The Impact of Urban Migration Variables on Tuberculosis Prevalence in Monrovia (West Africa)

Introduction Tuberculosis is a human infection that is caused by the bacterium, bacteria. The bacteria that is responsible for tuberculosis is called Mycobacterium tuberculosis. This bacterium is closely compared to Mycobacterium leprae, the bacterium that causes leprosy (Gupta, 2012). Tuberculosis affects anybody although it is more common in those whose people whom their socioeconomic status is low,est, people living with HIV, and people living in areas where one can get TB easily like psychiatric patients and prison inmates. The two types of TB are extra-pulmonary tuberculosis and pulmonary tuberculosis (Gupta, 2012). The most popular TB type is the pulmonary TB that is throughout the world, and the study will focus on this type of TB. Pulmonary TB occurs when the lungs are colonized by the causing distress in the in the respiratory. The study needs to be conducted so as to intervene on the causes of TB and how it can be prevented. In Liberia, cases of TB reported in 2011 were an estimate of 53%. Background Tuberculosis is a human disease infection caused by the bacterium, bacteria. The bacteria that is responsible for tuberculosis is called Mycobacterium tuberculosis. According to evidence based on archeology, Mycobacterium tuberculosis has been appeared firstly around between past 20,000 years to 35,000 years (Daniel, Sep 2006).
 
 
 
 
 
 
The Impact of Urban Migration Variables on Tuberculosis Prevalence in Monrovia (West Africa)
Linda Kudee
Walden University
Public Health – Community Health Education
Dr. Williams
01/19/16
 
 
 
 
 
 
 
 
 
 
Abstract
Tuberculosis commonly abbreviated as TB is the deadliest single infectious agent after HIV/ AIDS in the world. Tuberculosis has left millions of people dead globally. TB has posed to be a threat to public health in Liberia. This threat mostly applies to immigrants. The main objective of this study was to examine the correlation between the independent variables of the status of immigration, year of residence, and ethnicity or race and the dependent variable of TB infection within  in Monrovia between 2008 and 2014. In examining these possible relationships, an ecological perspective theory was employed by this quantitative study [PBW1] and thus the study used secondary data that was gotten from the Ministry of Health and Social Welfare. The most significant predictors of TB infection rates according to data analysis via linear regression were the immigrant status, and ethnicity or race. The study provided professionals in health with other resources that assisted in the effective ways of TB intervention and had the highest possibilities in the prevention of spreading TB through relevant data analysis. The research is important because it will help to reduce the incidences of TB, prevalence and best utilization of resources by directing them to the right target group.
 
 
 
 
 
 
 
 
 
 
 
The Impact of Urban Migration Variables on Tuberculosis Prevalence in Monrovia (West Africa)
Linda Kudee
Public Health – Community Health Education
Walden University
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Table of Contents
Chapter One: Introduction to the Study……………………………………………………..    1
Introduction…………………………………………………………………………….   1
Background of the Study……………………………………………………………….   1
Problem Statement………………………………………………………………………..  2
Purpose of the Study……………………………………………………………………  3
Research Questions and Hypotheses……………………………………………………    4
Theoretical Framework for the Study…………………………………………………..    5
Nature of the study………………………………………………………………………  6
Definitions………………………………………………………………………………   6
Assumptions…………………………………………………………………………….  6
Scope and Delimitations……………………………………………………………………    7
Limitations………………………………………………………………………………   7
Significance of the Study…………………………………………………………………    8
Summary………………………………………………………………………………….  8
References…………………………………………………………………………………..
 
