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Malaysia implements the integrated approach

Asian Popul Programme News, 1977;6(1):24-8.
PMID: 12260250
Matched MeSH terms: Public Policy
Thai midwives brought into family planning

IDRC Rep, 1974 Mar;3(1):17-20.
PMID: 12333530

PIP: In Thailand "granny" midwives are being tested and trained to take part in modern family planning and public health programs. In Malaysia a survey of conditions relating to an increase in induced early termination or abortion of pregnancies is in progress. The International Development Research Centre (IDRC) supports these projects as well as others in Asia. Local paramedical workers, like the "barefoot doctors" in China, are being trained. In Thailand a growth plan is attempting to reduce the annual rate of population increase from about 3.3% to 2.5%. Many granny midwives have been contacted. Several methods of incentive and training are being tried and will be evaluated. Eventually granny midwives in all of Thailand's 60,000 villages will be enlisted in the national planning program. Of Thailand's 6 million married women of reproductive age less than half use modern birth control methods. Abortion is illegal in Thailand which is a predominantly Buddhist country. The project in Malaysia is being carried out by the University of Malaysia and the Federation of Family Planning Associations. Abortion is also illegal in Islamic Malaysia, although there are illegal abortion clinics. Trends so far reported to IDRC indicate that 1) lower class women are more cooperative interviewees than others, 2) most couples use some method of birth control, 3) many wish to interrupt their pregnancies, 4) poorer families have more children than wealthier ones, 5) the Chinese and Indian people show a greater tendency to limit families than do the Malays, and 6) most couples want 3 or 4 children.

Matched MeSH terms: Public Policy
Fulltext Dietetic practices in the management of childhood obesity in Malaysia

Nor Baizura, M.Y., Ting, T.H., Zalilah, M.S., Ruzita, A.T., Spurrier, N.

Malays J Nutr, 2014;20(2):255-269.
MyJurnal

Introduction: Dietitians play an essential role in the management of childhood obesity and consistency in dietetic practices is required to ensure the effectiveness of treatment. This study assessed dietitians’ current practices in the management of childhood obesity, compared the practices with nutrition practice guidelines used by dietitians in other countries and identified practice components for the development of nutrition practice guidelines for the management of childhood obesity in Malaysia.
Methods: A cross-sectional study was conducted among 40 dietitians in 16 Ministry of Health hospitals and three teaching hospitals. Information on current dietetic practices in the management of childhood obesity was obtained through a mailed survey questionnaire. The practices included nutritional assessment, determination of energy requirement, dietary prescription and physical activity modification. Emails were sent to 31 dietetic associations in other countries to obtain information on practice guidelines used by dietitians.
Results: Frequently used dietary intervention and physical activity modification approaches were high fibre diet (65%), low fat diet (40%), reduction of sedentary pursuits and screen times (67.5%) and an increase in duration of current physical activities (60%). In comparison to other dietetic practice guidelines, the current dietetic practices in Malaysia do not usually include waist circumference, biochemical and blood pressure data. However, similar to other guidelines, the current dietetic practices included low dietary fat, high fibre diet, decreased sedentary activity and increased physical activity level.
Conclusions: The dietetic practices in the management of childhood obesity in Malaysia are diverse. A comprehensive nutrition practice guideline for management of childhood obesity is urgently needed for standardisation of dietetic practices in Malaysia.

Matched MeSH terms: Nutrition Policy
Fulltext Unheard voices : womens’ inner experiences during the Johore flood

Zabedah, B., Badrul Hisham, A.S.

