Principles and Control of communicable and non-communicable diseases | CHAPTER 20 | Community Health Nursing

Principles and Control of communicable and non-communicable diseases – This book covers the entire syllabus of ” Community Health Nursing” prescribed by the Universities of Bangladesh- for Basic and diploma nursing students. We tried to accommodate the latest information and topics.

This book is an examination-friendly setup according to the teachers’ lectures and examination questions. At the end of the book previous university questions are given. We hope in touch with the book students’ knowledge will be upgraded and flourish. The unique way of presentation may make your reading of the book a pleasurable experience.

Principles and Control of communicable and non-communicable diseases

Introduction:

Infectious diseases are disorders caused by organisms —– such as bacteria, viruses, fungi or parasites. Many organisms live in and on our bodies. They’re normally harmless or even helpful, but under certain conditions, some organisms may cause disease.

Medical Definition of communicable disease:

An infectious disease transmissible (as from person to person) by direct contact with an affected individual or the individual’s discharges or by indirect means (as by a vector)-compare contagious disease.

Or,

An illness due to a specific infectious agent or its toxic products capable of being directly or indirectly transmitted from man to man, animal to animal or from the environment (through air, dust, soil, water, food etc) to man or animal.

[Ref: K Park/26/101]

Or,

Any disease transmitted from one person or animal to another, also called contagious disease. Sometimes quarantine is required to prevent the spread of disease.

Example

1. Diarrheal disease
2. Tuberculosis
3. Malaria
4. Measles
5. Tetanus
6. Diphtheria
7. Pertussis
8. Polio

Contagious disease:

such a patient, or with an object touched by such a patient or by bodily discharges.

Or,

A contagious disease is a subset category of transmissible diseases, which are transmitted to other persons, either by physical contact with the person suffering the disease, or by casual contact with their secretions or objects touched by them or airborne route among other routes.

Example:

❖ Common Cold

❖ Influenza

❖ Strep Throat

❖ Ringworm

❖ Giardiasis

❖ HIV/AIDS

❖ Hepatitis B

❖ Gonorrhoea

❖ Tuberculosis

❖ All respiratory diseases

❖ Chancroid

❖ Chickenpox

❖ Conjunctivitis (Pink eye)

❖ Croup

❖ Diphtheria

❖ Encephalitis

❖ Flu (Influenza)

❖ Fungal skin infections

❖ Giardiasis

❖ HPV

❖ Leprosy

❖ Malaria

❖ Measles

❖ Meningitis

❖ Mononucleosis

❖ Mumps

❖ Nail fungus

❖ Pertussis (Whooping cough)

❖ Poliomyelitis (Polio)

❖ Ringworm

❖ Scabies

❖ Scarlet fever

❖ Shigellosis

❖ Smallpox

❖ Staph infection (MRSA)

❖ Strep throat

❖ Swine flu

❖ Syphilis

❖ Tetanus

❖ Tonsillitis

❖ Vaginitis

❖ Viral gastroenteritis

❖ Viral laryngitis

(Ref: K Park/26/1011)

The etiology of communicable disease

Infectious diseases can be caused by:

Bacteria. These one-cell organisms are responsible for illnesses such as strep throat, urinary tract infections and tuberculosis.

Viruses. Even smaller than bacteria, viruses cause a multitude of diseases the common cold to AIDS. ranging from

Fungi. Many skin diseases, such as ringworm and athlete’s foot, are caused by fungi. Other types of fungi can infect your lungs or nervous system.

Parasites. Malaria is caused by a tiny parasite that is transmitted by a mosquito bite. Other parasites may be transmitted to humans from animal feces.

