Displaying publications 3221 - 3240 of 10023 in total

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  1. Sattar, Kamran, Sethi, Ahsan, Akram, Ashfaq, Ahmad, Tauseef, John, Jennesse, Muhamad Saiful Bahri Yusoff
    MyJurnal
    The flipped classroom (FC), an innovative teaching and learning pedagogy has grown in medical education since last decade. In FC modality, students learn by means of print, audio or video-based material self-reliantly, before built-in teaching sessions in the classroom to overcome passive learning. In this review, the key concepts, benefits and best practices of the FC in health professions education have been described. The review was carried out using Medline, Scopus, Ovid, and Cochrane. The keywords were “Flipped method, Teaching strategy, Role of the teacher, and Medical students”. Flipped is an effective teaching modality which enables learners to be independent. Students do take ownership of what they learn. Tutors are also satisfied with what their learners acquire. The benefits of FC are robust and likely to augment the learning abilities of the students as well as supplementing the learning course content; group events can deliver added benefits too.
  2. Ahmad Na’im Abdul Rahman, Nurul Nadiah Mohd Firdaus Hum, Zitty Sarah Ismail
    Science Letters, 2019;13(2):25-29.
    MyJurnal
    Phytoremediation uses plants to remove, extract and absorb heavy or toxic matters from soil and water. This study explores Bougainvillea sp. heavy metals uptake capacity under different ratio of wastewater sludge condition. This study used 24 plants of Bougainvillea sp. and involves a duration of 2 months (61 days). The plants were divided and labelled according to six different treatments with four replications; A - Control (100% soil), B (20% sludge), C (40% sludge), D (60% sludge), E (80% sludge) and F (100% sludge). Accumulation of considered metals of lead and cadmium for leaf, stem and roots were analyzed using Inductive Coupled Plasma-Optical Emission Spectrophotometer (ICP-OES). The highest removal was found to be at 60% sludge mixture for both metals. The highest lead and cadmium accumulation were found in the root with the concentration of 0.1 mg kg-1 and 0.06 mg kg-1 respectively. Thus, the optimum lead and cadmium removal using Bougainvillea sp. was at the 60% sludge mixture (Treatment D).
  3. Nizar MHA, Chan CK, Khalil A, Yusof AKM, Lai KW
    Curr Med Imaging, 2020;16(5):584-591.
    PMID: 32484093 DOI: 10.2174/1573405615666190114151255
    BACKGROUND: Valvular heart disease is a serious disease leading to mortality and increasing medical care cost. The aortic valve is the most common valve affected by this disease. Doctors rely on echocardiogram for diagnosing and evaluating valvular heart disease. However, the images from echocardiogram are poor in comparison to Computerized Tomography and Magnetic Resonance Imaging scan. This study proposes the development of Convolutional Neural Networks (CNN) that can function optimally during a live echocardiographic examination for detection of the aortic valve. An automated detection system in an echocardiogram will improve the accuracy of medical diagnosis and can provide further medical analysis from the resulting detection.

    METHODS: Two detection architectures, Single Shot Multibox Detector (SSD) and Faster Regional based Convolutional Neural Network (R-CNN) with various feature extractors were trained on echocardiography images from 33 patients. Thereafter, the models were tested on 10 echocardiography videos.

    RESULTS: Faster R-CNN Inception v2 had shown the highest accuracy (98.6%) followed closely by SSD Mobilenet v2. In terms of speed, SSD Mobilenet v2 resulted in a loss of 46.81% in framesper- second (fps) during real-time detection but managed to perform better than the other neural network models. Additionally, SSD Mobilenet v2 used the least amount of Graphic Processing Unit (GPU) but the Central Processing Unit (CPU) usage was relatively similar throughout all models.

    CONCLUSION: Our findings provide a foundation for implementing a convolutional detection system to echocardiography for medical purposes.

