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Integration and family planning programme performance: an interpretive summary of research projects in Malaysia and the Republic of Korea on the determinants and impact of integration in family planning programmes

Chan Onn Fong, Kim KW, Ness GD

Popul Res Leads, 1982.
PMID: 12338570

PIP:
Results are presented of research undertaken in the Republic of Korea and Malaysia to determine how far integration affects the performance of family planning and allied programs and to identify organizational determinants of clinic level interactive linkages. The report discusses the background of the research, provides overviews of the country programs, outlines research methodologies and procedures, and presents findings. 41 clinics with high, medium, and low performance ratings in Korea and 17 main health centers, 31 sub-health centers, and 49 midwife stations in Malaysia, (some of them intensive input demonstration areas) were assessed on performance, interaction measures, and organizational determinants. The overall finding was that integration affects program performance, but the direction of the impact depends on how the integrated programs are organized. In Malaysia, where the program is specifically organized to integrate family planning with maternal and child health, the integration appears to have increased service delivery and resulted in larger numbers of family planning acceptors. No spill-over was found from the inputs of the 2 components to each other. The overall positive impact and lack of service reduction due to integration appears to result from specific planning for a limited degree of integration. In Korea, a mild negative relationship was found between clinic level performance in the family planning and community development, or Saemaul Undong (SU) components. In the field SU was observed to be more favored and powerful, and was not fully integrated with family planning. The major conclusion of the study was that integration works best when family planning is linked to similar services, and does not work as well with services that are different in character or in degree of government support.

Matched MeSH terms: Primary Health Care
Fulltext Notes for the primary care teacher: quality assurance in teaching

Chan SC

Malays Fam Physician, 2008;3(2):104-6.
PMID: 25606128
Matched MeSH terms: Primary Health Care
Fulltext Primary care--directions we should be taking

Chan SC

Med J Malaysia, 2005 Jun;60(2):127-9.
PMID: 16114150
Matched MeSH terms: Primary Health Care/trends*
Fulltext Appropriateness of medical admissions from a Malaysian public primary care clinic

Chan SC

Med J Malaysia, 1999 Sep;54(3):329-37.
PMID: 11045059

Appropriateness of medical admissions from a Malaysian public primary care clinic (Outpatient Department, Hospital Ipoh) was assessed by two physicians using a modified appropriateness evaluation protocol. Of 122 admissions between 16/6/96 and 15/7/96, 107 records (88%) could be traced from the records office. Eighty percent (86/107) were found to be appropriate and 20% (21/107) inappropriate admissions. Inappropriate admissions included admissions to the wrong discipline and patients who could be investigated and stabilised as outpatients or could be referred to specialist clinics. Protocols, provisions for urgent referrals and medical updates for doctors are recommended.

Study site: Outpatient Department, Hospital Ipoh

Matched MeSH terms: Primary Health Care*
Fulltext A Malaysian Well Person's Clinic--review of patients seen between April and December 1995

Chan SC

Med J Malaysia, 1997 Mar;52(1):53-9.
PMID: 10968053

The Well Man & Well Woman's Clinic in Ipoh Hospital provides screening for coronary risk factors and early detection of cancer. This retrospective review of 1095 patients screened between April and December 1995 showed 48% had one or more coronary risk factors--1 risk (29%), 2 risks (14%), 3 or more risks (5%). Modifiable risks included hypertension (10%), obesity (9%), diabetes mellitus (8%) and smoking (7%). Sixteen abnormal Papanicolaou smears and six cancers (three cervical, two breast and one ovarian) were detected. Public response was good. There is a need for clinics offering comprehensive screening in Malaysian primary health care.

Study site: The Well Man & Well Woman's Clinic in Ipoh Hospital

Matched MeSH terms: Primary Health Care*
The demographic and morbidity patterns seen in an outpatient department in a Malaysian General Hospital

Chan SC

Family Physician, 1995;7:3-10.

This study aimed to established baseline data on patients' demographic and morbidity patterns over three months in the Outpatients Department (OPD) Ipoh Hospital. Entry of the first ten thousand patients into a computerised database for analysis showed that the majority were unemployed and from the low income group. There were more Malays and Indians, less Chinese. Respiratory infections accounted for 18.5 % while major chronic diseases (hypertension, diabetes mellitus, asthma) were common. Overall a wide spectrum of illnesses were seen. A career structure for OPD doctors and incorporation of Family Medicine concepts were proposed to improve primary care in OPD.
Study site: Outpatients Department (OPD), Hospital Ipoh, Perak, Malaysia

Matched MeSH terms: Primary Health Care
Fulltext Comparing organization and management in private & public primary care clinics in Kinta district

Chan SC

Family Physician, 2003;12(2&3):36-40.

