The Pabon Lasso Model is one of the most important and suitable techniques applied in evaluating the performance of hospitals. The visual representation standardizes the comparative accomplishments of hospitals which information is used by planners in effort to improve productivity of the health care system by use of three pointers namely: (i) Average Length of Stay (ALS); (ii) Bed Occupancy Rate (BOR); (iii) Bed Turnover (BTO). The purpose of this study is to evaluate performance of wards in health centers affiliated to Kampala Capital City Authority (KCCA) and Ministry of Health (MOH) during the financial year 2012-2013 constructed on Pabon Lasso Model. Data for the nine health centers and two referral hospitals was taken by the nursing sisters who were in charge. To ensure accuracy, a weekly standard report was submitted to head office and the data included: a list of wards, number of beds, admissions, deaths, discharges and inpatient days. For all government health centers and hospitals, overall, the average indicators ALS=3.63 days, BTO= 74.0 times per year and BOR=49.3% were obtained. Based on the Pabon Lasso graph, two wards are in Zone 3, two wards in Zone 4, one ward in Zone 2 and five wards in Zone 1. The performance of health centers and hospitals in Kampala were somehow poor. This represented unacceptable levels of technical deficiency.
Toxoplasmosis, caused by an intracellular protozoan parasite, Toxoplasma gondii, is widespread throughout the world. The disease is of major medical and veterinary importance, being a cause of congenital disease and abortion in humans and in domestic animals.[1] In addition, it has gained importance recently due to toxoplasma encephalitis in AIDS patients.[2] T. gondii was discovered 100 years ago. Its identification was rapidly followed by the recognition that it was a human pathogen. During the past 100 years, the spectrum of diseases caused by this ubiquitous pathogen has expanded to include both congenital and acute infections as well as the recognition of diseases caused by this pathogen in the immune-compromised host. Recent data on behavioural changes in animals due to chronic toxoplasmosis is leading to research on the effect of this pathogen on the behaviour of humans.[3] Experimental studies on T. gondii have resulted in it becoming a model organism for studies on host pathogen interactions. Integration of clinical and experimental data on T. gondii should continue to lead to important insights into improvements in diagnosis for clinical management and vaccine development for control of toxoplasmosis.
Introduction: It is estimated that 4.9 million people worldwide died in 2000 as a result of their addiction to nicotine, about half of them prematurely. This huge death toll is rising rapidly, especially in low and middle income countries where most of the world’s 1.2 billion tobacco users live.
Objectives: This study aimed to determine (i) the prevalence of smoking among the community aged 18 and above in Terengganu state, and (ii) the relationship between smoking and age, sex, educational level, family and peer influence.
Methods: A cross-sectional study design was used in this study and data was collected using a standardised pre-tested structured questionnaire.
Results: The overall mean age of the respondents was 38.9 (95% CI= 37.7 – 40.2) years. The majority of the respondents were Malays (99.1%). Of the 653 respondents, 32.2% and 23.6% were ever and current smokers respectively. Of this, 211 ever smokers, 199 (94.3%) were males and only 12 (5.7%) were females. The prevalence of ever and current smokers for males was 73.2% and 53.7% respectively compared to the females (3.1% and 2.1% respectively). There was a significant association between smoking status and sex (p<0.001). The prevalence of ever smokers was lowest amongst respondents with college or university educational level. However, for current smokers, those with college or university education had the highest prevalence. The overall mean initiation age of ever smokers was 19.7 years (95% CI = 18.8 – 20.7). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001). The mean duration of smoking for the current smokers was 21.6 (95% CI= 19.1 – 24) years. There was also no significant difference in the mean duration of current smoking for males compared to the females (p = 0.5). The majority (93.4%) of the ever smokers started either because their friends asked them to try or they were trying for fun. The quit ratio was 27%.
