Im your existing member. Could you please send me quotation on attached file. Deadline is 21 march 2020.
I received your special discount mail- Discount code is 50MAR20.
The coursework will be in the form an essay informed by Analysis of a Case-study based on a real-world health systems situation. The details for the coursework are as follows:
See the structure of the article at the end of the case study.
Word count: 4,000 words (± 10%)
Referencing - Harvard style
Fighting Tuberculosis: A Global Health Perspective
Tuberculosis kills more people across the world than any other pathogenic illness. New drugs, vaccines and tests offer hope, though – if there is money enough to deploy them
In 1882 when Robert Koch discovered Mycobacterium Tuberculosis, the bacterium that causes tuberculosis, the disease caused 15% of deaths in America and Europe. Transmitted through droplets from coughs, sneezes or just talking, tuberculosis felled rich and poor alike. In the century that followed, TB (as the illness is called for short) beat the retreat, thanks to antibiotics and a vaccine that protected infants. By the 1990s, wiping it out completely seemed tantalisingly within reach.
Since then, however, progress has been glacially slow. New cases a falling by just 1 – 2% a year. Today, TB kills more people than any other single pathogen (see chart). The World Health Organization (WHO) estimate that 10 million people fall ill with TB each year and 1.5 million die. This is more than three times the number of those who succumb to malaria. A recent wave of scientific breakthrough is, though, starting to bear fruit, and there is now widespread optimism that things will change dramatically over the next decade. “It is the first year in which we have some hope,” says head of the Stop TB Partnership, a global alliance of antituberculosis organizations.
However, realising that hope will need money. And on December 10th, 2019, at a meeting in Jakarta, Indonesia, the partnership published an estimate of how much it will cost. The goal set by the United Nations (UN) in 2018 is to end TB by 2030. To have any hope of that, the partnership says, will require $15.6bn a year to be spent over the next five years. This is a doubling of the annual treatment and prevention budget to $13bn, a tripling of the R&D budget to $2.6bn a year.
One reason TB has been hard to crack is that the bacteria has an unusual life cycle. When someone inhales the bug, it is either killed by the immune system right away, or it takes up residence in the lungs. Instead of causing immediate symptoms, though, it usually remains dormant – a state called latent infection that is not contagious. About a quarter of the world’s population has such latent TB. But only 10% of those so infected ever go on to develop symptoms. Often, it is those with have weakened immune systems. People infected with HIV are at particular risk and about 40% of deaths among HIV-positive individuals are caused by TB. Others with higher than average risk of becoming symptomatic are the malnourished, smokers, and alcoholics.
Two developments have complicated the fight against TB since the 1990s. One is the spread of HIV. The other is the emergence of antibiotic resistant strains of TB. Nearly 500,000 of 2018’s new cases were untreatable with standard first-line drugs. And 16% of those cases are classified as excessively drug-resistant, meaning that few or no drugs work for them. Drug resistant TB has a particularly strong hold in Russia and other former communist countries, where it accounts for roughly one in five new cases.
At the moment, the standard treatment for drug-resistant TB involves taking highly toxic medications for as long as two years. A patient may have to swallow as many as 20 pills a day, and receive injections with nasty side-effects, such as permanent deafness. Even this regimen, however, has a cure rate of only 25 – 50%. But shorter and safer drug combinations tested in recent years are now being introduced.
They may get shorter still. In August, America’s drug regulator approved pretomanid, a drug developed by the TB Alliance, a non-profit organisation based on South Africa’s capital, Pretoria, after which it got the name. Used in combination with other drugs, pretomanid shortens treatment of the most drug-resistant forms of TB to just six months, with an 89% success rate and no injections. Trials are now underway to check whether simpler regimens that include pretomanid can work for strains of TB that are resistant to fewer of the standard drugs.
Treating those who fall ill promptly is crucial to preventing the spread of TB. Someone with active TB may, according to the WHO, infect as many as 15 others in the course of a year. But the WHO reckons that roughly a third of new cases in 2018 went undiagnosed. That is partly because the most widely employed diagnostic method today remains the one Koch himself used: examining a patient’s sputum under a microscope to look for tell-tale bacteria. This procedure, which some analysts call “an embarrassment to science”, detects only half of active TB cases. And on top of this, the most common test for drug-resistance is also ancient. It involves growing a sample in a Petri dish and sprinkling it with antibiotics to check whether they work. This is an exercise that can take up to 12 weeks to provide an answer.
Fancier diagnostic machines that detect TB genes in sputum samples – and can determine whether they are of the drug-resistant variety – have been available for about a decade. These provide results in less than two hours. But at $10 a test, they are out of reach of most health centres in those countries which host the bulk of TB cases. A urine dipstick test for active TB is available, but it works reliably only for people who also have HIV. The pipeline of new test is however packed. According to Stop TB, 18 new diagnostic products may be ready for evaluation by the WHO in 2020.
Moreover, some of the old-fashioned tools are having a makeover. Diagnosing TB is made tricky by the fact that symptoms such as a long-lasting cough, often do not present themselves during the early stage of illness. Someone who is seemingly healthy can this be infecting others.
Chest X-rays can nab such early stage TB. Scanning people en-mass in places where TB is common is therefore a sensible way to slow down transmission. A promising innovation on that front is mobile X-ray machines in which reading of the scans is delegated to artificial intelligence technology. Vans containing such machines now roam around Africa and Asia.
But the hardest to crack is predicting who among those with latent TB are likely to become ill – in order to treat them pre-emptively. Research in this area is concentrating on identifying patterns of gene expression in blood cells that might appear six months to a year before active TB develops. Those at risk can then be treated, for a single drug taken once a week for three months will clear their latent infection.
