Objective : This scientific writing is meant for describing the problems faced by pharmacy staffs during heavy flood situations in Johore and the actions to be taken for solving these problems.
Methodology : This finding is in accordance to the observations, experiences and interview of staffs (through questionnaires), who are involved directly and indirectly in preparations of emergency during flood. Efficiency of pharmaceutical services provided during flood is evaluated.
Result : Several problems were identified when providing pharmaceutical services, such as purchasing and supplying of items, pre-packing, preparing drug charts, visit to relief centers, post-flood health campaign, and doctors from NGOs prescibing medicines out of MOH drug formulary. During the period of flood, usage of drug and non-drug items increases drastically resulting in the current stock in store were not sufficient to compensate for the high demand. Moreover, inaccessibility of certain roads in districts such as Segamat and Kota Tinggi, aggravated and worsen the problems of obtaining goods from suppliers. Workload of pharmacy staffs increased especially in activities such as pre-packing and preparing drug charts due to shortage of manpower.
Conclusion : Even though workload increased drastically during flood, pharmaceutical services provided by the state pharmacy are still able to maintain good quality services to cater for the need of healthcare professionals and patients. Throughout the flood period, all the difficulties and hurdles faced by us had been solved; due to the cooperation from other agencies. Besides, by writing this article, a disaster preparedness guideline is produced for the purpose of improving management of future disasters.
Background : A safety culture practice through prevention needs skillful, knowledgeable and competencies workers. The effectiveness of occupational safety and health programme implementation needs the knowledge related to Occupational Safety and Health Acts, 1994 (OSHA 1994) and its regulations.
Objective : This study was to determine the level of knowledge and awareness towards Occupational Safety and Health (OSH) aspects among workers in medical laboratory.
Methodology : A cross-sectional study was carried out on 34 medical laboratories in which 17 were from private and another 17 laboratories were from public sectors. It consists of 112 medical laboratory disciplines. Data were obtained using self-administered questionnaire consisting of 33 questions related to Occupational Safety and Health (OSH). Each question was coded “know” and “do not know” and respondents were needed to state their understanding towards each OSH issue tendered.
Results : Respondent’s level of knowledge was analyzed according to socio-demography and socioeconomic factors. OSH level of knowledge among medical laboratory workers showed that there are significant differences (p0.05) in OSH knowledge according to between sex, marital status, income and services sectors among workers in medical laboratories. Only about 60.5% of respondents knew the existence of OSHA 1994, whereas those who knew about OSHA 1994 regulations were below than 50.0% from overall respondents.
Conclusion : Promotion and practices of dynamic safety culture through prevention needs high knowledge of OSH.
Background : Foot ulcers and its complications are an important cause of morbidity and mortality in diabetes. The aim of this retrospective study is to determine the ulcer-free survival in diabetic foot and its relevant predictors in a cohort of diabetic patients in the primary health care setting.
Methods : Data of newly diagnosed diabetics (n=1121) who received treatment in five health centers in the district of Kuala Langat, Selangor between 1st January 1999 until the 30th June 2008 were studied. Information was gathered by reviewing patient’s medical records. All patients were followed until 31st December 2008. The duration of ulcer-free survival was measured from the date of being diagnosed as diabetic until the development of the ulcer.
Results : The total incidence of diabetic foot ulcer was 9.9% (n=111), with an average annual incidence of 1%. The total incidence of amputation was 1.2%. Mean age of being diagnosed having diabetic was 52+10.7 year old and mean age of being diagnosed having diabetic foot ulcer was 54.68+10.16 year old. The mean for overall ulcer-free survival was 99 months (95%CI:96-102). Male gender (LR=6.56; p=0.01), smokers (LR=3.94; p=0.04), low body mass index (LR=4.45; p=0.03), impaired renal function (LR=5.17; p=0.02) and long duration between follow-up (LR=25.10; p
Background : Risk management strategy at the workplace needs two way interactions between employee and employer. Therefore, study on risk perception among workers based on scientific analysis is needed to gain knowledge and understanding on how workers perceived risk at the workplace in order to design risk management strategies more effectively.
