Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
Vol
.
5,
N
o
.
1
,
M
a
rch
2
0
1
6
,
pp
.
41
~
45
I
S
SN
: 225
2-8
8
0
6
41
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Challen
g
es and Opportunities
to I
m
prove Tubercu
losis
Screenin
g amon
g Immigrant Pl
antati
on W
o
rk
ers
in Sabah, Malaysia
Ma
ini Saba
i
t
1
,
Wan
Mohd Z
a
hirud
d
in W
a
n Moh
a
mm
ad
2
, Mo
ha
med Rusli Abdulla
h
3
, Julia
Oma
r
2
1
State Health D
e
partment of Sabah,
Ko
ta
Ki
na
ba
l
u
, Sa
b
a
h,
Mal
a
y
s
i
a
2
School of Med
i
cal Scien
ces, Un
iver
siti Sains Mala
y
s
ia, Malay
s
ia
3
International M
e
dical Schoo
l, Manageme
nt
and
S
c
ienc
e Univ
ers
i
t
y
, M
a
la
ys
i
a
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
Ja
n 12, 2015
Rev
i
sed
Au
g
21
, 20
15
Accepte
d
Ja
n 26, 2016
Tubercu
l
osis (TB) among immigrants ha
s substantial con
t
ribu
tion to th
e TB
epidem
iolog
y
in
Sabah.
This stu
d
y
aim
e
d to d
e
t
e
rm
ine the
yi
eld
of screeni
ng
for TB disease
among immigrant planta
tion w
o
rkers in Sabah
,
Malay
s
ia.
This was a pros
pective
cohort stud
y
involving
4
82 legal immigrant workers
aged 18
y
e
ars
and above, consented and
av
ailab
l
e at stud
y
sites
during th
e
stud
y
p
e
riod
.
Workers with p
r
evious histor
y
of TB or
currently
on
TB
treatment were exclud
ed from
partic
ipation. S
y
mptom based q
u
estionnaire
was
adm
i
nis
t
ere
d
along
with b
o
th
ch
est rad
i
o
g
raph and
sputum samples
coll
ect
ion for
sy
m
p
tom
a
tics
pa
rticip
ants.
Out
of
482 plantation workers
creen
ed, th
ere
was no case of activ
e
TB detected among the 44 (9.1%)
s
y
m
p
tom
a
tics parti
c
ipan
ts. Finding of low TB yield in this stud
y was rathe
r
unexpec
t
ed but
t
h
is
indica
tes
th
e
real
chal
leng
es
for the lo
cal h
eal
t
h
authori
t
y
t
o
c
o
me
out
wi
th more
c
o
st
e
ffec
t
i
v
e screening
programs, includ
ing reducin
g
stigma, in
activ
e TB scr
een
ing
among migrant p
opulation
.
Keyword:
Case d
e
tection
Immigrant workers
Scr
e
en
ing
Tu
berc
ul
osi
s
Copyright ©
201
6 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
W
a
n Mohd
Zah
i
ru
dd
in
W
a
n
Mo
h
a
mm
ad
,
Depa
rt
m
e
nt
of
C
o
m
m
uni
t
y
Medi
ci
ne,
School
of Medical Sciences,
Un
i
v
ersiti
Sains
Malaysia,
161
50
Ku
b
a
ng
Kerian
Kelan
t
an
Malaysia.
Em
a
il: d
r
zah
ir@u
sm
.
m
y
1.
INTRODUCTION
Saba
h is one
of the t
h
irteen states in Malaysia
wi
t
h
hi
g
h
t
u
berc
ul
osi
s
(TB
)
bu
rde
n
des
p
i
t
e
t
h
e
co
un
try statu
s
as in
term
ed
iate b
u
rd
en
coun
try.
In
c
r
easing TB case
notifications of
m
o
re than
100 cas
e
not
i
f
i
cat
i
o
n pe
r 10
0,
0
00
po
p
u
l
a
t
i
on de
spi
t
e
t
h
e ove
ral
l
count
ry
decrease
was ob
ser
v
ed
[1]
.
Thi
s
i
n
c
r
e
a
se has
b
een
asso
ciated
with
t
h
e immig
r
an
t en
t
r
y fro
m
TB en
d
e
mic n
e
ig
hb
ou
ri
n
g
cou
n
t
ries [2]. Filip
in
o
immig
r
an
ts
(coun
try of orig
in
fro
m
th
e Ph
ilip
p
i
n
e
s) contrib
u
t
e to
ab
ou
t
a t
h
i
r
d
of t
h
e
t
o
t
a
l
num
ber
of TB
case
s
re
po
rt
ed
i
n
Saba
h [
3
]
.
