The Role of Urban Migration Variables on TB Prevalence in Monrovia (West Africa)

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The Role of Urban Migration Variables on TB Prevalence in Monrovia (West Africa)

Linda Kudee

Walden University

Dr. Michael Schwab


The Role of Urban Migration Variables on TB Prevalence in Monrovia(West Africa)

Tuberculosis just like most infectious diseases, its spread and incidence goes hand-in-hand with the socioeconomic conditions. The mode of transmission is the exchange of air from an infected individual through coughing, sneezing, shouting or singing. In most developing nations including Liberia TB was a main cause of deaths in hospitals even before the HIV/AIDS epidemic (Hodes&Azbite, 1993). In Liberia TB is endemic but majorly in rural areas but as people move from rural areas to urban centers such as Monrovia in search of employment and better quality of life thus this increases the risk of TB infection in the capital. Most of these migrants are likely to be poor, stressed and living in poor housing conditions leading to the abuse of alcohol and tobacco, conditions that are risk factors for TB and this puts an entire population in danger of contracting this fatal disease.

According to Gushulak & MacPherson (2006) it is both a professional and personal requirement for someone to be screened of TB before travelling from one destination to another. In fact, international laws do not allow someone with active tuberculosis to travel from one place to another. However those with inactive state of the disease can travel as long as they can seek medical advice upon reaching their destination.

Tuberculosis infection can be detected by the use of tuberculin skin test to measure the swelling in the next 48-72 hours after administration of the test, for any hard swelling. A swelling of about 10 mm is usually indicative of an infection or childhood vaccination with BCG. But the swelling required for a HIV/AIDS patient is even lower.

The increase in new cases of infection cannot be solely blamed on the migrants coming from rural areas to urban centres in search of better lives because TB infections have been reported among local residents of Monrovia, suggesting that migration could not be the only factor leading to this upsurge but a number of factors such as environmental, sanitation, economic and political could be undergirding this increase (Marin et al, 2013).The question then becomes just how much are the migration variables contributing to these increase? Not much research has been done in this area to ascertain the influence of migration on TB infections.

New TB infections can be detected by administration of the tuberculin skin test whereby the size of the skin swelling is measured in the next 48-72 hours. If the swelling is 10mm then a new infection is said to have taken place but measurement is even lower in HIV-infected patients a measurement about 5 mm hard swelling is enough to detect infection. But disease detection can be done by taking a sample of the sputum and placed under a microscope to check for bacilli or by way of noticing some abnormalities in the chest by doing an x-ray. And lastly a positive response to anti-tuberculosis drugs confirms the disease diagnosis (Koslow, 2009).

People with weaker immune system such as children under the age of 5 and HIV – infected patients are in greater danger of going down with the disease and thus there is need for BCG vaccine especially for children and later on a vaccine booster to be administered to adolescents due to the weakening of the vaccine administered in infancy (Doherty et al, 2002). One of the challenges of TB treatment is that patients are required to take drugs for many months and this leads to relapse especially when patients feel better before the dose is completed and before the virus is completely eliminated. The consequence being that they are put on even stronger drugs with more side effects and thus there is need of direct observed therapy (DOT) where health workers supervise patients to ensure that they are taking their drugs. Above all, no TB control can succeed without the support of the government in terms of policy and financial, without this any effort is bound to fail.

Approach for the Study

The use of a quantitative approach while using systematic procedures to analyze the impact of rural-urban migration variables on the spread patterns of TB in Monrovia. This form of study helps in the evaluation of the healthcare system and structures in the region and reported cases of TB among the native residents in comparison to migrants and refugees. 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.

Susan Ukwu

Susan’s reply to Linda -Discussion – Week 5


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 Hi Linda,

Thanks for your informative post. I agree with the ecological perspective for intervention for the at risk groups, both in rural and urban areas in Liberia in stopping the tuberculosis endemic. Ecological perspective is a multilevel intervention system similar to systems thinking. It’s usefulness in understanding multilevel influences and the interrelationship between multiple factors such and environment, behavior, and the individuals that influence health to inform multilevel interventions is essential (Simons-Morton, Riley McLeroy, Wendel, 2012).

            The main use of ecological theory for health promotion is to develop effective interventions at multiple levels. For example, the health Planner develops interventions that influence personal health behavior, health and health-related behavior of those whose actions that can affect the health and behavior of others for example, families, neighbors, friends, health and education professionals, policy makers and others.

The concept of ecological perspective is that health is influenced by multiple

factors such as people’s behavior, environmental factors (social, economic, political, experiences, physical environment), genetics, and others. Therefore, one of the goals of health promotion is to enhance improvements in personal health behavior and environmental influences to achieve positive social behavior change.


Simons-Morton, B., Riley McLeroy, K., Wendel, M. (2012). Behavior Theory in Health Promotion Practice and Research (1st e.d). Burlington, MA: Jones & Bartlett.


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Doherty, T. (2002). Oral Vaccination with Subunit Vaccines Protects Animals against Aerosol

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

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Hodes, R. M.; and M. Azbite. 1993. Tuberculosis. In The Ecology of Health and Disease in

Ethiopia, edited by H. Kloos and Z. A. Zein. Boulder and Oxford: Westview Press. 265-84

Koslow, J. (2009). Cultivating health Los Angeles women and public health reform. New

Brunswick, N.J.: Rutgers University Press.

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

Causes, Consequences and Responses. New York: Routledge.

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