Displaying publications 1 - 20 of 34 in total

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  1. Abd Rashid MY, Abu Bakar A, Mohd Asri MT, Iskandar SM
    Med J Malaysia, 2004 May;59 Suppl B:135-6.
    PMID: 15468855
    Poly (p-phenylene vinylene) (PPV) was synthesized from p-xylylene bis(tetrahydrothiophenium chloride) using the Wessling route and characterized by Fourier Transform Infra-Red (FTIR) and UV-visible (UV-VIS) spectroscopic techniques. The significance of thermal treatment along with evolution of precursor polymer to polymer PPV was also studied through these spectroscopic techniques. Thermally Stimulated Current (TSC) measurements indicated the presence of crystallization, sulphonium group which occurred through the evolution from precursor polymer to polymer PPV during thermal treatment.
  2. Abdul Rahman M, Sani NS, Hamdan R, Ali Othman Z, Abu Bakar A
    PLoS One, 2021;16(8):e0255312.
    PMID: 34339480 DOI: 10.1371/journal.pone.0255312
    The Multidimensional Poverty Index (MPI) is an income-based poverty index which measures multiple deprivations alongside other relevant factors to determine and classify poverty. The implementation of a reliable MPI is one of the significant efforts by the Malaysian government to improve measures in alleviating poverty, in line with the recent policy for Bottom 40 Percent (B40) group. However, using this measurement, only 0.86% of Malaysians are regarded as multidimensionally poor, and this measurement was claimed to be irrelevant for Malaysia as a country that has rapid economic development. Therefore, this study proposes a B40 clustering-based K-Means with cosine similarity architecture to identify the right indicators and dimensions that will provide data driven MPI measurement. In order to evaluate the approach, this study conducted extensive experiments on the Malaysian Census dataset. A series of data preprocessing steps were implemented, including data integration, attribute generation, data filtering, data cleaning, data transformation and attribute selection. The clustering model produced eight clusters of B40 group. The study included a comprehensive clustering analysis to meaningfully understand each of the clusters. The analysis discovered seven indicators of multidimensional poverty from three dimensions encompassing education, living standard and employment. Out of the seven indicators, this study proposed six indicators to be added to the current MPI to establish a more meaningful scenario of the current poverty trend in Malaysia. The outcomes from this study may help the government in properly identifying the B40 group who suffers from financial burden, which could have been currently misclassified.
  3. Abdullah FC, Zakaria Z, Thambinayagam HC, Kandasamy R, Alias A, Abu Bakar A, et al.
    Malays J Med Sci, 2021 Dec;28(6):129-185.
    PMID: 35002497 DOI: 10.21315/mjms2021.28.6.13
    The history of neurosurgery in Malaysia traces back to 1962 and is filled with stories of vibrant and humble neurosurgeons who have dedicated their life to patients and professions. The early development of neurological and neurosurgical services begins from the establishment of the neurosurgery unit at Hospital Kuala Lumpur (HKL), followed by the foundation of the Tunku Abdul Rahman Neuroscience Institute (IKTAR). Due to the exponentially increased demand for the care of neurosurgical patients, many universities and government hospitals have opened their neurosurgical units. In 2001, the formal residency training programme (USM Masters in Neurosurgery) started and since then has produced qualified neurosurgeons that empowered and shaped the present generation. The formation of the Neurosurgical Association of Malaysia (NAM) is another turning point towards bidirectional collaboration with the World Federation of Neurosurgical Societies (WFNS). Many opportunities were created for educational activities and the expansion of subspecialties in neurosurgery. This article describes the impact of the past neurosurgeons and the endeavors that they had gone through; the present neurosurgeons who pioneered the current neurosurgical services in Malaysia, and the future neurosurgeons that will continue the legacy and bring neurosurgery further ahead in this country.
