In August 2000, the Disease Control Unit of T erengganu noted an increase in the number of serologically confirmed cases of hepatitis A virus (HAH in Kuala Terengganu Hospital. Preliminary investigation revealed that there were an outbreak of hepatitis A in districts of Kuala Terengganu and Marang. Eventually, a total of 334 associated cases were reported among Kuala Terengganu residents and 59 cases among residents of Marang. The age of the patients range j9·om 2 years to 71 years old (median 16 years). Males accounted for ( 69.5% of cases and had a higher sex specyic attack rate (96.35/100,000) than females (42. 70/100,000). The highest attack rate (128.3/100,000} occurred among patients aged 10 — 14 years. The health staff of Kuala Terengganu and Marang District Health Ojice had investigated a total of 229 case. Most cases (62.4%) occurred amongst school children. A case control study was carried out amongst 35 cases that were matched with 71 controls by age group, class and sex, to identyy the potential source of injection. The results indicated that eating fried noodle with shelh‘ish significantly increased the risk of being infected during the outbreak (OR 16.38[4.2l-74.53]).
Dengue and dengue hemorrhagic jiever are still a serious public health problem among people in developing countries. The study was conducted to assess the knowledge, attitude and practice among students in University Technology of MARA in Shah Alam Selangor, Malaysia, and to determine its association withprevious infection. A total of 218 students were selected randomly fom several residential colleges within the university main campus. They were interviewed for their perception of risk to dengue and their blood were taken for serological examination (Dengue IgG). It was found that 49.1% of students have had previous infection, however onlv 0.9% had history of symptomatic dengue infection. Males students originating fom urban areas were more at risk of being infected. The perception of risk to dengue was good among students but this factor is
unable to explain the magnitude of infection among them. Further study should look at the interaction between behaviour and environment among students who are sero negative.
Social security traditionally means a social insurance program providing social protection, or protection against socially recognized conditions, including poverty, old age, disability, unemployment and others. It also hovers around the subject of social insurance, where people receive benefits or services in recognition of contributions to an insurance scheme. Providing services for medical care, aspects of social work and even industrial relations may be included as part of social security services. Lately, the term is also used to refer to basic security, a term roughly equivalent to access to basic necessities. The 1 World Conference on Social Security organised by the Brazilian Government on 1st to 5th of December 2010 stimulates the countries to adopt universal, comprehensive and equitablesocial security systems as a valid, ethical and feasible option in the process of national reforms and regional integration. The main challenge to achieving the noble objective of universal social security system is financial sustainability and social cohesion supported by political will. As seen in a number of countries, Malaysia has a mixed social security schemes comprising state and private schemes, statutory obligatory requirements on the part of
employers as well as state social assistance programmes. Maintaining the quality of life of the individuals and their dependents has become the primary focus of policies and programmes in providing social security. Among the critical pressures on the population’s standard of living is the provision of health care. Extension of the coverage for social security is critical in ensuring social inclusion.
This study aims to explore the life experience of the husbands of women who survived breast cancer for more than five years following breast removal. Basic interpretative of qualitative methodology was applied in order to construct the phenomenon of breast cancer from the perspective of husbands. This approach allowed researchers to explore in-depth the experience of husbands in facing breast cancer of their wives. Four themes were identified. These are marital
challenges, pattern of life, supportive atmosphere and psychological defenses. Health strategies should direct the family member to the specific pathway in order to facilitate them towards the effective action of healthcare at their level. Evidence from this study is a direction for future research and health planning for better health policy.
