Bacterial skin infection was studied in 239 children between the ages of 1 and 12 years in an urban squatter area in Kuala Lumpur over a period of three months (January - March 1983). 62 children presented with dermatological problems, 33 of which were clinically diagnosed as pyoderma. Microbiological examination of swabs from the lesions yielded mixed growth from 54.5% (18/33) specimens. Beta-haemolytic streptococci were isolated from 63.6% (21/33) and Staphylococcus aureus from 54.5% (18/33) specimens. All streptococcal isolates were grouped with a commercial kit, the Streptex (Wellcome). 81% (17/21) belonged to Lancefield's group A, 90% of which were not M or T typable by the standard international set of antisera. Urine analysis, pharyngeal swab culture and determination of anti-streptococcal antibody titre were also performed for children with positive skin cultures for group A streptococcus. 6% (2/33) of children with impetigo developed acute glomerulonephritis, requiring hospitalization.
Study site: Growth and nutrition clinic, squatter area, Kuala Lumpur, Malaysia
Audit has improved certain aspects of management of typhoid fever detected through Klinik Perubatan Masyarakat at Hospital Universiti Sains Malaysia. We audited records of clinic patients who were blood culture positive for Salmonella typhi. For August to October 1992, we found 10 out of 31 cases (32%) were not admitted. Some of these were patients who defaulted, while some were managed as outpatients but not notified. We took action to educate the medical officers. For November 1992 - March 1993 we found 8 out of 24 cases (33%) were not admitted. Although the admission rate was no better, there was a non significant improvement in rate of notification by doctors. Defaulters were now the main problem, and so we took action to improve their follow-up, by using the clinic staff nurse. For April - August 1993, only 1 out of 16 cases (6%) was not admitted. This was a significant improvement (p=0.03)
Study site: Klinik Perubatan Masyarakat at Hospital Universiti Sains Malaysia
The hemoglobinopathies include all genetic diseases of hemoglobin (Hb) and fall into two main groups: the thalassemias and structural hemoglobin variants (abnormal hemoglobins). Thalassemia is a public health problem in Malaysia. About 4.5% of the Malays and Chinese are β-thalassemia carriers. We performed hemoglobin analysis on a total of 499 patients from a Government Hospital and Health Clinics in the state of Perlis, Malaysia. About 91.4% of the patients were Malays. All patients had microcytic hypochromic anemia except for a few who went for thalassemia screening. Female patients outnumbered male patients in the ratio of 3.5:1. About 75.7% of the female patients were of childbearing age (17 - 40 years) and a majority of them were there for their antenatal checkup. Using our screen tests (full blood count, high performance liquid chromatography (HPLC), and agarose gel electrophoresis), the common hemoglobinopathies detected were HbE trait (19.3%), β-thalassemia trait (14.6%), HbH disease (1.8%), Hb Constant Spring (1.6%), Homozygous HbE (1.4%), and HbE- β-thalassemia (1.4%). Thalassemia is preventable through screening and education programmes, and prenatal diagnosis. Thalassemia screening is provided free of charge at various government hospitals and health clinics throughout the country.
