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Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services

Kanchanachitra C, Lindelow M, Johnston T, Hanvoravongchai P, Lorenzo FM, Huong NL, et al.

Lancet, 2011 Feb 26;377(9767):769-81.
PMID: 21269674 DOI: 10.1016/S0140-6736(10)62035-1

In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face problems of maldistribution of health workers, and rural areas are often understaffed. Despite a high capacity for medical and nursing training in both public and private facilities, there is weak coordination between production of health workers and capacity for employment. Regional experiences and policy responses to address these challenges can be used to inform future policy in the region and elsewhere. A distinctive feature of southeast Asia is its engagement in international trade in health services. Singapore and Malaysia import health workers to meet domestic demand and to provide services to international patients. Thailand attracts many foreign patients for health services. This situation has resulted in the so-called brain drain of highly specialised staff from public medical schools to the private hospitals. The Philippines and Indonesia are the main exporters of doctors and nurses in the region. Agreements about mutual recognition of professional qualifications for three groups of health workers under the Association of Southeast Asian Nations Framework Agreement on Services could result in increased movement within the region in the future. To ensure that vital human resources for health are available to meet the needs of the populations that they serve, migration management and retention strategies need to be integrated into ongoing efforts to strengthen health systems in southeast Asia. There is also a need for improved dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with domestic health needs and equity issues.

Matched MeSH terms: Health Personnel/education
Consumer perception on generic medicines in Basrah, Iraq: preliminary findings from a qualitative study

Sharrad AK, Hassali MA

Res Social Adm Pharm, 2011 Mar;7(1):108-12.
PMID: 21397885 DOI: 10.1016/j.sapharm.2009.12.003

BACKGROUND: The use of generic medicines has been increasing steadily internationally, primarily because of cost concerns. Knowledge and use patterns of generic medicines in Iraq have not yet been measured.
OBJECTIVE: This study aimed to explore consumers' perception and knowledge on issues relating to generic medicine use in Basrah, Iraq.
METHODS: A qualitative approach was used to gather information from consumers in Basrah, Iraq. A purposive sample of 14 consumers in Basrah was interviewed face-to-face using a semistructured interview guide.
RESULTS: Thematic analysis of the interviews identified 5 major themes: understanding of the term "generic medicine," preference for generic medicine, refusal of generic medicine, generic substitution, and education on the use of generic medicines. Not all the consumers were familiar with the term "generic medicine;" they were familiar with the term "commercial medicine." Most of the participants understood that generics cost less compared with their branded counterparts. Most of the consumers said that their physicians and pharmacists had given them information on generics.
CONCLUSION: Knowledge of generic medicines may be lacking among consumers in Iraq. Development of consumer education on generics by health care providers is required to support the implementation of the policy on generic medicines in Iraq.

Matched MeSH terms: Patient Education as Topic/methods
Fulltext Information-seeking practices of senior medical students: the impact of an evidence-based medicine training programme

Lai NM, Nalliah S

Educ Health (Abingdon), 2010 Apr;23(1):151.
PMID: 20589599

CONTEXT: The practice of Evidence-based Medicine (EBM) involves physicians regularly accessing and appraising clinical information. Few prior studies have assessed the information-seeking behaviours of medical undergraduates. At the International Medical University (IMU), Malaysia, senior medical students receive clinically-integrated EBM training to facilitate their future practice of EBM.
OBJECTIVES: We assessed whether EBM training in the final six months of medical training changes our students' information-seeking practices and their confidence in understanding and appraising clinical evidence.
METHODS: Between September 2005 and February 2006, self-administered questionnaires were distributed to 65 senior medical students at the beginning and again at the end of their clerkship training during which there was a clinically-integrated EBM curriculum. The questionnaires covered the topics of their preferred sources of clinical information, online search frequencies, estimated time to retrieve an abstract, and their understanding and confidence in their critical appraisal skills.
FINDINGS: Sixty-four (98%) students completed the initial survey and 63 (97%) completed the follow-up survey. The majority indicated that they preferred to first consult another individual (colleagues, lecturers, hospital staff) for their clinical queries (60.9% in the initial survey and 61.9% in the follow-up survey), with no change in their overall preference following the EBM curriculum six months later (p=0.144). There were significant increases in search activities following the curriculum, for example, students who searched PubMed or Medline for more than three times per week increased from 9.7% to 31.7% (p < 0.001). Students reported that they more often accessed single journals than databases. Despite significant improvements in students' reported understanding of journals and their confidence in critical appraisal (p < 0.001), there was no improvement in reported search speed, with 48.4% in the initial survey and 49.2% in the follow-up survey reporting to take 30 minutes or less to trace an abstract of interest (p=0.979).
CONCLUSIONS: Our EBM training, offered within a supportive curriculum, increased our students' confidence and activity related to EBM, but failed to change students' reported information-seeking behaviours. Other factors influencing medical students' information-seeking practice need to be explored.

