The state of Johore, Malaysia had been hit by the worst flood in the Malaysian modern history on the 19th December 2006 (first wave) and the 12th January 2007 (second wave) affecting all the eight districts. A total number of 157,018 and 155,368 Johore population had been displaced by the first and the second wave event respectively. The Johore State Health Department activated the Flood Action Plan which include mobilising medical teams to conduct daily clinical examinations on the flood victims and health teams to inspect flood relief centres, food premises and homes at flood-hit areas with regard to prevent and control communicable diseases. The spreadsheet format was used to collect data on diseases, injury and death throughout the Johore flood disaster period starting from the 19th December 2006 until 19th February 2007. Analyses showed that 19,670 flood victims (36.3%) had communicable diseases and 34,530 (67.0%) had non-communicable diseases. As for the communicable diseases and symptoms/syndromes related to communicable disease, 41.3% were acute respiratory infections (ARI) followed by 25.9% skin infections, 19.1% fever, 10.1% acute gastroenteritis (AGE) and 3.0% acute conjunctivitis. Other infectious diseases include 61 notifiable diseases (46 food poisoning, 14 dengue fever and one tuberculosis), 20 leptospirosis (with two deaths), 20 chicken pox and two melioidosis cases. The Batu Pahat district had the highest incidence for the majority of the communicable diseases because of the prolonged flooding period. No cholera, typhoid, malaria, measles or hand-foot-mouth disease (HFMD) cases were detected among the Johore flood victims. Trends of disease incidence follow the number of evacuees placed in the relief centres corresponding to respective wave. A total of 507 flood victims had physical injuries related to flood mostly due to fall onto wet floor at the relief centres. Fifteen deaths due to drowning were mainly caused by accidental fall into the flood water. The incidence of communicable diseases encountered had been appropriately anticipated and managed attributed to enhanced public health control programmes augmented by syndromic and laboratory surveillance on potentialy fatal infectious diseases. Equal emphasis should be given to the surveillance and control of chronic diseases.
Introduction : Globalization has made health tourism possible and continues to flourish. For participating countries, this new industry rakes in billions of dollars a year, and is worth focusing on and being developed.
Objective : This write up aims to find out the history and success of health tourism in countries around the world, study the scenario in Malaysia and propose strategies which could make Malaysia prosper with this multibillion dollar industry.
Methodology: The methodology applied was compilation, data review and comparison from annual report, action plan report and articles.
Result : In the ASEAN region, Malaysia is making a mark in the health tourism industry, thanks to the availability of medical and technical expertise, political and economical stability, high quality infrastructure, and scenic beauty of the land. Nonetheless, despite all these, Malaysia has yet to be at par with her neighbours- Thailand, Singapore and India, in terms of the number of foreign patients and the revenue gained from this industry. Thus there is a serious and urgent need to conduct research to analyze the current situation and future prospects of health tourism in Malaysia. This industry is open to all countries around the world. It is those countries that can continually analyze and adapt that will prosper in the emerging medical tourism industry. Some of the key issues which need to be addressed are those of promotion, finding the niche market, branding, legislations, immigration and quality of healthcare. In addition to these, matters regarding human resource, particularly that of internal brain-drain, need to be looked into.
Conclusion : Malaysia has great potential of becoming the giant of the health tourism industry provided appropriate and timely actions are taken towards achieving it. The negative impact must not be ignored or overlooked; instead it must be thoroughly studied and rectified.
Introduction: In view of high healthcare expenditure, Malaysia also faces problems in healthcare financing. The policy option is to establish a national health financing scheme. However, it is a problem to develop mechanisms to cover social insurance package to more than one third of the population working in informal sector such as farmers. Therefore, there is an urgent need to assess the ability and willingness of the farming community. The main objective was to study the ability and willingness in the farming community to contribute to national healthcare financing scheme.
Methodology: This a cross sectional study involved 400 farmers in Selangor. A total of 92.3% farmers were able to pay for the healthcare.
Results: Willingness to contribute to The national healthcare financing scheme were RM2.00 per month.
Conclusion: The education level influenced the ability to pay while the educational level and per capita income influenced willingness to pay.
Introduction : Limited access to health services, variations in quality of health care and pressure to contain escalation of health care cost are problems in health care systems that are faced by all the societies in the world especially in developing countries. There is an urgent need to conduct a study to assess perception of individual towards health care services in the new planned National Healthcare Financing Scheme.
