There is a growing interest in research on satisfaction with healthcare provider (HCP) and HCP- patient communication as a measure of healthcare quality of HCP’s communication competency. However, many communication assessments were not comprehensive measures and are not entirely accurate in measuring what is supposed to be measured. This study aimed at assessing the validity and reliability of a newly developed HCP-PC instrument in a Malaysian primary care setting. The HCP-PC instrument was developed using items adapted from existing instruments as well as self-developed items. A pilot study involving 277 clients of an outpatient clinic was conducted in HKL using the proposed instrument which was distributed immediately after face to face consultation. The content validity and Cronbach alpha reliability were assessed. Factor analysis constructed 3 components, exchanging information (EI), socioemotional behaviour (SB) and communication style (CS). All items loaded on the corresponding component with factor loading ≥0.6, suggesting that all items in the respective component are measuring the same direction. PCA of the final 30 items explain 61.98% of the total variance with 6.66%, 47.18% and 8.13% explained by EI, SB and CS respectively. Component-based reliability show strong internal consistency with Cronbach alpha, αEI= 0.92, αSB= 0.96 and αCS= 0.70. The pilot study supported the instrument validity and reliability after initial tests. However, further study needs to be done to confirm its construct validity to help establish a valid and reliable HCP-PC instrument for measuring patient satisfaction with HCP-PC that can be used in primary care setting.
Study site: outpatient clinic was conducted in HKL
OBJECTIVE: We conducted this study to gain an insight into the experiences and views of practitioners of urut Melayu, the traditional Malay massage, which will be used in developing a preliminary framework of the urut Melayu process. DESIGN: We adopted a qualitative study design. We carried out a total of five focus group discussions (FGDs) comprising 6-10 urut Melayu practitioners each.
LOCATION: We carried out three FGDs at the Traditional and Complementary Medicine Division, Ministry of Health and two FGDs at a district Health Clinic.
SUBJECTS: All participants of the FGDs were urut Melayu practitioners registered with the Ministry of Health. Three (3) FGDs comprised all females while two comprised all males. A total of 12 males and 24 females participated in the study.
RESULTS: We identified six themes from the study, namely, indications for urut Melayu, the urut Melayu technique, other treatments in conjunction with urut Melayu, outcome of urut Melayu, ethics of urut Melayu, and practitioners' source of skills and knowledge.
CONCLUSIONS: Urut Melayu is a unique form of massage carried out for various purposes. Although it is common belief that there are vast differences in the way it is performed from one practitioner to another, this study revealed that similarities do exist and there is potential to develop a standard framework for urut Melayu for regulation and training purposes.
Introduction: Outbreak of vaccine preventable disease still persists despite good coverage of immunization in Malaysia. Health literacy on childhood immunization is one of essential factor for the outbreak to happen. Thus, this study determined the predictors of health literacy on childhood immunization among antenatal mother in Seremban, Negeri Sembilan.
Methodology: A cross sectional study was conducted among 424 antenatal women using a cluster sampling approach. Antenatal women who were Malaysian and not illiterate were chosen in this study. A selfadministered, validated and pretested questionnaire was used to collect data on sociodemographic, socio economic, awareness on immunization, utilization of health care services and health literacy on childhood immunization. The data was analyzed using SPSS version 22.0. Chi Square test was used in bivariate analysis and multiple logistic regression was used to determine the predictors of inadequate health literacy on childhood immunization.
Result: Out of 362 respondents, 81.2% were inadequate health literacy. The predictors were maternal education (AOR= 2.608, 95% CI 1.477-4.604), parity (AOR= 1.067, 95% CI 1.103-3.876), residential area (AOR= 2.344, 95% CI 1.184-4.641) and utilization of government hospital (AOR= 2.344, 95% CI 1.184-4.641).
Conclusion: Accessibility of health education with regard to immunization need to be strengthen among primigravida, low education and those staying in rural area. In addition, health education also needs to emphasize on the individual that is employed and low economic status with underutilization of government hospital. A simplified education material with interesting pictures and using visual aids help illiterate people for better understanding.
