Burden of TB in Sarawak

Dr. Marilyn UmarJabatan Kesihatan Negeri Sarawak

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Infectious Disease in Malaysia : Trend (Top 7)

• Morbidity

• Mortality

2006 2007 2008 2009 20101 Dengue Fever 64.37 85.78 167.76 136.89 148.732 TB 62.56 62.26 68.1 63.95 68.253 HFMD 19.3 46.21 56.13 60.6 47.274 Food Poisoning 26.04 53.19 62.47 36.17 44.185 Malaria 19.87 20.08 26.7 24.76 23.476 DHF 4.87 10.16 9.67 14.237 HIV 21.88 16.84 13.31 10.88 12.89

No. Infectious Disease Incidence/Notification Rate per 100,000 

2006 2007 2008 2009 20101 Dengue Fever 0.01 0.02 0.02 0.01 0.062 TB 5.37 5.53 5.49 5.59 5.53 HFMD 0.02 0 0.02 0 04 Food Poisoning 0.01 0 0.01 0.01 05 Malaria 0.08 0.07 0.01 0.09 0.126 DHF 0.28 0.38 0.29 0.427 HIV 1.43 0.72 0.54 0.65 1.14

No. Infectious DiseaseMortality rate per 100,000

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Burden of infectious disease/100,000 populations (Sarawak)

Infectious diseases 2009 2010 2011

Dengue/DHF 182 169 39

Malaria 86 112 69

HFMD 387 199 126

Food Poisoning 49 52 53

TB 79 (4) 79 (4) 81 (2)

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Notification rate of TB/100,000 populations in Sarawak & Malaysia 1995‐2011

4

0.0

20.0

40.0

60.0

80.0

100.0

120.0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Notificatio

n Ra

te /10

0,00

0 po

pulatio

ns

Sarawak Malaysia

For 2011,

•10% of all notified TB cases in Malaysia

•3rd highest in notification rate after Sabah & WPKL

5

365

42

22

46

2937

61 5849

4355 51

22 2229

175

3242

60

23

40 44

144

27

187

43

306

61

42

24

60.8

84.5

65.3

84.1 86.1 85.8

63.5

75.8

195.2

59.0

105.8

76.5

107.8111.7

87.1

67.9

134.5128.4

84.4

94.3

132.0

104.3

76.5

27.6

142.9

93.5

137.4

108.8

67.7

84.5

56.5

0

50

100

150

200

250

0

50

100

150

200

250

300

350

400

Notificatio

n rate/100

,000

 pop

ulations

Num

ber o

f cases

District

No of cases notified & Notification Rate/100,000 populations by district 2011

11 districts >100/100,000 populations

Mortality burden for TB in Sarawak

6

7

4.7%

5.4%

6.5%

7.2% 7.3%

6.2%6.4%

7.0%

5.5%

6.9%6.7%

5.0% 4.9%4.7%

5.3%

6.1%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Percentage of death from total cases

Who died of TB?

8

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

0.0

10.0

20.0

30.0

40.0

50.0

60.0

*0‐4 *5‐9 *10‐14 *15‐19 *20‐24 *25‐29 *30‐34 *35‐39 *40‐44 *45‐49 *50‐54 *55‐59 *60‐64 *65‐69 *70‐74 *75 andabove

Percen

tage

 

Age Specific Death Rate

Age Group

Age Specific Death Rate/100K Percentage from total death

Where are we going in TB Control Programme in Malaysia?

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Objectives of TB Control Programme

• Millennium Development Goals (MDG)• STOP TB Partnership 

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MDG: 2015  Goal 6: Combat HIV/AIDS, malaria and other diseases

Target 6c: Halt and begin to reverse the incidence of malaria and other major diseases

Indicator 6.9: Incidence, prevalence and deathrates  associated with TB 

Indicator 6.10: Proportion of TB cases detected and cured under DOTS 

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STOP TB Partnership 

•Targets set for 2015 and 2050 are :By 2015: Reduce prevalence and death ratesby 50%, compared with their levels in 1990

By 2050: Reduce the global incidence of activeTB cases to < 1 case per 1 million populationper year

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What is your role in TB Control Programme?

Case Detection Suspect and investigate

Case management Ensure complete quality treatment

Contact examination

Do not let the MA examined the contacts 

Pay close attention to childhood contact 

especially those below 7 years old

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Case detectionAre we doing enough?

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Case Detection Activity

Year No of patients screened

No of slides examined

No of patientspositive

PercentagePositive

2010 44,234 68,673 1,338 3.0%

2011 68,670 97,900 1,247 1.8%

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Key Performance Indicator in case detection in 2012

• To double the number of cases in 2012 as compared to 2012

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Division DistrictNo of cases notified No of cases to be detected

2011 2012

KuchingKuching 365 730Bau 42 84Lundu 22 44

Samarahan

Samarahan 46 92Asajaya 29 58Simunjan 37 74Serian 61 122

Sri Aman Sri Aman 58 116Lubok Antu 49 98

Betong Betong 43 86Saratok 55 110

Sarikei

Sarikei 51 102Julau 22 44Pakan 22 44Meradong 29 58

SibuSibu 175 350Selangau 32 64Kanowit 42 84

KapitKapit 60 120Song 23 46Belaga 40 80

Mukah Mukah 44 88Dalat 14 28Matu 4 8Daro 27 54

Bintulu Bintulu 187 374Tatau 43 86

Miri Miri 306 612Marudi 61 122

Limbang Limbang 42 84Lawas 24 48

Sarawak 2055 4110

Case managementAre we treating them right?

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Treatment Outcome of TB patients 2011 among 2010 cohortDistrict Cure Rate

Kuching 75.4%

Bau 96.6%

Lundu 80.0%

Samarahan 96.2%

Asajaya 75.0%

Serian 81.8%

Simunjan 87.5%

Sri Aman 89.7%

Lubok Antu 90.0%

Betong 82.8%

Saratok 100%

Sarikei 93.1%

Meradong 87.5%

Pakan 100%

Julau 80.0%

District Cure Rate

Sibu 76.6%

Selangau 87.5%

Kanowit 94.7%

Kapit 88.9%

Song 100%

Belaga 86.7%

Mukah 77.4%

Matu Daro 96.8%

Dalat 83.3%

Bintulu 67.1%

Tatau 77.8%

Miri 63.3%

Marudi 50.0%

Limbang 78.1%

Lawas 73.3% 19

TB contact managementAre we examining and detecting 

them enough?

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Contacts examination achievement for Sarawak

Year No of TBcases registered

No of contact identified

Ratio case:contact

No of contact examined

No of contact positive

% contactpositive

2010 2,000 9,109 1:4.5 8,551 20 0.2%

2011 2,055 6,267 1: 3 4,915 9 0.1%

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Why childhood TB is important?

• Indicator for community infection (Target is >2% of TB cases are among children)

• Public health principle in contact management

Childhood TB is to find the sourcevs

Adult TB is to find others who are exposed 

Contact examination is crucial in TB control

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Childhood TB 

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3.3% 3.1% 2.9% 2.4% 2.0% 2.4%

56.1% 57.2% 58.4%56.7%

53.7%56.6%

40.6% 39.7% 38.7%40.9%

35.7%

40.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

2005 2006 2007 2008 2009 2010

0‐14

15‐54

>=55

Thank you

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