Killing a killer
In the end, the biggest hope for beating TB is a new vaccine. The only one now available is BCG (Bacillus Calmette-Guerin), which goes back to 1921. It is effective in preventing the most severe forms of TB in children, such as brain inflammation. But it is unreliable against TB of the lungs – which is the most common form of the illness in adults.
Now a century after the development of BCG, there seems to be light at the end of the vaccine-search tunnel. At least seven candidates are in advanced clinical trials. A particularly promising one, code named M72/ASO1E, has been developed by Glaxo-SmithKline, a big and international drug company based in the United Kingdom. In trials in Africa, the latest results of which were published in October 2019, M72/ASO1E was about 50% effective in preventing TB of the lungs in people with latent infection. No other candidate vaccine has worked in this group of TB patients. This seemingly low efficacy is in fact good news for a disease that kills so many people.
Glaxo-SmithKline has not yet said whether it will proceed with the further trials needed to put M72/ASO1E on the market. Who would pay for these is an important question, for the $500m price tag involved is commercially unattractive. The firm says it is in discussions with outside organisations about the matter, and that saying anything more at this stage would compromise progress. Observers worry, though, that delay will mean the stockpile of vaccine available for trials will expire – and that creating more will add to costs. Money is the sinews of war, and human beings have been at war with TB for a long time. It does look now, however, as if the weapons needed to bring the conflict to an end are being forged. Whether people have the appetite to pay for them remains to be seen.
Tuberculosis is one of the commonest communicable diseases whose spread, control and management are influenced by globalization. You are required to: Critically analyses the impact of globalisation on emergence, spread and control of TB and set out the challenges facing global and public health agencies in their fighting the disease.
Through interpreting and analysis of issues highlighted in this case-study on global fight against TB, use the guidance below to write a 4,000 word essay in response to the task described:
1. Identify and describe FOUR globalization factors and clarify how EACH factor influences global prevalence of tuberculosis [1,500 words].
2. Identify and describe the role of FOUR categories of agencies involved in activities for the prevention, control and management of tuberculosis (governance) [800 words].
3. For each of the FOUR categories, identify and examine the challenges facing specific agencies in performing their role more effectively to reduce the global burden of tuberculosis [1,500 words].
4. Draw your conclusions about (i) globalization and TB prevalence, and (ii) governance issues in global efforts to prevent spread, control and management of TB [200 words].
4.2 Useful web sites
World Health Organisation (WHO) & their health reports archives (http://www.who.int/whr/previous/en/)
The Commission on Social Determinants of Health (CSDH) - http://data.worldbank.org/topic/health
The World Bank – health data - www.healthmap.org
Health Map - http://www.un.org/en/globalissues/health/
United Nations – health issues (https://sustainabledevelopment.un.org/?menu=1300)
United Nations Sustainable Development Goals- knowledge platform
International Journal of Health Policy and Management - http://www.ijhpm.com/issue
Globalisation and Health - https://globalizationandhealth.biomedcentral.com
THE LANCET Global Health - http://link.springer.com/journal/volumesAndIssues/38
International Journal of Public Health
Institute for Global Health - https://www.ucl.ac.uk/igh/
Importance of a good essay TITLE
Remember - Essay TOPIC ? Essay TITLE
A good Essay Title….
1. Demonstrates correct interpretation of the task – which guides the writing process
2. Facilitates in constructing logical arguments – essay structure (linking 4 listed sections)
3. Helps in presenting a coherent literature review
4. Saves time & effort in searching for what ideas to include in the essay
Attributes of a good essay title
MUST be specific (partly done in the task) & meaningful
i. It derives from a chosen TOPIC (theoretical construct)
ii. It clarifies WHAT the essay is about (out of many ideas in a TOPIC)
iii. It is a guide to avoiding a generalised essay
iv. It facilitates focused and in-depth analysis of the issues highlighted in the task
• A good essay title identifies the effect / outcome of a problem or opportunity
Examples of effect of a problem - already specified in the task description
i. increased burden of type-2 diabetes;
ii. emergence of TB / type-2 diabetes;
iii. spread & control of TB / type 2 diabetes,
iv. challenges facing global agencies etc. – Let us see such outcomes spelt out in your essay titles
Capture the topic & other task specifications in the title
A good title should be clear, precise & conforming to words used in the field of study:
• it ensures that you use relevant information & terminology when writing
• helps to avoid content not directly related to the topic & task description
• terms used should be specific for topic – neither too broad nor too narrow
Example 1: What is your judgement on an essay entitled…..?
“Globalisation and type-2 diabetes”
It is simply too broad - not precise & not informative in light of the described task
Example 2: What is your judgement on the title..…
Analysis of globalisation’s contribution to “emergence of type-2 diabetes” and challenges facing global health agencies in addressing the problem
Structure of essays
Essays always display their Titles - NOT headings & subheadings: e.g. Introduction, Recommendations, Conclusion, or other descriptions
• You could use them in the Plan but never make them visible elements in essay
-they affect your linking/Transition from one idea (paragraph) to the other to reduce the flow or fluency of your arguments
• Essay writing has objective to develop your skills in connecting ideas, explaining concepts and activities that affect service delivery
Structure of essays
No “headings” or “subheadings” within the essay, also……
No graphs, tables, listed items or bullet points – you are being tested for interpreting these
(i) briefly explain what the essay is about & how your argument is structured
(i) define globalisation, explain the factors & its dimensions (backed with References)
(ii) define TB / type-2, explain relationship to globalisation (backed with References)
Both Introduction & Background in context of item 1 of Guidance – 1,500
Rest of the body
Address requirements for item 2
Address requirements in item 3, and
Address requirements in item 4
References Harvard style