  4. Abu Bakar A, Abdul Rafa AA, Abdullah Sani A
    MyJurnal
    Food contamination is a crucial health problem as it could result in food-borne illness. This research aimed to evaluate the microbiological quality of ready-to-eat (RTE) fried rice dishes sold at different type of food premises in Kuantan city, Pahang. Total Plate Count (TPC), Staphylococcus aureus, Bacillus cereus and Aeromonas spp. bacteria were used as microbiological contamination indicators. About 52 samples were collected stratified randomly from four types of food premises (restaurant, cafeteria, food stall and night market) where about 13 samples were respectively collected from each type of the food premises. The results showed that TPC had medium mean count (6.30x105±1.47x105 cfu/g), S. aureus and B. cereus had high mean counts (7.70x104±2.22x105 cfu/g and 3.85x105±1.67x106 cfu/g respectively), while Aeromonas spp. had medium mean count (7.13x104±2.42x105 cfu/g). The mean counts of TPC in the samples collected from cafeteria were highest compare to other food premises.
  5. Abu Bakar A, Mohd Nor NA, Ab-Murat N, Jaafar N
    Int J Dent Hyg, 2015 Aug;13(3):199-205.
    PMID: 25040653 DOI: 10.1111/idh.12095
    OBJECTIVE: To assess Malaysian dental therapists' perceptions of their job satisfaction and future roles.
    METHODS: A nationwide postal survey involving all Malaysian dental therapists who met the inclusion criteria (n = 1726).
    RESULTS: The response rate was 76.8%. All respondents were females; mean age 35.4 years (SD = 8.4). Majority were married (85.5%) and more than one-half had a working experience of <10 years (56.1%). Majority worked in community dental service (94.3%) and in urban areas (61.7%). Overall, they were highly satisfied with most aspects of their career. However, they were least satisfied with administrative workload (58.1%), career advancement opportunities (51.9%) and remuneration package; specifically income (45.2%), allowances (45.2%) and non-commensurate between pay and performance (44.0%). Majority perceived their role as very important in routine clinical tasks such as examination and diagnosis, preventive treatment, extraction of deciduous teeth and oral health promotion. However, fewer than one-half consider complex treatment such as placement of preformed crowns on deciduous teeth (37.1%) and extraction of permanent teeth (37.2%) as very important tasks.
    CONCLUSION: Majority expressed high career satisfaction with most aspects of their employment but expressed low satisfaction in remuneration, lack of career advancement opportunities and administrative tasks. We conclude that most Malaysian dental therapists have positive perceptions of their current roles but do not favour wider expansion of their roles. These findings imply that there was a need to develop a more attractive career pathway for therapists to ensure sustainability of effective primary oral healthcare delivery system for Malaysia's children.
  6. Abu Bakar A, Sulaiman S, Omar B, Mat Ali R
    J Arthropod Borne Dis, 2012;6(1):28-35.
    PMID: 23293776
    Melaleuca cajuputi essential oil in aerosol spray was evaluated against the dengue vectors Aedes aegypti and Ae. albopictus at low cost housing flats in Section 10, Setapak, Kuala Lumpur, Malaysia.
  7. Abu Bakar A, Akhtar MN, Mohd Ali N, Yeap SK, Quah CK, Loh WS, et al.
    Molecules, 2018 Mar 08;23(3).
