A study on insect succession of monkey carcass in a forested area in Ulu Gombak, Selangor, Malaysia was conducted from 9 May to 18 June 2007. The third instar of the housefly, Musca domestica (Linnaeus) (Diptera: Muscidae) were only found on dry stage of a decomposed (Day-33) monkey carcass (Macaca fascicularis Raffles). This observation revealed that M. domestica maggots were found together with other muscid fly maggots, Hydrotaea (=Ophyra) spinigera (Stein) (Diptera: Muscidae) on dry stage of a carcass. However, the role of M. domestica on forensic entomological study remains unknown. This study recorded the first finding of M. domestica maggots on primate carcass in Malaysia.
Agarose gel electrophoresis is the standard method that is used to separate, identify, and purify DNA fragments. However, this method is time-consuming and capable of separating limited range of fragments. A new technique of gel preparation was developed to improve the DNA fragment analysis via electrophoresis
Chikungunya virus (CHIKV) is a mosquito-borne alphavirus which causes fever, rash, and arthralgia. In the past, life-threatening complications were very rarely reported. However, during the recent worldwide outbreaks, there have been several reports of unusually severe complications and deaths. Malaysia is experiencing a nationwide outbreak of CHIKV, with over 10 000 patients affected since April 2008. We report the first case of culture-confirmed CHIKV-associated death in Malaysia, in a patient with fever, rash, acute exacerbation of pre-existing heart failure, rhabdomyolysis, and multiple organ failure. CHIKV infections may cause atypical, severe or fatal presentations.
Iranihindia martellata (Senior-White, 1924) is recorded from peninsular Malaysia for the first time. Male and female specimens in the recent collections of forensically important sarcophagid flies were examined and identified based on morphology and DNA sequencing analysis. Male genitalia offer unambiguous species identification characteristics in the traditional taxonomy of flesh flies but the female flies are very similar to one another in general morphology. Female of I. martellata was determined by DNA sequencing (COI and COII) and PCR-RFLP (COI) analysis. Identified females were carefully examined and compared with the morphologically similar species, Liopygia ruficornis (Fabricius, 1794). Female genitalia are re-described and illustrated in this paper.
Methicillin-resistant Staphylococcus aureus (MRSA) is known to cause nosocomial infections and is now becoming an emerging problem in veterinary medicine. The objective of the study was to determine the presence of MRSA in 100 cats and dogs sampled between November 2007 and April 2008 at the University Veterinary Hospital, Universiti Putra Malaysia. MRSA was detected in 8% of pets sampled. Ten percent (5/50) and 6% (3/50) of the isolates were from dogs and cats, respectively. All MRSA isolates possessed the mecA gene and were found to be resistant to at least three antimicrobials with a minimum of Oxacillin MIC of 8 μg/mL. One isolate (CT04) had an extremely high MIC of >256 μg/mL. The MLST type ST59 found in this study have been reported earlier from Singapore and other countries as a strain from animal and community-associated MRSA respectively. Pulsed-field gel electrophoresis revealed five pulsotypes. Two isolates from cats (CT27 and CT33) and three isolates from dogs (DG16, DG20, and DG49) were respectively assigned to pulsotypes B and D. The study suggests that cats and dogs inn Malaysia are potential reservoirs for MRSA.