TB
am
ong i
m
m
i
gra
n
t
s
has
bee
n
i
n
creasi
n
gl
y
chal
l
e
ngi
n
g
t
h
e pu
bl
i
c
heal
t
h
sy
st
em
am
ong
ot
her
i
ssues rel
a
t
e
d t
o
im
m
i
grant
s
.
Im
m
i
grant
s
ha
ve di
sp
r
o
p
o
rt
i
onat
e
l
y
hi
g
h
er
preval
e
n
ce of TB co
m
p
ared to the
n
a
tiv
e
po
pu
latio
n du
e t
o
t
h
eir mig
r
atio
n statu
s
. Th
ey
ar
e
so
cially d
i
sadv
an
tag
e
d
,
li
v
i
ng
in
crow
d
e
d
hou
sing
whe
r
e t
h
ey are highly likel
y to e
n
counter indi
vidual
with TB a
n
d
po
or health acce
ss [4].
Additionally,
im
m
i
grant
s
cam
e from
count
ri
es wi
t
h
hi
g
h
TB
i
n
ci
dence
as wel
l
as l
a
t
e
nt
t
uber
c
ul
osi
s
i
n
fect
i
on (L
T
B
I) t
h
u
s
the inc
r
ease
d
ri
sk
of active TB
[5].
Upsc
aling TB case
detection and
prom
pt
tre
a
tm
ent
o
f
id
entified
n
e
w TB
cases rem
a
in
s to
p
p
r
i
o
rity
i
n
TB
c
ont
r
o
l
i
n
Sa
ba
h [
1
]
.
In
co
nj
u
n
ct
i
o
n
t
o
t
h
i
s
ef
fo
rt
, sc
r
eeni
n
g i
m
m
i
grant
s
w
h
o a
r
e t
h
o
u
ght
t
o
be at
hi
g
h
ri
sk
f
o
r
TB
di
sease w
e
re
ca
rri
ed
out
.
Sc
re
eni
n
g
fo
r
TB
di
sease a
r
e
pe
rf
orm
e
d as a
t
ool
i
n
TB
b
u
r
de
n
m
easurem
ent
,
m
oni
t
o
ri
n
g
TB
co
nt
r
o
l
p
r
og
ram
m
e perf
orm
a
nce as
w
e
l
l
as im
pro
v
i
n
g
det
ect
i
o
n
of
TB
resu
lting
in
earlier d
e
tection
an
d
t
r
eatm
e
n
t
an
d
h
e
n
ce cu
tt
in
g
sh
ort th
e
TB tran
sm
issi
o
n
i
n
th
e co
mm
u
n
ity.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 5
,
N
o
. 1
,
Mar
c
h
20
16
:
41
–
45
42
Screen
ing
tools th
at were
u
s
ually u
tilise
d
in
screen
ing
are
qu
estion
n
a
i
r
es on
TB sy
m
p
to
m
s
, ch
est
radi
og
rap
h
y
,
s
put
um
m
i
croscopy
, s
p
ut
um
cul
t
u
re
, o
r
com
b
i
n
at
i
o
ns
of t
h
ese t
ool
s
[6]
.
Ho
we
ver
,
scre
eni
n
g i
n
p
r
actice
was
variab
le in terms of ap
pr
oache
s
an
d sc
ree
n
i
n
g t
o
ol
s
use
d
[7
]
.
I
n
t
h
is stud
y,
w
e
condu
cted
th
e f
i
r
s
t
f
i
eld
scr
een
i
n
g
fo
r
activ
e TB am
o
n
g
leg
a
l i
m
m
i
g
r
an
ts wo
rk
ing
i
n
Sa
bah
pal
m
oi
l
pl
ant
a
ti
on.
Thi
s
pa
per
desc
ri
bes
t
h
e y
i
el
d o
f
scree
n
i
n
g,
i
ssues i
d
ent
i
f
i
e
d
a
n
d
reco
mm
en
d
a
tio
n
s
th
at m
a
y b
e
app
licab
le for fu
ture screen
in
g activ
ity.
2.
