Disease In Malaysia Research Articles

Mycotoxigenic potential of Fusarium species associated with pineapple diseases

Five species of Fusarium, F. proliferatum, F. fujikuroi, F. verticillioides, F. sacchari, and Fusarium sp. are associated with pineapple fruit rot and leaf spot diseases in Malaysia. Their ability to produce mycotoxins was analysed by the detection of the FUM1 gene as an indicator of fumonisin B1 (FB1) production and by quantification of FB1, moniliformin (MON), and beauvericin (BEA) using ultra performance liquid chromatography. All isolates of F. proliferatum, F. fujikuroi, and F. verticillioides showed the presence of FUM1 band and were able to produce FB1 in vitro. MON was produced by all isolates of Fusarium species, however, BEA was produced only by F. verticillioides isolates and some F. proliferatum, F. fujikuroi, and Fusarium sp. isolates. Production of FB1, MON, and BEA in vitro can be used to predict mycotoxigenic potential of the Fusarium spp. associated with pineapple diseases.

Prevalence of latent tuberculosis among refugee children in Malaysia.

IntroductionTuberculosis remains one of the top 10 major causes of global mortality, imposing social–economic and medical challenges in Malaysia. Refugees sheltered in Malaysia are a high-risk population but basic health checks upon their arrival, including tuberculosis screening, are not practised. This study aimed to identify the prevalence and risk factors of tuberculosis and latent tuberculosis infection (LTBI) among refugee children in Malaysia.MethodsA cross-sectional study was performed in three refugee schools in the Klang Valley, Malaysia, using tuberculin skin tests or interferon-γ release assays. Participants who tested positive were sent for further examination with chest radiography to confirm the tuberculosis diagnosis.ResultsFrom April 2018 to April 2019, we screened 430 refugee children with a median age of 13.0 years. Most of the children were born in Myanmar (n=274, 63.7%) and Pakistan (n=60, 14.0%). No children were diagnosed with active tuberculosis but 55 of the children (12.8%) were diagnosed with LTBI. Children with LTBI were generally older (OR 3.01, 95% CI 1.71–5.29; p<0.001) than those without LTBI infection. Sex, history of bacille Calmette–Guérin vaccination and country of birth were not associated with increased risk of LTBI.ConclusionThe relatively high LTBI burden among refugee children in this study poses an indication of possible LTBI risk among this population nationwide, and thus would be an important group to target for preventive therapy. This provides a unique opportunity for researchers to further examine and implement well-structured preventive strategies in combating the endemic infectious disease in Malaysia.

A novel de novo NLRC4 mutation reinforces the likely pathogenicity of specific LRR domain mutation

Autoinflammatory disorders are characterized by dysregulated innate immune response, resulting in recurrent uncontrolled systemic inflammation and fever. Gain-of-function mutations in NLRC4 have been described to cause a range of autoinflammatory disorders. We report a twelve-year-old Malay girl with recurrent fever, skin erythema, and inflammatory arthritis. Whole exome sequencing and subsequent bidirectional Sanger sequencing identified a heterozygous missense mutation in NLRC4 (NM_001199138: c.1970A > T). This variant was predicted to be damaging in silico, was absent in public and local databases and occurred in a highly conserved residue in the leucine-rich repeat (LRR) domain. Cytokine analysis showed extremely high serum IL-18 and IL-18/CXCL9 ratio, consistent with other NLRC4-MAS patients. In summary, we identified the first patient with a novel de novo heterozygous NLRC4 gene mutation contributing to autoinflammatory disease in Malaysia. Our findings reinforce the likely pathogenicity of specific LRR domain mutations in NLRC4 and expand the clinical spectrum of NLRC4 mutations.

An IoT Based Ovitrap System Applied for Aedes Mosquito Surveillance

Since the number of dengue fever cases has become the endemic disease in Malaysia, it is urgently need for rapid and efficient calculation of mosquito populations particularly for early detection and control measures. An ovitrap surveillance is used to determine the density of Aedes mosquito and it is one of the implemented method for vector control application. In this study, the prototype of an IoT-based ovitrap system was developed to automatically and simultaneously detect the Aedes mosquitoes using NodeMCU as the main IoT platform. The existing sticky ovitrap was modified to integrate the selected IoT components and to ensure its functionality for automatic detection. There are two phases were conducted in this study, with phase 1 evaluating the right IoT components to be selected and applied for automatic detection. Integrating the selected IoT components and modification of present ovitrap was carried out in phase 2 and the final revised design was considered. SWOT analysis and Pugh chart analysis also known as decision matrix method were used to select the best IoT components and final ovitrap design. It has been observed that the prototype D was the best design and be able to detect the adult mosquitoes. The lessons learned in the development of the IoT-based ovitrap were discussed in order to be employed for Aedes mosquitoes surveillance in the future.

