A retrospective epidemiological study was done on 41 deaths among patients treated for TB in the Klang Chest Clinic for the year 1999. The findings revealed a male preponderance of TB deaths with Indians having the highest case fatality rate (8.6%). The majority of deaths occurred within the 25-44 year age group. Of those cases diagnosed as Pulmonary TB, 69% were diagnosed as far-advanced, at presentation, based on chest x-rays reported. Eighty three percent of these patients were still on treatment when they died. HIV was the most common co-existing disease condition and was implicated in 14.6% of the deaths. The recommendations include implementation of clinical guidelines on TB screening for HIV patients, a study to evaluate the effectiveness of the current TB surveillance programme and for chest x-rays of all sputum smear negative patients to be reported by the radiologist to reduce the risk of misdiagnosis.
Study site: Chest clinic, Kelang, Selangor, Malaysia
A retrospective study of the incidence of Giant Papillary Conjunctivitis (GPC) seen in the Optometry clinic in Universiti Kebangsaan Malaysia from 1989 to 1994 was carried out. In the period of the 6 years, 37 contact wearers were diagnosed to have GPC. Of the 37 patients, 21 were Malays (57%), 12 were Chinese (32%) and the remaining 4 patients were Indians (11%). 18 or 48% of those with GPC were soft lens wearers, 46% of the wearers (17 patients) were rigid gas permeable lens wearers and 1 of the patients seen was a hard (PMMA) wearer (3%) and the other one was a disposable lens wearer (3%). Thirty patients were female (81%) and 7 (19%) were male. The age range of those with GPC were between 9 to 60 years old.
Study site: Optometry clinic, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Background: Diabetes quality of life (DQoL) instrument has been widely used to measure quality of life among diabetes patients. This study aimed to develop a revised version of DQoL instrument that incorporated issues of redundancies in the items and strengthen the basis of validity of the instrument.
Methods: This was a cross-sectional study where diabetes patients were recruited from December 1, 2014, until end of March 2015 at a public health clinic in Peninsular Malaysia. A questionnaire that included patients' information and DQoL instrument was distributed to patients. Item selection of DQoL instrument was conducted to screen and finalize the items based on issues of missing values and redundancy. Validity testing was conducted for the revised DQoL instrument based on exploratory factor analysis, confirmatory factor analysis, and Rasch analysis.
Results: The pattern structure matrix yielded three domains similar to the original version with 18 items. The minimum factor loading from the structure matrix was 0.358. The item's and person's reliability was excellent with 0.92 and 0.84 for "satisfaction" domain, 0.98 and 0.60 for "impact" domain, and 0.99 and 0.57 for "worry" domain, respectively. Confirmatory factor analysis has dropped 5 items and the revised version of DQoL contained 13 items. Composite reliability of the revised version was computed for "satisfaction" domain (0.922; 95% CI: 0.909-0.936), "impact" domain (0.781; 95% CI: 0.745-0.818), and "worry" domain (0.794; 95% CI: 0.755-0.832).
Conclusion: A revised version of DQoL that maintains the conceptualization of "satisfaction," "impact," and "worry" with 13 items was successfully developed.
Introduction: Continuous quality improvement of system is essential to improve efficiency of working environ- ment. Limited financial allocation in low resource setting results in the vicious circle of having inadequate money to purchase a new system and print paper documents that are required for the operation of clinic. A staff-initiated system improvement with the name of “PRW UMS Staff Portal” was attempted to break-free from the vicious cycle. Methods: An online system covering different aspects of routine clinical work of healthcare workers was created in Dec 2019 and implemented in Feb 2020 using Google SiteTM by the nurses of a local university community clinic, which included: submission of daily reports of nurses and assistant medical officers, submission of reports of all programmes conducted by the clinic, surveillance of health status of working staffs, announcement and request of working roster, archiving of documents, and medication inventory. The system could only be accessed using official working email for general documents while accesses to sensitive documents were restricted to relevant staffs to pro- tect privacy and confidentiality of information. Qualitative interviews were performed with all nursing staff involved. Results: Qualitative feeling of improvement in coordination of workflow was reported by all 23 staffs working in the clinic in view of the easy access of system using smartphone and computer at workstation. It also reduced the need to move away from the working station in order to access, replenish, or submit the printed documents and reports. Significant amount of paper and printing were saved monthly. Conclusions: Despite positive feedback from the staffs, the system requires further improvement in terms of function and security. Further evaluation on cost-efficiency of the system can be done to promote the system to other universities.
