Associated Factors for Positive CXR Among TB High Risk Group Screening in Kedah
Keywords:
Tuberculosis, screening, chest x-ray, high risk group, smokerAbstract
Screening for Tuberculosis (TB) using Chest X-Rays (CXR) among high-risk individuals is essential to help reach the End TB Strategy goal in reduction of 90% in TB incidence by 2035. Even though Ministry of Health Malaysia has made screening compulsory, the number of cases detected is not encouraging. Therefore, it is essential to identify factors contributing to positive screening that would improve case detection. High-risk groups are individuals that are compulsory to be screened using chest x-ray, regardless of presence or absence of TB symptoms. A cross sectional study was done in 2016 involving individuals belonging to TB high-risk groups who underwent screening in Kedah, Malaysia. Data was obtained from the TB information system (TBIS) 104 A, an information system used for TB screening monitoring and chest x-ray report of the selected individuals. It involved 1417 individuals who were randomly selected from various health facilities in six districts of Kedah. Among all 1417 study samples, 1036 (73.1%) individuals were asymptomatic. Among the asymptomatic individuals, only 91 (8.8%) had positive CXR findings. Smokers were found to have almost 3 times the odds of having positive CXR findings compared to non-smokers [Adjusted OR (95% CI): 2.71 (1.03, 7.15), p-value<0.05] when gender and age are controlled. The elderly age group had almost three times the odds of having positive CXR findings compared to the younger age group [adjusted OR (95% CI): 2.85 (1.83, 4.43), p-value <0.05]. Males had almost twice the odds of having positive chest x-ray compared to females [adjusted OR (95%CI): 1.7 (1.08, 2.09), p-value <0.05]. As a conclusion, smokers were important group of individuals that must be prioritised during high risk group TB screening, especially among males and elderly smokersReferences
World Health Organisation (2016). Global Tuberculosis Report 2016.
Disease Control Unit, Ministry of Health Malaysia (2017). Buletin Sektor TIBI & Kusta. Putrajaya: Kementerian Kesihatan Malaysia.
Jabatan Kesihatan Negeri Kedah (2016). Laporan Tahunan Unit TIBI Negeri Kedah, Kementerian Kesihatan Malaysia
UN. Improving Tuberculosis Case Detection. Stop TB Partnership, Chemin de Blandonnet 2 1214 Vernier, Geneva Switzerland, United Nations Office for Project Services (UNOPS) 2015
Borgdorff MW, Sebek M, Geskus RB, Kremer K, Kalisvaart N, van Soolingen D. The incubation period distribution of tuberculosis estimated with a molecular epidemiological approach. International journal of epidemiology. 2011;40(4):964-70.
Agizew T, Arwady M, Yoon J, Nyirenda S, Mosimaneotsile B, Tedla Z, et al. Tuberculosis in asymptomatic HIV-infected adults with abnormal chest radiographs screened for tuberculosis prevention. The international journal of tuberculosis and lung disease. 2010;14(1):45-51.
Jiménez-Fuentes M, Auge CM, Gómez M, Peiro JS, de Souza Galvao M, Maldonado J, et al. Screening for active tuberculosis in high-risk groups. The International Journal of Tuberculosis and Lung Disease. 2014;18(12):1459-65.
World Health Organisation (2013). Systematic screening for active tuberculosis, Principles and recommendations
Glaziou P, Sismanidis C, Floyd K, Raviglione M. Global epidemiology of tuberculosis. Cold Spring Harbor perspectives in medicine. 2019;5(2): a017798-a.
Nishikiori N, Van Weezenbeek C. Target prioritization and strategy selection for active case-finding of pulmonary tuberculosis: a tool to support country-level project planning. BMC public health. 2013;13(1):97.
Ministry of Health Malaysia (2016). Surat Pekeliling 1/2016: Pengukuhan Saringan Golongan Berisiko Tinggi TIBI Di Bawah Program Kawalan TIBI Kebangsaan. Putrajaya: Kementerian Kesihatan Malaysia.
Public Health Institute (2016). National Health Morbidity Survey (NHMS) 2016, Institut Kesihatan Umum.
Salwati NF, Nik Malek Template of X-Ray Reporting for TB Screening 2015.
Disease Control Unit, Ministry of Health Malaysia (2016). Buletin Sektor TIBI & Kusta. Putrajaya: Kementerian Kesihatan Malaysia.
Ministry of Health Malaysia (2015). National Strategic Plan for Ending AIDS. Putrajaya: Kementerian Kesihatan Malaysia.
Leung C, Chan C, Tam C, Yew W, Kam K, Au K, et al. Chest radiograph screening for tuberculosis in a Hong Kong prison. The international journal of tuberculosis and lung disease. 2005;9(6):627-32.
Leung C, Chan C, Tam C, Yew W, Kam K, Au K, et al. Chest radiograph screening for tuberculosis in a Hong Kong prison. The international journal of tuberculosis and lung disease. 2005;9(6):627-32.
Oh K, Kim H, Kim M. Non-communicable diseases and risk of tuberculosis in Korea. The International Journal of Tuberculosis and Lung Disease. 2016;20(7):973-7.
Kumar V, Abbas AK, Aster JC. Robbins basic pathology e-book: Elsevier Health Sciences; 2017.
Challenger A, Coleman T, Lewis S. Predicting default from smoking cessation treatment following enrolment. Health Education Journal. 2007;66(1):32-43.
