MATERIALS AND METHODS: A cross-sectional study was conducted at Klinik Kesihatan Bandar Kuantan, Kuantan, Pahang. Patients were selected using stratified random sampling, and 201 participants were selected. The selected participants were asked to fill up the self-administered validated questionnaires consisting of background characteristics and Patient Satisfaction Questionnaire 18 (PSQ-18). Data collection period was from March 2022 to August 2022. Descriptive analysis was used to describe the background characteristics of respondents and the score of patient satisfaction. Multiple linear regression was used to determine the factors associated with patient satisfaction while adjusting for cofounders.
RESULTS: A total of 201 eligible data points were analysed in the study. The respondent mean age was 47.1 ± 16.9. Most respondents were Malay (68.7%), having secondary education (54.2%) and predominantly from the B40 income class (88.1%). The overall mean patient satisfaction score was 3.83 ± 0.31. There were significant associations between overall satisfaction with patient education level (B = -0.144; 95% CI -0.246, -0.042; p = 0.006), waiting time (B = -0.371; 95% CI -0.534, -0.209; p = 0.001) and consultation duration (B = -0.154; 95% CI -0.253, -0.055; p = 0.0020). It was found that patients with secondary education were less satisfied compared to patients with primary education level on health care services they received. Meanwhile, those who were not happy with the waiting time and consultation duration showed less satisfaction with overall healthcare services.
CONCLUSION: Despite serving the most significant number of patients in Pahang state, most of the patient were satisfied by the health care services at Klinik Kesihatan Bandar Kuantan. However, it is recommended to improve the waiting time and the consultation time in this clinic.
STUDY DESIGN: 50 patients aged 2-18 years who perform CIC were included in this cohort study. Patient compliance with CIC was evaluated using the validated Intermittent Catheterization Adherence Scale (ICAS). CIC difficulties were assessed using the validated Intermittent Catheterization Difficulty Questionnaire (ICDQ). Data was obtained on patients' co-morbidity, caregiver factors, socio-economic factors, CIC technique, access to catheters and facilities, urinary tract infections, incontinence, urology tests and treatment. Statistical analysis was performed.
RESULTS: Mean age was 6.68 ± 4.34 years. 32 (64%) patients commenced CIC within the first month of life. Mean daily CIC frequency was 4.70 ± 1.33.30 (60%) participants showed strong adherence to CIC. 39 (78%) participants were able to catheterize with no or minor difficulties. Pain (6, 12%), transient blocking sensation (6.12%), and urinary incontinence (3, 6%) were the predominant difficulties encountered. CIC performed by caregiver was associated with improved adherence compared to patient self-catheterization (p = 0.039). The mean age of participants who self-catheterized was 10.7 ± 3.7 years. Strong adherence was also observed among patients who purchased their own CIC catheters (p = 0.007). Participants with lower ICDQ score were more likely to be compliant with CIC (p = 0.007). CIC adherence was not affected by patient's age, gender, co-morbidity, mobility, caregiver factors, socio-economic factors, and age at initiation of CIC. There was no significant association between CIC adherence and febrile urinary tract infections, upper tract deterioration, and bladder stones at 6 months follow-up.
DISCUSSION: There is lower CIC adherence when a child begins to self-catheterize and healthcare providers should be alert during this period of transition. Though most patients with spina bifida have decreased urethral sensation, some patients do experience significant pain during CIC which may impact their compliance. These patients would need a review of their catheterization techniques to improve adherence. The limitations of our study are its modest sample size from a single center and short study period. Our study provides insights into the feasibility of instituting CIC in developing countries.
CONCLUSION: Strong CIC adherence was observed among patients who were catheterized by their caregiver, purchased their own CIC catheters, and encountered minimal difficulties during catheterization. CIC adherence had no effect on short-term urological outcomes.
KEY WORDS: Needle sticks injury, health care workers, and standard precaution.
METHODOLOGY: Respiratory secretions were examined for chlamydiae by cell culture, enzyme-linked immunosorbent assay and polymerase chain reaction-enzyme immunoassay. Sera were tested by micro-immunofluorescence for chlamydial IgG, IgM and IgA. Other bacterial and viral pathogens were also looked for by standard cultural and serological methods.
RESULTS: Of 87 patients aged 2 months-3 years, an aetiologic diagnosis was made in 41 (47.1%). C. pneumoniae and C. trachomatis were each detected in 1 (1.2%) of the patients. Among common bacterial pathogens, Haemophilus influenzae (13.8%) and Streptococcus pneumoniae (8.1%) were the most frequently identified. Respiratory viruses and elevated Mycoplasma pneumoniae antibodies were found in 10.3% and 9.1% of patients, respectively.
CONCLUSION: Chlamydiae are infrequent causes of community-acquired acute lower respiratory tract infections in infants and very young children in Malaysia.