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  1. Tan EH, Batchelor P, Sheiham A
    Int Dent J, 2006 Oct;56(5):277-82.
    PMID: 17069070
    OBJECTIVES: To reassess the recall frequency interval for dental examinations for children, based on annual caries increments.

    METHODS: Cross sectional data collected on school children in eight rural and urban schools through the national Incremental Dental Care Programme (IDCP) for one district in Malaysia were analysed to assess their annual caries increment and trend lines. The Restorative Index was calculated to assess the success of the IDCP in rendering children dentally fit.

    RESULTS: The annual caries increments were low; the current caries levels were between 0.65 and 1.50 for 12 year-old children in Kota Tinggi District. Most of the caries experience was on pits and fissures. From 7 to 12 years old, the overall annual caries increment for the total study population was 0.19. The mean annual caries increment increased slightly between the ages of 12 to 14 years and 14 to 16 years and was 0.24 and 0.25 respectively. Two distinct caries incremental trend lines were observed for children aged 7 to 16 years. One group reached a mean DMFT of about 0.75 while the other group a mean DMFT of about 1.4 at 12 years. The trend lines continued over the next 4 years until the children were 16 years old. The Restorative Index was higher in urban schools that also had low DMFT levels.

    CONCLUSIONS: Based on the low annual caries increments of between 0.65 and 1.50, yearly dental examination intervals can safely be extended to 2-yearly intervals or even longer. Such a change of screening recall intervals would help improve resource allocation. Resources saved by extending recall intervals can be redirected to the small proportion of children with higher disease levels. This will help render more school children dentally fit and reduce inequalities in oral health.