Objective : The study objective is to examine the perception towards health care services among the farming community and to assess the willingness to contribute to The New National Health Financing Scheme.
Methods : A cross sectional study involving farmers in the state of Selangor in Peninsular Malaysia was conducted. A total of 400 farmers as the household head were selected using multistage random sampling method.
Results : The respondents’ mean score of perception towards public healthcare services were higher than the respondents’ mean score of perceptions towards private healthcare services except for accessibility and convenience aspects. There was no association between willingness to contribute to The New National Healthcare Financing Scheme and perception towards public healthcare services but there was association between willingness to contribute to The New National Healthcare Financing Scheme and perception towards private healthcare services.
Conclusion : Perception towards healthcare services is an important element in the implementation of The New National Healthcare Financing Scheme as it will determine the willingness of an individual to contribute to it.
Background: The COMBI concept is a novel approach by the WHO to control communicable diseases which are influenced by community behaviour. The Ministry of Health is currently evaluating its use against dengue in selected areas throughout Malaysia. COMBI doctrine differs from previous dengue campaigns. It acknowledges that the factors contributing to dengue proliferation may differ between areas. Factors for a given area are analysed, then a single precise behavioural goal to overcome those problems is formulated. To inculcate this behavioural change, the target community is subjected to an intensive campaign using Integrated Marketing Communication techniques adapted from the advertisingindustry, particularly involving volunteers from the community itself.
Methodology: In Selangor the pilot project was implemented in Section 3 and Section 4 of Bandar Baru Bangi, in the district of Hulu Langat. Here, Aedes breeding was found to occur mainly in water containers of semi permanent nature (eg. ‘kolah’, aquatic plant jars, flower pot bases etc). A total of 172 volunteers were recruited to disperse the message of “Suluh – Suluh, Basuh - Basuh” whilst distributing leaflets and flashlights to 2666 homes. Residents were instructed to illuminate such water containers twice weekly and scrub any containers found to contain larvae. The program commenced on 23/5/2004 and lasted 16 weeks.
Results : During this period, the initial Aedes Index of 5 was reduced to 0.96 while combined cases of Dengue Fever / Dengue Haemorraghic Fever in Sections 3 and 4 reported to the Hulu Langat District Health Office also dropped to 1 (unconfirmed).
Conclusion : The COMBI approach in Hulu Langat successfully demonstrated that correct problem identification synergized with community engagement can potentially reduce Aedes proliferationand dengue morbidity.
Each organization has a particular culture, due to personal interactions, with certain values shared by its members. Corporate culture is defined as ‘the set of shared, taken-for-granted implicit assumptions that a group holds and that determines how it perceives, thinks about, and reacts to its various environments’. Positive corporate culture is linked to increased staff alignment, advanced level of employee commitment, increased employee productivity, enhanced organizational effectiveness and increased profitability. Researchers claimed that most studies suggesting the associations between culture and performance are methodologically weak. Cultural transformation has been a big part of NHS reforms and health system redesign in United States to deliver improvements in quality and performance. Environment, market competition, technology advancement, information age and government policies will influence the cultural change within the organization. Undesirable culture might emerge if the organization does not act appropriately to manage its corporate culture. There are six critical success factors for the implementation of corporate culture changes: committed and effective leadership, clear definition of the desired goals, rigorous implementation of a change management model, effective mitigation of change resistance, active governance structure and a design model, and effective communication. Among the issues in implementing corporate culture within healthcare organizations are middle managers dilemma, cultural diversity and subcultures within the organization, size of healthcare organization and critical mass.
Introduction: The purpose of this article is to review the definitions of food security and food insecurity as well as the concepts related to food security.
Methodology: This is a systematic review on a few papers, research, and articles according to studies and research by various organizations, experts, scholars on food security in developed and developing countries.
Result: The first definition of food security was given to reflect the comprehensive concerns on the availability of world food supplies. The definition was expanded to incorporate accessibility of food for all people at all times. Then, the complex definitions of food security incorporated food accessibility and availability as well as the quality of food intake. Latest definition integrates the social aspect of food that should be accessed in a socially acceptable way. Broad definition of food insecurity and several terms that closely related were also discovered. The four main concepts of food security from these definitions were identified; availability, accessibility, acceptability and adequacy. These concepts of food security are relevant to micro, meso and macro levels of social and administrative organizations. Conclusion: Understanding definitions and concepts of food security can assist researchers, policy makers and program implementers to conduct research that address the issues of food security.
