A study was conducted in Kelantan, Mabysia, in the year 2001 , to assess the typhoid reporting coverage and timeliness, and to estimate the annual incidence. Cases were persons given the diagnosis of typhoid clinically, and conhrmed cases are those with positive laboratory results. In all, 174/252 (69%) cases (95% CI = 63%-75%) were reported, ofwhich 89/131 (83%) within 7 days of diagnosis. The estimated annual typhoid incidence in Kelantan is 37/ 1 00,000.
Misuse of alcohol among adolescents, particularly schoolchildren has become one of the public health concerns in Malaysia due to its serious effects and an increased risk of alcohol related injuries, especially motor vehicle injuries. This is the most common type of youthful fatal injury in Malaysia. However the availability of data on the extent of alcohol abuse particularly among school children in this country is limited. Therefore, we conducted this study with the objectives of identifying the prevalence of alcohol drinking among school children in Kuala Lumpur, factors rekited to alcohol drinking among the adolescents and to assess health status of their parents through the presence of any related alcohol diseases and the habits of alcohol drinking among their parents.
In this baseline study a two stage stratified sampling design was used to recruit 8532 eligible students from the selected secondary schools in Kuala Lumpur. The prevalence of alcohol drinking was 9.0% (771 / 8532) . Significant factors identihed related to alcohol consumption were akoholic father (OR=1.29), akoholic mother (1 .55) ; elder siblings consume alcohol (2 .49) and the Chinese ethnic group (1 .55) . The study revealed that factors which signihcantly contributed to the habit of alcohol drinking were related to whether their parents consumed alcohol or not or either their eMer siblings were ako taking alcohol. Therefore, the, results from this study could be used as a baseline data to describe the level of alcohol consumption among adolescents particularly school children. Ehfective public health interventions that focus on the familial context of adolescents' drinking habits may be developed.
Penyakit tifoid adalah penyakit berjangkit bawaan air dan makanan yang disebabkan oleh Salmonella typhii. Penyakit ini berlaku di seluruh durtia dan endemik di Kelantan. Pada April 2005, terdapat peningkatan kes tifoid yang dinotifikasi di daerah Bachok dan wabak telah diistiharkan. Pasukan siasatan telah dibentuk di mana setiap kes telahydisiasat dengan segera dan tindakan kawalan telah diambil seperti pemeriksaan dan penutupan premis makanan, kerja-kerja sanitasi dan pendidikan kesihatan. Pengesanan kes secara aktifjuga telah dilakukan. Mukim Gunong mencatatkan jumlah kes tertinggi iaitu 46.3%. Majoriti daripada kes terdiri daripadapelajar. Dua pembawa dari kalangan kontek juga turut dikesan. Lekuk epidemik menggambarkan berlakunya wabak purtca lazim. Lima daripada 1 1 1 bilangan sampel air dan dua daripada 146 bilangan sampel makanart yang diperiksa adalah positif terhadap Salmonella species tetapi tiada yang positif terhadap Salmonella typhii. Meskipun Pasar Jelawat merupakan lokasi yang disyakki sebagai punca utama jangkitan, ianya tidak dapat disahkan melalui penyiasatan dan ujan makmal.
A cross»sectional study was undertaken between April 2005 to _1 uly 2005 to determine the extent of the health problems experienced by individuals involved in the December 2004 tsunami wave disaster in the Northeast District of Penang, Malaysia. The overall health status of the respondents were evaluated using the Short Form 36 (SF-36) questionnaire. Out of 171 respondents, 160(93 .6%) were Malays, 8(4.7%) were Chinese and 3(1.8%) were Indians. The mean age ofrespondents was 45.4 years, 15.9 years. Ninety-four of the respondents were males (55.0%) while 7 7(45.0%) were females. The overall mean physical component score was significantly lower (66.9:23 .O) amongst respondents with low education level compared with those with high education level (76.3:19.1, p=0.004). This mean score was also significantly much lower ( 68.7:22 .3) amongst those who are married compared to those who were not married (79.8:1 7.4, p=0.003) . The overall mental health score was significantly much higher (78.8:14.6) amongst those who were not married compared to those who were married (68.5:19.2, p=0.001). The overall mental health score was also significantly higher amongst those in the younger age»group (62.3:16.1) compared to those in the older age»group (72.4:18.9, p=0.005). Based on the scores obtained on the Physical Health and Mental Health dimensions of the SF-36 questionnaire, it can be concluded that the health of victims with low education, elderly and those who were married were more adversely affected than others. Therefore, it is vital that medical as well as psychological attention should be channeled to these risk groups who responded more adversely to disasters.