CHAPTER ONE: INTRODUCTION TO THE STUDY
Introduction
Tuberculosis is a human infection that is caused by the bacterium, bacteria. The bacteria that is responsible for tuberculosis is called Mycobacterium tuberculosis. This bacterium is closely compared to Mycobacterium leprae, the bacterium that causes leprosy (Gupta, 2012). Tuberculosis affects anybody although it is more common in those whose people whom their socioeconomic status is low,est, people living with HIV, and people living in areas where one can get TB easily like psychiatric patients and prison inmates.[PBW2]  The two types of TB are extra-pulmonary tuberculosis and pulmonary tuberculosis (Gupta, 2012). The most popular TB type is the pulmonary TB that is throughout the world, and the study will focus on this type of TB. Pulmonary TB occurs when the lungs are colonized by the causing distress in the in the respiratory. The study needs to be conducted so as to intervene on the causes of TB and how it can be prevented. In Liberia, cases of TB reported in 2011 were an estimate of 53%.[PBW3]
Background
Tuberculosis is a human disease infection caused by the bacterium, bacteria. The bacteria that is responsible for tuberculosis is called Mycobacterium tuberculosis. According to evidence based on archeology, Mycobacterium tuberculosis has been appeared firstly around between past 20,000 years to 35,000 years (Daniel, Sep 2006). Since then, TB has been a plague and is still a plague to human beings. Other agents that are infectious in the world history can match TB for causing misery and mortality on the human race. Factors such as better housing, income, nutrition and, health have contributed greatly to reduction rates. Despite the advancement of the medical care in the 20th century still the treatment and prevention of TB did not fare as well. In 2013, globally 9,000,000 people contracted TB, and the disease killed an estimate of 1,500,000 people.
Nearly 2/3 of the world population has been infected with tuberculosis in this 21st century. Tuberculosis is an airborne infectious disease and is single deadliest across the world. TB in Liberia poses to be a threat because the case detection rate in 2011 was 54% (LISGIS, 2014). Tuberculosis affects anybody although it is more common in people living with HIV/AIDs, people of low socioeconomic status, and in areas of TB burden setting like psychiatric patients and prison inmates. The two types of TB are extrapulmonary tuberculosis and pulmonary tuberculosis. The most common type of TB is pulmonary tuberculosis that is found all over the world (Gupta, 2012). The study will focus on pulmonary tuberculosis. Pulmonary tuberculosis is caused when the lungs are colonized by the bacteria causing respiratory distress. Extra pulmonary tuberculosis occurs when the bacteria settle outside the lungs. In Liberia, 4/5 cases of tuberculosis are reported to be extrapulmonary tuberculosis[PBW4] .
Problem Statement
Tuberculosis (TB) is an infection in humans that is caused by the bacterium Mycobacterium tuberculosis, which is transmitted through the exchange of air from an infected individual through sneezing, coughing, shouting, and singing (Bynum, 2012). The two types of TB are pulmonary and extrapulmonary, but the former is more common. Few infectious diseases are as deadly as TB. According to Lawn and Zumla (2011), tuberculosis accounted for about 25% of all deaths in Europe during the 19th century. Even though the situation has improved with better housing and proper sanitation, the mortality rate for TB is still almost the same as it was a century ago (50% of those infected; World Health Organization [WHO], 2014).  In 2013, approximately nine million people contracted TB, and about 1.5 million died due to the disease (WHO, 2014). And while tuberculosis rates have fallen in the developed world, the same cannot be said of developing countries. In most developing nations, such as Liberia, TB remains the main cause of deaths in hospitals (Hodes&Azbite, 1993).  Liberia, with a population of about 3.8 million has a TB prevalence of rate 420/100,000, and it is growing at an alarming rate of about 2% per year (WHO, 2010). Little is known about the factors that contribute the high prevalence of TB in the Liberian capital, Monrovia (Corbett et al., 2000).