R
E
SEARC
H M
ETHOD
Th
is stud
y w
a
s a p
r
o
s
p
ectiv
e
co
hor
t stud
y co
ndu
cted
i
n
a
pal
m
oi
l
pl
ant
a
t
i
on at
Sa
nda
k
a
n, a
di
st
ri
ct
wi
t
h
t
h
e s
eco
n
d
hi
gh
est
TB
n
o
t
i
f
i
cat
i
on i
n
S
a
bah
.
I
n
M
a
y
20
1
3
,
48
2 l
e
ga
l
im
m
i
grant
w
o
r
k
er
s age
d
18
y
ears
and
a
b
o
v
e
we
r
e
rec
r
ui
t
e
d
t
o
part
i
c
i
p
at
e i
n
t
h
e st
udy
.
Im
m
i
gra
n
t
w
o
rke
r
s
wi
t
h
p
r
evi
o
us
hi
st
o
r
y
of
TB
or
was
currently on T
B
treatm
e
nt were exclud
e
d
fr
om
part
i
c
i
p
at
i
on. I
n
f
o
rm
at
i
on regar
d
i
n
g t
h
e
st
udy
was
gi
ve
n an
d
in
fo
rm
ed
co
n
s
en
t was sou
g
h
t
fro
m
in
te
rested workers
.
All the sessions we
re conducted
in Malay
language as
th
e work
ers
were
p
r
o
f
icien
t
i
n
th
e langu
age.
After ob
tain
ing
con
s
en
t,
th
e workers were
i
n
terv
ie
we
d ba
s
e
d o
n
a st
a
nda
r
d
p
r
of
orm
a
. Thi
s
i
n
cl
u
d
e
d
soci
o
-
dem
o
g
r
a
phi
c dat
a
an
d m
i
grat
i
on hi
st
ory
w
h
i
l
e
elicitin
g
sym
p
to
m
s
co
m
p
atib
le with
TB. Presence o
f
BCG scar
was
also e
x
am
ined.
A scre
en
ing
qu
estion
on
pr
esen
ce o
f
coug
h
w
a
s
ask
e
d
in
o
r
d
e
r
to
sep
a
r
a
te
coughing
parti
c
ipant
from
the rest as
well a
s
give
n
f
ace m
a
sk.
Worke
r
s
with TB sym
p
tom
s
had their
sput
u
m
sam
p
l
e
s col
l
e
ct
ed. T
w
o s
p
ot
sput
um
sam
p
l
e
s an
d o
n
e m
o
rni
n
g sam
p
l
e
s were c
o
nsi
d
e
r
e
d
ade
q
uat
e
. T
h
e fi
rst
sp
o
t
spu
t
u
m
sa
m
p
les were t
a
k
e
n
b
e
fo
re the in
terv
iew wh
ile th
e
second
o
n
e
was taken
p
o
st in
terv
i
e
w.
Th
e
m
o
rn
in
g
sam
p
le was tak
e
n
the o
n
fo
llowing
d
a
y. Particip
ants with
TB sym
p
to
m
s
were also
in
stru
cted
t
o
h
a
v
e
t
h
ei
r che
s
t
radi
og
ra
ph e
x
am
i
n
at
i
on t
a
ke
n at
t
h
e nea
r
est
di
st
r
i
ct
hos
pi
t
a
l
.
Th
e pl
ant
a
t
i
o
n m
a
nagem
e
nt
pr
o
v
i
d
e
d
th
e tran
sportatio
n fo
r th
e
p
a
r
ticip
an
ts
for t
h
is m
a
tter.
Data we
re a
n
a
l
ysed usi
n
g S
PSS
version
22 (IBM
Corporation, S
o
m
e
rs,
NY,
USA).
Categorical
vari
a
b
l
e
s were
prese
n
t
e
d as
f
r
eq
ue
nci
e
s an
d
perce
n
t
a
ge
(%
) while num
erical variables were presente
d
using
mean
and
stand
a
rd
d
e
v
i
ation (SD). Th
e stud
y pro
t
o
c
o
l
was rev
i
ewed
and
ap
prov
ed
b
y
th
e Un
i
v
ersiti Sains
Malaysia Hu
man
Research
Eth
i
cs Co
mmitte
e (USM
KK/PPP
/JEPeM 2
6
5
.
