DOTS has five main components, which can be summarized as government support, microscopes, observers, medicines and records.

1. Government Support
The Malaysian Government has identified TB as a major public health problem , and provides adequate funds and staffing at both Federal and State level to tackle the problem.

2. Microscopes
The best way to diagnose people with infectious TB is to examine their sputum by microscope. Smear-positive cases can spread the disease to others. They are also more likely to die of their disease if not treated. So, identifying the infectious (smear-positive) cases is the highest priority for TB control programmes.

3. Medicines.
Taking a full course of treatment is the key to TB control. This means that the TB control programme must guarantee a continuous and uninterrupted supply of high quality TB medicines to the patient.

4. Observers
TB treatment generally consists of a combination of drugs given over a period of 4 to 6 months or more. A treatment observer must watch a patient take his medicines for at least 2 full months of treatment, until the patient becomes non-infectious. Without such supervision up to 30% of patients tend to fail completing their treatment.

5. Records
A good monitoring system is essential to make sure the patients are taking their medicines. Proper registers must be maintained.

Failure to take medicines must be reported early and the reasons for default identified. (? financial ). Action must be taken to assist the patient , to ensure adherence to treatment.

Role of MAPTB

In Malaysia there is about 15% defaulter rate amongst TB patients. Early action must be taken to reduce this high rate.

MAPTB can play a very useful role in reducing this treatment defaulter rate because of its:

Guiding principles for MAPTB involvement in TB control

The following principles underline the best strategy for MAPTB involvement in the TB control programme.

1st principle.
The government has the primary responsibility for maintaining and improving public health. MAPTB must work with the government and become part of the National TB programme., and follow national policies.

2nd principle.
MAPTB’s role is to facilitate and support community action. It will take 5—10 years or more to control TB. MAPTB’s role is to strengthen the community’s capability to maintain services needed to fight TB.

3rd principle.
Need to use the inherent skills of the MAPTB personnel (eg. Advocacy, health education, case monitoring etc..) , and to integrate with other closely related NGO activities ( eg. Aids groups etc..)

MAJOR ACTIVITY of MAPTB in Malaysia
(where population needs information on TB)

Health education, information and communication.

Many people with TB lack awareness of the basic symptoms of TB. Many don’t know that diagnosis and treatment for TB is provided free by Government.

KEY ELEMENTS FOR SUCCESS OF MAPTB INVOLVEMENT

1. Collaboration.
Usually many groups are involved in the fight against TB. Important to work together to avoid duplication of effort.

2. Information.
Sharing of information on new developments in TB control to keep up to date, (newsletters, journals, conferences, meetings}. Training courses should form a vital activity of MAPTB.

3. Innovations.
Different situations will require different approaches and solutions. Within the National TB Policy guidelines MAPTB should be innovative whenever required.

4. Sustainability.
It will take a long time to eliminate TB as a public health problem. MAPTB should avoid any actions that endanger its own viability . Strong need to get new blood to ensure continuity.