Displaying publications 41 - 60 of 438 in total

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  1. Siti Fatimah M, Rosminah M, Suhaimi A, Omar O
    Hajj and ‘Umrah pilgrimage are a huge congregation performed by Muslims in Makkah, Saudi Arabia. The pilgrimage causes overcrowding and congestion that can lead to a high risk of health problems, especially when pilgrims have health problems. The purpose of this study is to assess the reliability of EQ-5D as a measuring tool to capture the health status of the pilgrims. Data collection was done during Ramadhan’s ‘Umrah in 2014. In this cross-sectional study, a total of 300 self-administered questionnaires attached with the EQ-5D-5L questions were distributed to Malaysian ‘Umrah pilgrims in Makkah and willing to participate in the study. The outcomes from the questionnaires and EQ-5D-5L were systematically analysed by using the SPSS software. The response rate was 64%, involved female (53%) and male (47%) respondents with the mean age of 55 years old. Hypertension (21.5%) and diabetes (16.2%) were the commonest underlying health problems suffered by the respondents in this study. Based on the EQ-5D outcomes, 53.3% of the respondents had no problem in their movement. However, the mean of EQ-VAS (visual analogue scale) presented 83 out of 100 scaling point, which means they might have problems in their health status. In addition, this study revealed, respondents with underlying illnesses had difficulty in some dimensions in EQ-5D. Hypertension was identified as the commonest underlying disease amongst the pilgrims. A contradicted outcome from the objective and subjective measuring scales of EQ-5D and EQ-VAS respectively; presented its sensitivity of EuroQol as a measuring tool for the quality of life among pilgrims living within such congestion.
  2. Abdul Rashid, K., Gomathy, S., Ab Manan, A.
    MyJurnal
    Majority of doctors show no interest in research although research is now a requirement and is being done in every field of medicine. The objective of this survey was to describe the involvement in research activities among doctors in Penang and Seberang Jaya hospitals in Penang. A self-administered questionnaire was used. A total of 302 doctors participated in the survey. The differences in age (p=
  3. Ade Suzana Eka Putri, Syed Mohamed Aljunid, Amrizal Muhammad Nur
    MyJurnal
    Indonesian government secures the access of the poor towards health services through subsidised schemes. This study is aimed to describe the pattern of health expenditure by households and to describe the pattern of health service utilisation across household’s socioeconomic level in the city of Padang after seven years of the introduction of subsidised schemes. A household survey was conducted involving 918 households, with multistage random sampling method. The proportion of out-of-pocket (OOP) health spending as a share of household’s capacity to pay was regressive across consumption quintiles. The proportion of households with catastrophic health expenditure was 1.6% while 1.1% faced impoverished health expenses. Among those who need health care, the utilisation among the rich was higher than the poor. Health insurance schemes in Padang provides financial protection, however with regards to household’s capacity to pay, the poor has the higher burden of health payment. The gap on health service utilisation between the poor and the better-offs was still apparent for outpatient services and it has been narrowed for inpatient care. This study suggests that the subsidised schemes for the poor are highly needed and the possibility of the leakage of subsidies to the rich should be considered by the government.
  4. Zulhaidi, M.J., Baba, M.D., Mohd Hanif, S., Ahmad Azad, A.R.
    MyJurnal
    This study aims to determine the job satisfaction (JS) level among professional driving instructors (PDIs) in the driver
    training and licensing system in Malaysia. Specifically, it looks at the influence of income level and remuneration
    scheme on PDI’s satisfaction. The average income of PDI is relatively low with three remuneration schemes: fixed
    income; fixed income plus commission; and commission only. The study adopted the cross-sectional survey using the
    20-item Minnesota Job Satisfaction Questionnaire (MSQ) (short-form) with end-specified 10-point scale. Analysis of
    the data revealed that PDIs with higher income are more satisfied with their job, t (179) = -3.248, p = 0.001.
    Similarly, three level One-way ANOVA of JS scores with three remuneration schemes revealed a significant difference
    of JS across these schemes, F (2,178) = 3.51, p ≤ 0.032. Researchers’ further exploration found a significant
    interaction between these two variables (income level vs. remuneration scheme), F (5,175) = 4.88, p = 0.001. In
    general, PDIs with higher income are more satisfied with their job only if they received it as a fixed income
    (regardless of having commission or not). This insightful finding can be a basis for relevant stakeholders in
    understanding the influence of income and remuneration scheme towards JS among PDIs in Malaysia.
