Intrarticular Hyaluronic Acid was administered to 45 patients with various grades of osteoarthritis in the knee. Following 3 fortnightly injections, these patients were reviewed at 6 weeks and 3 months with regard to their knee pain. We found the most patients (84.4%) has decreased knee pain following these injections. Patients who had severe grade osteoarthritis based on knee radiographs before the injections were less likely to have pain reduction compared to those with milder grade osteoarthritis. Only 4 (8.9%) patients showed no improvement and were subsequently considered for surgery. Many patients did not require any further treatment (24.4%) and the remaining were given analgesia (64.4%) to aid in their pain. One patient required another course of this injection. there were no complications recorded in this study. We concluded that Intrarticular Hyaluronic acid is an easy and safe method to treat osteoarthritis. The short-term outcome with regard to knee pain is good in patients with milder grades of osteoarthritis.
Study site: Private orthopaedic clinic, Johor, Malaysia
A proportion of patients with acute viral fever with thrombocytopaenia does not necessary have dengue infection. Managing them indiscriminately as dengue infection may not be appropriate. The prevalence of this problem is not exactly known. The objective of this study is to determine the prevalence of acute non-dengue febrile thrombocytopaenia among adult patients presenting with acute non-specific febrile illness in an outpatient setting. This was a clinic-based cross sectional study. Consecutive patients presenting with non-specific febrile illness of less than two weeks were selected from the Primary Care Centre of Hospital Universiti Kebangsaan Malaysia (HUKM) and the Batu 9 Cheras Health Clinic. Full blood count was done on the day of visit and dengue serology was done on day five of illness for all patients enrolled. Seventy three patients participated in this study from May to November 2003. Among the patients, 35 (47.9%) were noted to have thrombocytopaenia. Fourteen (40%) patients with thrombocytopaenia were serologically negative. The prevalence of non-dengue febrile thrombocytopaenia was 19.2%. A significant number of patients with acute non-specific febrile illness with thrombocytopaenia were negative for dengue serology. These patients should be differentiated from those with acute febrile thrombocytopaenia, as they might differ in their natural history from those with dengue infection, and hence require different management strategies.
Study site: Primary Care Centre of Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Rural health clinics in Sri Aman Division in Sarawak, Malaysia lack diagnostic tests for malaria. Many of the medical assistants in the clinic diagnose malaria solely on clinical ground. The study was to determine the sensitivity, specificity and positive predictive value of clinical diagnosis of rnahtria made by medical assistants using results of microscopy examination as gold standard. The study period was from September to December 2003. Three rural clinics without laboratory or diagnostic tests services and one urban clinic with laboratory facility serving malarious areas were selected. All patients clinically diagnosed as malaria by the attending medical assistants were included as clinical malaria cases. Blood slides were taken for examination of malaria parasites. Non clinical malaria cases were all other patients without clinical malaria for whom blood slides were taken for malaria parasites. Out of 362 patients included in the study, 75 were clinically diagnosed as having mahria. The sensitivity of headache, history of fever and chills/rigors to detect malaria cases was above 90% but the specificity and positive predictive value was low, below 40% and 20% respectively. The sensitivity, specificity and positive predictive value of malaria clinical diagnosis made by medical assistants was 82.1 %, 84 .4% and 30.7% respectively. Clinical diagnosis of malaria increases the slide positive rate by four folds. However the sensitivity, specincity and positive predictive value of clinical diagnosis by medical assistant and clinical characteristics was insufficient to enable each of them to be used alone to differentiate true malaria cases from non mahiria cases.
Health impact related to smoking is a critical public health predicament especially in pregnancy. However there is not much data available to describe the magnitude of the problem. Hence this study was conducted to determine the prevalence of smoking and its socioeconomic factors among antenatal mother and their opinion related to tobacco control measures. A cross sectional study was carried out involving newly registered antenatal mothers attending all government health clinics in Penang. Prevalence of ever smoking among antenatal mother is 1.4%, of which 42.4% is still smoking at first antenatal visit. It was found that single mothers are more likely to smoke (OR, 14.23: C12.52-53.27). It was also noted that spouse smoking (OR, 5,14: CI 1.95-17.09), primigravida (OR, 2.7: C1 1.3-5.62), age group less than 30 years old (OR, 2.41; CI 1.03-6.09) and living in urban area (OR, 2.33; CI 1.01 — 6.47) have a higher risk to indulge in smoking behaviour. Muslim OR 0.29; C1 0.14 - 0.60) and Malay (OR 0.22; CI 0.10 - 0.47) pregnant mothers are noted to be less likely to smoke as compared to non Muslim and non Malay. More than 85% of them agreed with the tobacco control measures regardless of their smoking status. Most of respondents agreed the influential people in community L;11T · such as medical personnel, teachers and parents should not smoke.