Prevalence of visual impairment among students is increasing in trends especially in rural area. A cross sectional study was conducted among secondary school students in Taman PKNS Beranang, Selangor in March 2008 with the objective of determining the prevalence of visual acuity impairment and its influencing factors. A total of 77 secondary school students were interviewed using guided questionnaire. The prevalence of visual acuity impairment among the respondents was 25.0% and study found that being female and have been watching television at a distance of less than two meters were significantly associated with visual acuity impairment. In conclusion, the problem occurred maybe due to the students sit nearer to the television (
Cancer of the cervix is the second most common cancer among Malaysian women. Pap smear screening can detect precursors of cervical cancer. This paper attempts to determine the factors that influence the uptake of Pap smear screening. This was a cross sectional study with 112 Malay women recruited from a public university. A questionnaire enquiring sociademographic characteristics and health seeking behaviour based on the Health Belief Model was modified, translated and pre·tested. Testeretest reliability was also conducted. The mean age of the participants was 35.8 + 9.1 years. Majority was married and had at least secondary education. Only 62% of them had ever undergone Pap smear screening. Multiple logistic regression analysis showed women who were married or divorced (OR: 50.79, 95% C1: 4.33; 596.36), older age (OR: 1.12, 95% CI: 1.03; 1.22) or perceived higher benefits of Pap smear (OR; 4.80, 95% CI: 1.14; 20.15)
were more lilcely to have undergone Pap smear screening. Measures in reducing barriers and educating the public on the benefits of Pap smear are strongly recommended.
Stroke is among the main cause of death and loss of work capability in Malaysia. Government hospitals statistic shows drastic increase of stroke cases and deaths resulting from it. Hospital Kuala Lumpur's statistic recorded about 30% to 35% fatality in cases of stroke. The study was carried out to identify the level of stroke recovery and its associated factors. The study was carried out at University Kebangsaan Malaysia Medical Center (UKMMC), Hospital Kuala Lumpur (HKL) and National Stroke Association of Malaysia (NASAM). The sampling method was universal sampling and respondents were interviewed using guided questionnaire. The stroke recovery was studied to identify the relationshiP with social support, age, coping, stroke severity and lifestyle. The response rate of this study was 50.3%. A total of 47.0% ofstroke patient received high stroke recovery. Among five factors studied, three factors have shown the significant relationship with stroke recovery; coping style OR 0.293 (95% Confidence Interval (CI), 0.129·0.668, P "0.004); lifestyle, OR 0.347 (95% Confidence Interval (CI), 0.154· 0.782, p" 0.01) dan social support OR 0.291 (95% Confidence Interval (CI), 0.128· 0.664, P"0.004), Establish significant relationshiP of stroke recovery with three studied factors which were social support, coping style and lifestyle. Most of the stroke patients in this study are retirees and housewives. These three factors are required further attention to ensure stroke patients recover.
Key words: Recovery, stroke, social support, coping, lifestyle
In recent years, there has been concern that non-smokers may also be at risk from secondhand smoke exposure, especially children. This study was done to determine the prevalence of secondhand smoke exposure at home and the association between secondhand smoke exposure and respiratory symptoms among primary schoolchildren in Kota Bharu, Kelantan. This was a comparative cross-sectional study involving children, aged 10·12 years. A structured questionnaire was used to obtain the information on sociodemographic, respiratory symptoms and smokers in the house. A random sample of 10 from 95 primary schools in Kota Bharu was included. Six classes were randomly selected from each school, two classes each from each school year of primary 4·6. A total of 795 children completed the questionnaire during September 2003 till March 2004. 386 of children (48.6%) were boys and 409 children (51.4%) were girls. Most of the children were Malay (99.9%). A total of 442 (55.6%) children lived with at least 1 smoker in the house mainly from the smoking fathers. Significantly increased odds ratios due to secondhand smoke exposure were observed for most of the respiratory symptoms. The odds ratios (95% confidence interval) were 1.67 (1.18, 2.39) for cough in the morning, 1.59 (1.10, 2.30) for cough at night, 1.76 (1.16, 2.65) for cough most days for the previous 3 months, 1.57 (1.14, 2.17) for phlegm in the morning, 1.49 (1.08, Z.07) for phlegm during daytime or at night, 1.38 (1.03, 1.86) for nose problems in the morning, 1.40 (1.03, 1.90) for nose problems at night and 1.78 (1.14, 2.78) for throat problems at night, 1.55 (1.06, 2.26) for ever wheeze or diagnosed asthma by doctor, 1.57 (1.05, 2.36) for throat problems in the morning and 1.81 (1.15, 2.85) for throat problems during daytime. The odds ratios increased with increasing number of smokers at home for cough in the morning, cough most days for the previous 3 months, phlegm in the morning, ever wheeze or diagnosed asthma by doctor, throat problems in the morning, throat problems during daytime and throat problems at night. In view of the significant health risks posed to children by secondhand smoke, public health policies are needed to protect this vulnerable population. The aim of such policies Ls to ensure the right of every child to grow up in an environment free of tobacco smoke.