Methodology : A cross sectional study was carried out among 628 respondents from 36 medical laboratories in the public and private sector in Klang Valley. Using a self administered questionnaire, respondents were required to perceive risk on 30 hazards which have been identified in the medical laboratory. Each hazard was encoded by using Likert scale 1= not risky, 2= risky but low, 3= moderate risk, 4= high risk and 5= very high risk.
Result : Overall, the study showed that working in the medical laboratory was perceived to of moderate risk. When comparing among ethic groups, the Malays had the highest perception of risk (3.07±0.88) as compared with Indians (3.03±0.88) and the Chinese (2.78±0.90). Employee with higher education and position level perceived low level of risk compared to those with lower education and position level. For those working in different types of laboratories, there are significant difference on risk perception, (p=0.001). Employees who work in government sector perceived higher (3.12±0.93) risk compared to workers in private sector (2.85±0.88). In terms of OSH based knowledge, those with higher level of education and position have a high score knowledge on OSH compared to those have lower education and position level.
Conclusion : This study showed that risk perception among workers in medical laboratory is influenced by socio-demography factor such race, education level, job position and the laboratory where the respondents are working.
Background : A cross-sectional survey was carried out in December 2007 to compare the healthrelated quality of life (HRQoL) of stroke survivors with that of general Malaysian population.
Methodology : Stroke patients were recruited from two community-based rehabilitation centres in Selangor. HRQoL was assessed using Medical Outcome 36-Item Short-Form Health Survey (SF-36).
Result : A total of 61 patients (34 males and 27 females) were interviewed. Majority were Chinese (85%) and a small percentage were Malays (15%). 82% (n=50) were elderly of 60 years and above, and the remaining 18% (n=11) were younger patients. 64% had stroke for one year and more, and 36% were less than a year post-stroke. All subjects were community-dwellers and lived with their families. The result showed that with the exception of bodily pain, the mean score of all SF-36 health domains of stroke patients were lower than that of the general population. The greatest difference was in role physical, followed by physical functioning. Female patients demonstrated higher score than the males in all SF-36 domains, in particular general health (57.2 vs 70.3, p=0.01) and social functioning (52.2 vs 73.1, p=0.00). There were no differences of HRQoL domains after comparison according to poststroke duration (all p>0.05).
Conclusion : HRQoL of stroke survivors is lower than that of Malaysian general population in all SF-36 health domains, with the exception of bodily pain.
Background : Safety and health is one of major concerns in public health issues. There are lots of injuries or accidents reported in the news which include school accidents and injuries.
Methodology : This survey was conducted among head of primary schools in Kota Bharu from May to June 2004. The objective of this study was to investigate the awareness about safety and health status among school’s head using a questionnaire.
Result : The study showed that knowledge on safety and health among the school’s heads were relatively low (7.7%). Forty-two percent of the schools did not implement any safety and health programme while more than 50 % did not have safety policies in their school.
Conclusions : It is necessary to have specific safety programmes in school in order to improve the safety and health awareness among teachers, staff, students and community.
Background : Visual impairment among the rural community has rarely been studied in this country. The purpose of this study is to determine the prevalence of visual impairment and its related factors among the adult population of Kampung Kuala Pajam, Branang.
Methodology : A cross sectional study was carried out in Kampung Kuala Pajam, Mukim Beranang from 25th of December till 30th of December 2007. Universal sampling is adopted and the sample size consists of 321 respondents who is 18 years and above. Trained interviewer has been used to obtain the data through questionnaire and eye examinations using logMAR chart, Red Reflex eye test, Relative Afferent Pupillary Defect (RAPD) test and Pin-Hole test.
Result : A total of 261 respondents who fulfil the criteria were interviewed and had eyes examination during the study period. The prevalence of visual impairment in this population was 9.2% and factors that showed significant association were age (p
Introduction : Selangor’s private clinic registry system had been introduced in 2006 following gazettment of The Private Healthcare Facilities and Services Act. Through the act, data’s from the private clinics can be obtained and its characteristics can be compared between the urban and rural private clinic. An overview of the services can be known and an appropriate action can be planned.
