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Fulltext Absence of antiretroviral therapy and other risk factors for morbidity and mortality in Malaysian compulsory drug detention and rehabilitation centers

Fu JJ, Bazazi AR, Altice FL, Mohamed MN, Kamarulzaman A

PLoS One, 2012;7(9):e44249.
PMID: 23028508 DOI: 10.1371/journal.pone.0044249

Throughout Asia, people who use drugs are confined in facilities referred to as compulsory drug detention and rehabilitation centers. The limited transparency and accessibility of these centers has posed a significant challenge to evaluating detainees and detention conditions directly. Despite HIV being highly prevalent in this type of confined setting, direct evaluation of detainees with HIV and their access to medical care has yet to be reported in the literature.

Matched MeSH terms: Health Services Accessibility*
Fulltext Profiles of men-who-have-sex-with-men seeking anonymous voluntary HIV counseling and testing at a community-based centre in Malaysia

Koh KC, Kamarulzaman A

Med J Malaysia, 2011 Dec;66(5):491-4.
PMID: 22390108 MyJurnal

Community-based HIV voluntary counseling and testing (VCT) services is an effective alternative for mapping the local demographics of at-risk populations for HIV as well as provide an acceptable and reliable means of early detection of HIV. We describe the profiles of men-who-have-sex-with-men (MSM) who sought VCT services in a community based centre in Kuala Lumpur.

Matched MeSH terms: Community Health Services/organization & administration*
Inappropriate prescribing in hospitalised Australian elderly as determined by the STOPP criteria

Wahab MS, Nyfort-Hansen K, Kowalski SR

Int J Clin Pharm, 2012 Dec;34(6):855-62.
PMID: 22864867 DOI: 10.1007/s11096-012-9681-8

BACKGROUND: The elderly population is increasing worldwide. Due to age-related physiological changes that affect the pharmacokinetics and pharmacodynamics of drugs, the elderly are predisposed to adverse drug reactions. Prescribing of potentially inappropriate medications (PIMs) has been found to be prevalent among the elderly and PIM use has been associated with hospitalisations and mortality.
OBJECTIVES: This study aims to identify the prevalence and nature of pre-admission inappropriate prescribing by using the STOPP (screening tool of older people's prescriptions) criteria amongst a sample of hospitalised elderly inpatients in South Australia.
SETTING: Medical, surgical and rehabilitation wards of a public teaching hospital in Adelaide, South Australia.
MAIN OUTCOME MEASURE: Pre-admission prevalence of PIM.
METHOD: Medication management plans of 100 patients of ≥65 years old were prospectively studied to determine the prevalence of pre-admission PIM use. Sixty-five criteria of STOPP were applied to identify PIMs.
RESULTS: The total number of pre-admission medications screened during the study period was 949; the median number of medicines per patient was nine (range 2-28). Overall the STOPP criteria identified 138 PIMs in 60 % of patients. The most frequently encountered PIM was opiates prescribed in patients with recurrent falls (12.3 %), followed by benzodiazepines in fallers (10.1 %) and proton pump inhibitors when prescribed for peptic ulcer disease for long-term at maximum doses (9.4 %). The number of medications were found to have a positive correlation with pre-admission PIM use (r(s) = 0.49, P < 0.01).
CONCLUSIONS: Pre-admission PIM use is highly prevalent among the studied population. Strategies to reduce PIM use should be undertaken by physicians and pharmacists. The use of the STOPP criteria in clinical practice to reduce prescriptions of inappropriate medications requires further investigation.