Peningkatan mutu penjagaan kesihatan menyaksikan peningkatan populasi wargatua di Malaysia. Antara gejab yang menjejaskan taraf kesihatan wargatua adalah rnorbiditi akibat amalan merokok. Meskipun pelbagai kajian tentang merokok telah dijalankan di negara ini, namun ttclak banyak yang berkaitan dengan amalan merokok di kalangan wargatua di Malaysia. Perbezaan faktor sosio ekonomi dan pengetahuan tentang amalan merolook di kalangan 850 responden lelaki berusia 60 tahun dan ke atas yang mengambil bahagian di dalam kajian peringkat kebangsaan sempena Kempen Cara Hidup Sihat 2002 dikaji. Maklumat tentang status merokok, pengetahuan dan sikap diperolehi melalui temubual bersemuka menggunakan borang soal selidik berstruktur. Prevalen merokok di kalangan responden adalah 39.2%. Prevalen diclapati paling tinggi di kalangan golongan bertaraf sosio ekonomirendah. Pengetahuan tentang bahaya amalan merokok berbeza mengikut status perokok. Perokok mempunyai pengetahuan yang lebih rendah, sikap yang lebih negatif tentang amalan merokok serta tanggapan risiko penyakit akibat amalan merokok yang lebih rentlah berbanding dengan bekas perokok dan yang tidak pemah rnerokok. Amalan merokok merupakan masalah yang masih membelenggu wargatua lelaki di negara ini. Prevalen merokok di kalangan wargatua Malaysia pada kadar 39 .2% adalah birth tinggi jikidibandingkanhdengan Amerika Syarikat (12%) dan China (26%). Program anti merokok yang mementingkan peningkatan pengetahuan dan sokongan kepada mereka yang ingin berhenti merokok dasar wargatua. Ini untuk meningkatkan kualiti kehidupan wargatua dengan mencegah penyakit kronik berkaitan dengan merokok.
The objective of this study was to evaluate compliance :0 the cliencs’ charter in a dental clinic and factors that may afect the updating of the charter. Our clients’ charter states that registration time is within IO minutes and waiting-mom time before being seen by the dentist is within 30 minutes. Convenience sampling was carried our over two weeks. Only patients above 12 years treated by dental officers were included. Data recorded included registration and wrziting-room time, treatment time, punctualiry afpaniems and workload of ajcicers. There were a total of 532 patients (407 walk»in/outpatients, 125 appointments). Results show that the mean waiting-mom time for all paticnm was nor compliant to the clients' charter (42.7 x 23.8 min for walking flll 44.9 : 32.7 min for appointments). Only 33% were seen within 30 min whilst about 23% waited for more than 60 minutes. All The mean registration time (17.9 1- 12.8 min) was ncmcomplianr everyday except on Thursdays where there were very few patients. Waiting time for elderly patients was not statistically significant from the younger patients. About 36% of appointment ariems were seen within 30 minutes; althou h hal 0 them were late, Exmzctivns, dentures and examination and diagnosis took the shortest time wrzh about 88%, 91% and 98% completed within 30 minutes respectwely. There was variable individual speed and number of patients managed by different operators, although the majority was flrsnyear dental officers. Factors that may contribute waiting time included number of patients per day, operator and punctualizy of patients.
A cross sectional study was conducted to determine the perception of Hospital Directors in performing clinical duties. This was done through a postal survey which was conducted covering all public hospitals in Malaysia. The majority of Hospital Directors had read the circular at the time of the study and agreed to do clinical work besides managerial duties. Before the issuance of the directive, the majority of those directors were already doing some clinical work. However they disagreed that by doing clinical work they could help overcome the problem of shortage of doctors. They agreed that the duration of 10 hours per week is suitable to do clinical duties. In term of confidence in giving curative treatment, the Hospital Directors especially those from district hospitals without specialists were confident in giving curative care to individuals. As for the clinicians, the majority felt that the implementation of the directive for Hospital Directors to do clinical work will not disrupt the clinicians' routine duties.
