INTRODUCTION AND AIMS: It is necessary to ascertain current prescribing of antibiotics for upper respiratory tract infections (URTIs) to address potential overuse. A retrospective analysis was conducted of all prescriptions for URTIs among 10 public primary healthcare centers in Kedah, Malaysia, from 1 January to 31 March 2014.
RESULTS: A total of 123,524 prescriptions were screened and analyzed. Of these, 7129 prescriptions were for URTI, with 31.8% (n = 2269) containing antibiotics. Macrolides were the most commonly prescribed antibiotic, constituting 61% (n = 1403) of total antibiotics prescribed. There was a statistically significant association between different prescribers and diagnoses (p = 0.001) and a weak positive trend suggesting family medicine specialists are more competent in antibiotic prescribing, followed by medical officers and assistant medical officers (τ = 0.122).
CONCLUSIONS: Prescribing practices of some prescribers were inconsistent with current guidelines encouraging resistance development. National antimicrobial stewardship programs and further educational initiatives are ongoing in Malaysia to improve antibiotic use.
KEYWORDS: Malaysia; antibiotics stewardship programs; guidelines; inappropriate use of antibiotics; primary healthcare centres; upper respiratory tract infections
Study site: Klinik kesihatan, Kedah, Malaysia
This study aims to assess the incidence rate of Pteropine orthreovirus (PRV) infection in patients with acute upper respiratory tract infection (URTI) in a suburban setting in Malaysia, where bats are known to be present in the neighborhood. Using molecular detection of PRVs directly from oropharyngeal swabs, our study demonstrates that PRV is among one of the common causative agents of acute URTI with cough and sore throat as the commonest presenting clinical features. Phylogenetic analysis on partial major outer and inner capsid proteins shows that these PRV strains are closely related to Melaka and Kampar viruses previously isolated in Malaysia. Further study is required to determine the public health significance of PRV infection in Southeast Asia, especially in cases where co-infection with other pathogens may potentially lead to different clinical outcomes.
Study site: Klinik Kesihatan Rembau, Negeri Sembilan, Malaysia
We report a case of human intestinal myiasis in a 41-yr-old female patient presented at a clinic in Seri Kembangan, Selangor, Malaysia. Larvae passed out in the patient's feces were sent to the Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. DNA barcoding confirmed the second case of intestinal myiasis in Malaysia involving the larvae of Clogmia albipunctatus (Duckhouse) (Diptera: Psychodidae). We review reported cases of myiasis and discuss the present case of intestinal myiasis in an urban patient.
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
The Malay version of the Medical Outcome Study (MOS) Social Support Survey was validated among a sample of postpartum Malay women attending selected health centers in Kedah, North West of Peninsular Malaysia. 215 women between 4 to 12 weeks postpartum were recruited for the validation study. They were given questionnaires on socio-demography, the Malay-versions of the MOS Social Support Survey, Edinburgh Postnatal Depression Scale (EPDS) and the 21-items Beck Depression Inventory-II (BDI-II). 30 of the women, who were bilingual, were also given the original English version of the instrument. A week later, these women were again given the Malay version of the MOS Social Support Survey. The scale displayed good internal consistency (Cronbach's alpha = 0.93), parallel form reliability (0.98) and test-retest reliability (0.97) (Spearman's rho; p<0.01). The negative correlations of the overall support index (total social support measure) with the Malay versions of EPDS and BDI-II confirmed its validity. Extraction method of the 19 items (item 2 to item 20) from the MOS Social Support Survey using principle axis factoring with direct oblimin rotation converged into 3 dimensions of functional social support (informational, affectionate / positive social interaction and instrumental support) with reliability coefficients of 0.91, 0.83 and 0.75 respectively. The overall support index also displayed low but significant correlations with item 1 which represents a single measure of structural social support in the instrument (p <0.01). The Malay version of the MOS Social Support Survey demonstrated good psychometric properties in measuring social support among a sample of Malay postpartum Malay women attending selected health centers in Kedah, North West of Peninsular Malaysia and it could be used as a simple instrument in primary care settings.
AIM: To reevaluate the psychometric characteristics of the Malay version of the Edinburgh Postnatal Depression Scale among a sample of postpartum Malay women attending the Bakar Bata Health Center in Alor Setar, Kedah, North West of Peninsular Malaysia.
