program kawalan dan pencegahan tb malaysia dr jiloris f dony ketua sektor tbkusta ipr 15 jul 2010
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PROGRAM KAWALAN DAN PENCEGAHAN TB
MALAYSIA
Dr Jiloris F Dony Ketua Sektor TBKUSTA
IPR 15 Jul 2010
Pengenalan• Diketahui sejak 2400 sebelum masihi• 1882 – Robert Koch menemui Mycobacterium TB• 1895 - X ray ditemui• 1921- BCG digunakan kepada manusia• 1949- PAS• 1952 –isoniazid• 1954-pyrazinamide• 1962-Ethambutol• 1963-Rifampicin
TB Burden 1993- “Global Emergency”
TB ranks Seventh as a global cause of death and will remain the major killer through 2020 (Murray and Lopez 1996) From 2005 highlight the TB Epidemic:-
-2 billion people i.e .one-third of the total population, estimated to be infected with M. tuberculosis- 8.9 million new cases of TB (140/100,000 population) - 1.7 million people (27/100,000) died from TB including those co-infected with HIV (248,000)
Milestone of Malaysia’s TBCP
1961
1972
1973
1. VERTICAL PROGRAMME : IPR AS MAIN NATIONAL TB REFERRAL CENTRE
2. AIM TO REACH 95% OF BCG COVERAGE
STATE TB OFFICERS CREATED.
BCG REVACCINATION – ‘BOOSTER DOSE’ FOR 12 Y.O 1975
CENTRAL TB REGISTRY AT IPR AND HOSPITAL (TB CLINICS)
1993
1995
1999
2003
HMIS-TB LAUNCHED
INTEGRATED SYSTEM BEGAN, REGISTRY REMAINED AT CHEST CLINICS
TBIS COMMITTEE CREATED
TBIS LAUNCHED FULLY AND IMPLEMENTED
2002 BCG REVACCINATION – ‘BOOSTER DOSE’ , STOPPED
Policies1. To notify TB patients according to place of residence2. To give standard regime of anti-TB to patients as
according to WHO guidelines3. To screen all HIV patients for TB4. To screen all TB patients for HIV5. Contact screening6. Infectious Disease Control Act 342 7. INH prophylaxis for HIV patients8. HAART for TB/HIV patients
BREAKING TRANSMISSION
National TB Control Programme (NTP)
Organization:• Director of Disease Control
- Head of the program• Head of Institute
Respiratory Medicine - Technical advisor
• State Health Director - State coordinator
• District Health Office – Basic management unit
TB SUPERVISION SYSTEM
OthersChest Clinic & Hospital
Health Centre
DTOT
PrivateUniv Hosp
DTOTDistrict TB Organizer
TeamDTOT
State TB Organizer
Team
DTOT
State(States TB Organizer Team)
RE-ORGANISATION OF TREATMENT CENTRES
District(District TB Organizer Team)
PR1 PR1
PR2
PR2
PR2
PR2 PR2
PR2
District(District TB Organizer Team)
PR1 PR1
PR2PR2
PR2 PR2
PR2
PR1
TB IS A NOTIFIABLE TB IS A NOTIFIABLE DISEASEDISEASE
• All All confirmed TB casesconfirmed TB cases (bacteriology & /or radiology & /or (bacteriology & /or radiology & /or clinical ) must be clinical ) must be notified notified to the to the nearest nearest District Health OfficeDistrict Health Office using CDCISusing CDCIS within 1 week of within 1 week of diagnosis.diagnosis.
• This is required under the This is required under the Infectious Diseases Act Infectious Diseases Act (1988)(1988)
Programs indicators
Programs indicators
do+s 1. Government commitment to
sustained TB control activities 2. Case detection by sputum
smear microscopy among symptomatic patients self-reporting to health services
3. Standardized treatment regimen of six to eight months for at least all sputum smear positive cases, with directly observed therapy (DOT) for at least the initial two months
4. A regular, uninterrupted supply of all essential anti TB drugs
5. A standardized recording and reporting system that allows assessment of treatment results for each patient and of the TB control programs
performance overall
IKRAB
HIGH RISK HIGH RISK GROUPSGROUPS....
• Contacts of PTB Sputum Smear +Contacts of PTB Sputum Smear +• Persons with HIV infectionPersons with HIV infection• Immigrants from high TB burden countriesImmigrants from high TB burden countries• Persons in Institutions (prisons & drug Persons in Institutions (prisons & drug
rehabilitation centers)rehabilitation centers)• Persons with other medical risk factors (diabetes Persons with other medical risk factors (diabetes
mellitus, renal failure, silicosis, prolonged steroid mellitus, renal failure, silicosis, prolonged steroid or other immunosuppressive therapy & or other immunosuppressive therapy & haematological malignancies)haematological malignancies)
Global TB Concerns Global TB Concerns
• *The rising incidence of *The rising incidence of HIV/AIDSHIV/AIDS worldwide and the worldwide and the close interaction close interaction between TB & HIV/AIDS.between TB & HIV/AIDS.
• *Increasing *Increasing international migrationinternational migration• *The emergence of multi-drug resistant *The emergence of multi-drug resistant
tuberculosis tuberculosis (MDRTB)(MDRTB)• Economic strife, war, famine & natural Economic strife, war, famine & natural
disaster which disrupted existing TB control disaster which disrupted existing TB control program.program.
• Decreased awarenessDecreased awareness about TB about TB amongst medical personnel including amongst medical personnel including doctors.doctors.