Key words: Hemoglobinopathies screening, β-thalassemia trait, HbE trait, Thalassemic diseases
The prevalence of psychiatric morbidity among patients attending primary care clinics is high and their attitudes towards psychiatry are often negative. The objectives of this study were to assess the prevalence of psychiatric morbidity and attitudes towards mental illness in relation to socio-demographic factors among primary care patients. A cross-sectional study was conducted on 245 patients attending the primary care clinic of Hospital Universiti Kebangsaan Malaysia at Bandar Tasik Selatan. A two-stage case identification process was used to detect psychiatric morbidity. The Malay translation of General Health Questionnaire-30 (GHQ-30) was used for screening and the Structured Clinical Interview for DSM-IV (SCID) was used to generate Axis-1 diagnosis. The Attitudes Towards Mental Illness Questionnaire was used to assess their attitudes towards mental illness. 8.2% of patients were found to have psychiatric morbidity, and they were significantly associated with the younger age group (p<0.05). Nevertheless, there was no significant association between psychiatric morbidity and sex, race, marital status, educational level, and social class of patients. The attitudes towards mental illness were significantly associated with age, race, marital status, educational level, social class and the presence of family history of psychiatry illness (p<0.05). There was no significant association between attitudes towards mental illness and patients'sex. Primary care doctors need to be equipped with psychiatry knowledge in order not to miss patients with psychiatry morbidity. Patients with psychiatry morbidity significantly believed in supernatural causes of mental illness compared with those without psychiatric morbidity. Keywords: Primary care, psychiatric morbidity, attitude towards psychiatry
Human Immunodeficiency Virus (HIV) epidemic remains a significant burden in Malaysia. Stigma related to HIV and its effect on the quality of life (QOL) of persons living with HIV (PLHIV) remains under-reported. The aim of the present study was to assess self-perceived stigma amongst PLHIV attending an urban community clinic and its influence on their QOL. Data was collected using HIV Stigma Scale and WHO-QOL HIV BREF Scale. The overall stigma experienced by PLHIV in this community was higher than previous studies (mean ± SD; 103.37 ±18.14). Majority participants had fear disclosing their disease status, while personalized stigma or the experience of prejudice and rejection was the least experienced. The overall QOL was low and was significantly impaired in social relationship domain (mean ± SD; 12.72 ± 3.59). However, their ability to perform daily activities was not affected by the illness (mean ± SD; 14.48 ± 2.91). PLHIV with higher spiritual values demonstrate lower perception of negative self-image and inferiority (r= -0.54). This finding was unique to PLHIV in this study and suggested the importance of spirituality and personal beliefs on their self-esteem. In conclusion, stigma remains as a significant problem among PLHIV in this community. Primary care offers the best platform to promote a holistic management of PLHIV, where the integration between counselors, religious experts, family and non-governmental associations could come together. The management of PLHIV is unique in every community, hence individualized approach based on cultural norms and beliefs could assist in the overall management of PLHIV.
Keywords: HIV, quality of life, social stigma
Introduction: This study was designed to determine the effectiveness of combined group Cognitive-Behavioral Therapy (CBT) in improving diabetes distress and glycemic control among 60 adults with type 2 diabetes.
Methods: Half the participants were the experimental group (n = 30), and the other half was the control group (n = 30). Group therapy consisted of eight sessions for three months. Measures obtained at pre-test and post-test included the Diabetes Distress Scale (DDS-17) and blood examination to examine the level of HbA1c.
Result: The results indicated that group CBT had significant effects on the amelioration of diabetes distress and level of HbA1c among the participants of the experimental group.
Conclusion: The effectiveness of group CBT in the maintenance of good diabetic control in people who are suffering from type 2 diabetes was successfully demonstrated.
Study site: Pusat Sejahtera (Universiti Sains Malaysia Clinic), Pulau Pinang, Malaysia
BACKGROUND: Self-efficacy has been shown to be positively correlated with self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus. However, such evidence is lacking in the Malaysian primary care setting. The objectives of this study were to i) determine the levels of self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting ii) determine the relationship between self-efficacy, self-care behaviour and glycaemic control iii) determine the factors associated with glycaemic control.
METHODS: This was a cross-sectional study involving patients with type 2 diabetes mellitus from two public primary care clinics in Malaysia. Self-efficacy and self-care behaviour levels were measured using previously translated and validated DMSES and SDSCA questionnaires in Malay versions, respectively. Glycaemic control was measured using HbA1c.
RESULTS: A total of 340 patients with type 2 diabetes mellitus were recruited. The total mean (±SD) of self-efficacy and self-care behaviour scores were 7.33 (±2.25) and 3.76 (±1.87), respectively. A positive relationship was found between self-efficacy and self-care behaviour (r 0.538, P care behaviour and better glycaemic control. Findings of this study suggest the importance of including routine use of self-efficacy measures in the management of type 2 diabetes mellitus in primary care.