Assessing receptiveness to change among primary healthcare providers by adopting the consolidated framework for implementation research (CFIR)

BackgroundAmid the current burden of non-communicable (NCD) diseases in Malaysia, there is a growing demand for more efficient service delivery of primary healthcare. A complex intervention is proposed to improve NCD management in Malaysia. This exploratory study aimed to assess primary healthcare providers’ receptiveness towards change prior to implementation of the proposed complex intervention.MethodThis study was conducted using an exploratory qualitative approach on purposely selected healthcare providers at primary healthcare clinics. Twenty focus group discussions and three in-depth interviews were conducted using a semi-structured interview guide. Consent was obtained prior to interviews and for audio-recordings. Interviews were transcribed verbatim and thematically analysed, guided by the Consolidated Framework for Implementation Research (CFIR), a framework comprised of five major domains promoting implementation theory development and verification across multiple contexts.ResultsThe study revealed via CFIR that most primary healthcare providers were receptive towards any proposed changes or intervention for the betterment of NCD care management. However, many challenges were outlined across four CFIR domains—intervention characteristics, outer setting, inner setting, and individual characteristics—that included perceived barriers to implementation. Perception of issues that triggered proposed changes reflected the current situation, including existing facilitating aspects that can support the implementation of any future intervention. The importance of strengthening the primary healthcare delivery system was also expressed.ConclusionUnderstanding existing situations faced at the primary healthcare setting is imperative prior to implementation of any intervention. Healthcare providers’ receptiveness to change was explored, and using CFIR framework, challenges or perceived barriers among healthcare providers were identified. CFIR was able to outline the clinics’ setting, individual behaviour and external agency factors that have direct impact to the organisation. These are important indicators in ensuring feasibility, effectiveness and sustainability of any intervention, as well as future scalability considerations.

SAT-212 Is Chronic Kidney Disease on the rise in Malaysia? Findings from a nationwide study

CKD represents a significant public health problem because of its associated socio-economic and health consequences. In 2011 the National Health and Morbidity Survey (NHMS) showed a 9.07% prevalence of CKD in West Malaysia. and identified diabetes, hypertension and older age as risk factors. The objective of this population-based study was to determine the trend in prevalence and risk factors of CKD in adults aged >18 years in both East and West Malaysia. A total of 1398 individuals ≥ 18 years old, representative of the adult population in Malaysia was randomly selected using a stratified cluster method. Respondents completed a lifestyle and medical history questionnaire and had blood pressure measured before blood and urine samples were taken. Glomerular filtration rate (eGFR) was estimated from calibrated serum creatinine using the CKD-EPI equation. Urinary albumin and creatinine were tested to assess albuminuria. CKD was defined as eGFR < 60 ml/min/1.73m2 or the presence of persistent albuminuria if eGFR ≥ 60 ml/min/1.73m2. The national CKD prevalence was estimated using complex design analysis where the sampling procedure and the population weight were adjusted for gender and urban/rural residence. Multivariate analysis was used to identify risk factors for CKD. A total of 1,047 individuals (75%) agreed to participate in this study. Of these, 977 respondents had serum creatinine measured. The final analysis set comprised 890 respondents i.e. those with eGFR< 60 ml/min/1.73m2 (N = 65) and those with eGFR ≥ 60 ml/min/1.73m2 who either had an initial negative urine albumin creatinine ratio (ACR) (N = 691) or a repeated sample of urine if the initial urine ACR was positive (N = 134). Mean age of respondents was 48.8 years, 41.1% were males, 19.6% had diabetes and 51% had hypertension. The overall prevalence of CKD was 15.48% (95% CI: 12.30, 19.31). An estimated 3.85% had stage 1 CKD (eGFR > 90 ml/min/1.73m2 and persistent albuminuria), 4.82% had stage 2 (eGFR of 60 – 89 ml/min/1.73m2 and persistent albuminuria), and 6.81% had stage 3 - 5 (eGFR < 60ml/min/1.73 m2). Only 5% of respondents with CKD were aware of their diagnosis. Risk factors for CKD included increasing age (aOR 1.06), Body Mass Index (aOR 1.06), diabetes mellitus (aOR 3.32) and hypertension (aOR 3.72). The prevalence of CKD in Malaysia has increased from 9.07% in 2011 to 15.48% in 2018. The risk factors for CKD are highly prevalent among the Malaysian population and now include Body Mass Index. The National CKD prevention program, adopted into the National Strategic Plan for Non-Communicable Disease in Malaysia in 2018, needs to be successfully implemented to address the rising tide of CKD.