Presently there are about 16,050 active TB cases in Liberia, mainly in the rural communities  areas where the majority of people are poor and live in squalid conditions. However their migration to bigger towns and cities such as Monrovia has aggravated the spread of the infection in Liberia. The rural-to-urban migration rate is currently 115/ 1000 people in the Liberian population (Saydee, 2015).The high rate of migration is a result of the rural population seeking medical treatment care for TB in Monrovia, where the government created a hub to encourage TB patients to come for treatment. After eight weeks of treatment, the cured individual can return home (Integrated Regional Information Networks [IRIN], 2009).
Purpose of the Study
The purpose of this research study is to investigate[PBW5]  assess the correlation between the high incidence and prevalence of tuberculosis in Monrovia and rural-urban migration drift in Liberia. Although a many studies have examined the effects of refugees and immigrants on the spread of TB, not much has been done on the effects of rural-urban migration as causative factors on the spread of tuberculosis. By studying these relationships, public health professionals in Monrovia and in Liberia generally, will be able to design interventions programs are aimed at addressing the variables that have the highest correlation levels. Further, the results may suggest intervention measures that can be taken in the rural areas, so that the citizens can be tested and possibly be put on medication to reduce the spread of TB. This study also will help in advocating for better reforms in the public health sector, because the spread of TB is caused by such factors that include lack of access to healthcare, sanitation, clean water, poor housing and overcrowding (Stanhop, 2014).
Research Questions
The following are the research questions for this study:
RQ1—What is the relationship between the rate of TB infection and population density in Monrovia between 2008 and 2014?
RQ2—What is relationship between the years of residence and TB infection rates in Monrovia between 2008 and 2014?
RQ3—To what extent does level of income influence the infection rate of TB among the population of Monrovia between 2008 and 2014?
Research Hypotheses
The following are the research hypotheses for this study:
H10: There is no relationship between TB prevalence and population density in Monrovia between 2008 and 2014.
H1A: There is a relationship between TB prevalence and population density in Monrovia between 2008 and 2014
H20: There is no relationship between the years of residence and TB prevalence rates among the population of Monrovia between 2008 and 2014.
H2A: There is a relationship between years of residence and TB prevalence rates in Monrovia between 2008 and 2014
H30: The level of income does not influence the infection rate of TB among the population of Monrovia between 2008 and 2014
H3A: The level of income influences the infection rates of TB among the population of Monrovia between 2008 and 2014
Theoretical Framework
The theoretical framework that will be used to guide this study is called Health Belief model[PBW6]  Model  (HBM). HEALTH Belief Model is a social science theory that was developed by Stephen Kegels, Godfrey Hochbaum, and IrinRosenstock in the 1960’s. HBM is underlied[PBW7]  by constructs that provide context on how individuals view and perceive about the disease and the research of social science have widely used these constructs. [PBW8] The figure below shows the HBM constructs that includes the perceived susceptibility, perceived benefit, perceived barrier, perceived severity, self efficacy, and cues to action.
Diagram depicting interconnection of the HBM constructs
Susceptibility
Figure 1.
 