• The The low priority given to TB low priority given to TB controlcontrol in terms of resource allocation in terms of resource allocation & training.& training.
• Changes in Changes in global populationglobal population demography.demography.
Global TB ConcernsGlobal TB Concerns
OUR ROLE• General
– *TB treatment and control team– Plan TB activities
• General public• Schools children• Health/medical staffs
– Collaborate with NGOs– *Supervise and monitor the progress of
implementation of TBIS
Role …
• Specific– Make correct and full diagnosis– Notify TB and other communicable
diseases– *Determine correctly the drugs and
dosage– Filling-up TBIS 10A-1, 10E, 10H, 10I– Ensure that TBIS 101A, 101B is
updated
FORMS AND REPORTS
Accessories(< 100 series )
Registers(100 series )
Reports( 200 series )
Treatment10A, 10B …
Lab20A, 20B
Treatment101A, 101B …
Lab102A, 102B
Treatment201A, 201B …
Lab202A
BCG203A
BCG103A, 103B
BCG30A, 30B
PR2PR2
PR1PR1
DHODHO
SHDSHD
MOHMOH
BCGBCGLabLabPt & ContactPt & ContactPlacePlace
Annual Report / WHO
REPORT: LOCATION AND FREQUENCY
201C
201C
201A (S)
201A (D)
201B
202A
202A
203A
203A 203B
203B
203B203A202A
103A101D
103A 103B
203A
203A
Situasi TB di Malaysia
25
Disease
Number of casesIncidence rate (IR)
2003 2004 2005 2006 2007 2007
Dengue Infection
14,76161.65
12.75551.50
15,86264.53
17,14768.47
23,31090.65
46,517177.92
TB 15,58263.29
15,42960.30
15,99161.20
16,66562.56
16,91862.26
17,50663.10
FP 6,62426.45
5,95723.40
4,64117.76
6,93826.04
14,45553.19
17,32262.47
HFMD 1,265 378 6,325 5,141 12,55846.21
15,56456.13
HIV 6,75631.27
6,42729.61
6,12028.09
5,83028.79
4,57721.01
4,57716.71
0
2
4
6
8
10
12
14
2003 2004 2005 2006 2007 2008
%
Peratus kes TB di kalangan wagra asing, 2003 - 2008
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
No
of
Cas
es
Year
TBHIV 1990-2008
No.TB cases No. TBHIV
TB SituationTB Burden Ranking TB among HCW
TB among Immigrant TB-HIV Co-infection
Disease
Number of casesIncidence rate (IR)
2003 2004 2005 2006 2007 2007
Dengue Infection
14,76161.65
12.75551.50
15,86264.53
17,14768.47
23,31090.65
46,517177.92
TB 15,58263.29
15,42960.30
15,99161.20
16,66562.56
16,91862.26
17,50663.10
FP 6,62426.45
5,95723.40
4,64117.76
6,93826.04
14,45553.19
17,32262.47
HFMD 1,265 378 6,325 5,141 12,55846.21
15,56456.13
HIV 6,75631.27
6,42729.61
6,12028.09
5,83028.79
4,57721.01
4,57716.71
TB SituationTB in Malaysia vs ASEAN Country TB Cases and IR 1985-2008
TB among Children Death Associated with TB
Country No. of cases
IR EstimatedNo. of cases
EstimatedIR
%case
detectionBrunei 207 53 230 59 90
Singapore 1359 31 1176 27 115.5
Malaysia 16129 61 27439 103 58.8
Thailand 54793 86 90878 142 60.3
Indonesia 275193 119 528063 228 52.1
TB Cases and Incidence Rate 1985-2008
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Year
No
.of
case
s
52
54
56
58
60
62
64
66
68
70
IR/1
00,0
00
0123
456
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Rate
per
100,0
00
popu
latio
n
Death Rate (per 100,000 population) Target: <3 per 100,000 population
NSP For TB Control 2011-2015
• 6 Strategies• 6 Elemen ( I – AMORE)
–Infrastructure , Advocacy; Manpower; Operational;
Research & Equipment
• 5 KPI • 7 “Vehicles”
– TBKUSTA sector, Family Development & Primary Care, Public Health Lab. Health Promotion and Health Promotion Board, TB Managerial Teams-State & District ,c NGO, CKAPS /MMA
6 Strategies
• Strengthening Components of health system• Enhance Case Detection• Delivering an enhanced and quality TB
treatment• empower people with TB and Community• Limiting people from contracting TB• Promote TB Centered Reseach
Year Death per 100,000
2000 5.6
2001 5.5
2002 5.3
2003 3.9
2004 5.2
2005 5.5
2006 5.4
2007 5.5
2008 5.5
2009 2010 2011 2012 2013 2014
2015 3.02016
CDR(2008): 68 % 70 % CURE R (2008): 81.7 % 85 %
Succes R (2008): 82.4 85 %Target & Road map to attain MDG Goal 6.c
32.3
NSP
do+s (TBIS)
Integrated health services
Isu dan cabaran
• Integrasi tetapi belum
terlaksana sepenuhnya
• Struktur organisasi kurang
jelas di beberapa negeri
• Pelaksanaan aktiviti
kurang diselaraskan
disebabkan kekurangan
sumber ; tenaga kerja,
kewangan & infrastruktur
Menjejaskan pengesanan kes , kapasiti diagnostik dan efisiensi rawatan
Sasaran MDG – 61 ke 31 setiap 100,000 penduduk
Scatter Diagram CDR & Cure Rate (Registered Cases 2008, Malaysia)