  4. Youssef, Khaled Ali Ahmed Ben, Abdullah, Ahmad Makmom, Helmi Zuhaidi Mohd Shafri, Ash’aari, Zulfa Hanan
    MyJurnal
    This study evaluates the spatiotemporal distribution of aerosol optical thickness (AOT) over Malaysia. The significance of aerosols in regional and global climate change assessment has become a pressing topic in recent climate discussions. Two different approaches are used in measuring AOT; satellite imagery and ground measurement approaches. However, the satellite approach is deemed the best way for monitoring the patterns and transport of aerosols largely due to its extensive spatial coverage and reliable repetitive measurements. The data in this study were obtained from a Sea-viewing Wide Field-of-view Sensor (SeaWiFS), a Multi-angle Imaging Spectroradiometer (MISR), and Moderate Resolution Imaging Spectroradiometer (MODIS) satellite sensors based on a NASA-operated Giovanni portal. Ground-based Aerosol Robotic Network (AERONET) datasets from two sites over the study area were also used. The results show that the highest AOT ground values of 1.93 and 2.00 were recorded in September 2015, at USM station and Kuching station, respectively. Throughout the 15 years of recorded data, the monthly average value of AOT reached its highest values in September, October, and November. In these months, the value of AOT went above 0.40, unlike in other months of the year. Significantly, the results indicate that Malaysian air quality can be evaluated based on AOT values, as these show the variation in optical properties of aerosol.
  5. Nur Zulaikhah Nadzri, Mohammad Hamiruce Marhaban, Siti Anom Ahmad, Asnor Juraiza Ishak, Zalhan Mohd Zin
    MyJurnal
    Referring to the existing model that considers the image boundary as the image background,
    the model is still not able to produce an optimum detection. This paper is introducing
    the combination features at the boundary known as boundary components affinity that is
    capable to produce an optimum measure on the image background. It consists of contrast,
    spatial location, force interaction and boundary ratio that contribute to a novel boundary
    connectivity measure. The integrated features are capable to produce clearer background
    with minimum unwanted foreground patches compared to the ground truth. The extracted
    boundary features are integrated as the boundary components affinity. These features were
    used for measuring the image background through its boundary connectivity to obtain the
    final salient object detection. Using the verified datasets, the performance of the proposed
    model was measured and compared with the 4 state-of-art models. In addition, the model
    performance was tested on the close contrast images. The detection performance was
    compared and analysed based on the precision, recall, true positive rate, false positive
    rate, F Measure and Mean Absolute Error (MAE). The model had successfully reduced
    the MAE by maximum of 9.4%.
  6. Ahmad Ismail, Munirah Hanapiah, Syaizwan Zahmir Zulkifli, Hishamuddin Omar, Nur Amiera Kamarudin
    MyJurnal
    The present study aims to determine the level of heavy metals in surface soils and street dust from selected urban and peri-urban locations in the metropolitan city of Kuala Lumpur. Samples were collected from 15 different locations, where Kuala Lumpur City Centre (KLCC) served as the centre point while other locations were located at specific distances from the centre. Surface soils and street dust were collected to detect the level of contamination based on five elements (Zn, Cu, Pb, Cd and Fe). Results indicated that the metal distribution displayed a descending trend as follows: [Fe] > [Zn] > [Pb] > [Cu] > [Cd] and [Fe] > [Zn] > [Cu] > [Pb] > [Cd] in the surface soil and street dust samples, respectively. Geoaccumulation index (Igeo), contamination factor (CF) and pollution load index (PLI) were calculated. Based on the Igeo index, Fe in both samples was found to cause no pollution in all study sites. In surface soils, CF showed all sites were contaminated with Cd in both soil and street dust. In conclusion, the soil sample was polluted with metals while no pollution was found in the street dust in all sites sampled. Further intensive studies are recommended in order to determine other factors which may cause contamination.
  7. Ahmad Hafizi Awang, Abdul Halim Abdul Razik, Azuin Mad Noor, Aainaa Izyan Nafsun
    MyJurnal
    Torrefaction is a thermal process to convert biomass into a coal-like material, which has better fuel characteristics than the original biomass. Torrefied biomass has more energy density and hydrophobic which is superior quality for handling and storage. The objective of this research was to develop a simulation model of the torrefied pelletization process from empty fruit bunch (EFB). The process was simulated using ASPEN Plus. Optimization involved a selection of the model option that produced the maximum mass yield and minimum energy requirement, with a converged base case simulation as a starting point. Torrefied biomass pellet offered coal-like properties such as high heating value, brittle, high bulk energy density and more hydrophobic. These properties could potentially avoid costly power plant modifications. On the other hand, Malaysia has issued National Biomass Strategy 2020 with target to solve the problem of under-utilized biomass in this country. Base model was based on previous study. For optimization of mass yield and overall energy consumption, six model options of design configurations were analysed. Design model 0 was used as the base model. For design model 1, flue gas from combustion reactor was channelled to torrefaction reactor. For design model 2, flue gas from combustion reactor was split to dryer and torrefaction reactor. For design model 3, combustion reactor was removed. For design model 4, flue gas was channelled to dryer reactor without combustion reactor. For design model 5, flue gas separator after dryer was removed. Out of five options, results were tabulated for the optimum one. The results showed that the highest mass yield was achieved by simulation Model 5 at 90.76 % and lowest energy requirement was achieved by simulation Model 4 at 411.336 kW. Optimization result meanwhile had shown that Model 4 was selected because it gave the maximum profitability of RM 72834.45 by considering the yield and the energy consumption simultaneously.
