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TB remains a major global and Malaysian public health threat, despite the availability of effective medical treatments.

The challenge of TB extends beyond medical care—social stigma plays a critical role in hindering control and recovery.

Stigma can be as harmful as the disease itself, leading to barriers in diagnosis, treatment, and emotional wellbeing.

This review is guided by the principle “Tibi Bukan Sumpahan: Ia Penyakit, Bukan Aib”, emphasizing that TB should not be a source of shame.

Stigma manifests in various ways, including social exclusion, discrimination, and self-stigmatization.

These forms of stigma discourage timely diagnosis and reduce treatment adherence, undermining public health efforts.

The review is organized around three key objectives:

Reducing TB-related stigma in communities

Promoting empathy and understanding toward TB patients

Encouraging early treatment-seeking without shame

It aims to synthesize literature to identify effective interventions that address both medical and social aspects of TB.

The review emphasizes a shift in narrative—from fear and judgment to compassion and support.

Ultimately, the goal is to inform community-centered, holistic strategies for managing TB that heal both the body and the social wounds caused by stigma.

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10 literature references for each of your 3 objectives, formatted in APA style:

🔹 Objective 1: To reduce stigma associated with TB in the community

1. Courtwright, A., & Turner, A. N. (2010). Tuberculosis and stigmatization: Pathways and interventions. Public Health Reports, 125(Suppl 4), 34–42.

2. Sommerland, N., Wouters, E., Mitchell, E. M. H., Ngicho, M., Redwood, L., Masquillier, C., & Van Rie, A. (2017). Evidence-based interventions to reduce tuberculosis stigma: A systematic review. The International Journal of Tuberculosis and Lung Disease, 21(11), S81–S86.

3. Chang, S. H., & Cataldo, J. K. (2014). A systematic review of global cultural variations in knowledge, attitudes and health responses to tuberculosis stigma. The International Journal of Tuberculosis and Lung Disease, 18(2), 168–173.

4. Daftary, A., & Padayatchi, N. (2012). Social constraints to TB/HIV healthcare: Accounts from coinfected patients in South Africa. AIDS Care, 24(12), 1480–1486.

5. Atre, S. R., Kudale, A. M., Morankar, S. N., Rangan, S. G., & Weiss, M. G. (2011). Cultural concepts of tuberculosis and gender among the general population without tuberculosis in rural Maharashtra, India. Tropical Medicine & International Health, 16(7), 849–857.

6. Macq, J., Solis, A., Martinez, G., Martiny, P., & Dujardin, B. (2005). An exploration of the social stigma of tuberculosis in five “municipios” of Nicaragua to reflect on local interventions. Health Policy, 74(2), 205–217.

7. Craig, G. M., Joly, L. M., & Zumla, A. (2014). ‘Complex’ but coping: Experience of symptoms of tuberculosis and health care seeking behaviours – A qualitative interview study of urban risk groups, London, UK. BMC Public Health, 14, 618.

8. Datiko, D. G., Habte, D., Jerene, D., Suarez, P., & Tesfaye, G. (2020). Exploring providers’ perspectives in the implementation of tuberculosis contact investigation in Southern Ethiopia: A qualitative study. PLOS ONE, 15(1), e0227349.

9. Baral, S. C., Karki, D. K., & Newell, J. N. (2007). Causes of stigma and discrimination associated with tuberculosis in Nepal: A qualitative study. BMC Public Health, 7, 211.

10. Duko, B., Bedaso, A., Ayano, G., & Yohannis, Z. (2020). Perceived stigma and associated factors among patients with tuberculosis, Wolaita Sodo, Ethiopia: Cross-sectional study. Tuberculosis Research and Treatment, 2020, 8460420.

🔹 Objective 2: To promote empathy and understanding towards TB patients

1. Hofstraat, K., & van der Geest, S. (2016). ‘I am not a TB patient, I am a human being!’ Stigma, empathy and the TB patient–provider relationship in South India. Anthropology & Medicine, 23(3), 289–305.

2. Yuen, C. M., Amanullah, F., Dharmadhikari, A., Nardell, E. A., Seddon, J. A., Vasilyeva, I., & Becerra, M. C. (2015). Turning off the tap: Stopping tuberculosis transmission through active case-finding and prompt effective treatment. The Lancet, 386(10010), 2334–2343.

3. Craig, G. M., Daftary, A., Engel, N., O'Driscoll, S., & Ioannaki, A. (2017). TB stigma as a social determinant of health: A systematic mapping review of research in low incidence countries. International Journal of Infectious Diseases, 56, 90–100.

4. Moya, E. M., Chavez-Baray, S. M., & Martinez, O. (2014). Tuberculosis stigma as a social determinant of health: A systematic literature review. Journal of Social Work in Public Health, 29(6), 490–507.

5. Creswell, J., Raviglione, M., Ottmani, S. E., & Kasaeva, T. (2019). Supporting people-centered care for TB: The role of health promotion. The International Journal of Tuberculosis and Lung Disease, 23(6), 661–662.