 
 
 
 
 
 
 
 
Barriers
 
 
 
***You should make sure that Figure 1 fits into one page.
The figure above shows that the relevant constructs to this study are the perceive barriers and the perceive benefits of the Health Belief Model. Perceived benefits refer to essentials of avoiding a threat of a disease. It is believed that the prevention and the reduction of the threat of a disease, social variables like knowledge of the disease, health education, and cultural belief have an impact on this HBM theory. For example, many people in the rural areas of Liberia believe that illness and diseases are punishments subjected to those people who go against their social and cultural norms. Migration affects the rates of TB, especially during the rural-urban migration. It is believed that regions areas of Liberia that experiences high rates of TB are mostly in the rural communities areas. The rate of TB increases in the urban setting the moment when people migrate from rural areas that experience high prevalent prevalence rates of TB. These immigrants settle in densely populated areas in the urban setting increasing the risk of contracting or being contracted with the disease tuberculosis
The rate of TB can be controlled by the reduction in the rural-urban migration, conducting health promotion, health education and disease prevention programs for the community.among the people and people should have knowledge about the disease. The perceived barrier means the cost one incurs to prevent him or her from contracting being contracted with the disease, and one of the practices is the screening for of TB. The costs involved are both psychological and tangible. For example, most health centers in the rural setting do not screen people residing in those areas for TB, representing an obvious barrier. Lack of the appropriate resources by these health centers presents another barrier, and if the resources are available, then the services are costly for the local community. The limited resources that were costly made the people be exposed to a high risk of contracting the disease, and this underlies to the psychological and tangible barrier to TB screening. The constructs of the HBM helps in explaining as to why screening of TB is not effective.
*** Please note that there are far more than these in explaining the use of HBM in theoretical framework for your study. Therefore, obvious more readings are important here in order to write this section well.
Nature of the Study
The nature of this study will be quantitative and will use multiple linear regression model. This quantitative research study will be based on a retrospective research design. It will be quantitative because it can best use the secondary data to evaluate hard data correlations. A retrospective research design is the best design for analyzing data has been previously collected and for comparing various sets of data that are linked to a variable or variables (Chumney& Simpson, 2006). This quantitative research can help to determine if there is any relationship between the independent variable (rural-urban migration to Monrovia) and the dependent variable (the rate of TB infection among the population of Monrovia).
Definitions
Immigrants: The population of the Monrovia (who are here either legally orillegally) who were not born in the Liberia or Liberia territories. Those who migrate into Liberia but they were not born in Liberia.
Tuberculosis (TB): for the study purpose, when the term TB is used, it refers to pulmonary tuberculosis both LTBI and LTB.
The population of Monrovia between 2008 and 2014: it involves the individuals either male or female who are the residents of Monrovia or have resided in the state for six months or more at the time of the study
Assumptions
This research is non-experimental and the analysis of the archived secondary data that is coded was obtained from sources that were approved by the Institution Review Board. Public Health Services tested all participants for tuberculosis. It was therefore assumed that there was less biased data. Minimum bias was to make sure that each group had sound and comparable results.
Scope and Delimitations
The study will cover the following areas; the correlation between trends in TB infections in Monrovia and rural-urban migration, and the effects of population density on the spread of TB. The effects levels of income are also other areas that will be covered in the study.  This study was considered because the increase in the rate of tuberculosis infection and the mortality rate was alarming. Some of the delimitations of the study are; the analysis of data covered a larger cross section of Monrovia, the study was relevant and valid. Lastly is that strong statistical results were because of the type of analysis that was employed.
Limitations
The participants were not selected randomly because the study was retrospective. Non-randomization only is reflected on the population that was used in the study and thus it might fail to reflect the general population. Controlling the numbers that had variables that were confounding was also difficult. Confounding variables have potential impacts on the rates of infection of TB. These variables are the willingness, being available, and or the necessity of what is required to test the study population of the state. The study population covers a wide cross section area that might limit the necessities to carry out the study. The requirements are to facilitate in the test of tuberculosis, testing the area residents comprehensively, and negative test of TB that were false among the study population. Because of these limitations, future researchers should conduct more research on this subject so as to develop it further.
 
 
Significance of the study
By investigating the correlation between trends in TB infections in Monrovia and rural-urban migration, the data obtained from the study will help the epidemiologists determine the causes of tuberculosis and how to prevent the disease from spreading. The determinant will not only benefit the study population, but it will be of beneficial to the whole state and across the world. The knowledge acquired from the study will make people be aware of tuberculosis, and thus, they will use that knowledge to refrain from contacting tuberculosis. Results from the study will help initiate positive social change by reducing the rate of TB infection.  Lastly, the impact of the study on the public health, economy, and the larger society will be positive.
Summary
Basing on this chapter, TB still poses to be a real threat to all populations. Furthermore, more research needs to be done concerning TB and the level of income, years of residence, and population density. More research will ensure the certain variables that greatly contribute to TB infection rate and how to avoid these risks. The analysis of these correlations within Monrovia will equip the officials of public health with the necessary ily valuable tools that will help them fight against TB. Public health officers will also use these tools to ensure the threats being posed by this disease to all populations are limited. The literature review will follow whereby it will highlight the research that has already been done into this topic for the past 32 years. The literature review also exposes the loops in this literature that the research hopes to fill.
 