Between 2/10/2000 and 30/1/2001, the organizational structure and management in 4 general practice (GP) clinics & 2 health centers (HC) in Kinta District were studied by 14 Level 4 medical students of Perak College of Medicine. Data collected from work process files and staff interviews / shadowing showed that GPs in the study had more working experience with postgraduate qualifications than HC doctors. All HC nurses but only one GP clinic nurse had formal training. HC organization was more complex with documentation. GP organization was simple and lacked documentation. HC management was by a group while GPs handled all management aspects. This study enhanced students' understanding of Malaysian primary care system.

Matched MeSH terms: Primary Health Care
Fulltext Research Notes. 1. Why research? What research?

Chan SC

Family Physician, 2005;13(3):23-24.

Matched MeSH terms: Primary Health Care
Fulltext A pilot study on psychiatric symptomatology amongst urban Form 4 students in Ipoh, Perak

Chan SC, Mahmud M

Family Physician, 2003;12(2&3):19-24.

Objectives: The objectives of this study were to screen for psychiatric symptomatology in Form 4 students in Ipoh, Perak and to determine demographic characteristics, contributing factors and the key person consulted for psychiatric / emotional problems. Methods: Between December 1997 and March 1998, 84 Form 4 students selected by random sampling from 2 Ipoh schools (one co-educational - S1 and one all boys - S2) were screened using the 30-item Malay version General Health Questionnaire (GHQ-30) and a demographic questionnaire. S1 students were interviewed by a psychiatrist (second author) to assess for anxiety / depression / somatization using DSM IIIR criteria. Results: Eighty three students (98.8%) completed their questionnaires. Twenty four students (28.9%) had high GHQ scores (8 and above). There was no significant association found between GHQ scores and gender, race, parental occupation and marital status / situation, number of siblings, frequency of illness and Penialian Menengah Rendah (PMR) results. A significant association was found between the GHQ scores and the students' birth order and perceived performance in the past 6 months as compared to PMR. Fifty percent consulted their friends for emotional problems, 29.2% their parents, 4.9% their siblings. None consulted their teacher / school counselor. Conclusion: Further studies are recommended to look into the prevalence of psychiatric symptomatology amongst our Malaysian secondary school students and into the possible use of the Malay version GHQ-30 as a screening tool in this age group.

Matched MeSH terms: Primary Health Care
Fulltext Perceptions of Malaysian medical students from different academic years on primary care: a qualitative research

Chan SC, Ganeson JV, Ong JT, Sugathan S

Fam Med Community Health, 2020;8(1):e000188.
PMID: 32201548 DOI: 10.1136/fmch-2019-000188

Objective: To explore the perception of medical students from a private medical college in Perak, Malaysia, on primary care practice and induce the factors influencing their perception and willingness to consider primary care as a career pathway.
Design: Qualitative study using focus group discussions. Participants' responses were audio recorded, transcribed, grouped under various domains and listed out and analysed.
Setting: A private medical college in Perak state, Malaysia.
Participants: Forty-six medical students from years 2 to 5 were included. Eight focus groups were formed with two focus groups from each academic year (six students each in seven groups and four students in one group). Students were informed through their respective student leader of each year and received a participant information sheet and an informed consent form which were completed and returned if they decided to participate in the focus group discussions.
Results: The participants had different levels of understanding of primary care depending on their level of exposure to primary care. Senior students with more exposure had a better understanding about primary care and its services. Attractive factors towards choosing primary care as a career included short working hours with a more balanced family and social life, being able to treat patients as a whole with continuity of care and closer relationship with patients. Unattractive factors included routine, unchallenging and boring practice, poor salary, work overload and administrative work in government clinics, being less recognised by other specialties; and the poor perception by other doctors that those pursuing primary care were not 'brilliant enough' for more 'sophisticated disciplines like surgery or paediatrics'.
Conclusion: This study showed that the medical students' level of exposure to primary care played a crucial role in determining their understanding of primary care practice and their choice of career in primary care. Issues to be addressed include remuneration, workload and the prejudice against primary care as a career pathway. Suggestions included introducing early exposure to fun and challenging primary care postings in the medical curriculum and producing well trained, skilled and enthusiastic role models.