Malaysian Journal of Community Health, 2009;15(3):98-103.
MyJurnal

Introduction : Human displacement during disaster would cause women and their dependent children to be particularly vulnerable. Yet, women failed to make their voices heard. Thus their needs, priorities and perceptions would not be identified which in turn could hinder an effective emergency response and a full recovery process.
Objective : This paper provides a general overview of problems and issues experienced by women and their dependent children during the Johore flood disaster. With this information, relevant agencies shall focus, among other considerations, on the special needs of women and children in planning and carrying out emergency responses in the future.
Methodology : This paper was written based on data and information obtained from the Johore Flood Disaster Report and observations made by the health teams on the flood victims throughout the flood period.
Findings and Discussions : Pregnant mothers with 36 weeks of gestation or more were evacuated from their homes to the health centres or hospitals when the Johore flood disaster struck. Regular maternal and child health (MCH) services were conducted at the flood relief centres. Despite the efforts by health care providers, we observed women facing some unique issues and problems. These include: 1) Effects of loss of security and protection; 2) Disruption of social relations and privacy; 3) Inadequate supply of basic items and; and 4) Economic disruption. Recommendations for future relief work are: i) Predisaster planning for emergency response must engage and involve women representatives. Women must also be recruited as emergency and relief workers; ii) Assessment of predetermined capacity of identified relief centres with gender consideration for evacuees must be done; iii) All relief centres shall have physical partition between families. Breast feeding room with access to clean water should also be provided; iv) Gender, cultural and religious sensitivity with regards to social protection and relations shall be observed at all times; v) Women should engage and be made occupied with suitable activities to encourage healthy social interaction thus avoiding feelings of boredom and helplessness; vi) Basic personal items for women and adolescent girls, such as sanitary towel and undergarments, and places to wash and hang them in privacy must be provided; vii) Elderly women may have to temporarily stay at unaffected relatives’ or old folk homes throughout the disaster period, and; viii) No smoking policy shall be enforced at all times in flood relief centres.
Conclusion : Women and their dependent children have been recognised as one of the vulnerable groups during disasters. Thus, women shall be empowered as partners in formulating any emergency response plan so that together they would be able to complement all disaster mitigation, relief and recovery efforts in amore effective manner.

Matched MeSH terms: Public Policy
Fulltext Dietary Fat and Fibre Intakes of Malaysian Adults: Issues and Implications when â€˜Western Targetsâ€™ Are Set as Dietary Goals

Malays J Nutr, 1997;3(2):-.
MyJurnal

This article examines the fat and fibre intakes of Malaysian adults and highlights discrepancies and practical limitations if these intakes are to match the levels for these nutrients advocated in the World Health Organisation (WHO) and American Heart Association (AHA) â€˜diet modelsâ€™. Local data on food consumption showed that the total fat intakes amongst Malaysian adults, contrary to common perception, were not high and the mean values obtained fell within the range of 40-66g or 22-26% kcal. As such, the dietary target of 30% kcal total fat or its intermediate target of 30-35% kcal, advocated by WHO and AHA mainly to address the problem of a high consumption of dietary fats in western populations, should not be adopted indiscriminately by Malaysians. Dietary fatty acid (FA) analysis by high performance liquid chromatography (HPLC) coupled with the use of food composition tables, showed that the typical Malaysian diet prepared with palm olein or palm olein-groundnut oil blends as cooking oil contained 3.2-4.0% kcal polyunsaturated fatty acids (PUFA), mainly as the w-6 linoleic acid, which is also the predominant essential fatty acid (EFA) in humans. This level of linoleic acid, with an Ï‰-6/ Ï‰--3 FA ratio approximating 10, is adequate for basal PUPA and EFA needs but fell short of the 4-10% kcal linoleic acid recommended by WHO (1993) to counter the effects of the cholesterol-raising saturated fatty acids (SFA). This raised upper limit of 10% kcal linoleic acid (previously 7% kcal), which equals the level of PUFA implied in the AHA diet model, appears unnecessarily high considering that the cholesterol-lowering potential of linoleic acid is maximum at about 6% kcal, while the health hazards associated with long-term high intakes of PUPA have never been completely dismissed. The new WHO lower limit for dietary linoleic acid (4% kcal) would have a controversial impact of raising the previous minimal 3% kcal EFA to above 4% kcal (linoleic + alpha-linolenic acids). Similarly, the WHO recommendation for total dietary fibre of 27-40g (equivalent to a daily combined intake of 400g of vegetables and fruits, 30g of which should come from pulses) appears at present, too high a dietary target for the average Malaysian adult whose habitual daily diet was estimated to contain about 180g of vegetables plus fruits, providing only about 13-16g total dietary fibre. Appropriately, an expert panel on Malaysian Dietary Guidelines has recommended instead, 20-30% kcal total fat containing 3-7% kcal PUFA, and 20-30g total dietary fibre for the local population.

Matched MeSH terms: Nutrition Policy
Fulltext Focusing health equity, efficiency and health maximization policy review

Thant, Z., Than, Mt, Shamsul, B.S., Wai, P.W., Htun, H.N.