Study site: University Malaya, Universiti Kebangsaan Malaysia; Hospital Kuala Lumpur, Malaysia
A cross·sectional study was done to determine the capacity of Public Health Inspectors in Selangor using a seh administered questionnaire and universal sampling, to determine the enforcement of public health legislation and its influencing factors. A total of 99 respondents from the District Health Offices and 100 respondents from the Local Health Departments participated. The level of enforcement is generally low in all the units except for the Food Unit and Sanitary and Hygiene Units. Factors influencing enforcement of Public Health Legislations are the unit where the respondents worlc and the length of service with the unit. Further analysis using multiple logistic regression, found that respondents from the Food Unit (OR ZZ; 95% C1: 7 .9-58.9 ) , being in the
U8 category (OR 5; 95% C1: l.4» 17.6), service offour years and above in the same unit (OR 6; 95% C1: 2.2»13.8) , received service rewards (OR 3; 95% C1 : 1.2· 6.9); low exposure to bribery (OR 46; 95% C1: 2.3·100.0) and offered bribes while on the field (OR 3; 95% C1: 1.02» 4.8) have higher kvel enforcement performance. Attention must be given to the enforcement organization with respect to duration of service, service awards and monitoring of bribes exposure to help develop the enforcement of public health legislations.
This survey was done to determine the knowledge, attitude and practice of preventive measures concerning Severe Acute Respiratory Syndrome (SARS) among Alor Gajah town community. The purpose of this study was to determine the knowledge level of SARS, to know their attitude towards SARS and health information provided, to know which sources that provide the best infomation about SARS and to identify the expectations and preferences of population on gaining health infomation. A cross-sectional study involving respondents age 18 and above staying in Alor Gajah town was done. The respondents were assessed using questionnaires comprising of 25 questions. A total 180 respondents had answered the questionnaire. All of them were aware of SARS with 93 .3% with high scores in the knowledge level. Furthermore, 9l .7% of respondents had high scores in their attitude towards SARS. About 98.9% of respondent got their information regarding SARS from television, and 83.9% of them believed the information given. Firty four percent choose television as the best method to convey information concerning SARS or other new emerging diseases. The knowledge and attitude of the respondents concerning SARS were good.
Several studies had shown that the problem of plate waste in hospitals ranged from 17% to 67%. This study aimed to determine the extent of plate waste in a district government hospital, the type of food item wasted and the factors contributing to food waste. A oross»sectional study was conducted in a district hospital, involving four third class wards. A total of 300 patients were included in the study. A plate waste was dehned as the proportion of edible portion of food served that was discarded by patients. The serving size was established by weighing each food item served over breakfast, lunch and dinner on a seven·day rotation menu, using the procedure recommended by the National Food Service Management, During the study period, the left over from each patient’s plate was weighed for all meals. The plate waste for each patient was determined by dividing the total weight of the left over with the average serving weight for the same serving in the same ward. Each patient was also given a self-administered questionnaire to obtain information on reasons or not consuming the ood items served. The overall mean ercentage plate waste of all food served in the four wards was 42.6%. Plate wastage occurred most at dinner (53.2%) and least at breakfast (31 .3%). Vegetables were the most wasted food items. Females wasted significantly higher than males for all meals. Food taste, portion size, appetite and staff service efficiency were factors found signihcantly contributing to plate waste. With almost half of the food served was wasted, hospital management need to direct more attention towards addressing the problem of plate waste since it has both nutritional and cost implications.