  2. Ahmad H, Ong SQ, Tan EH
    Int J Insect Sci, 2019;11:1179543318823533.
    PMID: 30675104 DOI: 10.1177/1179543318823533
    Megaselia scalaris (Loew) is one of the best-known diets for the swiftlet. Previous studies have addressed the problem of some mass rearing conditions for this insect; unfortunately, the details of the nutritional composition of the life stages and cost of the breeding materials were insufficiently reported, even though this information is crucial for farming the edible-nest swiftlet. We aimed to investigate the nutritional composition of the life stages of M scalaris on a cost basis using 3 common commercial breeding materials: chicken pellets (CPs), fish pellets (FPs), and mouse pellets (MPs). Modified Association of Official Analytical Chemists (AOAC) proximate and mineral analyses were carried out on the insect's third instar larvae, pupal, and adult stages to determine the nutritional composition. Regardless of the breeding materials, the adult stage of M scalaris had significantly higher crude protein than the other stages; the pupae were rich in calcium, which is required for egg production; and the third instar larvae had the highest amount of crude fat compared with the other stages. Regarding the energy content, there were no significant differences among the stages according to the breeding materials. In terms of nutritional cost, CP was the most economic breeding material and generated the highest amount of nutrients per US dollar (US $). Different life stages of M scalaris were used by the swiftlets by supplying the required nutrients, and future studies should focus on effective diet feeding methods.
  3. Ong SQ, Ahmad H, Tan EH
    Environ Entomol, 2018 12 07;47(6):1582-1585.
    PMID: 30165432 DOI: 10.1093/ee/nvy127
    Megaselia scalaris (Loew) (Diptera: Phoridae) provides great evidential value in estimating the postmortem interval (PMI) compared with other dipterans due to its common occurrence on human corpses both indoors and in concealed environments. Studies have focused on the effect of temperature, larval diet, and photoperiod on the development of the species; however, knowledge of M. scalaris development at different moisture levels is insufficient. This study aimed to investigate the effects of substrate moisture on the larval development time, pupal recovery, pupal weight, adult emergence, and adult head width of M. scalaris. The larvae were reared in five replicates on substrates with six moisture levels ranging from 50 to 90%. Larvae and puparia were sampled daily, and the collection time, number, and weight were recorded, measured, and then compared using multivariate analysis of variance with a post hoc least significant difference test. Larvae developed most quickly (3.75 ± 0.04 d) at 50% substrate moisture; the larvae were able to survive in extremely wet substrates (90% moisture), but the development time was significantly longer (6.48 ± 0.19 d). Moisture greatly influenced the pupation rate and adult emergence but showed a weak effect on the pupae weight and adult head width. Due to the significance of moisture on the development of M. scalaris, PMI estimation using M. scalaris with cadavers of different moisture content must be carefully conducted to avoid inaccuracy.
  4. Tan EH, Yusoff AA, Abdullah JM, Razak SA
    J Pediatr Neurosci, 2012 May;7(2):123-5.
    PMID: 23248692 DOI: 10.4103/1817-1745.102575
    In this report, we describe a 15-year-old Malaysian male patient with a de novo SCN1A mutation who experienced prolonged febrile seizures after his first seizure at 6 months of age. This boy had generalized tonic clonic seizure (GTCS) which occurred with and without fever. Sequencing analysis of voltage-gated sodium channel a1-subunit gene, SCN1A, confirmed a homozygous A to G change at nucleotide 5197 (c.5197A > G) in exon 26 resulting in amino acid substitution of asparagines to aspartate at codon 1733 of sodium channel. The mutation identified in this patient is located in the pore-forming loop of SCN1A and this case report suggests missense mutation in pore-forming loop causes generalized epilepsy with febrile seizure plus (GEFS+) with clinically more severe neurologic phenotype including intellectual disabilities (mental retardation and autism features) and neuropsychiatric disease (anxiety disorder).
  5. Tan EH, Razak SA, Abdullah JM, Mohamed Yusoff AA
    Epilepsy Res, 2012 Dec;102(3):210-5.
    PMID: 22944210 DOI: 10.1016/j.eplepsyres.2012.08.004
    Generalized epilepsy with febrile seizures plus (GEFS+) comprises a group of clinically and genetically heterogeneous epilepsy syndrome. Here, we provide the first report of clinical presentation and mutational analysis of SCN1A gene in 36 Malaysian GEFS+ patients. Mutational analysis of SCN1A gene revealed twenty seven sequence variants (missense mutation and silent polymorphism also intronic polymorphism), as well as 2 novel de-novo mutations were found in our patients at coding regions, c.5197A>G (N1733D) and c.4748A>G (H1583R). Our findings provide potential genetic insights into the pathogenesis of GEFS+ in Malaysian populations concerning the SCN1A gene mutations.
  6. Jawahir S, Mohamad Anuar NN, Sheikh Abdullah SF, Silvernayagam S, Tan EH
    Med J Malaysia, 2021 Jan;76(1):73-79.
    PMID: 33510113
    INTRODUCTION: Positive professional practice environments are crucial to safeguard a healthy and safe working conditions for health workforce, including nurses; so as to ensure provision of quality healthcare and safety of patient.

    METHODS: This was a cross-sectional study to assess nurses' perceptions towards nursing practice environment and factors associated with their perceptions. A validated Practice Environment Scale of the Nursing Work Index (PESNWI) questionnaire was administered to nurses working in two Ministry of Health hospitals. The questionnaire comprises of five subscales: Participation, Foundation, Managers Support, Workforce Adequacy and Physician/Nurse Relations. Mean scores of >2.50 were considered as favourable, and ≤2.50 were considered as unfavourable. Simple linear and multiple linear regression analysis were employed to identify factors associated with their perceptions. Analysis was carried out using STATA version 14.0.

    RESULTS: A total of 366 respondents took part in the study, with a response rate of 98.4%. Majority were working shift (89.6%) and working extended hours (62.3%). In general, the nursing practice environments were rated as favourable. Overall mean score was 2.90±0.03 and four out of five subscales' mean scores were >2.50. Foundation for quality nursing care was perceived as the most favourable subscale, while workforce adequacy was perceived as the least favourable. There were statistically significant association between working extended hours, doing double shift and working during day off with perceived unfavourable workforce adequacy.

