OBJECTIVE: This study aims to provide an up-to-date analysis of the changing global and regional asthma prevalence, mortality, disability, and risk factors among children aged <20 years by leveraging the latest data from the Global Burden of Disease Study 2019. Findings from this study can help inform priority areas for intervention to alleviate the rising burden of childhood asthma globally.
METHODS: The study used data from the Global Burden of Disease Study 2019, concentrating on children aged 0 to 14 years with asthma. We conducted an in-depth analysis of asthma, including its age-standardized prevalence, incidence, mortality, and disability-adjusted life years (DALYs), across diverse demographics, such as region, age, sex, and sociodemographic index, spanning 1990 to 2019. We also projected the future burden of the disease.
RESULTS: Overall, in the Western Pacific Region, the age-standardized prevalence rate of asthma among children increased slightly, from 3898.4 cases per 100,000 people in 1990 to 3924 per 100,000 in 2019. The age-standardized incidence rate of asthma also increased slightly, from 979.2 to 994.9 per 100,000. In contrast, the age-standardized death rate of asthma decreased from 0.9 to 0.4 per 100,000 and the age-standardized DALY rate decreased from 234.9 to 189.7 per 100,000. At the country level, Japan experienced a considerable decrease in the age-standardized prevalence rate of asthma among children, from 6669.1 per 100,000 in 1990 to 5071.5 per 100,000 in 2019. Regarding DALYs, Japan exhibited a notable reduction, from 300.6 to 207.6 per 100,000. Malaysia also experienced a DALY rate reduction, from 188.4 to 163.3 per 100,000 between 1990 and 2019. We project that the burden of disease in countries other than Japan and the Philippines will remain relatively stable up to 2045.
CONCLUSIONS: The study indicates an increase in the prevalence and incidence of pediatric asthma, coupled with a decrease in mortality and DALYs in the Western Pacific Region between 1990 and 2019. These intricate phenomena appear to result from a combination of lifestyle shifts, environmental influences, and barriers to health care access. The findings highlight that nations such as Japan have achieved notable success in managing asthma. Overall, the study identified areas of improvement in view of persistent disease burden, underscoring the need for comprehensive collaborative efforts to mitigate the impact of pediatric asthma throughout the region.
MAIN BODY: Focusing on COVID-19 and migrant workers in Malaysia, this review addresses two research queries: (i) what are the policy responses of the government toward migrants with regard to COVID-19? (ii) what are the lessons learned from the Malaysian experience of COVID-19 and migrants that can inform pandemic preparedness, especially regarding migrant health policy? The review used Arksey and O'Malley's methodological framework refined by Levac, Colquhoun, and O'Brien. In addition to the PubMed, Web of Science, Scopus, and EBSCO databases, and Malaysian English language newspapers, including the Malay Mail, Malaysiakini, and the New Straits Times, the search also included reports from the websites of government ministries and departments, such as the Immigration Department, Ministry of Human Resources, Ministry of Health, and the International Trade and Industry Ministry.
CONCLUSION: Using the case example of Malaysia and the policy approach toward migrant populations in Malaysia during the height of the COVID pandemic in 2020 and 2021, this paper unravels complex pathways and inter-linkages between the contexts of migration and health which coalesced to engender and exacerbate vulnerability to disease and ill-health for the migrant workers. The lack of coordination and coherence in policies addressing migrant workers during the pandemic, the normalization of cheap and disposable labor in neoliberal economic regimes, and the securitization of migration were key factors contributing to the failure of migration policies to provide protection to migrant workers during COVID-19. The review suggests that policy approaches embodying the principles of Health in All Policies, a whole-of-society approach, and the promotion of safe, just, and regular migration, predicated on equity and inclusion, are integral to a comprehensive and effective response to pandemics such as COVID-19.
DESIGN: Using a descriptive qualitative research approach informed by Levesque's framework of access to healthcare, we conducted phone interviews in the Malaysian language, which were audio-recorded and transcribed verbatim. Data were analysed inductively using a reflexive thematic analysis approach.
SETTING: Primary care clinics in five states in Peninsular Malaysia.
PARTICIPANTS: Adult patients with obesity receiving face-to-face care for obesity from healthcare providers in Peninsular Malaysia.
RESULTS: We interviewed 22 participants aged 24-62, with the majority being female (77%), Malay (95%), married (73%) and with tertiary education (82%). Most participants attended obesity management services at public primary care clinics. We identified five themes: (1) moving from perceiving the need to seeking obesity care is a non-linear process for patients, (2) providers' words can inspire patients to change, (3) patients' needs and preferences are not adequately addressed in current obesity care, (4) over-focusing on weight by patients and healthcare providers can lead to self-blame and loss of hope for patients and (5) obesity healthcare can have consequences beyond weight loss.
CONCLUSION: Patients lack the self-regulatory skills to continue their lifestyle changes and struggle with self-blame and hopelessness. Over-focusing on weight by patients and obesity healthcare increase patients' self-stigmatisation. While provider-initiated weight discussions and engaging and personalised consultation provide the initial step towards weight management, obesity healthcare could be enhanced by behavioural support and patient education on the complexity of obesity. Further considerations could be given to shifting from a weight-centric to a more holistic health-centred approach in obesity healthcare.
