76 | International Journal of Pharmaceutical Research | Apr-Jun 2015 | Vol 7 | Issue 2 Research Article Risk Factors Associated with Recurrence of Tuberculosis at the Chest Clinic, Hospital Raja Perempuan Zainab II Kota Bharu Malaysia MYAT MOE THWE AUNG 1 , NYI NYI NAING 2 , ABDULLAH MOHAMED RUSLI 2 , MAT JAEB MAT ZUKI 3 , NADIAH WAN-ARFAH 2 , MAINUL HAQUE 1 1 Universti Sultan Zainal Abidin. Faculty of Medicine, Jalan Sultan Mahmud, 20400 Kuala Terengganu, Ter- engganu, Malaysia. 2 School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia. 3 Department of Medicine, Hospital Raja Perempuan Zainab II, 15000 Kota Bharu, Kelantan, Malaysia. ABSTRACT Introduction: Tuberculosis (TB) was the disease with the second highest incidence rate and caused the highest mor- tality rate among communicable diseases in Malaysia. Current study wants to identify the associated factors of recur- rence among TB patients. Methods: A retrospective record review study of 114 patients registered as recurrent TB cases attending the Chest Clinic of Hospital Raja Perempuan Zainab II (HRPZ II), Kelantan, Malaysia within January 2003 to December 2009 were conducted. The Cox Proportional Hazards Regression analysis was used. Results: After adjustment of other potential confounding variables, the alcoholism (adjusted Hazard ratio [aHR]: 24.53, 95% CI:1.96,306.29), the sputum smear result at the initial diagnosis of previous occurrence of TB (aHR: 4.09, 95% CI:1.52,11.02) were more likely to have recurrent TB whereas the treatment regimen with twice weekly doses of Streptomycin (S), Isoniazid (H) and Rifampicin (R) drugs (S2H2R2) during the continuation phase (aHR: 0.11,95% CI:0.02,0.54)was found as a significant protective factor for recurrent TB. Conclusion: The recurrent TB cases can be reduced by treating the patients with S2H2R2 drug regimen during the continuation phase while we must be aware of hazards of recurrent TB for alcoholics and patients with positive sputum smear result at the initial diagnosis of TB. Keywords: Tuberculosis, Recurrent, Protective Factor, Cox Proportional Hazards Regression Analysis, Malaysia.  Address of Correspondence: Professor Dr. Nyi Nyi Naing, Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia. E-mail address: nyi@kb.usm.my, Phone: +609-7676828. Fax: +609-7653370. Received: 26/12/2014, Revised: 20/01/2015, Accepted: 10/02/2015 INTRODUCTION TB is a major worldwide problem and still at an alarming trend as a re-emerging contagious disease of importance. The TB burden falls chiefly on the developing countries. In 2009, the South-East Asia region accounted for the biggest number of new TB cases (35% of global total new cases) as well as the largest number of death cases whereas the highest TB incidence rate and the highest mortality per capita were found in the Africa Region [1]. Retreatment TB cases could partly account for such increased number of cases and high disease mortali- ty. Recurrent TB is one of the pivotal parameters to assess the success of any treatment regimen. Some studies revealed that even after adequate treatment, patients cannot get effective protective immunity against further re-infection with TB [2-3] and thus these evidences pointed out that end-of-treatment result did not reflect the long-term status of patients. TB recurrence in previously cured patients, in those who defaulted during a previous disease episode as well as in those whose previous treatment failed re- quires taking re-treatment [4]. WHO’s Western Pacific Region entailing 37 countries is accountable for around a quarter of all TB cases in the world [5]. In 2009, approximately 1.4 million cases including new and relapse cases were notified, whilst the estimated total TB cases stand at 2.9 mil- lion in the Western Pacific Region [6]. In Malaysia, TB has been a public health problem even before independence. Although Malaysian gov- ernment allocated enormous resources in terms of finance and manpower to make TB as no longer a public health problem, TB has re-emerged as a ma- jor threat in terms of morbidity and mortality in re- cent years [7]. According to the Health Fact 2009, TB was the disease with the second highest incidence