The aim of this study is to describe the epidemiological features of HFMD outbreak in the Hulu Langat District in 2000. Until November 2000, a total of 60 cases were reported and the worst ever reported to the previous years. The mean age of patients was 3.9; 5.8 years with majority of the cases aged between 1 to 4 years old (53.8 per 100,000 of population), male gender (8.3 per 100,000 of populations), and were of Chinese (12.2 per 11 100,000 of populations) and Malay ethnicity (7.2 per 100.000 of populations). All cases were uncomplicated cases and were diagnosed clinically. Most of the notified cases were front the government facilities, which are 44 cases (73.3%). Thirty-five (35) cases (58.4%) were treated as outpatient and 25 cases (41.6%) as in patients (p>0,05). Only 7 cases (11.7%) have history of contact with HFMD patients. The notified cases were mainly from the densely populated areas which were Cheras, Kajang and Ampang. No differences were noted between HFMD cases which have been breasfed for less than 6 month or more, and twenty nine (29) cases (48.3 %) had completed the immunization schedule. In conclusion, the recent emergence of HFMD brings a new challenge, which have to be faced in the prevention and surveillance activities of public health problems in the district.
Study site: Notified cases from Klinik Kesihatan, hospital, private clinics, Ulu Langat, Selangor, Malaysia
Introduction: The common cold is the commonest reason for primary care encounters worldwide. This paper aims to describe the reasons that influence patients to seek medical consultation for the common cold.
Methods: This was a cross-sectional survey conducted among adult patients of an urban teaching primary care clinic. An adapted bilingual survey form was administered by the researchers to obtain data regarding their decision to seek medical consultation for a cold and the reasons for their decision. Quantitative analyses were done to describe the close-ended responses. Open-ended responses were analysed using a qualitative approach and
the frequencies of the themes were reported. Results: A total of 320 respondents participated in this study, with a response rate of 91.4%. They were predominantly females (59.4%), Malay (70.9%), and had tertiary education (65.9%). More than half of the patients (52.5%) said they would seek consultation for cold symptoms. Fever was the commonest symptom (57-61%) which compelled them to seek consultation. The commonest reason for seeking consultation was to get medications (41.7%), whereas the commonest reason not to seek consultation was the practice of self-medication (44.2%). Ethnicity was found to be significantly associated with the decision to seek doctor’s consultation.
Conclusion: Colds are usually self-limiting and do not result in complications. Empowering
patients by providing appropriate self-care knowledge can help to reduce the burden of primary care services.
Patients should be taught about red flag symptoms as well as drug safety for medications commonly taken for
colds.
Keywords: Upper respiratory tract infections, patient acceptance of health care, primary health care.
The Municipal Maternal and Child Health Clinics at Kuala Lumpur were faced with a declining but continuing problem of diphtheria. The arrangements for immunization were such that a low coverage was obtained for triple vaccination, but a high one for smallpox, a disease they had not experienced for many years. By reversing the schedule, so that triple vaccine injections were administered first, and ensuring that fewer children were not immunized because of concurrent minor ailments, the diphtheria immunization coverage was greatly improved. There was some loss of smallpox cover.
The revision commenced in 1970 and the diphtheria incidence rate, which had been falling since 1965, continued to fall but at a lower rate. The author does not discuss possible explanations for this. The article illustrates a dramatic improvement in immunization cover by a simple re-arrangement better suited to the needs of the town
The advantages of breastfeeding have been well established. The objective of this study was to determine the practice and knowledge of breastfeeding in an urban com-munity and identify the influencing factors. This is a cross-sectional study. All mothers attending the Maternal and Child Health Clinic during the study period, who fulfilled the selection criteria, were included in the study. The mothers were interviewed using a self administered questionnaire. A total of 162 mothers participated in the study. The prevalence of initiating breastfeeding during the first week after childbirth was 93.8%. Breastfeeding was found to be higher among Malay mothers (p value
Study site: a Child Health Clinic in Cheras Baru, Kuala Lumpur
Introduction: Cervical cancer ranks as the second most frequent cancer among women in Malaysia. Although a cervical screening program has been introduced since 1960s and is provided free of charge in all government health facilities, the coverage and adherence rate to recommendation among Malaysian women remains low.
Objectives: To determine the proportion of non-adherence to Pap smear screening guidelines and its associated factors among women attending a health clinic in Malaysia.
