Understanding Tuberculosis: Impact, Spread, and Prevention

1. St Ivo School Model St. Ivo School

2. Geography of disease St. Ivo School • Tuberculosis chosen due to school immunisation programme! • A lot of preliminary work & research on • 1. Data for countries – multivariate data • 2. Tuberculosis as a disease • Preparing materials for 4 intro lessons as well as the World Health Summit (Dec 06)

3. St. Ivo School Lesson 1: Introduction to Tuberculosis

4. Tuberculosis – The facts! TB is curable but kills 5000 people every day or 2 million per year. 2 billion people (1/3 of world’s population) are infected with the microbes that cause TB 1 in 10 people infected with TB microbes will become sick with active TB in their lifetime TB is contagious & spreads through the air: if not treated each person with active TB infects 10-15 people every year (approx) Almost 9 million new cases occurred in 2004

5. What is TB? • Tuberculosis is an infectious disease caused by bacteria (mycobacterium tuberculosis) • The TB bacteria usually attack the lungs but it can also attack the kidneys, spine & brain. It is fatal if untreated.

6. How is TB spread? • TB germs are spread from person to person through the air. • The bacteria are put into the air when a person with active TB coughs or sneezes. • When a person breathes in TB bacteria they settle in the lungs & begin to grow, from there they can move through the blood to other parts of the body • Not everyone infected with TB gets sick. People can have latent TB infection they don’t feel ill, have any symptoms & can’t spread TB to others. These people can go on and get the TB disease.

7. Symptoms: Bad cough lasting 3 weeks or more Chest pain Coughing up blood or sputum Weakness / tiredness Weight loss Sweating at night No appetite Chills Fever With these symptoms people can spread TB to others. How would you know if you had TB?

8. Estimated number of TB cases 2004

9. Why the global increase of TB? • Population growth • Urbanisation • Increasing poverty • Rates of HIV infection – this weakens the immune system. If HIV + 100x more likely to develop TB. • Drug resistant TB (costs for LEDCs?) • Young adults & women aged 15-44 , most at risk • Poorly managed TB programmes – especially in LEDCs (Africa & SE Asia)

10. St. Ivo School Lesson 2: Interpreting Graphs and Data

11. Tuberculosis in the UK

12. BCG vaccination introduced (given to school leaving age) in 1953 Annotating the graph Vaccination also given to infants from 1960 TB incidence decreased 50,000 cases a year in 1950 On average 10500 people die from TB each year An average of 350 people die from TB each year TB levels started to increase Lowest recorded level of TB – 5745 in 1987

13. Since 1987 (lowest number of cases: 5745) cases have risen by 27% to 7300 a year Each year 350 people die from TB

14. The number of new cases… In 2004-05, we saw the largest increase in any one year since 1999!

15. Where is TB found?andWho gets it?

17. The largest increase was seen amongst patients who were not born in the UK. However, only 22% of these patients in 2005 arrived in the UK during the past two years. This suggests that the increase is not a result of a large number of individuals arriving recently with TB but rather a combination of TB disease developing in individuals who may have been infected for some time and new infections acquired in the UK, or as a result of travel to other countries where TB is common.

18. Fig 8 & 9:Tuberculosis rates per age group, England, Wales and Northern Ireland, 2001-5 Non-UK born UK born

19. The UK’s BCG vaccination programme has changed?

20. Vaccinations are no longer given to all school aged children; instead those people considered most at risk of catching TB are vaccinated.

21. Those who… • are in close contact with an infected person • have visited, lived or worked for a long time in countries with a high rate of TB • are the children of parents whose country of origin has a high rate of TB • have a weakened immune system due to disease or treatment (HIV) • are homeless or living in poor or overcrowded conditions or undernourished • may have been exposed to TB in their youth when the disease was more common in this country • young children and very elderly people

22. World Health Summit St. Ivo School

23. Opening Address St. Ivo School Welcome today to all honourable delegates from the UK, USA, China, Bangladesh, Kenya and Brazil for the 2006 WHO summit. The focus of this meeting is Tuberculosis – a disease that causes 2 million deaths per year (worldwide), one every 15 seconds. 98% of these deaths occur in developing (poorer) areas of the world. I am hoping that today will help us to understand some of the issues facing our countries with regards to TB. It should be our collective aim to try and eradicate TB globally. GLOBAL PLAN FILM Let us work together whatever our global position or level of wealth to sort out this disease. Please make a firm commitment today with how your country will join the Global plan to STOP TB 2006 – 2015. This disease can not be allowed to continue killing people, in the last century 100 million people have died, please support a TB free world.

24. St. Ivo School Outline of the day

25. St. Ivo School

26. St. Ivo School

27. St. Ivo School

28. St. Ivo School After break

29. St. Ivo School

31. St. Ivo School After lunch

32. Using multivariate data packages St. Ivo School

33. Multivariate data St. Ivo School • 5d plotters v fathom • Raw data • v percentages • Outline sheet of what to achieve • Many trends explored

34. Multivariate plotters St. Ivo School • Possibilities are there to explore in lots more detail • Fairly easy to use

35. St. Ivo School

36. Student evaluation of multivariate packages St. Ivo School • Easy to use & instant (sliding button) • Useful once understood how to work it • Lots of information on the graphs • The data was in an understandable form • The graphs helped ‘put the figures into perspective’ • Fathom difficult to understand • A small number of girls found it hard to use and understand

37. Evaluation of multivariate packages St. Ivo School • Every student was engaged throughout the lesson and computer project! • 99% of students were on task and managed to interpret some graphs and related the data back to the context • Plotters more approachable to students

38. Evaluation of TB project St. Ivo School • This involved one group of 30 year 9 students. • All students had 4 preparation lessons culminating in the mock world health summit (7/12/07) • Students completed an evaluation sheet at the end of the summit about all the work they had done.

39. Student opinions St. Ivo School • Lots enjoyed the lesson on TB in the UK, using graphs & matching statements • Interested to know about TB • Enjoyed using ICT and independent learning • Liked sorting out the costumes & finding out about their country • Some students commented that they enjoyed the WHS day better than the prep lessons

40. What did students learn about TB? St. Ivo School • How many people it kills • How easily it’s spread • The fact it’s curable • 1 person can infect 10-15 people • Affects 2 million per year • No longer vaccinated in lots of British schools & why • Many countries can’t afford immunisations

41. Our evaluation St. Ivo School • A lot of work • The projects remit was very broad • It was hard to integrate geography and maths while meeting all the aims of the project • We feel that we met the aims of the project successfully • Students learnt facts/info/skills • We have learnt from the experience • Unclear as to how the material can be transferred to other schools in order to minimise work and to keep data up-to-date

42. Overall… St. Ivo School Enjoyable project for both students and staff