The aim of the study is to describe the usage of dietary supplemenu among doctors working in the hospitals in Kota Bharu, Kelantan. The method used was a postal questionaire survey of the doctors, both specialists and medical officers working in these hospitals. The results showed that
only 28.7% of the doctors are taking dietary supplements. Significantly more female doctors and doctors on long term medication, were taking these supplements. The dietary supplements commonly used were multivitamins and minerals (92.3%), garlic (26.9%), vitamin C (26.9%) and
lecithin (15.4%). The majority of the doctors who took dietary supplements (60%) felt their health status have improved. These supplements were mostly obtained from hospital pharmacies. Doctors who puchase their own supplements spend between RMIO to RMIZO per month. The main reasons given for taking these supplements were that the doctors jfelt healthier' and to ‘prevent or as a supplementary treatment’ for conditions like hypercholesterolaemia, hypertension, ischaemic heart disease and cancers. There were four doctors who regularly use traditional dietary supplements. Most doctors will generally advice their patients and children to take dietary supplements regularly, as they felt that it is important for health.
Employee satnfaction surveys can provide the information needed to improved levek of productivity, job and loyalty. Management can identify the factors of job issues and provide solutions to improve the working environment. A cross sectional descriptive study on employee satisfaction among a health care district office’s staff was conducted in Perak in March - April 2006. A total of 19 staff were randomly picked and interviewed in the data collection process. Almost all understand the objectives of the administration unit (94%) and were satisfied with the management leadership’s style (78%- l 00%) . Majority agreed that their relationship with immediate superior and within the group was harmonious and professional (89%) and they preferred an open problem solving method in handling conflict (72 %). The most common type of incentive rewarded by the administration to express gratitude to their staff was certificate (56%); bonus and medal (33%); and informal gesture (28%). Majority (83%) were also satisfied by the method used to disseminate the information in their units. Majority agreed that the working environment in the administration unit were conducive (72%), their ideas were equally considered during decision making sessions (89%) and training opportunities were similarly given to them by the management (72%). This study revealed that employee satisfaction was determined by several factors such as management leadership's style, opportunity to contribute skills and idea; reward and incentive; and conducive king environment.
A cross»sectional study was conducted to determine the knowledge on family planning among Malay women who delivered at Hospital Universiti Sains Malaysia (H USM), Kelantan and their husbands. Three hundred and fifty five women were selected by systematic random sampling. An interview-guided questionnaire that included infomation on socio-demographic, obstetric and knowledge on family planning was conducted to the women and self-administered questionnaire was given to their husbands. There were 15 questions on knowledge which were validated prior to the study. More than half of the women (53.5%) and the husbands (57.7%) had poor knowledge score (less than 75%) on family planning. A majority (86.8%) of the women and 87.9% of the husbands knew the optimal age of a woman to be pregnant, but very few (3.4%) of the women and Ss 1% of the husbands could answer correctly all the questions on the effects of poor spacing. The level of knowledge on family planning among Malay women who delivered at H USM and their husbands were poor. Therefore, new and improved health education materiab and programmes are needed, to target both the women and their husbands.
