Tuberculosis (TB) in Malaysia is rising due to multiple factors and issues related to its management are addressed in the updated evidence-based clinical practice guidelines. Screening for active TB should be considered in high risk groups. Light emitting diode-based fluorescence microscopy and nucleic acid amplification tests are recommended investigations. Health education and standardised 6-month daily antituberculosis (antiTB) regimen are among important elements for successful treatment. Latent TB infection screening should only be performed on high risk individuals. AntiTB regimen offered to HIV-positive adults should be the same as for HIV-negative adults and timing to initiate highly active antiretroviral therapy in patients with TB is based on CD4 count. All patients on antiTB treatment should be monitored to assess their response to treatment and to identify problems associated with it.
In Malaya the author estimates that there are probably 500,000 to 600,000 tuberculous persons, representing about 10 per cent of the population, there are about 2,000 hospital beds for tuberculosis, of which 500 are in Singapore for a population of just over 1,000,000. The author states that in Malaya, for every 240 tuberculous patients, only one can have accommodation in hospital He discusses the subject and urges that mass radiography should be undertaken, and that cheaply built homes should be constructed to house infective patients under supervision He gives details of the structures he has in mind Education in health matters should be pressed, and BCG should be used.
A general survey has been made of tuberculosis in the Jesselton – Tauran area. Climatical, living, and occupational conditions tend to favour the spread and advancement of the disease. The death rate is high, but has been influenced by conditions attributable to the war. The native population, due to their mode of life, succumbs more easily to the disease that do the Chinese. Cases are usually seen in the late stages, mainly due to ignorance.
The main contention of the author is that although the tuberculosis problem is serious enough in Malaya, it is not so disastrous as some reports have indicated. He quotes death rates which compare favpurably with many European rates, though not with all. For instance, the death rate from tuberculosis in London between 1938 and 1946 varied around 80 per 100, 000; the rate for Kuala Lumpur in 1938 was 78, and this rose to 128 and 140 in 1946 and 1947 respectively. Compared with the war-time increases, in Warsaw, Rome, Prague and Paris, these rates are not high. In the State of Selangor the rate for 1937 was 71, rising to 86 in 1947. [It would have been interesting if the author had given an indication of how complete medical certification of death is in Kuala Lumpur and the other parts of Selangor. In the towns, no doubt, most deaths are correctly certified, but a reader is. not certain that in more remote places deaths, actually due to tuberculosis, may not have been ascribed by the head-men to other causes.] Charles Wilcocks.