The document discusses Malaysia's intensified case finding (ICF) program for tuberculosis (TB) detection. It provides an overview of the 3 main components of ICF: intensified case finding, isoniazid preventive therapy, and infection control. It emphasizes finding TB cases early through screening high-risk groups like people living with HIV and in institutional settings like prisons. The goal is to reduce TB transmission in communities and improve TB treatment outcomes.

1. PENGENALAN PROGRAM 3i
1.Intensified Case Finding
2.Isoniazid Prophylaxis Therapy
3.Infection Control for Tb

2.  Program yang diadaptasi daripada saranan
WHO
 Meningkatkan pengesanan kes melalui
saringan di kalangan golongan berisiko
tinggi
 Mengawal penularan penyakit tibi melalui
kawalan infeksi
 Mengurangkan risiko golongan berisiko
dari mendapat penyakit tibi

3. PENGENALAN PROGRAM 3i

4. 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 di
kalangan pesakit HIV
– Garispanduan Saringan Tibi di
Penjara

5. Isonazid Prophyalxis Therapy(IPT)
TBHIV 2013
Malaysia
- HIV-positive
screened
for TB 7017
- HIV-positive
provided
IPT 1220

6. Infection Control (IC)
• Garispanduan WHO
– TB IC: from everybody’s
problem to nobody’s business
• Pekeliling daripada Program

8. INTENSIFIED CASE FINDING

9. KEY RECOMMENDATIONS

10. 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, 2014
MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN

11. 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, 2014
MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN

12. CLINICAL ALGORITHM
(ADULTS AND ADOLESCENTS)

13. CLINICAL ALGORITHM
(PAEDIATRIC)

14. November 17, 2014
MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN

15. November 17, 2014
MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN

16. 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, 2014
MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN

19. GARISPANDUAN SARINGAN TIBI DI
PENJARA
• Di terbitkan pada tahun
2006 dengan kerjasama
Jabatan Penjara Malaysia
• Bertujuan untuk
meningkatkan pencegahan
dan pengawalan penyakit
Tibi di Institusi penjara
• Meningkatkan promosi
kesihatan di kalangan
banduan dan kakitangan
penjara
• Masih digunapakai sehingga
kini

21. What factors determine the yield
and cost-effectiveness of ACF?
Factor 1. TB prevalence among the target
Higher prevalence – higher yield
Factor 2. Diagnostic algorithms
More comprehensive screening- higher cost
&yield
November 17, 2014
MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN

22. November 17, 2014
MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN

23. November 17, 2014
MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN

24. 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, 2014
MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN

25. ICF-PROCESS
1. Survey your data
2. Analyze -? High TB burden district- ? Localilities
3. 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 course
5. Start ICF- house to house visit, TB screening, refer
positive symptoms to nearby clinic.
6. Writing the report
November 17, 2014
MESY. TWG BIL 2/2014, CROWN GARDEN
HOTEL, KELANTAN

26. Syor
1) Pelaksanaan garispanduan sediaada diperkukuh
2) Revisit dan operasikan pekeliling /garispanduan di
peringkat negeri dan daerah
3) Merangka tanggungjawab pelbagai stakehodler
yang berkaitan

27. TOP 5 COMMUNICABLE DISEASE,
Disease
MALAYSIA (2011- 2013)
2011 2012 2013
Incidence
Rate
Mortality
Rate
Incidence
Rate
Mortality
Rate
Incidence
Rate
Mortality
Rate
Dengue Fever 63.75 0 72.20 0 143.27 0.21
Tuberculosis 7 1 . 3 5 5.68 77.41 4.82 81.0 5.4
Hand, Food &
24.17 0 24.17 0 78.52 0.0
Mouth Diseases
Food Poisoning 5 6 . 2 5 0.03 56.25 0.03 47.79 0.04
Malaria 18.32 0.06 16.11 0.05 1.30 0.01
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. 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
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
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
TB Cases

29. 29
DISTRIBUTION OF CDR ACCORDING TO STATES,
50
(JAN-JUNE, 2014)
48 48 48 47 45
44 44 43 42 41 40 39 39
34
44
60
50
40
30
20
10
0
%
CDR (%) Target

30. 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

31. TBHIV (%) IN TB CASES, MALAYSIA
(2000- June,2014)
No.of cases %TBHIV
16
12
8
4
31
11,945
5.8
692
0
25,000
20,000
15,000
10,000
5,000
0
No.TB Cases No.of new TB Cases with HIV Positive %TBHIV in TB cases

32. COHORT ANALYSIS AMONG MALAYSIAN
(JAN-JUNE, 2013)
NEGERI Sembuh
(%)
Sempurna
(%)
Terhenti (%) Gagal
(%)
Mati (%) Pindah
Keluar&
Hilang (%)
Tukar
Diagnosa
(%)
Masih
Dalam
Rawatan (%)
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

33. TB CASES AND NOTIFICATION RATE (NR),
PAHANG (2000 – Sept , 2014)
Jan-Sept (2014) : 629 cases
Jan-Sept (2013) : 688 cases
52.2
45.5
49.3
46.8
45.2
56.3
61.2
48.7
51.5
54.3
51.2 50.8
56.1 56.4
100
90
80
70
60
50
40
39.4
64.7
62.3
58.7
63.5 60.3 60.8 61.6 62.3 63.1
63.5
68
72
77 81
80
30
20
10
0
1600
1400
1200
1000
800
600
400
200
0
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

34. TB CASES BY DETECTION METHODS
PAHANG 2008 – 2014
91%
90% 93% 94% 91% 91%
2008 2009 2010 2011 2012 2013
89%
Jan-Sept
2014
1000
800
600
400
200
0
Saringan 26 32 20 23 35 29 21
Aktif 37 53 40 23 48 48 48
Pasif 669 753 748 742 797 807 560
34

35. DOT COVERAGE IMPLEMENTED IN PAHANG
(2009 – Aug.,2014)
120
100
80
60
40
20
35
99 99
96
98
78.3
2009 2010 2011 2012 2013 Jan-Ogos 2014
1000
900
800
700
600
500
400
300
200
100
Jum. Kes 838 808 788 880 884 572
% DOT 99 99 96 98 78.3 75
% Sasaran DOT 95 95 95 95 95 95
75
0
0

36. TBHIV (%) IN TB CASES, PAHANG
(2009- Sept,2014)
98.2% 98.0% 99.4% 99.7%
838 808
788
880
87.2%
884 629
16% 17% 18%
15%
82.9%
12% 14%
137 134 139 131 107 86
120%
100%
80%
60%
40%
20%
0%
1000
900
800
700
600
500
400
300
200
100
0
2009 2010 2011 2012 2013 9' 2014
No. Of TB Cases TBHIV Cases %TBHIV in TB Cases HIV Sreening In TB Cases36

37. TB HCW ACCORDING TO JOB CATEGORY (JAN-SEPT, 2014)
DISTRICT MO PPP JT JM JTMP PPK
Radio-grapher
Pharm.
Asst.
PPKP Others Total
Bentong 0
Bera 0
C.Highland’s 0
Jerantut 1 1
Lipis 1 1
Kuantan 1 2 PTM &
PAP
3
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