Matched MeSH terms: Education, Medical, Undergraduate*
Hazarding health: experiences of body, work, and risk among factory women in Malaysia

Root R

Health Care Women Int, 2009 Oct;30(10):903-18.
PMID: 19742364 DOI: 10.1080/07399330903042807

In the 1970s, Malaysia launched an export-oriented development strategy as a means of financing the nation's modernization. The success of the strategy hinged significantly on intensive recruitment of women for factory employment. I draw on descriptive qualitative research, including interviews (51), surveys (106), and ethnography in Malaysia to investigate factory women's experiences of work and work-related health risks. Discourse analysis surfaced a latent consciousness of bodily changes in relation to work. A grounded theory analysis showed a compromised access to occupational risk knowledge that may bear negatively on women's well-being and the role women's new labor identities played in mediating the meanings of work and risks. Given the predominance of women workers in low-end manufacturing globally, I aimed to contribute to theoretical and applied understandings of gender, globalization, and health.

Matched MeSH terms: Women/education
Impact of a training intervention on use of antimicrobials in teaching hospitals

Akter SF, Heller RD, Smith AJ, Milly AF

J Infect Dev Ctries, 2009 Jul 01;3(6):447-51.
PMID: 19762958

BACKGROUND: Antimicrobials are often used inappropriately in paediatric wards of medical college hospitals in Bangladesh. Most of the antimicrobials are prescribed based on clinical grounds-signs and symptoms. This intervention study assessed the effectiveness of a training intervention on antimicrobials prescribing by physicians in paediatric wards of tertiary care level hospitals.
METHODOLOGY: This study was conducted at medical college hospitals in Bangladesh during the period from 1998 through 2000. The pre-intervention survey of antimicrobial use was conducted during 1998 in five hospitals. The post-intervention survey was conducted after the interactive training during the succeeding year in three of the original five hospitals, of which one was the intervention hospital and two control hospitals. A total of 3,466 admitted paediatric patients' treatment charts (2,171 in the pre-intervention and 1,295 in the post-intervention surveys) were reviewed.
RESULTS: The most commonly used antimicrobials were ampicillin, gentamicin, amoxicillin, cloxacillin and ceftriaxone. Appropriate antimicrobial therapy for the most common infectious diseases, pneumonia and diarrhoea, increased by 16.4% and 56.8% respectively in the intervention hospital compared with the two control hospitals and these improvements were significant (p = < 0.001 and p = 0.002, for pneumonia and diarrhoea respectively).
CONCLUSIONS: An interactive, focussed educational intervention, targeted at physicians, appears to have been effective in improving appropriate antimicrobial prescribing for the most common paediatric infectious diseases in a medical college hospital in Bangladesh.

Matched MeSH terms: Education, Medical, Continuing/methods*
A preliminary study on the effect of pharmacist counseling on awareness of and willingness to quit smoking in Malaysian population

Babar ZU, Bukhari NI, Sarwar W, Efendie B, Pereira R, Mohamed MH

Pharm World Sci, 2007 Jun;29(3):101-3.
PMID: 17288012 DOI: 10.1007/s11096-005-2905-4

OBJECTIVES: This paper presents an outcome of pharmacist counseling among Malaysian smokers for their awareness of and willingness to quit smoking.