A review of betanodavirus vaccination as preventive strategy to viral nervous necrosis (VNN) disease in grouper

Viral disease outbreak is the most serious issue as it may cause severe losses to farmers as well as to economy in the marine industry worldwide. Among fish viral diseases, betanodavirus is a significant pathogen that causes viral nervous necrosis (VNN) and can result in mass mortalities to fish culture especially at larval stages. In Malaysia, betanodavirus had been isolated from groupers, seabass, red snappers, and golden pomfret. Recently, inconsistent seed supply is observed due to viral infection at larval stages which limits the growth of fish culture. Therefore, seeds of grouper are often imported from neighboring countries such as Indonesia by farmers. Strict importation regulations should be practiced as the importation of fish seeds may become a possible source of the virus entering the country. It is a challenge to track farmers who are affected by the disease in order to segregate or eliminate the VNN carrier spawners. This scenario had resulted in incomplete destruction of diseased fish population and leads to re-occurrence of the disease at the early stage of grouper. This situation warrants immediate attention to develop promising prevention strategies such as a new vaccine which is very important and could work effectively with better farm management approaches. This article discusses the occurrence of viral nervous necrosis (VNN) disease in Malaysia and reviews possible preventive measures via vaccination to combat the disease.

A four-decade analysis of the incidence trends, sociodemographic and clinical characteristics of inflammatory bowel disease patients at single tertiary centre, Kuala Lumpur, Malaysia

BackgroundInflammatory bowel disease (IBD) was once considered as a Western disease. However, recent epidemiological data showed an emerging trend of IBD cases in the Eastern Asia countries. Clinico-epidemiological data of IBD in Malaysia is scarce. This study aimed to address this issue.MethodsRetrospective analysis of ulcerative colitis (UC) and Crohn’s disease (CD), diagnosed from January 1980 till June 2018 was conducted at our centre.ResultsA total of 413 IBD patients (281 UC, 132 CD) were identified. Mean crude incidence of IBD has increased steadily over the first three decades: 0.36 (1980–1989), 0.48 (1990–1999) and 0.63 per 100,000 person-years (2000–2009). In the 2010 to 2018 period, the mean crude incidence has doubled to 1.46 per 100,000 person-years. There was a significant rise in the incidence of CD, as depicted by reducing UC:CD ratio: 5:1 (1980–1989), 5:1 (1990–1999), 1.9:1 (2000–2009) and 1.7:1 (2010–2018). The prevalence rate of IBD, UC and CD, respectively were 23.0, 15.67 and 7.36 per 100,000 persons. Of all IBD patients, 61.5% (n = 254) were males. When stratified according to ethnic group, the highest prevalence of IBD was among the Indians: 73.4 per 100,000 persons, followed by Malays: 24.8 per 100,000 persons and Chinese: 14.6 per 100,000 persons. The mean age of diagnosis was 41.2 years for UC and 27.4 years for CD. Majority were non-smokers (UC: 76.9%, CD: 70.5%). The diseases were classified as follows: UC; proctitis (9.2%), left-sided colitis (50.2%) and extensive colitis (40.6%), CD; isolated ileal (22.7%), colonic (28.8%), ileocolonic (47.7%) and upper gastrointestinal (0.8%). 12.9% of CD patients had concurrent perianal disease. Extra intestinal manifestations were observed more in CD (53.8%) as compared to UC (12%). Dysplasia and malignancy, on the other hand, occurred more in UC (4.3%, n = 12) than in CD (0.8%, n = 1). Over one quarter (27.3%) of CD patients and 3.6% of UC patients received biologic therapy.ConclusionThe incidence of IBD is rising in Malaysia, especially in the last one decade. This might be associated with the urbanization and changing diets. Public and clinicians’ awareness of this emerging disease in Malaysia is important for the timely detection and management.