Kajian kuasbeksperimental telah di lakukan di tiga buah penempatan pembangunan tanah di negeri Johor, Pahang dan Perak, Semenanjung Malaysia daripada Januari 2003 sehingga Disember 2003 untuk menilai keberkesanan satu program intervensi yang komprehensif dalam mengurangkan tingkahlaku berisiko dikalangan remaja. Tiga buah sekolah yang diberi intervensi (disebut sebagai sekolah kes) dan tiga buah lagi sekolah tidak diberi sebarang intervensi (sekolah kawalan) telah dipilih untuk ketiga»tiga kawasan penempatan pembangunan tanah tersebut. Data pra»intervensi dan pos-intervensi telah diambil daripada setiap remaja tingkatan satu yang menjadi sampel kajian. Walaupun terdapat peningkatan signifikan dalam peratusan remaja yang bertingkahlaku berisiko pos-intervensi, namun peningkatan tersebut adalah lebih tinggi (32 .2%) di sekolah kawalan berbanding
Y sekolah kes (29.2%). Penurunan yang signifikan dikalangan mereka yang telah dikenalpasti sebagai bertingkahlaku berisiko semasa pra»intervensi berlaku cli sekolah kes (25.8%) dan juga kawalan (32.6%). Kajian ini telah menunjukkan kepentingan program interventif remaja yang bukan sahaja boleh mengurangkan bilangan remaja yang bertingkahlaku berisiko malah mencegah
sebahagian besar remaja daripada bertingkahlaku berisiko.
Health traditionally has been compared using mortality and morbidity and in recent years health related instruments have been utilized along to complement those measures. Health related quality oflife instruments are important because they provide patient's opinion and decision of management and for monitoring and evaluating health status. The quality of life instruments such as health related quality of life questionnaires are increasingly being used and these questionnaires are classified into disease specific and generic questionnaires. They require proper assessment using psychometric analysis of reliability and validity, For reliability, the two common analyses are the test-retest and internal consistency and for validity, it requires the assessment of content validity and analyses of construct validity and criterion validity. Reliable and valid quality of lhfe questionnaires provide consistent and accurate information. The purpose of this paper is to provide crucial assessment and analyses of the reliability and validity of health related quality of life questionnaires.
The knowledge, attitude and practice of breastfeeding among young mothers during pre-Baby Friendly Hospital Initiative implementation was conducted at seven private hospitals in Malaysia. A structured interviewer administered questionnaire was given to all mothers (n=Z52) visiting the antenatal/postnatal clinic of the hospitals. The main respondents were Malays (57.5%) and Chinese (35%) . For most mothers, breastfeeding was combined with supplementary feeds of formula milk, with only 30% breastfed exclusively. The majority of mothers knew that breast-milk contained antibodies and can prevent illness, however many were unaware of breastfeeding's contraceptive effect if practised exclusively. Most mothers did not relate breastfeeding as being environmental friendly. Generally, there was no knowledge gained from the experience of having more children with reference to breastfeeding. Most mothers were influenced by their own beliefs regarding choice of feeding method. Therefore, a mother was empowered with the knowledge of all practical aspects of breastfeeding, it would encourage her to breastfeed her baby.
Study site: seven private hospitals in Malaysia
Hospital UKM is the first hospital to implement case·mix system in Malaysia. The objective of the programme is to utilise case-mix system as a tool in improving efficiency and quality of care. From July 2002 to June 2004, a total of 35,568 cases were grouped using IRDRG-Version 1.1 case-mix grouper. Out of these, 3,622 cases or 10.2 % were cardiology cases in MDC 05 (Diseases and Disorders of the Circulatory System). Medical Cardiology cases consist of 86.5% and the remaining 13.5% were Surgical Cardiology. Most of the cases were in severity level one (43.4%), 29.5 % in severity level two and 27.1% in severity level three. The mortality rates for severity level one, two and three were 1.0%, 2.6% and 11.5% respectively. Top three cardiology cases were Acute Myocardial Infarction Without Comorbidity and Complication (IRDRG 05331) (8.4%), Acute Myocardial Infarction With Major Comorbidity and Complication (IRDRG 05333) (7.6%) and Cardiac Catheterization for Ischemic Heart Disease Without Comorbidity and Complication (IRDRG 05311) (7.4%). Step-down costing was carried out to obtain the cost for each DRG group. The mean cost per episode of care for Medical Cardiology cases was RM 3,562 (SD= RM 2, 1 19) with average LOS of 6.4 days (SD= 3 .8days) . For the Surgical Cardiology cases, the mean cost per episode ofcare was RM 6,526 (SD= RM 4,585) and average LOS of5.8 days (SD= 4.1 days). The main components of cost for Medical Cardiology cases are ICU cost (28.8%), pharmacy (17.3%) and Ward Services (15.3%). In Surgical Cardiology, the biggest component of cost was for Operation Theatre (27.9%), followed by Ward Services (25 .4%) and pharmacy (8.5%). Multivariate analysis using multiple linear regression showed that factors which significantly influence the treatment cost of cardiology cases were length of stay, age of the patient, discharge outcome, case type ('surgical partition') and severity level.