  5. Nurul Atikah Zuhairi, Yau, Meng Kuan, Faudziah Abd Manan, Knight, Victor Feizal, Rokiah Omar
    MyJurnal
    The lack of awareness about comprehensive eye examination amongst athletes could impact their eye health, hence it needs to be addressed. The authors hypothesize that a majority of athletes in Malaysia have never undergone a thorough eye examination. The present study aims to determine Malaysian athletes’ awareness of the importance of eye assessment. One hundred and twenty-one junior athletes, aged 13 to 16 years participated in the visual screening programme. A questionnaire consisting of fourteen dichotomous questions was developed in two languages, each being English and Malay language and administered prior to eye examination. The questionnaire was designed to measure self-reported visual function, ocular symptoms, and perceptions towards eye health. Questionnaire analysis showed 67.8% of participants never underwent any eye examination. A majority of participants, 66.9% and 75.2%, complained of visual and ocular symptoms respectively. The critical finding of this study showed that 57.9% of participants had reduced vision which could be visually corrected. Overall 90.9% of the participants agreed that eye examination was important. Almost none of the athletes owned any sports safety eyewear nor had undergone any visual training. The importance of wearing protective eyewear during sports needs to be given emphasis. This study implies that athletes' awareness of eye health, as well as visually related issues, is still at a very low level. Hence, the need for comprehensive eye examination and regular review among athletes’ needs to be emphasized. Athletes should also be educated on the importance of regular eye examinations from a young age.
  6. Aniza Ismail, Ahmad Taufik Jamil, Ahmad Fareed A Rahman, Jannatul Madihah Abu Bakar, Natrah Mohd Saad, Hussain Saadi
    MyJurnal
    Hospital Information System (HIS) is a comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital. This study is to describe those aspects of the implementation of hospital information system in three tertiary hospitals in Klang Valley; Serdang Hospital, Selayang Hospital and University Kebangsaan Malaysia Medical Centre (UKMMC). A qualitative study was conducted to obtain views on information system development and implementation in the hospitals mentioned above. In-depth interviews with personnel representing both the system providers and the end-users were done guided by a questionnaire. The results of the interviews were categorized into few themes namely the system development, human resource, scope of implementation, support system, user-friendly, training, hardware and security. There were differences in hospital information system development and implementation in the three hospitals. Each system has its own strengths and weaknesses that make it unique. In developing HIS, its important to ensure the system can work effectively and efficiently. Quality human resource, good support system, user-friendly and adequate training of the end-user will determine the success of implementation of HIS. Upgrading of hardware and software as needed is the basis to keep up with the pace of technology advancement and increasing number of patients. It is hoped that HIS will be implemented in all other hospitals with effective integration and networking.
  7. Phua, K.L.
    MyJurnal
    The Orang Asli of Malaysia continue to experience poor health. There appears to be stagnation of certain aspect of their health status. Underweight (low weight-for-age) and stunting (low height-for-age) are significant amongst Orang Asli children. Worm infestation such as Ascaris, Trichuris and hookworm continue to afflict Orang Asli communities in Malaysia. Orang Asli communities can also be afflicted by other kinds of parasites, e.g. malaria parasites, microsporida parasites and Cryptosporidium parasites. Thus, primary care doctors who treat Orang Asli patients should be on the lookout for malnutrition and its effects (including anaemia, iodine deficiency, Vitamin A deficiency) as well as worm and parasite infestations. Such patients may need to undergo de-worming at regular intervals because of the tendency to get re-infected. Primary care doctors also need to be aware of possible interactions between infestations and nutritional deficiencies.
  8. Aishah Knight, A.S.
    MyJurnal
    Cancer screening is an important part of any cancer control program and the success of any screening program is partly dependent on having large numbers of the high risk population availing themselves of the service. The purpose of this study was to assess the cancer screening behavior of fulbtime employed women staff of an institute of higher learning using the Health Belief Model (HBM) construct. The results showed that the rate of reported regular cancer screening behavior (Pap smear screening, breast self examination (BSE), clinical breast examination (CBE) and mammography screening) were low. The rates for regular screening were 42.5% (Pap smear), 20.9% (BSE), 15.5% (CBE) and 9.4% (mammography). There were differences in the dimensions of the HBM between the women who reported regular screening and those that did not. The perceived barriers", "perceived benefits” and “motivation” dimensions were different in Pap smear screening, whereas the "confidence” dimension was different in BSE. Recommendations were made for a health education program targeting both women and men to increase uptake of cancer screening services by women.