METHOD: It was a cross-sectional study during a 3-day public health campaign at a shopping complex. Each self-referred participant was asked to complete a questionnaire apart from the question regarding improvement, and if any in their awareness and willingness to quit smoking, were asked to respond after counseling. Pharmacists counseled each participant about smoking cessation strategies and smoking related diseases. The data were analyzed by chi2 test.

RESULTS: Among respondents, 25.5% had been smoking for more than 10 years, 31% for 5-10 years, 25.4% for 2-5 years and 18.3% for 1-2 years. The participants declaring no awareness about smoking were 22.9%, with little awareness 44.3%, having moderate awareness 25.7% and with considerable awareness were 7.1%. After counseling, 4.1% revealed unawareness, 17.8% little awareness, 43.8% moderate and 34.2% had considerable awareness on the above aspects. The post counseling awareness on smoking was observed to be significantly higher (P < 0.01). Among smokers studied, 67% showed willingness to quit smoking.

CONCLUSION: Increase in awareness of and willingness to quit smoking reflects that pharmacist counseling seems to be helpful in cessation of smoking.

Matched MeSH terms: Patient Education as Topic*
Fulltext Knowledge of diabetes mellitus among diabetic and non-diabetic patients in Klinik Kesihatan Seremban

Ding CH, Teng CL, Koh CN

Med J Malaysia, 2006 Oct;61(4):399-404.
PMID: 17243515 MyJurnal

The Malaysian Ministry of Health has undertaken various campaigns on healthy lifestyle and health promotion over the years. The impact of these campaigns has been mixed and not well documented. This cross-sectional study evaluated the knowledge level of patients with and without diabetes in a large urban polyclinic using a 41-item questionnaire. One hundred and forty-nine adults (83 with diabetes, 66 without diabetes) participated in this study. Patients with diabetes had higher overall knowledge scores than those without diabetes (81.8% vs 64.0%, p < 0.001). While the overall knowledge of patients without diabetes appeared to be acceptable, several areas of knowledge deficiency were identified in this group--areas that should be filled by the on-going health promotion activities.
Study site: Klinik Kesihatan Seremban, Seremban, Negeri Sembilan, Malaysia

Matched MeSH terms: Patient Education as Topic*
How does conjugated bilirubin appear in the bloodstream?

Tarmalinggam Y, Prakash ES

Adv Physiol Educ, 2007 Dec;31(4):370-1.
PMID: 18057413
Matched MeSH terms: Education, Medical, Undergraduate*
Clinical pathways in primary dental care in Malaysia: clinicians' knowledge, perceptions and barriers faced

Tay HL, Raja Latifah RJ, Razak IA

Asia Pac J Public Health, 2006;18(2):33-41.
PMID: 16883968 DOI: 10.1177/10105395060180020601

The Oral Health Division, Ministry of Health in Malaysia piloted clinical pathways (cpath) in primary care in early 2003. This study investigated the knowledge, perception of cpaths and barriers faced by the clinicians involved in the pilot project. Self-administered questionnaires were sent to the clinicians (n=191). Dentists (67.9%) and dental nurses (70.6%) had good overall knowledge of cpaths. The majority of the clinicians (67.9% to 95.6%) perceived cpath positively in all areas. Only 9.2% of dentists encountered difficulties in using cpath forms compared to 28.4% of dental nurses. A higher proportion of dental nurses (73.5%) compared to dentists (64.8%) were willing to continue using cpath. The majority of dentists (76.7%) and dental nurses (73.1%) were willing to participate in future development of cpaths. Overall, there was evidence of managerial support for the pilot project. A follow-up of the pilot project was somewhat lacking as less than half (43.3%) of the clinicians reported that the state coordinator obtained feedback from them. The findings auger well for the future implementation of cpath should the Oral Health Division decide to adopt cpath routinely in the public oral health care service.

Matched MeSH terms: Dental Assistants/education
Breaking open a closed system

Cyranoski D

Nature, 2005 Aug 11;436(7052):884-5.
PMID: 16136648
Matched MeSH terms: Research Personnel/education
The Medical Council of India and its revolutionary, way of allowing Indian medical graduates from foreign universities to practice in India

Raju C

Med J Malaysia, 2005 Aug;60 Suppl D:75-8.
PMID: 16315630

This paper attempts to sensitize the participants to understand the benefits of looking at the regulations of accreditation for medical courses in the neighbouring nearby countries. Deregulation of Medical Education like what they have done will bring enormous revenue benefits for the existing assets like the airports, hospitals, hotels resorts and the communication infrastructure of Malaysia.