Direct contact:

An easy way to catch most infectious diseases is by coming in contact with a person or animal who has the infection. Three ways infectious diseases can be spread through direct contact are:

• Person to person. A common way for infectious diseases to spread is through the direct transfer of bacteria, viruses or other germs from one person to another. This can occur when an individual with the bacterium or virus touches, kisses, or coughs or sneezes on someone who isn’t infected. These germs can also spread through the exchange of body fluids from sexual contact. The person who passes the germ may have no symptoms of the disease, but may simply be a carrier.
• Animal to person. Being bitten or scratched by an infected animal even a pet-can make you sick and, in extreme circumstances, can be fatal. Handling animal waste can be hazardous, too. For example, you can acquire a toxoplasmosis infection by scooping your cat’s litter box.
• Mother to unborn child. A pregnant woman may pass germs that cause infectious diseases to her unborn baby. Some germs can pass through the placenta. Germs in the vagina can be transmitted to the baby during birth.

Indirect contact

Disease-causing organisms also can be passed by indirect contact. Many germs can linger on an inanimate object, such as a tabletop, doorknob or faucet handle. When you touch a doorknob handled by someone ill with the flu or a cold, for example, you can pick up the germs he or she left behind. If you then touch your eyes, mouth or nose before washing your hands, you may become infected.

Insect bites

Some germs rely on insect carriers such as mosquitoes, fleas, lice or ticks to move from host to host. These carriers are known as vectors. Mosquitoes can carry the malaria parasite or West Nile virus, and deer ticks may carry the bacterium that causes Lyme disease.

Food contamination

Another way disease-causing germs can infect you is through contaminated food and water. This mechanism of transmission allows germs to be spread to many people through a single source. E. coli, for example, is a bacterium present in or on certain foods such as undercooked hamburger or unpasteurized fruit juice.

[Ref: K Park/26/101]

Risk factors of communicable disease

While anyone can catch infectious diseases, you may be more likely to get sick if your immune system isn’t working properly. This may occur if:

• You’re taking steroids or other medications that suppress your immune system, such as anti-rejection drugs for a transplanted organ
• You have HIV or AIDS
• You have certain types of cancer or other disorders that affect your immune system In addition, certain other medical conditions may predispose you to infection, including implanted medical devices, malnutrition and extremes of age, among others.

Signs and symptoms of communicable disease

Each infectious disease has its own specific signs and symptoms. General signs and symptoms common to a number of infectious diseases include:

• Fever
• Diarrhea
• Fatigue
• Muscle aches
• Coughing

When to see a health care provider:

Seek medical attention if you:

• Have been bitten by an animal
• Are having trouble breathing
• Have been coughing for more than a week
• Have severe headache with fever
• Experience a rash or swelling
• Have unexplained or prolonged fever
• Have sudden vision problems

[Ref: K Park/26/101]

Complications of communicable disease:

Most infectious diseases have only minor complications. But some infections—-such as pneumonia, AIDS and meningitis can become life-threatening. A few types of infections have been linked to a long-term increased risk of cancer:

• Human papilloma virus is linked to cervical cancer
• Helicobacter pylori is linked to stomach cancer and peptic ulcers
• Hepatitis B and C have been linked to liver cancer

[Ref: www.Myoclinic.com+ Lecture]

Self-management of communicable disease:

Lifestyle and home remedies

Many infectious diseases, such as colds, will resolve on their own. Drink plenty of fluids and get lots of rest.

Prevention

Infectious agents can enter your body through:

• Skin contact or injuries
• Inhalation of airborne germs
• Ingestion of contaminated food or water
• Tick or mosquito bites
• Sexual contact

Follow these tips to decrease your risk of infecting yourself or others:

• Wash your hands. This is especially important before and after preparing food, before eating, and after using the toilet. And try not to touch your eyes, nose or mouth with your hands, as that’s a common way germs enter the body.
• Get vaccinated. Immunization can drastically reduce your chances of contracting many diseases. Make sure to keep up to date on your recommended vaccinations, as well as your children’s.
• Stay home when ill. Don’t go to work if you are vomiting, have diarrhea or have a fever. Don’t send your child to school if he or she has these signs and symptoms, either.
• Prepare food safely. Keep counters and other kitchen surfaces clean when preparing meals. Cook foods to the proper temperature using a food thermometer to check for doneness. For ground meats, that means at least 160 F (71 C); for poultry, 165 F (74 C); and for most other meat, at least 145 F (63 C). In addition, promptly refrigerate leftovers—-don’t let cooked foods remain at room temperature for extended periods of time.
• Practice safe sex. Always use condoms if you or your partner has a history of sexually transmitted infections or high-risk behavior.
• Don’t share personal items. Use your own toothbrush, comb and razor. Avoid sharing drinking glasses or dining utensils.
• Travel wisely. If anyone traveling out of the country, talk to your doctor about any special vaccinations —- such as yellow fever, cholera, hepatitis A or B, or typhoid fever —- may need.

[Ref: K Park/26/101-102]

Modes of Transmission

1. Direct transmission:

a. Direct contact :(kissing, sex, bites)
e.g. “mono”, HIV, gonorrhea, herpes, Chlamydia, rabies

b. Droplet infection:( coughing, sneezing, aerosol, droplet)
e.g. influenza, TB, whooping cough, diphtheria, respiratory infection

c. Contact with soil:
e.g. Hookworm larvae, tetanus, mycosis

d. Bite of animal and insects (mosquitoes, ticks, fleas)
e.g. malaria, Lyme disease, rabies. Kala-azar.

e. Contaminated needle and syringe:
e.g. Hepatitis B, Hepatitis C

f. Transplacental:
e.g. Rubella infection, Hepatitis B, Hepatitis C, AIDS, Syphilis

2. Indirect transmission (drinking glasses, toothbrushes, toys)

a. Airborne (coughing, sneezing, aerosol, droplet)
e.g. influenza, TB

b. Vector-borne (mosquitoes, ticks, fleas)
e.g. malaria, Lyme disease

c. Waterborne (pools, streams)
e.g. cholera, Giardia diarrhea

d. Food borne (chicken, seafood)
e.g. food poisoning, hepatitis A, tapeworms

e. Fecal-oral (poor hand washing)
e.g. polio salmonella

f. Fomite borne:
e.g. Diphtheria, diarrhea, dysentery, hepatitis A, Typhoid fever.

g. Unclean objects and fingers:
e.g. Diphtheria, diarrhea, dysentery, hepatitis A, Typhoid fever, parasite infection.

10 important communicable diseases in Bangladesh:

1. Diarrheal disease

2. Tuberculosis

3. Malaria

4. Measles

5. Tetanus

6. Diphtheria

7. Pertussis

8. Polio

9. Intestinal worm infection

10. Scabies

Other important communicable disease in Bangladesh:

➤ Leprosy

➤ Small pox

➤ Food poisoning

➤ Dysentery

➤ STDs

➤ Cholera

➤ Meningococcal meningitis

➤ ARI

➤ Typhoid

➤ Rabies

➤ Viral Hepatitis(A,B,C,E)

➤ Hookworm infection

➤ Chickenpox

[Ref: K Park/26/101-102]

Disease of national program:

Disease of national program:

✔ Gastroenteritis

✔ Tuberculosis

✔ Leprosy

✔ Malaria

[Ref. Neuron CHN/8/143]

Old and new diseases threatening the world.

A. Old disease:

• TB
• Leprosy
• Malaria
• Small pox
• Poliomyelitis
• Diarrhoea

B. New diseases:

• Swine flu
• Bird flu
• Severe Acute Respiratory Syndrome (SARS)
• Metcow’s disease
• AIDS
• Cancer
• Hepatitis B

[Ref: K Park/26/101-102]

Principle of prevention of communicable diseases:

A. Source or reservoir level prevention:

1. Early diagnosis by

➤ Clinical exam

➤ Laboratory investigation

2. Notification:

➤ Respective physician

➤ Health office

➤ Teacher

➤ Students

➤ Political leader

➤ Administrative leaders

➤ Imum

3. Epidemiological investigations:

➤ Identification of source of infection

➤ Factors influencing the spread of infection

➤ Character of the agent, reservoir, vectors

➤ Geographical situation

➤ Social, culture, behavioral pattern

➤ Climate condition etc.