This is a prospective study of clinical questions generated in primary care consultations and a comparison of two approaches to answering those clinical questions. Twenty-one doctors in a university-based primary care clinic submitted 78 clinical questions arising from patient consultations during 24 clinic days (0.01 question per patient encounter). These doctors subsequently found answers to 40% of their questions but were satisfied with only 67% of these answers. The investigators were able to provide answers for 95% of the questions asked and the doctors rated these answers as satisfactory in 86% of instances. Answers obtained by investigators had significantly higher satisfaction score than those obtained by doctors' search (p = 0.002). The two main findings of this study are (1) almost all questions arising in clinic setting could be answered by intensive search; (2) answers found by intensive searches were judged to be more satisfactory than those found routinely by doctors. Provision of an information retrieval service in addition to training in the searching and appraisal of medical literature are possible solutions to the information needs of busy clinicians.
Study site: Primary Care Clinic,
University Hospital Kuala Lumpur i
A total of 44 patients suspected of streptococcal infections were studied in outpatient clinics in Tokyo during the one year from December 1988 to December 1989. Employing bacteriological culturing and serodiagnosis, the following results were obtained. 1) There were 9 cases of impetigo and 15 cases of erysipelas with typical clinical manifestations and age distributions. 2) It seemed that some of the skin infections were caused by group A streptococci whose M-types were different from those of upper respiratory infections typically occurring in Japan. 3) The type distribution of group A streptococci found were quite similar to those isolated in Thailand or Malaysia. 4) There were found group A streptococci exhibiting unique combinations of T- and M-types, such as T11 and M9, T11 and M62 or T13-49 and MOD8 (Provisional type). 5) As for serodiagnostic method, ADNB (anti-deoxyribonuclease B) titer reflected infection by group A streptococcus only, while ASK (anti-streptokinase) and ASO (anti-streptolysin O) reflected not only group A streptococcal infections but group G infections as well.
The aim of this study is to describe the epidemiological features of HFMD outbreak in the Hulu Langat District in 2000. Until November 2000, a total of 60 cases were reported and the worst ever reported to the previous years. The mean age of patients was 3.9; 5.8 years with majority of the cases aged between 1 to 4 years old (53.8 per 100,000 of population), male gender (8.3 per 100,000 of populations), and were of Chinese (12.2 per 11 100,000 of populations) and Malay ethnicity (7.2 per 100.000 of populations). All cases were uncomplicated cases and were diagnosed clinically. Most of the notified cases were front the government facilities, which are 44 cases (73.3%). Thirty-five (35) cases (58.4%) were treated as outpatient and 25 cases (41.6%) as in patients (p>0,05). Only 7 cases (11.7%) have history of contact with HFMD patients. The notified cases were mainly from the densely populated areas which were Cheras, Kajang and Ampang. No differences were noted between HFMD cases which have been breasfed for less than 6 month or more, and twenty nine (29) cases (48.3 %) had completed the immunization schedule. In conclusion, the recent emergence of HFMD brings a new challenge, which have to be faced in the prevention and surveillance activities of public health problems in the district.
Study site: Notified cases from Klinik Kesihatan, hospital, private clinics, Ulu Langat, Selangor, Malaysia
OBJECTIVE: To study the knowledge, attitudes and practices on various contraceptive methods among all government health clinic staff in the state of Kelantan.
DESIGN: Questionnaire-based study.
SETTING: All government health clinics in the state of Kelantan which are health facilities located outside the general hospital and seven district hospitals.
SUBJECTS: All 711 nursing staff employed in government health clinics in Kelantan state (sisters, staff nurses, assistant nurses and midwives).
METHOD: Pretested, prestructured proforma was sent out to all the nursing staff employed in all peripheral health centres to be completed by them and returned the same day via the medical officer in charge of that district.
