INTRODUCTION

TB remains a global predicament consuming 9

million people around the world with the disease in
the year 2013 and causing 1.5million TB-related
deaths worldwide.
[Centers of disease control & prevention: TB data & statistics]

It has been estimated that between the years 2000

and 2020, approximately one billion people will be
infected with Mycobacteriumtuberculosis, 200 million
infected people will develop active disease, and 35
million will die from TB globally if prevention and
control plans are not further developed and executed.
[Bhunu C, Mushayabasa S, Tchuenche J:A theoretical assessment of
the effects of smoking on the transmission dynamics of tuberculosis.]

 Although a declining trend was observed in most developed

countries, this was not evident in many developing countries.
[Progress towards millennium development goals for TB control in seven Asian
countries.Chadha VK Indian J Tuberc. 2009 Jan]

This resurgent disease has become a significant worldwide

public health problem and is largely related to immigration
from countries with a high prevalence of TB; infection with
HIV; social problems, such as poverty, homelessness, and
drug abuse; and dismantling of TB services.
[Raviglione and OBrien, 2005]

In a descriptive retrospective study in southern Karnataka,

they found that DM was the most common co-morbid
condition followed by smoking, alcoholism and then HIV,
although a rising trend of HIV in TB has been observed.
[Role of risk factors and socio-economic status in pulmonary tuberculosis: a search for the
root cause in patients in a tertiary care hospital, South India Tropical Medicine & International
Health Vol. 16, Issue 1]

 In 2010, the World Health Organization estimated

8.8 million new cases of TB globally with 1.1
million deaths among HIV-negative cases of TB and
an additional 0.35 million deaths among people who
were HIV-positive.
Malaysia is an intermediate tuberculosis (TB)
burden country, with an incidence rate of between
58.7 and 67.8 per 100 000 population over the
past 10 years
[Ministry of Health [MOH] Malaysia, National Tuberculosis Control Programme,
Kuala Lumpur, 2009, unpublished]

In year 2011, a total of 19,251 of new TB cases

were reported in Malaysia, with pulmonary TB as
the commonest form of TB.
[Sistem Maklumat Tibi Kementerian Kesihatan Malaysia. Fakta-Fakta Utama Program Kawalan
Tibi. 2011]

 In the early 1940s and 1950s, TB was the number

one
cause
of
death
in
Malaysia.
Antituberculosis drugs became available in
Malaysia only in the late 1950s.
The National TB Control Program (NTCP) was
launched in 1961, and subsequently the directly
observed treatment, short course (DOTS) strategy
was implemented into the program in the late 90s.
The main aim was to control and reduce the
prevalence of TB.
[Iyawoo K., 2004; Tuberculosis in Malaysia: problems and prospect of treatment and
control.]

 About 10% of TB notified cases have been

discovered among the immigrant population,
particularly those from high TB burden
neighboring countries
[Iyawoo, 2004]

Immigrants contributed more than 24% of the

newly detected TB cases in Sabah, East
Malaysia.
[Dony et al, 2004]

In year 2010, a report by Jabatan Kesihatan

Negeri Kelantan delineated a total of 1333 cases,
7% of total population in Kelantan

 The incidence and prevalence of TB in Malaysia

varies in different age groups. The majority of
patients are in the 21 - 60 years age group
(69.5%) and there is a male predominance
(65%)
[Jetan C, Jamaiah I, Rohela M, et al.]

Corresponds to the global scale where TB is also

more common among men and affects mostly
adults in the economically productive age
groups. Approximately two-thirds of cases were
estimated to occur among people aged 1559
years .
[WHO 2011}

 TB has been recognised as an occupational

hazard and, with the increased risk of
nosocomial transmission, some countries have
advocated screening health care workers for TB
infection as part of the TB control programme
[CDC: Guidelines for preventing the transmission of Mycobacterium
tuberculosis in health-care settings]

The incidence of TB infection was also found to

be highest among HCWs working in the ED
compared to all the other workplaces.
[Serial testing of Malaysian health care workers with QuantiFERON-TB
Gold In-Tube, The International Journal of Tuberculosis and Lung Disease]

 The necessary investigation of patients who are

suspected of having pulmonary tuberculosis should
be the microscopic examination of their sputum
samples.
[Global Tuberculosis Control: WHO Report 2011]

It is a simple, rapid and inexpensive technique which

is highly specific in areas with a very high prevalence
of tuberculosis
[International Standards for Tuberculosis Care]

It is also widely applicable in various

populations with different socio-economic
levels
[Fluorescence versus conventional sputum smear microscopy for
tuberculosis: a systematic review.Steingart KR, Henry M, Ng V, Hopewell PC,
Ramsay A, Cunningham J, Urbanczik R, Perkins M, Aziz MA, Pai M Lancet
Infect Dis. 2006 Sep; 6(9):570-81.]