This paper describes selected maternal and child health indicators based on a cross-sectional study of citizens and migrants in Sabah, Malaysia. A total of 1,515 women were interviewed from a multi-stage random sample of households in eight urban centers. Among the 1,411 women in the sample who had experienced a pregnancy before, 76% were local citizens and 24% were migrants. There were statistically significant differences between citizens and migrants in ethnicity, religion, education, household income, and access to treated water supply and sanitary toilet facilities. Significantly fewer migrants practiced any form of contraception and obtained any antenatal care during any pregnancy. Furthermore, citizens tended to initiate care as early as three months but migrants as late as seven months. Despite these differences, only the infant mortality rate, and not pregnancy wastage, was statistically significantly higher among migrants. Pregnancy interval was also similar between the two groups. The influence of several socioeconomic factors on pregnancy wastage and infant mortality was explored.
Matched MeSH terms: Maternal Health Services/utilization
OBJECTIVE: The Asthma Insights and Reality in Asia-Pacific (AIRIAP) survey collected detailed information on asthma severity and management in the urban centres of eight areas of the Asia-Pacific region. This study compared asthma morbidity and management practices in these areas.
METHODOLOGY: Following recruitment, face-to-face interviews were completed with 2323 adults with diagnosed asthma, who had current symptoms or were using asthma medication. Comparisons between areas were made for asthma severity, asthma burden and management practices.
RESULTS Asthma severity varied significantly between areas (P < 0.01), with Vietnam and mainland China reporting the most cases with severe, persistent symptoms. Severity of asthma was significantly associated with advancing age and a lower level of education in a multivariate analysis (P < 0.001). The total use of acute healthcare for asthma was significantly associated with increased asthma severity. Work absence due to asthma was highest in the Philippines (46.6%) and lowest in South Korea (7.5%). The use of inhaled corticosteroids was associated with age in a non-linear manner. There was significant variation among countries in usage of inhaled corticosteroids, from 1.3% in South Korea to 29.0% in Taiwan (P < 0.00001). A peak flow meter was owned by a total of 7.7% of respondents, and overall, 17.9% of adults had a written action plan for asthma management.
CONCLUSIONS: Within the Asia-Pacific region, asthma in adults differs significantly in disease severity, management and treatment according to area of residence. International recommendations on the management of asthma are generally not being followed.
Study site: urban areas in several countries in Asia-Pacific region (via random street interception, random door-to-door recruitment, or telephone recruitment)
A pragmatic and rational approach to the management of five child psychiatric cases in Malaysia is briefly reviewed. The significance of sociocultural factors in treating these cases within the context of a rapidly developing plural society is emphasized. The implications of overemphasis on educational and material achievements are noted.
Matched MeSH terms: Community Mental Health Services/utilization
One hundred and twenty specialists from the Ministry of Health, the Universities and the private sector provided information on 4,802 patients seen over a total of two hundred and forty working days. This information was used to classify the patients into four categories based on a disease complexity classification. Each specialist's perception on the appropriateness of utilisation of his expertise was obtained. Complex cases requiring specialist expertise in management made up 69.8%, 73.5% and 19.1% of the cases of the Ministry of Health, University and private sector specialists respectively. Underutilisation was most marked with paediatricians and obstetricians in the private sector. The Specialist Register, the Programme for Accreditation of Hospitals and a National Health Financing Plan can be used to influence positively the case-mix of specialists.
University Malaysia Sabah campus moved to its present site in Kota Kinabalu, Sabah, Malaysia in 1999. A health centre was included in the development plans and a two-storey building was constructed to provide the facility for in-patient and out-patient care. Clinical catchments include 10,000 students, 1000 academic and support staff. The medical faculty was inaugurated in 2003, and it was given the responsibility to establish and run the facility for students and staff of the University. This paper describes the development of the facility from merely a physical structure to what is now a comprehensive, functional outpatient service catering for student healthcare, screening, preventive medicine and health promotional activities. Currently, these services are provided by the faculty members of the Medical School. The incorporation of the medical student teaching and collaborative research adds intangible value to the facility. Future plans for expansion include specialist medical services.