Introduction: Back pain associated with sense of pain and less comfort in back part of the body especially at the lower back area. Back pain is an occupational health problem with significant impact to productivity of workers.
Methodology: A cross sectional study was conducted to study the prevalence of back pain towards individual, physical and psychosocial factors associated among body shop’s operators at national Automotive Manufacturers.
Result: A total of 32 operators were involved in this study. Nordic Musculoskeletal questionnaire has been used in this study and body position assessment was done by using Ovako Working Posture Analyzing System (OWAS) method. Study showed the prevalence of back pain among operators throughout their work and in the last 12 months was 93.8% and 87.5% respectively. There are significant association (p0.05) between prevalence of back pain with another individual, physical and psychosocial factor.
Conclusion: This study shows that back pain prevalence were influenced by types of activity and body posture during working at assembling division among workers. Attention should be given to ergonomics factors to prevent back pain incident among automotive industry assembly workers.
Background: A randomised single blinded clinical trial comparing the effectiveness of two methods of cataract surgery with intraocular lens implantation: extracapsular cataract extraction (ECCE) and phacoemulsification (PEA) was carried out at Hospital Universiti Kebangsaan Malaysia (HUKM) between March 2000 and August 2001. Methods: The effectiveness of cataract surgery was assessed from the quality of life specifically for vision via Visual Function 14 (VF-14) preoperatively, one week, two months and six months after surgery. Results: The result showed that there was a significant increased in VF-14 scores after a week, two months and six months postoperation compared to the score before surgery for both techniques. However there was no significant difference in VF-14 scores when compared between ECCE and PEA. Conclusions: This study indicated that both techniques give equal benefit to cataract patients. Since effectiveness of cataract surgery with intraocular lens implantation is unrelated to operative procedures, less costly technique should be promoted.
Background : Foot ulcers and its complications are an important cause of morbidity and mortality in diabetes. The aim of this retrospective study is to determine the ulcer-free survival in diabetic foot and its relevant predictors in a cohort of diabetic patients in the primary health care setting.
Methods : Data of newly diagnosed diabetics (n=1121) who received treatment in five health centers in the district of Kuala Langat, Selangor between 1st January 1999 until the 30th June 2008 were studied. Information was gathered by reviewing patient’s medical records. All patients were followed until 31st December 2008. The duration of ulcer-free survival was measured from the date of being diagnosed as diabetic until the development of the ulcer.
Results : The total incidence of diabetic foot ulcer was 9.9% (n=111), with an average annual incidence of 1%. The total incidence of amputation was 1.2%. Mean age of being diagnosed having diabetic was 52+10.7 year old and mean age of being diagnosed having diabetic foot ulcer was 54.68+10.16 year old. The mean for overall ulcer-free survival was 99 months (95%CI:96-102). Male gender (LR=6.56; p=0.01), smokers (LR=3.94; p=0.04), low body mass index (LR=4.45; p=0.03), impaired renal function (LR=5.17; p=0.02) and long duration between follow-up (LR=25.10; p
Introduction: To determine association between occupational stress and personality characteristics among nurses at Maternal and Child Health Clinic in the state of Malacca, emphasizing on type of personality and personal perception of stress.
Methods : A cross sectional study was conducted among 152 nurses of Maternal and Child Health Clinics in Malacca using self administered questionnaires and selected via multistage sampling.
Results : This study showed that a total of 28.3% of the nurses were found to be stressed. Almost half (41.2%) of those who perceived that they were stressed were likely to be really stressed (p = 0.004). Therefore those who perceived themselves to be stressed should be referred for stress evaluation and further management if necessary. However selfperception of stress cannot be used as a screening tool for stress due to its lack of sensitivity (56.8%) and poor Positive Predictive Value (41.2%). Majority of the nurses were of Guardians Personality Type (98%) and 72.4% of them had extrovert trait. However there were no significant associations between stress with personality type or characteristic, most probably due to the preponderance of one personality type or characteristic. Other studied variables such as socio-demographic factors (age, gender, ethnicity, religion, marital status, educational level, body mass index, type of work place, position, duration of service and poverty level) and social factors (placement, chronic medical illness, chronic care taker, smoking status and alcohol drinker) were suggestive of an association between them and stress but were not statistically significant.