Matched MeSH terms: Education, Medical/standards*
HIV and sexual health knowledge and sexual experience among Australian-born and overseas-born students in Sydney

Song A, Richters J, Crawford J, Kippax S

J Adolesc Health, 2005 Sep;37(3):243.
PMID: 16109347 DOI: 10.1016/j.jadohealth.2004.08.032

PURPOSE: To examine differences between Australian-born and Asian-born first-year university students in Sydney in their sexual behavior and knowledge about the prevention and transmission of human immunodeficiency virus (HIV) and other sexually transmissible infections (STIs).
METHODS: Students were recruited from a stall during the student Orientation Week in both 2002 and 2003 at the University of New South Wales. A short questionnaire was completed and returned anonymously. Data on age, gender, country of birth, sexual behavior, and sexual health knowledge were collected. A score was calculated based on the sum of the correct answers given to 12 HIV/STI transmission and prevention questions. The students were then divided into three groups according to their country of birth (Australia, Asia, and elsewhere) and their knowledge scores were compared. Students born in certain Asian countries were also asked their perception of the HIV epidemic in their home country compared with Australia.
RESULTS: A total of 1185 first-year students completed the questionnaire. Although older on average, Asian-born students were less likely to have had sexual intercourse and had had fewer sexual partners. They also had consistently poorer HIV/STI knowledge scores than Australian-born students. Students born in China, Hong Kong, Indonesia, Malaysia, and Singapore but not Thailand underestimated the prevalence of HIV in their country of birth in comparison with Australia.
CONCLUSION: The combination of poorer knowledge, apparent misconception of the extent of HIV epidemic in their home country (or Australia), and potential later frequent travel indicates a potential risk for later transmission of HIV/STIs. The university is an underused setting for prevention health education.

Matched MeSH terms: Health Education*
Issues post-stroke for Muslim people in maintaining the practice of salat (prayer): A qualitative study

Mohamed CR, Nelson K, Wood P, Moss C

Collegian, 2015;22(3):243-9.
PMID: 26552194

BACKGROUND: Muslims throughout the world perform salat (prayer) five times a day; salat involves a person reciting the Holy Qur'an while being in several positions. There are several steps that should be carried out before prayer, including wudhu (ablution) and covering one's awrah (body).
OBJECTIVES: To identify educational needs for stroke patients and their caregivers in Malaysia. Another purpose is to report on the needs identified by stroke patients and their families related to salat.
METHODS: Descriptive qualitative study. Phase 1 involved semi-structured interviews with stroke patients (n = 5), family caregivers (n = 5) and health professionals (n = 12) in Kelantan Malaysia. Phase 2 involved presenting the findings from Phase 1 to the health professionals with the aim of establishing priorities and processes to develop education strategies for stroke patients and their families.
RESULTS: Preparing for and performing salat was challenging for both patient and family carers to do following a stroke. Themes identified were prayer and the meaning of the stroke events for participants, difficulties praying post-stroke, prayer as part of rehabilitation therapy.
CONCLUSION: Providing culturally safe care should include how nurses assess and support patients and their caregivers post stroke to meet their prayer needs. Nurses have a role in discussing with stroke patients and their families how in addition to its spiritual and customary benefits, prayer and for Muslims reciting the Holy Qur'an can have cognitive and rehabilitation benefits, as well as being a source of psychological support for stroke patients.

