• Case
– TB confirmed by bacteriology OR clinician
• Sputum smear exam:
– Positive: 2 +ve smears OR 1 +ve smear with either culture +ve/radiological abnormalities of active pulmonary TB
– Negative: 3 –ve smears but with TB symptoms and X-ray abnormalities/culture +ve
• 3 Sputum sample to be taken. (At least 1 early morning sample- overnight accumulation of secretions which has highest yield of AFB)
• For outpatients, collect 1 sample at the time of presentation (known as spot specimen). Suspect given 2nd sputum container for collection on the following morning and it is being sent to the laboratory. When the patient returns the morning specimen, another spot specimen is collected. (spot…. Smear… spot)
• For hospitalized patients, early morning sputum taken for 3 consecutive days.
A. DOTS Strategies
o Government commitment to a national TB Control Programme
o Case detection through sputum smear microscopy examination of TB suspects in general health services.
o A standardized short course TB treatment regimen of 6 months under direct supervision of trained supervisor to ensure the patient takes every dose of medication.
o A regular uninterrupted supply of quality anti-TB drugs
o A monitoring and reporting system to evaluate treatment outcome to each and every patient with proper documentation.
B. First line drugs
o Isoniazid (H)
o Rifampicin (R)
o Streptomycin (S)
o Pyrazinamide(Z)
o Ethambutol (E)
C. * 2nd line drugs not being used in Malaysia
D. Treatment regimens
· Intensive phase – daily doses for 2 months
· Maintenance phase – thrice weekly doses for 4 months.
1. Implementation of activities
I. Home visit done weekly with specialist permission in cases involving bed ridden and old age patient.
II. 2 weeks after initiating treatment
a. review result
b. Look for any allergic reactions
III. Referral to hospital done only when the problems related to treatment is not overcome.
Kota Star District has a total of 10 KK. Out of these, KK Bandar Kota Star functions as Pusat Rawatan 1 (PR1)/ Treatment Centre 1 and there are 6 KK functions as Pusat Rawatan 2 (PR2).
Activities in PR1 (Personnel involved in PR1 are MO/Specialist, Nurses)
· Diagnose TB
· Initiate treatment
· DOTS
Activities in PR2 (Personnel involved in PR2 are Nurses, MA)
1. Maintenance of records and reports
· TBIS (done manually)
· Borang 101D (record patient’s compliance)/ Buku rawatan (separate for infectious and non-infectious TB)
· Borang 10A-1, 10A-3,10A-4, 10C-1, 10C-2
Buku rawatan TB (Yellow for infectious cases - sputum smear +ve and white for non infectious – extrapulmonary TB, sputum –ve smear)
Programme monitoring & evaluation
DOTS under supervision of Nurses, MA, trained family members.
A. Investigation done by IK (Inspektor Kesihatan)
I. Call patient
II. Visit to patient’s house (done about 2 weeks after reporting/ as soon as patient is on treatment)
Default in Treatment (Pt missed >25% treatment doses in a month : > 6 doses of daily treatment, >2 doses of biweekly treatment)
by Mohanajothi Samasuvam
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