3
(
7
)
). Particip
atio
n
was co
m
p
letely
vol
unt
a
r
y
and
wo
rke
r
s c
oul
d wi
t
h
dra
w
at
any
t
i
m
e
. The wo
rke
r
s w
e
r
e
not
di
sa
d
v
a
n
t
a
ge
d by
re
f
u
sal
t
o
participate in the st
udy
or any
com
pone
nt
of
th
e study. C
o
nfidentiality was
kept at all tim
es.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
A to
tal o
f
48
2 p
l
an
tatio
n
work
ers were in
vo
lv
ed
as th
e stu
d
y
p
a
rticip
an
t
s
. Th
e resu
lt d
e
scrib
e
s the
an
alysis on
th
e b
a
selin
e screen
ing
s
p
e
rfo
rm
e
d
in th
is st
u
d
y
.
3.
1.
Socio De
mogr
aphic
Tabl
e 1 s
h
o
w
s
t
h
e soci
o
-
dem
o
g
r
a
phi
c p
r
ofi
l
e of t
h
e st
udy
part
i
c
i
p
a
n
t
s
. F
o
u
r
h
u
n
d
r
e
d
s a
nd si
xt
y
fi
ve
(9
6.
5%
) pl
ant
a
t
i
on w
o
r
k
ers
w
e
re In
d
onesi
a
n
im
m
i
grant
s
. T
h
e fact
t
h
at
m
a
jo
ri
t
y
of t
h
e st
udy
pa
rt
i
c
i
p
ant
s
were
o
f
In
don
esian
o
r
i
g
in
cou
l
d
b
e
on
e
o
f
th
e explan
atio
n
s
fo
r the yield
of
TB
d
i
sease scr
e
en
in
g in th
is st
u
dy, and
whet
her appropriate infere
nc
e on t
h
e TB
ri
sk a
n
d inci
dence can
be m
a
de
to all immigrants in the state.
Tabl
e 1. Soci
o-
dem
ogra
phi
c p
r
o
f
i
l
e
o
f
st
u
d
y
part
i
c
i
p
a
n
t
s
(
n
=
4
8
2
)
V
a
r
i
ab
le
s n
(%
)
Age categories (y
ears)
18-
29
30-
39
40-
49
50-
59
60-
65
165 (
34.
2)
189 (
39.
2)
113 (
23.
4)
1
2
(2
.5
)
3
(0
.6
)
Sex
Male
Fe
m
a
le
260 (
53.
9)
222 (
46.
1)
Count
ry of
origin
I
ndonesia
Philipines
465 (
96.
5)
17 (
3
.
5
)
Ti
m
e
since e
n
try
to Sabah (
m
ean,
SD)
11.
7 (
5
.
99)
Age at en
try to Sa
bah (
m
ean,
SD)
21.
8 (
7
.
01)
H
i
st
ory of
TB
cont
act
2
5
(5
.2
)
Presence
of BC
G
Scar
131
(7
.2
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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S I
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Ch
a
lleng
es and
Oppo
rtun
ities
to
Imp
r
o
ve Tu
b
e
rcu
l
o
s
is S
c
reen
ing
Amo
ng
Immigran
t
.... (Ma
i
n
i
Sab
a
it)
43
Th
e stud
y also
no
ted th
at on
ly 5
.
2
%
o
f
t
h
e stud
y p
a
r
ticip
an
ts
h
a
v
e
histo
r
y of
con
t
act w
ith
TB
pat
i
e
nt
.
H
o
we
ver
,
i
t
ha
s
bee
n
s
h
ow
n i
n
pr
evi
o
us st
udi
es
t
h
at
ha
vi
n
g
T
B
di
sease
o
r
a
ssoci
at
ed
wi
t
h
any
o
n
e
with
TB cou
l
d lead
to
stig
ma [8
]. Sin
ce
we relied
on
p
a
rticip
an
ts to
sup
p
l
y th
e informatio
n
,
we cou
l
d
no
t
ascertain
wh
et
h
e
r
so
m
e
p
a
rt
icip
an
ts ch
o
s
e no
t to
rev
eal
their ass
o
ciation t
o
a
TB
pat
i
e
nt
.
F
u
rt
he
rm
ore,
p
a
rticip
an
ts
may n
o
t
k
now fo
r su
re wh
eth
e
r th
e sy
m
p
to
ms
o
f
th
eir co
lleag
u
e
o
r
fam
ily
m
e
m
b
ers were really
TB
di
sease. M
o
st
act
i
v
e case det
ect
i
on
rel
i
e
d o
n
hi
st
ory
o
f
co
nt
act
befo
re deci
di
ng
whet
her o
r
not
t
o
i
nvest
i
g
at
e t
h
e
m
furt
he
r [9]
,
[
10]
. T
h
e im
pl
i
cat
i
on o
f
t
h
i
s
f
i
ndi
n
g
wa
s hea
l
t
h
care pr
ovi
d
e
r m
a
y
be prevent
e
d
fr
om
assi
st
i
ng
t
h
em
i
n
obt
ai
ni
ng
p
r
om
pt
and
pr
o
p
er
TB
t
r
ea
tm
ent
.
