Epidemiological and clinical outcomes of tuberculosis with its co-morbidities in general population and in prisons in Malaysia
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Date
2011
Authors
Hayat Khan, Amer
Journal Title
Journal ISSN
Volume Title
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Abstract
The threat of tuberculosis (TB) seemed to have become increasingly looming
with the fatal combination of co-morbid conditions like human immunodeficiency
virus (HIV)-acquired immune deficiency syndrome (AIDS), diabetes mellitus (DM)
and hepatitis. Globally, prison population is at a higher risk to acquire these diseases
as compared to general population. However, there is no substantial data concerning
the different types of TB and its co-morbidities in Malaysia. The aim of the present
study was to obtain a comprehensive data pertaining to the epidemiology and clinical
evaluation of TB alone and with co-morbidities in the hospitals and prisons of the
four states of Malaysia i.e. Penang, Sabat..., Sarawak and Selangor. A retrospective
study was performed by collecting data of 9337 patients, from the patient records
available at the hospitals and prisons and a prospective study was also conducted
through direct question-answer session from January 2006 to December 2008. Out of
the total selected 9337 patients, 405 were from the prisons and the remaining were
from the general population. Data obtained was a..i.alyzed with Statistical Package for
the Social Sciences (SPSS) software. The highest number of patients was from Sabah
state. Among the total selected patients, majority of them (7781) had pulmonary
tuberculosis (PTB). Out of the total number of 1222 patients with confirmed extrapulmonary
tuberculosis (EPTB), majority were suffering from lymphadenitis TB [325
(26.6%)]. Among the total number of cases, 8159 (87.4%) were newly registered and
675 (7.2%) were relapsed cases. Of the total number of patients 6650 (71.2%) were
found to be sputum smear positive. When socio-demographic factors were related to
the prevalence of the three types of TB the occurrence was higher among the male
population, unmarried, Malay race and the age group 31 - 50 yr. Furthermore, the
occurrence of PTB, EPTB along with co-morbidity were significantly higher in urban
population. Alcohol consumption was identified as a risk factor for PTB with EPTB
combination. The prevalence of TB-Hepatitis and TB-HIV was higher in unmarried
and unemployed male smokers of Malay race, whereas tuberculosis-Diabetes
Mellitus (TB-DM) was predominantly seen in Chinese race. The older age group (56-
65 yr) was highly affected with TB-DM, whereas TB-HIV and TB-Hepatitis was
more in the sexually active age group. Patients with DM had a higher incidence of
PTB (87.5%) and patients with HIV/AIDS had a higher incidence of EPTB (26.1%)
and PTB \\Olth EPTB (6.1 %). The incidence rate of TB in the prison was 440/100,000
populations. The higher incidence rate (7551100,000 population) was seen in
Selangor prisons. Majority of the patients (78.9%) in the study complained of cough
as the symptom experienced. Culture sensitivity test was the most reliable laboratory
test for diagnosis, as 70.6% of the patients responded positively. Of the 9337 patients
in the present study, 7241 (77.6%) patients were successfully treated. The Odd Ratio
(OR) of patients treated successfully in the hospital compared to those in the prison
was 6.696. The treatment success rate was highest in PTB group patients (79.5%).
When TB-DM, TB- HIV/AIDS and TB-Hepatitis cases were assessed, 73.3%, 68.6%
and 75.4% of patients were successfully treated respectively. The mortality rate was
higher (23 .8%) in the TB-DM-HIV group of patients. The risk factors identified for
higher mortality rate in this group of patients were increased age, alcohol
consumption and Chinese race.