Study site: two public primary care clinics (Klinik Kesihatan Taman Ehsan and Klinik Kesihatan Sungai Buloh), Selangor, Malaysia
INTRODUCTION: Diabetic patients generally have a good idea about healthy diet however their awareness regarding specific dietary recommendations is questionable. Thus, this paper aims to examine the awareness regarding specific dietary components among diabetic patients at a primary care clinic and its influence on self-reported dietary practice.
MATERIALS AND METHODS: The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire (English-Malay version) was used. It was adapted with additional questions to assess respondents’ awareness on: (1) healthful eating plan, (2) the quantity of one serving of fruits and vegetables, (3) choices and the allowed quantity of high fat food intake, (4) meaning of carbohydrate, and (5) carbohydrate spacing per day.
RESULTS: From the 360 respondents, 85.0% knew about healthful eating plan. However, those who were unaware of the meaning of carbohydrate, carbohydrate spacing, the allowed high fat food intake, and the quantity of one serving of fruits and vegetables were 34.1%, 47.5%, 40.0%, and 30.8% respectively. Generally, the dietary practice reported by those who knew ‘one serving of fruits and vegetables’ (p<0.001), ‘allowed quantity of high fat food intake’ (p=0.001), ‘meaning of carbohydrate’ (p<0.001), or ‘carbohydrate spacing’ (p<0.001) was significantly different than those who were unaware of these terms.
CONCLUSION: Although most respondents knew about healthful eating plan, majority of them were unaware of the specific dietary components, suggesting superficial dietary knowledge. Unfortunately, poor dietary awareness significantly influenced their self-reported dietary practice which could be considered as inaccurate. Thus, strategies to improve their dietary knowledge is necessary at the primary care setting.
Keywords: Type 2 diabetes mellitus, diet, awareness, self-care, primary care
Study site: Klinik Kesihatan Sungai Buloh, Selangor, Malaysia
Introduction: Primary health care plays an important role in healthcare systems. In Malaysia, One (1) Malaysia Clinic (now known as Community Clinic since 2018) was established in 2010 aims to increase healthcare services accessibility within the poor urban population. The aim was to look at the effectiveness of One (1) Malaysia Clinic as a new form of public primary health clinic by looking at expectations and perceptions of the quality of the provided services by the patients. Method: It applied a cross sectional study involving nine clinics in of the busiest district in Kelantan namely, Kota Bharu district. 386 respondents which were Malaysian citizen, 18 years old and above were involved in this study. The survey used Malay validated SERVQUAL questionnaire. The Service Quality (SQ) gap was calculated. Result: The empathy dimension obtained the highest expectation and perception score, while the tangi- ble dimension has the lowest expectation and perception score. In all SERVQUAL dimension, the expectations and perceptions of the service provided was significantly different with P < 0.001. The most critical dimension identified was tangible dimension as it has the largest negative SQ gap score. Conclusion: Negative gaps for all SERVQUAL dimensions and individual items indicated that provided services at One (1) Malaysia Clinic still could not fulfilled the patient’s expectation. A continuous improvement program is needed especially on tangible dimension in deliv- ering a quality healthcare services.
BACKGROUND: Causes of low vision and types of low vision devices (LVDs) prescribed in other low vision clinics have been studied extensively. Similar studies have not been conducted in Malaysia. This paper reports the results of a retrospective study of 573 patients seen at the Universiti Kebangsaan Malaysia-Malaysian Association for the Blind (UKM-MAB) low vision clinic in Kuala Lumpur. METHODS: The record cards of 573 patients seen at the UKM-MAB clinic over 10 years were examined and the following information extracted: date of first consultation, age, sex, cause of visual impairment as diagnosed by an ophthalmologist and types of low vision devices (LVDs) prescribed. RESULTS: The majority of patients were from the younger age groups with 423 (73.8 per cent) less than 50 years of age. Three hundred and ninety-five (68.9 per cent) of the subjects were males and 178 (31.1 per cent) female. The main causes of low vision were congenital structural defects including nystagmus among patients in the zero to 29 years age group, retinitis pigmentosa among the 30 to 59 years age group and age-related macular degeneration (ARM) among those over 60 years of age. CONCLUSIONS: Since the majority of the patients were from the younger age group the main causes of low vision were congenital and hereditary diseases. Three hundred and forty-one (59.5 per cent) patients seen at the low vision clinic accepted the use of LVDs.