Conclusion : There is no association between occupational stress and personal characteristics among nurses in Malacca.
Introduction : Johor Bahru has one of the highest rates of dengue disease in this country in spite of the implementation of COMBI (Communication for Behavioural Impact) in 2001.
Methods : To identify factors contributing to this problem, a case control study was conducted, focusing on risk factors such as the weather (rainfall and temperature), environment and sociodemography. Cases were selected from confirmed dengue cases from January to June, 2006. Controls were selected from patients who had no past history of having dengue illness from Health Clinics in Johore Bahru. Both case group and control group were matched by age and sex. All risk factors were analysed using SPSS version 11.5.
Results : Results from time-series analysis indicated that the cases of dengue illness were related to changes in the minimum temperature (r =-0.149; p
Introduction : A retrospective cohort study was conducted among ESRD who received dialysis treatment (Haemodialysis and CAPD) in all government hospitals in the State of Pahang from 1st January 2000 to 31st December 2004.
Objective : The aim of the study was to identify factors affecting the survival of patients undergoing dialysis in the state of Pahang.
Methods : Survival time was measured from the date of dialysis until the subjects died, lost to follow up or until the end of the study period at 31st December 2004.
Results : Diabetes mellitus was the major cause for ESRD (33%) out of 132 subjects eligible for the study. Seven (7.1%) and five (15.2%) deaths occurred among haemodialysis and CAPD patients respectively, but statistically of no difference between the two treatments (log-rank, p=0.093). Factors influencing the survival of haemodialysis patients were diabetes mellitus (p=0.014), albumin (p=0.0005), creatinine (p=0.020) and hemoglobin level (p=0.002), while age of treatment and diabetes mellitus affecting the survival of CAPD patient. Cox Proportional Hazard Regression showed that haemodialysis subjects with low albumin (HR 0.669 df 95% 0.513 - 0.873) and hemoglobin (HR 0.403 df 95% 0.225 - 0.720) level had lower survival rate but none for CAPD.
Conclusion : Good nutritional status, higher hemoglobin level and prevention of diabetes mellitus are important for the survival of haemodialysis patient.
Introduction : Mersing, a district in north-east Johore was also affected by the recent worst flood in 100 years that striked Johore. Orang Asli settlements were among the worst affected by the flood in Mersing due to their location along the river. For Kg. Peta, not only flooded, the communications as well as the access roads were also tarnished. This settlement situated very deep interior about 100 km from Mersing town and next to Endau- Rompin National Park. Besides the distance, the geography and the communication issues make the flood operation even more difficult. Even then, the welfare of this minority group was never been neglected. Our Medical and Health Teams made a move in but unfortunately were also been trapped in between the flood waves.
Methodology : It was a qualitative finding. The data for this report were collected from various means. Some data were collected through informal interview among the staffs that being trapped, head villager and the dwellers, local head departments of government and non-government organizations. Others were from the relevant photographs, formal flood returns as well as through the observation.
Finding : The existence of very good involvement, cooperation and coordination from various agencies was the main factor that ensures all the villagers of Kg. Peta received our services despite of many difficulties or challenges. During this disaster, no outbreak of infectious disease or death from the settlement was reported. The welfare and the needs of all who affected and those involved in the flood operation were taken care off. Therefore, we believed that without good support and cooperation from others, we will not be able to deliver our services and their welfare especially when health was concerned will be deprived. The objectives of this write up were to share our experience in managing flood in very remote area and to show the importance of good integration between agencies in disaster management.