Malaysian Journal of Public Health Medicine, 2013;13(1):64-71.
MyJurnal

With economic growth and significant technological advances in the health sector, many countries have developed aggregate outcomes in terms of both health services and individual well-being. Life expectancy has seen a remarkable increase of more than fifty per cent between 1950 and 2009. Achievement is uneven, however, and some groups are better able to access health services than others. In our review, we explore the need and how to maximize health equity, efficiency and effectiveness. Methodology is the review and web surfing on public health, social science, humanity and development literature. The increasing gap in health inequality, however, calls for further reform of the health system to achieve both equity and efficiency. Health is essential for survival and human capability. Good health enables people to participate in society. A new approach to efficient and cost-effective health service provision is community participation in health development. Participation can increase the skills and knowledge of local people, thus providing opportunities to improve their lives (empowerment). Analysis suggests four functional changes to achieve equity and efficiency in maximizing health outputs: reforms targeting universal coverage to achieve universal access to health; people-centred service delivery through concentrating on health services based on need; public policy change targeting integrated and multi-system health planning; and collective health system and community response to achieve health for all.

Matched MeSH terms: Public Policy
Fulltext Secondhand smoke exposure at home and respiratory symptoms among primary school children in Kota Bharu, Kelantan

Sharina, D., Zulkifli, A., Nyi, N.N.

Malaysian Journal of Public Health Medicine, 2007;7(2):59-63.
MyJurnal

In recent years, there has been concern that non-smokers may also be at risk from secondhand smoke exposure, especially children. This study was done to determine the prevalence of secondhand smoke exposure at home and the association between secondhand smoke exposure and respiratory symptoms among primary schoolchildren in Kota Bharu, Kelantan. This was a comparative cross-sectional study involving children, aged 10·12 years. A structured questionnaire was used to obtain the information on sociodemographic, respiratory symptoms and smokers in the house. A random sample of 10 from 95 primary schools in Kota Bharu was included. Six classes were randomly selected from each school, two classes each from each school year of primary 4·6. A total of 795 children completed the questionnaire during September 2003 till March 2004. 386 of children (48.6%) were boys and 409 children (51.4%) were girls. Most of the children were Malay (99.9%). A total of 442 (55.6%) children lived with at least 1 smoker in the house mainly from the smoking fathers. Significantly increased odds ratios due to secondhand smoke exposure were observed for most of the respiratory symptoms. The odds ratios (95% confidence interval) were 1.67 (1.18, 2.39) for cough in the morning, 1.59 (1.10, 2.30) for cough at night, 1.76 (1.16, 2.65) for cough most days for the previous 3 months, 1.57 (1.14, 2.17) for phlegm in the morning, 1.49 (1.08, Z.07) for phlegm during daytime or at night, 1.38 (1.03, 1.86) for nose problems in the morning, 1.40 (1.03, 1.90) for nose problems at night and 1.78 (1.14, 2.78) for throat problems at night, 1.55 (1.06, 2.26) for ever wheeze or diagnosed asthma by doctor, 1.57 (1.05, 2.36) for throat problems in the morning and 1.81 (1.15, 2.85) for throat problems during daytime. The odds ratios increased with increasing number of smokers at home for cough in the morning, cough most days for the previous 3 months, phlegm in the morning, ever wheeze or diagnosed asthma by doctor, throat problems in the morning, throat problems during daytime and throat problems at night. In view of the significant health risks posed to children by secondhand smoke, public health policies are needed to protect this vulnerable population. The aim of such policies Ls to ensure the right of every child to grow up in an environment free of tobacco smoke.

Matched MeSH terms: Health Policy
Role of schools of public health on maternal and child health programmes in the Asia-Pacific region

Zulkifli SN, Yun-Low W, Yusof K

Asia Pac J Public Health, 1998;10(1):10-6.
PMID: 10050201

This paper assessed the role of public health schools on maternal and child health programmes in the Asia Pacific region. Economic development and its associated effects, particularly in the ASEAN countries, for example, migrant labour, ageing, environmental health, turbulence and social climate, has a tremendous impact on maternal and child health. Based on these current issues, it is evident that public health schools can play a major role in maternal and child health in terms of policy formulation and programme development. Several areas were proposed as to what schools of public health can do, namely, through networking, communication, research and training.