  8. Da’u Abba Umar, Mohammad Firuz Ramli, Ahmad Zaharin Aris, Muhammad Amar Zaudi
    MyJurnal
    Determining the response of basin water resources to rainfall and temperature fluctuations is a crucial source of information for basins water resources planning and management. The study used a descriptive, Mann-Kendall trend test (M-K) and Multiple Linear Regression (MLR). The mean, standard deviations and variations were spatially interpolated using the geostatistical technique. The trend results showed an increase in both rainfall and temperature series. However, the only statistically significant trends were in June and September for rainfall series and in February, May, and April for the temperature series. Rainfall exhibited high temporal variability whereas temperature showed high spatial variability. The intra-annual variability was higher than the inter-annual variability, suggesting that the local climate is largely controlled by natural force. The result of the multiple linear regression (R2=0.431), indicates that the hydrology and water resources of the basin are impacted largely by factors not considered in this study such as land use changes, infiltration, and rate of evaporation among others. However, among the factor considered, rainfall (Beta = 0.505; P = 001) has the highest impacts on the river discharge behavior and should be given preference while addressing water resources predicaments in the catchment.
  9. Mohd Hamim Abdul Aziz, Siti Khairunniza Bejo, Fazirulhisyam Hashim, Nur Hidayah Ramli, Desa Ahmad
    MyJurnal
    Basal stem rot (BSR) caused by Ganoderma boninense is a major disease attacking the oil palm plantation in Malaysia, and incur big losses in palm oil industries. The disease is spread mostly by root either through spore availability in soil or roots contacts. Soil properties were reported to have significant influence on the growth of fungi. Meanwhile, the value of soil resistivity is influenced by soil properties. This paper presents a new approach of BSR detection by using soil moisture sensor which measures resistivity of soil in unit ohm (Ω) at 15 cm surrounding the basal stem of oil palm trees. The study was conducted on 39 oil palm trees at different healthiness levels. The sensor was embedded approximately 4.7 cm deep in the soil at eight different points for each palm. The results showed that healthy oil palm trees significantly have higher mean (ERMEAN ≥ 400) of electrical resistance (ER) readings compared to infected trees (ERMEAN< 400). More specifically, ER readings at points without symptoms (i.e. fruiting bodies and/or hollow) were significantly higher compared with ER readings at points where symptoms appeared even though the points of measurements were on the same palm. This finding has brought to the introduction of a new index to detect Ganoderma infection, named as K-index. Combination of ERMEAN taken from eight points of measurement and its K-index gave better results of detection and a new model was developed based on these two parameters (i.e. ERMEAN and K-index). The developed model has accuracy rates of 82% and gained 100% successful rate during validation. This research showed that soil resistivity can contribute to Ganoderma-infected detection in oil palms with a high degree of accuracy.
  10. Ahmad MS, Suardi N, Shukri A, Mohammad H, Oglat AA, Alarab A, et al.
    J Med Ultrasound, 2020 01 28;28(1):7-16.
    PMID: 32368444 DOI: 10.4103/JMU.JMU_4_19
    Liver phantoms have been developed as an alternative to human tissue and have been used for different purposes. In this article, the items used for liver phantoms fabrication are mentioned same as in the previous literature reviews. Summary and characteristics of these materials are presented. The main factors that need to be available in the materials used for fabrication in computed tomography, ultrasound, magnetic resonance imaging, and nuclear medicine were analyzed. Finally, the discussion focuses on some purposes and aims of the liver phantom fabrication for use in several areas such as training, diagnoses of different diseases, and treatment planning for therapeutic strategies - for example, in selective internal radiation therapy, stereotactic body radiation therapy, laser-induced thermotherapy, radiofrequency ablation, and microwave coagulation therapy. It was found that different liver substitutes can be developed to fulfill the different requirements.
  11. Pavapriya Ponvel, Devinder Kaur Ajit Singh, Soon, Ming Shan, Siti Salwana Kamsan, Mohd Azzuan Ahmad
    Jurnal Sains Kesihatan Malaysia, 2019;17(2):147-155.
    MyJurnal
    Knee osteoarthritis (OA) is a common musculoskeletal condition that leads to decreased physical performance and falls among older adults. However, there is limited information comparing physical performances among older adult fallers with and without knee OA. The aim of this study was to compare physical performance between older adult fallers with and without knee OA. Participants were divided into two groups using the clinical diagnosis of knee OA based on National Institute of Health and Care Excellence guidelines; with and without knee OA. Participants performed a battery of physical performance tests that included chair sit and reach, back scratch, dominant handgrip strength, timed up and go (TUG), 30 seconds chair stand and 2 min walk. Independent t-test was used to compare physical performance between groups. Thirteen older adult fallers with knee OA (mean age = 70.92 ± 8.83 years) and 20 older adult fallers without knee OA (76.4 ± 7.92 years) participated in this study. There were no significant differences in sociodemographic profiles and physical performance among older adult fallers with and without knee OA (p > 0.05). However, hamstring flexibility was not within norm in 64% of older adult fallers with knee OA compared to 42% without OA. Physical performance between fallers with and without clinically diagnosed knee OA was similar. Hence, physiotherapy interventions for both groups may be similar and focused on strength and endurance training. In addition, to minimize falls risk and further improve physical performance, hamstring stretching must be emphasized among older adults with knee OA.