References
Amor, Y. B. (2008). Underreported threat of multidrug-resistant tuberculosis in Africa. London: Emerging infectious diseases,.
Austin, M. (2007). Species distribution models and ecological theory: a critical assessment and some possible new approaches. London: Ecological modelling,.
Berger, D. S. (2015). Tuberculosis: Global Status. New York: GIDEON Informatics Inc.
Daniel, T. M. (Sep 2006). The history of tuberculosis. Cleveland: Elsevier Inc.
Grossman, D. B. (2013). Pneumothorax in Liberia: Complications of Tuberculosis. Monrovia: Western Journal of Emergency Medicine.
Grossman, D. B. (2013). Pneumothorax in liberia: complications of tuberculosis. Monrovia: The western journal of emergency medicine.
Gupta, D. K. (2012). Hutchison’s Paediatrics. New Delhi: Jaypee Brothers Medical Publishers Pvt. Ltd.
Gwenigale, W. T. (2011). An analysis of Liberia’s 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict. Monrovia: Global Health.
John D H Porter. (2007). Assessing Tuberculosis Prevalence Through Population-based Surveys. London: World Health Organization.
Kruk, M. E. (2010). . Availability of essential health services in post-conflict Liberia. New York: Bulletin of the World Health Organization.
LISGIS. (2014). Liberia Demographic and Health Survey. Monrovia: Ministry of Health and Social Welfare.
 
Linda,
You still have a lot of work to do in order to put your prospectus in true perspective. Please kindly follow your instructor’s advice and make corrections as requested in order progress well in your dissertation writing. Again you must have to read latest literature more on the subject matter.
 
Dr. Williams
[PBW1]To do what???
[PBW2]You need more research  work in this area.
[PBW3]Your entire introduction is very poor. You need to read more on this subject to be able to write better inline with  what is expected of doctoral dissertation.
[PBW4]It is difficult to understand what you are trying to say here. Please kindly consult and read   current public health literature
Before starting to write your any part of your dissertation.
[PBW5]It is surprising that after reviewing your paper and putting it  the way it should read, you turn around put back most of what
I had earlier corrected. This does not make sense  at all.  If you do this again,  you may have to supervise  yourself.
[PBW6]This was also corrected before.
[PBW7]What does this mean ???
[PBW8]You have to thoroughly read about this theory,  know  and understand  how it can be used in behavioral science research,  what it stands for and how it can be applied towards your research.
 
 
 
 
 
Prospectus
Impact of Rural – Urban Migration Variables on High Prevalence of Tuberculosis in Monrovia, Liberia
 
Linda Kudee
 
Public Health – Community Health Education
A00472109
 
 
 
 
 
 
 
 
Prospectus
Impact of Rural – Urban Migration Variables on High Prevalence of Tuberculosis in Monrovia, Liberia
 