Overweight during adolescence has many psychological consequences and low self·esteem is the immediate detrimental effect observed. Adolescents with low self»esteem are at risk for many emotional and behavioural disorders while high self-esteem adolescents experience an incremental improvement in their quality of life. The objective of this study was to compare seh'-esteem between overweight and non-overweight Malay adolescents in Kota Bharu, Kelantan. A cross-sectional study was conducted between January to ]une 2005 among 1364 students selected from ten co-educational government secondary schools in Kota Bharu using stratified multistage cluster sampling. A set of guided self-administered questionnaire which included a Malaysian version of Rosenberg Self-Esteem Scale and Body Mass Index measurement was used. Data was entered using SPSS 12.0 and analysed using STATA 8. O. The prevalence of overweight among secondary school students in Kota Bharu was 12.5% and there was no significant difference in self-esteem between overweight and non-overweight students. However, the findings may not be generalized to out-of-school youth and other ethnic groups in this country. Infomation on other modifers, such as parental acceptance or lack of concern regarding the child’ obesity was not elicited in this study. It is an important protective factor for self-esteem and need to be included in future studies.
A cross sectional survey was conducted in Kampung Datuk Kerarnat, an urbanized residential area in Kuala Lumpur from August to November ZOO5 to assess knowledge, attitude and preventive practices on dengue among its residents. A two stage sampling strategy was used to select survey household. An adult aged at least 21 years old was identified from each selected household and interviewed using a standardized questionnaire. Data was collected on demographics, dengue related KAP and house-types. Knowledge, attitude and practice were assessed using a scoring system. Each appropriate answer was given a point and the points for each section of the questionnaire were totalled. Knowledge was assessed as ‘good' or ‘moderate to poor’ based on arbitrary cut-off point. Out of 133 respondents interviewed, 78.2% were able to identify at least one clinical sign of dengue, 73% knew that dengue fever was caused by the bite of dengue infected Aedes mosquitoes, 71 % correctly identified breeding sites, 69.2% correctly identified the Aedes mosquito and 42% correctly reported biting times ofthe mosquito vector. Overall, knowledge
was categorized as poor, attitude was good and dengue control and prevention practices was moderately poor. There was a weak but significant positive correlation between knowledge and practice (r=0.271, p=0.002) but there was no significant correlation between attitude with practice and between attitude with knowledge (p>0.05) . The results suggested that inspite of good attitude l
on dengue fever, it did not correlate with good practices and good knowledge in dengue prevention. We conclude that there is a need to increase health promotion activities to increase knowledge which forms the basis for preventive practices as part of the strategy to control dengue. Preventive strategies are the only means of controlling the disease.
This study was conducted to determine the patterns of disease and treatment at two disaster sites. Studies prior to this have shown that all natural disasters are unique in that each affected region of the world have different social, economic and health backgrounds. However, similarities exist among the health effects of different disasters which if recognized can ensure that health and emergency medical relief and limited resources are well managed. This study found that although Aceh and Balakot were two totally different areas with reference to locality and climate it was noticed that the patterns of disease two months post disaster are similar the commonest being respiratory conditions followed by musculoskeletal conditions and gastrointestinal conditions. For the treatment patterns it was observed that the two areas prescribed almost similar, types of medicine mainly for gastrointestinal and respiratory systems. However in Aceh, there were more skin treatment and in Balakot there was more usage of musculoskeletal drugs.