Study site: Klinik Kesihatan, Seremban district, Negeri Sembilan, Malaysia
A retrospective study was carried out to determine the distribution of intraocular pressure in normal patients who came for vision problems at the Optometry Clinic, Universiti Kebangsaan Malaysia (UKM) Kuala Lumpur Campus, and to determine the differences in intraocular pressure with respect to age, gender and race. The cohort consisted of 148 subjects divided into five groups with age ranged from 10 to 59 years. The inclusion criteria were, subjects had no sistemic or ocular disease, subjects were not taking any medication, visual acuity was 6/6 or better, refractive errors < ±6.00D, astigmatism < 2.00D, anisometropia <2.00D, and mean intraocular pressure measured using the X-PERT tonometer and taken between 9 am to 2 pm. Statistical analysis (ANOVA) showed the mean intraocular pressure without consideration for age, race or gender was 12.6 mmHg (SD ±2.5). There was no significant differences in intraocular pressure between right and left eyes, between different age groups and between different genders. However, the intraocular pressuse for the Chinese was found to be significantly higher than the Malays. It was found that the intraocular pressure of patients who came for vision problems at the Optometry Clinic UKM follows a normal distribution and there was no significant diference found between right and left eyes, between different age groups and genders. Race seemed to contribute to the differences in intraocular pressure. Keywords: Age; clinic population; genders; pressure; intraocular pressure; race
Study site: Optometry clinic, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
A study was undertaken to evaluate the efficiency of health services at two maternal and child health (MCH) clinics in Kuala Lumpur. The time spent for individual patient care by the clinic staff was used as an indicator for the evaluation. The main objective was to derive a model of ideal operation time for specific patient care activities at a MCH clinic. Primary data was collected through systematic random sampling of patients between 25/7/1985 and 31/7/1985. Secondary data was obtained from available clinic records for July, 1985. The time a patient spent at the clinic and the time she spent at each examination station and waiting between stations was recorded with digital watches. Results show tha patients spent 80% of their time at the clinics waiting. The actual time spent on each patient was found to be considerably less than the ideal time measured under ideal conditions. Various recommendation are presented in the paper to reduce waiting time and extend examination time. The ideal patient capacity for the two clinics was also calculated.
Objectives: The aim of the study was to explore the association of waist circumference with microvascular complications in Malaysian patients with type 2 diabetes.
Methods: We utilised data of type 2 diabetes patients followed up in Malaysian public sector primary care clinics contained in the National Diabetes Registry in the year 2012. Variables of interest were the presence of microvascular complications, namely nephropathy and retinopathy. Multiple logistic regression was used to explore the association between presence of microvascular complications and waist circumference, which was adjusted for age, sex, duration of diabetes, systolic blood pressure, insulin use, total cholesterol and HbA1c.
Results: A total of 114,719 patients with type 2 diabetes were included in the study. The mean age of patients was 59.8 years (SD: 11.2) with mean duration of diabetes of 6.8 years (SD: 5.1). Male
patients comprised 39.9% of the sample population and 83.5% of the patients were overweight with BMI ≥ 23 kg/m2. Nephropathy and retinopathy was present in 9.1% and 7.9% of patients respectively. The mean waist circumference was 94.1 cm (SD: 11.8) for males and 90.8 cm (SD: 11.8) for females; while 78.4% of the patients had waist circumference above the cut off (≥ 90 cm for men and ≥ 80 cm for women). Larger waist circumference was found to be significantly associated with nephropathy (adj. OR 1.005; p-value< 0.001; 95% CI: 1.003–1.008) after adjusting for confounding factors. However, waist circumference was not significantly associated with retinopathy (adj. OR 0.998; p= 0.209; 95% CI: 0.996–1.001).
Conclusions: Analysis showed that patients with higher waist circumference were more likely to have nephropathy than patients with lower waist circumference. The analysis also showed that waist circumference
was not associated with retinopathy in the study population.
Objectives: The aim of the study was to explore the association of waist circumference with glycaemic control in Malaysian patients with type 2 diabetes.