Conclusion : The prevalence of ever and current smokers in males is very high (73.2% and 53.7% respectively) compared with the females (3.1% and 2.1% respectively). The mean initiation age for the males (19.1 years) was significantly lower compared to 29.8 years for the females (p<0.001). Key words: Smoking, prevalence, initiation age, duration, Terengganu state
Objective: To assess the prevalence of iron deficiency, anaemia and iron deficiency anaemia (IDA) in women aged 20-40 years and its association with iron intake. Methods: A total of 388 women were recruited from universities and work sites in Kuala Lumpur and its suburbs. The subjects comprised 135 Malays, 130 Chinese and 123 Indians. Dietary intake was estimated using a single 24-hour food recall and a semi-quantitative food frequency questionnaire. Haemoglobin (Hb), haematocrit (hct), mean corpuscular volume (MCV) and serum ferritin were determined. Results: The prevalence of anaemia (Hb
Objective: This study was conducted to determine prevalence and factors associated with obesity in Selangor, Malaysia. Methods: A population-based cross-sectional study was conducted in all districts of Selangor State. All individuals, 15 years and above in the selected households, were included. A pre-tested structured questionnaire was used to collect the data. Weight was recorded using TANITA model HD-309 and height was measured using SECA Body meter Model 208. Statistical analysis was performed using Stata 8.2 taking into account the complex survey design. Results: The overall mean age of the 2219 respondents was 36.6(95% CI 35.7 – 37.6) years. There was no significant difference in the mean age of the males and females (p=0.697). The majority of the respondents were Malays (52.9%), followed by Chinese (30.9%), Indians (15.4%) and
other races (0.9%). The overall mean BMI was 24.1 kg/m2 (95% CI=23.8- 24.4). The overall prevalence of obesity was 12.2% (95% CI 10.6%, 14.0%). There was no significant difference in the prevalence of obesity in the males compared to females (p>0.05). The prevalence of obesity increased with age up to the ages of 40-59 years and then decreased after 60 years. The highest prevalence of obesity was in the 40-59 years age groups in both sexes. The overall prevalence of obesity was significantly higher amongst the Malays (15.2%) compared to the Indians (11.6%) and Chinese (7.3%). Multivariate logistic regression analysis showed that only age and ethnicity were associated with obesity. Sex and educational level were not associated with obesity.
Introduction: Women are exposed to stress such as working full time while still being responsible for the family and house.
Objective: The objective of this study was to determine the prevalence of depressive symptoms among adult women in Selangor, and to determine the potential risk factors associated with depression.
Method: A community based cross sectional study was conducted in all districts of Selangor state, Malaysia in July 2004. Multi stage stratified proportionate to size sampling method was used to collect data. The Patient Health Questionnaire (PHQ-9) was used to determine the presence or absence of depressive symptoms among the respondents. All respondents aged 20 to 59 years old in the selected households were interviewed.
Results: Out of 1032 women, 972 agreed to participate in this study, giving a response rate of 94.2%. The mean age of the respondents was 37.91 ± 10.91. Majority were Malays (54.9%), married (83.8%) and had secondary education (54.5%). The results showed that the prevalence of depressive symptoms was 8.3% in Selangor. Race, religion, education level, history of having a miscarriage within the last 6 months and history of difficulty in getting pregnant were significantly associated with depressive symptoms (p<0.05). Women with history of a miscarriage within the last 6 months and absence of formal education were potential risk factors for depressive symptoms (OR, CI = 2.576 (1.165-5.696), p<0.01 and OR, CI = 5.766 (1.949-17.053), p < 0.01).
Conclusion: Depressive symptoms among adult women in Selangor was 8.3% and was associated with race, religion, education, history of miscarriage and difficulty in getting pregnant. The main potential risk factors were having a miscarriage within the last 6 months and absence of formal education.
Keywords: Depressive symptoms, Prevalence and Risk Factors, Selangor Women
In pregnancy, the diagnosis of primary hyperparathyroidism (PHP) may be delayed due to physiological changes that occur during this period. The maternal related complications of PHP during pregnancy has been reported to be as high as 67%, whilst fetal complications up to 80% of cases.1 The therapeutic gold standard and definitive treatment for PHP in pregnancy is minimally invasive parathyroidectomy in the second trimester. We report a case of a 22-year old primidgravida who underwent parathyroidectomy in the third trimester of her pregnancy for PHP with persistent hypercalcemia. She was also found to have Vitamin D deficiency which probably led to secondary hyperparathyroidism and made her hypercalcemia more apparent during pregnancy
Pathological laughing or crying (PLC) were recognized after the occurrence of stroke, with a prevalence of 15% to 18%. There is no apparent triggering stimulus, and is often misdiagnosed as a mood disorder as it is a disorder of emotional expression rather than a primary disturbance of feeling. We reported a case of a 32 year old lady, who presented with giddiness and altered consciousness progressing to fever and neck stiffness, who’s CT showed a massive left cerebellar infarct. No risk factors were identified. Psychiatrically, she developed sudden crying spells after one month and a diagnosis of Major Depressive Disorder was made with subsequent commencement of anti-depressants. A week later, she developed continuous inappropriate laughter without the feeling of elation, which was beyond her control. There were no symptoms of mania or psychosis.