Matched MeSH terms: Health Policy
Global economic evaluations of rotavirus vaccines: A systematic review

Kotirum S, Vutipongsatorn N, Kongpakwattana K, Hutubessy R, Chaiyakunapruk N

Vaccine, 2017 06 08;35(26):3364-3386.
PMID: 28504193 DOI: 10.1016/j.vaccine.2017.04.051

INTRODUCTION: World Health Organization (WHO) recommends Rotavirus vaccines to prevent and control rotavirus infections. Economic evaluations (EE) have been considered to support decision making of national policy. Summarizing global experience of the economic value of rotavirus vaccines is crucial in order to encourage global WHO recommendations for vaccine uptake. Therefore, a systematic review of economic evaluations of rotavirus vaccine was conducted.
METHODS: We searched Medline, Embase, NHS EED, EconLit, CEA Registry, SciELO, LILACS, CABI-Global Health Database, Popline, World Bank - e-Library, and WHOLIS. Full economic evaluations studies, published from inception to November 2015, evaluating Rotavirus vaccines preventing Rotavirus infections were included. The methods, assumptions, results and conclusions of the included studies were extracted and appraised using WHO guide for standardization of EE of immunization programs.
RESULTS: 104 relevant studies were included. The majority of studies were conducted in high-income countries. Cost-utility analysis was mostly reported in many studies using incremental cost-effectiveness ratio per DALY averted or QALY gained. Incremental cost per QALY gained was used in many studies from high-income countries. Mass routine vaccination against rotavirus provided the ICERs ranging from cost-saving to highly cost-effective in comparison to no vaccination among low-income countries. Among middle-income countries, vaccination offered the ICERs ranging from cost-saving to cost-effective. Due to low- or no subsidized price of rotavirus vaccines from external funders, being not cost-effective was reported in some high-income settings.
CONCLUSION: Mass vaccination against rotavirus was generally found to be cost-effective, particularly in low- and middle-income settings according to the external subsidization of vaccine price. On the other hand, it may not be a cost-effective intervention at market price in some high-income settings. This systematic review provides supporting information to health policy-makers and health professionals when considering rotavirus vaccination as a national program.

Matched MeSH terms: Health Policy
Indirect effect of management support on users' compliance behaviour towards information security policies

Humaidi N, Balakrishnan V

Health Inf Manag, 2018 Jan;47(1):17-27.
PMID: 28537207 DOI: 10.1177/1833358317700255

BACKGROUND: Health information systems are innovative products designed to improve the delivery of effective healthcare, but they are also vulnerable to breaches of information security, including unauthorised access, use, disclosure, disruption, modification or destruction, and duplication of passwords. Greater openness and multi-connectedness between heterogeneous stakeholders within health networks increase the security risk.
OBJECTIVE: The focus of this research was on the indirect effects of management support (MS) on user compliance behaviour (UCB) towards information security policies (ISPs) among health professionals in selected Malaysian public hospitals. The aim was to identify significant factors and provide a clearer understanding of the nature of compliance behaviour in the health sector environment.
METHOD: Using a survey design and stratified random sampling method, self-administered questionnaires were distributed to 454 healthcare professionals in three hospitals. Drawing on theories of planned behaviour, perceived behavioural control (self-efficacy (SE) and MS components) and the trust factor, an information system security policies compliance model was developed to test three related constructs (MS, SE and perceived trust (PT)) and their relationship to UCB towards ISPs.
RESULTS: Results showed a 52.8% variation in UCB through significant factors. Partial least squares structural equation modelling demonstrated that all factors were significant and that MS had an indirect effect on UCB through both PT and SE among respondents to this study.
CONCLUSION: The research model based on the theory of planned behaviour in combination with other human and organisational factors has made a useful contribution towards explaining compliance behaviour in relation to organisational ISPs, with trust being the most significant factor. In adopting a multidimensional approach to management-user interactions via multidisciplinary concepts and theories to evaluate the association between the integrated management-user values and the nature of compliance towards ISPs among selected health professionals, this study has made a unique contribution to the literature.