This was a cross-sectional study which attempt; tu determine the prevalence of breastfeeding practice among mothers in Klcmg district, Malaysia and the association between lyrcastfceding practice with place of delivery and knowledge 011 breastfeeding. Dam collection was conducted by face·t0·face interview using a premuded structured questionnaire amung mothers with fum month old infants only who attended che government clinics in Klang, A total of 508 mothers were recruited ima the study. The study showed 92.9% ever breastfed, 55.1% exclusively lareastfed fur one month and 20.5% exclusively bremtfcd for four months. Malays brcastfed the most, while
Chinese the least. Breastfeeding was more common among mothers with lower education, delivered in government hospitals and with good knowledge on breastfeeding. A high proportion uf mothers in Klang wouki initiate breastfeeding and the [neualence of exclusive breastfeeding was comparable nationally. Breastfeeding was associated with mothers delivered in government hospitals and with good knowledge on breastfeeding. Continued promotional efforts targeted at private hospitals with information on breastfeeding should result in further increase in breastfeeding prevalence.
Study site: Klinik Kesihatan, Kelang district, Selangor, Malaysia
Stress has been recognized one of the factors causing disease. About 70-80% of all diseases may be stress related. Thus, stress management can be a part of an early measure of disease prevention. A descriptive cross sectional, randomized study was conducted to determine the stress inducing factors among preclinical students (universal sampling) in a public university in Selangor, Malaysia from 24th April to May 2005. A total of 163 students (52.8% year 1, 36.8% year 2 and 10.4% year 3) were interviewed in the data collection process. The main reasons students entered - medical school was because of their own interest or ambition (65%) and family influence (20.9%). Majority (76.4%) suffered moderate to great stress over hot conditions in lecture hall, tutoriaV small group session rooms and laboratories while 53.4% suffered when using the other facilities like cafeteria, toilet and transportation:. Almost all (95.1%) felt that examination was the most stressful, followed by early clinical exposure sessions (68.1%), problem·based learning sessions (62.5%), hospital visitations (59.7%), tutoriay small group sessions (49.3%), practical class (44.5%) and attending lectures (3 8.5%). Musculoskeletal System was the most stressful module among the first year students, followed by Nervous System and Gastrointestinal System with the percentage of 94.2%, 90.7% and 88.4% respectively while, 95% of the second year students felt that General, Hemopoietic ci? Lymphoid and Nervous System are the most stressful modules. This study revealed that academic sessions and lack of conducive teaching and learning environment as the main stress inducing contributors to preclinical medical students.
A cross sectional study to determine general health and body composition was conducted for comparison between rural samples (Teluk Intan, Perak) and urban samples (Klang Valley, Selangor). Systematic random sampling was used in Z health clinics in Klang Valky and 4 health clinics in Telult Intan, Perak The results showed that urban population was more heterogeneous (Malay 63.7%, Indian 19.8%, Chinese 14.9%) compared with the rural population (Malay 75%, Indian 22.1%, Chinese 2.9%). Mean age for urban population was 44 2 1.6 years and for rural was 50 i 14.4 years. There was significant difference in the BMI (p < 0.05) between urban and rural populations where more people in the urban areas had higher BMI. There was a significant difference in the waist hip ratio (p < 0.05) between urban and rural areas where more people in the urban areas had above normal waist hip ratio. There was no significant difference in chronic diseases suffered and family medical history of the rural and urban samples.
Various studies have reported that excess body weight may increase the risk to various diseases and death. A study reported that adolescents who were overweight were almost 18 times more likely than their leaner peers to be obese in early adulthood and were 8.5 times more likely to have hypertension as young adults. Therefore, this study was conducted to determine the body composition and four dietary factors i.e., prudent diet habits, calorie control habits, dietary fat/ cholesterol and sodium/salt control which may affect blood pressure and the risk of heart disease among year 1 medical students in a public university in Selangor. Body composition was determined by measuring the body mass index (BMI) and body fat percentage. None of the female students showed excellent/good eating habits while majority were fair (37.7%) and poor/very poor (62.3%). Nearly half of the male students showed excellent/good eating habits (42.5%), but more than half (57.5%) were poor/very poor. Majority of the female (85.7%, 85.7% and 94.8% respectively) and male students (80.9%, 57.5% and 93.6% respectively) showed excellent/good eating habits in calorie, dietary fat and salt control. Majority of the students (64.9% female and 61.7% male) have normal BMI values while 24.7% of female and 10.6% of male students were underweight (BMI values less than 18.5). Only a small number of female students were overweight (5.2%) and obese (5.2%). However 14.9% of male students were overweight and another 12.8% were obese.