RESULTS: Most of the respondents were more than 30 years of age, married, multiparous and working for more than 5 years. Eighty to ninety percent practised contraception, with the majority of midwives preferring pills and the majority of staff nurses preferring condoms. Thirty to forty percent from all groups felt that folk methods are effective, and should be encouraged. Only about 50% of staff nurses are well informed on all contraceptive methods, but among assistant nurses and midwives, this figure is only 33%. A high proportion felt that the nursing curriculum deals inadequately with this subject.
CONCLUSION: The first step towards achieving success in our family planning programme lies in imparting more information to this target group of health workers, by incorporating more lectures during training and sending them for courses.
PIP: 711 government health clinic nursing staff in Kelantan state were surveyed about their knowledge, attitudes, and use of various contraceptive methods. 11 sisters, 122 staff nurses, 173 assistant nurses, and 334 midwives returned the questionnaire the same day of receipt. Most respondents were older than age 30 years, married, multiparous, and working for more than 5 years. 80-90% practiced contraception, with the majority of midwives preferring oral pills and the majority of staff nurses preferring condoms. 30-40% from each subgroup of respondents believed folk methods of contraception are effective and worthy of being encouraged. Approximately 50%, 33%, and 33% of staff nurses, assistant nurses, and midwives, respectively, were well informed on all contraceptive methods. A high proportion of staff felt that the nursing curriculum fails to adequately address the subject. The authors stress that in order to realize success in the family planning program, more information must first be imparted to these health personnel. To that end, more lectures could be provided during training, followed by frequent and thorough refresher courses for all nursing staff.
The number of deliveries increased very signdicantly in all hospitals in Terengganu since 1986. It is in line with the promotion of Safe Motherhood Initiative' with the aim to reduce maternal mortality and morbidity in a Terengganu. The aim of the study was to determine the pattern of choice for place of deliveries by local people in Terengganu and also to identdy risk factors related to their place of choice. A total of 9741 deliveries home January 1999 to 30”’ of June 1999 were included in the study. About 46% delivered in Hospital Kuala Terengganu, where 72% of them were high-risk mothers. Whereas deliveries in the district hospitals were 9.9% in Kemaman Hospital, 9.7% in Besut Hospital, 7.2% in Dungun Hospital and 3.4% in Hulu Terengganu Hospital. About 67% of district hospital deliveries were high-risk mothers. Only 12.4% of deliveries were home deliveries, however 49% of them were high-risk mothers. Utilization of alternative birthing centre in health clinics was only 1.7%. The study revealed that mothers’ risk factors are the factors signaicantly influence the place of choice for deliveries. The study jindings call for an urgent need of three essential services, Firstly an urban birthing centre conducted by obstetrician or the medical ojicers to be developed at the vicinity of the present general hospital to cater for the high percentage of high—risk pregnancies in the state. Secondly, all or selected district hospital to be given post for obstetrician, and thirdly it is a need to evaluate the current ‘High Risk Checklist for Antenatal Mothers’ to ensure treatment priority is indeed given to those really in need based on appropriate risk factors.
Client satisfaction upon health services is important for public especially for those who have to undergo treatment for tuberculosis (TB) noted for its difficult regime. The purpose of this study is to measure client dissatisfaction level towards TB treatment & services among TB patients in government outpatient health services and the factors that influenced it. This study was carried out in all the districts of West Coast Division of Sabah. It was conducted from June 2002 to November 2002. Study design is cross-sectional, with population samples taken on those who are currently receiving outpatient TB treatment in government health facilities. Questionnaires forms were used as study tool and filled by either by respondent or through the help of trained interviewer. The outcome is based on the total score obtained through Likert scales to determine the proportion of dissatisfied group from the respondents. A total of 488 patients took part in this study. Results of study showed overall percentage of 31.8% dissatisfaction level towards TB
treatment & services, while dissatisfaction towards TB treatment and upon health services alone were 54.3% and 24.0% respectively. The predictive factors for client dissatisfaction towards TB treatment and services are those without education, longer waiting time and have opinion of insufficient number of health staff.
Key words: Tuberculosis, client satisfaction, TB treatment, services, Sabah.
