Sabah records Malaysia’s highest TB cases: The reality on the ground

PAUL (not his real name) is a 45-year-old construction worker living on the outskirts of Kota Kinabalu. He shares a small hostel room with four other men. Dust fills the air at work and coughing often feels routine in that environment. When the cough refused to disappear, when night sweats followed, and when his body weight began to drop, he finally visited a clinic. The diagnosis was tuberculosis.

The medication did not scare him. The silence did. Some roommates stopped sitting near him. One colleague asked quietly whether he would be sent home. Paul worried about losing his income more than losing his health. Missing work even briefly meant uncertainty for his family in Beaufort. His story reflects how tuberculosis intersects with work and crowded living conditions in Sabah.

Tuberculosis remains a major infectious disease. The World Health Organization estimates that in 2024, 10.7 million people developed TB and 1.23 million died. It spreads through airborne droplets, particularly in crowded and poorly ventilated environments.

Malaysia’s situation reflects this global struggle. The Ministry of Health Malaysia reported 26,781 tuberculosis cases in 2023, with national incidence at 76.9 per 100,000 population in 2024. Tuberculosis remains a significant cause of preventable death, with 2,580 TB-related deaths recorded in 2024. The plan focuses on early detection, preventive therapy, strengthening treatment adherence, and reducing transmission in vulnerable communities.

Recent Ministry of Health surveillance confirms that Sabah remains at the centre of Malaysia’s tuberculosis burden. As of Epidemiological Week 6 of 2026, Sabah recorded 755 TB cases, the highest number in the country, surpassing more populous states such as Selangor and Johor. Nationally, 3161 cases were reported during the same period, representing a 9.8% increase compared to the previous year. Importantly, 85% of cases involve Malaysians, highlighting that TB transmission is largely driven by local conditions rather than external factors. These findings reinforce that TB in Sabah remains driven by structural determinants including geography, socioeconomic vulnerability, and barriers to early diagnosis. Sabah has consistently recorded the highest TB burden among Malaysian states for more than a decade, accounting for a disproportionate share relative to its population size.

Distance remains a major barrier. Many rural communities are hours from diagnostic facilities, and transport costs and lost wages discourage timely care. These indirect costs lead some to delay testing or miss follow-up appointments.

Housing conditions also play a role. Worker hostels and plantation quarters often have poor ventilation and crowded conditions, allowing TB bacteria to circulate easily. TB affects both migrant and local Sabahan communities, particularly those facing poverty and undernutrition.

I spoke to Dr. Noorhafizah binti Asmat, Medical Officer at Putatan Health Clinic, who oversees the PR1 Putatan (Pusat Rawatan) for tuberculosis. She said, “In Sabah, distance and employment conditions remain major barriers to early tuberculosis detection. Many patients living in remote areas or working in construction sites, plantations, or crowded hostels delay seeking care because transport is costly and missing work means lost income. As a result, they often present late, sometimes after weeks or months of symptoms. Our district TB teams play an important role in ensuring early diagnosis, contact tracing, and treatment supervision to prevent further transmission.”

TB is notifiable under the Prevention and Control of Infectious Diseases Act 1988 (Act 342), requiring case reporting, contact tracing, and treatment monitoring under national guidelines. On paper, the strategy is sound. On the ground in Sabah, challenges remain. Rural terrain limits outreach. Clinics face staffing pressures. Language barriers can complicate communication in multiethnic communities. Poverty and undernutrition weaken immunity, increasing the chance that latent infection becomes active disease. Stigma discourages people from coming forward. Some Sabahan patients have described being avoided by neighbours or losing customers when others learn about their illness.

Drug resistant TB presents an even greater challenge. These cases occur when TB bacteria no longer respond to standard first line anti tuberculosis medications, often as a result of incomplete or interrupted treatment. Management requires longer treatment regimens, sometimes extending beyond 18 months, with more complex drug combinations and closer clinical monitoring. National and global data show that treatment success rates for drug resistant TB are significantly lower than for drug sensitive TB. In Sabah, the challenges of distance, treatment adherence, and socioeconomic barriers make sustained supervision more difficult, increasing the risk of prolonged illness and continued transmission.

TB often begins quietly. A cough lasting more than two weeks, night sweats, unexplained weight loss, fever, or coughing up blood are important warning signs. These symptoms should never be ignored. Early testing protects families and coworkers. There is also latent TB, where a person carries the bacteria without symptoms and is not infectious. However, latent infection can develop into active disease later, particularly when immunity weakens. Close contacts and individuals in crowded settings should be screened when advised.

Recent MOH surveillance has identified tuberculosis clusters in close contact settings such as households, worker hostels, workplaces, and institutional environments, highlighting the importance of early case detection and contact investigation. These findings have prompted intensified screening, contact tracing, and treatment supervision, particularly in high burden areas such as Sabah where crowded living and working conditions increase transmission risk. Health teams conduct screening, contact tracing, and directly observed therapy (DOTS), a cornerstone of Malaysia’s National Tuberculosis Control Programme. Under this system, healthcare workers or trained supervisors observe patients taking their medication regularly, ensuring the full course of treatment is completed. Treatment typically lasts at least six months, and supervision reduces interruption, prevents drug resistance, and improves cure rates.

Ministry of Health Malaysia surveillance shows that TB transmission remains active at community level. As of February 2026, 10 TB clusters were reported nationwide, with all clusters still under active monitoring by health authorities with many linked to close contact settings such as households, workplaces, and institutional environments. The MOH has strengthened digital surveillance through MySejahtera to monitor infectious disease activity and respond to emerging clusters.

District TB teams led by Medical Officers coordinate diagnosis, treatment initiation, contact tracing, treatment supervision, and completion certification, supported by multidisciplinary teams including Assistant Medical Officers (AMO), nurses, laboratory staff, pharmacy personnel, and public health specialists.

For Sabahan readers, prevention and early action are essential. Tuberculosis is curable, but delayed diagnosis allows transmission to continue. Anyone with a cough lasting more than two weeks, unexplained weight loss, night sweats, or coughing up blood should seek medical evaluation promptly. Covering the mouth when coughing, wearing a mask when unwell, and improving ventilation by opening windows can reduce transmission risk. Most importantly, patients diagnosed with TB must complete the full course of treatment, even when symptoms improve. Treatment interruption increases the risk of drug resistance and prolonged illness. Early detection and full treatment remain the most effective tools in protecting families and communities.

Paul is now on treatment and regaining strength. His case was reported as required. His close contacts were screened. His recovery shows the system can work. Yet Sabah’s numbers remind us that TB in Sabah is not only a medical issue. It is tied to living conditions, work environments, access to care, and social attitudes. With strong law, clear policy, supportive employers, and community understanding, Sabah can reduce this burden. World Tuberculosis Day, observed annually on 24 March, carries the 2026 theme “Yes! We Can End TB: Commit, Invest, Deliver,” reinforcing that tuberculosis is curable but requires sustained awareness, early detection, and community support to protect families and communities across Sabah.

Melvin Ebin Bondi is a PhD candidate in Public Health at Universiti Malaysia Sabah. He writes a weekly public health column for The Borneo Post.