The purpose of this study was to determine the quality of counter service at the Ministry of Health hospitals as perceived by patients. This was a cross sectional study using selfadrninistered questionnaires distributed to patients at the outpatient departments in all Ministry of Health Hospitals. By the end ofthe data collection period, 118 of 121 hospitals (total number of MOH Hospitals) participated with 93.2% response rate., The hospitals were divided into four categories, for the purpose of this study 1000 sample size were needed in each category, the number of sample size were obtained using Epi Info Program based on assumption that 30% Of patients were dissatisyded with the services provided and with a precision of 10%. In this study the quality were based on clarity and provision of services based on Client Charten deliverance of clear infomation by the healthcare personnel, priority treatment given to urgency of the cases, cleanliness of the facilities and teamwork among the staff This study revealed about 64% of patients perceived that the hospitals had provided quality services at the counter: Only about 11% of patients were not happy with the quality of the services given at the counter. The proportion of happy patients increased from the smaller to the bigger hospitals. In terms of delivering services according to the Client Charter; only about 15% said that service was not provided by the counter staff according to the Client’s Charter On the aspect of priority on the urgent cases, about 64% of the patients perceived that urgent cases were not seen immediately. About 64% of the respondents felt that the hospitah do provide quality services. Strategies should focus on the bigger hospitals because non conformance to quality occurs more frequently there. The post of Counter Supervisor should be created to ensure that quality services are delivered.
Study site: outpatient departments in all Ministry of Health Hospitals
Public health care programme evaluation includes determining the programme effectiveness (outcome assessment), efficiency (economic evaluation), accessibility (reachability of services) and equity (equal provision for equal needs). The purpose of this study was to make comparison on cost·( efficiency and costeffectiveness in managing type 2 diabetes between the Ministry of Health (MOH) health clinics with family medicine specialist (FMS) and health clinics without FMS. A costeffectiveness analysis was conducted alongside across-sectional study at two government health clinics in Machang, Kelantan, one with FMS and the other without FMS. A total of 300 patients, of which 155 from the health clinic without FMS and 145 from the other group were evaluated for sociodemographic and clinical characteristics from August 2005 to May 2006. HbA1c
analysis was measured for each patient during the study period. Macrocosting and microcosting were used to determine costs. The provider cost for diabetic management ranged from RM270.56 to RM4533.04 per diabetic patient per year, withla mean cost of RM1127.91(t906.08) per diabetic patient per year in health clinic with FMS. In health clinic without FMS, the provider cost ranged from RM225.93 to RM4650.13, with a mean cost of RM802.15 (:626.26). Proportion ofgood HbA1c was 17.2% for health clinic with FMS and 10.3% for the health clinic without FMS. The annual mean provider cost per proportion of good HbA1c control (< 7%) (Costefkctiveness ratio/ CER) was RM6557.65.for health clinic with FMS and RM7787.88 for health clinic without FMS. This provider cost-epfectiveness ratio was not different statistically between the health clinic with FMS and health clinic without FMS (p=0.063). The cost of building, equipments, overheads, staff and consumables were higher for FMS group. Sensitivity analysis was performed for three discount rates (0, 5 and 7%). Relative cost-effectiveness of diabetes management in health clinic with FMS and health clinic without FMS was unchanged in all sensitivity scenarios. Even though, there was no significantly difference in provider CER in type 2 diabetes management at Malaysian MOH health clinics, but the provider CER in health clinic with FMS was lower compared to health clinic without FMS. Therefore, we can conclude that the presence of FMS in the health clinic will effectively improved the management of type 2 diabetes.