Matched MeSH terms: Health Services for the Aged*
Fulltext The UK-SEA-ME Psychosocial-Cultural Cancer Research Network: setting the stage for applied qualitative research on cancer health behaviour in southeast Asia and the Middle East

Lim JN

Asian Pac J Cancer Prev, 2011;12(6):1627-9.
PMID: 22126510

Psychosocial and cultural factors influencing cancer health behaviour have not been systematically investigated outside the western culture, and qualitative research is the best approach for this type of social research. The research methods employed to study health problems in Asia predominantly are quantitative techniques. The set up of the first psychosocial cancer research network in Asia marks the beginning of a collaboration to promote and spearhead applied qualitative healthcare research in cancer in the UK, Southeast Asia and the Middle East. This paper sets out the rationale, objectives and mission for the UK-SEA-ME Psychosocial-Cultural Cancer Research Network. The UK-SEA-ME network is made up of collaborators from the University of Leeds (UK), the University of Malaya (Malaysia), the National University of Singapore (Singapore) and the University of United Arab Emirates (UAE). The network promotes applied qualitative research to investigate the psychosocial and cultural factors influencing delayed and late presentation and diagnosis for cancer (breast cancer) in partner countries, as well as advocating the use of the mixed-methods research approach. The network also offers knowledge transfer for capacity building within network universities. The mission of the network is to improve public awareness about the importance of early management and prevention of cancer through research in Asia.

Matched MeSH terms: Health Services Research/methods*
Human papillomavirus vaccination in the resourced and resource-constrained world

Woo YL, Omar SZ

Best Pract Res Clin Obstet Gynaecol, 2011 Oct;25(5):597-603.
PMID: 21684811 DOI: 10.1016/j.bpobgyn.2011.05.004

Human papillomavirus has been established as the causal agent for cervical cancer. The identification of a clear cause presents an unparalleled opportunity for cancer control. As such, the development of prophylactic human papillomavirus vaccines has been rightly hailed as one of the significant scientific triumphs of the past 20 years. This story of scientific triumph over disease, however, is not yet complete. The fruit of scientific labour must be delivered to the people in order to fulfil the underlying intent of the research (i.e. to prevent cancer and save lives). The success of a vaccination programme, however, does not depend on the biological efficacy of the vaccine alone. Various other local factors, such as poverty, gender inequality, cultural traditions, or religious beliefs, can significantly constrain the success of any vaccination programme. In this chapter, we provide an overview of how the human papillomavirus vaccine works and its global uptake, as well as, how variations in local contexts can affect the successful implementation of a vaccination programme. Other factors besides vaccine costs also need serious attention. With better understanding of such factors, policy makers and medical health professionals will be better equipped to make informed decisions to maximise the potential benefits of the human papillomavirus vaccines for the most number of people in individual countries.

Matched MeSH terms: Health Services Accessibility*
Evaluate the impact of hospital types on the availability of antidotes for the management of acute toxic exposures and poisonings in Malaysia

Al-Sohaim SI, Awang R, Zyoud SH, Rashid SM, Hashim S

Hum Exp Toxicol, 2012 Mar;31(3):274-81.
PMID: 21478291 DOI: 10.1177/0960327111405861

The availability of antidotes may be considered essential and lifesaving in the management of certain poisonings. Surveys carried out in a number of countries have demonstrated inadequate availability of a variety of poisoning antidotes.

Matched MeSH terms: Health Services Accessibility*
Transition of water demand and treatment plant overcapacity: a case study of the Seoul Metropolitan City, Korea

Lee S, Park H

Water Sci Technol, 2010;61(12):3129-40.
PMID: 20555209 DOI: 10.2166/wst.2010.454

This study deals with the overcapacity problem of water treatment plants in Korea, and mainly discusses status, causes, and engineering options. To this end, we first statistically analyze the recent trend of demand, revealing that the demands of small- and mid-size systems are still increasing while that of large-size systems is now decreasing. Since the existing approach to plan capacity implicitly assumes that demand will increase at a regular rate, we estimate excess capacities and system utilizations of large-size systems. From these results it is found that the large-size systems are suffering from serious overcapacity, thus necessitating that engineers make very difficult decisions given that systems are still expanding the capacities of plants due to a lack of awareness of the current demand trend. For other systems where there is a better understanding of the transition of demand, planners have ceased to expand plants or have closed down relatively old plants in efforts to reduce O&M costs. To address this problem, quick recognition of the transition of demand is being highlighted by the concepts of integrated resources management and cybernetics. Therefore, we examined how quickly the new trend of the Seoul case could be precisely recognized and appropriately addressed. Using the Bayesian parameter estimation method, we found that a new trend can be recognized six years after the transition of demand.