Methodology : A cross-sectional study was done on private clinics registered in state of Selangor. Using databased known as MedPCs (Medical Practice Control System), a purposive sampling was used to select four districts – two urban and two rural. All private clinics in the selected districts were studied and all details shall be collected online.
Result : District of Gombak and Klang were selected as urban and Sabak Bernam and Kuala Selangor represented rural area. Of a total 625 clinics selected, 90.0% (562) from urban and 10.0% (63) rural. Distributions of clinic were in line with the act. The most prominent services were general treatment (89.4%) and ability to serve more than eight hours daily (89.4%). Medical clinic still dominated at 84.0% compared to dentistry at 16.0%. About 70.6% were operated by male doctors. Though clinic services in rural were relatively as good as urban, the different were significantly observed to the ethnicity of the doctor. Indian doctors more in rural (46.03%), whilst in urban, Malay doctors were more dominant (39.50%). Followed closely by seniority, where rural doctors were much senior (51.02 years old), however, most of the doctors in rural private clinics experienced less exposure in government sectors, compared to those in urban areas.
Conclusion : There were obvious difference in terms of distribution, where more clinics were located in urban compared to rural, but all were still in line to the act and their services were comparable. Most noticeable differences were ethnicity, seniority and past experience working in the public sector. Indian doctors were dominant in rural and Malay in urban. Although rural doctors were more senior, relatively they were less experienced working in the government sector.
Background : Anemia in pregnancy is a worldwide problem. Ministry of Health Malaysia has conducted prophylaxis program to distribute hematinic pills to pregnant women since 3 decades ago.
Methodology : A cross sectional study was conducted among pregnant women who attended government health clinics in Johor Bahru district to assess the prevalence of taking iron tablet and factors associated with it by using a structured questionnaire.
Result : Prevalence of respondents taking ferrous pill daily was 68.6%. Anemia prevalence found in this study was 37.5%. Majority of the respondents did not take pills regularly said their reason as forgotten(54.0%), side effects caused by taking pill (39.3%) and did not like the taste (6.7%). The haemoglobin mean was directly inclined with frequency of ferrous pill intake. The significant associated factor in taking iron pill was only frequency of drinking tea. Multivariate logistic regression analyses revealed that drinking tea was the only factor that contributing to iron pills consumption.
Conclusion : Education is the most important factor in improving adherence to iron pill. Besides that, motivation and behaviour modification of pregnant women also needs to be taken into account.
Introduction : Quality is an important aspect in health care delivery not only because it is one of the most important factors in individual and community health, but it also influences lives in improving lifespan, health status and also reduction in disease and the burden of diseases.
Methodology : This is a systematic review on various papers, studies and articles based on studies and researches done by a few scholars, experts and organizations involved in quality, quality assessment and monitoring.
Results : Quality in health care delivery involves six main aspects including access to services, suitability to the needs, effectiveness, equity, social acceptance and efficiency. Quality is taken from the perspective of the consumers and the providers. Some of the issues surrounding quality assessment are identifying and balancing between the difference perspective among the stakeholders, producing accountable framework of assessment and also finding suitable criteria for outcome assessment. Health care services in Malaysia are provided both by the government and the private sector with each sector has its own advantages, disadvantages and challenges.
Conclusion : The challenges in improving and maintaining quality include balancing advances in science and technology with the available brainpower and human resources. Therefore all agencies should work together in order to provide the best health care delivery and to keep improving the quality in health care services.
Background : The worldwide prevalence of diabetes is increasing, as is the demand for and cost of medical care. Diabetic Mellitus (DM) prevalence in Malaysia rose from 6.3% of the population in 1986 to 8.3% in 1996 and costs need to be managed more effectively.
Objective : To estimate the financial burden of diabetic care, including providers’ and patients’ costs in government facilities in Selangor and to determine factors influencing cost of diabetic care.
Methodology : A cross-sectional study was conducted from September to November 2005 among Hospitals with and without Specialist and Health Clinics. Total sample of 361 subjects with type 2 diabetes representing both inpatient and outpatient were chosen randomly. Results were analyzed using SPSS version 13.0.