Methods: We utilised data of type 2 diabetes patients followed up in Malaysian public sector primary care clinics contained in the National Diabetes Registry in the year 2012. The variable of interest was poor glycaemic control, defined as HbA1c≥ 6.5%. Multiple logistic regression was used to explore the association between glycaemic control and waist circumference, which was adjusted for age, sex, duration of diabetes, systolic blood pressure, total cholesterol, use of insulin and other medications.
Results: A total of 98,825 patients with type 2 diabetes were included in the study. The mean age of patients was 59.9 years (SD: 10.9) and 38.9% were males. The mean duration of diabetes was 6.8 years (SD: 5.0) and 76.2% of patients had HbA1c ≥ 6.5%. The mean waist circumference was 94.0 cm (SD: 11.8) for male and 90.7 cm (SD: 11.8) for female; while 78.3% of the patients had waist circumference above the cut-off (≥ 90 cm for men and ≥ 80 cm for women). Larger waist circumference was found to be significantly associated with HbA1c≥ 6.5% (adj. OR 1.009; p< 0.001; 95% CI: 1.007–1.011) after adjusting for confounding factors.
Conclusions: Analysis showed that glycaemic control was poorer in patients with higher waist circumference than in patients with lower waist circumference.
Traditionally, Chinese women adhere to special dietary practices during the month following childbirth. This paper discusses the dietary practices and food taboos practised by Chinese women in Kuala Lumpur. A total of 134 Chinese mothers of children below one year were recruited from three Maternal and Child Health Clinics and Maternity Hospital, Kuala Lumpur. Questionnaires and in-depth interviews were used to obtain information on socioeconomic background, dietary practices, food taboos and cooking methods during the confinement period. Food intake was assessed by multiple 24-hour dietary recall among 34 mothers during their confinement month (zuo yuezi). Body weight and height were measured, and body mass index calculated. Majority of the respondents had secondary school education (77.6%), household income between RM1001 and RM3000 (64%), and were homemakers (48.5%). The women were aged 18-39 years, and 68% were of normal weight. Most women (82%) practised 30 days of confinement, during which they adhered to special dietary practices. The diet was directed at attaining yin-yang (cold-hot) balance, whereby â€œhotâ€ foods were most commonly used and â€œcoldâ€ foods were avoided. Ginger, rice wine and sesame seed oil, considered â€œhotâ€ foods, were used in large amounts in the cooking. Rice, chicken and pork were also consumed in large amounts. Most vegetables and fruits were considered â€œcoldâ€ and were prohibited during confinement. Most mothers drank specially-prepared teas boiled from Chinese herbs. Mean energy intake was 19% below RNI, while mean protein intake was 93% above RNI (NCCFN, 2005). Mean intakes of thiamin, riboflavin and niacin were above 75% of RNI, while vitamins A and C were at half of RNI or less. Mean iron and calcium intakes were at 222% and 67% of RNI, respectively. It is concluded that most Chinese women in Kuala Lumpur do conform to special dietary practices during zuo yuezi.
Study site: three Maternal and Child Health Clinics and Maternity Hospital, Kuala Lumpur
Introduction: The prevalence of diabetes mellitus among Malaysian aged ≥ 18 years increased from 11.6% (2006) to 17.5% (2015). Positive self–care behaviour leads to good glycaemic control. The objective of this study is to determine the self-care behaviour, its associated factors and predictors among type 2 diabetes mellitus (T2DM) patients in government health clinics at a district of Northern Peninsular Malaysia.
Methodology: A cross-sectional study was conducted on 546 T2DM patients aged ≥ 18 years, recruited by simple random sampling method. A validated self-administered questionnaire including socio-demographic characteristics, diabetes profile, knowledge, Health Belief Model (HBM) and Summary of Diabetes Self-care Activity Scale (SDSCA) was used. Data were analysed using SPSS version 22.0. Self-care behaviour is the dependent variable.