Study site: Outpatient clinics, hospitals, Sabah, Malaysia
Citation: Mohd Ghazali RJ. A study on the adequacy of outpatient management of essential hypertension in MOH hospitals and health centres. Kuala Lumpur: Institute of Health Management, Ministry of Health, Malaysia; 2006
Health care systems play a vital role in providing health services and in optimising the population’s health of each nation. The Malaysian health care system primarily consists of the public and private health services. One of the prominent private health care services offered in the General Practitioner’s (GP) Clinic. Despite the prominent role GPs play in the health care system in this country, little is known about their practices, the issues and challenges faced by GPs in this country. The objective of this study was to describe the current GP practice operations in Malaysia in terms of its general operations, financial expenditure and revenue, market competitiveness and laboratory services offered by the clinics.
OBJECTIVES: The objective of this study was to evaluate the general practitioners' (GPs') knowledge and perceptions towards generic medicines in a northern state of Malaysia.
METHOD: A postal cross-sectional survey involving registered GPs in Penang, Malaysia was undertaken. A 23-item questionnaire was developed, validated and administered on the GPs. Eighty-seven GPs responded to the survey (response rate 26.8%).
RESULTS: The majority of the respondents (85.1%) claimed that they actively prescribed generic medicines in their practice. On the other hand, only 4.6% of the respondents correctly identified the Malaysia's National Pharmaceutical Control Bureau's bioequivalence standard for generic products. There were misconceptions among the respondents about the concepts of "bioequivalence", "efficacy", "safety", and "manufacturing standards" of generic medicines. GPs in this survey believed that a standard guideline on brand substitution process, collaboration with pharmacists, patient education and information on safety and efficacy of generic medicines were necessary to ensure quality use of generics. Furthermore, advertisements and product bonuses offered by pharmaceutical companies, patient's socio-economic factors as well as credibility of manufacturers were factors reported to influence their choice of medicine.
CONCLUSION: Although it appeared that GPs have largely accepted the use of generic medicines, they still have concerns regarding the reliability and quality of such products. GPs need to be educated and reassured about generic products approval system in Malaysia concerning bioequivalence, quality, and safety. The current findings have important implications in establishing generic medicines policy in Malaysia.
This is a study of infant feeding practices of 126 mothers. Seventy-seven mothers or 61.1% practised breast feeding. The typical breast feeding mother was more likely to be a Malay, with lower family income and residing in the rural area. The educational status of the mother was not an important factor in influencing her to breast feed. Health education on breast feeding should be intensified in schools to reinforce the implementation of the Malaysian Code of Ethics for Infant Formula Products.
985 medical certificates issued by primary care doctors at the Klinik Perubatan Masyarakat and the staff health clinic at Universiti Sains Malaysia were analysed. Most common diagnoses were URTls, conjunctivitis, and gastro-enteritis. Mean duration of absence ranged from 1.3 to 3.4 days. HUSM staff with skin infections were given certificates nearly twice more often than the public. Backache earned more time off for the staff compared to the public. There is a need to formulate guidelines for medical certificates.
Study site: Klinik Perubatan Masyarakat and the staff health clinic at Universiti Sains Malaysia
A survey of smoking habits among the students attending the Student Health Clinic for various ailments showed:
(1) Smoking in women is very uncommon (only 2 out of 79; 2.53%)
(2) About 30% of men smoke (106 out of 322; 32.9%)
3. The majority of these had commenced smoking before they entered the university.
4. The majority smoked filter tipped brands.
5. Where the mothers in the family smoked, the sons seem to take to smoking more readily.
6. Knowledge of the effects of smoking on health was poor, but equal in all three groups viz in women and in both smoking and non-smoking men.
Objective: Primary care management of knee osteoarthritis (OA) has received little attention in the scientific literature and the main reason for this survey is to study and explore the variations and patterns of primary care management and assess both conventional and complementary therapy usage in knee OA in the primary care setting.
Methods: A cross-sectional survey of 200 randomly selected general practitioners (GPs) in the peninsular states of Malaysia was undertaken using a questionnaire. The GPs involved were asked about basic knowledge of OA in terms of diagnosis, investigation, and treatment. They were also asked about their usage of conventional and complementary medication.