Results : The average cost for a diabetic patients’ admission in a Hospital with Specialist was RM1951 and RM1974 for patient admitted in a Hospital without Specialist and these cost difference was not statistically significant (p>0.05). Providers’ mean cost for outpatient care was RM772.69 and RM761.07 respectively for Hospital with Specialist and Hospital without Specialist per year. As for the health clinics the average providers’ cost for a patient was RM385.92 per year. The cost difference was statistically significant (p0.05). The mean total costs of outpatient care were RM841.46, RM832.80 and RM458.01 per year for Hospital with Specialist, Hospital without Specialist and Health Clinics respectively. Level of care and length of stay were the influencing factors for inpatient provider’s cost. The overall provider’s cost for outpatient diabetic care was influenced by level of care, number of visits and complications. Cost of treating diabetes mellitus year 2004, was estimated at RM18,956,021.51 which was equivalent to 3.3% of total state health expenditure.
Conclusion : As much as 60.2 % was spent on management of outpatient diabetic care and 39.8% for management of inpatient diabetic care. Financial burden of diabetic care is predominantly for outpatient care. Therefore, effective and efficient management of outpatient care is needed to improve allocate efficiency, equity, accessibility and appropriateness of the health care system so that the health care services delivered to the nation are of good quality.
Introduction : Health management is a tool to ensure an effective running of health program and at the same time avoiding flaws to its components including patients, workers and the entire organization. Risk management is a new concept in health management where the determinants of the problems or the risks are put to minima. It’s strategies are oriented towards prevention as well as controlling to all its administrative system.
Methodology : This is a systematic review on various papers, studies and observations put forwards by risk management experts. It is also supported by feedbacks from many scholars who are involved in research and teaching.
Results : It is been observed that risk management activities have been on practiced in health care delivery system. It is not a new form, but rather a situational action based on certain issues. In fact, it happens in any organization – public or private. Close observation on this area has triggered development of various risk management models including some administrative standard and guidelines.
Conclusion: Risk management is a new approach that need to be practiced by all manager and leader. Its discipline involves interpretation of risk at all angles. It is not only confined to the explicit component, but should also be expended to others area as well. It needs a good sense and good attitude of the manager. The essence of risk management is to minimize the risk to patient, staff, public and the entire organization.
Introduction : Globalization has made health tourism possible and continues to flourish. For participating countries, this new industry rakes in billions of dollars a year, and is worth focusing on and being developed.
Objective : This write up aims to find out the history and success of health tourism in countries around the world, study the scenario in Malaysia and propose strategies which could make Malaysia prosper with this multibillion dollar industry.
Methodology: The methodology applied was compilation, data review and comparison from annual report, action plan report and articles.
Result : In the ASEAN region, Malaysia is making a mark in the health tourism industry, thanks to the availability of medical and technical expertise, political and economical stability, high quality infrastructure, and scenic beauty of the land. Nonetheless, despite all these, Malaysia has yet to be at par with her neighbours- Thailand, Singapore and India, in terms of the number of foreign patients and the revenue gained from this industry. Thus there is a serious and urgent need to conduct research to analyze the current situation and future prospects of health tourism in Malaysia. This industry is open to all countries around the world. It is those countries that can continually analyze and adapt that will prosper in the emerging medical tourism industry. Some of the key issues which need to be addressed are those of promotion, finding the niche market, branding, legislations, immigration and quality of healthcare. In addition to these, matters regarding human resource, particularly that of internal brain-drain, need to be looked into.
Conclusion : Malaysia has great potential of becoming the giant of the health tourism industry provided appropriate and timely actions are taken towards achieving it. The negative impact must not be ignored or overlooked; instead it must be thoroughly studied and rectified.
Introduction : Limited access to health services, variations in quality of health care and pressure to contain escalation of health care cost are problems in health care systems that are faced by all the societies in the world especially in developing countries. There is an urgent need to conduct a study to assess perception of individual towards health care services in the new planned National Healthcare Financing Scheme.
Objective : The study objective is to examine the perception towards health care services among the farming community and to assess the willingness to contribute to The New National Health Financing Scheme.
Methods : A cross sectional study involving farmers in the state of Selangor in Peninsular Malaysia was conducted. A total of 400 farmers as the household head were selected using multistage random sampling method.