Matched MeSH terms: Organizational Policy
Fulltext The Power of Multidimensional Poverty in Explaining Life Expectancy: Empirical Evidence from Cross-Sectional Data of 62 Developing Countries

Tafran K, Tumin M, Osman AF

Iran J Public Health, 2020 Sep;49(9):1709-1717.
PMID: 33643946 DOI: 10.18502/ijph.v49i9.4088

Background: We examined whether multidimensional poverty index (MPI) explained variations in life expectancy (LE) better than income poverty; and assessed the relative importance of MPI indicators in influencing LE.
Methods: Cross-sectional data from 62 developing countries were used to run several multivariate linear regressions. R2 was used to compare the powers of MPI with income-poverties (income poverty gaps [IPG] at 1.9 and 3.1 USD) in explaining LE.
Results: Adjusting for controls, both MPI (β =-0.245, P<0.001) and IPG at 3.1 USD (β=-0.135, P=0.044) significantly correlates with LE, but not IPG at 1.9 USD (β=-0.147, P=0.135). MPI explains 12.1% of the variation in LE compared to only 3.2% explained by IPG at 3.1 USD. The effect of MPI on LE is higher on female (β=-0.210, P<0.001) than male (β=-0.177, P<0.001). The relative influence of the deprivation indictors on LE ranks as follows (most to least): Asset ownership, drinking water, cooking fuel, flooring, child school attendance, years of schooling, nutrition, mortality, improved sanitation, and electricity.
Conclusion: Interventions to reduce poverty and improve LE should be guided by MPI, not income poverty indices. Such policies should be female-oriented and prioritized based on the relative influence of the various poverty deprivation indicators on LE.

Matched MeSH terms: Policy
Fulltext Perceived Safety and Effectiveness of Electronic Cigarettes among Malaysian Adults and Public Support for Regulations

Draman S, Ab Rahman NS, Nik Mohamed MH, Ab Rahman J, Kartiwi M

J Pharm Bioallied Sci, 2020 Nov;12(Suppl 2):S718-S727.
PMID: 33828367 DOI: 10.4103/jpbs.JPBS_384_19

Context: Electronic cigarettes have been used as a harm reduction method toward tobacco cessation. Malaysian government has enforced a strict policy to regulate the sale of electronic cigarette products because its liquid contains nicotine.
Aims: This study aimed to explore the general public's perception toward electronic cigarette use. Public support toward electronic cigarette regulation was also examined.
Settings and Design: This was a Malaysian population-based survey.
Materials and Methods: Data were obtained from the National E-Cigarette Survey (NECS) 2016, which used a multistage stratified cluster sampling household survey representing all Malaysian adults aged 18 years old. A cross-sectional survey was conducted among a total of 4288 adults.
Statistical Analysis Used: Descriptive and logistic regression analysis.
Results: Majority were aged 25-44 years old (44%), completed at least secondary education (69%), of Malay ethnicity (73%), and married (68%). Majority (88.1%) have never used electronic cigarette. A quarter (25.5%) perceived electronic cigarette helps people quit cigarette smoking, whereas 20.3% perceived electronic cigarette helps people to maintain cigarette abstinence. Approximately 85% believed that electronic cigarette use does not help in improving breathing and coughing. Majority (91.8%) disagreed that electronic cigarettes should be allowed in places where tobacco smoking is banned. Thus, 63.4% agreed that electronic cigarette should be banned completely rather than regulated.
Conclusion: Majority of general public had negative perception about electronic cigarette use.

Matched MeSH terms: Policy
Fulltext Reducing the stigma of mental health disorders with a focus on low- and middle-income countries

Javed A, Lee C, Zakaria H, Buenaventura RD, Cetkovich-Bakmas M, Duailibi K, et al.

Asian J Psychiatr, 2021 Apr;58:102601.
PMID: 33611083 DOI: 10.1016/j.ajp.2021.102601

Mental health disorders are a burgeoning global public health challenge, and disproportionately affect the poor. Low- and middle-income countries (LMICs) bear 80 % of the mental health disease burden. Stigma associated with mental health results in delayed help seeking, reduced access to health services, suboptimal treatment, poor outcomes and an increased risk of individuals' human rights violations. Moreover, widespread co-occurrence of physical comorbidities such as noncommunicable diseases with mental health disorders makes the treatment of both conditions challenging and worsens prognosis. This paper explores various aspects of stigma towards mental health with a focus on LMICs and assesses measures to increase help-seeking and access to and uptake of mental health services. Stigma impacts persons living with mental illness, their families and caregivers and healthcare professionals (mental health professionals, non-psychiatric specialists and general practitioners) imparting mental health care. Cultural, socio-economic and religious factors determine various aspects of mental health in LMICs, ranging from perceptions of health and illness, health seeking behavior, attitudes of the individuals and health practitioners and mental health systems. Addressing stigma requires comprehensive and inclusive mental health policies and legislations; sustainable and culturally-adapted awareness programs; capacity building of mental health workforce through task-shifting and interprofessional approaches; and improved access to mental health services by integration with primary healthcare and utilizing existing pathways of care. Future strategies targeting stigma reduction must consider the enormous physical comorbidity burden associated with mental health, prioritize workplace interventions and importantly, address the deterioration of population mental health from the COVID-19 pandemic.