Matched MeSH terms: Student Health Services/utilization
The high maternal and neonatal mortality rates in South Asia and Sub-Saharan Africa can be attributed to the lack of access and utilization of health services for delivery. Data from the Demographic and Health Surveys conducted in Bangladesh, India, Pakistan, Kenya, Nigeria, and Tanzania show that more than half of the births in these countries were delivered outside a health facility. Institutional delivery was closely associated with educational level, family wealth, place of residence, and women's media exposure status, but it was not influenced by women's work status and their roles in decision-making (with the exception of Nigeria). Controlling for other variables, higher parity and younger women were less likely to use a health facility for delivery. Within each country, the poorer, less educated and rural women had higher unmet need for maternal care services. Service related factors (accessibility in terms of cost and distance) and sociocultural factors (e.g., did not perceive the need for the services and objections from husband and family) also posed as barriers to institutional delivery. The paper concludes with some suggestions to increase institutional delivery.
Matched MeSH terms: Maternal Health Services/utilization*
Several Asian regions have undergone a dramatic transformation, some becoming very affluent. This paper aims to ascertain how countries that are becoming wealthy have dealt with child and adolescent mental health issues.
Matched MeSH terms: Mental Health Services/utilization*
Determining factors that affect healthcare utilization by the elderly is vital for the health system to be more responsive in providing care to this vulnerable group. The main objective of this paper is to identify the effect of the predisposing, enabling, and need factors on doctor visits and in-patient care for the elderly residing in the northern region of Malaysia. A multistage cluster sampling was used in selecting the sample for the study. A total of 1414 respondents aged 60 and over were interviewed face-to-face using a structured questionnaire. A probit model was used in estimating the utilization equations. At a significance level of 0.05, except for age, all predisposing and enabling factors were not statistically significant in affecting the doctor visits. On the other hand, being a male, smoker, medical insurance holder or had not actively involved in social interaction within the reference period increases the likelihood of being in-patient. Health-related variables remain the most significant factors that determine healthcare utilization, including both doctor visits and in-patient stays, in the area of study, which suggests that government policies to improve population health may influence the level of healthcare use in the future.
This paper is concerned with the relationship between child mortality and the use of health care. We develop a simultaneous model of fetal and postnatal mortality risks and input demand equations for prenatal medical care and institutional delivery. This model is applied to retrospective data from Peninsular Malaysia covering 1950-1988. The results show that prenatal medical care and institutional delivery have strong beneficial effects on child survival probabilities, and that these effects are substantially underestimated when adverse self-selection among users of health care is ignored. The effectiveness of prenatal health care in Malaysia improved until 1980, and then deteriorated. We find that the risk of infant and child mortality is not independent of fetal survival, but show that ignoring selective fetal survival introduces only mild biases in infant and child mortality estimation. Higher infant and child mortality rates among young mothers are partly explained by their lower likelihood of purchasing health care.
Matched MeSH terms: Child Health Services/utilization*
The objective of this study was to know the status of the foreign workers' access to public health services in Malaysia based on their utilization pattern. The utilization pattern covered a number of areas, such as frequency of using health services, status of using health services, choice and types of health institutions, and cost of health treatment. The study was conducted on six government hospitals in the Klang Valley area in Kuala Lumpur, Malaysia. Data were collected from 600 foreign patients working in the country, using an interview method with a structured questionnaire. The results showed that the foreign workers' access to public health services was very low. The findings would be an important guideline to formulate an effective health service policy for the foreign workers in Malaysia.
In a survey of 5233 patients seen in the clinics of three general practitioners, 339 patients were found to be doctor hoppers (6.48 per cent). Respiratory symptoms and fever were the commonest presentation affecting mainly the paediatric age group. No improvement in the symptoms was quoted as the most common reason for switching to another doctor. Many factors contributed to doctor hopping and these were best considered in relation to the illness, the patient and the doctor: From the point of prevention, the doctor himself has a significant role to play, particularly in improving the doctor-patient relationship and patient compliance.