Results: The respondents practised 3.4 (SD = 1.11) days self-care behaviour past 1 week. The predictors of self-care behaviour were self-efficacy (standardized β = 0.257, p < 0.001), knowledge (standardized β = 0.112, p = 0.007), female (standardized β = 0.107, p = 0.010), combination oral hypoglycaemic agents (OHA) and insulin (standardized β = -0.182, p = 0.002), and monthly income < RM1,000 (standardized β = -0.129, p = 0.002). The entire group of variables significantly predicted self-care behaviour [F (6, 539) = 15.79, p < 0.001, adjusted R2 = 0.140] with total variance of 14.9%. Self-efficacy was the strongest predictor in self-care behaviour.
Conclusion: The findings enable us to identify the specific groups with predicted lower self-care behaviour which are useful in future planning and implementation of intervention.
Study site: Klinik Kesihatan, Malaysia
BACKGROUND: Knowledge of candidate gene polymorphisms in a population is useful for a variety of gene-disease association studies, particularly for some complex traits. A single nucleotide variant of the angiotensinogene gene (AGT M235T) and endothelial nitric oxide synthase gene (eNOS G894T) have been associated with hypertension.
METHOD: A cross-sectional study consisting of 200 hypertensives and 198 age- and sex-matched controls was conducted. Subjects involved in this study were pure Malay for 3 generations. The AGT M235T and eNOS G894T polymorphisms were determined by PCR-RFLP method.
RESULTS: The distribution of M235T genotype in the population was 3.5% for MM, 30.4% for MT and 66.1% for TT. No significant difference was observed in genotype (chi(2)=1.30, p=0.52) and allele (chi(2)=0.87, p=0.35) frequencies among the 2 study group. In contrast, the distribution of genotypes for G894T was 74.1% for GG, 24.6% for GT and 1.3% for TT, respectively. Similarly, no significant difference was observed in genotype (chi(2)=0.94, p=0.33) and allele (chi(2)=0.60, p=0.44) frequencies between both study groups.
CONCLUSION: The AGT M235T and eNOS G894T polymorphisms are unlikely to play an important role in the pathogenesis of hypertension in Malays.
Study site: Outpatient clinic, Hospital Universiti Sains Malaysia (HUSM); government clinics, Kelantan, Malaysia.
Flare of Systemic Lupus Erythematosus (SLE) may occur during pregnancy and puerperium. We studied the prevalence and factors associated with SLE relapse during pregnancy and post-partum period in a multi-ethnic SLE cohort. Consecutive SLE patients who attended the outpatient clinic were reviewed for previous history of pregnancies in our institution. Patients who had a complete antenatal, delivery, and post-partum follow up were included. Their medical records were retrospectively analysed to assess the disease activity at pre-pregnancy/conception, during antenatal, and post-partum period. Presence of flare episodes during pregnancy and puerperium were recorded. The pregnancy outcomes recorded include live birth, foetal loss, prematurity and intra-uterine growth restrictions (IUGR). Univariate and multivariable logistic regression with generalized estimating equations (GEE) analyses were performed to determine the factors associated with disease relapse and the pregnancy outcomes. A total of 120 patients with 196 pregnancies were included, with a live birth rate of 78.6%. Four (2.0%) were diagnosed to have SLE during pregnancy. The flare rate in pregnancy was 40.1% while post-partum 17.4%. Majority of the relapse in pregnancy occurred in haematological system (62.3%) followed by renal (53.2%), musculoskeletal (22.1%), and mucocutaneous (14.3%). In GEE analyses, active disease at conception was the independent predictor of SLE relapse during and after pregnancy, whereas older maternal age and Malay ethnicity were associated with higher flare during post-partum. HCQ use was significantly associated with reduced risk of flare in univariate analysis but it was no longer significant in the GEE analyses. Presence of disease flare in pregnancy was significantly associated with prematurity. In conclusion, pregnancy in SLE need to be planned during quiescent state as pre-pregnant active disease was associated with disease relapse in both during and after pregnancy. Malay patients had an increased risk of post-partum flare but further larger prospective studies are needed to confirm the association between pregnancies in the different ancestral background.