Matched MeSH terms: Health Services Needs and Demand/standards
Impact of HIV prevention programs on drug users in Malaysia

Kamarulzaman A

J Acquir Immune Defic Syndr, 2009 Nov;52 Suppl 1:S17-9.
PMID: 19858930 DOI: 10.1097/QAI.0b013e3181bbc9af

Faced with a rising HIV epidemic among injecting drug users, harm reduction policies and programs were introduced in Malaysia in 2005. The positive impact seen since the introduction of these programs comprise the inclusion of the health aspects of illicit drug use in the country's drug policies; better access to antiretroviral therapy for injecting drug users who are HIV infected; reduction in HIV-risk behavior; and greater social benefits, including increased employment. Despite these achievements, tension between law enforcement and public health persists, as harm reduction exists alongside an overall drug policy that is based on abstinence and zero tolerance. Unless there is harmonization of this policy, sustainability and scale-up of harm reduction programs will remain a challenge.

Matched MeSH terms: Health Services Research*
Ownership, control, and contention: challenges for the future of healthcare in Malaysia

Chee HL

Soc Sci Med, 2008 May;66(10):2145-56.
PMID: 18329149 DOI: 10.1016/j.socscimed.2008.01.036

The recent history of healthcare privatisation and corporatisation in Malaysia, an upper middle-income developing country, highlights the complicit role of the state in the rise of corporate healthcare. Following upon the country's privatisation policy in the 1980s, private capital made significant inroads into the healthcare provider sector. This paper explores the various ownership interests in healthcare provision: statist capital, rentier capital, and transnational capital, as well as the contending social and political forces that lie behind state interests in the privatisation of healthcare, the growing prominence of transnational activities in healthcare, and the regional integration of capital in the healthcare provider industry. Civil society organizations provide a small but important countervailing force in the contention over the future of healthcare in the country. It is envisaged that the healthcare financing system will move towards a social insurance model, in which the state has an important regulating role. The important question, therefore, is whether the Malaysian government, with its vested interests, will have the capacity and the will to play this role in a social insurance system. The issues of ownership and control have important implications for governance more generally in a future healthcare system.

Matched MeSH terms: Health Services Accessibility/legislation & jurisprudence*
Universities in capacity building in sustainable development: focus on solid waste management and technology

Agamuthu P, Hansen JA

Waste Manag Res, 2007 Jun;25(3):241-6.
PMID: 17612324

This paper analyses some of the higher education and research capacity building experiences gained from 1998-2006 by Danish and Malaysian universities. The focus is on waste management, directly relating to both the environmental and socio-economic dimensions of sustainable development. Primary benefits, available as an educational legacy to universities, were obtained in terms of new and enhanced study curricula established on Problem-oriented Project-based Learning (POPBL) pedagogy, which strengthened academic environmental programmes at Malaysian and Danish universities. It involved more direct and mutually beneficial cooperation between academia and businesses in both countries. This kind of university reach-out is considered vital to development in all countries actively striving for global and sustainable development. Supplementary benefits were accrued for those involved directly in activities such as the 4 months of field studies, workshops, field courses and joint research projects. For students and academics, the gains have been new international dimensions in university curricula, enhanced career development and research collaboration based on realworld cases. It is suggested that the area of solid waste management offers opportunities for much needed capacity building in higher education and research, contributing to sustainable waste management on a global scale. Universities should be more actively involved in such educational, research and innovation programmes to make the necessary progress. ISWA can support capacity building activities by utilizing its resources--providing a lively platform for debate, securing dissemination of new knowledge, and furthering international networking beyond that which universities already do by themselves. A special challenge to ISWA may be to improve national and international professional networks between academia and business, thereby making education, research and innovation the key driving mechanisms in sustainable development in solid waste management.