  9. Badrul Hisham Abd Samad, Nooraini Baba, Mohd.Raili Suhaili, Prathapa Senan, C., Daud Abd.Rahim
    MyJurnal
    The hand, foot, and mouth disease (HFMD) outbreak occurred in the state of Johor, Malaysia in the months 0f October and November 2000 aber the HFMD outbreak started in Singapore in September 2000. The HFMD notification and investigation forms sent to the Epidemiology Unit of the Johor Health Department from district health offices and hospitals during the outbreak were analysed. Patients’ specimens were sent to the Institute for Medical Research, Kuala Lumpur and the Universiti Malaya Medical Centre, Kuala Lumpur for viral isolation. A total of 1,122 HFMD cases were notified during the outbreak period with 2 deaths giving 0.2% casefatality rate. From all the cases, 544 (48.5%) patients were admitted to the hospital while the rest were treated as outpatients. Majority (81.7%) of children with HFMD were aged below 5 years old with the commonest age group (46.9%) being between 1 to 2 years old. Sixty-eight patients had positive specimens for viral isolation belonging to enteroviruses namely Enterovirus 71 (43 cases), Coxsackievirus Type A16 (11), Echovirus 7 (3), and Coxsackievirus Type B (2); and non-enteroviruses namely Herpes Simplex Virus Type 1
    (5), and Adenovirus (4). Fever and mouth ulcer were the two most common symptoms among HFMD children but vesicles on palms and soles were more common than rashes in children with positive enteroviral isolation.

    Study site: University Malaya Medical Centre (UMMC)
  10. Abuduli, Maihebureti, Zaleha Md Isa, Syed Mohamed Aljunid
    MyJurnal
    Although the Ministry of Health Malaysia has been encouraging the practice of Traditional and Complementary Medicine (T&CM)1, 2 , 3, 4 but patients/clients has not been able to apply it for their need of medical treatments and sometimes it leads to negative outcomes due to lack of knowledge on T&CM and its safe applications5,6’ 7,8 Most of the western-trained physicians are ignorant of risk and benefits of T&CM9,10,11 . This study was aimed to determine the gap between knowledge regarding T&CM and perception on education in T&CM among the medical staffs in five selected hospitals in Malaysia. A cross-sectional survey was done at five public hospitals among medical staff in Malaysia by using quantitative methods. A total of 477 medical staffs were involved in this study. The study showed that the overall knowledge of T&CM among the medical staffs were poor (61.2%). Having good knowledge regarding T&CM were significantly higher in Hospital Duchess of Kent (52%, p=0.001), among the non-Malays (44%, p=0.047) and pharmacists (47.2%, p=0.030). Positive perception on health education in T&CM among medical staffs were high (85.3%) especially among females (88.1%, p=0.002) and pharmacists (93.7%, p< 0.001). The use of T&CM among the general population is relatively high in Malaysia and many patients increasingly seek the information on T&CM therapies from medical staffs. Knowledge regarding T&CM was poor in this study because most of the medical staffs have not been exposed to T&CM education. This interesting scenario between poor knowledge and high positive perception on health education in T&CM shows the demand of urgent intervention in educating the medical staffs. We recommend that medical staffs must have some basic education and knowledge about T&CM before they could offer advice to their patients. Doctors are of the utmost important in this regard because they play a very important role in patient care. Providing T&CM education to medical staff may help to integrate T&CM into the mainstream medicine.