Matched MeSH terms: Health Policy
Fulltext Are our healthcare workers well protected during COVID-19? learning from current experiences and challenges

Siti Munira Yasin,, Kamarulzaman Muzaini, Ely Zarina Samsudin, Mohamad Ikhsan Selamat, Zaliha Ismail

Journal of Clinical and Health Sciences, 2020;5(2):4-18.
MyJurnal

The outbreak of novel coronavirus disease 2019 (COVID-19) has been declared a Public
Health Emergency of International Concern by the World Health Organization. The incidence
of this pandemic continues to rise, with 40,665,438 confirmed cases and 1,121,843 deaths
worldwide by 21 October 2020. During this public health crisis, healthcare workers are at the
frontline of the COVID-19 outbreak response, and as such are at risk of being infected and
developing job burnout while in the line of duty. This study reviews the history of COVID-19
outbreak, infection control measures in hospitals during COVID-19 outbreak, healthcare
workers’ risk of infection and other health effects from battling COVID-19, and challenges and
recommendations for protecting healthcare workers during this pandemic. At present,
healthcare workers are every country’s most valuable resources, and their safety must thus
be ensured. Strong medical leadership, clear pandemic planning, policies and protocols,
continuous educational training, adequate provision of personal protective equipment,
psychological support, and the provision of food, rest, and family support for healthcare
workers would augment a climate of safety in the workplace, ensure their wellbeing, and
improve their capacity to battle this ongoing pandemic.

Matched MeSH terms: Policy
Fulltext The Influence of Person-Environment Fit on the Turnover Intention of Nurses in Jordan: The Moderating Effect of Psychological Empowerment

Amarneh S, Raza A, Matloob S, Alharbi RK, Abbasi MA

Nurs Res Pract, 2021;2021:6688603.
PMID: 33815841 DOI: 10.1155/2021/6688603

There is an acute shortage of nurses worldwide, including in Jordan. The nursing shortage is considered to be a crucial and complex challenge across healthcare systems and has stretched to a warning threshold. High turnover among nurses in Jordan is an enduring problem and is believed to be the foremost cause of the nurse shortage. The purpose of this study was to investigate the multidimensional impact of the person-environment (P-E) fit on the job satisfaction (JS) and turnover intention (TI) of registered nurses. The moderating effect of psychological empowerment (PE) on the relationship between JS and TI was also investigated. Based on a quantitative research design, data were collected purposively from 383 registered nurses working at private Jordanian hospitals through self-administered structured questionnaires. Statistical Package for Social Sciences (SPSS) 25 and Smart Partial Least Squares (PLS) 3.2.8 were used to analyze the statistical data. The results showed that there is a significant relationship between person-job fit (P-J fit), person-supervisor fit (P-S fit), and JS. However, this study found an insignificant relationship between person-organization fit (P-O fit) and JS. Moreover, PE was also significantly moderate between JS and TI of nurses. This study offers an important policy intervention that helps healthcare organizations to understand the enduring issue of nurse turnover. Additionally, policy recommendations to mitigate nurse turnover in Jordan are outlined.

Matched MeSH terms: Policy
Fulltext Evaluation of a Multidisciplinary Antimicrobial Stewardship Program in a Saudi Critical Care Unit: A Quasi-Experimental Study

Haseeb A, Faidah HS, Al-Gethamy M, Iqbal MS, Barnawi AM, Elahe SS, et al.