Study site: Johor (Johor Bahru, Batu Pahat, Muar)
Matched MeSH terms: Personal Health Services/utilization*
This cross sectional study explored the health problems and health needs in the local Chinese community in Glasgow. Several data collection methods have been used in this study, including face-to-face and telephone structured interviews, postal and hand delivered questionnaires. A total of 800 questionnaires were processed, and 493 were completed, giving an overall response rate 61.6%. The results from the present survey indicated that the health status of Chinese residents in Glasgow is poorer than that of the local population. The most important findings of the study is that the Chinese community in Glasgow underuse health services, and unmet health needs exist in the community. The main barrier to effective use of present health services and benefit from the health promotion and health education programmes is language difficulties. Following discussion with the local community, options for improving the health services for the Chinese community in Glasgow were obtained. The findings of the study have implications for health service purchaser/providers of health care to the Chinese population generally in Scotland.
This study examines the inequality of the use of skilled delivery assistance by the rural women of Bangladesh using the 2007 Bangladesh Demographic and Health Survey data. Simple cross-tabulation and univariate and multivariate statistical analyses were employed in the study. Overall, 56.1% of the women received at least one antenatal care visit, whereas only 13.2% births were assisted by skilled personnel. Findings revealed apparent inequality in using skilled delivery assistance by socioeconomic strata. Birth order, women's education, religion, wealth index, region and antenatal care are important determinants of seeking skilled assistance. To ensure safe motherhood initiative, government should pay special attention to reduce inequality in seeking skilled delivery assistance. A strong focus on community-based and regional interventions is important in order to increase the utilization of safe maternal health care services in rural Bangladesh.
Matched MeSH terms: Maternal Health Services/utilization*
This paper investigates the use and provision of biomedicine among Korean-Australian men on the basis of interview data from all of the eight Korean-speaking doctors practising in the Korean community in Sydney in 1995. From the viewpoint of these general practitioners, an analysis is made of the processes Korean men go through in adjusting to a new country, being involved in constant hard manual work and long working hours, and explores how they make use of all available resources to stay healthy. The Korean men have fully utilized the 'freely' available medical services under government-subsidized Medicare, bearing in mind that health is a capacity to work under the current environment, although illegal migrants restrained themselves from using it until they obtained legal status. Korean-speaking medical practitioners have been able to provide their fellow Koreans with 'culturally appropriate' health care, with the key factor being the absence of a language barrier. The level of patient satisfaction is high, possibly due to the excellent understanding the doctors have of the social aspects of illnesses, although the doctors do not go beyond curative medicine in their practice. However, the increasing number of Korean-speaking doctors in the small Korean community means that there is competition for patients. Consequently, the medical care is highly entrepreneurial. Referral by Korean doctors to practitioners of Korean herbal medicine is also a notable feature of the health care sector of the Korean community, especially as this offers Korean patients 'satisfactory' health relief for problems that are not easily relieved by doctors in the biomedical system.
Matched MeSH terms: Community Health Services/utilization*
Previous research suggests that care-seeking in rural northern Ghana is often governed by a woman's husband or compound head. This study was designed to explore the role grandmothers (typically a woman's mother-in-law) play in influencing maternal and newborn healthcare decisions. In-depth interviews were conducted with 35 mothers of newborns, 8 traditional birth attendants and local healers, 16 community leaders and 13 healthcare practitioners. An additional 18 focus groups were conducted with stakeholders such as household heads, compound leaders and grandmothers. In this region, grandmothers play many roles. They may act as primary support providers to pregnant mothers, care for newborns following delivery, preserve cultural traditions and serve as repositories of knowledge on local medicine. Grandmothers may also serve as gatekeepers for health-seeking behaviour, especially with regard to their daughters and daughters-in-law. This research also sheds light on the potential gap between health education campaigns that target mothers as autonomous decision-makers, and the reality of a more collectivist community structure in which mothers rarely make such decisions without the support of other community members.
Matched MeSH terms: Maternal-Child Health Services/utilization*
There are many crucial determinants of the individual outcome and benefit of a university education including the stressful interplay of cultural and socioeconomic factors which are of growing importance in the inflationary 1970's. An epidemiological study of university students from 1969-1972 in Canada, 1973-1974 in Britain, and 1975 in Singapore, attempted to identify stresses leading to mental ill-health in these students. Singapore was chosen as an example of a culture bridging the developed Northern and developing Southern nations of the world. Cultural differences affecting the results of the study are discussed as is the role of social change.
Matched MeSH terms: Student Health Services/utilization