Prospectus: The Impact of Urban Migration Variables on TB Prevalence in Monrovia (West Africa)
Problem Statement
Tuberculosis (TB) is an infection in humans that is  caused by a bacterium,  Mycobacterium Tuberculosis, which is transmitted through the exchange of air from an infected individual through sneezing, coughing, shouting, and singing (Bynum, 2012). The two types of this infection TB are pulmonary and extrapulmonary tuberculosis, but the former is more common. Few infectious diseases are as deadly as TB. According to Lawn and Zumla (2011), tuberculosis accounted for about 25% of all deaths in Europe during the 19th century. Even though the situation has improved with better housing and proper sanitation, the mortality rate for TB is still almost the same as it was a century ago with 50% of those infected ( World Health Organization [WHO], 2014).  In 2013, approximately nine million people contracted TB, and about 1.5 million died due to the disease (WHO, 2014). And while tuberculosis rates have fallen in the developed world, the same cannot be said of developing countries. In most developing nations, such as Liberia, TB remains the main cause of deaths in hospitals (Hodes&Azbite, 1993).  Liberia, with a population of about 3.8 million has a TB prevalence of rate 420/100,000, and it is growing at an alarming rate of about 2% per year (WHO, 2010). Little is known about the factors that contribute the high prevalence of TB in the Liberian capital, Monrovia (Corbett et al., 2000).
Presently there are about 16,050 active TB cases in Liberia, mainly in the rural communities  areas where the majority of people are poor and live in squalid conditions. However their migration to bigger towns and cities such as Monrovia has aggravated the spread of the infection in Liberia. The rural-to-urban migration rate is currently 115/ 1000 people in the Liberian population (Saydee, 2015).The high rate of migration is a result of the rural population seeking medical treatment care for TB in Monrovia, where the government has created a hub to encourage TB patients to come go for treatment. After eight weeks of treatment, the cured individual can return home (Integrated Regional Information Networks [IRIN], 2009).
Purpose of the Study
The purpose of this research study is to assess investigate the correlation between the high incidence and prevalence of tuberculosis in Monrovia and rural-urban migration drift in Liberia. Although a many studies have examined the effects of refugees and immigrants on the spread of TB, not much has been done on the effects of rural-urban migration as causative factors for on the spread of tuberculosis. By studying these relationships, public health professionals in Monrovia, and in Liberia generally, will be able to design interventions programs are aimed at addressing the variables that have the highest correlation levels.Further, the results may suggest intervention measures that can be taken in the rural areas, so that the citizens can be tested and possibly be put on medication to reduce the spread of TB. This study also will help in advocating for better reforms in the public health sector, because the spread of TB is caused by such factors that include lack of access to healthcare, sanitation, clean water, poor housing and overcrowding (Stanhop, 2014).
 
Background
 
Some of the articles and studies that have looked at the incidence, prevalence, and variables that have contributed to the spread of TB are listed below:
Linda:
 
You will then utilize the articles/citations below to formerly write out precisely The Background of the Study as one of the Subheadings for Chapter 1 of your proposed dissertation.
 
 
i.             Johnson& Rhodes (2009) explains human beings as social creatures whose behaviors and health are influenced by intrapersonal, interpersonal and community factors.
ii.             Integrated Regional Information Networks (2009) provides significant information about the spread of TB infections among Liberians in the capital of Monrovia. The spread of TB is due to Due to inadequate awareness about the spread of TB, the status of immigration overcrowded housing, and poor hygiene, nutrition, and sanitation, as well as the destruction of the health care infrastructure during 14 years of civil war. People who come from areas that are densely populated are at a high risk of contracting or being contracted with the disease (Networks, 2009). Rural-Urban migration also contributes to the high rate of TB infection because rural areas are said to be areas that contain high burden of TB. The rate of TB can be high if people have insufficient knowledge concerning TB and TB rates can be controlled if people are taught on the causes, effects of the disease and how the disease can be prevented
iii.         Chumney& Simpson (2006) gives clear guidelines on how the actual research on Tuberculosis should be designed and conducted. The retrospective cross-sectional analysis was conducted in this study where the study relied on the primary data of the literature review of chapter 2 (Chumney, 2006). According to the retrospective cross-sectional analysis, the study indicated that the immigrants who had settled in Monrovia for less than a year are at a high risk of contracting the disease to the overall population. People who receive less income also are at a high risk of contracting or being contracted with the disease because they believe that the disease in costly for them to control.
iv.        Saydee (2015) gives quantitative data about internal migration in Liberia in the form of the total populations of rural and urban cities. The source also gives significant data about those migrating to and from the cities in Liberia (Saydee, 2015). People migrate from their rural set to up to the urban setting for the purpose of improving their socio-economic status. The data obtained from the study indicate that immigrants from rural areas are at high risk of contracting TB because rural areas are known to contain a high burden of TB.
v.       Stanhope (2014) provides important information on the causes of tuberculosis and the possible ways of treating the disease in a medical setting. Some of the factors that contribute to the spread of tuberculosis are poor sanitation, overcrowding, and poor nutrition (Stanhope, 2014). The factors affecting the rates of TB infection are population density, the level of income, and years of residence.
vi.     Bynum (2012) gives a general overview of tuberculosis including its history and causes, among other aspects. Globally, 25% of tuberculosis rates was accounted in Europe. Tuberculosis has been a plague killing millions of people yearly all over the world. There is little knowledge concerning the causes of TB (Bynum, 2012). However, the factors that contribute to high rate of TB are high population density, low level of income, and the less period in years of residence.
vii.    Centers for Disease Control (2015) offer a Health Belief Model on the various sociological factors that affect the health of an individual including the causes of tuberculosis. These factors include cultural values, SES, knowledge concerning the disease, and the status of immigration (Control, 2015). There is two construct of the Health Belief Model that helps in explaining as to why the screening of TB in the rural areas is not effective.  These constructs of HBM are the perceive barrier and the perceive benefits.
 