Results: One hundred and eighty (90%) GPs responded to the questionnaires sent: 77% were in solo practice and 33% in group practice. Most of the GPs surveyed (60%) had been in practice for more than 10 years, 30% for 5-10 years and 10% were in practice for less than 5 years. Of GPs surveyed, 55% saw an average of more than 20 patients per week, 35% about 10-20 patients and 10% less than 10 patients per week. Of GPs surveyed, 65% would arrange an X-ray, 55% would arrange a blood test, mostly serum uric acid, rheumatoid factor and erythrocyte sedimentation rate. Pharmacological management consists of first-line treatment with non-steroidal anti-inflammatory drugs (NSAIDs) (61%), analgesics (35%) or a combination of the two (4%). Non-pharmacological management consisted of advice on exercise (27%), weight reduction (33%) and referral to physiotherapy (10%). Of GPs surveyed, 85% prescribed some form of complementary medications, 60% prescribed glucosamine sulphate, 21% chondroitin sulphate, 11% cod liver oil and 9% evening primrose oil. Only 10% of GPs surveyed perform intra-articular injections.
Conclusion: The data suggest that in the primary care setting, the majority of GPs over-investigate the diagnosis of OA. Pharmacological interventions largely concentrate on analgesics and NSAIDs. The use of physiotheraphy and non-drug approaches were significantly under-utilized. There is a need to further educate GPs in the management of OA.
BACKGROUND: Based on the `European Position Paper on Rhinosinusitis and Nasal polyps (EP3OS 2007)`, this study aimed to investigate general practitioners (GPs) and other specialists` understanding when managing patients with acute rhinosinusitis (ARS) in Asia.
METHODOLOGY: Among a total of 2662 questionnaires completed, 2524 (94.8%) were valid for analysis. There were 1308 GPs (51.8%), 989 otolaryngologists (39.2%) and 227 paediatricians (9%) from Mainland China, Hong Kong, Indonesia, India, Malaysia, Pakistan, Philippines, Singapore, Thailand and Taiwan.
RESULTS: ARS is affecting an estimated 6 - 10% of patients seen in a daily out-patient practice. The EP3OS criteria are well supported by Asian physicians (94.1%). Most physicians (62.7%) agreed that radiological investigation is not needed to diagnose ARS. However, even for mild ARS (common cold), medical treatments were still recommended by 87% of GPs, 83.9% of otolaryngologists, and 70% of paediatricians. The top three first-line treatments prescribed were antihistamines (39.2%), nasal decongestants (33.6%), and antibiotics (29.5%). Antibiotics usage increased as the first line treatment of moderate (45.9%) and severe (60.3%) ARS.
CONCLUSION: ARS is commonly managed by GPs, otolaryngologists, and paediatricians in Asia. However, understanding of the management of ARS needs further improvement to minimize unnecessary use of radiological investigations, overuse of antibiotics, and under use of nasal corticosteroids.
BACKGROUND: Anxiety disorders are common mental health disorders with significant impact on the individual as well as burden on the country as a whole.
METHODS: A systematic review of databases, reference lists, internet sources, and input from content experts revealed 42 studies that documented the prevalence of anxiety symptoms or disorders. 12 of these studies specifically evaluated anxiety disorders.
RESULTS: 4 studies looked at the prevalence of anxiety disorders in the general population, whilst the remainder focused on selected population groups: university students (4 studies); substance abuse (3 studies); and victims of abuse (1 study). Studies in the general population showed that the prevalence of generalised anxiety disorder was 0.4-5.6%, mixed anxiety and depression were 3-5%, panic without agoraphobia 0.4%, phobia unspecified 0.5-%, and anxiety not-otherwise-specified 0.3-6.5%. We found significant variability in anxiety disorders in the studies in selected population groups. The variability could also have been affected by methodological factors within each study.
CONCLUSION: This study provides a broad overview of the prevalence of anxiety disorders in Malaysia. More research is required to develop diagnostic instruments that are validated for local use and comparable with international standards. Reliable prevalence estimates are lacking within certain groups, e.g. those in rural, indigenous, migrant population groups and those exposed to natural disasters.