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)

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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