This study was designed to mimic homicide or suicide cases using gasoline. Six adult long-tailed macaque (Macaca fascicularis), weighing between 2.5 to 4.0 kg, were equally divided into control and test groups. The control group was sacrificed by a lethal dose of phenobarbital intracardiac while test group was force fed with two doses of gasoline LD50 (37.7 ml/kg) after sedation with phenobarbital. All carcasses were then placed in a decomposition site to observe the decomposition and invasion process of cadaveric fauna on the carcasses. A total of five decomposition stages were recognized during this study. This study was performed during July 2007. Fresh stage of control and test carcasses occurred between 0 to 15 and 0 to 39 hours of exposure, respectively. The subsequent decomposition stages also exhibited the similar pattern whereby the decomposition process of control carcasses were faster than tested one. The first larvae were found on control carcasses after 9 hours of death while the test group carcasses had only their first blowfly eggs after 15 hours of exposure. Blow flies, Achoetandrus rufifacies and Chrysomya megacephala were the most dominant invader of both carcasses throughout the decaying process. Diptera collected from control carcasses comprised of scuttle fly, Megaselia scalaris and flesh fly, sarcophagid. We concluded that the presence of gasoline and its odor on the carcass had delayed the arrival of insect to the carcasses, thereby slowing down the decomposition process in the carcass by 6 hours.
Whole-cell Pertussis (wcPertussis) vaccines combined with diphtheria and tetanus toxoids are effective in preventing clinical pertussis. The study aimed at determining the cost of managing fever and convulsions and cost of adverse events associated with wcPertussis. Parents who brought their children to health clinics and parents of children who were admitted for febrile convulsions were interviewed using structured questionnaire and the information were used to determine the cost of managing adverse events. Mean cost of managing mild fever per case was RM249, mean cost of managing high fever per case was RM1,036 and mean cost of managing convulsions was RM1,225. Total cost of managing adverse events was RM261 million for mild fever, RM66.7 million for high fever and RM1.3 million for convulsions. Costs of managing mild and high fever were less than the cost of managing convulsions. Total cost of managing mild fever was highest at RM261 million compared with RM66.7 million for high fever and RM1.3 million for convulsions. Thus, lower risk of adverse events actually contributed to higher costs of managing the adverse event.
MeSH terms: Ambulatory Care Facilities; Child; Seizures, Febrile; Costs and Cost Analysis; Cross-Sectional Studies; Diphtheria; Diphtheria Toxoid; Fever; Hospitals; Humans; Malaysia; Parents; Surveys and Questionnaires; Seizures; Tetanus Toxoid; Whooping Cough
Introduction: Anemia in pregnancy is still a public health problem in developing countries including Malaysia. Early screening of pregnant mothers who have risk factors of anemia could help identifying these potential anemic mothers and hence targeted for intervention.
Methodology: A cross sectional study IN 2008 was conducted among pregnant women who attended government health clinics in Johor Bahru district to assess the prevalence of anemia in pregnancy and factors associated with it using a structured questionnaire.
Result: Prevalence of anemia in pregnancy (Hb<11.0 g/dl) was 36.6% and majority in mild category (Hb 9-<11 g/dl). The associated factors of anemia in pregnancy were birth spacing, dietary intake with high iron content and iron pill consumption. Multivariate analyses revealed that iron pill intake was the most important factor influencing anemia in pregnancy.
Discussion and conclusion: Even though Johor Bahru is a big town with good health facilities, the prevalence of anemia in pregnancy was quite high. Results were compared with previous studies. Emphasis on compliance to iron pills is very important in prevention and treating anemia in pregnancy
Key Words: anemia in pregnancy, birth spacing and iron pill intake
Study site: Four urban and two rural klinik kesihatan, Johor, Malaysia
On 24th April 2009 the World Health Organisation (WHO) announced Pandemic Influenza A (H1N1) alert phase 4 which was later raised to phase 6 on 11th June 2009. By 11th October 2009, 199 countries were affected with 399,232 laboratory confirmed cases resulting in 4735 death. In Pahang, the state and district operation rooms were activated on the 28th April and 5th May 2009 respectively to monitor surveillance, control and preventives measures carried out. This study was done to describe the situation of Pandemic Influenza A (H1N1) in Pahang from 28th April 2009 till 10th October 2009 in terms of laboratory confirmed cases and clusters reported, Influenza-Like Illness (ILI) surveillance, Severe Acute Respiratory Infection (sARI) surveillance and health education activities. During the period, 490 laboratory confirmed Influenza A (H1N1) cases were registered with 5 deaths. The age ranges from less than 1 year to 76 years with median of 16 years old. 207 ILI clusters were recorded, 139 (67.5%) were Influenza A (H1N1) clusters. For surveillance activity, 11,570 (2.2%) of outpatient attendances were ILI cases while 966 (2.0 %) of total admissions were sARI cases. There were 14,927 health education activities carried out during the period. The number of people affected by Pandemic Influenza A (H1N1) in Pahang reached its peak in mid August 2009 and later showed a downward trend. ILI surveillance was a useful tool to detect Influenza A (H1N1) activity in Pahang.