    CONCLUSION: Nursing practice environment was perceived as favourable in the studied hospitals. Policy makers, service providers, and hospital managers could explore further on human resource planning and management of nursing personnel to tackle the issue of nurse staffing in the country.

  7. Chong DWQ, Jawahir S, Tan EH, Sararaks S
    PMID: 33921985 DOI: 10.3390/ijerph18094435
    Since its inception in 1986, the contents of the National Health and Morbidity Survey (NHMS) have been periodically updated to support emerging health data needs for evidence-based policy and program development. In 2018, the healthcare demand questionnaire was redesigned to capture diverse and changing population demand for healthcare services and their utilization pattern. This paper describes the methods and processes undertaken in redesigning the questionnaire. We aim to highlight the systematic and inclusive approach, enabling all potential evidence users to be involved, indirectly encouraging research evidence uptake for policy and program planning. We applied a systematic approach of comprehensive literature search for national-level population survey instruments implemented globally and translated non-English tools to English. The development phases were iterative, conducted in parallel with active stakeholder engagements. Here, we detailed the processes in the planning and exploratory phase as well as a qualitative assessment of the questionnaire. We included instruments from 45 countries. The majority were from the Organisation for Economic Co-operation and Development (OECD) countries and focused on perceived health, health-related behavior, and healthcare use. Thirty-four stakeholders from 14 areas of expertise were involved. Stakeholders identified additional content areas required, such as chronic pain, alternative use of healthcare services (community pharmacy, home-visit, and private medical laboratory), family doctor, and informal caregiving. The questionnaire, redesigned based on existing literature with concordant involvement and iterative feedback from stakeholders, improved the choice of health topics through the identification of new topics and modification of existing questions to better meet future evidence needs on health problems, strategy, and program planning towards strengthening the nation's health systems.
  8. Hamidi N, Tan YR, Jawahir S, Tan EH
    BMC Health Serv Res, 2021 Jul 04;21(1):649.
    PMID: 34217293 DOI: 10.1186/s12913-021-06656-1
    BACKGROUND: Community pharmacies provide alternatives for medication procurement and other basic and minor health-related services in addition to mainstream hospitals and primary healthcare services. This study aimed to determine the characteristics of community pharmacy users and associated factors for community pharmacy utilisation in Malaysia.

    METHODS: Secondary data analysis was performed using data from the National Health and Morbidity Survey 2019, a nationwide cross-sectional household survey that used a two-stage stratified random sampling design. Adults aged 18 years and over were included in the analysis. Respondents who reported visiting the community pharmacy for health purposes two weeks prior to the study were considered as users. Complex sample descriptive statistics were used to describe the respondents' characteristics. Logistic regression analyses were employed to determine factors associated with community pharmacy utilisation.

    RESULTS: Of the 11,155 respondents interviewed, 10.3 % reported community pharmacy utilisation for health purposes. Females (OR = 1.41, 95 % CI = 1.14, 1.73), those with tertiary education (OR = 2.03, 95 % CI = 1.26, 3.29), urban dwellers (OR = 1.42, 95 % CI = 1.13, 1.79), and those with self-reported health problems (OR = 7.62, 95 % CI = 6.05, 9.59) were more likely to utilise the community pharmacy.

    CONCLUSIONS: Demographic and socioeconomic factors were important determinants of community pharmacy utilisation in Malaysia with sex, age, education level, locality, and self-reported health problems as the associated factors. These findings serve as evidence for policy interventions, crucial for improvements in accessibility to healthcare services.

  9. Tan YR, Tan EH, Jawahir S, Mohd Hanafiah AN, Mohd Yunos MH
    BMC Oral Health, 2021 01 19;21(1):34.
    PMID: 33468125 DOI: 10.1186/s12903-020-01388-w
    BACKGROUND: Throughout the years, oral healthcare utilisation in Malaysia has been low despite various efforts by the Ministry of Health Malaysia for improvement. This study aimed to determine the prevalence of oral healthcare utilisation and identify factors associated with oral healthcare utilisation among adults in Malaysia.