A cross sectional study on Type 2 diabetes patients seeking treatment in the Primary Health Care outpatient clinic of the University Malaya Medical Centre, Kuala Lumpur was undertaken. Two hundred and thirty-three subjects participated. They were asked questions on biodata and dietary intake using face-to-face interview techniques. Dietary intake was assessed using the 24-hour dietary recall. Anthropometric measurements including weight and height were taken and Body Mass Index (BMI) was computed to establish the extent of obesity. Of the 196 subjects, 66.8% were overweight (BMI ≥25 kg/m2) with 15.8% obese (BMI ≥30 kg/m2). The mean BMI of males and females were 25.9±4.3 kg/m2 and 27.2±4.7 kg/m2 respectively. The findings from the dietary survey showed that the mean energy intake of the subjects only achieved about 72% of the Recommended Daily Allowance (RDA) for Malaysia while protein intake of all subjects was adequate. The macronutreint contribution to the total calorie was consistent with the recommendation of the Malaysian Diabetic Association for a healthy diet for diabetes patients. The male subjects were found to meet the RDA requirements for all nutrients while the female subjects did not have sufficient intake of calcium, vitamin A and niacin. No consistent pattern in energy and nutrient intake was observed among different age groups. On the other hand, the Malay subjects seemed to have lower energy and all nutrient intake (except vitamin A and vitamin C) compared to the Chinese and Indian subjects. The Indian subjects seemed to have the highest intake of calcium compared to the others. Advice needs to be given to those who did not have adequate nutrient intake as well as those who need to reduce their weight.
Study site: Primary health care clinic, University Malaya Medical Centre (UMMC)
We report a case of human intestinal myiasis in a 41-yr-old female patient presented at a clinic in Seri Kembangan, Selangor, Malaysia. Larvae passed out in the patient's feces were sent to the Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. DNA barcoding confirmed the second case of intestinal myiasis in Malaysia involving the larvae of Clogmia albipunctatus (Duckhouse) (Diptera: Psychodidae). We review reported cases of myiasis and discuss the present case of intestinal myiasis in an urban patient.
Family planning is an important practice for women as it can help to improve financial and social status. Unwanted pregnancy has negative effects for husband and financial. However, couples married at a late age may not practice family planning because they want to have kids. The aims of this study were to determine the prevalence, factors associated with
husband’s socio demography and decision making in family planning practices among women in reproductive age who attended a polyclinic in Serdang, Malaysia. A cross sectional study was conducted on 245 women with a systematic random sampling. Descriptive analysis, Fisher exact and Chi-square tests were conducted to identify the influence of husband’s socio demographic factors and decision making in family planning practices. The prevalence of family planning practices among married women was moderate (53.9%). Family planning practices among women showed significant relationship with the husband’s socio demography which were husband’s race (p = 0.018), religion (p = 0.008) and making decision in family planning (p = 0.002). The husband’s socio demography showed a significant relationship with the prevalence of the wife practicing family planning. This clearly indicates that the husband is the individual that influence the wife to use contraceptive method. Decision making in family planning by both the husband and wife is important in choosing to use contraceptive method. Health promotion in the concept of health education for male contraceptive method such as pamphlet and booklet is important to promote husband involvement in family planning.
Study site: Klinik Kesihatan Seri Kembangan, Serdang, Selangor, Malaysia
PURPOSE: A cross sectional descriptive study, which involved government hospitals and health clinics from Peninsular Malaysia sought to identify the continuing professional education (CPE) needs and their readiness for E-learning. This paper focuses on the first phase of that study that aimed to determine the factors that influence nurses' participation in CPE.
METHODS: Multistage cluster sampling was used to recruit 1,000 nurses randomly from 12 hospitals and 24 health clinics from four states in Peninsular Malaysia who agreed to be involved. The respondent rate was 792 (79.2%), of which 562 (80%) had participated in CPE in the last 12 months.