Method: A cross sectional study involving 316 women aged 20 to 65 years who had undergone a Pap smear. Universal sampling method was applied to select participants among women who attended the selected health clinic from January 2013 to May 2013. A self-administered questionnaire was used to obtain the socio-demographic characteristics, socio-health data and perceptions about cervical cancer and Pap smear screening. The data was analysed using descriptive statistics and multiple logistic regression.
Result: The proportion of non-adherence to Pap smear screening was 90.5%. Age, marital status, duration of marriage, education level, employment, household income and number of children were not significantly associated with non-adherence. Perceived severity, perceived susceptibility, perceived benefit, perceived barrier and cues to action did not show significant association with non-adherence to Pap smear screening.
Conclusion: Non-adherence to Pap smear screening was high among Malaysian women. Measures should be taken to increase Pap smear screening coverage in our country. Other factors beyond Health Belief Model that influence Pap smear screening practice among Malaysian women should be explored.
Introduction: During pregnancy, increased acidity in the mouth increases the risk of antenatal mother to get dental caries. It is worsen if antenatal mother has morning sickness like vomiting during pregnancy. It can aggravate the problem by exposing the teeth to more gastric acid. In addition, antenatal mothers have hormonal changes that they are more susceptible to periodontal problems. Therefore, it is important for antenatal mother to get dental treatment and use oral health service. This study aim is to describe barriers to utilisation of oral health care services among antenatal mothers attending the Klinik Kesihatan Ibu dan Anak around Kuantan. Materials and Methods: A cross sectional study which was conducted among purposely selected 296 antenatal mothers aged 18-45 years from Kuantan, Pahang in 18 months duration. Study used validated self-administered questionnaire to obtain information on the variables of interest. Results: Common barriers to utilization of services among antenatal mothers are fear to dental pain (45.6%), time constraints- busy at workplace (36.5%) and feeling of not having any dental problems (36.1%). Meanwhile the least barrier to oral health care services among antenatal mothers is attitude of the dentist (0.7%), followed by attitude of the staff (1.4%) and condition of treatment room (1.7%) Conclusion(s): Fear of dental pain is the main barrier to utilization of service among antenatal mothers and dissatisfaction of the service provided is the least barrier among other factors.
KEYWORDS: barriers, antenatal, pregnant mothers, dental caries, periodontal
The study aimed to assess whether sharing of health services improved service quality in health centers in Kampala Capital City Authority (KCCA). With multi-stage sampling, data was gathered by face to face interviews, via translators from residents in the five divisions of KCCA, using a questionnaire. Schedules were made with Local Council I chairmen, and support to fill in the questionnaire was given to the respondents. The statistical methods used for analysis included a Chi-square, Spearman correlations and hierarchical regression. The study found that regarding tangibility, sharing health services significantly determines the number of modern medical equipments (p=0.000) and the number of medical personnel that had a neat and professional appearance (p=0.000) but did not determine the number of visually appealing health facilities (p=0.386). Recentralizing health care changed the mode of delivery. Health workers were responsive, reliable and provide better care for patients. There was increased availability of basic medical equipment, and health workers were neater in appearance with increased confidence and hence were better able to provide for the safety of residents.
Study site: clinic, Kampala, Uganda
Objectives: We sought to determine the prevalence of traditional and complementary medicine (TCM) use for knee osteoarthritis and its associated factors among patients attending a referral hospital in an eastern coastal state of Malaysia.
Methods: This cross-sectional study included 214 patients with knee osteoarthritis. A universal sampling method was applied to patients who attended the outpatient clinic in Hospital Universiti Sains Malaysia from May 2013 to October 2013. Participants were given a questionnaire to determine their sociodemographic information and a validated Bahasa Malaysia version of the Western Ontario and McMaster Universities Arthritis Index (WOMAC). This questionnaire was used to assess the severity of knee osteoarthritis (i.e., pain, stiffness, and disturbances in daily activity).
Results: Over half (57.9%) of patients reported using TCM to treat knee osteoarthritis. Factors associated with TCM use were gender (odd ratio (OR) = 2.47; 95% confidence interval (CI): 1.28-4.77), duration of knee osteoarthritis (OR = 1.51; 95% CI: 1.03-2.23), and the severity of knee pain (OR = 2.56; 95% CI: 1.71-3.86).
Conclusions: The prevalence of TCM use among eastern Malaysian patients with knee osteoarthritis was high. Physicians caring for these patients should be aware of these findings so that inquiries regarding TCM use can be made and patients can be appropriately counseled.
Study site: Primary care clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
Introduction: Osteoporosis has frequently been regards as a disease of women only. However, men are also at risk of developing osteoporosis. We aimed to evaluate the knowledge of osteoporosis among men and its associated factors.