This cross sectional study was conducted to determine the validity of three screening tools, Mini Nutritional Assessment Short Form (MNA-SF), Malnutrition Risk Screening Tool for Community (MRST-C) and Malnutrition Risk Screening Tool for Hospital (MRST-H) among elderly people at health clinics. The screening tools were validated against anthropometric and functional assessments. The anthropometric assessments that were carried out included body weight, height, arm span, body mass index (BMI), calf circumference (CC) and mid upper arm circumference (MUAC). A set of questionnaire on manual dexterity, muscular strength, instrumental activities daily living (IADL) and cognitive status was used to assess functional abilities. A total of 156 subjects were recruited from rural (38 subjects) and urban (118 subjects) health clinics at Sabak Bernam and Cheras respectively. Subjects' age ranged from 60 to 83 years old, with 44.2% were men and 55.8% women. The prevalence of muscle wasting among the subjects assessed from MUAC and CC were both 7.0%. MNA-SF had the highest correlation with BMI (r = 0.497, p<0.001), followed by MUAC (r = 0.398, p<0.001), CC (r = 0.473, p<0.001), cognitive assessment (r = 0.229, p<0.001) and handgrip strength (r = 0.209, p<0.001). Whilst MRST-C had the highest correlation with IADL score (r =-0.320, p<0.001) and MRST-H had the highest correlation with the lock and key test (r = -0.325, p<0.01). Sensitivity was the highest for MNA-SF (93.2%), followed by MRST-H (52.5%) and MRST-C (25.8%). Specificity was the highest for MRST-H (97.3%), followed by MRST-C (90.8%) and MNA-SF (79.4%). Positive predictive value (PPV) for MRST-H, MNA-SF and MRST-C was 55.5%, 18.2% and 14.1%, respectively. In conclusion, among the screening tools being validated, MNA-SF is considered the most appropriate tool to be used in health clinics for identification of elderly individuals who are at high risk of malnutrition.
Underlying causes of most nutrition related problems are diverse, including biological, social, cultural, and economic factors. Qualitative approaches complement quantitative methods in identifying the underlying meanings and patterns of relationships involved in managing malnutrition. This study examined perceptions regarding malnutrition among health workers from 7 clinics (community and health clinics) in Tumpat, Kelantan. A total of 18 nurses and 2 doctors, who were involved in monitoring child health and nutrition, were included in the study. These health workers were interviewed using a semi-structured questionnaire adapted from Sastry's framework on malnutrition (Sastry, 1996). The questionnaire included biological, behavioral and environmental factors that influence child health and nutrition. All the health workers perceived that mothers/caregivers play the main role in improving the health of malnourished children. The quality of childcare was rated as moderately satisfactory by the health workers. Most of the affected families who were given the Food Baskets did not fully use all the items for the malnourished child. Child feeding practice was based on the needs of the whole family rather than according to the target child's needs. Most of the mothers preferred processed cereals than rice porridge because the former is easier to prepare for the child. Although they were from a low socioeconomic background, most of the mothers were not earning additional income for the family. The qualitative methodology provided information that can be used as a basis for the designing of quantitative questionnaires to assess malnutrition among children. The induction characteristic of qualitative methods was used to gain an understanding of the underlying reasons or phenomena such as behaviours that are directly observable.