    PMID: 29518053 DOI: 10.3390/molecules23030616
    Flavokawain B (1) is a natural chalcone extracted from the roots of Piper methysticum, and has been proven to be a potential cytotoxic compound. Using the partial structure of flavokawain B (FKB), about 23 analogs have been synthesized. Among them, compounds 8, 13 and 23 were found in new FKB derivatives. All compounds were evaluated for their cytotoxic properties against two breast cancer cell lines, MCF-7 and MDA-MB-231, thus establishing the structure-activity relationship. The FKB derivatives 16 (IC50 = 6.50 ± 0.40 and 4.12 ± 0.20 μg/mL), 15 (IC50 = 5.50 ± 0.35 and 6.50 ± 1.40 μg/mL) and 13 (IC50 = 7.12 ± 0.80 and 4.04 ± 0.30 μg/mL) exhibited potential cytotoxic effects on the MCF-7 and MDA-MB-231 cell lines. However, the methoxy group substituted in position three and four in compound 2 (IC50 = 8.90 ± 0.60 and 6.80 ± 0.35 μg/mL) and 22 (IC50 = 8.80 ± 0.35 and 14.16 ± 1.10 μg/mL) exhibited good cytotoxicity. The lead compound FKB (1) showed potential cytotoxicity (IC50 = 7.70 ± 0.30 and 5.90 ± 0.30 μg/mL) against two proposed breast cancer cell lines. It is evident that the FKB skeleton is unique for anticancer agents, additionally, the presence of halogens (Cl and F) in position 2 and 3 also improved the cytotoxicity in FKB series. These findings could help to improve the future drug discovery process to treat breast cancer. A molecular dynamics study of active compounds revealed stable interactions within the active site of Janus kinase. The structures of all compounds were determined by ¹H-NMR, EI-MS, IR and UV and X-ray crystallographic spectroscopy techniques.
  8. Abu Bakar A Majid, Lokman H Johari, Amal M Nasir, Anselm, S.T., Chan, W.H., Noraziah A Rahman, et al.
    MyJurnal
    A cross—sectional study conducted in the fasting month of Ramadan targeting muslim males assessed their religious beliefs in relation to smoking and their intentions t0 quit smoking in Ramadan. It was found that there law; is a strong association between their perceptions on the religious ruling of smoking as haram (prohibited) in relation to their smoking status. Among the non smokers and ex smokers, 87.8% and 73.6% respectively accept the ruling on smoking as prohibitea'(haram), while only 31.6% of smokers accept smoking as prohibited. Among the smokers, 97.7% smoke a lesser number of cigarettes during Ramadan, while 96.7% of them felt that it is easier to quit during the fasting month. The findings suggest that the religious department needs to provide more information and education to the Muslim population as to the reasons of the ruling on smoking as haram(prohibited) on religious grounds . It was also found that the majority felt it is easier to quit during quit smoking programmes can be emphasized and carried out on a bigger scale during fasting months in the future.
  9. Abu-Bakar A, Hu H, Lang MA
    Basic Clin Pharmacol Toxicol, 2018 Sep;123 Suppl 5:72-80.
    PMID: 29788535 DOI: 10.1111/bcpt.13046
    The murine cytochrome P450 2a5 (Cyp2a5) gene is regulated by complex interactions of various stress-activated transcription factors (TFs). Elevated Cyp2a5 transcription under chemical-induced stress conditions is achieved by interplay between the various TFs - including as aryl hydrocarbon receptor (AhR) and nuclear factor (erythroid-derived 2)-like 2 wild-type (Nrf2) - at the 'stress-responding' cluster of response elements on the Cyp2a5 promoter, as well as through mRNA stabilization mediated by interaction of the stress-activated heterogeneous nuclear ribonucleoprotein A1 (hnRNP A1) with the 3'-UTR of the CYP2A5 mRNA. We designed a unique toxicity pathway-based reporter assay to include regulatory regions from both the 5' and the 3' untranslated regions of Cyp2a5 in a luciferase reporter plasmid to reflect in vivo responses to chemical insult. Human breast cancer MCF-7 cells were stably transfected with pGL4.38-Cyp2a5_Wt3k (wild-type) or mutant - pGL4.38-Cyp2a5_StREMut and pGL4.38-Cyp2a5_XREMut - reporter gene to monitor chemical-induced cellular response mediated by AhR and Nrf2 signalling. The recombinant cells were treated with representative of AhR agonist, polycyclic aromatic hydrocarbons, brominated flame retardant, fluorosurfactant, aromatic organic compound and metal, to determine the sensitivity of the Cyp2a5 promoter-based gene reporter assays to chemical insults by measuring the LC50 and EC50 of the respective chemicals. The three assays are sensitive to sublethal cellular responses of chemicals, which is an ideal feature for toxicity pathway-based bioassay for toxicity prediction. The wild-type reporter responded well to chemicals that activate crosstalk between the AhR and Nrf2, whilst the mutant reporters effectively gauge cellular response driven by either Nrf2/StRE or AhR/XRE signalling. Thus, the three gene reporter assays could be used tandemly to determine the predominant toxicity pathway of a given compound.