Materials and method: A cross-sectional study of 245 male patients aged 50 and above was conducted in the primary care clinic, University Kebangsaan Malaysia Medical Centre. The research instrument used in this study was a validated self-administered questionnaire which consists of socio-demographic data and 16 items of knowledge of osteoporosis among men.
Results: The mean score for knowledge was 7.78± 3.32 out of 16 points. Most of the subjects (83 percent) knew the definition of osteoporosis but were not aware that osteoporosis was a silent disease. Only a quarter of subjects (38 percent) recognized family history as a risk factors for osteoporosis. Despite 78 percent of subjects answer correctly regarding importance of calcium intake in their diet however only 7 percent
of them knew the recommended dosage of daily calcium intake. Knowledge of osteoporosis was found to be significantly associated with education and total monthly household income.
Conclusion: Findings indicate limited knowledge of osteoporosis among the subjects. Public education of osteoporosis among men is important to increase their knowledge. Meanwhile, primary care doctors should also emphasize and educate men regarding osteoporosis to enhance their knowledge of the disease.
The aim of study was to evaluate the level of satisfaction of patients treated in the undergraduate Year 4 and Year 5 of University of Malaya. The subjects were patients treated in the Year 4 periodontology clinic (Polyclinic B) (n=38) and Year 5 periodontology clinic (Polyclinic C) (n=30). Data was gathered using a questionnaire which consisted of 4 components namely appointment facilities, infrastructure and basic facilities, behaviour of students dental clinician, and quality and efficiency of treatment provided. The results showed that for appointment facilities the level of satisfaction was almost 80%; for infrastructure and basic facilities the satisfaction was more than 85%; for behavior of students dental clinician the level of satisfaction was more than 90% and for quality and efficiency of treatment provided the level of satisfaction was more than 60%. When all the components were compared between patients treated in Polyclinic B to patients treated in Polyclinic C, there was no statistically significant difference (p>0.05). In conclusion, the level of satisfaction of patients treated in the undergraduate Year 4 and Year 5 periodontology clinic of University of Malaya is the same
BACKGROUND: The practice of modern contraceptives still remains a sceptical issue in the society and dormant due to increasing objection of husbands who play a significant role in the family planning practice.
OBJECTIVES: This study was done to determine the factors affecting the ever use of modern contraceptive methods among married men visiting a healthcare clinic in Malaysia.
MATERIAL AND METHOD: A cross sectional study of 443 men aged over 18 years was conducted using convenient sampling from January 2016 till March 2016 at a primary care clinic. A self-administered questionnaire assessing sociodemographic characteristic, attitude towards family planning, spousal communication and ever used of modern contraceptive methods was used.
RESULTS: The proportion of ever used modern contraception was 48% (n=192). Multiple logistic regression revealed that spousal communication on family planning (Adjusted OR 15.8; 95% CI 7.0 - 35.6) and attitude towards marital relationship (Adjusted OR 1.1; CI 1.0 - 1.1) were significant predictors for ever used of modern contraception among married men.
CONCLUSION: The proportion of ever used modern contraception is still not high. Men who communicated with their spouse on modern contraception and perceived family planning as means to preserve their marital relationship were more likely to practice modern contraceptive method.
Study site: Klinik Kesihatan, Selangor, Malaysia
Situated learning characterises the learning that takes place in the clinical environment. Learning in the workplace is characterised by transferring classroom knowledge into performing tasks and this may take various forms. In the medical education field, the cognitive apprenticeship instructional model developed by Collins (2016) supported this learning in the workplace setting due to its common characteristics of apprenticeship. This paper analysed two concrete learning situations in a Malaysian undergraduate and an Omani postgraduate learning environment. Both learning situations occurred in the primary healthcare outpatient setting. The cognitive apprenticeship model was used to identify characteristics of the individual learning environments and discusses factors that stimulate learning. Attention was paid to the role of reflection in stimulating learning in the described settings. The paper provided the context in both institutes, described the learning situation and provided an analysis based on the theoretical framework. Based on the analysis of the situations, solutions to problems in the two settings were suggested.
CONTEXT: Family planning is crucial for everyone within the reproductive age to promote the health and welfare of every member of the family. For the medical students, it is essential to have core knowledge, understanding of family planning concept, and competency in communication skills with the patients. The final-year medical students are posted in Maternal and Child Health Clinics for 3 weeks to gain the knowledge and practical experiences on the primary healthcare in the community.
AIMS: The aim of this study was to explore the experiences of final-year medical students on family planning services offered at community clinics in Malaysia.
SETTINGS AND DESIGN: This was qualitative study.