Matched MeSH terms: Primary Health Care*
Fulltext Stigmatizing attitudes toward people living with HIV/AIDS (PLWHA) among primary health care providers in Kinta District, Perak

Chan YC, Binti Mawardi M, Ismail Daud AH

Malays Fam Physician, 2021 Mar 25;16(1):31-38.
PMID: 33948140 DOI: 10.51866/oa0001

Background: Stigmatizing attitudes expressed by health care providers prevent some members of at-risk populations from accessing human immunodeficiency virus (HIV) screening and care. This attitude contributes to the continuity of the infection dissemination within our community, which gives an impact on the healthcare service and the curtailment of the global HIV/acquired immunodeficiency syndrome (AIDS) pandemic.
Objective: This study was conducted to identify stigmatizing attitudes toward people living with HIV/AIDS (PLWHA) and their determinants among primary health care providers in Kinta District, Perak.
Methodology: A cross-sectional study was conducted in 36 primary care clinics in Kinta District, Perak. Using stratified random sampling, 365 primary health care providers were recruited into the study. A validated self-administered questionnaire was used to obtain sociodemographic data as well as information on the healthcare experiences of healthcare providers, their knowledge of HIV/AIDS, and attitudes toward PLWHA. Determinants were identified using multiple linear regression.
Results: More than half of the respondents (54.1%) had never provided care to HIV/AIDS patients. A minority (29.9%) had received training on HIV/AIDS. This study shows that doctors (Coef.= -9.50, 95% CI: -18.93, -0.07, p= 0.048), respondents with HIV-positive relatives, (Coef.= -5.61, 95% CI: -10.57, -0.65, p= 0.027), those who had provided care to HIV/AIDS patients (Coef.= -2.38, 95% CI: -4.31, -0.45, p= 0.016), and those with a higher knowledge score on HIV/AIDS (Coef.= -0.86, 95% CI: -1.59, -0.13, p= 0.021) were less likely to show stigmatizing attitudes toward PLWHA.
Conclusion: The issue of stigmatizing attitudes toward PLWHA among primary health care providers needs to be addressed. This study finds that knowledge, profession, experiences with caring for PLWHA, gender, and having HIV-positive relatives are significant predictors of stigmatizing attitudes toward PLWHA among primary health care providers in Kinta District, Perak. Interventional programs to improve knowledge and awareness, as well as decrease stigma toward PLWHA, should be implemented among all health care providers, especially those who have no opportunity to provide direct care.

Matched MeSH terms: Primary Health Care
Fulltext Barriers to smoking cessation: a qualitative study from the perspective of primary care in Malaysia

Chean KY, Goh LG, Liew KW, Tan CC, Choi XL, Tan KC, et al.

BMJ Open, 2019 07 09;9(7):e025491.
PMID: 31289057 DOI: 10.1136/bmjopen-2018-025491

OBJECTIVES: This qualitative study aims to construct a model of the barriers to smoking cessation in the primary care setting.
DESIGN: Individual in-depth, semistructured interviews were audio-taped, then verbatim transcribed and translated when necessary. The data were first independently coded and then collectively discussed for emergent themes using the Straussian grounded theory method.
PARTICIPANTS AND SETTING: Fifty-seven current smokers were recruited from a previous smoking related study carried out in a primary care setting in Malaysia. Current smokers with at least one failed quit attempts were included.
RESULTS: A five-theme model emerged from this grounded theory method. (1) Personal and lifestyle factors: participants were unable to resist the temptation to smoke; (2) Nicotine addiction: withdrawal symptoms could not be overcome; (3) Social cultural norms: participants identified accepting cigarettes from friends as a token of friendship to be problematic; (4) Misconception: perception among smokers that ability to quit was solely based on one's ability to achieve mind control, and perception that stopping smoking will harm the body and (5) Failed assisted smoking cessation: smoking cessation services were not felt to be user-friendly and were poorly understood. The themes were organised into five concentric circles based on time frame: those actionable in the short term (themes 1 and 2) and the long term (themes 3, 4, 5).
CONCLUSIONS: Five themes of specific beliefs and practices prevented smokers from quitting. Clinicians need to work on these barriers, which can be guided by the recommended time frames to help patients to succeed in smoking cessation.

Matched MeSH terms: Primary Health Care*
Health and nutrition of the Orang Asli: The need for primary health care amidst economic transformation

Chee HL

Indigenous Minorities of Peninsular Malaysia: Selected Issues and Ethnographies, 1996.

