Kuala Muda DHO Posting
Fifth Day (9th July 2009)
First Session
Venue : Meeting Room (Inspectorate Unit)
Time : 9.00 am
Topic : Briefing on Communicable Disease Control
Person in charge : PPKP Rosmayati (CDC Unit)
1. Kuala Muda Communicable Disease Unit consists of 1 Senior Environmental Health Officer , PPKP(K) and 4 Environmental Health Officer (PPKP).
• 1 PPKP – HIV/AIDS
• 1 PPKP – TB/Leprosy
• 1 PPKP – Food and Water Borne Diseases
• 1 PPKP – others except vector borne diseases
2. Responsibility and Action of the unit
• Receive notification from Medical Officer from phone call as well as e-notice
• Register notification in the e-notice
• To make sure whether further investigation needed based on communicable disease guidelines which have to be investigated under the order of Minister of Health (MOH) and Kuala Muda District Health Office (KMDHO)
• Investigation is done according to communicable diseases guidelines
3. References
• Prevention and Control of Communicable Diseases Act 1988
• General Guidelines for Food and Water Borne Diseases in Malaysia (6 volumes)
• Guidelines for list of diseases that need to be investigated under MOH
4. Review of e-notification system and its uses
Any failure in notification by the medical officers in charge of the related clinics or hospitals will be fined usually with a compound notice under the 342 Act, Pengawalan dan Pencegahan Penyakit 1988.
Second Session
Venue : PPKP Office (Inspectorate Unit)
Time : 3.00 pm
Topic : Briefing on Tuberculosis Unit
Person in charge : PPKP Rosli (CDC Unit)
There are basically 2 types of treatment centres in Kuala Muda District allocated for Tuberculosis patients:
Pusat Rawatan 1 / Treatment Centre 1 (Diagnosing and Treatment):
- Hospital Sultan Abdul
- Klinik Kesihatan Bandar
- Klinik Kesihatan Merbok
Pusat Rawatan 2 / Treament Centre 2 (Treatment and Follow-ups):
- Klinik Kesihatan Bakar Arang
- Klinik Kesihatan Bukit Selambau
- Klinik Kesihatan Bedong
- Klinik Kesihatan Bandar Bharu, Sg.Lalang
- Klinik Kesihatan Kuala Muda
The specific notification form used to notify Tuberculosis cases is the TBIS 10A-1.
There is no specific target for sputum sampling but the target for contact tracing is about 85%.
There are some problems faced in the process of contact tracing as the 10A-1 form does not include phone numbers. Contact tracing by using address as the only means of contact appears to be a problem as there maybe some typing error or frequent changes of house addresses. This is particularly very true in the case of tracing foreign workers.
Any suspected contacts who do not attend the treatment centre for screening within 14 days of notification will be liable for legal action. In the event of a foreign worker who is tested positive with tuberculosis, the district health office will write a report to the immigration department. Usually, the foreign worker will be deported back to his or her country within a week.
The 10J form deals with the auditing for patients who have died because of Tuberculosis.
In terms of treatment, DOTS (directly observed treatment short course) is done in either treatment centre 1 or 2 depending on whichever one is nearest to the patient. The patient must take the medications based on the recommended regime in front of the staff nurse.
Up to date, there are 50 patients in this year receiving the DOTS in Kuala Muda Tuberculosis Clinic. 25 patients are dedicated with KK Bandar while the rest are referred from Hospital Sultan Abdul Halim. Treatment regimes are divided into 2 phases:
- Phase 1: daily for 2 months
- Phase 2: twice weekly for 4 months
The drugs are:
- isoniazide
- pyrazinamide
- ethambutol
- streptomycin
- rifampicin
- Streptomycin (the only drug available in the form of injection)
Note that, streptomycin is contraindicated in patients with Hepatitis B and non-pulmonary TB.
If a patient failed to attend the treatment centre for 2 days in a row, he or she will be considered as a defaulter. On the first day of absence, the nurse in-charge will try to call the patient. On the second day of absence, the patient’s name will be submitted to the PPKP in-charge from the CDC Tuberculosis Unit (PPKP Rosli). It is then, the PPKP responsibility to try to make a contact with the patient and find out the reason why the patient has failed to turn up for the medications. If a patient missed his treatment default for a few times (short durations) the patient will just have to continue the existing regime that he is currently on. However, if the patient defaulted for more than 20 weeks, the whole medication cycle will have to be repeated. It is worth noting that treatment defaulting should be taken very seriously to avoid resistant cases of Tuberculosis.
Kuala Muda Tuberculosis unit in conjunction with the Kementerian Kesihatan also carry out exhibitions and health campaigns to inculcate awareness among the community within the society about the disease itself and how important the compliance to treatment is. This includes the latest ‘Tuberculosis Carnival’ which was held in May 2009 as a joint operation with Ministry of Health. There were posters, quizzes, and contests. Incentives were also given to patients who never missed the DOTS in the form of certificates and gifts.
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2 comments:
Dear students,
You have mentioned that under DOTS,there are two phases and you have given the duration of each of them.But is this duration constant for all the different types of Tuberculosis cases or there is a difference.Please find out more about it.
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