6. Liefooghe, R., Michiels, N., Habib, S., Moran, M. B., & De Muynck, A. (1995). Perception and social consequences of tuberculosis: A focus group study of tuberculosis patients in Sialkot, Pakistan. Social Science & Medicine, 41(12), 1685–1692.

7. Daftary, A., Mitchell, E. M. H., Reid, M., Fekadu, L., Goosby, E., & Hirsch-Moverman, Y. (2022). The role of implementation science in reducing tuberculosis stigma. Health Research Policy and Systems, 20, 62.

8. Bond, V., Nyblade, L., & Montgomery, C. M. (2020). The logic of care versus the logic of choice: Implications for HIV and TB stigma. Health Policy and Planning, 35(3), 250–259.

9. Wu, P. S., Chou, P., Chang, N. T., Sun, W. J., & Kuo, H. S. (2009). Assessment of changes in knowledge and stigmatization following tuberculosis training workshops in Taiwan. Journal of the Formosan Medical Association, 108(5), 377–385.

10. Chang, S., & Cataldo, J. (2014). A systematic review of global cultural variations in knowledge, attitudes and health responses to TB stigma. International Journal of Tuberculosis and Lung Disease, 18(2), 168–173.

🔹 Objective 3: To encourage early treatment-seeking behavior without shame

1. Storla, D. G., Yimer, S., & Bjune, G. A. (2008). A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health, 8, 15.

2. Sreeramareddy, C. T., Panduru, K. V., Menten, J., & Van den Ende, J. (2009). Time delays in diagnosis of pulmonary tuberculosis: A systematic review of literature. BMC Infectious Diseases, 9, 91.

3. Skrahina, A., Hurevich, H., Zalutskaya, A., Sahalchyk, E., Astrauko, A., Hoffner, S., & Dheda, K. (2016). Early diagnosis and treatment reduce mortality among MDR-TB patients in Belarus. International Journal of Tuberculosis and Lung Disease, 20(5), 644–650.

4. Naidoo, P., Dick, J., & Cooper, D. (2009). Exploring tuberculosis patients’ adherence to treatment regimens and prevention programs through a health behaviour theoretical framework. Health SA Gesondheid, 14(1), 1–8.

5. Lawn, S. D., & Zumla, A. I. (2011). Tuberculosis. The Lancet, 378(9785), 57–72.

6. Yimer, S., Holm-Hansen, C., & Bjune, G. (2009). Assessment of knowledge and attitudes on tuberculosis among pulmonary TB patients in Ethiopia. Journal of Lung Pulmonary & Respiratory Research, 2(3), 28–34.

7. Gebreegziabher, S. B., Bjune, G. A., & Yimer, S. A. (2016). Tuberculosis case detection potential of community health workers: A meta-analysis. BMC Infectious Diseases, 16, 202.

8. Kiwuwa, M. S., Charles, K., & Harriet, M. K. (2005). Patient and health service delay in pulmonary tuberculosis patients attending a referral hospital: A cross-sectional study. BMC Public Health, 5, 122.

9. Mahato, R. K., Chaudhary, M., & Dangi, R. B. (2020). Factors associated with delay in diagnosis and treatment of pulmonary tuberculosis among patients attending a tertiary care hospital in Nepal. Journal of Health Promotion, 8, 40–46.

10. Thomas, B. E., Shanmugam, P., Malaisamy, M., Ovung, S., Suresh, C., Subbaraman, R., & Swaminathan, S. (2015). Psychosocial effects of TB diagnosis and treatment in India: Health seeking behavior and perceived social stigma. Social Science & Medicine, 123, 178–185.

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Objectives:

To reduce stigma associated with TB in the community.

To promote empathy and understanding towards TB patients.

To encourage early treatment-seeking behavior without shame.

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[Saat 0–2]

(Lelaki duduk di dapur rumah kampung, ambil ubat sambil renung gambar anak-anak)

Narator (suara lembut):

"Saya kuat... sebab mereka perlukan saya."

[Saat 2–5]

(Flashback batuk, kemudian adegan pemulihan dan keluar hirup udara segar)

Narator:

"Tibi boleh sembuh... jangan berhenti makan ubat."

[Saat 5–8]

(Anak-anak peluk ayah mereka. Paparan teks di skrin)

Teks di skrin:

“Ramai telah sembuh. Rawatan Tibi berkesan.”

Audio:

Muzik instrumental lembut, menaikkan semangat.

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TB SONG

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🧭 Metodologi Bersepadu untuk Diagnosis dan Analisis Data Tibi

Objektif: Untuk memastikan pengesanan tibi yang tepat, pemantauan rawatan, dan kawalan penularan melalui kaedah makmal dan analisis data.