 
 
 
Framework
The theoretical framework that will be used to guide this study is called Health Belief Model model (HBM). HEALTH Belief Model is a social science theory that was developed by Stephen Kegels, Godfrey Hochbaum, and IrinRosenstock in the 1960’s. HBM is underlied???  by constructs that provide context on how individuals view and perceive about the disease and the research of social science have widely used these constructs.[PBW1]  The figure below shows the HBM constructs that includes the perceived susceptibility, perceived benefit, perceived barrier, perceived severity, self efficacy, and cues to action.
Diagram depicting interconnection of the HBM constructs
 
 
 
 
 
 
 
 
 
 
Barriers
 
 
 
The figure above shows that the relevant constructs to this study are the perceive barriers and the perceive benefits of the Health Belief Model. Perceived benefits refer to essentials of avoiding a threat of a disease. It is believed that the prevention and the reduction of the threat of a disease, social variables like knowledge of the disease, health education, and cultural belief have an impact on this HBM theory. For example, many people in the rural areas of Liberia believe that illness and diseases are punishments subjected to those people who go against their social and cultural norms. Migration affects the rates of TB, especially during the rural-urban migration. It is believed that areas of Liberia that experiences high rates of TB are mostly the rural areas. The rate of TB increases in the urban setting the moment when people migrate from rural areas that experience high prevalent rates of TB. These immigrants settle in densely populated areas in the urban setting increasing the risk of contracting or being contracted with the disease. [PBW2]
The rate of TB can be controlled by the reduction in the rural-urban migration, health education among the people and people should have knowledge about the disease. The perceived barrier means the cost one incurs to prevent him or her from being contracted with the disease, and one of the practices is the screening of TB. The costs involved are both psychological and tangible. For example, most health centers in the rural setting do not screen people residing in those areas for TB presenting an obvious barrier. Lack of the appropriate resources by these [PBW3] [PBW4] health centers presents another barrier, and if the resources are available, then the services are costly for the local community. The limited resources that were costly made the people be exposed to a high risk of contracting the disease, and this underlies to the psychological and tangible barrier to TB screening. The constructs of the HBM helps in explaining as to why screening of TB is not effective.[PBW5]
Research Questions
The following are the research questions for this study:
RQ1—What is the relationship between the rate of TB infection and population density in Monrovia between 2008 and 2014?
RQ2—What is relationship between the years of residence and TB infection rates in Monrovia between 2008 and 2014?
RQ3—To what extent does level of income influence the infection rate of TB among the population of Monrovia between 2008 and 2014?
Research Hypotheses
The following are the research hypotheses for this study:
H10: There is no relationship between TB prevalence and population density in Monrovia between 2008 and 2014.
H1A: There is a relationship between TB prevalence and population density in Monrovia between 2008 and 2014
H20: There is no relationship between the years of residence and TB prevalence rates among the population of Monrovia between 2008 and 2014.
H2A: There is a relationship between years of residence and TB prevalence rates in Monrovia between 2008 and 2014
H30: The level of income does not influence the infection rate of TB among the population of Monrovia between 2008 and 2014
H3A: The level of income influences the infection rates of TB among the population of Monrovia between 2008 and 2014
 
We will later take another look at your research questions and research hypotheses as you advance into your dissertation writing. You may also want to look for and examine other variables of interest that can result in the manifestation of high incidence and prevalence of TB in rural and urban communities of Liberia.
 
