Jelip Jenarun, Mathew George G, Yusin Tanrang, Dony Jiloris F, Singh Nirmal, Ashaari Musa, Lajanin Noitie, Shanmuga Ratnam C, Yusof Ibrahim Mohd, Gopinath Deyer
Sabah Health Office, Tuaran, Sabah, Malaysia.
Tuberculosis (Edinb). 2004;84(1-2):19-23. doi: 10.1016/j.tube.2003.08.015.
Tuberculosis (TB) is one of the main public health problems in Sabah; 30% of the total number of TB cases reported in Malaysia every year occur in Sabah. The average incidence of TB among health care workers over the past 5 years is 280.4 per 100,000 population (1, Annual Report of Sabah State TB Control Programme, 1998). At present, there are no specific measures for the prevention of TB transmission in health care facilities. A case-control study was conducted among health care workers in Sabah in 2000-2001. Cases were health care workers with TB diagnosed between January 1990 and June 2000. Controls were health care workers without TB and working in the same facility as cases during the disease episode. The study attempted to identify risk factors for TB among the study population. Data were collected through structured interviews and review of patients' records. The notification rate of TB among health care workers was significantly higher than that to the general population (Z=4.893, p<0.01). The average notification rate of TB among health care workers over the last 5 years was two times higher than in the general population (280.4/100,000 compared to 153.9/100,000). Regression results showed that ethnicity, designation, family contact and TB related knowledge did not significantly contribute to the risk of contracting TB in this study. However, after controlling for the above factors, age, gender, history of TB contact outside the workplace (other than family contact), duration of service and failure to use respiratory protection when performing high-risk procedures, were the main risk factors of TB among health care workers. This study succeeded in identifying some of the risk factors of TB among health care workers. We managed to include the large ratio of controls to case (3:1) and those cases spanned over a period of 10 years. However, the findings from the study have to be applied with caution due to the limitations of this study, which include recall bias, dropouts, and small sample size. Based on the study findings, we recommend that health care workers in the first 10 years of service should take extra precautions, such as using respiratory protection when performing procedures that are considered to be of high risk with respect to TB infection. They should also undergo TB screening at least once every 2 years and, if symptomatic, offered prophylactic treatment. The Respiratory Protection Programme should be fully implemented to help reduce the risk of TB among health care workers in Sabah.
结核病（TB）是沙巴州主要的公共卫生问题之一；马来西亚每年报告的结核病病例总数中，有30%发生在沙巴州。过去5年中，医护人员的结核病平均发病率为每10万人280.4例（1，《沙巴州结核病控制项目年度报告》，1998年）。目前，医疗机构中没有预防结核病传播的具体措施。2000 - 2001年在沙巴州的医护人员中进行了一项病例对照研究。病例为1990年1月至2000年6月期间被诊断患有结核病的医护人员。对照为未患结核病且在病例患病期间与病例在同一机构工作的医护人员。该研究试图确定研究人群中结核病的危险因素。通过结构化访谈和查阅患者记录收集数据。医护人员中的结核病报告率显著高于普通人群（Z = 4.893，p < 0.01）。过去5年中，医护人员的结核病平均报告率比普通人群高出两倍（分别为每10万人280.4例和153.9例）。回归结果表明，在本研究中，种族、职位、家庭接触和结核病相关知识对感染结核病的风险没有显著影响。然而，在控制上述因素后，年龄、性别、工作场所以外（非家庭接触）的结核病接触史、服务年限以及在进行高风险操作时未使用呼吸防护设备，是医护人员中结核病的主要危险因素。本研究成功识别了医护人员中结核病的一些危险因素。我们设法纳入了较大比例的对照与病例（3:1），且病例跨度为10年。然而，由于本研究存在回忆偏倚、失访和样本量小等局限性，研究结果的应用需谨慎。基于研究结果，我们建议工作前10年的医护人员应采取额外的预防措施，如在进行被认为有高结核病感染风险的操作时使用呼吸防护设备。他们还应至少每2年进行一次结核病筛查，如有症状应接受预防性治疗。应全面实施呼吸防护计划，以帮助降低沙巴州医护人员感染结核病的风险。
