KUALA MUDA, 29.7.08, (DAY 3): DAILY REPORT: CDC HIV, TB AND LEPROSY + FOGGING!

We assembled at the Communicable Disease Control (CDC) Unit meeting room at 8am with Mr. Mohd Fendi Ibrahim, Ass. Env. Health Officer PPKP of CDC unit in charged of Tuberculosis and Leprosy.


Mr. Fendi, Ass. Env. Health Officer PPKP of CDC unit

Mr. Fendi briefed us regarding the procedures undertaken to register patients diagnosed with TB and Leprosy. There are 120 patients diagnosed with TB in KMDHO. When a patient has been diagnosed with TB, the notification form together with several other forms such as that mentioned below are filled:

1) TBIS 10A1: Regarding the details of commencement of treatment
2) TBIS 10A4: To be filled by investigator and sent to Pusat Rawatan 1 regarding registration details.
3) TBIS 10C1: Concerning the investigation carried out to confirm diagnosis

4) TBIS 10A3: Regarding socioeconomic status, drug treatment, detail regarding conditions of the surrounding environment, and to identify risk factors.

These forms are filled up by the medical and health officer (M&HO) and sent to the DHO, where it is registered in a registration book for TB patients. Details regarding treatment, whether the patient is dead or alive is also entered in the registration book . If the patient is dead, it is important to mention if the patient passed on within 2 months of commencement of treatment or after (signify that the patient is in severe TB infection). The death of a TB patient should also be documented in Borang Siasatan Kematian Kes Tibi Dalam Rawatan. The case is then entered into the e-notifikasi database and separately MyTB database system.

Mesyuarat Audit Kematian Tinggi is held once in 6 months among doctors who treated TB patients and PPKP of TB & Leprosy unit to discuss the cases and certify deaths due to TB. If the patient diagnosed with TB is a foreigner, a letter is sent to the immigration department to facilitate the sending off of the patient to native country.

Defaulter who is present with TB symptoms 2 months after commencement of treatment will be registered as new case.

Then, we were told about the registration of Lepers.

There are only 2 cases of leprosy to date in KUALA MUDA district, one of them being a Nepalise who has been sent back to Nepal. The protocols to be followed in dealing with a leper is according to Manual Pengurusan Kusta. When a patient is diagnosed with leprosy, Borang Appendix 2A is filled up and submitted to KMDHO.

Mr. Hasani, PPKP of HIV/AIDS division

At 10am we were joined by Mr. Hasani, PPKP of HIV/AIDS division. he first explained the objectives of this division, which is to decrease the incidence of HIV patients in the community by health promotion, curt transmission of HIV infection and to prevent HIV infection among teenagers via PROSTAR (Program Sihat Tanpa AIDS untunk Remaja).
He continued to explain to us regarding the procedures undertaken to register a HIV/AIDS patient. Notification form is filled in by the doctor who diagnosed the patient with HIV infection or AIDS. The notification form is submitted to the DHO and registered by the PPKP in charge. Investigation will be carried out on all reported cases by the PPKP in charged. All persons who are in contact with the patient will be given retroviral therapy and counselling.


Kavitha, are you yawning? GOtCha~~~~!

Death of a HIV/AIDS patient will have to be documented and submitted to the Ministry of health. The HIV/AIDS division will have to send representative to the late patient's house to observe the rituals that are performed to the remains, are performed as required. This division conducts course annually to educate the community on how to manage the remains of a HIV/AIDS patient following death according to HIV/AIDS Standard Precaution. We dispersed for lunch at 11am.

We assembled at Unit Kawalan Penyakit Bawaan Vektor (Vector Control Unit) at 2.30pm. We were given a talk by Mr. Burke A/K Patrick Lummuria regarding the notification and investigations of a dengue case. Once the Notification form of a dengue case is submitted to the DHO, a Health Inspector from the Klinik Kesihatan will be dispersed to investigate the case. The Health inspector will be required to fill up an investigation form for dengue case which will encompass details concerning the patiend and his/her surrounding environment. The inspector will be required to elicit details about the patient's activities for 14 days prior to the notification , as the incubation period for the virus before signs and symptoms manifest is 14 days. The details collected are also registered in Record Book and Vekpro (a database that is used but it is not online database system like e-notifikasi)

Mr. Burke A/K Patrick Lummuria PPKP of Vector (Control Unit)

24 hours following the notification, activities such as investigate the hospitalised patient,fogging, larvaciding and 'search and destroy' are performed within 24 hours following the notification. Aedes Survey is conducted within 48 hours of notification, whereby this unit will dispatch it's members to survey houses in the vicinity of the patient's house for larvae in bredding places such as stagnant water. The results of this survey will be converted into Aedes Index (BRETEAU INDEX) which is the number of house with positive larvae divided with number of houses surveyed times 100. If the index is more than 1 % control measures should be taken. The Aedes Index limit varied according to time.

Hen larvae is identified, the owner of the followint house or premises will be issued compund as follows:

a) House = RM100

b) Shop = RM150

c) Schoo = RM150

d) Factory = RM500

The container consist of the larvae will be preserved with 70% + hot water. It will be used for investigation for the type of mosquitoe and act as exhibit if lawsuit should be approached.

At 5.30pm till 7.30pm, we followed members of this team for fogging activity at Pekan Baru housing area. we arrived at teh housing area around 6pm. we individually went and notified occupants of teh houses that the fogging activity will comnece at 7pm and approprate measures should be taken to prevent contamination of the food during the fogging activity. The fogging activity began at 7pm and we called it a day at 7.30pm after snapping pictures and observed the activities.

Reported by Praveena.