00:10hello and good evening i'm melissa idris welcome to consider this this is the show where we want
00:15you to consider and then we consider what you know of the news of the day world tuberculosis
00:19day is observed on the 24th of march each year which is very timely because the disease is back
00:25in the spotlight malaysia after a recent rise in reported cases and during this hari raya period
00:32when many malaysians will travel and gather with family and friends what are the risks we should be
00:38aware of joining me now to help us think all of this through is professor dr ahmad izwanuddin ismail
00:44who is professor of medicine at uitm's faculty of medicine and the acting director of hospital
00:50al-sultan abdullah uitm he's also the president of the malaysian thoracic society prof thank you so
00:56much for joining me on the show today um so tuberculosis back in the spotlight after recent
01:01rising reported cases from your perspective uh prof how concerned should malaysians be right now in
01:07terms of tb being a public health issue in malaysia okay uh first of all thank you malisa for this
01:13kind
01:14invitation uh and thank you for asking me to give my views on the current situation of the tb infection
01:23in malaysia but before i answer the pertinent question let me bring back to uh some of the background history
01:32first um when uh we suffer from our covid pandemics uh our fights uh against tb were really badly affected
01:43and at that time uh what happened was the tb rates uh tb notification rates were reduced by about 10
01:52percent
01:52and tb death were increased by five percent that was back in 2020 uh so i mean it's not surprising
02:01because
02:01at that time we were focusing uh on uh fighting the covid 19 but we have to be aware from
02:08the global
02:09point of view uh that put in uh quite a number of targets that we have to achieve and this
02:14is stated in
02:15their target for the sdgs uh in 2030 and there's also this ntb strategy uh 2035 uh set by who
02:26to get a
02:28target of about 90 percent reduction of the tb incidence rate and 95 percent reduction in tb mortality rate
02:36as indicator for measurements of progress by 2035 so what happened back in 2020 we come up with what we
02:44call national strategic plan to ntb and that lasts between 2021 to 2030 and what we put our target was
02:55we
02:55want to get a tb notification rate to reduce to about 30 cases per hundred thousand population and also to
03:05have a tb mortality death reduced by about 50 percent to baseline and we take about uh the number in
03:142015
03:14as our baseline rate uh so putting that uh in perspective uh in 2020 in 2015 the tb rate was
03:24about 79 per
03:26hundred thousand population and tb death at that time were about 1696 uh death and tb cases were about 24
03:37000
03:37okay uh giving you some figures from 2024 okay um i know there's recent spike uh has been talked about
03:47uh in uh the last few weeks or so in 2024 uh the tb cases was about 26 183 cases
03:57that give your
03:58incidence rates of about 76.9 per hundred thousand and tb deaths we still have about 2580 deaths and that's
04:08giving a mortality rate of 7.6 per hundred thousand population so we were we are way off target that
04:17we
04:17want to achieve by 2030 so that's why it is still really concerning because we're still facing with quite a
04:25number of
04:26cases uh every year right yeah thank you so much for giving us the data because i think many people
04:32um
04:33wrongly assume that tb is a disease of the past where but it's still there's still tb happening today
04:39it's still the disease that's a concern in terms of public health what are the risks doctor if um
04:45the there's the public awareness about tb tb has declined over time how does that affect us the public
04:52recognizing this disease the symptoms and um affecting early uh detection and diagnosis
05:01uh i i think in when we come up with that natural strategy plan we outline uh two uh main
05:08factor that leads to a higher number of uh this number one is the behavior from uh uh our population
05:18late seeking behavior so for example for you to have uh uh to be suspected to have tb usually the
05:27symptoms okay by having cough for more than two weeks uh recurrent fever a bit of weight loss uh loss
05:34of
05:35appetite or even having episode of uh coughing up blood and what happened when someone coughing up blood they
05:43don't think about tb they won't think about uh some other reason uh so that will delay for them to
05:53seek
05:53treatment so that's number one and number two in terms of uh the treatment itself the treatment for tb take
06:02some time so the usual treatment is about six months and to make sure that someone continue to take regular
06:11treatment we need to have a regular follow-up and so on so what happened most of the time they
06:19initially take this in the medication because let's say having symptoms but usually if you take the
06:25medication religiously after about a month the symptoms start to resolve and then they stop taking
06:32it but the fact that they still need to continue and take it and complete the treatment duration and that's