  11. Nor Radhiah M, Rosminah M, Suhaimi A, Omar O
    The large population of human congestion in Makkah during Hajj would promote contagious diseases. Thus, the pilgrims require health care services that are efficient, effective, and high quality. The aim of this study is to determine the type of health-related problems among Malaysian pilgrims and to identify the health care services required by them during Hajj in Makkah. A cross-sectional study was conducted in which involved 379 Malaysian pilgrims in 2013/14234H. The survey was conducted after the pilgrims completed their Hajj ritual. A total of 400 sets of questionnaires were distributed at Abraj Janadriyah Hotel, which was occupied by more than 3000 Malaysian pilgrims. The response rate for this survey was 93%. Male respondents were constituted of 49.6% and female respondents were 50.4% with the mean age 52 years old. The underlying disease among Malaysian pilgrims during Hajj was respiratory disease (77.5%). The demands for health personnel (36.1%) and quality medication (34.7%) are among the important healthcare services required by the Malaysian pilgrims in Makkah. Respiratory disease is a common disease experienced by Malaysian pilgrims in Makkah. A certain types of services such as health personnel and quality medicine are strongly demanded by the Malaysian pilgrims to overcome their health problem during Hajj. This research provides a fundamental input to the health care providers, and also benefited the Hajj management authority to improve the quality of hajj management in future.
  12. Nor Radhiah, M.N., Rosminah, M., Suhaimi, A.W., Omar, O.
    MyJurnal
    The large population of human congestion in Makkah during Hajj would promote contagious diseases. Thus, the pilgrims require health care services that are efficient, effective, and high quality. The aim of this study is to determine the type of health-related problems among Malaysian pilgrims and to identify the health care services required by them during Hajj in Makkah. A cross-sectional study was conducted in which involved 379 Malaysian pilgrims in 2013/14234H. The survey was conducted after the pilgrims completed their Hajj ritual. A total of 400 sets of questionnaires were distributed at Abraj Janadriyah Hotel, which was occupied by more than 3000 Malaysian pilgrims. The response rate for this survey was 93%. Male respondents were constituted of 49.6% and female respondents were 50.4% with the mean age 52 years old. The underlying disease among Malaysian pilgrims during Hajj was respiratory disease (77.5%). The demands for health personnel (36.1%) and quality medication (34.7%) are among the important healthcare services required by the Malaysian pilgrims in Makkah. Respiratory disease is a common disease experienced by Malaysian pilgrims in Makkah. A certain types of services such as health personnel and quality medicine are strongly demanded by the Malaysian pilgrims to overcome their health problem during Hajj. This research provides a fundamental input to the health care providers, and also benefited the Hajj management authority to improve the quality of hajj management in future.
  13. Adlina, S., Narimah, A.H.H., Ahmad Fahmi, A.Z., Iskandar, M.A., Nur Amirah, S., Nurul Farahiyah, A., et al.
    MyJurnal
    A cross-sectional study was conducted in May 2007 on stress and stress self management among the prisoners and wardens of a prison in Selangor. This study was conducted as part of an elective posting for second year medical students and the topic was chosen to add on to the body of knowledge on stress among prisoners and wardens. A self administered questionnaire was distributed by random sampling and the respondents consisted of 100 prisoners and 97 wardens. Majority of the prisoners did not have stress with reference to interpersonal factors such as conflict with cellmates, conflict with wardens and conflict with inmates, For interpersonal factors, majority of the prisoners experienced stress because they felt bored (78%), thought they had no bright future (63%) and they also had no visitors (61%). Stress resulted in physical effects, whereby 67% admitted that they experienced health problems and 64% experienced sleep disturbance. Emotional effects of stress experienced by the prisoners were sadness (67%), anxiousness (63%) and confusion (56%). The major spiritual effect was regret (84%) followed by feeling closer to God (78%) and feeling high spirited (59%). The major social effects experienced by
    the prisoners were low self esteem (63%) and embarrassment (58%). Methods of stress self management were prayers and conduct of religious activities (87%), sharing problems with friends (78%), doing recreational activities (77%), sleeping (72%) , doing a hobby (68) and seeking help from doctors (57%). As for the wardens, with reference to interpersonal factors, high level of stress was experience with reference ta prisoners behavior (82.5%) and problems with higher authorities (83.5 %), For intrapersonal factors, sleep disturbances (64%), career problems (76.3%), financial problems (73.2%) and feeling bored (75.3%) highly contributed to stress. Wardens physical effects were 38.1% health problems and 29.9% sleep disturbances. For emotional effects, must of them were depressed (54.6%), anxious (67%), angry (63.9%), confused (64.9%), frustrated (59.8%), threatened (53.6%) and patriotic (51.5%). The spiritual effect were feeling closer to God (86.6%), feeling responsible for duties (82.5%), regret doing the job (74.2%), feeling high spirited (58.8%). For social effects, low self esteem is the highest effect experienced (68%). Wardens managed stress by praying and conducting religious activities (91.8%), recreational activities (88.7%), doing a hobby (85.6%), sleeping (74.2%), and sharing problems (68%).