MATERIALS AND METHODS: 64 women between 4 to 12 weeks postpartum were recruited for there validation study. They were given questionnaires on socio-demography, the 21-item Malay version of the Beck Depression Inventory II (BDI-II) and the 10-item Malay version of the Edinburgh Postnatal Depression Scale (EPDS). All the participants were later interviewed using the Hamilton Depression Rating Scale (HDRS-17) and the Composite International Diagnostic Interview (CIDI). All diagnoses were made based on the Tenth Edition of the International Classification of Diseases (ICD-10)
RESULTS: 9 women (14.1%) were diagnosed to have significant depression (7 mild depressive episodes and 2 moderate depressive episodes according to ICD-10). EPDS was found to have good internal consistency (Cronbach alpha =0.86) and split half reliability (Spearman split half coefficient = 0.83). The instrument also showed satisfactory discriminant and concurrent validity as evidenced by the statistically significant difference in EPDS scores between the depressed group and their non-depressed counterparts (Mann Whitney U test: 2 tailed p value < 0.01) and good correlations between the instrument and both the Malay version of BDI-II and the HRDS-17 (Spearman rank correlation coefficients of 0.78 and 0.88 respectively). At the 11/12 cut-off score the sensitivity of the EPDS is 100%, with a specificity of 98.18%, positive predictive value of 90%, negative predictive value of 100 % and misclassification rate of 1.56%.
CONCLUSION: This study confirmed the reliability and validity of the Malay version of the Edinburgh Postnatal Depression Scale in identifying postpartum depression among recently delivered Malay women attending the Bata Bata Health Center in Alor Setar, Kedah, North West of Peninsular Malaysia.
KEYWORDS: EPDS; postnatal depression; rating scale; validation
Study site: Klinik Kesihatan Bakar Bata, Alor Setar, Kedah, Malaysia
Munchausen syndrome by proxy is a rare disorder in child psychiatric practice. A case of Munchausen syndrome by proxy that was managed in the Child Psychiatric clinic, Universiti Sains Malaysia Hospital is reported. Factors that suggest the diagnosis are discussed. Multidisciplinary approach to the management of such cases is warranted.
The traditional birth attendant (bidan kampong) or the TBA is still responsible for a substantial number of deliveries in Peninsular Malaysia. In the study area, the TBA s were responsible for about 47.2% of the deliveries in 1976. They were also responsible tor a substantial number of maternal deaths in the district. Therefore it was decided to identity and train the TBAs to identity ‘at risk’ cases at mothers and children and refer them to the nearest health facility. The TBA s were trained to use simple hygenic and aseptic procedures. At the end oi their training all at them were presented with a UNICEF midwifery kit. The short training proved useful because they now deliver fewer ‘at risk' cases and there is an in- creasing trend among them to refer the ‘at risk’ cases to the hospitals. The utilizations of TBA s in the maternal and child health program is a useful tool for the attainment at primary health care objective for developing countries by the year 2000.
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
BACKGROUND: Smoking cessation clinics have been established in Malaysia since 2004, but wide variations in success rates have been observed. This study aimed to evaluate the proposed pharmacist-led Integrated Quit Smoking Service (IQSS) in Sabah, Malaysia, and identify factors associated with successful smoking cessation.
METHODS: Data from 176 participants were collected from one of the quit-smoking centres in Sabah, Malaysia. Pharmacists, doctors and nurses were involved throughout the study. Any health care provider can refer patients for smoking cessation, and free pharmacotherapy and counselling was provided during the cessation period for up to 3 months. Information on demographic characteristics, smoking behaviours, follow-up and pharmacotherapy were collected. The main outcome measure was the abstinence from smoking, which was verified through carbon monoxide in expired air during the 6-month follow-up.
RESULTS: A 42.6% success rate was achieved in IQSS. Smoking behaviour such as lower cigarette intake and lower Fagerström score were identified as factors associated with success. On top of that, a longer duration of follow-up and more frequent visits were significantly associated with success in quitting smoking.
CONCLUSION: Collaboration among health care practitioners should be the main focus, and we need a combination of proven effective modalities in order to create an ideal smoking cessation module.
Study site: Klinik Kesihatan Luyang, Kota Kinabalu, Sabah, Malaysia
This is a cross sectional study to assess the performance of Putrajaya Health Clinic in meeting the client's expectation among 403 clients who came to seek medical treatment through a systematic random sampling in the month of July 2006. Our aim is not only to reduce dissatisfaction among clients but also try to meet their expectations; we have adopted SERVQUAL method which defined satisfaction as the difference between perceptions and expectations. We would also like to refer this dissatisfaction as not able to meet clients' expectations. It was found that there were only 6.9% of clients dissatisfied in Putrajaya Health Clinic, but they had not been able to meet 81.5% of clients' expectation. As for demographic characteristics, there appeared to be a significant association between client's satisfaction and age, gender, ethnicity and educational level. For outpatient's, the greatest dissatisfaction is in the dimension of Reliability. Clients were not happy with the waiting time at the clinic. Apart from recruiting more staff, management should develop a comfortable waiting environment to reduce the agony of waiting.