Front Pharmacol, 2020;11:570238.
PMID: 33776750 DOI: 10.3389/fphar.2020.570238

Background: Antimicrobial stewardship programs (ASPs) are collaborative efforts to optimize antimicrobial use in healthcare institutions through evidence-based quality improvement strategies. With regard to critically ill patients, appropriate antimicrobial usage is of significance, and any delay in therapy increases their risk of mortality. Therefore, the implementation of structured multidisciplinary ASPs in critical care settings is of the utmost importance to promote the judicious use of antimicrobials. Methods: This quasi-experimental study evaluating a multidisciplinary ASP in a 20-bed critical care setting was conducted from January 1, 2016 to July 31, 2017. Outcomes were compared nine months before and after ASP implementation. The national antimicrobial stewardship toolkit by Ministry of health was reviewed and the hospital antibiotic prescribing policy was accordingly modified. The antimicrobial stewardship algorithm (Start Smart and Then Focus) and an ASP toolkit were distributed to all intensive care unit staff. Prospective audit and feedback, in addition to prescribing forms for common infectious diseases and education, were the primary antimicrobial strategies. Results: We found that the mean total monthly antimicrobial consumption measured as defined daily dose per 100 bed days was reduced by 25% (742.86 vs. 555.33; p = 0.110) compared to 7% in the control condition (tracer medications) (35.35 vs. 38.10; p = 0.735). Interestingly, there was a negative impact on cost in the post-intervention phase. Interestingly, the use of intravenous ceftriaxone measured as defined daily dose per 100 bed days was decreased by 82% (94.32 vs. 16.68; p = 0.008), whereas oral levofloxacin use was increased by 84% (26.75 vs. 172.29; p = 0.008) in the intensive care unit. Conclusion: Overall, involvement of higher administration in multidisciplinary ASP committees, daily audit and feedback by clinical pharmacists and physicians with infectious disease training, continuous educational activities about antimicrobial use and resistance, use of local antimicrobial prescribing guidelines based on up-to-date antibiogram, and support from the intensive care team can optimize antibiotic use in Saudi healthcare institutions.

Matched MeSH terms: Policy
Phylogenetic analysis of nucleoprotein gene of Rabies virus in Malaysia from 2015 to 2018

Leow BL, Khoo CK, Syamsiah Aini S, Roslina H, Faizah Hanim MS

Trop Biomed, 2021 Jun 01;38(2):72-78.
PMID: 33973576 DOI: 10.47665/tb.38.2.043

Rabies is a fatal zoonotic disease caused by rabies virus (RABV) and remains a public health problem in Malaysia. Malaysia was declared rabies-free in 2012, however rabies outbreaks occurred at few states in Peninsular Malaysia three years later; and for the first time, in Sarawak (East Malaysia) in 2017 which has caused more than 20 human deaths. This study describes the phylogenetic analysis of the complete nucleoprotein (N) gene of RABV from animal samples in Malaysia from year 2015 to 2018. The N gene of 17 RABVs from Perlis, Kedah and Sarawak were amplified and sequenced. The nucleotide and deduced amino acid similarities of N gene analysis indicated that there is high similarity among the local RABVs. Phylogenetic analysis of the N gene revealed that all Malaysia RABVs belonged to the Asian clade. Among these, RABVs from Peninsular Malaysia were clustered together with RABVs from Thailand, Vietnam and other Southeast Asia countries except Indonesia. However, RABVs from Sarawak were grouped together with Indonesian strains from Kalimantan. Our study provides baseline genetic information of the potential origins of the circulating RABVs in Malaysia. This crucial information helped the authority in policies making and strategies to be taken in outbreak control. Continuous surveillance program to monitor the disease trend, strict border control, vaccination of dog and cat population and public awareness are important steps to control the spread of the RABV.

Matched MeSH terms: Policy
Fulltext Dietary nutrient intake and meal-related situations among elderly outpatients with chronic obstructive pulmonary disease from respiratory clinics, Malaysia

Nor-Farahain Yahya, Noraida Omar, Ummi-Nadira Daut, Siti-Nur’Asyura Adznam, Barakatun-Nisak Mohd Yusof

Malaysian Journal of Medicine and Health Sciences, 2020;16(106):170-177.
MyJurnal