Matched MeSH terms: Health Services Research/organization & administration*
Medicines prices and Malaysia--untangling the medicines web

Hill S

PLoS Med, 2007 Mar 27;4(3):e149.
PMID: 17388686
Matched MeSH terms: Health Services Accessibility*
Evaluating drug prices, availability, affordability, and price components: implications for access to drugs in Malaysia

Babar ZU, Ibrahim MI, Singh H, Bukahri NI, Creese A

PLoS Med, 2007 Mar 27;4(3):e82.
PMID: 17388660

Malaysia's stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components.

Matched MeSH terms: Health Services Accessibility*
Are essential medicines in Malaysia accessible, affordable and available?

Saleh K, Ibrahim MI

Pharm World Sci, 2005 Dec;27(6):442-6.
PMID: 16341951 DOI: 10.1007/s11096-005-1318-8

OBJECTIVE: To assess the pharmaceutical sector to know whether people have access to essential medicines.

SETTING: The study was conducted in 20 public health clinics, five public district drug stores and 20 private retail pharmacies selected randomly in five different areas randomly selected (four states and a federal territory).

METHOD: The methodology used was adopted from the World Health Organization study protocol. The degree of attainment of the strategic pharmaceutical objectives of improved access is measured by a list of tested indicators. Access is measured in terms of the availability and affordability of essential medicines, especially to the poor and in the public sector. The first survey in the public health clinics and public district drug stores gathered information about current availability of essential medicines, prevalence of stock-outs and affordability of treatment (except drug stores). The second survey assessed affordability of treatment in public health clinics and private retail pharmacies.

MAIN OUTCOME MEASURE: Availability, stock-out duration, percent of medicines dispensed, accessibility and affordability of key medicines.

RESULTS: The average availability of key medicines in the public health clinics for the country was 95.4%. The average stock-out duration of key medicines was 6.5 days. However, average availability of key medicines in the public district drug stores was 89.2%; with an average stock-out duration of 32.4 days. Medicines prescribed were 100% dispensed to the patients. Average affordability for public health clinics was 1.5 weeks salary and for the private pharmacies, 3.7 weeks salary.

CONCLUSIONS: The present pharmaceutical situation in the context of essential medicines list implementation reflected that the majority of the population in Malaysia had access to affordable essential medicines. If medicines need to be obtained from the private sector, they are hardly affordable. Although the average availability of essential medicines in Malaysia was high being more than 95.0%, in certain areas in Sabah availability was less than 80.0% and still a problem.

Matched MeSH terms: Health Services Accessibility*
The evidence for emergency obstetric care

Paxton A, Maine D, Freedman L, Fry D, Lobis S

Int J Gynaecol Obstet, 2005 Feb;88(2):181-93.
PMID: 15694106

We searched for evidence for the effectiveness of emergency obstetric care (EmOC) interventions in reducing maternal mortality primarily in developing countries.

Matched MeSH terms: Maternal Health Services/standards*
Fulltext Inappropriate utilization of emergency department services in Universiti Sains Malaysia hospital

Selasawati HG, Naing L, Wan Aasim WA, Winn T, Rusli BN

Med J Malaysia, 2004 Mar;59(1):26-33.
PMID: 15535332

Inappropriate utilization of Emergency Departments (ED) services may result in compromised management of patients requiring true emergency treatment. Significant attendance of non-emergency cases in ED was found in several countries. A cross-sectional study was conducted in Universiti Sains Malaysia Hospital (HUSM) to determine the proportion of the inappropriate cases and the utilization pattern by time (over 24 hours and within a week) and by diagnoses. A sample of 350 cases was randomly selected from ED-HUSM register of the year 2000. A decision flowchart, which was adopted from 4 guidelines, was applied to classify appropriate and inappropriate cases. There were 55% inappropriate cases in this study. The inappropriate cases increased considerably in early morning, late evening, during the weekend and early part of the week. Most common diagnoses of inappropriate cases were upper respiratory tract infections, mild acute gastroenteritis and urinary tract infections. Considerable attendance of inappropriate cases calls for interventions.