  10. Ahmad Hamdan AF, Abu Bakar A
    Malays J Med Sci, 2023 Oct;30(5):169-180.
    PMID: 37928795 DOI: 10.21315/mjms2023.30.5.14
    INTRODUCTION: A no-show appointment occurs when a patient does not attend a previously booked appointment. This situation can cause other problems, such as discontinuity of patient treatments as well as a waste of both human and financial resources. One of the latest approaches to address this issue is predicting no-shows using machine learning techniques. This study aims to propose a predictive analytical approach for developing a patient no-show appointment model in Hospital Kuala Lumpur (HKL) using machine learning algorithms.

    METHODS: This study uses outpatient data from the HKL's Patient Management System (SPP) throughout 2019. The final data set has 246,943 appointment records with 13 attributes used for both descriptive and predictive analyses. The predictive analysis was carried out using seven machine learning algorithms, namely, logistic regression (LR), decision tree (DT), k-near neighbours (k-NN), Naïve Bayes (NB), random forest (RF), gradient boosting (GB) and multilayer perceptron (MLP).

    RESULTS: The descriptive analysis showed that the no-show rate was 28%, and attributes such as the month of the appointment and the gender of the patient seem to influence the possibility of a patient not showing up. Evaluation of the predictive model found that the GB model had the highest accuracy of 78%, F1 score of 0.76 and area under the curve (AUC) value of 0.65.

    CONCLUSION: The predictive model could be used to formulate intervention steps to reduce no-shows, improving patient care quality.

  11. Boo NY, Abu Bakar A
    Med J Malaysia, 1984 Mar;39(1):35-7.
    PMID: 6513837
    The transcutaneous (Tc) bilirubinometer was evaluated in 105 jaundiced neonates, comprising 38 Malays, 37 Chinese and 30 Indians, who had not been treated with phototherapy or exchange transfusion. Tc bilirubin index and serum bilirubin concentration correlated at statistically significant levels in all the three racial groups. Unlike the Chinese and Malay babies, the action levels, using Tc bilirubin index, in the Indian babies are not reliable due to the wide variation of skin pigmentation. Neonatal jaundice is conventionally monitored by estimation of serum bilirubin level. This involves blood sampling. The transcutaneous (Tc) bilirubinometer, however, is non-invasive, small and portable. In this study, the use of the Tc bilirubinometer in the management of neonatal jaundice' in the three racial groups was evaluated.
  12. Das S, Palaniandy K, Abu Bakar A, Idris Z, Abdullah JM
    Cureus, 2020 Feb 03;12(2):e6850.
    PMID: 32181085 DOI: 10.7759/cureus.6850
    Cervical spine injuries are rare occurrences in children, especially the congenital anomalies of the atlas vertebra. Any injury involving the craniovertebral junction such as Jefferson fracture, is a valid cause for alarm due to the complex nature of the craniovertebral junction and the morbidity associated with it. We report the case of a 10-year-old male, who had failure of fusion of anterior arch of atlas due to the failure of formation of the anterior midline synchondrosis, and this mimicked a Jefferson fracture. If it was not for the peculiar absence of any corresponding evidence to suggest spinal injury, we might have mistaken this extremely rare but benign anomaly for a Jefferson fracture and subjected the patient to needless surgical treatment. Hence, it is concluded that keen clinical acumen and clear understanding of the developmental anatomy of these patients may be necessary to adequately manage them.
  13. Dzulkifli AR, Aishah AL, Ch'ng HS, Rose A, Rahmat A, Isa AM, et al.
    J Audiov Media Med, 1994 Jul;17(3):117-20.
