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Licensed Unlicensed Requires Authentication Published by De Gruyter December 8, 2020

Environment as the risk factor for tuberculosis in Malaysia: a systematic review of the literature

Nur Adibah Mohidem, Zailina Hashim, Malina Osman, Farrah Melissa Muharam, Saliza Mohd Elias and Rafiza Shaharudin



To investigate the prevalence and incidence of TB by focusing on its environmental risk factor in Malaysia.


Databases search of Scopus, ScienceDirect, PubMed, Directory of Open Access Journals (DOAJ), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, MyJournal, Biblioteca Regional de Medicina (BIREME), BioMed Central (BMC) Public Health, Medline, Commonwealth Agricultural Bureaux (CAB), EMBASE (Excerpta Medica dataBASE) OVID, and Web of Science (WoS) was performed, which include the article from 1st January 2008 until 31st August 2018 using medical subject heading (MeSH). Articles initially identified were screened for relevance.


Out of 744 papers screened, nine eligible studies did meet our inclusion criteria. Prison and housing environments were evaluated for TB transmission in living environment, while the other factor was urbanization. However, not all association for these factors were statistically significant, thus assumed to be conflicting or weak to end up with a strong conclusion.


Unsustainable indoor environment in high congregate setting and overcrowding remained as a challenge for TB infection in Malaysia. Risk factors for transmission of TB, specifically in high risk areas, should focus on the implementation of specialized program. Further research on health care environment, weather variability, and air pollution are urgently needed to improve the management of TB transmission.

Corresponding author: Zailina Hashim, Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia, Phone: +603 89472406, E-mail:

Funding source: Universiti Putra Malaysia

Award Identifier / Grant number: GP-IPS/2018/9613800

  1. Research funding: This study was funded by the Geran Putra Institut Pengajian Siswazah [IPS], Universiti Putra Malaysia.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: We declare no competing interests.

  4. Informed consent: Informed consent is not applicable.

  5. Ethical approval: The conducted research is not related to either human or animal use.


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Received: 2020-07-31
Accepted: 2020-11-16
Published Online: 2020-12-08
Published in Print: 2021-12-20

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