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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
13
% 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)
20
Acknowledgement
• Dr. Fuad Hashim (National TB Control
Programme Manager, Ministry of Health)
• Staff of the National MAPTB