During a 24-month period, 21 children with acute bacterial meningitis were identified and studied. The majority of the children was from low socio-economic group and the male:female sex ratio was equal. Seventeen children (81%) were aged twelve months or below. In 15 (71.5%) of the children. Haemophilus influenzae type b was recovered, while Streptococcus pneumoniae was isolated from 4 children. Neisseria spp and Salmonella spp were identified respectively in each of the other two cases. The case fatality was four (19.0%) with nine others (42%) exhibiting neurological sequelae. Except for the Salmonella spp strain that was resistant to the cephalosporin, the rest of the bacterial species were sensitive to the commonly used antibiotics. As Haemophilus influenzae type b is still the most prevalent cause of acute bacterial meningitis, it is therefore strongly recommended that the national immunisation programme in this country should include the vaccine for it in our effort to minimise the mortality and morbidity caused by this organism.
Objectives: This paper reports the outcome of Session With Carer, one of the activities in the Year 4 Personal and Professional Development (PPD) module in the new integrated curriculum of the Undergraduate Medical Programme at the Faculty of Medicine,
Universiti Kebangsaan Malaysia (UKM). Methods: This activity involves groups of 14 – 15 students sitting in with family members of individuals with mental illness. The session starts with the carer giving his or her perspective of patient’s care and the challenges involved. This is followed by a question and answer session. Finally, the carer provides a written feedback by way of scoring certain items as well as brief comments. After the session, each student is required to prepare an individual report in the form of reflective writing. Results: Out of a total of 224 students, the reflections of 126 students were reviewed to assess what they had learnt from the Session With Carer. Among the more significant findings were: 100% learnt about the various challenges faced by carers. 31.7% learnt the importance of
faith/spirituality of the carer in caring for a mentally ill family member. 29.4% learnt the importance of family and others’ support. An equal number, that is, 26.2% learnt that it helps for the carer to have good mental health and a positive attitude, as well as good
knowledge of the illness. Those who became aware of the benefits of the carer having patience and determination made up 23.8% of the total reflections reviewed. Conclusion: The findings show that the Session With Carer is very educational, and helps create more
awareness of the importance of the carer’s role in patient management and support. In other words, carers can act as teachers in creating more public awareness about mental illness and
ultimately, help in gradually removing the stigma associated with mental illness. Therefore, carers should be utilized for this purpose.
Objective: This study aims to determine the quality of life (QOL) of Malaysian women based on their physical and mental scores and correlates with age and cervical disease severity. Methods: This is a cross-sectional study from Nov 2006 till Dec 2007 from participating
Gynecology-Oncology outpatient and in patient’s wards. QOL interviews used the SF-36 questionnaires. Main domains were the Physical Composite Scores (PCS) and the Mental Composite Scores (MCS). Results: A total of 396 participated in the study. Mean respondents age were 53.31 ± 11.21 years, educated till secondary level (39.4%), Malays (44.2%) with mean marriage duration of 27.73 ± 12.12 years. Among pre-invasive diseases, the cervical intra epithelial neoplasia (CIN) 1 was the highest in percentage of cases
(8.1%). Among invasive cancer, stage 1 cancer was highest (31.1%), followed with stage 2 (28.3%), stage 3 (7.3%) and stage 4 cancers (5.8%). PCS scores are highest among the pre-invasive and stage 1 cancer (F=4.357; p
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Objective: The aim of this study was to identify depression among HIVinfected patients attending Infectious Disease Clinic in University Malaya Medical Centre (UMMC). Methods: This is a cross sectional study on HIVinfected patients attending Infectious Disease Clinic, UMMC. Those who fulfilled inclusion criteria were recruited and interviewed. Sociodemographic characteristics and clinical conditions such as mode of transmission, year of diagnosis, CD4+ counts, drug treatment and clinical stage were collected. The patients were then subjected to self-administered questionnaires, Patient Health Questionnaire, (PHQ-9) and Hospital Anxiety & Depression Scale (HADS). Results: 89 patients were recruited. Scores from PHQ9 showed 32% of depression rate while scores from HADS showed 19% of depression rate among the respondents. Non-self financial supporter, nonalcoholic drinkers and females were more likely to be depressed (P
In a retrospective analysis of paediatric referrals to a Neurology outpatients clinic, the largest single category of 47 patients (32%) presented with acute recurrent headache. There were 30 girls and 17 boys. Using conventional criteria 43 of the children could be classified as classical migraine ( 10 ), common migraine (20), basilar migraine (3), opthalmoplegic migraine (1) and tension headache (9). The 9 children with tension headache, all girls, had pain char-acteristics distinct from the rest, but in terms of severity and duration of headache attacks ,were similar to those with classical migraine, which is against the theory that tension headache and migraine are at different ends of the spectrum of the same process. These findings are consis-tent with recent adult data, but have not been noted in paediatric work. (Copied from article).
