Enhancing Tuberculosis Prevention through community engagement and involvement: A case study in Sabah, Malaysia

Aim: to improve recognition of TB symptoms by migrant community in Sabah to facilitate earlier case finding. Context: Tuberculosis (TB) cases in Sabah, Malaysia, remain high, accounting for 20% of all cases in the country, with many individuals presenting with advanced disease, indicating a delay in diagnosis. Up to one third of these cases involve migrants, primarily characterised by low literacy rates, residing in high-density squatter areas without basic amenities. Intervention: In response to the imperative to reach out to this marginalised group for early diagnosis and prevention of continuous transmission within the community, we implemented a Community Engagement and Involvement (CEI) initiative. Identifying two hotspots, namely Kg Lok Kurai on Gaya Island and Kampung Bahagia in Sandakan, we planned a half-day exploration of their understanding of TB. Strategy for change: We developed simple, easy-to-understand health education materials tailored to these illiterate communities, educating them on the causes, symptoms, and modes of TB transmission to dispel prevalent misconceptions and stigma. Additionally, we conducted interviews with public healthcare personnel to gain contextual insights into TB care-seeking behaviors in the communities. A key aspect of this initiative involved training ten community volunteers at each site. These volunteers were equipped with pictorial flip charts and translated talks, empowering villagers, especially those without legal documentation, to seek medical assistance without fear. The CEI initiative facilitates the connection of community volunteers with public healthcare personnel, aiming to increase the referral of symptomatic cases to clinics. This enables ongoing communication with healthcare personnel to address any queries and assist in coordinating care. Impact: We plan to evaluate the effectiveness of this initiative after one year. Lessons: Willingness of community volunteers to engage? Barriers such as socioeconomic factors, lack of legal documents, and illiteracy were identified as hindrances to seeking healthcare.