  12. Nor Hazwani Ahmad, Siti Razila Abdul Razak, Mustafa Fadzil Farid Wajidi
    MyJurnal
    Introduction: The alkaloids present in Catharanthus roseus (C. roseus), vinblastine and vincristine are important an- ticancer agents that cause cell cycle arrest and apoptosis in various types of cell lines. However, there is no previous reports that emphasized the clear mechanisms of anticancer exerted by a crude aquoeus extract of C. roseus although it has been historically used to treat various diseases. Methods: The cytotoxicity effects of C. roseus aqueous extract on Jurkat cells were evaluated by annexin/PI staining, caspase 3/7 assay, JC-1 assay and cell cycle assay. Gene ex- pression profiling was performed by using SmartChip Real-Time PCR system to evaluate the expression profiles of on- cology-related genes of Jurkat cells treated with C. roseus aqueous extract. Results: Flow cytometry analysis revealed that the extract has caused S-phase arrest and associated with apoptosis through the externalization of phosphati- dylserine and depletion of mitochondrial membrane potential in time-dependent manner. The apoptosis mechanism was mediated through the activation of caspase 3/7. From the gene expression analysis, 8 differentially regulated genes were associated with apoptosis which were CDKN1C, CHI3L2, BIRC8, GFER, ID3-1, BBC3-2, TRAF4 and VCAN. Meanwhile, 7 differentially regulated genes were associated with cell cycle progression which were PIMI-1, CDKN1C, SKP1A, CDC25C, LTBP1, CCNG2 and RBL1. Conclusion: The recent data may facilitate the identification of specific targeting pathways induced by the extract. The information obtained may be used as diagnostic tools, prognostic markers, and predictors of response to C. roseus treatment especially for this particular type of cancer.
  13. Che Yaakob CA, Dzarr AA, Ismail AA, Zuky Nik Lah NA, Ho JJ
    PMID: 20556784 DOI: 10.1002/14651858.CD007801.pub2
    BACKGROUND: Thromboembolic complications are much higher in pregnancy due to procoagulant changes. Heparin does not cross the placenta and the use of unfractionated heparin (UFH) is the current established practice in prophylaxis and treatment for thromboembolism in pregnancy.