4. Isolation: Detection of infected person for longest period of communicability

5. Treatment: To reduce the infectious agent before transmission

B . Interruption of transmission:

1. Safe water supply

2. Environmental sanitation

3. Covering of food

4. Maintenance of personal hygiene

5. Killing of vectors

B. Protection of susceptible host:

1. Active immunization-vaccine

2. Passive immunization-Ig, Breast feeding

3. Combined- Active immunization and Passive immunization

4. Non-specific measures

[Ref: K Park/26/101-102]

Five communicable diseases with causative organisms:

[Ref: K Park/26/101-102]

Non-communicable disease:

A non-communicable disease (NCD) is a medical condition or disease that is non- infectious or non-transmissible. NCDs can refer to chronic diseases which last for long periods of time and progress slowly.

Or,

A non communicable disease (NCD) is a medical condition or disease that is by definition non-infectious and non-transmissible among people. Currently, NCDs are the leading causes of death and disease burden worldwide.

Or,

An EURO symposium in 1957(1) gave the following definition:

An impairment of bodily structure or function that necessitates a modification of the patient’s normal life, over an extended period of time.

[Ref: K Park/26/407]

Risk factors of non-communicable disease

A. Non Modifiable Risk Factors

❖ Age

❖ Gender

❖ Family History

❖ Genetic factors

❖ Personality (type A)

❖ Race

B. Modifiable Risk Factors

❖ Cigarette smoking

❖ Life style changes (dietary patterns, physical activity)

❖ Overweight/Obesity

❖ Stress factors

❖ Alcohol abuse

[Ref: K Park/26/407]

Communicable versus non-communicable diseases

[Ref: K Park/26/408 and Lecture]

List of Non-communicable diseases:

1. Cancer

2. Diabetes

3. Asthma

4. Alzheimer’s

5. Heart disease

6. Fibromyalgia

7. Hypertension

8. Coronary heart disease

9. Stroke

10. Blindness

11. Obesity

12. Malignancies

13. Psychiatric disorder

14. Osteoporosis

15. Autoimmune diseases

16. Malnutrition

17. Poisoning

18. Hormonal conditions

19. Injuries

20. Trauma

21. Fractures

22. Mental disorders

[Ref: K Park/26/411-415]

Cardinal features/characteristics of non-communicable disease:

➤They are permanent

➤ They leave residual disability

➤ They are caused by non-reversible pathological cause

➤ They require special training of the patient for rehabilitation

➤ they may be expected to require a long period of supervision, observation or cure.

NCDs increased in Bangladesh:

➤ Lack of physical activity, causing health problems related to cardiovascular systems and metabolism, along with the development of certain kinds of cancer

➤ Poor, unbalanced diets which fail to supply the proper nourishment and nutrients, with problems regarding salt, sugar and fat consumption contributing towards the development of NCDs

➤ Abuse of tobacco and alcohol which leaves people vulnerable to a host of diseases including lung disease, metabolic disorders and cancer

➤ Environmental factors resulting from unsustainable practices and emissions that influence bodily function and aid in the development if NCDs

[Ref: K Park/26/411-415]

Prevention

Prevention means-

➤ To promote the health

➤ To preserve the health.

➤ To restore the health, when it is impaired.

➤ To minimize suffering and diseases.

So, prevention includes all steps that stop the progress of disease at any stage of its course.

Or,

Prevention/Disease prevention, understood as specific, population-based and individual-based interventions for primary and secondary (early detection) prevention, aiming to minimize the burden of diseases and associated risk factors.