Past major flooding events for the state of Johore, Malaysia were recorded in 1926, 1967, 1968 and 1971. However, major meteorological phenomena that hit Johore on the 19th December 2006 (first wave) and the 12th January 2007 (second wave) were claimed to be the worst flood disaster in Johore in a 100 years. All eight districts were affected displacing 157,018 and 155,368 population during the first and the second wave event respectively. The Johore Health Department deployed substantial number of medical and health personnel to deal with the Johore flood crisis. Flood-related data were collected on daily basis between 19th December 2006 and 19th February 2007 using spreadsheet format from Flood Operational Rooms located at respective District Health Offices. Among flood victims 34,530 were found to have non-communicable diseases and 19,670 with communicable diseases. No major food- and water-borne disease outbreaks, such as cholera and typhoid, were reported in Johore. High success of public health measures was depending on the workforce of medical and health personnel on the ground. On the other hand, voluntary services offered by non-governmental organisations (NGOs), private sector and other volunteers should be well coordinated without compromising regulatory and ethical requirements. Crisis guidelines and plan of actions shall be updated so that they would be more relevant to the crises encountered on the ground.
Introduction : Human displacement during disaster would cause women and their dependent children to be particularly vulnerable. Yet, women failed to make their voices heard. Thus their needs, priorities and perceptions would not be identified which in turn could hinder an effective emergency response and a full recovery process.
Objective : This paper provides a general overview of problems and issues experienced by women and their dependent children during the Johore flood disaster. With this information, relevant agencies shall focus, among other considerations, on the special needs of women and children in planning and carrying out emergency responses in the future.
Methodology : This paper was written based on data and information obtained from the Johore Flood Disaster Report and observations made by the health teams on the flood victims throughout the flood period.
Findings and Discussions : Pregnant mothers with 36 weeks of gestation or more were evacuated from their homes to the health centres or hospitals when the Johore flood disaster struck. Regular maternal and child health (MCH) services were conducted at the flood relief centres. Despite the efforts by health care providers, we observed women facing some unique issues and problems. These include: 1) Effects of loss of security and protection; 2) Disruption of social relations and privacy; 3) Inadequate supply of basic items and; and 4) Economic disruption. Recommendations for future relief work are: i) Predisaster planning for emergency response must engage and involve women representatives. Women must also be recruited as emergency and relief workers; ii) Assessment of predetermined capacity of identified relief centres with gender consideration for evacuees must be done; iii) All relief centres shall have physical partition between families. Breast feeding room with access to clean water should also be provided; iv) Gender, cultural and religious sensitivity with regards to social protection and relations shall be observed at all times; v) Women should engage and be made occupied with suitable activities to encourage healthy social interaction thus avoiding feelings of boredom and helplessness; vi) Basic personal items for women and adolescent girls, such as sanitary towel and undergarments, and places to wash and hang them in privacy must be provided; vii) Elderly women may have to temporarily stay at unaffected relatives’ or old folk homes throughout the disaster period, and; viii) No smoking policy shall be enforced at all times in flood relief centres.
Conclusion : Women and their dependent children have been recognised as one of the vulnerable groups during disasters. Thus, women shall be empowered as partners in formulating any emergency response plan so that together they would be able to complement all disaster mitigation, relief and recovery efforts in amore effective manner.
The state of Johore suffered a massive flood disaster from 19th December 2006 to 1st January and from 12th January to 19th February 2007. The possible upsurge of dengue was of foremost concern and led to efforts in increasing control activities. Anyone with history of high fever with at least two symptoms of severe headache, pain behind the eyes, muscles and joint paint, rashes and petechiae were notified as dengue. Active and passive case finding was initiated at all 371 evacuation centres as well through health facilities and hospitals through an active surveillance system. Presumptive larval survey was also carried together with control activities by 46 health teams. Data were collected using the format ‘Aktiviti harian kawalan denggi di kawasan pos banjir- Lampiran E‘ and ‘Laporan aktiviti harian kawalan denggi di pusat pemindahan banjir – Lampiran D2’. Dengue serology and blood film for malaria was sent for as well as vector species identification. A total of 594 dengue cases were reported for the period of 19th December 2006 till 19th February 2007, which was an increase in comparison to the 5-year median but less than that reported in year 2006. However only 14 (2.3%) cases were from flood affected areas. During the flood phase, a total of 5,929 inspections were carried out at the evacuation centres with Aedes Index (AI) of 1.86%, while the post flood period showed a lower index. However Breteau Index (BI) and Container Index (CI) were higher. Preventive fogging were carried out at the evacuation centres using adulticides, thermal fogging was carried out at 21,959 premises (40.04% of inspected premises) and 350.6 L adulticides (malathion, fenitrothion and permethrin) were used. Dengue was expected to increase during flood as a result of increase Aedes potential breeding sites. However with intensive and integrated control activities, Johore was able to minimize the impact of flood for vector-borne diseases as seen from the low cases reported in flood related areas. A special guidelines for surveillance and control was developed during this flood as a reference for future occurrences.
