There is a lot of interesting data available on tuberculosis (TB) in Singapore, available from multiple sources. I was quite privileged to receive a copy of Dr Heng Bee Hoon’s (Director, Health Services and Outcome Research, National Healthcare Group) 1988 Master of Science in Public Health thesis “The Secular Trends of Tuberculosis in Singapore” from the author herself. It is full of useful data and facts about tuberculosis in Singapore up to the 1980s. Below is a chart on TB rates, with data compiled from Dr Heng’s thesis, as well as from the MOH Communicable Diseases report in 2014. The 2014 datapoint was obtained via MOH’s press release. It is important to note that the data refer to “Singapore residents” (Singaporean citizens and permanent residents) rather than to all TB cases in Singapore – TB rates are far higher among foreigners, as many are from countries in the region where TB remains a major problem.
It is also interesting to note that TB rates fell dramatically way before short-course multiple-drug therapy was introduced in Singapore. This is consistent with the results from other developed countries, and is attributed to a variety of factors including better public health, less crowding, better nutrition, and improving socioeconomic status of the people in general. What were the short-course anti-TB regimens of the 1980s? Quite interestingly, according to Dr Heng, ethambutol only featured in the 9-month regimen:
- 1SHRZ-5H3R3 (1 month of daily streptomycin, isoniazid, rifampicin and pyrazinamide followed by 5 months of thrice-weekly isoniazid and rifampicin).
- 2SHRZ-4H3R3 (2 months of daily streptomycin, isoniazid, rifampicin and pyrazinamide followed by 4 months of thrice-weekly isoniazid and rifampicin).
- 2HRE-7HR (2 months of daily isoniazid, rifampicin and ethambutol followed y 7 months of self-administered daily isoniazid and rifampicin).