    METHODS: Secondary data analysis of adults aged 18 years and over from the National Health and Morbidity Survey 2019 was conducted in this study. Characteristics of respondents and those who utilised oral healthcare were described using complex sample descriptive statistics. Logistic regression analysis was performed to examine the association between the dependent and independent variables. Dependent variable was oral healthcare utilisation in the last 12 months. Independent variables were demographic and socioeconomic factors (predisposing, enabling and need characteristics) based on Andersen's Behavioural Model.

    RESULTS: A total of 11,308 respondents, estimated to represent 21.7 million adults aged 18 years and over in Malaysia were included in the analysis. Prevalence of oral healthcare utilisation in the last 12 months was 13.2%. Demographic factors of sex, age, marital status, and socioeconomic factors of education level and occupation as well as health belief such as medical check-up were significantly related to oral healthcare utilisation. Enabling factor of household income quintile had significant association with oral healthcare utilisation. Inequalities were observed; females (OR = 1.57, 95% CI = 1.25, 1.96), younger adults (OR = 1.64, 95% CI = 1.15, 2.33), those who were married (OR = 1.65, 95% CI = 1.23, 2.22), those with higher education (OR = 2.21, 95% CI = 1.23, 3.99), those who had medical check-up in the last 12 months (OR = 1.86, 95% CI = 1.53, 2.25) and those with higher income (OR = 1.43, 95% CI = 1.04, 1.96) were more likely to utilise oral healthcare.

    CONCLUSION: Understanding factors associated with utilisation of oral healthcare could help in formulating effective interventions to improve oral healthcare utilisation. Demographic and socioeconomic factors are strong determinants of oral healthcare utilisation in Malaysia. Appropriate interventions to strengthen the existing programmes aimed to promote regular and timely oral health check-ups are needed to improve oral healthcare utilisation.

  10. Kong YL, Anis-Syakira J, Jawahir S, R'ong Tan Y, Rahman NHA, Tan EH
    BMC Public Health, 2021 Jun 01;21(1):1033.
    PMID: 34074275 DOI: 10.1186/s12889-021-11022-1
    BACKGROUND: The increase in the elderly population, chronic and degenerative diseases, as well as accidents at work and on the road in Malaysia would result in an increased demand for informal care. This paper aimed to determine the associated factors of informal caregiving and its effects on health, work and social activities of adult informal caregivers in Malaysia.

    METHODS: The data from the 2019 National Health and Morbidity Survey (NHMS), a nationwide cross-sectional survey with a two-stage stratified random sampling design, was used in this research. The study included respondents who were 18 years and older (n = 11,674). Data were obtained via face-to-face interviews using validated questionnaires. Descriptive and complex sample logistic regression analyses were employed as appropriate.

    RESULTS: 5.7% of the adult population were informal caregivers. Provision of informal care were significantly associated with the female sex (OR = 1.52, 95% CI [1.21, 1.92]), those aged 36-59 years (OR = 1.61, 95% CI [1.15, 2.25]), and those who reported illness in the past 2 weeks (OR = 1.79, 95% CI [1.38, 2.33]). The risk of having their health affected were associated with female caregivers (OR = 3.63, 95% CI [1.73, 7.61]), those who received training (OR = 2.10, 95% CI [1.10, 4.00]) and those who provided care for 2 years or more (OR = 1.91, 95% CI [1.08, 3.37]). The factors associated with the effects on work were ethnicity, received training and had no assistance to provide the care. In terms of effect on social activities, female caregivers (OR = 1.96, 95% CI [1.04, 3.69]) and caregivers who received training were more likely (OR = 2.19, 95% CI [1.22, 3.93]) to have their social activities affected.