Study site: Klinik kesihatan, Tumpat, Kelantan, Malaysia
A retrospective study of anaemia in pregnancy in rural Kelantan was conducted. The study sample consist of 9,860 mothers who had antenatal care at one of the 102 rural health clinics selected and had delivered a live baby. Anaemia in pregnancy was determined by reviewing the antenatal records for the haemoglobin level recorded at the first and last antenatal visit. Estimation of haemoglobin was done either by photocalorimetric methods or the Sahli's method in these rural clinics. At the time of booking, 47.5% of the mothers were anaemic by WHO criteria (Hb < 11.0 g/dl), with 1.9% having less than 9.0 g/dl. Age of mother, parity and late gestational age at the first antenatal visit were associated with anaemia during pregnancy at the time of booking. However, practise of contraception by the mother did not show any association with anaemia in pregnancy. There were 594 mothers (6.0%) who delivered a baby weighing less than 2.5 kg. There was no association between the low birth weight of the child and the status of anaemia in the mother at the last antenatal visit.
Introduction: The prevalence of type 2 diabetes mellitus (T2DM) is on the rise in Malaysia. Physical inactivity is common among T2DM patients and is an important aspect that warrants action as it may lead to poor glycemic control. The objective of this cross-sectional study was to assess the prevalence of physical inactivity and its associated factors among T2DM patients.
Methods: The sample consisted of 121 T2DM patients aged 18 to 65 years who attended the UKMMC primary clinic for routine follow up. A questionnaire consisting of three sections was used to collect the data: (i) socio-economic and diabetes-related factors; (ii) physical inactivity using shortened International Physical Activity Questionnaire (IPAQ); and (iii) five domains leading to physical inactivity.
Results: The mean age of the sample was found to be 56.2 ± 8.5 years; 55% were physically inactive; 76% had low education; 55.4% had low income; 76% had poor glycemic control; and mean duration of illness was 7.8 ± 6.9 years. Factors significantly associated with physical inactivity were presence of health complications (x2 = 5.89; p=0.015) and factor domains of 'respondent's current physical health' (t=5.88, p<0.001), 'availability of facility' (t=3.45, p<0.001), 'availability of time' (t=3.57, p<0.001) and 'respondent's perception of possibility of sustaining pain and injury during physical activity' (t=3.64, p<0.001). Using multiple logistic regression, only factors of 'physical health factor' (Adjusted OR: 1.58, confidence interval 95% (CI 95%): 1.31-1.92, p<0.001) and 'time' (adjusted OR: 1.27, CI 95%: 1.12-1.45, p<0.001) were found to be associated with higher odds for physical inactivity.
Conclusion: The results indicate that facility availability, time management and better management of health complications could increase physical activity among T2DM patients.
Key words: Physical inactivity, type 2 diabetes
Study site: Pusat Perubatan Universiti Kebangssan Malaysia (PPUKM) primary care clinic, Cheras, Kuala Lumpur, Malaysia
Introduction: This study seeks to identify the socio-demographic and behavioral characteristics of smokers (aged 18 and above), thus develop a predicting model for tobacco abstinence receiving cessation services for tobacco dependence at the Smoking Cessation Clinics (SCC) in government Primary Health Centers in Malaysia. These predictors would improve the effectiveness and efficiency of these clinics.
Methods : Smokers who sought smoking cessation therapy at the SCCs from 1st January 2004 to 31st
December 2004 were chosen randomly from clinic’s registries, and 254 smokers were recruited from 8 clinics chosen through stratified random sampling. Data analyses were performed with SPSS 12.0. 17.3% of smokers attending SCCs were able to quit smoking for at least six months.
Results : Factors significantly contributing to quitting success were elderly smokers (above 40 years old), smoked for more than 15 years, smoked less than ten sticks per day, had a previous history of quitting attempt, self referral to the clinic, high confidence level, attended SCC at least four times, each counseling session lasted for at least 30 minutes and were satisfied with the clinic service. In logistic regression model, smokers aged 40 years and above were 6.7 times more successful to quit, high level of confidence were nine times more successful, smoked more than ten sticks per day were ten times less successful, self referred smokers were ten times more successful and attending for at least 30 minutes counseling session were 12 times more successful.
Conclusion : This study concludes that more concerted effort is needed to approach various groups of target population and SCCs clinic services need to be improved.
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
BACKGROUND: Patients' education and empowerment are essential parts of a disease management. Patients have to be educated on the disease as well as lifestyle changes that they need to practise for a holistic and consistent improvement in their disease status. This study examined patients' knowledge on diabetes and nutrition as well as the role of dietician in the patient education.