Citation: Chee HL. Health and nutrition of the Orang Asli: The need for primary health care amidst economic transformation. In: Abd Rashid MR (editor). Indigenous Minorities of Peninsular Malaysia: Selected Issues and Ethnographies. Kuala Lumpur : Intersocietal and Scientific; 1995, p48-73

Matched MeSH terms: Primary Health Care
Primary health care among the Iban of Sarawak

Chen PC, Tan YK

Trop Geogr Med, 1981 Dec;33(4):403-9.
PMID: 7342391
Matched MeSH terms: Primary Health Care/organization & administration*
Fulltext Health care in Sarawak's jungles

Chen PCY

World Health Forum, 1989;10(2):190-2.
PMID: 2610830

A primary health care system is being developed in Baram District, Sarawak, Malaysia, for the benefit of the Penans, who, until recently, were largely nomadic. Many of them are now attempting to adopt a settled mode of existence, and this in itself creates special health problems because the people lack the skills needed for living in one place. Substantial progress has already been achieved in mother and child care and in immunization coverage.

Matched MeSH terms: Primary Health Care*
Developing primary health care for a nomad tribe: the Penans of the Baram

Chen PCY

Asia Pac J Public Health, 1987;1(1):34-7.
PMID: 3452377 DOI: 10.1177/101053958700100109

Unlike much of Peninsular Malaysia, the Baram District of Sarawak remains sparsely populated and underserved, one of the most underserved peoples being the nomadic and semi-nomadic Penans of the Baram. Until quite recently these Penans lived as small nomadic bands of hunter-gatherers. More recently, they have begun to settle in longhouses. However, lacking the necessary skills to live a settled mode of life, these Penans suffer a great deal of hunger, malnutrition, disease and death. Primary health care with its emphasis on the seven essential elements, including food production and nutrition, environmental sanitation, good maternal and child health, knowledge of disease and how it can be prevented as well as the treatment and control of locally endemic diseases, is of critical value in the survival of the semi-nomadic Penans. The specially designed primary health care programme for the Penans of the Baram is outlined briefly in this paper.
Keyword: Baram, Penans, Primary Health Care, Sarawak, Village Health Promoter.

Matched MeSH terms: Primary Health Care/organization & administration*
Fulltext A primary health care project in Sarawak

Chen PCY, Tan YK

Med J Malaysia, 1982 Mar;37(1):25-34.
PMID: 7121343

A joint pilot project between the Ministry of Health and the Department of Social and Preventive Medicine, University of Malaya, to test the value of village aides in extending the health care system into isolated Iban communities was started in May 1979 in the Entabai District of Sarawak. A group of 15 village aides consisting of 11 traditional Iban manangs (medicine-men) and 4 youths were trained to provide primary health care including simple curative care, preventive care and to assist in the detection of malaria. Evaluation carried out 2 years later showed the following. In respect of curative care, the village aides were each, on the average, treating 70.6 patients per month, the most common illness being headaches (30.4 percent), which together with abdominal pain, constipation, bodyaches, diarrhoea, vomiting, fever, worm infestations, cough and sore throat, accounted for 89 percent of all illnesses seen by them. Subsequent to the introduction of village aides in the project area, the number ofseriously ill patients requiring admission to the rest beds of the klinik desa dropped by 43.8 percent and the number of emergency referrals to the back-up divisional hospitals fell by 46.1 percent showing that patients were coming to the klinik desa for treatment at an earlier stage. The 11 traditional Iban manangs, who had received training had, on their own accord, drastically reduced the use of traditional Iban modes of therapy in preference for "modern" medicine. During the 24 months immediately after the introduction of village aides into Entabai, 9 gravity feed water supply systems together with the related "health package" advocating general cleanliness, the use of latrines andfences were effected, whereas only 6 such systems were installed in the previous 24 months, indicating that it is likely that the village aides were of some assistance in mobilizing the community is respect of these self-help efforts. During the same period, the majority of longhouses in the area successfully established a number of vegetable gardens growing foods for home consumption, and continue to vigorously advocate breast feeding of infants in opposition to bottle feeding. During the 23 months after village aides were introduced, a total of 1,093 blood films were collected by the 15 village aides, the average number of blood films per village aide being 3.2 blood slides per month. Village aides are socially accepted by the Iban community who utilize their curative skills when mild illnesses disturb them, but who proceed directly to the klinik desa when more serious illnesses such as fevers strike them. The project has established clear lines of communication between the health team and the community, and has stimulated the community to organize itself to achieve an increasingly high level of health through community participation and self reliance. Plans have been approved in principle to train a further 2000 village aides in primary health care for the state of Sarawak.