An Epidemiological Review on Emerging and Re-Emerging Parasitic Infectious Diseases in Malaysia

Emerging infectious diseases are infections that have recently appeared in a population over a defined period of time whereas, re-emerging infectious diseases are those that were once a health problem in a particular region or a country and are now emerging again. Parasitic infectious diseases represent a serious health problem in many developing countries and recently have started spreading to developed nations via international traveling or immigration. Malaysia is facing many challenges caused by various parasitic pathogens. The lack of awareness among disadvantaged populations such as the Orang Asli community and the dependency on foreign workers has led to an influx of immigrants to Malaysia from countries endemic to various parasitic diseases. Understanding the social and economic dynamics of such diseases can help anticipate and subsequently control their emergence. Raising public awareness, developing robust public health infrastructure and implementing point-of-care diagnostics will help curb the spread of such diseases. This review provides epidemiological insights into the reported emerging and re-emerging parasitic infectious diseases in Malaysia over the past two decades.

Consensus among healthcare stakeholders on a collaborative medication therapy management model for chronic diseases in Malaysia; A Delphi study.

BackgroundThe general problem is lack of inter-professional collaboration and the way private primary care responds to manage chronic diseases in Malaysia. Absence of prescription review, inadequate patient education, the highest percentage of prescribing errors and half of the chronic disease patients are nonadherent. Medicines are the most common and life long used interventions in chronic diseases. Hence, the need to manage medicine in chronic diseases becomes obligatory. As both general practitioner and community pharmacist can dispense medications, this has resulted in a business rivalry. There is a need to build consensus among various healthcare stakeholders for a collaborative medication therapy management model (CMTM) where community pharmacist has an active role in chronic care.MethodThis study utilized modified e-Delphi method to build consensus. A validated e-Delphi survey was administered to a purposive sample of 29 experts. Consensus was pre-defined to be the point where >85% of the experts fall in either agree or strongly agree category for each statement. The inter-expert agreement was computed in both rounds using Intra-class correlation coefficient and Kendall's W. Delphi operates in an iterative fashion till there comes stability in responses. At the end of each round, experts were provided aggregate response, their own response and choice to change their response in the light of aggregate response.ResultsResponse rate was 70.73% and 100% in 1st and 2nd round, respectively. Consensus was achieved on 119/132 statements which mainly referred to the need, structural and regulatory aspects of CMTM model in Malaysia. However, there were some flashpoints on dispensing separation and means to finance this model. Stability in response of experts was achieved after 2nd round; hence, no next round was executed.ConclusionOverall, the study findings witnessed the expert panel’s support for the CMTM model. Study helped to sketch CMTM model and facilitated development of some recommendations to the authorities which may help to formulate a policy to bring CPs under a working relationship with GPs. Hence, this study should be taken as a call for redefining of the roles of CPs and GPs in Malaysia.

The 2017 M Balasegaram Memorial Lecture: The Changing Landscape of Liver Diseases in Malaysia—60 Years On!

The landscape of liver diseases in Malaysia has changed dramatically since the time of Professor Balasegaram Manickavasagar—an eminent surgeon in the 1960s.The most significant discoveries in hepatology have been that of hepatitis B virus in 1963 and hepatitis C virus in 1989, which have both been shown to be predominantly blood borne diseases.Hepatitis B and C infections result in long term carrier state and a high propensity to develop liver cirrhosis and cancer. Hepatitis B is the most common cause of liver cirrhosis and cancer in Malaysia. Blood bank screening and public health preventive measures have reduced the disease burden significantly and an effective vaccination for hepatitis B is now incorporated in our National Immunisation Programme. Although no vaccine is available for hepatitis C, highly effective eradication therapies were introduced in 2011. These agents will significantly change the disease scenario across the world.A “new” disease was described in 1980, by Ludwig et al.—non-alcoholic fatty liver (NAFLD) disease. With the global epidemic of obesity and diabetes mellitus, NAFLD is set to increase exponentially across the world including in Malaysia. It will be the most important liver disease in the future, replacing hepatitis B and C infections.