Despite awareness of the detrimental effects of smoking, many adolescents initiate or continue to smoke. One possible explanation for smoking 13 the belief that it can control body weight. The objective of this study was to determine the association between Body Mass Index and smoking among Malay adolescents in Kota Bharu, Kelantan. A cross·sectional study was conducted between January to June 2005 among 1364 students selected from ten co»educational government secondary schools in Kota Bharu using stratified multistage cluster sampling. Guided self-administered questionnaire and anthropometric measurement were taken. Data was entered using SPSS 12.0 and analysed using STATA 8.0. The overall prevalence of smoking was 6. 7%. The prevalence of smoking among boys was 13.8% and among girls was 1.1%. There was no association between Body Mass Index and smoking. However, the findings may not be generalized to out-of·school youth and other ethnic groups in this country. The study was not conducted anonymously and the use of questionnaire to report smoking status can lead to measurement bias. Strategies aimed at correcting the belief that smoking can reduce weight should be included as one of the components in the prevention of smoking.
The population of the world is ageing and Malaysia is no exception. The proportion of those above 60 will be 9.5% by the year 2020. Cognitive impairment and depression are two common problems in this age group. The objective of this study was to determine the prevalence of cognitive impairment and depression and their associated factors in the elderly population in a rural community in Kedah. The study design was descriptive cross sectional study. A standardized questionnaire was used in two villages in Mukim Kota Kuala Muda. Barthels index, geriatric depression scale and elderly cognitive assessment questionnaire were also used. The prevalence rate of cognitive impairment was 18.5%. Cognitive impairment was higher among females (22.6%) than males (12.8%). 34.8% of the widowed were cognitively impaired and it increases with age 15.1% within age groups 60 to 69 years, 42.9% in age groups 80 to 89 years and the one and only participant above 90 years was cognitively impaired. Among those with disability, the only one with very severe disability had cognitive impairment, 40% among the severely disabled and 33. 3% among the moderately disabled (p<0.05). Those with cognitive impairment were living with some functional disabilities involving feeding (p<0.05), bathing (p<0.05), grooming (p<0.05), dressing (p<0.05), bladder control (p<0.05), toilet use (p<0.05), transfer from bed to chair (p<0.05), mobility on level surfaces (p<0.05) and climbing stairs (p<0.05). The prevalence of depression was found to be 46.4%. Higher among males (48.4%) as compared to females (44.7%). Depression was 50.0% among the age groups 80 to 89 and 52.4% among the age groups 70 to 79. 63.6% of those living alone were depressed as were 54.8% of the unemployed. 43.8% of those depressed had functional disability. The only one with severe disability was depressed and 66. 7% of those with severe disability were depressed. 47.5% of those with hypertension were depressed. It is a matter of concern that even in a small population the rate of cognitive impairment and mental depression is very high. Health screening is an important aspect of health promotion and disease prevention in people over 60 years. Although screening for many conditions cannot conclusively prove benefit, special attention to these factors can decrease morbidity and improve quality of life in aging population.
Key words: elderly, cognitive impairment, depression, rural community, Malaysia
Study site: Two villages in Mukim Kota Kuala Muda, Kuala Muda District, Kedah, Malaysia
Device, Questionnaire & Scale: Barthels index; Geriatric Depression Scale (GDS-30); Elderly Cognitive Assessment Questionnaire
The high morbidity and mortality caused by smoking is a major public health problem today. Smoking prevention has been acknowledged and identified as a long-term measure to overcome this problem. This is a longitudinal knowledge; attitude and practice (KAP) study among form five students over l year. The response rate at follow‘up was 251/337 (74.5 %). The smoking prevalence changed after 1 year (from 29.7% to 26. 7%) after one year. The male to female smoking rates were 52.1% to 3.1% respectively. Students who smoke were found to have a positive attitude as well as poor knowledge of the risks of smoking. The initiation risk factors identified were being male and having a friend who smokes Positive peer influence also contributed to smoking cessation after a period of one year. Holistic measures that stress on micro macro and approaches such as health education programe to enhance knowledge of smoking hazards and community participation ( cooperation of school, family and community member) should be fomtulated in order to reduce initiation of smoking among the adolescents. Quit smoking programmes must also be readily available.