Strengthening TB Care for Malaysia’s Unsung Workforce

Despite medical advancements, Malaysia continues to grapple with TB, particularly among vulnerable populations like migrant workers. Systemic gaps in policy and healthcare access allow cases to go undiagnosed and untreated, fuelling further transmission.

WORDS DR JO ANN ANDOY GALVAN

FEATURED EXPERT DR JO ANN ANDOY GALVAN Senior Lecturer School of Medicine Faculty of Health and Medical Sciences Taylor’s University

Migrant workers, both documented and undocumented, face significant barriers to healthcare access, which increases their risk of tuberculosis (TB) transmission.

Many live and work in high-traffic environments such as restaurants, construction sites, and factories — crowded settings where TB can spread easily.

OUR COUNTRY PROVIDES FREE TB TREATMENT FOR ALL

• The Ministry of Health provides free TB treatment for all, including foreign workers.
• Through decentralization, treatment facilities have expanded into underserved semi-urban and rural areas, reducing barriers to healthcare.
• This initiative, eliminating costs for everyone, marks a significant step toward eradicating TB in Malaysia.

CHALLENGES TO THIS INITIATIVE

• The fear of deportation discourages undocumented workers from seeking medical care, often leading to delayed diagnosis and treatment.
• Documented workers who test positive for TB during mandatory screenings often face refusal to renew their work permit by relevant authorities.
• During the annual health screening process for migrant workers suspected with latent TB infection (LTBI) — a non-contagious, treatable condition that has not progressed to active disease, are deemed unfit with no opportunity for treatment and continuation of work in the country. Their work permits are denied with no exceptions.

Latent TB Infection (LTBI)

One of the key challenges in TB prevention is the lack of differentiation between two types:

Active TB disease

• Shows symptoms
• Is contagious
• Requires immediate treatment

Latent TB infection (LTBI)

• No symptoms
• Not contagious
• Has the potential to become active (see above)

Currently, the Immigration Department of Malaysia refuses to renew work permit of workers who test positive for TB through the QuantiFERON-TB Gold (QFT-G) test, without distinguishing between active and latent infection.

As a result, individuals with LTBI lose their legal work status.

• This outcome forces many to choose between health and survival.
• Driven by the need to support families back home, some sacrifice their health and avoid seeking treatment — a decision that increases the risk of TB transmission within the community.

WHAT SHOULD BE DONE ABOUT WORKERS WITH LTBI

• Instead of refusal of work permit renewal, migrant workers diagnosed with LTBI should be encouraged to seek treatment at Klinik Kesihatan under Directly Observed Therapy (DOT) or regular follow up for those able to comply.
• This approach would prevent the progression to active TB.
• It will also reduce the risk of possible transmission rates and strengthening Malaysia’s TB control efforts.

A CALL FOR ACCELERATED ACTION

Malaysia’s National Strategic Plan to End TB (2021-2030) aligns with the World Health Organization’s End TB Strategy.

Yet gaps remain in addressing active TB and LTBI among migrant workers.

A multidisciplinary, evidence-based approach is essential to improve TB prevention and treatment.

Interagency Collaboration

The Immigration Department of Malaysia, Department of Occupational Safety & Health Malaysia (DOSH), Malaysia’s Foreign Workers Medical Examination Monitoring Agency (FOMEMA), and employment agencies must coordinate data-sharing and policy integration.

Legal Protection for LTBI Cases

Legal migrant workers with LTBI should receive treatment and support without the risk of work permit renewal refusal.

Refined Screening Protocols

Positive QFT-G results should prompt secondary testing such as chest X-ray and sputum test to confirm active disease before initiating treatment or making public health decisions.

Comprehensive Patient Follow-Up and Adherence Monitoring

Robust tracking systems should be implemented to monitor patient adherence through digital tools (SMS reminders, mobile apps), home visits, or direct healthcare provider engagement.

A patient-centered approach should also be adopted when screening close contacts to ensure early detection and timely intervention.

Health Education Initiatives

Medical professionals should educate migrant workers on early detection, adherence to treatment, and prevention of TB transmission among vulnerable populations.