    PMID: 7636117
    A number of health databases is now available in Malaysia, but few are accessible to the general public. However, recently a service was launched nationwide via a videotex system to also target the Malaysia public. This service is provided by the School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM) in collaboration with several Malaysian Government ministries and agencies. Access to health information via videotex, be it medical, pharmaceutical or environmental is viewed as an effective means of on-line information dissemination. It provides not only rapid retrieval but is also economical and interactive, particularly suitable for a developing country.
  14. Hassan R, Sharis Othman S, Ahmad Mukari SA, Abu Bakar A
    Med J Malaysia, 2013 Jun;68(3):264-6.
    PMID: 23749020 MyJurnal
    Pituitary apoplexy is a well-known complication of a pituitary adenoma. However, an ischaemic event caused by pituitary apoplexy is rare. We reported a case of pituitary apoplexy with middle cerebral artery infarction in a 44-year old man who presented with a sudden onset of altered sensorium. Vasospasm is the most likely underlying cause of the infarction in this case secondary to transdiaphragmatic rupture of the sella tumour into the subarachnoid space.
  15. Hazalin NA, Lim SM, Cole AL, Majeed AB, Ramasamy K
    Anticancer Drugs, 2013 Sep;24(8):852-61.
    PMID: 23764760 DOI: 10.1097/CAD.0b013e3283635a47
    There is growing interest in the discovery of bioactive metabolites from endophytes as an alternative source of therapeutics. Identification of their therapeutic targets is essential in understanding the underlying mechanisms and enhancing the resultant therapeutic effects. As such, bioactive compounds produced by endophytic fungi from plants at the National Park, Pahang, Malaysia, were investigated. Five known compounds were identified using LC-UV-MS-NMR and they include trichodermol, 7-epi-brefeldin A, (3R,4S)-4-hydroxymellein, desmethyl-lasiodiplodin and cytochalasin D. The present study went on to investigate the potential anticancer effects of these compounds and the corresponding molecular mechanisms of the lead compound against human breast adenocarcinoma, MCF-7. For the preliminary screening, the cytotoxicity and apoptotic effects of these compounds against MCF-7 were examined. The compounds were also tested against noncarcinogenic hepatocytes (WRL68). The differential cytotoxicity was then determined using the MTT assay. Desmethyl-lasiodiplodin was found to suppress the growth of MCF-7, yielding an inhibitory concentration (IC50) that was seven-fold lower than that of the normal cells. The cytotoxic effect of desmethyl-lasiodiplodin was accompanied by apoptosis. Subsequent analysis demonstrated increased expression levels of caspase 3, c-myc and p53. Further, desmethyl-lasiodiplodin resulted in inhibition of monocyte chemotactic protein (MCP)-3, a cytokine involved in cell survival and metastasis. Hence, this study proposed that desmethyl-lasiodiplodin inhibited growth and survival of MCF-7 through the induction of apoptosis. This anticancer effect is mediated, in part, by upregulation of apoptotic genes and downregulation of MCP-3. As desmethyl-lasiodiplodin elicited minimal impact against normal hepatocytes, our findings also imply its potential use as a specific apoptotic agent in breast cancer treatment.
  16. Idrus NL, Md Jamal S, Abu Bakar A, Embong H, Ahmad NS
    PLoS Negl Trop Dis, 2023 Dec;17(12):e0011839.
    PMID: 38113250 DOI: 10.1371/journal.pntd.0011839
    BACKGROUND: The timely identification of severe dengue in peadiatric patients is of utmost importance, as any delay in diagnosis could lead to an irreversible state of shock potentially leading to fatal consequences. The primary aim of our study was to characterize dengue severity in paediatric patients based on initial symptoms, signs, and laboratory investigation of their presentation in the emergency department.

    METHODOLOGY: We conducted a retrospective data retrieval from the medical records of 254 paediatric patients who had been diagnosed with confirmed cases of dengue fever. The clinical characteristics were compared between severe and non-severe dengue. Multiple logistic regression analysis was utilised to elucidate the variables that exhibited associations with severe dengue.