Matched MeSH terms: Primary Health Care/manpower; Primary Health Care/organization & administration*
People, behavioural patterns and disease problems

Chen PCY

Family Practitioner, 1977;2:36-38.

In the behavioural conceptual model of health education, behavioural pattern is placed first in the chain of events which can lead from health to disease. If such a model is acceptable, it implies that primary health education must be directed at those behavioural patterns that pre-dispose to diseases. There are obviously numerous behavioural patterns that one is familiar with which would pre-dispose to diseases. The paper discussed some of the more important examples to illustrate the role of behavioural patterns in the causation of disease and the consequential need for health education directed at such behavioural patterns. In relation to nutritional diseases, behavioural patterns in many areas of the developing world are a major contributory factor to the prevalence of protein calorie malnutrition. Such dietary restrictions may even cause the sick individual to be denied the very food he requires. Examples of behavioural patterns in relation to communicable and non-communicable diseases and to medical care were also discussed.

Matched MeSH terms: Primary Health Care
Fulltext Poor glycemic control in younger women attending Malaysian public primary care clinics: findings from adults diabetes control and management registry

Cheong AT, Lee PY, Sazlina SG, Mohamad Adam B, Chew BH, Mastura I, et al.

BMC Fam Pract, 2013;14:188.
PMID: 24325794 DOI: 10.1186/1471-2296-14-188

BACKGROUND: Women of reproductive age are a group of particular concern as diabetes may affect their pregnancy outcome as well as long-term morbidity and mortality. This study aimed to compare the clinical profiles and glycemic control of reproductive and non-reproductive age women with type 2 diabetes (T2D) in primary care settings, and to determine the associated factors of poor glycemic control in the reproductive age group women.
METHODS: This was a cross-sectional study using cases reported by public primary care clinics to the Adult Diabetes Control and Management registry from 1st January to 31st December 2009. All Malaysian women aged 18 years old and above and diagnosed with T2D for at least 1 year were included in the analysis. The target for glycemic control (HbA1c < 6.5%) is in accordance to the recommended national guidelines. Both univariate and multivariate approaches of logistic regression were applied to determine whether reproductive age women have an association with poor glycemic control.
RESULTS: Data from a total of 30,427 women were analyzed and 21.8% (6,622) were of reproductive age. There were 12.5% of reproductive age women and 18.0% of non-reproductive age women that achieved glycemic control. Reproductive age group women were associated with poorer glycemic control (OR = 1.5, 95% CI = 1.2-1.8). The risk factors associated with poor glycemic control in the reproductive age women were being of Malay and Indian race, longer duration of diabetes, patients on anti-diabetic agents, and those who had not achieved the target total cholesterol and triglycerides.
CONCLUSION: Women with T2D have poor glycemic control, but being of reproductive age was associated with even poorer control. Health care providers need to pay more attention to this group of patients especially for those with risk factors. More aggressive therapeutic strategies to improve their cardiometabolic control and pregnancy outcome are warranted.

Matched MeSH terms: Primary Health Care*
Blood pressure control among hypertensive patients with and without diabetes mellitus in six public primary care clinics in Malaysia

Cheong AT, Tong SF, Sazlina SG, Azah AS, Salmiah MS

Asia Pac J Public Health, 2015 Mar;27(2):NP580-9.
PMID: 23536235 DOI: 10.1177/1010539513480232

Hypertension is a common comorbidity among diabetic patients. This study aimed to determine blood pressure (BP) control among hypertensive patients with and without diabetes. This was a cross-sectional study in 6 public primary care clinics in Wilayah Persekutuan, Malaysia. Hypertensive patients aged ≥18 years and attending the clinics were selected via systematic random sampling. The BP control target was defined as <130/80 mm Hg for diabetic patients and <140/90 mm Hg for nondiabetic patients. A total of 1107 hypertensive patients participated in this study and 540 (48.7%) had diabetes. About one fourth (24.3%) of the hypertensive patients with diabetes achieved BP control target, compared with 60.1% patients without diabetes (P < .001). Being diabetic and on ≥2 antihypertensive treatments were associated with poor BP control. Attention needs to be given to these groups of patients when managing patients with hypertension.

Matched MeSH terms: Primary Health Care/statistics & numerical data*

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