Tuberculosis (TB) is endemic in Malaysia and has been a long-standing public health concern.
Although the frequency has decreased since I was a medical student, there has been a steady increase in recent years, with TB continuing to consume the country’s healthcare resources.
The Dewan Negara was informed on March 13 (2026) by the Health Minister that there were 26,183 cases in 2024, of which 21,959 were Malaysians (83.9%).
The cases in foreigners have continued to increase since 2019 with 3,384 cases in 2019, and 4,224 in 2025.
The death rate from TB had increased from 6.8 per 100,000 residents in 2019 to 7.58 per 100,000 residents in 2024.
There were understandable public concerns when the Health Ministry reported 3,161 cases in the first six weeks of 2026 – a 10% increase from last year.
Notification numbers do not tell the whole story, however.
The Health Ministry should have included certain data to help ascertain the seriousness of the numbers disclosed, such as:
- Whether the cases were new infections or relapses in patients who defaulted their treatment
- The secondary infection rate in close contacts of the cases
- The stability of treatment completion rates
- Changes in drug-resistant TB rates, and
- If there were increased cases in children, which would suggest recent spread.
Be that as it may, the public response should include increasing their knowledge about TB and its preventive measures, as well as active participation in controlling and ending TB.
Clinical features
TB is an infectious disease caused by a bacterium.
It spreads through the air when an infected person coughs, sneezes or spits.
It usually affects the lungs, but can also affect the kidneys, brain, spine, and even the fallopian tubes.
In general, an infected person can actually feel well and is not contagious.
Only a small proportion of those infected will get the disease and develop symptoms.
Babies and children are at increased risk of developing the disease if infected.
Symptoms may be mild for many months, so it is easy to spread to others without knowing it.
Common symptoms include:
- Prolonged cough (sometimes with blood)
- Chest pain
- Weakness
- Fatigue
- Weight loss
- Fever, and
- Night sweats.
Other symptoms can also occur depending on the affected part of the body, e.g. infertility if the fallopian tubes are infected.
TB and HIV (human immunodeficiency virus) together are potentially lethal.
HIV patients are 12 times more likely to get TB.
Diagnosis and treatment
The Health Ministry’s guidelines for the diagnosis of TB of the lungs (pulmonary TB) include:
- Sputum for mycobacterial culture and drug susceptibility testing
- A molecular test for TB and rifampicin resistance if smear-negative pulmonary TB is suspected
- Sputum for both the molecular test and mycobacterial culture from individuals suspected to have recurrent pulmonary TB, and
- Chest X-ray.
The diagnosis of latent infection and children at risk of progressing to active TB include an interferon gamma release assay (IGRA) or tuberculin skin test (TST), and chest X-ray.
The diagnosis of TB in other body organs include the molecular test, mycobacterial culture, histopathological examination, biochemistry for adenosine deaminase and imaging studies.
TB treatment involves the administration of antibiotics.
The ones commonly used are rifampicin, isoniazid, pyrazinamide and ethambutol.
TB that does not respond to these antibiotics is termed drug-resistant TB and requires different antibiotics, as does TB affecting organs apart from the lungs.
The antibiotics have to be taken daily for four to six months for them to be effective.
It is dangerous to stop the antibiotics early or without medical advice as it can lead to drug- resistant TB.
Close follow-up is necessary to monitor response to treatment and early detection of multidrug- resistant TB (MDR-TB), for which different antibiotics will be required.
Prevention
Several measures can be taken to prevent TB and its spread. They include:
- Seeking medical attention if there are symptoms like prolonged cough, fever and unexplained weight loss.
Early treatment can help stop the spread of TB and improve chances of recovery.
- Getting screened for TB if one is at increased risk, e.g. if one has HIV or are in regular contact with people who have TB in the household or workplace.
- Completing the full course of TB preventive treatment (TPT) if prescribed.
This prevents the infection from becoming disease.
- Practising good hygiene when coughing, including avoiding contact with other people and wearing a face mask; covering the mouth and nose when coughing, sneezing or spitting; and disposing of sputum and used tissues properly, If one has TB.
Special measures, like use of respirators and designing well-ventilated spaces, are also important to reduce infection in healthcare facilities, dormitories and other enclosed places.
World TB Day 2026
World TB Day was commemorated last Tuesday (March 24).
The theme for this year (2026) was “Yes! We can end TB”.
The World Health Organization (WHO) has messages for many groups.
For policymakers:
- “Allocate sufficient resources to improve the quality of TB diagnosis, prevention, treatment and care services, and make them more resilient and sustainable.
- “Support and empower health workers to deliver high-quality TB services in line with WHO recommendations, including the new near-point-of-care TB diagnostic guidelines, and ensure their systematic implementation to improve access, quality and outcomes.
- “Empower communities to combat TB-related stigma and discrimination.”
For the healthcare workforce:
- “Incorporate TB into routine health interventions.
- “Deliver care that is kind, respectful of human rights and without stigma.
- “Ensure you are trained and have the latest WHO guidance available to you for TB prevention, diagnosis, treatment and care services.”
For community leaders:
- “Ensure essential TB services are maintained in the community.
- “Support community health workers, including nurses and midwives, to provide essential TB services in line with WHO recommendations.
- “Combat stigma and discrimination to ensure that everyone feels safe to access TB services.”
For the public:
- “Educate yourself on TB causes, symptoms and prevention.
- “If you think you are affected with TB, get tested, get treated and follow the advice of your healthcare provider.
- “Don’t believe in myths or misinformation.
- “Stand up against TB stigma and discrimination.
- “Advocate for investment of resources, support, care and information to win the fight against TB.
- “Support TB patients in the community with resources and advice.”
In Malaysia
The Health Ministry’s National Strategic Plan (NSP) to end TB by 2035 and the Sustainable Development Goals (SDGs) 2030 target a reduction by 90% of the TB incidence rate, and reduction by 95% of the absolute number of TB deaths by year 2035, using the data of 2015 as a baseline.
In 2015, the TB incidence was 79 per 100,000 population and the TB deaths numbered 1,696.
The current data are nowhere near the mid-points of the targets set for 2030 or 2035.
Currently, TB treatment is mainly delivered in public clinics.
Suspected TB cases in private clinics are referred to government facilities for treatment.
There has not been much focus on TB in foreign workers, for whom access to healthcare may be problematic because of factors like finance, and fear of detention and deportation in undocumented workers.
When diagnosis is delayed, the risk of spread of TB increases.
The reason is simple: no one can determine the nature of the air breathed.
If the Health Ministry is serious about its NSP, the following needs to be implemented:
- Improved cooperation and coordination with private clinics and hospitals
- Safe access to diagnosis and treatment for foreign workers
- Uninterrupted therapy, even during detention
- Close coordination with immigration authorities
- Proper screening and follow-up in high-density worker housing.
The tools to end TB have been available for a long time.
Will we be able to reach our NSP and SDG TB reduction targets in time?
Only time will tell.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