Study site: Klinik kesihatan, outpatient clinics, hospitals, Pahang, Malaysia
MeSH terms: Ambulatory Care Facilities; Health Education; Hospitalization; Hospitals; Humans; Influenza, Human; Laboratories; Malaysia; Outpatient Clinics, Hospital; Outpatients; Retrospective Studies; Virus Diseases; World Health Organization; Influenza A Virus, H1N1 Subtype
Family planning is one of the main pillars of safe motherhood initiatives. It is therefore a very crucial area that needs continuous strengthening and improvement in order to reduce maternal morbidity and mortality which will ultimately improve the general condition of women. Findings from the Confidential Enquiries into Maternal Death (CEMD) Malaysia Report 2001 - 2005 revealed that up to 70% of the maternal deaths never practiced any form of family planning. The contraceptive prevalence rate (CPR) in Malaysia for the year 2004 was 51.7% compared to Thailand, Vietnam and Singapore which was 79%, 74% and 74% respectively. One neglected area that has never been emphasized seriously in the family planning programme in Malaysia is male participation, gender awareness and sharing of responsibility by both partners. In realizing this, efforts have been made to include men as target groups in the national family planning programme. This paper will highlight the importance of optimum gender relations and sharing of responsibility with special emphasis towards the role of husbands and male medical personnel in the effort to improve family planning activities. It will also discuss the efforts put by the Ministry of Health in order to create gender awareness and encourage male participation in family planning.
Contact time was defined as the time spent by health personnel with a patient. The study was conducted for four months in 2007 to assess the contact time and to determine the appropriate contact time as perceived by patients attending clinics of various clinical disciplines as well as Out-Patient Departments and Emergency Departments at Ministry of Health Hospitals. This study was a cross-sectional study carried out on out-patients who came to the hospitals’ clinics for treatment. Information was gathered through self-administered questionnaires, distributed at twenty-one hospitals. The respondents were selected using stratified random sampling method. Out of 21,750 questionnaires distributed, 13,463 patients responded, a response rate of 61.9%. This study shows that the average contact time increases from small hospitals (8 minutes) to bigger hospitals (15 minutes). The contact time also varies between the clinics of various disciplines. Obstetrics and Gynecology (O&G) clinics and Pediatric clinics had the longest average contact time of 20 minutes and 15 minutes respectively. The percentage of patients who were satisfied with the contact time corresponded with the type of clinics and hospitals which had the longest contact time. Thus, it is suggested that clinics and hospitals, whenever possible try their best to follow the duration of contact time as perceived appropriate by the patients.