[Ref: K Park/26/48]

Different levels of prevention/intervention at different level:

Prevention means-

➤ To promote health

➤ To preserve health

➤ To restore the health

➤ Top minimizes the suffering and disease

Level of prevention:

1. Primordial prevention

2. Primary prevention

3. Secondary prevention

4. Tertiary prevention

1. Primordial prevention:

It is a new concept in the prevention of chronic disease where these micro-organisms have yet not be discovered. The main intervention in Primordial prevention in through individual & education.

Example

✔ Hypertension.

✔ Diabetes mellitus.

✔ Ischemic heart disease

✔ Cancer.

✔ Atherosclerosis

If we can prevent the development of risk factor for the chronic diseases by taking measures in the early childhood, then the disease can be prevented later stage. Example: In childhood we can give health education to parents regarding the habits and life style are properly developed

✔Avoidance of smoking

✔ Eating habit

✔ Doing exercise

2. Primary prevention:

Primary prevention is the action taken prior to the onset of disease which removes the possibility of occurrence of disease. It signifies intervention in the pre-pathogenesis phase of a diseases or health problems (e.g. LBW)

There are two modes of intervention in the primary level of disease prevention

a. Health promotion: The measures are-

✔ Health education.

✔ Good nutrition

✔ Good housing

✔Personal hygiene

✔ Marriage and genetic counseling.

✔ Family planning

✔ Periodic health screening

✔ Health legislation

b. Specific protection:

✔ Immunization

✔ Food fortification

✔ Protection against accidents

✔ Chemoprophylaxis

✔ Protection from occupational hazards

✔ Protection from carcinogens

✔ Avoidance of allergens.

✔ The control of specific hazards in the general environment .e.g. air pollution, noise.

3. Secondary prevention:

Secondary prevention is the action, which halts the progress of a disease at its early stage and prevents complications. The specific interventions are:

a. Early diagnosis by:

✔ Case finding measures individual and mass.

✔ Screening surveys.

✔ Surveillance techniques

✔ Periodic examination

✔ Selective examination of people at high risk

b. Adequate treatment.

4. Tertiary prevention:

All measures available to reduce or limit impairment and disabilities, minimize suffering caused by disease and to promote the patient’s adjustment to irremediable conditions.

There are two modes of intervention of tertiary level-

a. Disability limitation

b. Rehabilitation;

✔Medical rehabilitation

✔ Vocational rehabilitation

✔ Social rehabilitation

✔ Psychosocial rehabilitation

[Ref: K Park/26/48]

Or (Short answer)

Prevention of non-communicable disease:

There are 4 levels of prevention of non-communicable disease:

1) Primordial prevention

2) Primary prevention

3) Secondary prevention.

4) Tertiary prevention

1) Primordial prevention:

➤ Prevent the risk factors;

➤ To learn the causes or etiology of risk factors;

➤ Avoidance of smoking:

➤ Eating habit;

➤Doing exercise;

2) Primary prevention:

➤ Health education;

➤Good nutrition(Balance diet);

➤ Personal hygiene;

➤ Marriage and genetic counseling;

➤ Family planning:

➤ Screening:

➤ Protection against accident; Protection from carcinogens;

➤ Avoidance of allergens;

3) Secondary prevention:

➤ Early diagnosis

➤ Adequate treatment;

➤ Reduce symptoms;

➤ Promotive measures of health;

4) Tertiary prevention:

➤ Disability limitation;

➤ Rehabilitation;

➤Management of complications;

➤ Therapeutic measures;

(Lecture of BIRDEN NCJ)

The impact of NCDs:

1. Physical

➤ Disability,

➤ Loss of life

➤ Multiple dysfunctions

2. Mental

➤ Personality disorder

➤ Depression,

➤ Family hardship

➤ Loss of confidence

3. Economical

➤ Poverty.

➤ Economic loss of country

➤ Impact on family income

[Lecture of KDH sir]

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