RSCH 8250 Dissertation Prospectus

Dissertation Prospectus

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Statement of the problem

According to Bynum (2012) Tuberculosis (TB) is an infection in humans caused by the bacteria (Mycobacterium tuberculosis) and the mode of transmission is the exchange of air from an infected individual through coughing, sneezing, shouting or singing. There are few infectious that are as deadly and that can match TB. According to Lawn and Zumla (2011) TB accounted for 25% of all deaths in Europe in the 19th century.

Though the situation has improved with better housing and proper sanitation but the mortality that is caused by TB is still almost the same as it was a century ago (50% of those infected). In 2013, approximately 9 million people contracted TB and about 1.5 million succumbed to the disease (WHO, 2014). TB remains the single deadliest infectious agent to date. It is important to mention that there are two types of TB; pulmonary and extra pulmonary TB but it is the former that is more common.

Even though TB rates have greatly fallen in the developed world the same cannot be said of the developing countries. In most developing nations including Liberia TB was a main cause of deaths in hospitals even before the HIV/AIDS epidemic (Hodes&Azbite, 1993).

Liberia with a population of about 3.8 million people has a TB prevalence of about 420/100,000 and it is growing at an alarming rate of about 2% per year in the larger population (WHO, 2010). The growth rate is even higher among patients who have HIV patients. There are about 16,000 active TB patients in Liberia and this trend suggests that the numbers could also be on the rise.

TB in Liberia is mainly common in the rural areas where majority of the people are poor and live in the squalid condition but with their migration to bigger towns such as Monrovia this leads to the spread of the infectious agent. Most people who move to Monrovia do so because they are searching for better economic opportunities.

Even though International laws do not allow someone with active tuberculosis to travel from one place to another (Gushulak & MacPherson, 2006) unless they are tested there is no evidence to suggest that this happens in the case of Liberia. However those with inactive state of the disease can travel as long as they can seek medical advice upon reaching their destination.

What isn’t clear is if whether the t medical facilities in Monrovia can handle this constant influx of people some who are carriers of TB and if these people are screened upon arrival

The health sector in Liberia .suffered greatly during the time of the civil war and thus TB detection and treatment was very low but with some advances that have been witnessed in Liberia some positive changes are taking place.

Though war and strife are known to contribute to the spread of TB and there is a lot of literature to confirm that most Liberian refugee’s especially young adults tested positive to TB the same cannot be said of those who move from the rural areas to Monrovia in search of better lives.

The study aims to use a quantitative approach while using systematic procedures to analyze the impact of rural-urban migration variables on the spread patterns of TB in Monrovia. The quantitative analysis of these variables will help to know the impact of rural-urban migration on the TB epidemics reported across the Monrovian region.

This study seeks to find how the independent variable which is rural-urban migration and what impact it has on the dependent variable which is TB infection

Significance of the study

The main purpose of this study is to investigate the correlation between TB infections in Monrovia and rural-urban migration and the impact that it has had on the trends of the disease in Monrovia. To accomplish this data of rural-urban migration in Liberia were examined among the population of Monrovia. The data concerning the native residents of Monrovia and the incidence and prevalence among this segment of the population is also important in determining the impact of migration to the spread of TB. The study will help to determine this impact and this will be key to the health care system in Monrovia to plan and be able so as to cope with an influx of people migrating from the rural areas to the city.

Some intervention measures can also be taken at the rural areas so that before someone embarks on a journey to Monrovia one can be tested and possibly be put o medication so that the disease doesn’t spread.

This study also will help in advocating behavior change because the spread of TB is caused by a multiple of factors some of which include poor and unhealthy lifestyles. The study will aim to sensitize people to go for TB screening and treatment and also to improve the conditions in which people live. So that people can live in clean environment because that is a great contributor to the spread of TB.

Although lots of research has been done to find out the effects of refugees and immigration on the spread of TB there isn’t a lot done on the effects of rural urban migration and that is why this research aims to find that connection. By studying these relationships, public health professionals in Monrovia and Liberia in general will have the ability to design interventions that are aimed at addressing the variables that have the highest correlation.

Background

Some of the articles and studies that have looked at the incidence, prevalence and other variable that have contribute to the spread of TB are listed below:

Bynum, H. (2012). Spitting blood: The history of Tuberculosis. Oxford, UK: Oxford University Press.

Chumney, E., & Simpson, K., eds. (2006). Methods and designs for outcomes research. New York, NY: ASHP

Gushulak, B. (2006). Migration medicine and health: Principles and practices. Hamilton, Ont.:

B. C. Decker.

Johnson, M., & Rhodes, R. (2009). Human behavior and the larger social environment: A new synthesis. New York, NY: Pearson

Lawn, S., & Zumla, A. (2011). Tuberculosis. Lancet, 378, 57 – 72. doi:10.1016/S0140- 6736(10)62173-3.