An analysis of perinatal statistics in Peninsular Malaysia from 1980 — 1989 was undertaken. The Perinatal Mortality Rate showed a 42% decrease over the 10 year period. The Perinatal Mortality Rate was higher among the Indian and Malay ethnic groups compared to the Chinese. This was largely contributed by the higher Stillbirth rate in the former 2 ethnic groups. The Indians have the highest rate of low birthweight babies. There is a decline in the rate of low birthweight babies born over the studied decade. The major causes of early neonatal mortality included problems asociated with prematurity, asphyxia neonatorum, septicaemia and congenital anomalies. Further epi-demiological research is required to identify other riskfactors which contribute to this ethnic biased perinatal mortality rates. Besides intensifying and upgrading current multifaceted approaches, interventional strategies need to be directed to the identified high risk groups. (Copied from article).
Cross-sectional studies on infant feeding practices in Malaysia have shown that even though there is a high percentage of initial breastfeeding, there is also a very rapid fall-off of full breastfeeding to be replaced by mixed feeding or full formula feeding. This paper gives the findings of a study conducted on 148 mothers who had just delivered their babies at the Maternity Hospital, Kuala Lumpur. 56 of these mothers were followed up to identify the feeding practices up to 6 months of the infant's life. Just after delivery, 83 .1% of the 148 motftrs had indicated interest to breasffeed either fully or partially. However, in the 56 mothers followed up later, 15 (26.7%) babies were not breasffed or breasffed for less than 1 week and only 15 (26.5%) were breasffed at least 6 months. Several factors affect breastfeeding rate amongst these mothers. Breastfeeding rate was significantly higher and longer amongst the Malays and least and shortest amongst the Chinese. The number of Malay mothers breastfeeding less than 1 week was 2 out of 24 (8.3%) whereas the number of Chinese mothers was 10 out of 19 (52.6%). Similarly, the number of Malay mothers breastfeeding beyond 3 months was 16 out of 24 (67.7%) and Chinese mothers only 4 out of 19 (21.0%). Other important factors are the type of initial feeding and the onset of initial formula feeding. Out of 26 babies initiated on breastmilk as the first feed, 12 were breasffed for at least 6 months whereas 8 of the 18 started on formulas were not breasffed at all or for less than 7 days and only one breastfed for at least 6 months. Similarly, out of 27 babies given formula feeding in the first 2 days, 15 were not breasffed at all or for less than 1 week and only 3 breasffed at least 6 months. This suggests the importance of early mixed feeding in the rapid decline of breastfeeding. The employment status of the mother and the family income do not seem to affect the breastfeeding rate and its duration for the baby.
The neonatal Intensive Care Unit (NICU) in the Maternity Hospital Kuala Lumpur (MHKL) was frequently understaffed and overcrowded. A separate special care nursery (called K5) was set up in July 1991 for the purpose of providing non-intensive neonatal care for infants. Mothers were simultaneously admitted and they provided a major bulk of feeding and nursing care. Case records for 2 months prior to and 2 months after opening of the ward were studied. The average duration of hospital stay per neonate was shorter in the later period (9.18 days vs 11.05 days, p < 0.05). Also the very low birth weight infants (VLBW) gained weight faster (28 grams a day) compared to similar infants in the earlier period (22 grams a day, p < 0.05).
