Tuberculosis Control in Malaysia (Mar 2009)

TUBERCULOSIS CONTROL IN MALAYSIA

J.Yeop1, B. Venugopalan2

1 President, Malaysian Association for The Prevention of Tuberculosis2 Medical Director, Malaysian Association for The Prevention of Tuberculosis

Country Demographics

People Population:

24,821,286 (July 2007 est.)

Population growth rate: 1.759% (2007 est.)

Population Below Poverty Line: 5.1% (2002 est.)

Infant mortality rate: 16.62 deaths/1,000 live births

Life expectancy at birth: total population: 72.76 yearsmale: 70.05 yearsfemale: 75.65 years

Total fertility rate: 3.01 children born/woman (2007 est.)

Ethnic groups: Malay 50.4%, Chinese 23.7%, indigenous 11%, Indian 7.1%, others 7.8% (2004 est.)

Nationality: noun: Malaysian(s) adjective: Malaysian

GDP (ppp) per CAPITA $12,900 (2006 est.)

Religions: Muslim 60.4%, Buddhist 19.2%, Christian 9.1%, Hindu 6.3%, Confucianism, Taoism, other traditional Chinese religions 2.6%, other or unknown 1.5%, none 0.8% (2000 census)

Languages: Bahasa Malaysia (official), English, Chinese (Cantonese, Mandarin, Hokkien, Hakka, Hainan, Foochow), Tamil, Telugu, Malayalam, Panjabi, Thai note: in East Malaysia there are several indigenous languages; most widely spoken are Iban and Kadazan

Literacy: total population: 88.7%male: 92%female: 85.4% (2000 census)

Health System in Malaysia

Primary Care Clinics Primary Care Clinics Primary Care Clinics Primary Care Clinics

General Hospitals General Hospitals General Hospitals

Tertiary Hospitals Tertiary Hospitals

Private Hospitals/ clinicsUniversity Hospitals

Army/ Navy Hospitals

Public Health System

Health Financing System

• Minimal cost (RM 1) for primary care clinics

• ‘Free’ (public health sector) for all communicablediseases including TB

• ‘Out of pocket’ expenses

• Medical insurance

History of the National TB Control Programme

1940-60’s: TB was the top 10 communicable diseases

notified & cause of death

1957: Independence from British rule

Prior 1961: Fragmented programme mainly done

by NGOs such as the MAPTB

1961: National TB Control Programme was

established as a ‘vertical programme’

under the Ministry of Health

History of the National TB Control Programme…..

1961-1994:

- National TB control programme was

coordinated technically and administratively

from the National TB Center (NTBC),

Kuala Lumpur

1994:

- The national TB control programme was

integrated into the general communicable

disease control programme

- The state TB control programme was under

the responsibility of the respective state

health directors

- The NTBC was redesignated as a tertiary

National Chest Institute

History of the National TB Control Programme….

NOTIFIED TB CASES, MALAYSIA 1985-2007

46 cases/day4 deaths/day46 cases/day4 deaths/day

All Forms = 16,918Infectious = 10,264 (61%)

CASE NOTIFICATION RATES OF TB,

MALAYSIA 1985-2007

Mid Year Pop 2007: 27,173,700

Tuberculosis In Malaysia 2007

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% TB AMONG FOREIGNERS, 1993 - 2007

TB Foreigners 2007 = 2055

TB/HIV Notification: 1986-2007

TB/HIV 2007 = 9.6%

TB- HIV Co Infection

• New TB cases with HIV, 2006 – 1,488 cases• % new TB with HIV – 8.93%• % TB-HIV death, 2005 – 40.9%

Challenges to the National TB Control Programme

• Reduced programme focus after integration

• HIV epidemic

• Aging population

• Increasing patient burden with chronic illnesses

such as diabetes, renal failure and other

immunosuppressed conditions

• Migration of foreign workers

Current National TB Control Programme Initiatives

• Renewed support from senior national policy

managers and increased resource allocation

• Strengthening the state TB control team

• TB-HIV screening programme

• Emphasis on DOT and treatment outcome

• Enhanced public-private partnership

• Working with NGOs to increase community

awareness

Role of MAPTB

• Community awareness & advocacy on TB

• TB Treatment Allowance Scheme (TAS)

• DOT public-private initiatives

• Supporting human resource training & technical

initiatives such as the 1st IUATLD Asia Pacific

Region Conference in Kuala Lumpur (2007)

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Acknowledgement

• Dr. Fuad Hashim (National TB Control

Programme Manager, Ministry of Health)

• Staff of the National MAPTB