    RESULTS: A total of 254 paediatric patients were included, among whom 15.4% (n = 39) were diagnosed with severe dengue. Multiple logistic regression analysis identified lethargy, systolic blood pressure (SBP) below 90 mmHg, capillary refilled time (CRT) longer than 2 seconds, ascites, and hepatomegaly were independently associated with severe dengue.

    CONCLUSION: In paediatric patients, severe dengue is associated with specific clinical indicators, including lethargy, low systolic blood pressure, prolonged capillary refill time (CRT), and the presence of ascites and hepatomegaly. Identifying these clinical features early is crucial for primary care physicians, as it enables accurate diagnosis and timely intervention to manage severe dengue effectively.

  17. Islam MS, Phoungthong K, Ismail Z, Othman IK, Shahid S, Ishak DSM, et al.
    PMID: 36644961 DOI: 10.1080/10934529.2022.2148811
    The spreading of sewage sludge from wastewater treatment plants and various industries arouses the growing interest due to the contamination by trace elements. Sludges were collected from one sewage treatment plant and two industries in Dhaka City, Bangladesh to assess physicochemical parameters and total and fraction content of trace elements like Cr, Ni, Cu, As, Cd, Pb, Fe, Mn and Zn in sludges. We evaluated the bioavailability of theses metals by determining their speciation by sequential extraction, each metal being distributed among five fractions: exchangeable fraction, bound to carbonate fraction, Fe-Mn oxide bound fraction, organic matter bound fraction and residual fractions. We found that all the analyzed sludges had satisfactory properties from an agronomic quality point of view. The average concentration (mg/kg) of trace metals in sludge samples were in the following decreasing order Fe (12807) > Cr (200) > Mn (158) > Zn (132) > Cu (68.2) > Ni (42.5) > Pb (36.4) > As (35.1) > Cd (3.7). The results of the sequential extraction showed that Cr, Ni, Cu, Fe and Mn were largely associated with the residual fraction where As, Cd and Pb was dominantly associated with the exchangeable and carbonate bound fractions and Zn showed a considerable proportion in carbonate bound fraction. These results showed that regulations must take into account the bioavailability with regard to the characteristics of the agricultural soils on which sludge will be spread.
  18. Jaafar S, Mohd Noh K, Abdul Muttalib K, Othman NH, Healy J, Maskon K, et al.
    ISBN: 978-92-9061-584-2
    Citation: Jaafar S, Mohd Noh K, Abdul Muttalib K, Othman NH, Healy J, Maskon K, et al. Malaysia Health System Review. Geneva: World Health Organization; 2013

    Malaysia is a federation of 13 states and 2 territories in a parliamentary democracy, with the Prime Minister the head of government and a constitutional monarch elected by the Sultans. Malaysia is a multicultural society and a secular state with Sunni Islam as the official religion. Classified by the World Bank as an upper middle-income country, its society and economy were transformed by rapid economic growth in the latter half of the 20th century. Malaysia’s population (now numbering over 28 million with 70% living in urban areas) has benefited from a well developed health care system, good access to clean water and sanitation, and strong social and economic programmes. Life expectancy at birth is 73 years. Noncommunicable diseases now account for most mortality and morbidity but communicable diseases remain a concern. Section 2 describes the organization and governance of the health system. Health care services consist of tax-funded and governmentrun primary health care centres and hospitals, and fast-growing private services mainly located in physician clinics and hospitals in urban areas. Public sector health services are administered by the Ministry of Health through its central, state and district offices. The Ministry of Health regulates the private sector, pharmaceutical industry and food safety and plans and regulates its own health care services. Legislation governing health care professionals requires them to register with statutory professional bodies. Section 3 reports on health care financing. Malaysia’s public health system is financed mainly through general revenue and taxation collected by the federal government, while the private sector is funded principally through out-of-pocket payments from patients and some private health insurance. Spending on health reached 4.6% of GDP in 2009 with the majority from public spending, reaching 56% of total health expenditure (THE) in 2009. The main sources of THE in 2008 were the Ministry of Health (42%), followed by household out-of-pocket expenditure at nearly 34%. The Ministry of Health funds public facilities through line item budgets and patients pay private physicians and private hospitals on a fee-for-service basis. Physical and human resources are described in Section 4. The number of public primary care facilities (currently 802 centres and over 2000 small community clinics) and dental clinics were expanded steadily in earlier decades, particularly to reach people in under-served rural areas. Secondary care is offered in smaller