Shiffman S, Ferguson SG, Dunbar MS, Scholl SM. Tobacco dependence among intermittent smokers. Nicotine & Tobacco Research. 2012;14(11):1372-81.
Downloads
Additional Files
Published
Issue
Section
License
JBCS Publication Ethics
JBCS is committed to ensure the publication process follows specific academic ethics. Hence, Authors, Reviewers and Editors are required to conform to standards of ethical guidelines.
Authors
Authors should discuss objectively the significance of research work, technical detail and relevant references to enable others to replicate the experiments. JBCS do not accept fraudulent or inaccurate statements that may constitute towards unethical conduct.
Authors should ensure the originality of their works. In cases where the work and/or words of others have been used, appropriate acknowledgements should be made. JBCS do not accept plagiarism in all forms that constitute towards unethical publishing of an article.
This includes simultaneous submission of the same manuscript to more than one journal. Corresponding author is responsible for the full consensus of all co-authors in approving the final version of the paper and its submission for publication.
Reviewers
Reviewers of JBCS treat manuscripts received for review as confidential documents. Therefore, Reviewers must ensure the confidentiality and should not use privileged information and/or ideas obtained through peer review for personal advantage.
Reviews should be conducted based on academic merit and observations should be formulated clearly with supporting arguments. In cases where selected Reviewer feels unqualified to review a manuscript, Reviewer should notify the editor and excuse himself from the review process in TWO (2) weeks time from the review offer is made.
In any reasonable circumstances, Reviewers should not consider to evaluate manuscripts if they have conflicts of interest (i.e: competitive, collaborative and/or other connections with any of the authors, companies, or institutions affiliated to the papers).
Editors 
Editors should evaluate manuscripts exclusively based on their academic merit. JBCS strictly do not allow editors to use unpublished information of authors  without the written consent of the author. Editors are required to take appropriate responsive actions if ethical complaints have been presented concerning a submitted manuscript or published paper.
CONFLICT OF INTEREST
Journal of Biomedical and Clinical Sciences requires authors to declare all competing interests in relation to their work. All submitted manuscripts must include a ‘competing interests section at the end of the manuscript listing all competing interests (financial and non-financial). Where authors have no competing interests, the statement should read ,The authors have declared that no competing interests exist. Editors may ask for further information relating to competing interests.
Editors and reviewers are also required to declare any competing interests and will be excluded from the peer review process if a competing interest exists. Competing interests may be financial or non-financial. A competing interest exists when the authors interpretation of data or presentation of information may be influenced by their personal or financial relationship with other people or organizations. Authors should disclose any financial competing interests but also any non-financial competing interests that may cause them embarrassment if they were to become public after the publication of the article.
HUMAN AND ANIMAL RIGHTS
All research must have been carried out within an appropriate ethical framework. If there is suspicion that work has not taken place within an appropriate ethical framework, Editors will follow the Misconduct policy and may reject the manuscript, and/or contact the author(s) institution or ethics committee. On rare occasions, if the Editor has serious concerns about the ethics of a study, the manuscript may be rejected on ethical grounds, even if approval from an ethics committee has been obtained.
Research involving human subjects, human material, or human data, must have been performed in accordance with the Declaration of Helsinki and must have been approved by an appropriate ethics committee. A statement detailing this, including the name of the ethics committee and the reference number where appropriate, must appear in all manuscripts reporting such research. Further information and documentation to support this should be made available to Editors on request.
Experimental research on vertebrates or any regulated invertebrates must comply with institutional, national, or international guidelines, and where available should have been approved by an appropriate ethics committee. The Basel Declaration outlines fundamental principles to adhere to when conducting research in animals and the International Council for Laboratory Animal Science (ICLAS) has also published ethical guidelines.
A statement detailing compliance with relevant guidelines (e.g. the revised Animals (Scientific Procedures) Act 1986 in the UK and Directive 2010/63/EU in Europe) and/or ethical approval (including the name of the ethics committee and the reference number where appropriate) must be included in the manuscript. The Editor will take account of animal welfare issues and reserves the right to reject a manuscript, especially if the research involves protocols that are inconsistent with commonly accepted norms of animal research. In rare cases, Editors may contact the ethics committee for further information.
INFORMED CONSENT 
For all research involving human subjects, informed consent to participate in the study should be obtained from participants (or their parent or guardian in the case of children under 16) and a statement to this effect should appear in the manuscript, this includes to all manuscripts that include details, images, or videos relating to individual participants.
DATA SHARING POLICY
JBCS strongly encourages that all datasets on which the conclusions of the paper rely should be available to readers. We encourage authors to ensure that their datasets are either deposited in publicly available repositories (where available and appropriate) or presented in the main manuscript or additional supporting files, in machine-readable format (such as spreadsheets rather than PDFs) whenever possible
Authors who do not wish to share their data must state that data will not be shared, and give the reason.
COPYRIGHT NOTICE
The JBCS retains the copyright of published manuscripts under the terms of the Copyright Transfer Agreement. However, the journal permits unrestricted use, distribution, and reproduction in any medium, provided permission to reuse, distribute and reproduce is obtained from the Journal's Editor and the original work is properly cited.
While the advice and information in this journal are believed to be true and accurate on the date of its going to press, neither the authors, the editors, nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Copyright (c) 2023 Journal of Biomedical and Clinical Sciences (JBCS)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.



