Background: Tuberculosis (TB) is of high public health importance in Malaysia. Sabah State, located on the island of Borneo, has previously reported a particularly high burden of disease and faces unique contextual challenges compared with peninsular Malaysia. The aim of this study is to describe the epidemiology of TB in Sabah to identify risk groups and hotspots of TB transmission. Methods: We conducted a retrospective review of TB cases notified in Sabah, Malaysia, between 2012 and 2018. Using data from the state's 'myTB' notification database, we calculated the case notification rate and described trends in the epidemiology, diagnostic practices and treatment outcomes of TB in Sabah within this period. The Chi-squared test was used for determining the difference between two proportions. Results: Between 2012 and 2018 there were 33 193 cases of TB reported in Sabah (128 cases per 100 000 population). We identified several geographic hotspots, including districts with > 200 cases per 100 000 population per year. TB rates increased with age and were highest in older males. Children < 15 years accounted for only 4.6% of cases. Moderate or advanced disease on chest X-ray and sputum smear positivity was high (58 and 81% of cases respectively), suggesting frequent late diagnosis. Multi-drug resistant (MDR) TB prevalence was low (0.3% of TB cases), however, rapid diagnostic test coverage was low (1.2%) and only 18% of all cases had a positive culture result. Treatment success was 83% (range: 81-85%) in those with drug-sensitive TB and 36% (range: 25-45%) in cases of MDR-TB. Conclusion: Between 2012 and 2018, TB notifications in Sabah State equated to 20% of Malaysia's total TB notifications, despite Sabah representing only 10% of Malaysia's population. We found hotspots of TB in urbanised population hubs and points of migration, as well as evidence of late presentation and diagnosis. Ensuring universal health coverage and expansion of GeneXpert® coverage is recommended to reduce barriers to care and early diagnosis and treatment for TB.
Setting: Outpatient clinics, Kota Kinabalu, Malaysia; January–April 2018. Objectives: To identify barriers to full participation in tuberculosis (TB) contact investigation. Methods: Cross-sectional study of knowledge, perceptions, and behaviours among TB contacts. This study was conducted among contacts who attended an initial clinic visit to explore retention in care. During this first visit, contacts were approached for participation in a questionnaire at a follow-up visit. Contacts who consented but did not subsequently attend were interviewed at home. Associations between questionnaire findings and attendance were tested using logistic regression. Results: Of the total 1436 identified contacts, 800 (56%) attended an initial clinic visit. Of 237 consenting TB contacts, 207 (87%) attended their follow-up appointment. In univariable analyses, the odds of attendance were highest for people notified to attend the TB clinic directly by a health inspector; close relatives of TB patients; non-students; people with higher incomes and smaller households; older individuals; males; and people not perceiving TB as stigmatising. In multivariable analysis, mode of notification to attend and having a close relative with TB remained significant. Conclusions: Health inspectors provide an effective role in TB contact investigation through direct personal communication to encourage the completion of the TB screening process, but this requires further integration with clinical processes, and with workplace and school-based investigations.
Introduction: Melioidosis, also known as Whitmore disease, is caused by the gram-negative bacillus, Burkholderia pseudomallei and remains a public health concern in Southeast Asia and northern parts of Australia. This study attempts to identify all possible complications of melioidosis and its outcomes. Methods: Literature search was conducted from databases such as PubMed, Science Direct and Scopus from 1st January 2000 to 31st August 2019. Medical Subject Headings (MeSH) search strategy was used with the terms ‘Melioidosis’ or ‘Burkholderia pseudomallei’ and ‘Complications’. Results: A total of 162 titles were identified and 22 articles were included in the review. Findings showed that among the 22 articles, the ratio of male to female melioidosis incidence was 2.3 to 1, with most cases (86.4%) aged older than 14 years old and showed a mean age of 46 years old. A third (7/22) of the papers reported the involvement of the nervous system as a complication of melioidosis followed by cardiovascular complications. Among the 23 cases reported, 13 had underlying medical conditions with most of them (84.6%) having diabetes mellitus or newly diagnosed with diabetes mellitus. Overall, only one case (4.3%) had resulted in mortality, while 17.4% developed complications and 78.3% managed a full recovery after undergoing treatment for melioidosis. Conclusion: The most commonly found complication of melioidosis involved the nervous system but patient outcomes were favourable. Rare complications included mycotic aneurysm that can be fatal. Melioidosis can affect almost any organ leading to various complications.
Background: Chest radiography, or chest X-ray (CXR), is not only an important tool for triaging and screening for pulmonary tuberculosis (TB) but is also useful in aiding diagnosis when pulmonary TB cannot be confirmed bacteriologically. Sabah is a state with high TB burden with the incidence rate of 124/100,000 population in 2015. Access to chest radiography is limited in many settings in Sabah. In 2016, the TB and Leprosy Control Unit of Sabah State Health Department started systematic screening for TB with the help of a mobile digital X-ray unit. Keywords: tuberculosis, systematic screening, mobile digital chest radiography
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