Study site: Out-Patient Departments and Emergency Departments at Ministry of Health Hospitals (21)
MeSH terms: Cross-Sectional Studies; Emergency Service, Hospital; Female; Health Personnel; Hospitals; Humans; Malaysia; Outpatient Clinics, Hospital; Outpatients; Personal Satisfaction; Surveys and Questionnaires
Osteoporosis is a global health problem both in the developed and developing countries. Patient education forms an important part in the management of osteoporosis. The objective of this study was to evaluate knowledge about osteoporosis and its correlates among women aged ≥ 40 years attending an urban health centre in India and to identify their sources of information on osteoporosis. Knowledge about osteoporosis was assessed using the Osteoporosis Questionnaire (OPQ) in 243 women over 40 years of age, attending an urban health centre in the city of Mumbai located in the state of Maharashtra in western India. This exploratory cross-sectional study was conducted over a period of eight months. The OPQ analysis was performed using SPSS for Windows Version 13.0. The scores were expressed as mean ± SD (Standard Deviation). The one sample-t test was used to study the differences in the mean scores between socio-demographic variables. The mean total OPQ score was 0.91 (SD ± 5; range -9 to 10; maximum possible score 20). There was a significant difference in the total OPQ scores by the level of education and family history of osteoporosis (p
MeSH terms: Ambulatory Care Facilities; Cross-Sectional Studies; Demography; Developing Countries; Female; Humans; India; Osteoporosis; Surveys and Questionnaires; Urban Health; Global Health; Knowledge; Disease Management
Many studies on adolescent smoking have been conducted in Malaysia, but very limited information is available on smoking amongst lower secondary school male students (Forms 1 and 2). We present data from a baseline study in Kota Tinggi District, Johor on the psychosocial factors, stages of smoking acquisition and susceptibility to smoking initiation and their relationship to adolescent smoking. The study is the first wave of a 3-year longitudinal study which was conducted from March 2007 to May 2009, aimed to describe the prevalence of smoking among students in the lower secondary classes. A three stage stratified sampling was performed to obtain a sample. The Bogus Pipeline Method was employed to confirm smoking status. Prevalence of smoking was 35.5%. Smoking prevalence among students of schools located in the Federal Land Development Authority (FELDA) settlement areas (42.9%) was two-fold higher than in the rural and town schools combined (20.29%). Using the Fagerstrom scale, 90% of current smokers had lower addiction to nicotine. Smoking was associated with peer smoking [OR, 4.19 (95% CI, 2.57-6.82)], having a brother smoking [2.17 (1.31-3.61)], parental smoking [1.73 (1.17-2.80)] and locality where respondents attend school [1.94(1.11-3.39)]. The study indicates that, the prevalence of smoking was high in all areas especially FELDA settlement areas. Measures such as teaching of skills to resist social pressure to smoke, establishment of peer support groups and involvement of parents in anti-smoking programs are recommended to curb the high prevalence of smoking among lower secondary school students in Kota Tinggi.
Cat fleas were reported to attack human in RPR Batu Kawa, a housing area about 3 km from Kuching town, resulting in an outbreak. A total of 19 people (10 adults and 9 children) were attacked by fleas. They presented with red spots, slightly raised (swollen) and irritation of skin, mostly found on the ankles and legs. The first 4 cases were reported on 29 September 2007 and the last case was on 17 November 2007. The remaining 12 cases which represent the majority of cases reported on 4th October 2007. The study conducted based mainly on field investigation and flea sampling from animals on field at that moment to find out the causes of the disease spread. Flea samples from human and cats were found to be Ctenocephalides felis; which is the most prevalent species in the world. However, no fleas were found on dog, rabbit and rat. This is the first reported case in Kuching; the study was carried out to determine the cause and the epidemiological pattern of the disease. This is important, because cat flea might attack human especially if house owners fail to monitor their pets and practice proper sanitation method to avoid the presence of cat flea larvae at home.
The Universal Declaration of Human Rights, 1948 stated that everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international cooperation and in accordance with the organization and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the free development of his personality. Equity, solidarity and social justice are understood as basic characteristics of universal access to social health protection founded on burden sharing, risk pooling, empowerment and participation. It is up to national governments and institutions to put these values into practice. The financing of social health protection can be through a mixture of taxation and contributions to public and mandated private insurance. Through risk pooling, these funds provide for equity, solidarity and affordability of services. According to International Labour Organization (ILO), ultimate objective in social health protection is to achieve universal social health protection coverage defined as effective access to affordable health care of adequate quality and financial protection. Social protection plays a vital part in reducing the vulnerability of the poor so that they can fruitfully access health and education services.