Introduction: Chronic obstructive pulmonary disease (COPD) patients usually have dietary problems leading to malnutrition issues. Therefore, this study aimed to determine macro and micronutrient intakes and meal-related sit- uations among outpatients COPD elderly and its adequacy according to their requirements. Methods: 140 patients were included in this cross-sectional study at Respiratory Clinics of Hospital Serdang and Institut Perubatan Respira- tori. Socio-demographic and health status data were collected by interviewing patients and reviewing their medical records. A three-day diet history (two-day on weekdays, one day on weekend) was analysed using Nutritionist Pro and compared against their requirements. Meal-related situation was assessed using three open-ended questions that related to food shopping, cooking and eating and analysed using content analysis. Results: Patients were 70±7 years old, 97% male, 59% Malay, 48% had primary education, 75% married, 72% ex-smokers and 54% presented with comorbidities. Majority of them had no episode of exacerbation for the past one year and in moderate stage of the COPD severity. Mean energy intake was 916±221 kcal/day with 98% of them have under-reported their intake. Almost all patients had inadequate macro and micronutrient intake; energy (97%), protein (97%), carbohydrate (86%), fat (99%), vitamin A (95%), C (86%), D (99%) and E (99%). The meal-related situation reported patients had difficulties with food shopping and preparation and problems during mealtime. Conclusion: COPD elderly reported inadequate intake of macro and micronutrients and had problems during mealtime. This indicates the need for Ma- laysian nutrition guidelines specific to COPD patients and nutrition intervention in the primary setting.

Matched MeSH terms: Nutrition Policy
Fulltext Public and private sectors collective response to combat COVID-19 in Malaysia

Tan CS, Lokman S, Rao Y, Kok SH, Ming LC

J Pharm Policy Pract, 2021 May 03;14(1):40.
PMID: 33941265 DOI: 10.1186/s40545-021-00322-x

Over the last year, the dangerous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly around the world. Malaysia has not been excluded from this COVID-19 pandemic. The resurgence of COVID-19 cases has overwhelmed the public healthcare system and overloaded the healthcare resources. Ministry of Health (MOH) Malaysia has adopted an Emergency Ordinance (EO) to instruct private hospitals to receive both COVID-19 and non-COVID-19 patients to reduce the strain on public facilities. The treatment of COVID-19 patients at private hospitals could help to boost the bed and critical care occupancy. However, with the absence of insurance coverage because COVID-19 is categorised as pandemic-related diseases, there are some challenges and opportunities posed by the treatment fees management. Another major issue in the collaboration between public and private hospitals is the willingness of private medical consultants to participate in the management of COVID-19 patients, because medical consultants in private hospitals in Malaysia are not hospital employees, but what are termed "private contractors" who provide patient care services to the hospitals. Other collaborative measures with private healthcare providers, e.g. tele-conferencing by private medical clinics to monitor COVID-19 patients and the rollout of national vaccination programme. The public and private healthcare partnership must be enhanced, and continue to find effective ways to collaborate further to combat the pandemic. The MOH, private healthcare sectors and insurance providers need to have a synergistic COVID-19 treatment plans to ensure public as well as insurance policy holders have equal opportunities for COVID-19 screening tests, vaccinations and treatment.

Matched MeSH terms: Policy
Home and expatriate nurses' perceptions of job satisfaction: Qualitative findings

Almansour H, Gobbi M, Prichard J

Int Nurs Rev, 2021 May 27.
PMID: 34043818 DOI: 10.1111/inr.12699

AIM: This paper is part of a larger doctoral study that investigated the impact of nationality on the job satisfaction of nurses and their intentions to leave Saudi Arabian government hospitals. The paper aims to gain an understanding of the impact of expatriate status on nurses' perceptions, by comparing the factors that influence job satisfaction among Saudi nurses to those that affect nurses recruited from other countries.
BACKGROUND: Job satisfaction is a known predictor of nurse retention. Although there is a broad understanding of the factors that affect job satisfaction, little is known about how these vary between home and expatriate nurses working in countries which rely on a multicultural migrant workforce.
METHODS: A descriptive qualitative approach was taken, in which 26 semi-structured interviews were conducted with nurses selected from different nationalities, all of whom were working in Saudi Arabian hospitals. Eight participants were Saudi Arabian, six Filipino, four Indian, four South African, two Jordanian and two Malaysian.
FINDINGS: Five themes were identified that differentiated the perceptions of expatriates regarding their job satisfaction from those of the home nurses: separation from family, language and communication, fairness of remuneration, moving into the future and professionalism.
CONCLUSION: Focusing on the enhancement of job satisfaction experienced by expatriate nurses can result in a healthier work environment and greater retention of these nurses.
IMPLICATIONS FOR NURSING AND NURSING POLICY: To enhance nurse retention, policy makers in countries with migrant nurses should address their socio-economic needs. This includes providing both greater access to their dependent family members, and language lessons and cultural orientation to reduce linguistic and cultural challenges.

Matched MeSH terms: Policy

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