SUBJECTS AND METHODS: This qualitative study used the data of the students' reflection written in the case reports on family planning. Coding, identification of subthemes, and themes were done by two researchers independently using RQDA software.
STATISTICAL ANALYSIS USED: Thematic analysis.
RESULTS: Final-year medical students who had exposure to the clinical services at primary care clinic, regarding Malay word (Klinik Kesihatan) gained the learning opportunities during family planning session such as learning by observation, clerking, and counseling the patients, understanding the barriers to utilizing services and learning for their self-improvement. These learning opportunities lead to developing the positive attitudes on their learning experiences and the positive attitudes toward the concept and services of family planning.
CONCLUSIONS: To have the better understanding of family planning services and provide the better care to the community in the future, the clinical exposure at the primary care clinics should be promoted for medical students in Malaysia.
Evidence-based data confirm the relationship between an increased availability of effective contraception and reduction in induced abortion rate. In Malaysia, the contraception prevalence rate in 1966 was 8.8 per cent to 52 per cent in 1984, but has levelled off since then. In recent years there has been increasing report of babies ‘abandonment’ in Malaysia. The aim of this study is to determine the knowledge, attitudes and practices related to contraception among women and doctors in Kota Kinabalu the capital of Sabah, Malaysia. Descriptive and analytical community-based cross-sectional study was used. A total of 240 women and 60 doctors were selected from either private or public clinics. The instrument used was face-to-face interview for the women and self-administered questionnaires for doctors. Analysis was done using SPSS version 21. The doctors (80%) felt that contraception is extremely important, and routinely discuss (63%) with their patients. Oral contraceptive pill (97%) is the most common type of contraceptive available in their clinics. About 68% of doctors surprisingly cited that abstinence plays a major part in their contraceptive advice. The average correct answer by doctors on knowledge is 62%. The women surveyed (98.8%) have heard of contraception. The main reason for using is for spacing of pregnancy and many stopped or did not use because of fear of side effects. Women attending the public clinic appear to know more about female and male sterilization and intrauterine contraceptive device compared to those attending private clinic. Further research is needed to reinforce this study.
Study site: Klinik Kesihatan (maternal and child health clinics), private general practitioner clinics. Kota Kinabalu, Sabah, Malaysia
Introduction: Adherence towards childhood immunization (completeness and timeliness), with consideration of age-dependent-seroconversion, is the basis for children protection. Despite high global and national immunization coverage, vaccine preventable diseases’ are rising. This study aimed to determine adherence (completeness and timeliness) towards different vaccines of childhood immunization and associated factors among mothers of under five children. Methods: Cross-sectional study design was conducted at a health clinic in Seremban. Total of 320 mothers of under five children attending child health clinic selected via systematic random sampling. Data collection was via validated self-administered questionnaires and proforma, analysed using SPSS version 22. Associations between categorical variables determined by chi-square tests. Results: Consented respondents were 314; resulting in response rate of 98.1%. Adherence (completeness) was 98.09% but only 56.5% - 97.1% of respondents adhered in terms of timeliness. Types of transportation was significantly associated with adherence (completeness), p=0.041. Employment status was significantly associated with adherence (timeliness) towards BCG (p=0.008), Hepatitis B dose one (p=0.018) and dose two (p=0.040) vaccines. Education level was significantly associated with adherence (timeliness) towards DTaP/IPV/HiB dose four (p=0.019). Maternal age and usage of government clinic were significantly associated with adherence (timeliness) of MMR dose one, p=0.030 and p=0.017 respectively. Conclusion: Adherence (completeness) was high but varying adherence towards vaccine timeliness. Transportation types associated with completeness. Employment status associated with BCG, first and second doses of Hepatitis B vaccines’ timeliness. Education level associated with fourth dose of DTaP/IPV/HiB. Maternal age and usage of government clinic associated with timeliness of first dose MMR.
In Malaysia, breastfeeding was dominantly practiced among Malay whose deeply believe in Islam and any decision should abide by Islamic teachings. Existing literature appear to have limited evidence on Malay mothers’ interpretation and construction of this practice. The decision to breastfeed was believed to be influenced by social and cultural context. Therefore, in order to explore life experience of breastfeeding mothers on their beliefs related to religious and sociocultural, qualitative study design was used. A minimal guidance of phenomenological approach adopted as the methodological framework. Semi structured interviews were carried out among 15 mothers whose were recruited from four Maternal and Child Health Clinic in Kuantan using purposive sampling. The experience of researchers thorough out their journey will be shared in terms of challenges; barriers and solution to overcome the concerned that exist while conducting in-depth interview session.