    OBJECTIVES: To compare the effectiveness of anticoagulant therapies for the treatment of deep vein thrombosis in pregnancy. The anticoagulant drugs included are UFH, low molecular weight heparin (LMWH) and warfarin.

    SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2010) and reference lists of retrieved studies.

    SELECTION CRITERIA: Randomised controlled trials comparing any combination of warfarin, UFH, LMWH and placebo in pregnant women.

    DATA COLLECTION AND ANALYSIS: We used methods described in the Cochrane Handbooks for Systemic Reviews of Interventions for assessing the eligibility of studies identified by the search strategy. A minimum of two review authors independently assessed each study.

    MAIN RESULTS: We did not identify any eligible studies for inclusion in the review.We identified three potential studies; after assessing eligibility, we excluded all three as they did not meet the prespecified inclusion criteria. One study compared LMWH and UFH in pregnant women with previous thromboembolic events and, for most of these women, anticoagulants were used as thromboprophylaxis. There were only three women who had a thromboembolic event during the current pregnancy and it was unclear whether the anticoagulant was used as therapy or prophylaxis. We excluded one study because it included only women undergoing caesarean birth. The third study was not a randomised trial.

    AUTHORS' CONCLUSIONS: There is no evidence from randomised controlled trials on the effectiveness of anticoagulation for deep vein thrombosis in pregnancy. Further studies are required.

  14. Kamarul Aryffin Baharuddin, Mohd Hashairi Fauzi, Mohd Boniami Yazid, Mohammad Zikri Ahmad, Wan Hazuraini Wan Zain
    MyJurnal
    Severe acutepoisoning of cypermethrin is rare. We reportedthiscase about a47-year old man who was brought to the Emergency Departmentwith drowsiness and drooling of saliva after intentional self-harm with 2.25gram of cypermethrin.His initial condition was stable. However, nine hours after admission, he developed seizures and reduced conscious level. He was ventilated overnight for airway protection. Management of acute severe poisoning is discussed in this case report.
  15. Cheong, Chee Yen, Rashidi Ahmad, Nesarajah, Kiran, Aida Bustam, Muhaimin Noor Azhar
    MyJurnal
    Diagnosis of pulmonary embolism (PE) remains a challenge in clinical practice, especially in emergency setting despite availability of various diagnostic tools. It is desirable to have a rapid and accurate bedside test to rule out PE.The aim of this study is to evaluate the diagnostic accuracyof CUEPED, a novel method of ruling out pulmonary embolism using a combination of end-tidal CO2(ETCO2), Compression Ultrasonography (CUS) and Transthoracic Echocardiography (TTE).In this pilot study, patients who presented to the Emergency Department at Univers it y Malaya Medical Centre with suspected acute PE from December 2013 to October 2014,who fulfilled the inclusion and exclusion criteria, were assessed using CUEPED. CUEPED was considered positive if the measured ETCO2 was less than 35 mmHg, or if there was presence of venous incompressibility in lower limb ultrasonography orif tricuspid annular plane systolic excursion (TAPSE) in transthoracic echocardiography was less than 1.6. All patients received a computed tomography pulmonary angiography (CTPA) for confirmation of diagnosis. Data obtained was analyzed to determine if a negative CUEPED has the potential to accurately rule out a PE. 30 patients (mean age = 48 years [SD = 13.6]) were involved with an equal distribut io nbetween gender. The incidence of PE was 56.7%. CUEPED had a sensitivity of 100% for PE. Negative CUEPED ruled out PE with a negative predictive value of 100%. Positive CUEPED ruled in PE with a low specificity of 53.8% and moderate positive predictive value of 73.9%. This diagnostic study showedthat a negative CUEPED is potentially accurate in ruling out PE.
  16. Tahir ARM, Ee XW, Rashid AA, Yahaya AYB, Devaraj NK
    J Immigr Minor Health, 2021 Dec;23(6):1159-1169.
    PMID: 33543426 DOI: 10.1007/s10903-021-01150-6
    The Rohingyas fled from their home to escape ethnic persecution. Due to their status as refugees they have difficulties in accessing healthcare leading to avoidable mortality and morbidity. Infectious diseases are reported to be among the causes. To ease access to healthcare, IMAM Response and Relief Team (IMARET) provides a free monthly clinic for them. The objective of this study is to determine the proportion of infectious diseases and appropriateness of antimicrobial usage among its pediatrics patients. It was conducted in 2017, through universal sampling. Information retrieved were via interviews and medical records. The majority diagnosis were infectious diseases (57.1%), which include respiratory infections (77.3%), skin (13.6%), gastrointestinal (4.5%), eye and ear infection (both 1%). Albendazole (40.7%) was the most prescribed. Only 7.4% were appropriately prescribed antimicrobials. Age (p = 0.005) and BMI (p = 0.006) were significantly associated with infections.
  17. Mohamad Hidayat Jamal, Ahmad Khairi Abd Wahab, Chik Maslinda Omar, Daeng Siti Maimunah Ishak
    MyJurnal
    Riparian vegetation has been recognized for its remarkable environmental and
    management implications. Occurred within the dynamic tract of river systems, riparian
    vegetation is a complex character that often exposed to the changes of river water and
    river beds. Their spatial extent is strongly controlled by inundation and flood
    disturbance, which result in the riparian vegetation migration to the point of
    destruction, if the competition for the area and other sources are lacking. This paper
    presents the findings of collected riparian vegetation information along Sg Johor at the
    upstream and downstream of Kota Tinggi. Using Point-Centre-Quarter Method, the
    vegetation’s species, density, basal area, diameter at breast height and relative
    composition were recorded, identified and classified. Vitex pubescens and Drypetes
    spp. dominantly occurred along the upstream and downstream of this river,
    respectively. Species like Gymnacranthera bancana, Endospermum malaccense, and
    Aquilaria malaccensis are also found inhabit along Sg Johor bank. Classified as woody
    vegetation, these vegetations are equipped with buttress roots that enable them to
    increase soil strength. This paper also suggests that proper study of riparian vegetation
    along river banks could promote a better understanding of the function of each
    species, to ensure the sustainability of riparian vegetation as part of river system
    engineer.
  18. Mohamed Zahidi J, Ahmad N, Tay BY, Hashim R, Khoo E, Ahmad N, et al.
    Genome Announc, 2017 Aug 03;5(31).
    PMID: 28774972 DOI: 10.1128/genomeA.00689-17
    Human brucellosis is a neglected zoonotic disease and has widespread geographical distribution. Brucella melitensis has caused outbreaks and sporadic cases in Malaysia. Here, we present the whole-genome sequences of four B. melitensis strains isolated from brucellosis patients in Malaysia.
  19. Hairi HA, Shuid AN, Ibrahim N', Jamal JA, Mohamed N, Mohamed IN
    Curr Drug Targets, 2019;20(2):192-200.
    PMID: 28814228 DOI: 10.2174/1389450118666170816123740
    BACKGROUND: Phytoestrogens have recently been claimed to positively influence menopausal discomforts, including hot flashes. However, little is known about the influence of phytoestrogens on core body temperature during oestrogen fluctuation at menopause.

