Post on 16-Jul-2015
PENGENALAN PROGRAM 3i
1.Intensified Case Finding2.Isoniazid Prophylaxis Therapy3.Infection Control for Tb
Program yang diadaptasi daripada sarananWHO
Meningkatkan pengesanan kes melaluisaringan di kalangan golongan berisikotinggi
Mengawal penularan penyakit tibi melaluikawalan infeksi
Mengurangkan risiko golongan berisikodari mendapat penyakit tibi
PENGENALAN PROGRAM 3i
Intensified Case Findings(ICF)
• Garispanduan WHO
– “find as many cases as possible, as early as possible”
– Systematic Screening of Active TB, 2013 – Facility Initiated
• Inisiatif di peringkat negeri
– ICF dalam Komuniti
– TB Combi
– HASRAT
• Pekeliling daripada Program
– IPT , pemeriksaan TB dikalangan pesakit HIV
– Garispanduan Saringan Tibi diPenjara
Isonazid Prophyalxis Therapy(IPT)
TBHIV 2013 Malaysia- HIV-positive
screened for TB 7017
- HIV-positive provided IPT 1220
Infection Control (IC)• Garispanduan WHO
– TB IC: from everybody’s
problem to nobody’s business
• Pekeliling daripada Program
INTENSIFIED CASE FINDING
KEY RECOMMENDATIONS
INTENSIFIED CASE FINDING (ICF)• Intensified Case Finding (ICF) is an activity, recommended
by the WHO, intended to detect possible TB cases as
early as possible among people living with HIV – usually by
using a simple questionnaire for the signs and symptoms of
TB.
• ICF: Intensified Case Finding for TB means regularly
screening all people with or at high risk of HIV or in
congregate setting for the symptoms and signs of TB,
followed promptly with diagnosis and treatment, and then
doing the same for household contacts.
November 17, 2014MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN
ICF Goals• Reduce morbidity and mortality
More intensive case-finding leads to fewer TB deaths and less severe post-TB complications
Focus on those most at risk of severe morbidity
• Reduce TB transmission General community Institutional settings Marginalised populations
• Increase case-finding Target high risk groups Community-wide approach
November 17, 2014MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN
CLINICAL ALGORITHM(ADULTS AND ADOLESCENTS)
CLINICAL ALGORITHM(PAEDIATRIC)
November 17, 2014MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN
November 17, 2014MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN
ICF OPPORTUNITY• Screening of high risk groups
Symptomatic out pt,
PLHIV,
Diabetes,
HCW
• Screening in institutions
Prisons
PUSPEN
Old folk homes
• Screening in community
High prevalence TB locality
November 17, 2014MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN
GARISPANDUAN SARINGAN TIBI DI PENJARA
• Di terbitkan pada tahun2006 dengan kerjasamaJabatan Penjara Malaysia
• Bertujuan untukmeningkatkan pencegahandan pengawalan penyakitTibi di Institusi penjara
• Meningkatkan promosikesihatan di kalanganbanduan dan kakitanganpenjara
• Masih digunapakai sehinggakini
What factors determine the yield and cost-effectiveness of ACF?