3.
2.
Tuberculosis
Symptoms
The sc
reeni
n
g in this study was
s
u
ccess
f
ul in ide
n
tifying
44 (9.1
%
)
sym
p
tom
a
tic
participa
n
ts.
Tabl
e 2
sh
o
w
s t
h
e p
r
o
p
o
rt
i
on
o
f
pa
rt
i
c
i
p
ant
s
ha
vi
n
g
T
B
sym
p
t
o
m
s
. C
o
u
g
h
was
t
h
e m
o
st
com
m
on TB
co
m
p
atib
le sym
p
to
m
s
id
en
tified
am
o
n
g
th
e
p
a
rticip
an
ts.
Ou
t
o
f
44
p
a
rticip
an
ts with co
ug
h,
on
ly 3 (6
.8%)
o
f
th
e p
a
rticip
an
ts h
a
d
seek
m
e
d
i
cal at
ten
tio
n
fo
r th
eir sym
p
t
o
m
s
. On
e o
f
th
e p
a
rticip
an
ts h
a
s th
e lo
ng
est co
u
gh
du
rat
i
o
n o
f
3
m
ont
hs wi
t
h
o
u
t
ever seeki
n
g m
e
di
cal
at
t
e
nt
ion
.
It
sh
o
u
l
d
b
e
bo
rne i
n
m
i
n
d
t
h
at
t
h
ere m
i
ght
be a
num
ber
of
part
i
c
i
p
ant
s
w
h
o di
d n
o
t
re
veal
pr
esence
of TB
s
y
m
p
t
o
m
s
. Ho
weve
r, i
t
s
h
o
u
l
d
be
rem
e
m
b
ered t
h
at
cou
g
h
m
a
y be rega
rde
d
as n
o
r
m
a
l am
ong s
m
okers [1
1]
. I
n
p
r
evi
ous st
u
d
i
e
s, st
i
g
m
a
rel
a
t
e
d t
o
TB
di
agn
o
si
s,
fear
of
dep
o
r
t
a
t
i
on,
bei
n
g pl
a
ced at
di
sad
v
a
n
t
a
ge, a
n
d di
sc
ri
m
i
nat
i
on ass
o
ci
at
ed wi
t
h
TB
di
ag
nosi
s
was
not
e
d
.
Th
us,
fear
o
f
b
e
i
ng
di
ag
n
o
se
d
wi
t
h
TB
di
sea
s
e m
i
ght
l
ead t
o
a
voi
dance
f
r
o
m
seeki
n
g
he
al
t
h
care
[
8
]
.
Tabl
e
2. TB
Sy
m
p
t
o
m
s
am
ong t
h
e
st
u
d
y
par
t
i
c
i
p
ant
s
(
n
=
4
4
)
V
a
r
i
ab
le
s n
(%
)
Any
cough
44 (
9
.
1
)
Cough
m
o
r
e
than
7 day
s
13 (
29.
5)
Dur
a
tion of cough
(m
ean,SD
0.
69 (
4
.
93)
Pr
oductive with sputu
m
Haem
opty
s
is
24 (
5
%)
0
(0
.0
)
Fever
Night sweats
L
o
ss of weight
L
y
m
ph node swelling
9
(1
.9
)
3
(0
.4
)
3
(0
.6
)
0
(0
.0
)
Th
irth
y eigh
t (8
6.4%) th
e sym
p
to
m
a
tics p
a
rticip
an
ts submit
ted
ad
equ
a
te sp
u
t
u
m
sa
m
p
le fo
r spu
t
u
m
micro
s
cop
y
exa
m
in
atio
n
.
Ho
wev
e
r, no
n
e
o
f
th
e spu
t
u
m
m
i
cro
s
co
p
y
sa
m
p
les were fo
und
to
b
e
positiv
e
.