RESULTS: Findings suggested that updating knowledge and providing quality care are the most important factors that motivate participation in CPE, with respective means of 4.34 and 4.39. All the mean scores for educational opportunity were less than 3.0. Chi-square tests were used to test the association of demographic data and CPE participation. All demographical data were significantly associated with CPE participation, except marital status.
CONCLUSIONS: Implementation of mandatory CPE is considered an important measure to increase nurse's participation in CPE. However, effective planning that takes into consideration the learning needs of nurses is recommended.
Nurses need to participate in CPE to update their knowledge and increase their competencies. This research was carried out to explore their current practice and the future general needs for CPE. This cross-sectional descriptive study involved registered nurses from government hospitals and health clinics from Peninsular Malaysia. Multistage cluster sampling was used to recruit 1000 nurses from four states of Malaysia. Self-explanatory questionnaires were used to collect the data, which were analyzed using SPSS version 16. Seven hundred and ninety-two nurses participated in this survey. Only 80% (562) of the nurses had engaged in CPE activities during the past 12 months. All attendance for the various activities was below 50%. Workshops were the most popular CPE activity (345, 43.6%) and tertiary education was the most unpopular activity (10, 1.3%). The respondents did perceive the importance of future CPE activities for career development. Mandatory continuing professional education (MCPE) is a key measure to ensure that nurses upgrade their knowledge and skills; however, it is recommended that policy makers and nurse leaders in the continuing professional development unit of health service facilities plan CPE activities to meet registered nurses' (RNs) needs and not simply organizational requirements.
AIM: The aim of this study was to investigate the prevalence of orgasmic dysfunction and the potential risk factors that may be associated with orgasmic dysfunction among women at a primary care setting in Malaysia.
METHODS: A validated questionnaire for sexual function was used to assess orgasmic function. A total of 230 married women aged 18 to 70 years participated in this study. Their sociodemographic and marital profiles were compared between those who had orgasmic dysfunction and those who did not, and the risk factors were examined.
RESULTS: The prevalence of orgasmic dysfunction in the primary care population was 51.9%. Women with orgasmic dysfunction were found to be significantly higher in the following groups: age >45 years, being non-Malay, having lower academic status, married longer, having more children, married to an older husband, and being at menopausal state.
CONCLUSION: Women with infrequent sexual intercourse are less likely to be orgasmic (odds ratio = 0.29, 95% confidence interval = 0.11-0.74).
The aim of the study was to compare sexual functioning among Malaysian women in a primary care setting between those with a low and high frequency sexual intercourse. Across-sectional study on 230 married Malaysian women in a primary-care setting was conducted at the Bandar Tun Razak Clinic, Cheras. A validated Malay version of Female Sexual Function Index questionnaire (MVFSFI) was used to assess the sexual functioning profiles among women with low and high sexual activity. The percentage of women who had sexual intercourse 3-4 times a week, 1-2 times a week and < 1-2 times a month were 13.4%, 44.3 % and 42.4 % respectively. Women with a low frequency of sexual intercourse (Low SI) tended to suffer from more sexual dysfunction, (χ²=28.98, p < 0.001) compared to those with a high frequency of sexual intercourse (High SI) group. Women who were less sexually active (having low frequency intercourse, ie. ≤ 1 – 2 times per week) were found to be less sexually aroused (χ²= 25.9, p< 0.001), less orgasmic (χ²=19.8, p< 0.001), less lubricated during sexual activity (χ²=11.1, p< 0.001), complain of sexual pain (χ²=4.3, p = 0.033) and feels less satisfied sexually (χ²=12.6, p< 0.001).The problem of female sexual dysfunction (FSD) in the Malaysian primary care population with low sexual activity needs to be addressed.
Sivasampu S, Lim Y, Abdul Rahman N, Hwong WY, Goh PP, Abdullah NH
Citation: Sivasampu S, Lim Y, Abdul Rahman N, Hwong WY, Goh PP, Abdullah NH. National Medical Care Statistics: Primary Care, 2012. Kuala Lumpur: National Clinical Research Centre, Ministry of Health, Malaysia; 2014