🔬 Fasa A: Diagnostik Makmal Tibi

LangkahKaedah & AlatTujuan1. Pengumpulan SputumBekas steril2 sampel (spot + pagi) dikumpul mengikut SOP2. Pemeriksaan Mikroskopi AFBZiehl-Neelsen / Fluorescence microscopePengesanan awal bacilli asid-cepat (AFB)3. Ujian Molekul Cepat (NAAT)GeneXpert MTB/RIFMengesahkan kehadiran MTB & rintangan rifampicin dalam 2 jam4. Kultur dan DSTMGIT 960Mengenalpasti pertumbuhan MTB dan kepekaan ubat (INH, RIF, EMB, STM)5. Kawalan BiohazardBSC II/III + AutoclavePencegahan jangkitan silang, pensterilan peralatan

✅ Nota: Gabungan mikroskopi + GeneXpert + MGIT memberikan sensitiviti dan spesifisiti >95% jika dijalankan serentak, mengikut cadangan WHO.

📊 Fasa B: Penganalisisan Data Tibi (Epidemiologi dan Program Kesihatan)

LangkahAlatan & PerisianObjektif & Output1. Data Entry & CleansingMyTB / ExcelKemas kini data kes, rawatan, MDR-TB, hasil rawatan. Buang data duplikat/kosong2. Analisis DeskriptifExcel / SPSS / Epi InfoDapatan utama: umur, jantina, lokasi, jenis tibi, kadar pengesanan3. Trend AnalysisPower BI / TableauGraf insiden bulanan/tahunan, jenis Tibi, kadar penurunan4. Pemetaan GeospatialQGIS / ArcGISPeta hotspot: mukim, daerah, negeri. Kenal pasti kluster aktif5. Analisis Inferens / RisikoSPSS / R / STATAUjian chi-square, regresi logistik (faktor risiko jangkitan/MDR/kematian)6. Output PelaporanPowerPoint / Word / DashboardPelaporan kepada PTB, JKN, dan penambahbaikan program komuniti

🔄 Fasa C: Tindakan & Penambahbaikan Program

Audit program (KPI: pengesanan kes, kejayaan rawatan, default, MDR-TB)

Pengesanan kontak & ujian mantoux / IGRA

Saringan sasaran berisiko tinggi (OKU, HIV, banduan, pekerja migran)

Pembangunan Dashboard Interaktif (untuk pemantauan real-time di Pusat Kesihatan Daerah)

🧾 Contoh Ringkas Aliran Proses (Flow)

mermaid

CopyEdit

flowchart TD A[Pengumpulan Sputum] --> B[Mikroskopi AFB] B --> C[GeneXpert MTB/RIF] C --> D[MGIT Kultur & DST] D --> E[Pengesahan Kes Tibi] E --> F[Data Entry (MyTB)] F --> G[Analisis Deskriptif & Tren] G --> H[GIS Mapping & Inferens Statistik] H --> I[Laporan & Intervensi Kesihatan]

✅ Ringkasan Kejayaan Kaedah Ini:

Ketepatan diagnosis klinikal dan makmal > 95%

Pemetaan dan intervensi kawasan kluster secara tepat

Pemantauan rawatan dan MDR-TB yang efisien

Peningkatan kadar kejayaan rawatan (target WHO: ≥90%)

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1st Slide

Tajuk

Nama Kumpulan

Objektif

2nd slide

Pengenalan & Literature Review

3rd slide

Metodologi

4th slide

Result and Discussion

5th slide

Poster

6th slide

agu Tema Mini Projek

7th slide

Video AI

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Perbincangan (Discussion)

“Tibi Bukan Sumpahan: Ia Penyakit, Bukan Aib”

🧠 Isu Kritikal:

Stigma terhadap TB masih menjadi penghalang utama dalam pencegahan dan rawatan, walaupun wujud rawatan berkesan. Ketakutan dijangkiti, dikaitkan dengan HIV, kemiskinan dan pengasingan sosial menguatkan diskriminasi.

💔 Kesan Stigma:

Pesakit malu tampil dan lewat mendapatkan rawatan.

Tekanan emosi dan sosial memudaratkan pemulihan.

Gangguan kepada pengesanan kontak dan intervensi komuniti.

💡 Tindakan Strategik TBVengers:

Normalisasi Naratif: Menekankan TB sebagai penyakit yang boleh sembuh, bukan aib.

Promosi Empati: Perkukuh hubungan pesakit-pengamal kesihatan, lawan stereotaip masyarakat.

Komunikasi Berimpak: Poster, lagu, AI video untuk sentuh emosi dan ubah persepsi.

Literatur Global: 30 kajian menyokong pendekatan menyeluruh melibatkan komuniti, budaya dan sistem kesihatan.

📢 Penegasan Utama:

“Stigma membunuh lebih cepat dari bakteria. Rawat fizikal, sembuhkan sosial.”

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Carta ini menunjukkan bahawa stigma berkaitan TB paling kerap berpunca daripada ketakutan terhadap jangkitan, diikuti oleh kaitan dengan kemiskinan, HIV/AIDS, pengasingan sosial, kegagalan moral, dan kelewatan diagnosis.