Martin, S. F., Weerasinghe, S., & Taylor, A. (2014). Humanitarian Crises and Migration:

Causes, Consequences and Responses. New York: Routledge

Theoretical Framework

The theoretical framework applied is the ecological perspective. It was selected because it helps a researcher to prioritize the most important issues that need to be addressed and at the same time it enables a researcher to determine areas that require a lot of emphasis. According to Johnson & Rhodes (2009) the ecological perspective theory was introduced by Carel Germaine in 1973 to supplement the systems theory because it offers an alternative hypothesis about the interaction of factors.

Carel Germaine was a prominent researcher of the past century and she was known mainly for her research in the area of social work on the impact of multiple level of society on human behavior. Although this perspective was initially meant for social work it can also be helpful to other fields especially on matters to do with the use of alternative hypothesis and the relation between causation and correlation (Johnson &Rhodes, 2009).Some of the concepts of the perspective theory developed by Germaine include habitat, niche, adaptation and goodness-of-fit .

The ecological perspective looks at factors from three levels: intrapersonal, interpersonal and community level .Intrapersonal level has to do with someone’s individual factors such as attitude, lifestyle, beliefs and behavior while interpersonal factors are concerned with someone’s circles such as friends, peers and family and how they influence them and give them a sense of identity and belonging. On the other hand community level factors are divided into three categories such as public policies such as laws and regulations that ensure the health of the people is preserved. The community category comprises of issues such as networks and connections that someone knows and lastly is the institutional factors comprise things such as rules and regulations that someone interacts with on a day to day basis. The ecological theory is used to help health officers to be able to develop interventions at multiple levels.

Research questions and hypothesis

Nature of the study

1. What is the relationship between the rate of TB infection rates and rural-urban migration to the population of Monrovia between 201 and 2014?
   • there is no relationship between rural-urban migration and TB infections rates among the population of Monrovia between 2010 and 2014
   • there is a relationship between rural-urban migration and TB infection rates among the population of Monrovia between 2010 and 2014
2. What is the relationship between the years of residence and TB infection rates in Monrovia between 2010 and 2014?
   • there is no relationship between rural-urban migration and TB infection rates among the population of Monrovia between 2010 and 2014
   • there is a relationship between the years of residence and the TB infection rates among the population of Monrovia between 2010 and 2014
3. To what extend does the level of income influence the infection rate of TB among the population of the Monrovia between 2010 and 2014?
   • there is a no relationship between the level of income and the TB infection rate among the population of Monrovia between 2010 and 2014
   • There is a relationship between the level of income and the TB infection rate among the population of Monrovia between 2010 and 2014

   The nature of this study will be quantitative and will use multiple linear regression. This quantitative research study will be based on the retrospective research design. It will be quantitative study because it can best use the secondary data to evaluate hard data correlations. A retrospective research design is the best design that can be used to analyze data has been previously collected and it can also be used to compare various sets of data that is linked by a variable or variables (Chumney & Simpson, 2006).this quantitative research can help to find out if there is any relationship between the independent variable that is rural-urban in Monrovia and the dependent variable which the rate of TB infection among the population in Monrovia, Liberia.

   Types and possible source of information

   Limitations of the study

   1. Journals and peer-reviewed that have addressed the correlation between migration and the TB infection rates
      • The world health organization index on the global incidence and prevalence of TB together the annual health reports published by the government on Liberia on the state of the healthcare system in Liberia
      • Interview with doctors and other health professionals who have served overseas in a developing country in Africa generally in specifically in Liberia
   2. Interview with Liberian immigrants staying in the USA who should know about the healthcare situation in Liberia

   Some of the possible limitations of the study is that it is a retrospective and that means that randomization was not used in selection of the findings may not be generalized to other populations. The results of the findings might only reflect the specific population that has been studied and may not be reflective of the whole population of Monrovia.

   References

   Bynum, H. (2012). Spitting blood: The history of Tuberculosis. Oxford, UK: Oxford University

   Press.

   Chumney, E., & Simpson, K., eds. (2006). Methods and designs for outcomes research. New

   York, NY: ASHP

   Gushulak, B. (2006). Migration medicine and health: Principles and practices. Hamilton, Ont.:

   B. C. Decker.

   Johnson, M., & Rhodes, R. (2009). Human behavior and the larger social environment: A new synthesis. New York, NY: Pearson

   Lawn, S., & Zumla, A. (2011). Tuberculosis. Lancet, 378, 57 – 72. doi:10.1016/S0140-

   6736(10)62173-3.

   Martin, S. F., Weerasinghe, S., & Taylor, A. (2014). Humanitarian Crises and Migration:

   Causes, Consequences and Responses. New York: Routledge