Ch
est rad
i
og
rap
h
do
n
e
fo
r al
l th
e p
a
rticip
an
ts with
sym
p
to
m
s
co
m
p
atib
le with
TB sym
p
to
m
s
also
d
i
d
no
t
have e
v
i
d
e
n
ce
of act
i
v
e TB
di
sease. Al
t
h
o
u
g
h
chest
ra
di
og
ra
ph as a screeni
ng t
o
ol
w
a
s wel
l
est
a
bl
ishe
d,
ho
we
ver o
f
co
ncer
n we
re t
h
e
fact
t
h
at
imm
i
gra
n
t
po
p
u
l
a
t
i
o
n ha
ve pre
p
on
dera
nce t
o
ext
r
apul
m
onary
T
B
[12]
.
Hence
t
h
e
l
i
m
i
t
e
d use
f
ul
ness
o
f
c
h
est
ra
di
og
ra
ph
i
n
det
e
ct
i
ng e
x
t
r
a
p
u
l
m
onary
TB
.
Thi
s
st
udy
wa
s al
so
l
i
m
i
t
e
d by
t
h
e fact
t
h
at
t
h
e fo
cus was m
o
re on
det
ect
i
on o
f
pul
m
onary
t
u
berc
ul
osi
s
. It
i
s
al
so possi
bl
e t
h
at
som
e
cases coul
d ha
ve
been
m
i
ssed by
che
s
t
radi
o
g
ra
p
h
[
13]
as t
h
e fi
n
d
i
ngs c
oul
d ha
v
e
l
a
gge
d be
hi
n
d
t
h
e
cl
i
n
i
cal
pi
ct
ure
s
[
11]
.
An
ot
he
r
possi
bl
e reas
on
wa
s t
h
at
t
h
e pa
rt
i
c
i
p
ant
s
we
re
m
o
st
ly
non
re
cent
im
m
i
grant
s
wh
o h
a
v
e
st
ay
ed i
n
Sa
ba
h f
o
r m
o
re t
h
a
n
a dec
a
de
(an
avera
g
e
of
nea
r
l
y
12 y
ear
s),
h
e
nce t
h
e l
o
we
r
ri
sk
of
get
t
i
ng
TB
as
shown by fi
ndi
ng
from
Frothi
ngham
et al. [14]. Howe
ve
r,
m
o
re recent
studies s
h
owe
d
the ris
k
for
developing
act
i
v
e TB
rem
a
i
n
hi
g
h
eve
n
aft
e
r m
a
ny
y
e
ars p
o
st
m
i
grat
i
on [
12]
,
[
1
5
]
,
[
16]
. T
h
e fi
n
d
i
ngs m
i
ght
al
so im
pl
y
th
at p
r
ob
ab
ly better liv
in
g cond
itio
n
s
of th
e l
a
b
our immig
r
an
ts in
t
h
e state
p
l
an
tation
s
as
ev
id
en
ce
h
a
s sh
own
th
at a sign
ifican
t propo
rtion
of TB am
ong
m
i
gra
n
t
s
i
s
act
ua
l
l
y
react
i
v
at
ed
or
ne
wl
y
acq
ui
red a
s
a r
e
sul
t
of t
h
e
p
oor co
nd
itio
ns th
rou
g
h
wh
ich
m
i
g
r
an
ts trav
el and
t
h
en wo
rk
an
d live [1
7
]
.
Ap
art
fro
m
th
at, th
e study
fi
n
d
i
n
gs m
i
ght
al
so i
ndi
cat
e t
h
e ri
g
o
r
o
us sc
reeni
ng
pol
i
c
i
e
s desi
g
n
ed t
o
pre
v
e
n
t
t
h
e en
t
r
y
of m
i
grant
s
wi
t
h
act
i
v
e TB
ha
v
e
bee
n
d
o
n
e
[1
8]
, he
re
by
b
o
t
h
ori
g
i
n
c
o
u
n
t
r
i
e
s (I
nd
o
nne
si
a an
d t
h
e
Phi
l
i
ppi
nse)
an
d al
so t
h
e
receiving c
o
untry Malaysia.
As t
h
e
pre
v
i
o
us st
u
d
y
by
D
ony
et
al
. [
3
]
whi
c
h sh
o
w
ed
a t
h
i
r
d
of t
h
e
TB
cases i
n
Saba
h w
e
r
e
Filip
in
o
immi
g
r
an
ts, it is th
u
s
im
p
o
r
tan
t
to
con
s
id
er
app
r
op
riate represen
tativ
e sam
p
les o
f
immig
r
an
ts to
Sab
a
h
in th
e
fu
ture stud
y
p
a
rticu
l
arly th
o
s
e
fro
m
th
e Ph
illip
in
es. On
t
h
e
o
t
h
e
r
h
a
nd
, th
i
s
find
ing
cou
l
d serv
e
to
in
form
u
s
th
at th
e curren
t
med
i
cal ex
ami
n
atio
n fo
r immig
r
an
t wo
rk
ers in
th
is setting
h
a
s
p
e
rform
e
d
well.