Diabetes mellitus is the most common endocrine defect among children. Good diabetes management is important to give better health for both the children and the whole family. The goal of this study was to identify the level of mother involvement in children type·1 Diabetes Mellitus management, to identify factors related with mother involvement and to determine the relationships between mother
involvement and glycemic control. A cross·sectional study was carried out with 92 respondents selected by universal sampling from mothers who had diabetic children aged 5-15 years old and from medical visit appointment at University Kebangsaan Malaysia Medical Centre (UKMMC) and Putrajaya Hospital (HP1). Data was obtained through medical record and self reporting questionnaire. The study shown that 58.6% mothers had high involvement and 41.4% mothers had low involvement. Mothers' education level had a significant (p=0.0Z) relationship with a level of mother involvement. Most mothers gave high involvement in diet management (64.1%) and blood glucose monitoring (52. 7%), however most mothers gave low involvement in exercise management (63.0%) and insulin injection (60.9%). Mothers involvement in four management tasks were not statistically significant (p>0,05) with glycemic control. Mothers involvement in children diabetic management was high. There was high mother involvement in children's insulin injection and dietary intake and low mother involvement in children`s blood glucose monitoring and exercise, This study abo showed that there was no significant relationship between level of mother involvement and glycemic control.
This survey elucidated the perceptions and implementation 0f orthodontic Clinical Practice Guidelines (CPGs) by all ortlmduntistc and dental officers in the Ministry of Health Mahysia (MOH). Two different set: uf xelf-administered questionnaires were targeted at first·year dental officers (FYDO), dental officcrx (DO) and administrative Senior Dental Officers (SDO) in one group and unhocluntists in another group. Only 30% responded from a total of 1,327 MOH dental officers, with no participation from three States. Majority (89%) of officers have heard of CPG: although some were unsure of their purpose and usage. About 69% have read orthodontic CPG; of whom 87% have read other MOH dental CPG:. About 78.6% found CPGs 'gaud to excellenf but 16,0% did not answer this question. Same comments received included: language was confusing, inadequate details and pictures, need improvement, irrelevant, need CPG: for other orthodontic problems, need more knowledge first and requests for mare copies. Only 27.7% used them often, 53% occasionally and 15% hardly follow CPG:. About 82% felt that they were encouraged to use CPGx in their workplace and the majority (86%) knew where they were kept especially SDC: and DO; About 90% in the orthndonzist group have received hard copies of orthodontic CPGs but the majority (76%) has not seen them on the website. Although all felt that CPG; were useful to officers and encouraged their use, only 62.5% have introduced CPGs to their officers. There was generally more awareness and usage of CPGS among SDOs compared with DOs and FY DO; The dissemination and availability of orthodontic CPG: is reasonably good. However, the implementation by mthodontists and administrative officers can be improved for better awareness, understanding and usage by dental officers, especially FYDOs.
Undergoing a Pap smear screening is widely accepted as a costeffective screening for detection of cervical abnormalities. In Peninsular Malaysia, cervical cancer was the second commonest cancer among women with incidence rate of 17.8 per 100,000 populations in 2002. Despite the high incidence of cervical cancer, only 26% of eligible woman had undergone Pap smear screening. To determine the prevalence of Pap smear screening, reasons for not undergoing the screening as well as the associated sociodemographic factors among women in Mukim Jaya Setia, a crass-sectional study was conducted in ]anuary 2005. Two hundred and ninety five from 350 households were randomly selected by using a Random Digit Table. Two hundred and eighty consented married women, aged 18 years and above were interviewed by the trained interviewers using structured
questionnaires. The questionnaires consisted of socio-demographic characteristic, Pap smear screening practice and risk factors of cervical cancer. There were 280 women who responded to the questionnaires. Majority of them were housewives (75%) and with low income (84.3%). Most ofthe women completed their education up to lower secondary school only (95%). Only 144 (51.4%) women undergo Pap smear screening but not on a regular basis. Most of them were screened only once, which was more than 3 years ago. Lack of knowledge, no accommodation, feel unnecessary and shy and no time were among the reasons that deterred the women from Pop smear screening. Women who were younger and with higher education level had more Pap smear screening compared to the older and with low education level. The practices of Pap smear screening among women in these villages were still low and was associated with age and educational level.