    CONCLUSION: Our study revealed that sex, age, and self-reported illness were factors associated with being an informal caregiver in Malaysia. Informal caregivers faced effects on their health, work, and social activities which may be detrimental to their well-being. This understanding is crucial for planning support for caregivers.

  11. Chew ZL, Tan EH, Palaniandy SA, Woon KS, Phuang ZX
    Sci Total Environ, 2023 Jan 15;856(Pt 1):159007.
    PMID: 36167122 DOI: 10.1016/j.scitotenv.2022.159007
    Improper discard of oil palm trunk and empty fruit bunch renders massive greenhouse gases. Turning these palm wastes into solid biofuels could aid in carbon reduction. The embodied environmental impacts of the solid biofuel densification process are neglected in carbon emission quantification studies applying Greenhouse Gas Protocol while the significance of classifying the system's direct and indirect carbon emissions were overlooked in those utilising life cycle assessment. Despite the prospect of both methodologies to complement their limitations for carbon emissions quantification, no study integrates both methodologies to investigate direct and indirect emissions systematically from a life cycle perspective. An integrated framework of life cycle assessment and Greenhouse Gas Protocol is developed to quantify the direct and indirect carbon emissions of oil palm trunk and empty fruit bunch densification from cradle-to-gate for three pellet plants in Indonesia and Malaysia. The emissions are categorised into three emission scopes: Scope 1, Scope 2, and Scope 3 according to the Greenhouse Gas Protocol, integrated with avoided emissions which are quantified via life cycle assessment. The pellet plants generate 534.7-732.3 kg CO2-eq/tonnepellet per hour, in which Scope 1 (i.e., direct emissions) is the major emission scope due to high emissions from wastewater production and drying fuel combustion. Washing equipment (169.2-439.0 kg CO2-eq/tonnepellet per hour) and burners (87.1-214.5 kg CO2-eq/tonnepellet per hour) are the hotspots found in the pellet plants. Producing empty fruit bunch pellets could reduce 62.0-74.1 % of emissions than landfilling the empty fruit bunch. Empty fruit bunch pellet and oil palm trunk pellet are recommended to co-fire with coal to phase down coal usage in achieving COP26 pledge. This study provides data-driven insights for quantifying carbon emissions through the integrated framework and could be a reference in future life cycle carbon footprint studies of the biomass densification process.
  12. Jawahir S, Tan EH, Tan YR, Mohd Noh SN, Ab Rahim I
    BMC Health Serv Res, 2021 Apr 27;21(1):391.
    PMID: 33906646 DOI: 10.1186/s12913-021-06412-5
    BACKGROUND: Provision of informal care may adversely affect health, daily and social activities of the informal caregivers, but few studies have examined these effects in relation to caregiving intensity. This study examined the predictive factors associated with the effects of caregiving roles on health, daily and social activities of informal caregivers, accounting for caregiving intensity.

    METHODS: Data of adults aged 18 years and over from the National Health and Morbidity Survey 2019 were used. Respondent's demographic, socioeconomic, health, and caregiving-related characteristics were described using complex samples analysis. Logistic regression analysis was performed to examine the factors affecting health, daily and social activities of caregivers, accounting for caregiving intensity.

    RESULTS: Five point one percent of adults in Malaysia provided informal care. High intensity caregivers were more likely to be actively employed and provided longer duration of care compared with low intensity caregivers. For low intensity caregiving, females, those aged 35-59 years, and those with long-term condition were more likely to have negative effects on health. Daily activities of non-Malays were more likely to be affected, while no factor was found significantly associated with effect on social activities. For high intensity caregiving, caregivers aged 60 and over, those received training and those without assistance were more likely to have negative effects on health. Daily activities of those without assistance were more likely to be affected. Social activities of non-Malays, those received training and those providing care for 2 years or more were more likely to be affected.