Melioidosis and scrub typhus co-infection in a patient presenting with acute undifferentiated febrile illness

Melioidosis and scrub typhus are endemic diseases in Malaysia. However, unlike melioidosis, scrub typhus is more difficult to be diagnosed and in Malaysia its true disease burden is unknown. We report a case of severe melioidosis and scrub typhus co-infection in a patient living in a small village in Peninsular Malaysia whom presented with fever and headache. This case highlights the importance of considering scrub typhus as a diagnostic possibility in cases of acute undifferentiated febrile illness in rural areas such as that of in Peninsular Malaysia.

Analysis of codon usage patterns and influencing factors in Nipah virus

Codon usage bias (CUB) is the unequal usage of synonymous codons of an amino acid in which some codons are used more often than others and is widely used in understanding molecular biology, genetics, and functional regulation of gene expression. Nipah virus (NiV) is an emerging zoonotic paramyxovirus that causes fatal disease in both humans and animals. NiV was first identified during an outbreak of a disease in Malaysia in 1998 and then occurred periodically since 2001 in India, Bangladesh, and the Philippines. We used bioinformatics tools to analyze the codon usage patterns in a genome-wide manner among 11 genomes of NiV as no work was reported yet. The compositional properties revealed that the overall GC and AT contents were 41.96 and 58.04%, respectively i.e. Nipah virus genes were AT-rich. Correlation analysis between overall nucleotide composition and its 3rd codon position suggested that both mutation pressure and natural selection might influence the CUB across Nipah genomes. Neutrality plot revealed natural selection might have played a major role while mutation pressure had a minor role in shaping the codon usage bias in NiV genomes.

Geospatial-Based Model for Diagnosing Potential High-Risk Areas of Tuberculosis Disease in Malaysia

Malaysia has a medium burden of tuberculosis (TB) incidence based on World Health Organization (WHO) indicator, but the current trend of TB cases is generally alarming. The Ministry of Health (MOH), Malaysia has set up several guidelines to control the disease, however, the national TB technical report in 2015 addressed that existing detection methods of TB on the site still need to be integrated with relevant alternatives. A geospatial based model is proposed to identify potential high-risk areas of TB especially for targeting missing cases and undiagnosed people. The model was developed with three core stages; framework construction, data collection, and risk analysis and modelling. Eight risk factors: urbanisation, distance to factory, socio-economic status (SES), risk group, human mobility, house type, distance to healthcare centres, and number of population were utilised to determine risk rate of TB modelling. This innovative model has successfully estimated a 65 % of potential high-risk TB areas and targeted 106 high-risk localities in the 10 risk sections of the study area. These risk localities have general similarities with other endemic areas worldwide, but there are some interesting findings revealed in this local study towards in the TB control programme. Most of these cases did not only occur in high rise housing areas, but they are concentrated at industrial location, mobility pattern and socio-economic status in urban city. Although, urban areas are favoured area for the local TB, the disease could also potentially occur in semi-urban or rural areas.

Effects of global warming on the incidence of infectious diseases in Malaysia

Global warming has its impact on infectious diseases by effecting the pathogen, host and transmission. This study aimed to assess the effect of climate change by measuring the incidence of certain infectious diseases.

Psychosocial Distress and Blood Pressure among Young Adults: Role of Cortisol as Mediator

Introduction: Hypertension is the most prevalent risk factor of cardiovascular diseases in Malaysia. 17.3% of hypertension cases in Malaysia is attributed to adults aged 18 to 39 years. Psychosocial distress is a possible risk factor for elevated blood pressure in young adults, and cortisol could be the mediating factor. The aim of this study is to evaluate the mediating role of cortisol in hypertension and psychosocial distress in young adults. Materials and Methods: A comparative crosssectional study was conducted in 240 young adults aged 45 years or less. The body mass index, waist circumference and blood pressure parameters were recorded. Serum cortisol, creatinine, fasting blood glucose and lipid profile were measured following acute mental stress test. Psychosocial distress was assessed using the DASS-21 questionnaire. Results: Mean (standard deviation) values for SBP, DBP and MAP were 126.0 (16.3), 84.1 (12.2) and 98.1 (13.1) mmHg respectively. Anxiety was significantly associated with systolic blood pressure (β = 0.644), diastolic blood pressure (β = 0.454) and mean arterial pressure (β = 0.516) after adjusting to sex, age and cortisol. However, it was not mediated by cortisol. Depression and stress were not found to have any effect on blood pressure of the young adults studied. Conclusion: The data suggest that there is no elevated risk for psychosocial distress and hypertension that cortisol poses in young adults.