Factor 1. TB prevalence among the targetHigher prevalence – higher yield
Factor 2. Diagnostic algorithmsMore comprehensive screening- higher cost
&yield
November 17, 2014MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN
November 17, 2014MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN
November 17, 2014MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN
ICF ACTIVITY I(3)T
IDENTIFY
TRAIN
TRACE
TREAT
• Identify the localities with high burden of TB
• Conduct training to the staff & community volunteers
• House to house visit- TB screening & refer for positive symptoms
• Ensure treatment is given for positive TB
November 17, 2014MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN
ICF-PROCESS1. Survey your data2. Analyze -? High TB burden district- ? Localilities3. Start planning your ICF project –
- Approval fr. TKPK KA, PKD, Local leaders-Conduct meeting with local leaders-Design your action plan- Gantt chart, budgetting, training, ICF form
4. Conduct the training course5. Start ICF- house to house visit, TB screening, refer
positive symptoms to nearby clinic.6. Writing the report
November 17, 2014MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN
Syor
1) Pelaksanaan garispanduan sediaada diperkukuh
2) Revisit dan operasikan pekeliling /garispanduan di peringkat negeri dan daerah
3) Merangka tanggungjawab pelbagai stakehodler
yang berkaitan
Disease
2011 2012 2013Incidence
Rate Mortality
Rate Incidence
Rate Mortality
RateIncidence
Rate Mortality
Rate
Dengue Fever 63.75 0 72.20 0 143.27 0.21
Tuberculosis 71.35 5.68 77.41 4.82 81.0 5.4
Hand, Food & Mouth Diseases
24.17 0 24.17 0 78.52 0.0
Food Poisoning 56.25 0.03 56.25 0.03 47.79 0.04
Malaria 18.32 0.06 16.11 0.05 1.30 0.01
TOP 5 COMMUNICABLE DISEASE, MALAYSIA (2011- 2013)
Source: MOH
27
Note:*Incidence Rate was per 100,000 population except for Malaria per 10,000 population *Mortality Rate was per 100,000 population except for Malaria per 10,000 population
28
DISTRIBUTION OF TB CASES BY STATE : (2011- JUNE, 2014)
Sbh Sel Srk Jhr KL Prk Klt Kdh PP Phg Trg Mlk NS Pls Lbn
2011 3794 3242 2056 2038 1907 1309 1448 1084 1126 788 667 511 449 141 106
2012 4426 3560 2430 2046 1906 1554 1436 1174 1245 890 733 546 480 185 99
2013 4526 4148 2673 2248 1967 1573 1402 1169 1272 884 770 548 631 160 99
06'2014 2337 2003 1398 1089 886 809 722 607 601 422 385 295 281 62 48
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
TB C
ase
s
29
5048 48 48 47 45
44 44 43 42 41 40 39 39
34
44
0
10
20
30
40
50
60
%
CDR (%) Target
DISTRIBUTION OF CDR ACCORDING TO STATES, (JAN-JUNE, 2014)
PENCAPAIAN PEMERIKSAAN KONTAK TIBI PADA SARINGAN PERTAMA JAN-SEPT 2014
NEGERI SASARAN PEMERIKSAAN KONTAK
BIL KONTAK DIPERIKSA %PEMERIKSAAN KONTAK (>70%)
JOHOR 14810 5574 38
KEDAH 9160 2317 25
KELANTAN 10330 8245 80
MELAKA 4780 2575 54
N. SEMBILAN 4510 2187 48
PAHANG 6290 1623 26
PERAK 11550 9822 85
PERLIS 910 500 55
P. PINANG 9040 3332 37
SABAH 34630 26751 77
SARAWAK 20930 14423 71
SELANGOR 29130 32039 110
TERENGGANU 5400 2313 43
WPKL 13330 3385 25
WP LABUAN 700 456 65
MALAYSIA 174960 115542 66
TBHIV (%) IN TB CASES, MALAYSIA (2000- June,2014)
