APPLICATION OF FLORENCE NIGHTINGALE’S THEORY TO THE TUBERCULOSIS SITUATION IN A SMALL COMMUNITY LIVING IN HINDUKUSH

Abstract

Background: Tuberculosis (TB) continues to pose a major public health threat in Pakistan, particularly in remote regions like Chitral, Khyber Pakhtunkhwa. Despite multiple governmental and non-governmental TB control initiatives, the disease remains endemic in certain valleys. The emergence of Multi-Drug Resistant Tuberculosis (MDR-TB) has further complicated the burden. One key limitation of current interventions is their narrow biomedical focus. Florence Nightingale’s Environmental Theory offers a broader framework to explore the environmental and social dimensions influencing TB transmission.

Objective: To analyze the environmental, sociocultural, and structural risk factors contributing to TB in a rural community of Chitral district, and to apply Florence Nightingale’s Environmental Theory as a guiding model for integrated public health interventions.

Methods: A qualitative observational study was conducted using the windshield survey method in a TB-endemic village of Chitral. Environmental and housing conditions, sociocultural practices, and health system accessibility were assessed. Household-level data were gathered through informal interviews with community members, including one TB-diagnosed individual. Ethical approval was obtained, and informed verbal consent was secured. Thematic analysis was conducted within the framework of Nightingale’s theory, focusing on its core paradigms and thirteen environmental canons.

Results: Over 80% of houses surveyed were built with mud and lacked adequate ventilation. Approximately 90% used indoor wood fires for heating, with sealed windows and no direct sunlight, contributing to poor air quality. Most families (average size: 9–12 members) lived in overcrowded, single-room dwellings. Stigma surrounding TB was evident, with affected individuals socially isolated despite being under treatment. Animal sheds located adjacent to homes, along with fodder piles on rooftops, limited airflow and sanitation.

Conclusion: TB control in such communities requires a multidimensional approach. Integrating Florence Nightingale’s environmental principles can enhance disease prevention by addressing socioeconomic, cultural, and infrastructural determinants of health.