    CONCLUSIONS: Our study indicates that both low- and high-intensity caregivers have common features, with the exception of employment status and care duration. Caregiving, regardless of intensity, has a significant impact on caregivers. In order to reduce the negative consequences of caregiving responsibilities, all caregivers need assistance from the community and government, that is customised to their needs. By addressing the factors contributing to the negative effects of caregiving, a continuation of informal caregiving can be sustained through policies supporting the growing demand for informal care necessitated by an ageing population and higher life expectancy in Malaysia.

  13. Rannan-Eliya RP, Anuranga C, Manual A, Sararaks S, Jailani AS, Hamid AJ, et al.
    Health Aff (Millwood), 2016 May 01;35(5):838-46.
    PMID: 27140990 DOI: 10.1377/hlthaff.2015.0863
    Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia's results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia's hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia's hybrid health system presents continuing unresolved policy challenges, but the country's experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources.
  14. Fun WH, Sararaks S, Tan EH, Tang KF, Chong DWQ, Low LL, et al.
    BMC Health Serv Res, 2019 Apr 24;19(1):248.
    PMID: 31018843 DOI: 10.1186/s12913-019-4072-7
    BACKGROUND: Health Research Priority Setting (HRPS) in the Ministry of Health (MOH) Malaysia was initiated more than a decade ago to drive effort toward research for informed decision and policy-making. This study assessed the impact of funded prioritised research and identified research gaps to inform future priority setting initiatives for universal access and quality healthcare in Malaysia.

    METHODS: Research impact of universal access and quality healthcare projects funded by the National Institutes of Health Malaysia were assessed based on the modified Payback Framework, addressing categories of informing policy, knowledge production, and benefits to health and health sector. For the HRPS process, the Child Health and Nutrition Research Initiative methodology was adapted and adopted, with the incorporation of stakeholder values using weights and monetary allocation survey. Workshop discussions and interviews with stakeholders and research groups were conducted to identify research gaps, with the use of conceptual frameworks to guide the search.

    RESULTS: Seventeen ongoing and 50 completed projects were identified for research funding impact analysis. Overall, research fund allocation differed from stakeholders' expectation. For research impact, 48 out of 50 completed projects (96.0%) contributed to some form of policy-making efforts. Almost all completed projects resulted in outputs that contributed to knowledge production and were expected to lead to health and health sector benefits. The HRPS process led to the identification of research priority areas that stemmed from ongoing and new issues identified for universal access and quality healthcare.

    CONCLUSION: The concerted efforts of evaluation of research funding impact, prioritisation, dissemination and policy-maker involvement were valuable for optimal health research resource utilisation in a resource constrained developing country. Embedding impact evaluation into a priority setting process and funding research based on national needs could facilitate health research investment to reach its potential.

  15. Yu CY, Ang GY, Chua AL, Tan EH, Lee SY, Falero-Diaz G, et al.
    J Microbiol Methods, 2011 Sep;86(3):277-82.
    PMID: 21571011 DOI: 10.1016/j.mimet.2011.04.020
    Cholera is a communicable disease caused by consumption of contaminated food and water. This potentially fatal intestinal infection is characterised by profuse secretion of rice watery stool that can rapidly lead to severe dehydration and shock, thus requiring treatment to be given immediately. Epidemic and pandemic cholera are exclusively associated with Vibrio cholerae serogroups O1 and O139. In light of the need for rapid diagnosis of cholera and to prevent spread of outbreaks, we have developed and evaluated a direct one-step lateral flow biosensor for the simultaneous detection of both V. cholerae O1 and O139 serogroups using alkaline peptone water culture. Serogroup specific monoclonal antibodies raised against lipopolysaccharides (LPS) were used to functionalize the colloidal gold nanoparticles for dual detection in the biosensor. The assay is based on immunochromatographic principle where antigen-antibody reaction would result in the accumulation of gold nanoparticles and thus, the appearance of a red line on the strip. The dry-reagent dipstick format of the biosensor ensure user-friendly application, rapid result that can be read with the naked eyes and cold-chain free storage that is well-suited to be performed at resource-limited settings.
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