Nature of the Study
The nature of this study will be quantitative and will use multiple linear regression analysis. This quantitative research study will be based on a retrospective research design. It will be quantitative because it can best use the secondary data to evaluate hard data correlations. A retrospective research design is the best design for analyzing data has been previously collected and for comparing various sets of data that are linked to a variable or variables (Chumney& Simpson, 2006). This quantitative research can help to determine if there is any relationship between the independent variable (rural-urban migration to Monrovia) and the dependent variable (the rate of TB infection among the population of Monrovia).
Possible Types and Sources of Information or Data
This study relies on quantitative data that can be measured and compared on ordinal, nominal, and continuous scales. The nominal scale measures the variables that will define the rates of migration and infection in the region, as well as the gender of those studied. The ordinal scale measures the variables that will be used to define the different age groups that are used in the study. The continuous scale measures the variables that define the prevalence of tuberculosis and number of individuals per household.  The study uses secondary data obtained from demographic and health surveys conducted in Liberia and financed by United States Agency for International Development (Liberia Institute for Statistics and Geo-information Services, 2014). The data is important in studying the effects of various migration variables on the prevalence of tuberculosis in Monrovia. In addition, this study uses data from the Tuberculosis Indicator survey, which was conducted to measure the prevalence of the disease, its causes, and how it can be controlled.
The retrospective cross-sectional analysis was used in this dissertation to examine the relationship between the population density and or residential years in Liberia and the rate of infection of TB infection in the study population. The analysis was used to evaluate the effectiveness of the program of the Liberia Ministry of the Public Health and Social Welfare. Sensitivity analysis was conducted for the purpose of determining how the population density affects the rate of TB infection at the state level. Another purpose of the analysis was to identify loops that will be reviewed and be used for further study. Time series decomposition analysis was also conducted to determine the seasonal rates and the areas of Liberia that are highly affected by the rates of TB. By the use of Time Series Decomposition Analysis, it will be possible for one to know the season that highly affects the rates of TB.
 
 
 
 
 
 
 
 
 
References
Bynum, H. (2012). Spitting Blood: The History of Tuberculosis. Oxford, UK: Oxford            University Press.
Centers for Disease Control. (2015). The social-ecological model: A framework for prevention. Atlanta, GA: National Center for Injury Prevention and Control. Retrieved from http://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html
Chumney, E., & Simpson, K., eds. (2006).Methods and designs for outcomes research. New York, NY: American Society of Health-System Inc.
Corbett, E.L., et al. (2000). The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. National Center for Biotechnology Information Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12742798
Integrated Regional Information Networks.(2009). LIBERIA: Disease rife as people squeeze into fewer toilets. Monrovia: Humanitarian news and analysis. Retrieved from http://www.irinnews.org/report/87110/liberia-disease-rife-as-more-people-squeeze-into-fewer-toilets
Johnson, M., & Rhodes, R. (2009).Human behavior and the larger social environment: A new synthesis. New York, NY: Pearson.
Liberia Institute for Statistics and Geo-information Services. (2014). Liberia Demographic and Health Survey. Ministry of Health and Social Welfare. Monrovia, Liberia. Retrieved from https://dhsprogram.com/pubs/pdf/FR291/FR291.pdf
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[PBW1] This is very poorly written. It is important  you read and study this model well ahead before utilizing it as the  theoretical framework gfor your study..
[PBW2] It is difficult to understand what you are trying to say here
[PBW3]
[PBW4] Please kindly take  pains to re-write the entire  section  of  the Theoretical Framework to reflect  what is expected of you in Chapter 1 of the dissertation
[PBW5]Please kindly take pains to re-write the entire   section  of  the Theoretical Framework to reflect  what is expected of you in Chapter 1 of the dissertation