06:39how the resistance in treatments comes about and so on because they don't complete the treatment cost and i
06:48suppose the other uh major factors is the fact that um we had quite a number of uh population who
06:57suffer
06:58from chronic disease diabetes is still number one in malaysia and and by having those meaning that
07:06uh i mean in country like malaysia with very high endemicity meaning that the tb is actually within the
07:14population so if you suffer from all this chronic disease meaning more than likely you will develop
07:20into an active disease sometime during your uh course of life right so so that it's um tb is closely
07:28linked to
07:30comorbidities which unfortunately in malaysia we have quite a high risk of a high percentage in the population of diabetes
07:37um
07:38and other comorbidities um can you talk to me a little bit about the late seeking behaviors in terms of
07:44diagnosis
07:45is tb hard easy to diagnose i'm curious to know whether there's been improvements over the years in terms of
07:52i guess diagnostic tools or the speed of detection is there a way we can um change that late seeking
07:59behavior
07:59uh pattern uh traditionally to diagnose tb you need to give a sputum sample and there were two tests that
08:08we normally do one which is what we call smear test where we look at the sputum sample under the
08:13microscope to see there's any uh tb bacteria or not in that and number two is to have a culture
08:21where we
08:21try to see whether the tb can be grown from that or not but nowadays we have quite a number
08:27of advancement in
08:28terms of the diagnostic test now we have the molecular diagnostic test such as there's rapid
08:34nucleic acid amplification test which now can detect tb as well as drug resistant within just few hours
08:44so then the advancement is is there and in fact nowadays i mean if you also aware we also have
08:52the
08:53love health initiative and in that love health initiative one of the main thing that we focus
08:58on is that ai guided chest x-ray which is really a main tool to diagnose or suspect the presence
09:06of tb or
09:06not in in in a patient right uh prof you mentioned drug resistant tb can you talk to me more
09:13about that how
09:14concerned are you about drug resistant tb uh it is emerging uh of course globally and also in malaysia
09:22although the number is still relatively small but the cases is important because it's difficult to treat
09:32and usually the cost will be much more expensive and also it require longer treatment courses so we we need
09:43to prevent this and and the easiest part to prevent this is to make sure for someone who had what
09:50we call
09:51a normal tb to fully comply with the treatment regime fully and making sure that complete the initial
09:59treatment regime so that it does not become a resistant tb and makes it more difficult for us to treat
10:06um you mentioned there's a national plan for this and also international plan for this who clearly has
10:14guidelines for this but what what would you say are some of the most effective measures to prevent tb
10:19transmissions uh tb transmission at a population level do we have to adopt some of the lessons that we
10:26learned in the kovi 19 pandemic so we have to understand the fact that tb uh is uh is a
10:34slow progressing
10:35disease and and one of the key important uh way to prevent it is to have an active case detection
10:44and
10:44contact tracing um and uh and especially within the household and so on and then that would be
10:52really uh the best preventive way to prevent this if a contact person is diagnosed to have latent
11:01infection for example meaning that you had the tb uh bacteria in your body but you're not displaying
11:08active disease okay that's a preventive treatment available for that and and one can take that preventive
11:16treatment to reduce the areas because if you diagnose with latent tb there's about 10 percent increase
11:23uh uh in the life uh in the life uh in the lifetime for you to develop active infection right
11:31okay so uh
11:33prof during this raya period everyone's going to be traveling and gathering and meeting family friends
11:38what would you advise um our audience today what practical steps can we take to um stop a transmission or
11:49reduce at least the risk of um tb transmission
11:53i suppose the best advice is for all of us to be uh to stay vigilant we have to understand
12:00that tb is really
12:01preventable treatable and curable but we need to have a stronger public awareness we need to advocate early
12:09testing if you have persistent cough or if you have other symptoms to suggest treatment treatment to suggest tb infection
12:20and if you were diagnosed with tb you need to be fully adherence to uh the treatment uh regime
12:27so that you don't develop a resistance in the future right thank you so much for professor dr ahmad izanuddin
12:35ismail
12:35from uitm's hospital al-sultan abdullah thank you for um being on the show uh we'll be right back with
12:42more on the issue of um tb and public health after this stay tuned to consider this
12:48um
12:54you
12:55you
Comments