Th
e
p
a
rticip
ants in
th
is st
u
dy h
a
v
e
h
a
d
mu
ltip
le ann
u
a
l
m
e
d
i
cal ex
amin
atio
n
s
.
Hen
ce, t
h
ey cou
l
d
h
a
v
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 5
,
N
o
. 1
,
Mar
c
h
20
16
:
41
–
45
44
b
e
n
e
fitted
from
th
e regu
lar
workers m
e
d
i
cal ex
am
in
atio
n
re
su
ltin
g
i
n
n
o
n
e
o
f
t
h
e p
a
rticip
an
ts d
i
agno
sed
with
active
TB during
the study
pe
riod.
Fi
ndi
ng
s of l
o
w y
i
el
d i
n
TB
screeni
n
g am
on
g i
m
m
i
grant
s
has bee
n
sh
ow
n i
n
ot
her s
t
udi
es [
19]
.
Howev
e
r, th
is
sh
ou
l
d
no
t d
e
t
a
in
th
e h
ealth
p
r
ov
id
er
fro
m
co
n
tinu
i
ng
to
screen
immig
r
an
ts as it was sh
own
that earlier cas
e detection, re
duce
d
a
d
m
i
ssion t
o
hos
p
ita
l
,
du
rat
i
o
n o
f
sy
m
p
t
o
m
s
were sho
r
t
e
ne
d a
n
d
hence
decrease
TB
t
r
ansm
i
ssi
on co
ul
d
res
u
l
t
fr
om
scree
n
i
n
g
pr
o
g
ram
m
es [20]
.
Furt
herm
ore,
i
m
m
i
grant
p
o
p
u
l
a
t
i
o
n
s
h
a
v
e
an
elev
ated
risk
o
f
TB
ev
en after m
a
n
y
years o
f
settlin
g
i
n
to
a
n
e
w co
un
try
[12
]
,[2
1
]
. Th
erefo
r
e, it is
i
m
p
o
r
tan
t
t
h
at surv
eillan
ce
fo
r
activ
e TB
sh
ou
l
d
b
e
co
ntin
u
e
d v
i
g
ilan
t
ly as for
recen
t
immig
r
an
ts as th
e
WH
O’
s
W
e
st
e
r
n Paci
fi
c R
e
gi
on
, w
h
i
c
h i
n
cl
ude c
o
u
n
t
r
i
e
s l
i
k
e M
a
l
a
y
s
i
a
and t
h
e P
h
i
l
i
ppi
nes, bea
r
s nea
r
l
y
one-
f
i
f
t
h
of
th
e gobal TB bu
rd
en
acco
m
p
an
ied
b
y
th
e alar
m
i
n
g
l
y in
cr
easi
n
g burd
e
n of
M
D
R-
TB [
2
2
]
.
4.
CO
NCL
USI
O
N
Thi
s
st
u
d
y
sh
o
w
ed t
h
at
TB
s
c
reeni
ng am
on
g i
m
m
i
grant
s
coul
d be
pe
rf
o
r
m
e
d i
n
t
h
e fi
el
d set
t
i
ng
especially at their work and li
ving
places.
Howe
ve
r, it s
hould
be
noted
t
h
at fi
ndi
ng
of
low TB
yield am
ong
im
m
i
grant
wo
rke
r
s i
n
t
h
i
s
s
t
udy
was
rat
h
er
une
x
p
ect
ed
gi
ven
hi
ghe
r
back
g
r
o
u
n
d
T
B
pr
eval
e
n
ce i
n
t
h
ei
r
ori
g
i
n
c
o
u
n
t
r
y
.
M
a
ny
p
o
ssi
bl
e reas
ons
ha
ve
bee
n
ex
pl
ai
ne
d b
u
t
t
h
i
s
m
a
y bec
o
m
e
t
h
e real
chal
l
e
nge
s a
m
ong
the local
health authority of
t
h
e receivi
ng country like Mala
ysia to co
m
e
out with better a
p
proaches
and
m
o
re
cost e
ffective
TB scree
n
ing
program
s
a
m
ong m
i
gran
ts.