Non-communicable diseases (NCDs) represent among the most common and debilitating conditions seen in primary care. Patients’ care will often involves multiple providers and follow-up requires persistence by patients and clinicians alike, therefore ideal outcomes are often difficult to achieve. The need for better disease management policies and practice is growing. This is due to the changing demographic profile of the population, the increasing cost of managing people in acute care hospitals and the availability of new technologies and services. All these changes enable a different care paradigm which is more cost effective and provides people with chronic conditions an improved quality of life. Management of the NCDs therefore offers an excellent opportunity to practice chronic disease management - a systems approach designed to ensure excellent care.
The NCD team has developed a comprehensive approach to chronic disease care. We would like to describe the NCD Program in Ampangan Health Clinic which represents many typical government health clinics in Malaysia and the processes by which it was developed. Included are specific examples of the tools and how they can be used by individual clinicians in caring for patients. The integration of Chronic Disease Management Services into health care systems is the direction being undertaken to tackle the burden of chronic disease. Disease management supports the shift in healthcare from an emphasis on managing the acute episode to managing the entire disease course, highlighting both prevention and maintenance of wellbeing for patients with chronic diseases. Disease management promotes better integration and coordination of care across all aspects of the health sector.
A survey of smoking habits among the students attending the Student Health Clinic for various ailments showed:
1. Smoking in women is very uncommon.
2. About 30% of men smoke.
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.
Mild cognitive impairment (MCI) is a common disorder among elderly and may worsen to dementia. The aim of this study is to develop a nutrition and lifestyle booklet to implement better lifestyle modification, as an effort to delay cognitive decline. A series of discussions with a research group comprising of dieticians, nutritionists, a geriatrician and a public health physician were conducted to ascertain the content of the booklet. There were seven guidelines in the booklet including; eat more fish, eat more foods rich in folic acid, eat more fruits and vegetables, exercise regularly, do activities to stimulate memory, stop smoking and alcohol drinking and stay cheerful and positive. Evaluation of acceptance for the booklet was carried out which comprised of assessment on content, graphic and design among elderly and health staff at health clinic in Cheras. The assessment involved 15 Malay elderly subjects aged 60 to 81 years (mean age 66.1 ±6.6 years), with 60.0% men and 40.0% women and 10 health staff aged 36.6 ± 12.0 years, with range of 27 to 58 years, consists of 20.0% men and 80.0% women also participated. Most of elderly subjects (80.0%, n = 12) indicated they understood information in the booklet. Meanwhile, 20.0% (n = 3) of elderly expressed they did not fully understand the content of the booklet in particular on sentence and terminology. All health staff (100.0%) understood the information in the booklet. This booklet was well accepted by elderly subjects and health staff, however adding more graphics, simplifying sentence structures and minimizing scientific terminologies to improve understanding were suggested. The booklet has the potential to increase the nutritional and health knowledge of elderly specifically with MCI. This would motivate them to adopt healthy eating and lifestyle, thus reducing cognitive decline and prevent dementia.
Keywords: Cognitive, education, booklet, elderly, lifestyle
To assess the oral health related quality of life
(OHQoL) of a selected population of Malaysian adults and to compare the OHQoL by periodontal status. Material & Methods: This cross-sectional study comprises a convenient sampling of fifty subjects from the Primary Care Unit, Faculty of Dentistry, University of Malaya. OHQoL was assessed using the Malaysian version of Oral Health Impact Profile-14 (OHIP-14). Basic periodontal examination (BPE) was performed on all subjects to determine their periodontal status. Descriptive statistics and bivariate analysis were performed.
Results: Psychological discomfort, physical pain and psychological disability domains were the most affected dimensions in this population. Subjects with income levels >RM2,500 had higher impacts on their OHQoL as compared to those from other income levels (p0.05).
Conclusion: Subjects with high income levels had high impacts on their OHQoL. Those with periodontitis experienced higher impacts on their OHQoL as compared to those who had a healthy periodontium or gingivitis and affected a wide range of domains of quality of life.
OBJECTIVE: To determine the minimum number and duration of blood pressure(BP) measurement needed to estimate long term visit-to-visit blood pressure variability (BPV) for predicting 10-year cardiovascular (CV) risk.
DESIGN AND METHOD: This is a 10-year retrospective cohort study of 1403 patients from a primary care clinic. Three monthly BP readings per year were retrieved from 10 years of clinic visits. Standard deviation (SD) of systolic blood pressure (SBP) was used as a measure of BPV. SD was calculated for each cumulative year of readings. CV events defined as fatal and nonfatal coronary heart disease and fatal and nonfatal stroke. We used Pearson's correlation to examine the concordance between the SD of each additional year of follow-up and SD at the end of 10 years. Multiple logistic regression was used to estimate the CV risk and compare the odd ratio (OR) between 10-year SD and SD of each additional year of follow-up.