METHODS: This was a cross-sectional study of patients aged more than 18 years, in a primary care centre in Kuala Lumpur. Patients responded to a pre-tested self-administered questionnaire which contains socio-demographic profiles of patients, knowledge on diabetes and nutrition. Patients were also asked on dietician consultation and the number of dietician visits. Patients were conveniently selected on the data collection days. Only consented patients and those who could understand Malay or English language were selected.
RESULTS: There were 110 patients who participated in the study. Overall the patients had good knowledge on diabetes and nutrition. The mean total knowledge score was 71.2% ± 9.34. Domains such as diabetes complications, exercise, meal practice, food sources and proportion need reinforcement. Only 60 (54.9%) patients had seen a dietician. Patients who had seen dietician showed significantly higher level of knowledge score (p=0.04). However frequent meeting with the dietician did not show any significant improvement in the knowledge (p=0.10). Factors such as patients' gender, ethnicity, level of education, employment status, glycaemic level, duration of illness and body mass index did not show any significant association with the overall diabetic and nutrition knowledge.
CONCLUSION: There is still a need to improve the overall diabetic education particularly in areas that patients were lacking such as diabetes complications, exercise, meal practice, food sources and proportion. It is equally necessary to encourage all diabetics to see a dietician since it helps to improve their level of knowledge as shown in this study.
Stroke is the third leading cause of death, a major cause of disability in adults, and is frequently more disabling than fatal. With a decline in mortality from initial cerebral infarction and an increase in the life expectancy of the population, the number of patients with recurrent stroke and ensuing cardiovascular events will become greater. Thus it is important to find out those patients at high risk of stroke recurrence. This case report illustrates the process of recurrent stroke and the resulting disabilities and morbidities in a 42-year- old man. The role of integrated stroke rehabilitation programme is described.
Objective: Female sexual dysfunction is a known complication of diabetes mellitus. The aims of this study is to estimate the prevalence of sexual dysfunction and the types of sexual dysfunction experienced by Malay women with type 2 diabetes mellitus.
Methods: Cross sectional study was conducted on married Malay women with type 2 diabetes mellitus, receiving treatment from two community clinics in Selangor, Malaysia. Female sexual function was assessed using Malay version of Female Sexual Function Index.
Results: This study found that sexual dysfunction was present among 18.2% women. Lack of libido was the commonest symptom among these women and was observed in 40.9% of women followed by sexual dissatisfaction (36.4%). Sexual arousal disorder was observed in 22.7%, 18.2% complained of lack of lubrication, and 22.7% had vaginal discomfort. Orgasmic dysfunction was found in only 4.5% of these women.
Conclusion: This preliminary research showed sexual desire disorder was the commonest type of sexual disorder among diabetic women.
Leisure participation in old age is often a continuation of their participation at younger age. This study aims to explore the association between current and former leisure participation of the elderly. Methods: A cross-sectional survey was conducted among 268 persons aged 60 years and above, purposively selected from eight health clinics in Selangor. Current leisure participation was measured using a validated Leisure Participation Questionnaire (LPQ), specific for Malaysian elderly. The LPQ consists of 25 activities, categorized into recreational (physical), cognitive, social and productive activity. Frequency of participation in each activity was measured on a 6-point scale. Leisure participation at younger age only involved their general participation in leisure. The most common daily leisure activities were having conversations while relaxing (78.7%) and watching television (74.6%), while the least were from playing golf (0.01±0.12) and performing musical instruments (0.04±0.36). More than half (64.9%) reported being actively involved in any leisure
activity at younger age. Results: The study found there was a significant association between former and current leisure participation, especially for cognitive (t=-2.45, p=0.015), social (t=-2.68, p=0.008) and productive (t=-2.89, p=0.004) activities. However, only productive activity involvement was predicted by their leisure participation while younger (B=1.304, p=0.027). Conclusion: The findings suggest the importance of considering active intervention programmes at younger age to ensure better leisure participation of the elderly, especially in recreational physical activity.