Matched MeSH terms: Health Services Misuse*
Fulltext Diagnostic yield of kidney biopsies performed in a suburban, satellite hospital

Draman CR, Seman MR, Mohd Noor FS, Kelsom WM

Saudi J Kidney Dis Transpl, 2013 Jan;24(1):178-83.
PMID: 23354221

Kidney biopsy is indicated to confirm the clinical diagnosis or to evaluate prognosis of a renal problem. It is a reliable and safe procedure, especially with real-time ultrasound guidance. This is a single-center, retrospective review of the biopsies performed in Hospital Tengku Ampuan Afzan, Pahang from 2000 to 2010. The demographic data, clinical parameters, and histological reports were extracted from clinic records and analyzed to determine the diagnostic adequacy of biopsy samples for both lupus and non-lupus patients. A total of 219 biopsies were performed throughout the period and only 74 were included in this review. Their mean age was 22.5 ± 10.5 years. 59.5% of the biopsies were performed on female patients. Malays comprised 79.7% (n = 59) of them, followed by Chinese (18.9%, n=14) and Indian (1.4%, n=1). About one-third of the biopsies(n = 25) were performed on patients with lupus nephritis and two-thirds (n = 49) on non-lupus nephritis patients. At the time of biopsy, their serum creatinine values were normal, serum albumin 28.4 ± 10 g/L and total cholesterol 8.9 ± 4.6 mmol/L (mean ± SD). The urine dipstick was 3+ for both proteinuria and hematuria and daily protein excretion was 3.6 ± 3.2 g. Sixty-seven specimens were considered adequate and only six (8%) were inadequate for histological interpretations. The mean number of glomeruli in the biopsy specimens was 16 ± 9.9 (range: 0-47 glomeruli). In non-lupus patients, focal segmental glomerulosclerosis was the commonest histological diagnosis (n = 15, 30.6%), followed by minimal change disease (n = 13, 26.5%) and mesangial proliferative glomerulonephritis (n = 7, 14.3%). Membranous nephropathy was diagnosed in four (8.2%) and membranoproliferative glomerulonephritis in two (4.1%) specimens. Both post-infectious glomerulonephritis and advanced glomerulosclerosis were found in one specimen each. Among the lupus nephritis patients (n = 25), 88% of them were females (P <0.05) and lupus nephritis WHO class IV was the commonest variant (n = 12, 48%) followed by WHO class III (n = 7, 28%). Membranous glomerulopathy or lupus nephritis WHO class V was found in three (12%), and two (8%) had lupus nephritis WHO class II. Serum albumin, urinalysis findings, and daily urinary protein excretion were comparable for both lupus and non-lupus patients. In conclusion, renal biopsy in our center is adequate and sufficient for histological interpretations and management of patients with renal problems.

Matched MeSH terms: Suburban Health Services*
Fulltext Utilization of health care services for childhood morbidity and associated factors in India: a national cross-sectional household survey