MATERIALS AND METHODS: This scoping review was performed through electronic databases (PubMed and ScienceDirect) using keywords: 'spatial accessibility', 'floating catchment area' and 'factors'. Google Scholar and Mendeley Network were also used as additional sources to obtain relevant studies.
RESULTS: A total of 32 articles were included in this review. Factors identified can be distinguished into two broad categories, which are spatial and non-spatial factors. Spatial factors were remoteness or distance from the urban centre, areas in close proximity to main roads, and some specific geographical characteristics such as mountainous and deltaic regions, whereas non-spatial factors were the degree of urbanisation, population density and various demographic profiles of the population such as socioeconomic status, health need, and minority ethnic composition.
CONCLUSION: This study adds to the body of literature pertinent to the factors associated with spatial accessibility to healthcare services. These findings could give insight for researchers to consider and incorporate those additional variables to further improve the FCA-based method calculations.
METHOD: Between September and December 2020, a health questionnaire was administered via telephone to n = 250 migrants from Venezuela. Descriptive statistics summarized the constructs of Andersen's Behavioral Model. The model comprised of predisposing factors including migrants' social characteristics; enabling factors namely monthly earnings, education level and most trusted source of information on medical needs; need for care factors such as migrants self-reported health status, presence of non-communicable health conditions and having visited a doctor in the past 12 months; and the outcome variables which were migrants' decisions to seek public and private health services. Pearson χ2 tests, odds ratios and multivariable logistic regression with backward elimination examined the factors influencing a migrant's decision to seek health services.
RESULTS: Overall, 66.8% of migrants reported they would seek public health services, while 22.4% indicated they would seek private health services. Predisposing factors namely length of time residing in Trinidad and Tobago (p = 0.031) and living with family/friends (p = 0.049); the enabling factor of receiving information from publicly available sources (p = 0.037); and the need for care factor of visiting a doctor for a physical health problem (p = 0.010) were significant correlates of their decision to seek care in the public sector. Predisposing factors namely living with family/friends (p = 0.020) and the enabling factor of having difficulty accessing healthcare services (p = 0.045) were significant correlates of their decision to seek care from private providers.
DISCUSSION: Our findings demonstrated the positive association between social networks and a migrant's decision to use public and private health services, thus underscoring the importance of family and friends in facilitating health service use, promoting proper health practices and preventing diseases. Overall, the use of Andersen's Behavioral Model aided in identifying the factors associated with the use of health services by Venezuelan migrants in Trinidad and Tobago. However, further studies are needed to better understand their need for ongoing care, to inform policy, and to plan targeted health interventions for addressing the gaps in health service access, barriers and use.
METHODS: A clinician-led financial plan was developed at the University of Malaya to create the Centre for Image Guidance and Minimally Invasive Therapy (CIGMIT) to provide an integrated platform for high-end care for Malaysian patients of all ages, both public and private, requiring complex neurosurgical and spinal procedures and stereotactic and intensity-modulated radiotherapy. The challenges faced during development of the plan were documented together with an audit of patient throughput and analyses of financial risk and return.
RESULTS: CIGMIT opened in 2015. Patient throughput, both public and private, progressively increased in all facilities. In 2015-2019, 37,724 patients used the Centre's facilities. CIGMIT has become progressively more profitable for the University of Malaya, the public and private hospitals, and the investor. CIGMIT has weathered the challenges posed by coronavirus disease 19.
CONCLUSIONS: Focused, small-scale mini-public-private partnerships have a potential role in providing advanced technology for the benefit of patients in developing nations, particularly middle-income countries, subject to an approach that balances equity of access between public and private health care systems with fair reward.
OBJECTIVES: To examine the differentials and determinants of the utilization of private providers for family planning services.
METHOD: This study used the 2014 Malaysian Population and Family Survey data. Cross-tabulations and logistic regression were performed on 1,817 current users of modern methods.
RESULTS: Overall, 26% of modern method users obtained their supplies from private clinics/pharmacies and 15.2% from other sources, such as drug stores and sundry shops. The odds of utilizing the private sector for family planning services differ significantly across regions and socio-economic groups. The odds of obtaining supply from the private clinics/pharmacies were higher among the Chinese and urban women (AOR > 1), and it was lower among those from the eastern region (AOR = 0.47, 95% CI = 0.30-0.73). Non-Bumiputera, urban, higher educated, and working women, and those whose husbands decided on family planning had higher odds of obtaining the supply from the other sources (AOR > 1).
CONCLUSION: The private sector complements and supplements the public sector in providing family planning services to the public.
METHODS: The location and capability of hospitals to perform the Bellwether procedures was obtained from the Ministry of Health (MoH) and MoH hospital specific websites. The Malaysian population data were retrieved from the national department of statistics. Times for patients to travel to hospital were calculated by combining manual contouring and geospatial mapping.
RESULTS: There were 49 Bellwether-capable MoH hospitals serving a national population of 32.5 million. Overall 94% of Malaysia's population have access to the Bellwethers within two hours. This coverage is universal in West (Peninsular) Malaysia, but there is only 73% coverage in East Malaysia, with 1.8 million residents of Sabah and Sarawak not having timely access. Malaysia's Bellwether capacity compares well with other countries in World Health Organisation's Western Pacific region.
CONCLUSION: There is good access to essential and emergency surgical services in Malaysia. The incomplete access for 1.8 million people in East Malaysia will inform national surgical planning.