  14. Saperi Sulong, Haris Cendera Khazaani Osman, Aniza Ismail
    MyJurnal
    The rapid development in the health sector has spurred many healthcare organizations to improve their productivity and quality, particularly in terms of service. Clinical Pathways was introduced with the objective of improving the quality of care and services in health; while at the same time eyeing the possibility of reducing the medical expenses. It can be defined as a document based tool that links the best available evidence and clinical practice and provides recommendations, the process and time frame for the clinical management of healthcare. A cross sectional study was carried out at University Kebangsaan Malaysia Medical Centre (UKMMC) Malaysia with the aim to evaluate the level of knowledge about Clinical Pathways (CP) and to ascertain its level of practice in the implementation of CP among healthcare workers at UKMMC; and to establish correlated determinant factors. The study involved a total of 127 respondents; majority of whom were female (77.2%), aged between 32 and 45 years (51.2%), working as nurses (71.7%), and having working experience of six years or longer (52.0%) at UKMMC. The findings reveal that 52.8% of respondents agreed that there is a proper implementation of the Clinical Pathways (CP) programme at UKMMC; and that 52.0% of the respondents have a higher level of knowledge about CP and 70.1% of them practiced it well. The findings also unravel two factors (position and working experience) as the predictors of respondents’ level of knowledge about CP, and position as a predictor representing the practice of it at UKMMC. It can be safely surmised that most of the respondents have a higher level of knowledge about Clinical Pathways and that they practice it well in their daily task as healthcare workers.
  15. Noor, N.S.M., Ghazalli, Z., Mamat, R., Kadirgama, K., Sani, M.S.M., Ahmad, Z., et al.
    MyJurnal
    Seating comfort is one of the important indicators while driving especially for a long hour drive. The objective of this study was to execute a preliminary study of survey and identify the discomfort of body while driving and after driving session by conducting a survey. The questionnaire developed was tested for its reliability. By using Cronbach’s Alpha, this paper’s contribution was found to be significant in which it provides a survey with acceptable test reliability in which the alpha (α) was 0.887. The survey was conducted on 30 students of University Malaysia Pahang (20 male and 10 female) with driving experience and valid driving license. The subjects should have experiences in driving small size car or mini car as well. The results showed that the body area that the drivers felt discomfort while driving and after driving should be known. The findings showed that the discomfort was intense at the neck, upper back, and lumbar while and after driving.
  16. Mohd Syazwan Solah, Baba Md Deros, Zulhaidi Mohd Jawi, Nur Zarifah Harun, Azhar Hamzah, Aqbal Hafeez Ariffin
    MyJurnal
    Mobile phone distraction is a global issue in road safety perspective especially involving the pedestrians. A lot of
    research findings had suggested that the use of mobile phone increase the risk for pedestrians while crossing the
    road, but there have been very few studies that could explain the said threat in Malaysia’s situation. This study aims
    to identify the distracted pedestrian behaviour via the video recording method. More than 300 samples were
    observed as involved in mobile phone distractions while crossing the roads from a total of approximately 1,500
    analysed samples. The study also found that the highest mode of distraction observed among pedestrians was the
    “handheld usage” (conversing) as compared to the “hands-free” and “application usage” modes. In addition, the
    distractions had significantly affected the time to cross and the observed road users who were involved in
    “application usage” took longer time to cross. These results provide a prevalence material that may be useful in the
    development of countermeasures.