    OBJECTIVE: Previously published findings showed that phytoestrogens could relieve menopausal complaints, thus, the present review was aimed at assessing the effects of phytoestrogens on thermoregulatory mechanism during menopausal transition.

    RESULTS: The molecular mechanisms underlying hot flashes are complex. Oestrogen fluctuations cause hypothalamic thermoregulatory centre dysfunction, which leads to hot flashes during menopause. The phytoestrogens of interest, in relation to human health, include isoflavones, lignans, coumestans, and stilbenes, which are widely distributed in nature. The phytoestrogens are capable of reducing hot flashes via their oestrogen-like hormone actions. The potential effects of phytoestrogens on hot flashes and their molecular mechanisms of action on thermoregulatory centre are discussed in this review.

    CONCLUSION: The effects of phytoestrogens on these mechanisms may help explain their beneficial effects in alleviating hot flashes and other menopausal discomforts.

  20. Rozaimah Abu Talib, Idayu Badilla Idris, Rosnah Sutan, Norizan Ahmad, Norehan Abu Bakar, Sharifah Hildah Shahab
    Int J Public Health Res, 2016;6(2):719-726.
    MyJurnal
    Introduction In Malaysia although mortality rate among women of reproductive ages has
    reduced over the years, the reduction has been stagnant for the past ten years.
    In order to achieve the 5th Millennium Development Goal, several measures
    need to be taken including a proper implementation of pre-pregnancy
    services in this country. This study explores the awareness, intention and
    usage of pre-pregnancy care (PPC) services and its determinant among
    women of reproductive ages in Kedah, Malaysia.

    Methods This is a qualitative study, which consisted of a focus group discussion
    (FGD) among women in the ages of 18 to 45 years old from all ethnic groups
    who attended four government clinics in the state of Kedah. The mothers
    were chosen through purposive sampling from twelve districts that were
    selected through a multistage random sampling. A semi-structured
    questionnaire was utilized during the FGD. The results from the FGD were
    recorded verbatim and thematic analysis was finalized once saturation of
    information from respondents was achieved.

    Results These are two themes was identified, namely personal reasons and reasons of
    service and there are several subthemes under two main themes. Under the
    Personal reason themes, the subthemes including awareness and intention to
    used the services, knowledge, perception, social support and history of
    medical illness. While under pre-pregnancy care services themes, the
    subthemes including the promotion of the services, the communication
    relationship with the health staff, the waiting time and also the accessibility
    of the service.

    Conclusions As a conclusion, there is still part of society who was unaware of prepregnancy
    services and its importance in reducing maternal mortality rate as
    well as producing good pregnancy outcome. Information and knowledge on
    pre-pregnancy care services should be disseminated among community
    members through various means including roadshows and pre wedding
    workshops.
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