Sreeramareddy CT, Sathyanarayana TN, Kumar HN

PLoS One, 2012;7(12):e51904.
PMID: 23284810 DOI: 10.1371/journal.pone.0051904

BACKGROUND: Information about utilization of health services and associated factors are useful for improving service delivery to achieve universal health coverage.
METHODS: Data on a sample of ever-married women from India Demographic and Health survey 2005-06 was used. Mothers of children aged 0-59 months were asked about child's illnesses and type of health facilities where treatment was given during 15 days prior to the survey date. Type of health facilities were grouped as informal provider, public provider and private provider. Factors associated with utilization of health services for diarrhea and fever/cough was assessed according to Andersen's health behavior model. Multinomial logistic regression analyses were done considering sampling weights for complex sampling design.
RESULTS: A total of 48,679 of ever-married women reported that 9.1% 14.8% and 17.67% of their children had diarrhea, fever and cough respectively. Nearly one-third of the children with diarrhea and fever/cough did not receive any treatment. Two-thirds of children who received treatment were from private health care providers (HCPs). Among predisposing factors, children aged 1-2 years and those born at health facility (public/private) were more likely to be taken to any type of HCP during illness. Among enabling factors, as compared to poorer household, wealthier households were 2.5 times more likely to choose private HCPs for any illness. Children in rural areas were likely to be taken to any type of HCP for diarrhea but rural children were less likely to utilize private HCP for fever/cough. 'Need' factors i.e. children having severe symptoms were 2-3 times more likely to be taken to any type of HCP.
CONCLUSION: Private HCPs were preferred for treatment of childhood illnesses. Involvement of private HCPs may be considered while planning child health programs. Health insurance scheme for childhood illnesses may to protect economically weaker sections from out-of-pocket health expenditure during child illness.

Matched MeSH terms: Health Services*
Development and validation of a multilateral index to determine economic status in developing countries: the Patient Financial Eligibility Tool (PFET)

Saba J, Audureau E, Bizé M, Koloshuk B, Ladner J

Popul Health Manag, 2013 Apr;16(2):82-9.
PMID: 23276290 DOI: 10.1089/pop.2012.0049

The objective was to develop and validate a multilateral index to determine patient ability to pay for medication in low- and middle-income countries. Primary data were collected in 2009 from 117 cancer patients in China, India, Thailand, and Malaysia. The initial tool included income, expenditures, and assets-based items using ad hoc determined brackets. Principal components analysis was performed to determine final weights. Agreement (Kappa) was measured between results from the final tool and from an Impact Survey (IS) conducted after beginning drug therapy to quantify a patient's actual ability to pay in terms of number of drug cycles per year. The authors present the step-by-step methodology employed to develop the tool on a country-by-country basis. Overall Cronbach value was 0.84. Agreement between the Patient Financial Eligibility Tool (PFET) and IS was perfect (equal number of drug cycles) for 58.1% of patients, fair (1 cycle difference) for 29.1%, and poor (>1 cycle) for 12.8%. Overall Kappa was 0.76 (P<0.0001). The PFET is an effective tool for determining an individual's ability to pay for medication. Combined with tiered models for patient participation in the cost of medication, it could help to increase access to high-priced products in developing countries.

Matched MeSH terms: Health Services Accessibility/economics
Improving access to essential drugs for people living with HIV/AIDS

Balasubramaniam K

Issues Med Ethics, 2000 Jan-Mar;8(1):26-7.
PMID: 16323335
Matched MeSH terms: Health Services Accessibility/economics*
The impact of immigration on health systems: a legal analysis from a three-country perspective

Blum J, Carstens P, Talib N

Med Law, 2005 Jun;24(2):323-36.
PMID: 16082868

The focus of this paper will be on how health care systems in three countries, Malaysia, South Africa and the United States, are responding to the health needs of immigrants with a strong focus on the legal aspects of the respective national responses. The Malaysia portion emphasizes legal immigration and analyses as to how the country's Ministry of Health and the delivery system itself is responding to the demands of immigrant's health. In the context of South Africa, the paper explores implications of the South African Constitution, which establishes a right to access health care, and explores whether such a right can be extended to non-citizens, or can be tempered by economic constraints. In the American discussion the focus is on whether publicly supported health care programs can be accessed to provide coverage for undocumented residents, and highlights recent constraints in using government monies in this area.

Matched MeSH terms: Health Services Needs and Demand*

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