public hospitals and more complex tertiary care, in regional and national hospitals (including university teaching hospitals run by the Ministry of Higher Education). Growth has slowed in recent years, however, and public services in urban areas have not kept pace with rapid urbanization, while the population ratio of hospital beds has declined slightly. Private clinics and hospitals in urban areas have grown rapidly over the last decade. The supply of health professionals remains seriously below the required number, although the government has increased the number of training places. Section 5 looks at provision of services. National health policies stress public health and health promotion, that is, ‘a wellness’ as well as a ‘disease’ perspective. The Ministry of Health has developed an extensive network of public primary care centres and also dental services especially for children, but these services are under strain and have staff shortages, so patients often encounter long waits. Primary care exerts only a limited gatekeeper function since people can bypass a referral from a general practitioner and for a small additional fee (if in the public sector) can go directly to specialists and hospitals. Government services increasingly serve the poor and private services the better-off people who live in urban areas. Hospital policy currently has three main thrusts: strengthening specialty care in large public hospitals; increasing the number of day surgery centres; and expanding top-end private hospital care to cater to the medical tourism market (with 35 participating hospitals in 2010). Malaysia has a large pharmaceutical manufacturing sector that exports to other countries and also supplies 30% of domestic demand. The principal health care reforms are discussed in Section 6. The government has stepped up its surveillance and early response to infectious disease outbreaks as a result of recent pandemics such as SARS and avian flu, which had a major impact on the country’s economy. The Ministry of Health has maintained its extensive vaccination programmes, has consolidated its primary health care clinics and upgraded its hospitals, and is slowly introducing information communication technology into its public facilities. The government has increased training places to counter shortages of health professionals, has strengthened food and drug safety regulation, is considering price xv regulation of pharmaceuticals, and is positioning the country as a medical tourism destination. Section 7 provides an assessment of the health system. Malaysia has a strong population health tradition and well-established and extensive health care services. Although total health expenditure at 4.6% of GDP in 2008 is in the range for middle-income countries, the government is concerned about future sustainable financing. Successive administrators have prioritized the provision of cost-effective, preventative and mainly free primary health care in public clinics. The rapid growth of private health care means that private spending has risen faster than public spending, including out-of-pocket payments by the public, with the government share (from general revenue) just above half (56%) of health expenditure in 2009. In conclusion, Malaysia has achieved impressive health gains for its population with a low-cost health care system funded through general revenue that provides universal and comprehensive services. Like many other countries in the region, Malaysia has struggled to produce an adequate supply of health professionals, and to integrate and regulate its rapidly growing private health sector. Public services have not kept pace with population growth in urban areas and those with higher purchasing power use private rather than public doctors and hospitals, which leaves the public sector with more poorer and sicker patients. The Malaysian Government recently revived the debate over options for a national social health insurance scheme. The financing challenge is to agree on a scheme for fair and sustainable funding and its respective contributions from general revenue and private payments. The regulatory challenge for the Malaysian Government is to strengthen its governance of both public and private health services in order to ensure high quality and safe services and fair charges. The structural challenge is to determine the balance between public and private sector delivery and to engage in a more productive partnership between public and private sectors. The administrative challenge is to consider whether the community would be better served by more decentralized and responsive services. As Malaysia seeks to attain high income country status, and as demographic and epidemiological transitions continue and new technology expands the possibilities for intervention, the demand for xvi health care by the population will continue to rise. The government will need to address growing concerns about equity, efficiency and budgetary constraints and balance conflicting policy principles. Pressures are building up for health system reform in Malaysia looking towards the year 2020 and beyond.
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