MeSH terms: Financial Management; Humans; Human Rights; International Cooperation; Personality; Public Policy; Social Justice; Social Security; Taxes; Universal Coverage; Federal Government
Analysis of count event data such as mortality cases, were often modelled using Poisson regression model. Maximum likelihood procedures were used by using SAS software to estimate the model parameters of a Poisson regression model. However, the Negative Binomial distribution has been widely suggested as the alternative to the Poisson when there is proof of overdispersion phenomenon. We modelled the mortality cases as the dependent variable using Poisson and Negative Binomial regression and compare both of the models. The procedures were done in SAS by using the function PROC GENMOD. The results showed that the mortality data in Poisson regression exhibit large ratio values between deviance to degree of freedom which indicate model misspecification or overdispersion. This large ratio was found to be reduced in Negative Binomial regression. The Normal probability plot of Pearson residual confirmed that the Negative Binomial regression is a better model than Poisson regression in modelling the mortality data. The objective of this study is to compare the goodness of fit of Poisson regression model and Negative Binomial regression model in the application of air pollution epidemiologic time series study by using SAS software.
MeSH terms: Air Pollution; Probability; Software; Models, Statistical; Effect Modifier, Epidemiologic; Binomial Distribution
Increasing prevalence of chronic diseases is a major contributor for rapid rise in healthcare cost in developing countries since the last decade. It was estimated that around 54% of deaths in developing countries are due to chronic non-communicable diseases which is predicted to rise by 65% by 2030. Diabetes mellitus is among the most prevalent chronic diseases suffered by more than 180 million people worldwide. By 2030 it is estimated that around 400 million people in the world will be afflicted with diabetes. Annual deaths attributable to diabetes are probably as high as 3 million with more than 80% occur in developing countries. India, China and Indonesia are three countries in the Asian region with most number of people with diabetes. The total number of cases in these three countries is expected to increase more than double from 61 million in 2000 to 163 million in 2030. China and India will suffer cumulative GDP loss of 13.8% and 16.7% respectively, over the next ten year period. Assessing economic burden of diabetes is a challenging task for researchers because identification of direct and indirect cost of the disease is often complex since patients with diabetes also suffers from other complications and co-morbidities. In conclusion, the heavy economic burden of diabetes pose major challenges to health policy makers in developing countries to assess the current approach in managing this chronic disease. Serious efforts should be made on focusing and up-scaling activities on health promotion and prevention of diabetes so that to provide a more cost-effective solution to this condition with huge and increasing economic loss.
MeSH terms: China; Chronic Disease; Developing Countries; Diabetes Mellitus; Guanosine Diphosphate; Health Policy; Health Promotion; Humans; India; Indonesia; Research Personnel; Comorbidity; Prevalence; Health Care Costs
Health services are considered to be of good quality if customers’ expectations and perceptions are well balanced. Determinants confirming customers’ expectations will lead to satisfaction, while factors disconfirming it will result in customers’ dissatisfaction, reduced compliance to physicians’ treatment and deterioration in overall disease management. A cross-sectional comparative study was carried out from September till October 2008 to determine population satisfaction with health services provided by the public health clinics in Selangor. A total of 3840 respondents from the urban Health Clinics (HCs) and 4768 respondents from rural HCs were selected applying multi-stage random sampling from 54 HCs in nine districts from Selangor. Self-administrated questionnaires formulated by adopting SERVQUAL method based on modified five dimensions plus four dimensions of Clinics Corporation were used . Results showed the proportion of satisfaction among the population towards services provided by the public HCs was high at 86.1%. From X2 bivariate analysis; satisfied respondents were significantly from Indian and Chinese ethnic community more than the Malays, more among the less educated, the older age category (more than 33 years old) and males’ were slightly more satisfied than females. Patients who visited HCs more than three times were more satisfied than one time visitors. Occupation, marital status and HCs urban-rural locality were not significantly associated with customers’ satisfaction level. All dimensions showed high satisfaction level especially on treatment outcome, except on health care workers (HCWs) caring and professionalism domains. Working as a team was slightly higher in the urban areas compared to rural area. Overall, the SERVQUAL score of all dimensions were higher among the urban respondents albeit not significant. Clients’ perceptions were generally higher than expectations reflecting the high satisfactions among clients at 86.1%. Much improvement needs to be put into training HCWs to be more caring and adapting a professional attitude towards clients. Clients’ satisfactions in the urban and rural HCs were almost equal and did not reflect a decrease of health services priority in the rural areas.