Flooding is the most frequent of all natural disasters. A flood is any water flow that exceeds the capacity of the drainage system and usually subsides in relatively shorter period. However, the flood that hit Batu Pahat District were different from other districts. Batu Pahat flooding extended for 48 days from the first wave until it subsided fully. It gives positive and negative effects not only to the victims but also to the health care workers (HCWs) while executing their duties during and post flood. This write up aims to share HCW’s experience and voices from those who were involved in the flood disaster. Methods used are brainstorming sessions, discussion, observation and interview. From this study, 10 main themes were highlighted. This flood disaster has given the HCWs to prepare mentally, physically and increase knowledge and skills to face any disaster in the future.
Background: Without any doubt, the combo of user ID and password are the most used authentication method in the computing and internet environment. However, due to the enormous number of accounts that require password authentication, users tend to develop bad habits in their password practices which in turn will put their account security at risk. With the increasing use of computing in health-care settings and the use of EMR in hospitals, such practices are a cause for concern.
Methods: This is a cross-sectional study using self-administered questionnaires, investigating the practice of the respondents in keeping their passwords secure. Respondents in this survey are the undergraduate students of Faculty of Medicine, Universiti Kebangsaan Malaysia.
Results: Among the findings are that 87.4% of the respondents used the same password for more than one account. If a user used the same password for several accounts, it might trigger a domino effect if any of the account passwords were compromised. A total of 98.9% of the respondents memorised their password only in their mind, without writing down the password anywhere. This may lead to using easily guessable passwords which may introduce additional security risk to their accounts. The majority of the respondents (96.6%) never or rarely change their passwords. The study also showed that 82.7% of the respondents used passwords which are 6-8 characters in length. Longer passwords are usually safer but harder to remember. The questionnaire also explored the users’ password combination style, whether they used numbers only or combination of numbers and alphabets or some other pattern. A total of 39.1% used letters only but 27.6% used combination of numbers only which is less secure. About 77% of the respondents used personal information such as their birthday date or a person’s name as part of their password.
Conclusions: This habit may make their password guessable to people who are close to them. In conclusion, most medical students are not practising safe password conduct and they should be educated on this. If not, patients’ data confidentiality may be compromised in the future due to such practices.
Background and Objective : Johor was affected by the worst flood in 100 years in December 2006 and again in January 2007. The concern that improper sanitary facilities and contaminated water supply at relief centres would result in contaminated food made monitoring of food hygiene vital. The objective of this paper is to describe food hygiene surveillance activities carried out in flood relief centres and flood affected areas and the challenges faced in carrying out these activities.
Methodology : The food hygiene surveillance activities were carried out by the Assistant Environmental Health Officers (AEHO) in the districts. Among the surveillance activities carried out are inspection of food preparation areas in relief centres, inspection of food premises in flood affected areas and food sampling. Premise inspections were carried out using a specific inspection format. Food samples taken were sent to Public Health Laboratory, Johor Bahru for microbiological analysis. Anti typhoid vaccination for food handlers were also carried out. Apart from that, observations made by the health teams were alsotaken into account.
Results : A total of 3,159 food preparation areas in relief centres were inspected. During the same period, a total of 2,317 food premises in flood affected areas were inspected as soon these premises started operating after the floods. Inspections showed that 69 food preparation areas in relief centres and 181 food premises in flood affected areas had unsatisfactory hygiene. A total of 1,566 holding samples were taken and 425 samples were sent to the laboratory for analysis. Forty-six of the samples analysed were found to be positive for pathogenic bacteria such as e. coli, staphylococcus aureus and salmonella.
Conclusion : The health personnel from the Johor Health Department in various districts carried out an excellent job in ensuring food safety during the floods. There were no outbreaks of food poisoning. However analysis of food samples taken during the floods did show the presence of pathogenic organisms but probably their numbers were not high enough to cause any food poisoning. The promotion and enforcement of food hygiene requirements should be carried out continuously to ensure that every individual understands the need for hygiene and food safety during disaster situation such as flood.