Burden of TB in Sarawak
Dr. Marilyn UmarJabatan Kesihatan Negeri Sarawak
1
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)
3
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
16
17
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
23
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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