from a global perspective, infectious diseases are still one of the leading causes of morbidity and mortality and play a significant role in public health. Most of the regions of the world, mainly the developing countries are yet to fully establish a useful measure to management and control of non-communicable diseases. Approximately 26% of global deaths and 26% of global burden of disease were attributed to infectious diseases in 2001(2). The prevalence of infectious diseases such as tuberculosis, hepatitis B, C and other sexually transmitted infections are relatively low in developed countries such as Norway compared to many developing countries where asylum seekers migrate from(3, 4). Increased rate of infectious diseases has been linked to the immigration of people from high incidence countries into low incidence countries.

With roughly 2% of the global population residing outside their country of birth, the possible effect of population morbidity on the health of significant implications. The process of international migration, the drivers of mobility, and the recurrent transitioning between differential risk environments is critical for the management and control of non-communicable diseases within migrant-receiving areas. The administration issues are high-level, broad and cross-cutting, such as policy decisions on management of the migration process important to addressing the requirements of skilled-labor, biometric characteristics, family reunification population demographics; to program concerns encompassing education and training of healthcare professionals, ensuring competence, and communication of world events of importance to the public health. Migration is likewise critical for the development of control and management guidelines, most specifically for non-endemic diseases, as well as access to therapeutic and diagnostic interventions for rare and exotic clinical presentations.

Several research articles show that newly diagnosed cases of TB, hepatitis B, C, HIV/AIDS and some other sexually transmitted diseases often stem from imported new strains rather than from person-to-person transmission within Norway (5, 6). The objective was to investigate the link between the prevalence of infectious diseases and asylum intake in Saltdal municipality, as well as to identify initiated measures of disease treatment, prevention and spreading. Infectious diseases represent a significant cause of mortality and morbidity among foreign-born individuals. The increasing migration flows through the globe over the recent past are a growing concern about the potential related risks for the native population. Movement facilitates the spread of infectious diseases. The section reports the trend in and reviews the relation between international migration and contagious diseases globally but the primary focuses on Norway.

1.1 Infectious Diseases in Norway-Burden and Trends

Tuberculosis which is derived from the Latin word tuberculum meaning "small knot," is an airborne communicable disease caused by the bacteria Mycobacterium tuberculosis. This bacteria is a small, aerobic, non-motile bacillus, which was first detected in 1882. This infectious disease affects both the lungs and other organs and is transmitted from person to person mostly through coughing(7).the disease can either be acute or chronic lasting from months to several years. The disease can now be prevented and treated but remains one of the deadly infections of all-time (7). According to World health organization, Tuberculosis is one of the leading causes of death worldwide. In 2016, 10.4 million people fell ill with the disease, and 1.7 million died from it.

In Norway tuberculosis was an infectious disease that had a very high mortality rate around 1900 during which many Norwegians suffered from a very high burden of the disease. Norway had one of the highest incidence rates of tuberculosis in Europe with about 7,000 deaths annually among a population of approximately two million inhabitants. But then the disease slowly declined and was stabilized about three decades ago. Most of the decline came before the introduction of vaccines and drug treatment and was mainly due to the fact that there was an improvement in the socio-economic status of the country, and also the Norwegian Institute of Public Health gradually became better in the 1900s thereby introducing various control programs that reduced the infection`s morbidity and mortality rates (8). At the beginning of the twentieth century, the mortality due to tuberculosis in Norway was slightly over 30 per 10,000 with a variation by a threefold factor among the individual counties. A steady reduction in the TB mortality then began at the century shift lasting throughout the whole century(9). In the 5-year periods before, during and after World War II, the crude rates were 9, 7 and five deaths per 10,000 population respectively. In 1946 the number of new tuberculosis cases reported to Statistics Norway was 10,333(9).The survey revealed that in 1946 Norway was suffering from a very high burden of tuberculosis with an unusually high number of documented cases, this made the health authorities to set in place several measures to adequately handle the epidemic. Norway is now one of the countries in Western Europe with the lowest incidence of tuberculosis, reporting 5.7 cases per 100,000 population as of 2002 (1). Disease in Norway now occurs mostly among specific defined risk groups.

Another research report of the cases of pulmonary tuberculosis per 10,000 residents in Finnmark and Oppland counties during 1950-1968 showed that there was a reduction in the number of reported cases of pulmonary TB in the two counties. There was a linear reduction in the incidence of tuberculosis from 1950, and a leveling off was observed during the early 1960s. There was a variation in the incidence of pulmonary tuberculosis, from 5 to 35 per 10,000, these research findings gave an estimate of the rate of the disease spread and its mortality rate within the two counties (9). Registered cases of infectious tuberculosis have been approximately halved since 1970. According to the Norwegian statistics, bureau revealed that the average number of recorded cases was 224 per year during the five-year period from 1983-1987 and that the infectious disease affected specific groups of people which were mainly older men over 55 years (SSB Health Statistics 1983 and 1987).

Based on a joint report done on the prevalence of TB, in Norway by the European Centre for Disease Prevention and Control and the World Health Organization Regional Office for Europe (WHO/EURO), it was showed that the overall TB-trend in Norway has been on the low with a decreasing to stable trend among the native population and a slight increase among people with foreign origins. Several graphical representations of the publication illustrated the epidemiologic situation in the country from 2000 till the year 2009. It showed that in the year 2000 there was a decline in the incidence/prevalence of TB and then in 2001 there was a slight increase and a subsequent drop was seen remaining stable up until 2008 was it drastically increased and has since been on the rising side ever since then(10).

1.1.1 Hepatitis B and C

Hepatitis B and C are viral infections which can cause acute and chronic hepatitis and are the leading causes for hepatic cirrhosis and cancer, thus creating a significant burden to the healthcare systems due its high mortality rate and costs of treatment. A report by World Health Organization states that Hepatitis B and C affect millions of people globally. It also indicates that worldwide, about 500 million people are estimated to be infected with either hepatitis B or C. These viruses kill 1.5 million people a year; one in every three people has been exposed to either, or both viruses and most infected people do not even know that they are infected due to the dormant disease symptoms. A study, which described the epidemiology of acute and chronic hepatitis B infection in Norway between 1992 and 2009, revealed that the route of transmission for acute hepatitis B was mainly through intravenous drug use and sexual transmission. It further established that both acute and chronic hepatitis B were mostly seen among young aged p...