No.of cases %TBHIV
31
11,945
692
5.8
0
4
8
12
16
0
5,000
10,000
15,000
20,000
25,000
No.TB Cases No.of new TB Cases with HIV Positive %TBHIV in TB cases
COHORT ANALYSIS AMONG MALAYSIAN(JAN-JUNE, 2013)
NEGERI Sembuh(%)
Sempurna(%)
Terhenti (%) Gagal(%)
Mati (%) PindahKeluar& Hilang (%)
TukarDiagnosa(%)
MasihDalamRawatan (%)
JOHOR 406 (43.1) 354 (37.6) 21 (2.2) 0 101 (10.7) 9 (1) 17 (1.8) 33 (3.5)
KEDAH 230 (43.6) 132 (25) 44 (8.3) 0 69 (13.1) 5 (0.9) 8 (1.5) 40 (7.6)
KELANTAN 320 (45) 183 (25.7) 41 (5.8) 2 (0.3) 77 (10.8) 1 (0.1) 42 (5.9) 42 (5.9)
MELAKA 134 (53) 65 (25.7) 10 (4.0) 0 25 (9.9) 0 6 (2.4) 13 (5.1)
N.SEMBILAN 126 (44.1) 61 (21.3) 10 (3.5) 0 42 (14.7) 5 (1.7) 5 (1.7) 37 (12.9)
PAHANG 181 (43.8) 104 (25.2) 19 (4.6) 0 64 (15.5) 2 (0.5) 9 (2.2) 34 (8.2)
PERAK 349 (49.7) 184 (26.2) 38 (5.4) 0 82 (11.7) 6 (0.9) 26 (3.7) 17 (2.4)
PERLIS 33 (45.8) 19 (26.4) 1(1.4) 0 11 (15.3) 2 (2.8) 1 (1.4) 5 (6.9)
P.PINANG 269 (47.2) 178 (31.2) 25 (4.4) 0 69 (12.1) 3 (0.5) 20 (3.5) 6 (1.1)
SABAH 940 (59.9) 365 (23.3) 39 (2.5) 2 (0.1) 124 (7.9) 20 (1.3) 25 (1.6) 54 (3.4)
SARAWAK 601 (51.1) 364 (31) 23 (2) 3 (0.3) 116 (9.9) 2 (0.2) 47 (4.0) 20 (1.7)
SELANGOR 617 (37.5) 461 (28) 69 (4.2) 0 113 (6.9) 15 (0.9) 15 (0.9) 268 (16.3)
TERENGGANU 198 (50.6) 83 (21.2) 13 (3.3) 3 (0.8) 71 (18.2) 1(0.3) 3 (0.8) 19 (4.9)
WPKL 118 (23.1) 158 (30.9) 38 (7.4) 0 38 (7.4) 6 (1.2) 1(0.2) 92 (18)
WP LABUAN 15 (48.4) 7 (22.6) 3 (9.7) 0 3 (9.7) 0 1(3.2) 2 (6.5)
MALAYSIA 4537 (46.3) 2718 (27.7) 394 (4.0) 10 (0.1) 1005 (10.3) 77 (0.8) 226 (2.3) 682 (7)
32
TB CASES AND NOTIFICATION RATE (NR),
PAHANG (2000 – Sept , 2014)
Jan-Sept (2014) : 629 cases Jan-Sept (2013) : 688 cases
52.2
45.549.3
46.845.2
56.361.2
48.751.5
54.351.2 50.8
56.1 56.4
39.4
64.762.3
58.7
63.5 60.3 60.8 61.6 62.3 63.163.5
68
72
77 8180
0
10
20
30
40
50
60
70
80
90
100
0
200
400
600
800
1000
1200
1400
1600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 9' 2014
Bilangan Kes NR Pahang NR WHO NR Mal
33
TB CASES BY DETECTION METHODS
PAHANG 2008 – 2014
2008 2009 2010 2011 2012 2013Jan-Sept
2014
Saringan 26 32 20 23 35 29 21
Aktif 37 53 40 23 48 48 48
Pasif 669 753 748 742 797 807 560
91%90% 93% 94% 91% 91%
89%
0
200
400
600
800
1000
34
DOT COVERAGE IMPLEMENTED IN PAHANG
(2009 – Aug.,2014)
35
2009 2010 2011 2012 2013 Jan-Ogos 2014
Jum. Kes 838 808 788 880 884 572
% DOT 99 99 96 98 78.3 75
% Sasaran DOT 95 95 95 95 95 95
99 9996
98
78.375
0
20
40
60
80
100
120
0
100
200
300
400
500
600
700
800
900
1000
TBHIV (%) IN TB CASES, PAHANG
(2009- Sept,2014)
838 808
788880
884 629
137 134 139 131 107 86
16% 17% 18%15%
12% 14%
98.2% 98.0% 99.4% 99.7%
87.2%
82.9%
0%
20%
40%
60%
80%
100%
120%
0
100
200
300
400
500
600
700
800
900
1000
2009 2010 2011 2012 2013 9' 2014
No. Of TB Cases TBHIV Cases %TBHIV in TB Cases HIV Sreening In TB Cases36
TB HCW ACCORDING TO JOB CATEGORY (JAN-SEPT, 2014)
DISTRICT MO PPP JT JM JTMP PPKRadio-
grapher
Pharm.
Asst. PPKP Others Total
Bentong 0
Bera 0
C.Highland’s 0
Jerantut 1 1
Lipis 1 1
Kuantan 1 2 PTM &
PAP3
Maran 1 1
Pekan 1 1
Raub 1- PT 1
Rompin 1 1
Temerloh 2 2
PAHANG 0 2 0 3 0 3 0 0 0 3 11
37