Bacteriology in Diabetic Foot Infections: A Multicentre Crosssectional Study in Malaysia and Comparison with Southeast Asia Countries

Introduction: Diabetes mellitus is a major non-communicable disease in Malaysia and Southeast Asian Countries. In this study, we aimed to determine the microbiological profile of diabetic foot infection and the antibiotic susceptibility in Malaysia and to compare our findings with that from other Southeast Asia countries. Materials and Methods: A cross-sectional study was conducted in three district hospitals (Bentong, Raub and Kuala Lipis) from the 1 st January to the 31st December 2016. Microbiological profiles of intra-operative deep tissue and bone samples from diabetic foot infection were included. Studies reporting the microbiological profiles from Southeast Asia countries were reviewed and the data were extracted for comparison. Results: A high incidence of gram negative pathogens was isolated (73.4%). The predominant pathogens isolated included Staphylococcus sp (17.5%), Klebsiella sp (17%), Pseudomonas sp (15.4%) and Proteus sp (13.8%). Among those gram negative pathogens tested, a high number of them were resistant to ampicillin and amoxicillin/clavulanic acid. They were sensitive to imipenem (98.9%), tazosin (97.7%) and ampicillin-sulbactam (84.8%). All Southeast Asian countries studied except Singapore have high gram negative to gram positive pathogens ratio. Conclusion: The empirical antibiotics should be tailored to the local bacteriological profiles of diabetic foot infection.

Malaysian Ropac Registy: Pregnancy with Structural Heart Disease in Malaysia

Malaysian Ropac Registy: Pregnancy with Structural Heart Disease in Malaysia

Economic benefit of leptospirosis prevention in Kelantan, Malaysia: Willingness-to-contribute approach.

Leptospirosis is an endemic disease in Malaysia. Despite the increasing incidence rate, knowledge on the economic assessment of preventing leptospirosis is still limited. This paper introduces the willingness-to-contribute (WTC) method for estimating the economic benefit of preventing leptospirosis. A cross-sectional study using the WTC method was applied to measure how much time respondents in Kelantan were willing to contribute toward preventing leptospirosis. Study respondents were wet market traders aged 18years old and above who were fluent in the Malay language. The average WTC value was multiplied by the population of Kelantan to derive the monetary value of preventing leptospirosis. Two hundred and fifty respondents participated in the study. The mean time contribution was 6.68hours (SD9.01) per month. The average WTC corresponded to a monthly cost savings of US$4.94 per person. Approximately between US$106.7million to US$315million per annum can be saved through the prevention of leptospirosis in Kelantan. Preventing leptospirosis is beneficial to Kelantan and would bring major economic savings. The findings are intended to help policy makers in the planning and management of leptospirosis policies and interventions.

Demographic, socio-economic and behavior as risk factors of tuberculosis in Malaysia: a systematic review of the literature.

Background Tuberculosis (TB) is making a comeback and has remained one of the main causes of mortality among the list of infectious diseases in Malaysia. Objective To evaluate the burden and demographic, socio-economic and behavior as risk factors of TB among communities in Malaysia. Method A comprehensive search of Scopus, Sciencedirect, PubMed, DOAJ, CINAHL Plus, MyJournal, BIREME, BMC Public Health, Medline, CAB, EMBASE (Excerpta Medica dataBASE), and Web of Science (WoS) was undertaken from the articles published from 1st January 2008 to 31st December 2017 using medical subject heading (MeSH) key terms. Results Of 717 papers screened, 31 eligible studies met our inclusion criteria. Gender, age, marriage status, ethnicity, area of living, being in prison and immigrant were evaluated as demographic factors, while educational level, occupation and household income were evaluated as socio-economic factors. For behavioral factors, smoking, drug abuse, alcohol consumption and other lifestyle practices were evaluated. However, not all the studies were statistically significantly associated with these risk factors. Studies on household income were few and too small to permit a conclusion. We also did not find any study that investigated TB infection among sex workers. Conclusion Immigrant in high density settings may increase the progression of disease infection in Malaysia. The risk factors for the development of TB, specifically in a high-risk population, should be targeted through the implementation of specialized interventions. Further research into the role of indoor and outdoor physical environments is required to better understand the association between the physical environment and the social environment with TB infection.