Engaging Community Pharmacists and Alternative Practitioners: An Approach to Active Case Finding of Tuberculosis in Malaysia

Contact tracing is the most commonly employed process of identifying the relevant contacts of a person with an infectious disease. A systematic review and meta-analysis on contact tracing of tuberculosis (TB) suspects has shown that the yield of household contact investigation in lowand middle-income countries was 6.5 %. However, a recent study from Malaysia has shown the yield of TB contact tracing as low as 0.49 %. Engaging community pharmacists and alternative practitioners in tracing TB suspects in Malaysia is context-specific and can significantly decrease transmission and incidence of the disease. Tropical Journal of Pharmaceutical Research is indexed by Science Citation Index (SciSearch), Scopus, International Pharmaceutical Abstract, Chemical Abstracts, Embase, Index Copernicus, EBSCO, African Index Medicus, JournalSeek, Journal Citation Reports/Science Edition, Directory of Open Access Journals (DOAJ), African Journal Online, Bioline International, Open-J-Gate and Pharmacy Abstracts Tuberculosis (TB) is a global health tragedy with an incidence of nine million cases every year. With an estimated two million deaths every year, it is one of the leading causes of adult mortality. Malaysia is ranked as an intermediate-burden country with an estimated 81 new cases per 100,000 in 2011. From 2000 to 2011, nationwide TB case notification has increased from 16,000 to 20,666 cases. It is thus imperative to comprehend that an amalgamation of incomplete case detection and protracted diagnostic delays renders steady transmission of TB in the community. One potential strategy in controlling the growing incidence of TB is early case detection by actively screening general population and/or higher risk groups [1]. Population-wide mass-screening is not recommended in resource-limited countries due to high cost per identified case. However, screening in high risk groups and adequately prioritized contacts can be a realistic and effective approach [1]. Contact tracing is the most commonly employed process of identifying the relevant contacts of a person with an infectious disease (the index patient) and ensuring they are aware of their exposure. Contact investigation identifies both relatively smaller group of people with active TB and those already have infection without disease. Although the standard TB treatment should be immediately started in active TB patients, people in latter category may also be candidates for treatment. Contact investigation is often complementary to “passive case finding” that can significantly improve case detection and thereby can reduce the transmission of the disease. Prioritization of contacts and diagnostic strategy