RESULTS: Mean SD increased with more SBP measurements for each increasing year. Pearson's correlation increased with the years of SBP measurements indicating increasing concordance with 10-year SD when more years of SBP readings was included from the baseline. With 10-year SD, the OR for CV risk was associated with an increase in SD (OR 1.121, 95% CI 1.057-1.188, p care clinic, Universiti Malaya Medical Centre (UMMC)
OBJECTIVE: To assess a better strategy to implement oral iron supplementation in preschool Orang Asli children with high prevalence of iron deficiency, as opposed to the current practice, yet inefficient, of daily oral iron supplementation regime. METHODS: A randomized controlled trial was conducted in preschool children presenting to a remote health center (Klinik Desa Kenang, Sungai Siput, Perak) with iron deficiency state. Oral iron prescribed as a daily unsupervised dose (group A) was compared to a weekly supervised administration (group B) over eight weeks. RESULTS: Before intervention, iron deficiency was prevalent in these children (91.2%). The mean baseline haemoglobin and ferritin levels of group A were 9.9 (+/- 1.1) g/dL and 8.9 (+/- 1.3) mg/L respectively, and that of group B were 9.9 (+/-1.2) g/dL and 9.7 (+/- 1.9) mg/L respectively. After eight weeks of treatment, the mean rise in haemoglobin and ferritin levels of group A were 1.2 (+/- 0.6) g/dL and 18.1 (+/- 15.1) mg/ L respectively, as compared to group B, where the mean rise in haemoglobin and ferritin levels were 1.8 (+/- 0.7) g/dL and 35.2 (+/- 21.8) mg/ L respectively. The differences in the rise of haemoglobin and ferritin levels of the two groups were statistically significant (p
Belaga District, in the heart of Borneo, is probably the most remote district in Sarawak. Although Belaga town is now accessible by land (50% are timber camp unsealed road) from Bintulu, the journey takes 5 hours and transport cost is high. Accessibility to Belaga by river is also subject to weather conditions and the town often gets cut off during the dry season and also during the wet season. All these pose immense challenges to the delivery of health care services to the people of Belaga and greatly reduce their accessibility to even basic health services. Access to specialist services is even more challenging as it is only available in Sibu and Bintulu; and visiting clinics in Belaga are infrequent due to the shortage of specialists and difficult transport. (Copied from article).
Introduction : Nursing is an occupation associated with high risk of developing back pain due to their nature of work practices. The aim of this study was to determine the prevalence of back pain among nurses working in government health clinics and hospitals in Port Dickson and the factors associated with it.
Methods : A cross sectional study was conducted involving 126 nurses working in government health clinics and district hospital in Port Dickson. They were universally sampled. A selfadministered questionnaire, assessing personal and socio-demographic characteristics, back pain, work factors and psychosocial factors.
Results :The prevalence of back pain among nurses was 79.4% and factors that showed significant association were workplace (p=0.026) and carried heavy load (p=0.043).
Conclusion : Where one work and nature of work one does has been shown in this study to be important issues to be considered in helping to manage back pain related to work. It is also recommended that staff need to be encouraged to do exercise to strengthen the back muscles, increase spinal flexibility and blood circulation to the spine as well as need to be reminded regarding ergonomic adjustment at work.
Diversified leisure involvement pose various health benefits to the elderly population. However, some elderly are too focus on doing a particular type of activity during their leisure time such as religious activity. This study aims to explore factors that could possibly contribute to the higher involvement in religious activity among the Malay ethnic elderly in Malaysia. In depth interviews were conducted, involving a total of 20 elderly aged 60 years and above with stratification by background characteristics. Each interview was conducted for an average of 15 to 30 minutes. They were purposively selected from two health clinics located in two different districts in the state of Selangor, representing an urban and a rural area. Majority of the elderly interviewed perceived that by engaging in religious activities such as prayer and reciting the Holy Quran or old Islamic scripture gives them serenity or calmness. Additionally, they also felt that involvement in such activities is very synonymous with being old and therefore one should be actively involved in religious activities with increasing age. In view of the lack of diversity of leisure involvement among the elderly and the passive and solitary nature of some of the religious activities, the elderly should be made aware of the importance of participating in other types of leisure activities especially physical activities. Although, they gain spiritual and social benefits from involving in religious activities, they also need to perform other form of activities that can improve the physical health status.