MeSH terms: Adult; Ambulatory Care Facilities; China/ethnology; Cross-Sectional Studies; Female; Health Personnel; Humans; India/ethnology; Malaysia; Malaysia/ethnology; Male; Patient Compliance; Personal Satisfaction; Surveys and Questionnaires; Patient Satisfaction; Marital Status
Background and Objectives: Unmet need for contraception is the gap between women's reproductive intentions and their contraceptive behavior. This community based interventional study was carried out to determine the unmet needs for contraception, the reasons for this and to assess the impact of interventional measures on acceptance of contraception.
Subjects and Methods: This study was conducted in 52 villages in the state of Maharashtra, India, among 363 married women selected by cluster sampling. Data was collected using an interview guide. An intervention was done for the women who had an unmet need and an assessment of the change was done subsequently. Data was analyzed by using SPSS.
Results The prevalence of contraceptive usage was 59.2% and the prevalence of unmet need for contraception was 44% (160). The unmet need for spacing births was 53.8%, 38.7% for limiting births and 7.5% women were dissatisfied with the current contraceptive method. The reasons ranged from side effects to contraceptives to source of obtaining contraceptives. Age of the respondents, education and number of living children showed statistically significant association with unmet needs. Post intervention, the contraceptive prevalence rate increased significantly 85.7% and there was a significant reduction in the unmet needs for spacing and limiting births, equally there was a significant reduction of dissatisfaction with using contraception.
Conclusion: Improvement in the use of contraception and addressing the unmet need for contraception requires community involvement and ongoing, sustained efforts by health workers to ensure quality care to the beneficiaries.
Dengue is one of the main vector-borne diseases affecting tropical countries and spreading to other countries at the global scenario without cease. The impact of climate variability on vector-borne diseases is well documented. The increasing morbidity, mortality and health costs of dengue and dengue haemorrhagic fever (DHF) are escalating at an alarming rate. Numerous efforts have been taken by the ministry of health and local authorities to prevent and control dengue. However dengue is still one of the main public health threats in Malaysia. This study was carried out from October 2009 by a research group on climate change and vector-borne diseases. The objective of this research project is to assess the community vulnerability to climate variability effect on dengue, and to promote COMBI as the community responses in controlling dengue. This project also aims to identify the community adaptive measures for the control of dengue. Various research methodologies were applied in this research project in different localities. Site visits, review on surveillance data and mapping on Aedes population, dengue cases and climate variability, community survey on the knowledge prevalence , opinions and practices (KOP) and mosquito ecology were carried out during pre- and post intervention phases. Community vulnerability towards Aedes and dengue were mapped out applying GIS. A series of workshops, group discussions and activities such as COMBI activities to promote Aedes control were conducted involving the Ledang communities, the health district officers and UKM researchers. These activities also included interventions and documentation of community responses and their adaptive capacities towards dengue. Trends on Aedes population, dengue cases and community surveys pre and post-interventions, the processes for dengue control activities were analysed. The research findings could provide understanding on the community vulnerability to dengue against climate variability, their responses and adaptive measures. The community advocacy on combats against Aedes is a possible effective solution in dengue control. This research could provide other dimensions in public health management to address the impacts of climate change on vector-borne diseases.
MeSH terms: Aedes; Animals; Climate; Dengue; Documentation; Ecology; Malaysia; Public Health; Surveys and Questionnaires; Research Personnel; Prevalence; Health Care Costs; Severe Dengue; Climate Change