Results : The respondents’ mean score of perception towards public healthcare services were higher than the respondents’ mean score of perceptions towards private healthcare services except for accessibility and convenience aspects. There was no association between willingness to contribute to The New National Healthcare Financing Scheme and perception towards public healthcare services but there was association between willingness to contribute to The New National Healthcare Financing Scheme and perception towards private healthcare services.
Conclusion : Perception towards healthcare services is an important element in the implementation of The New National Healthcare Financing Scheme as it will determine the willingness of an individual to contribute to it.
Background: Social misconduct amongst adolescents is a worrying and ever growing problem in Malaysia, despite efforts taken to overcome it.
Methods : A cross sectional study was conducted among secondary school students in Melaka Tengah District to measure the prevalence and determine the factors associated with social misconduct amongst adolescents. A total of 414 form four students were recruited by systematic random sampling fulfilling the study criteria between Jun to September 2008, from eight randomly selected secondary schools in the district. Data were collected using a structured self-administered questionnaire and analyzed using SPSS software version 12.0. Socio-demographic, housing and family factors in relation with social misconduct were studied.
Results : The prevalence of the social misconduct in this study was 70.5%. The most prevalent misconduct includes loitering (37.4%), truancy (30.0%), watching pornographic films (28.7%), and involved in pre-sexual activities (23.7%). The factors that showed significant association with social misconduct were sex and race.
Conclusion : The prevalence of social misconduct is high among adolescent and males as well as Malays are at higher risk. Activities planned for adolescents should be stressed on the danger and effects of social misconduct and be more focused towards male and Malay adolescents.
Aims : The review was to determine the prevalence of needlestick injury especially among health care personnel and to determine the score of knowledge and compliance to the Standard Universal Precaution.
Method : Twelve theses were reviewed from year 1996 to 2007 of Master in Community Health Science, Master in Community Health and Postgraduate Diploma in Occupational Health of Community Health Department Universiti Kebangsaan Malaysia Medical Center involving of 1645 respondents of health care personnel, support staff and student of nursing and medical. Eleven studies were cross sectional design and only one study was retrospective.
Results : Respondents were dominated by female (74.6%) and Malay ethnicity (65%), as young as 19 years old to 56 years old of age. Majority had received Hepatitis B vaccination (79.4%) but only 37.1% had completed the 3 doses regime. The incidence of episodes of needle stick injury among health care personnel was double (53.7%) compared to final year medical students (20.9%). Needle stick injuries did not occur at random as there were a few health care personnel injured repeatedly. Those who had higher mean or median score for compliance to Standard Universal Precaution were non case of needlestick injury. Work practices had been highlighted in few studies of being risk factors for needlestick injury such as blood withdrawing related activities. Other risk factors were job category, predictive factor for compliance to Standard Universal Precaution, risk perception and training.
Conclusion : Even though the review could not extrapolated to general population of healthcare personnel but it gave some illustrated pictures to what had happened in small clustered locations. Episodes of needle stick injury was 53.7% for past 12 years, it was double in comparison to final year medical students in year 2001. 13.2% were injured repeatedly. The score of knowledge was more the 50% of range but compliance to Standard Precaution made differences in being cases or non cases among respondents. The seroconversion status till date was unknown.
Background : Family planning is a method to control family size and to increase the intervals between chidbirths using multiple methods of contraceptives.
Objectives : This study aims to determine the pravelance of family planning practice among married women (wife less than 55 years old) and its related factors and also to determine the husbands knowledge on family planning and their support.
Methodology : This is a cross sectional study done through direct interviews amongst 118 married couples in Kampung Sesapan Batu Mingkabau, Hulu Langat Selangor.
Results : On family planning practise, 43.2% of couples is currently practising, 22.0% have practiced but stopped and 34.8% have never used any types of family planning methods. As high as 75% of wives received support from their husband to pratice family planning. There is a significant association between family planning practice and wife’s age, husband’s age, wife’s occupation, wife’s education, wife’s knowledge and husband’s support. Husband’s knowledge , number of live children and husband’s education have no significant assocation in influencing family planning practice.