  17. Zailina Hashim, Wee, Bee Suan, Juliana Jalaludin, Jamal H. Hashim
    MyJurnal
    Cr0ss»sectional studies on lung functions of 100 smokers and 100 non-smokers was conducted among a university student population. The objectives of the studies were to determine the correlation between the lung functions with smoking frequency and duration among smokers as well as to compare the lung functions with non-smokers. The smokers’ mean age was 20.74 years, their smoking initiation age was 16.18 years, the smoking duration was 4.41 years and the smoking frequency was 8.72 cigarettes per day. Among smokers, signqicant inverse correlation was shown between FEV] predicted and the smoking frequency (number of cigarette per day) (ri-0.241, p=0.016). Multiple regression confirmed the relationship between FEV]% predicted with respondent’s age (p=0.013) and smoking frequency (p=0.002), FVC% predicted with age (p=0.005) and smoking frequency (p=0.009). The FEV;/FVC% predicted was signyicantly related to phlegm symptoms (p=0.03), while the FEFZ5.y5% predicted was signdicantly related to age (p=0.005), height (p=0.043) and smoking duration (p=0.046). The lung functions (FEV1% predicted, FVC% predicted and FEV]/FVC% predicted ) for smokers were not statistically dyferent from non-smokers. This study showed that the lung functions for the smokers were still quite normal due to their short smoking duration, their low number of cigarette smoked per day and their young age.
  18. Ismail, A.H., Deros, B.M., Khamis, N.K.
    MyJurnal
    Discomfort and pain issue at the body part are common complaints reported by car drivers. It is due to driving task
    require physical demands and need to maintain and adapt several postures in a constrained space while controlling
    the car. Hence, this study aims to determine the pattern of shoulder activation muscle consisting of the Trapezius
    muscle in two different driving posture. Respondents were required to grasp the steering wheel at 8 and 4 hand
    position. The Surface Electromyography was used to get the reading for left muscle’s Trapezius Descendent (TD) at
    two different positions; i) closest distant from steering wheel and ii) far distant from the steering wheel. Then,
    Temporal Analysis was used to evaluate the pattern of the driving action. From the experiment, it shows the
    different value of muscle activation occurred while driving according to turning action. The far seated position
    depicted greater activation on driving action compared to the closer seated to the steering wheel. In conclusion, the
    driving posture effects the activation of shoulder and arm’s muscles as early as after 20 seconds of driving activity.
    Hence, choosing the correct driving posture allowed a comfortable driving environment for the driver.
  19. Nazlin, H.A., Siti Zawiah, M.D.
    MyJurnal
    This study focuses on the application of the Malaysian Driving Behaviour Questionnaire(DBQ). The aim of this study is
    to investigate and analyse the significant driving behaviour of the ageing Malaysian automobile drivers. The sets of
    questionnaire was completed by a total number of 102 ageing drivers consists of 58 males (56.86%) and 44 females
    (43.14%). The age of respondents ranges from 50 to 75 years (M = 57.21) and (SD = 5.60). The DBQ contains 12 items
    of demographic questions and 41 items measuring driving behaviour in traffic. The driving behaviours were classified
    into four factors which are driving distractions, violations, errors and lapses. The most significant correlation
    coefficient is between age and distractions (r = 0.456, p
  20. Noriah, B., Roslan Johari, M.G., Teng, Seng Chong, Tahir, A., Nadhirah, R.
    MyJurnal
    The purpose of this study was to determine the quality of counter service at the Ministry of Health hospitals as perceived by patients. This was a cross sectional study using selfadrninistered questionnaires distributed to patients at the outpatient departments in all Ministry of Health Hospitals. By the end ofthe data collection period, 118 of 121 hospitals (total number of MOH Hospitals) participated with 93.2% response rate., The hospitals were divided into four categories, for the purpose of this study 1000 sample size were needed in each category, the number of sample size were obtained using Epi Info Program based on assumption that 30% Of patients were dissatisyded with the services provided and with a precision of 10%. In this study the quality were based on clarity and provision of services based on Client Charten deliverance of clear infomation by the healthcare personnel, priority treatment given to urgency of the cases, cleanliness of the facilities and teamwork among the staff This study revealed about 64% of patients perceived that the hospitals had provided quality services at the counter: Only about 11% of patients were not happy with the quality of the services given at the counter. The proportion of happy patients increased from the smaller to the bigger hospitals. In terms of delivering services according to the Client Charter; only about 15% said that service was not provided by the counter staff according to the Client’s Charter On the aspect of priority on the urgent cases, about 64% of the patients perceived that urgent cases were not seen immediately. About 64% of the respondents felt that the hospitah do provide quality services. Strategies should focus on the bigger hospitals because non conformance to quality occurs more frequently there. The post of Counter Supervisor should be created to ensure that quality services are delivered.

    Study site: outpatient departments in all Ministry of Health Hospitals
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