The aim of this study is to design radon irradiation technique in the field of hematology for an invitro study. In addition, deposit of alpha particles into the human blood surface and its effects on the thrombocytopenia estimated using nuclear track detectors (NTDs). In this technique, amount of radon gas (2210±5.1Bq/m 3 ) collected in a tight PVC container with the appropriate engineering dimension using two sources of radium (5μCi). Blood samples (10 male and 10 female) and CR-39NTDs (40 pieces) are exposed to radon gas at various exposure time. Complete blood test and the computer scanning for each piece of CR-39NTDs before and after exposure has done. The results show that the present technique has a good efficiency (96%) to the invitro exposure of human blood. When the radon gas moved on the surface of blood sample, alpha tracks registered into CR-39NTDs. Thus, this technique improved that the comparative method to evaluate alpha particle density into exposure blood samples is an effective way; this depended on the geometry of design and the sensitivity of CR-39NTDs to track registration. Radon detector version 7 (RAD7) used to make a certain suitability of CR- 39NTDs. Amount of radon concentration losses during the exposure process, in the present work it was variable from 0.41% to 1.4%. Radon concentration effected on the thrombocytopenia; this depended on time of exposure and alpha energy loss into the blood and CR-39 through the atomic displacements. At the time of exposure of 10 minutes, rate of absorption dose was 2.255±0.11μSv (39%), and the platelet (PLT) cont reduced rapidly (high effected on reduce PLT, this makes thrombocytopenia.
Helicobacter pylori has been implicated as an aetiologic agent for type B chronic gastritis, peptic ulcer and gastric cancer. It is considered the most common bacterial infection in the world with approximately 50% of the population being infected. The majority of infected individuals are asymptomatic, with some developing gastritis only. However, chronic infection with H. pylori without antibiotic treatment predisposes infected individuals to the development of gastric cancer. The aim of this study is to determine active H. pylori infection among patients with symptoms of dyspepsia using three combinations of diagnostic methods. In this report, we studied 1,376 consecutive patients who underwent upper gastrointestinal endoscopy at Universiti Kebangsaan Malaysia Medical Center (UKMMC) for dyspepsia from the period January 1999 to December 2002. The classification of patient’s diagnosis was assessed by endoscopic and histological examination. The H. pylori status was determined by rapid urease test, histological examination or H. pylori culture. Presence of H. pylori infection was confirmed in 30.8% of patients with dyspepsia. H. pylori infection was more prevalent in older patients and in males compared to females. Patients with severe gastroduodenal diseases were more commonly infected with H. pylori. There was a significant difference in H. pylori prevalence among the different ethnic groups. Indians had the highest infection rate (45.4%), followed by Chinese (36.8%) and the lowest were seen in Malays (18.3%). This finding on determination of active H. pylori infection among patients with dyspepsia is consistent with serological studies that showed racial differences in H. pylori prevalence. However, the pattern of H. pylori infection does not reflect the prevalence of severe gastroduodenal diseases among different ethnic groups.
Retinopathy of prematurity (ROP) is a disorder describing an immature vascularisation
of a developing retina in low birth weight preterm infants. This condition potentially
leads to blindness. ROP developed as a response of hypoxia of the eye due to
incomplete development of the retinal vessels. ROP is commonly reported as
bilateral disease,a small percentage of infants have asymmetrical changes. We
report a case of long-term outcome of a asymmetry ROP changes with peripheral
retinal ablation in a single eye. This particular case demonstrates the possible longterm
outcome of unilaterally treated ROP which could either be due to the severity
of the disease itself or the treatment she received. It is important to highlight the
possibility of unequal development of the eye in asymmetrical presentation of ROP.
Objective: To audit the amount and complexity of case load and the waiting time for orthodontic treatment in Orthodontic Department of Universiti Kebangsaan Malaysia (UKM).
Materials and Methods: This study involved three waiting list records in Orthodontic department, UKM and 484 patients’ record were selected using Random Sampling technique. Demographic data of the patients were noted. Data on date of patient’s visit to ‘Klinik Rawatan Utama’ (KRU), Screening clinic and first orthodontic treatment (removable/fixed) clinics were also recorded. The severity of referred cases were graded using complexity scale (Russle et al, 1999).
Results: Patients were mostly female (76%) with age ranging from 10 to 52 years old. 75% of the referred cases were complex cases. From the year 2002-2007, 35% were referred for removable and 65% were referred for fixed clinic. In average, orthodontic screening waiting time was 6.9 ± 2.5 month. Patient would received removable and fixed appliance treatment after 4.4 ± 1.0 months and 14.5 ± 9.8 months respectively.
Conclusions: Most patients were referred to fixed waiting list. The waiting time from 2002 until 2007 for orthodontic treatment in UKM was longest for fixed followed by screening. The shortest waiting time was for the removable treatment.
Study site: Orthodontic Department of Universiti Kebangsaan Malaysia (UKM)