Conclusion : To achieve better knowledge and family planning practises, husband’s involvement and support must be encouraged to ensure the correct informations and support are delivered to both couples. Approach through husbands is regarded as one of the key factors to the success of rural women family planning practice.
Introduction : Shift work is practised in manufacturing industry to increase production capacity up to three times compared to the normal daily eight hours working system and able to optimize the utilization of machine and equipment. However, shift work has negatif effects on human social interaction, health and safety.
Methodology : The study was conducted to evaluate production workers’ perception on the effects of working at night shift. The respondents of the study were production workers in Company X in Kuala Lumpur. The Data was collected using self administered questionnaires. The study objectives was to study the work schedule design, to find out their perceptions on the effects of night shift and to study on personal factors, employees’ level of acceptance on the work schedule design and personal factors that cause safety and health disruption.
Result : A total of 200 production workers participated in the study. The result of the study shows 61% of production workers took sick leave and 43.5% were absent between 1 and 2 times a month. In terms of health and safety disruption, 77% of respondents agreed that they faced lack of focus with family and friends, 75.5% of them did not have enough sleep and 76.5% felt sleepy during working time. Regarding the work schedule and workstation design, 81.5% said they felt uncomfortable because they were required to stand during working and 77% felt that the resting period provided by the factory was too short and inadequate. More than 70% of the respondents proposed the rest period should be extended from the current 40 minutes to one hour. More than 80% of respondents agreed they would feel comfortable if standing at work is changed to sitting work system.
Conclusion : To minimize the unwanted effect of night shift among the production.
Introduction : A retrospective cohort study was conducted among ESRD who received dialysis treatment (Haemodialysis and CAPD) in all government hospitals in the State of Pahang from 1st January 2000 to 31st December 2004.
Objective : The aim of the study was to identify factors affecting the survival of patients undergoing dialysis in the state of Pahang.
Methods : Survival time was measured from the date of dialysis until the subjects died, lost to follow up or until the end of the study period at 31st December 2004.
Results : Diabetes mellitus was the major cause for ESRD (33%) out of 132 subjects eligible for the study. Seven (7.1%) and five (15.2%) deaths occurred among haemodialysis and CAPD patients respectively, but statistically of no difference between the two treatments (log-rank, p=0.093). Factors influencing the survival of haemodialysis patients were diabetes mellitus (p=0.014), albumin (p=0.0005), creatinine (p=0.020) and hemoglobin level (p=0.002), while age of treatment and diabetes mellitus affecting the survival of CAPD patient. Cox Proportional Hazard Regression showed that haemodialysis subjects with low albumin (HR 0.669 df 95% 0.513 - 0.873) and hemoglobin (HR 0.403 df 95% 0.225 - 0.720) level had lower survival rate but none for CAPD.
Conclusion : Good nutritional status, higher hemoglobin level and prevention of diabetes mellitus are important for the survival of haemodialysis patient.
Introduction : Stress is part of our life. It can happen anywhere including in medical school. Medical school is perceived as being stressful because their difficulties in education, longest period of study and dealing with the patients. Stress can be perceive as negative or positive. Coping strategies are the method that we can use to prevent stress when it comes to us. The aim of this study was to determine the prevalence of stress and coping strategies among of medical students in National University of Malaysia, Malaysia University of Sabah and Universiti Kuala Lumpur Royal College of Medicine Perak.
Methods : This study involved 450 medical students through stratified sampling in which 150 medical students from each of the three universities. This study was conducted through self administered questionnaires. The questionnaires included were socio demographic factor, Personal Stress Inventory (using Stress Symptoms Scale with 52 items), BRIEF COPE (Coping Orientation for Problems Experienced with 28 items). The determination of cut off point for stress symptoms score was using Receiver Operating Characteristic (ROC) curve.
Results : Response rate was 90.8%. The prevalence of stress among medical students were 44.1%. The contributory factors to the stress were financial problems, stress of up coming examination period, relationship problems with parents, peers, siblings and lecturers. Coping mechanisms which had significant association with stress includes self distraction, venting of emotion, denial, behavioral disengagement, humor and self blaming. Multiple linear regression analysis revealed a significant association (p