Im
portantly, advocacy
an
d public
education efforts
a
m
ong t
h
e governm
e
nt and
ot
her sta
k
eh
olde
rs, incl
udi
ng e
m
ployers, on t
h
e im
portance
of e
n
s
u
ri
ng ac
cess to
TB
scree
n
i
n
g a
n
d
care
f
o
r
m
i
g
r
ant
p
o
p
u
l
a
t
i
o
n
s
nee
d
t
o
be st
r
e
ngt
hene
d a
s
wel
l
.
ACKNOWLE
DGE
M
ENTS
Th
e au
thors wo
u
l
d
lik
e to
firstly
th
an
k
Sawit Kin
a
b
a
lu
Sdn
.
B
h
d
fo
r allowing
th
e u
s
e th
eir facilities
t
o
co
n
duct
t
h
i
s
st
udy
.
We
w
oul
d al
so
l
i
k
e t
o
ac
kn
o
w
ledg
e th
e su
ppo
r
t
and
assist
anc
e
from
the State Health
Dep
a
rtm
e
n
t
o
f
Sab
a
h
,
Dr
Azi
a
h
Daud
,
Dr Aziah
Ism
a
il, Dr Ah
m
a
d
Filza
an
d
Dr Noo
r
Kh
alili, in
th
e
p
r
o
cess
of c
o
m
p
l
e
t
i
ng
t
h
i
s
resea
r
ch
.
The st
udy
was
fu
n
d
ed
by
M
i
ni
st
ry
o
f
E
d
uc
at
i
on’s
L
o
n
g
T
e
rm
R
e
search
Gra
n
t
(LRGS) a
n
d
Unive
r
siti Sain
s
Malaysia’s Short
Term
Research (n
o. 304/
PPSP/
61312117)
gr
ant
schemes. The
fund
ing
bod
y h
a
s
n
o
i
n
vo
lv
emen
t in
th
e d
e
sig
n
, d
a
ta co
llec
tio
n
,
an
alysis an
d
i
n
terp
retatio
n
of d
a
ta, as
well as
in
th
e
prep
aratio
n of t
h
is m
a
n
u
s
cri
p
t.
REFERE
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r
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u
lmonar
y
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ulosis: im
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irator
y
s
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ecim
e
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ures
”,
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BIOGRAP
HI
ES OF
AUTH
ORS
Maini Sabait (
M
D, MPH) is
a doctora
te in
public health (
E
pidemiolog
y
)
graduated fro
m
Universiti Sa
ins Mala
ysia
in 20
15. She
is cu
rr
entl
y post
e
d an
d working in th
e Sabah St
at
e
Health
Depar
t
m
e
nt,
Mal
a
y
s
ia.
Wan Mohamed Zahirudd
in Wan
Mohammad (
M
D, M.Comm.
Med (E
pid.
& Biostats) is an
Associate Profes
sor in com
m
unity m
e
di
cine
in Universiti Sa
ins Mala
y
s
ia
. His re
search in
ter
e
sts
are
tuber
c
ulos
is
,
HIV, lep
t
os
pir
o
s
i
s
and com
m
unicab
le d
i
s
eas
e
epid
em
iolog
y
.
He is
act
ive
l
y
involved in
con
ducting workshop in research
methodolog
y
an
d medical statis
tics as well as
consultan
c
y
in
evaluation of
pub
lic health
programs.
Mohamed Rusli Abdullah (MD, MPH, and Phd)
is
a Dean
a
nd P
r
ofes
s
o
r in Epidem
iol
o
g
y
(Com
m
unicable Dis
eas
es
and Tr
opica
l Medicine) with subs
peci
a
lisation
in sports
m
e
dicin
e
.
He
is an active figur
e in ep
id
emiolog
i
cal stud
y
and has been involve
d
in various resear
ch projects in
public
hea
lth
in
Mala
y
s
ia
.
J
u
lia Om
ar (M
D, M
P
ath) is
a
pathologis
t
wit
h
a vas
t
exp
e
ri
ence
in th
e fie
l
d of chem
ic
al
patholog
y
.
She
is curren
t
ly
the
head of
dep
a
rt
m
e
nt of
Chem
ic
al
Patholog
y
in U
n
iversiti
Sains
Mala
y
s
ia
.
Evaluation Warning : The document was created with Spire.PDF for Python.