Matched MeSH terms: Patient Education as Topic*
Fulltext Why is there variation in the practice of evidence-based medicine in primary care? A qualitative study

Hisham R, Ng CJ, Liew SM, Hamzah N, Ho GJ

BMJ Open, 2016 Mar 09;6(3):e010565.
PMID: 26962037 DOI: 10.1136/bmjopen-2015-010565

OBJECTIVE: To explore the factors, including barriers and facilitators, influencing the practice of evidence-based medicine (EBM) across various primary care settings in Malaysia based on the doctors' views and experiences.
RESEARCH DESIGN: The qualitative study was used to answer the research question. 37 primary care physicians participated in six focus group discussions and six individual in-depth interviews. A semistructured topic guide was used to facilitate both the interviews and focus groups, which were audio recorded, transcribed verbatim, checked and analysed using a thematic approach.
PARTICIPANTS: 37 primary care doctors including medical officers, family medicine specialists, primary care lecturers and general practitioners with different working experiences and in different settings.
SETTING: The study was conducted across three primary care settings-an academic primary care practice, private and public health clinics in Klang Valley, Malaysia.
RESULTS: The doctors in this study were aware of the importance of EBM but seldom practised it. Three main factors influenced the implementation of EBM in the doctors' daily practice. First, there was a lack of knowledge and skills in searching for and applying evidence. Second, workplace culture influenced doctors' practice of EBM. Third, some doctors considered EBM as a threat to good clinical practice. They were concerned that rigid application of evidence compromised personalised patient care and felt that EBM did not consider the importance of clinical experience.
CONCLUSIONS: Despite being aware of and having a positive attitude towards EBM, doctors in this study seldom practised EBM in their routine clinical practice. Besides commonly cited barriers such as having a heavy workload and lack of training, workplace 'EBM culture' had an important influence on the doctors' behaviour. Strategies targeting barriers at the practice level should be considered when implementing EBM in primary care.
Study site: klinik kesihatan, general practice clinics, Klang Valley, Malaysia

Matched MeSH terms: Health Personnel/education
Effect of an Educational Intervention on Knowledge of Human Papillomavirus Vaccination among Pre-University Students in Malaysia

Kwang NB, Mahayudin T, Yien HL, Abdul Karim AK, Teik CK, Shan LP

Asian Pac J Cancer Prev, 2016;17(1):267-74.
PMID: 26838222

BACKGROUND: Cervical cancer is the fourth most common cancer among women worldwide. Studies evaluating the effect of health education on knowledge and perception of cervical cancer have generated conflicting results. Thus, this study aimed to evaluate the effect of educational intervention towards knowledge of HPV vacccination for cervical cancer prevention among pre-university students in Malaysia.
MATERIALS AND METHODS: This was an experimental before and after study performed between October 2014 and March 2015. Five hundred and eighty students were randomly assigned into intervention and control groups. All were required to complete both pre-intervention and post-intervention questionnaires. Those in the intervention group were given an information leaflet to read before answering the post-intervention questionnaire.
RESULTS: Almost half (48.3%) of the students had poor knowledge, with a score less than 5, and only 51 (8.8%) exhibited good knowledge, with a score of 11 and above. After educational intervention, the number of students with poor knowledge was reduced to 177 (29.3%) and the number of students who exhibited good knowledge increased to 148 (25.5%). Students from the intervention group demonstrated significant higher total scores in knowledge regarding 'HPV infection and cervical cancer' (p=0.000) and 'HPV vaccination and cervical cancer prevention' (p=0.000) during post-intervention as compared to the control group.
CONCLUSIONS: Knowledge on HPV infection and vaccination is low among pre-university students. Educational intervention in the form of information leaflets appears effective in creating awareness and improving knowledge.

Matched MeSH terms: Health Education*
Fulltext Effects of coaching supervision, mentoring supervision and abusive supervision on talent development among trainee doctors in public hospitals: moderating role of clinical learning environment

Subramaniam A, Silong AD, Uli J, Ismail IA

BMC Med Educ, 2015;15:129.
PMID: 26268222 DOI: 10.1186/s12909-015-0407-1

Effective talent development requires robust supervision. However, the effects of supervisory styles (coaching, mentoring and abusive supervision) on talent development and the moderating effects of clinical learning environment in the relationship between supervisory styles and talent development among public hospital trainee doctors have not been thoroughly researched. In this study, we aim to achieve the following, (1) identify the extent to which supervisory styles (coaching, mentoring and abusive supervision) can facilitate talent development among trainee doctors in public hospital and (2) examine whether coaching, mentoring and abusive supervision are moderated by clinical learning environment in predicting talent development among trainee doctors in public hospital.

Matched MeSH terms: Medical Staff, Hospital/education*
Identifying the need for a multidisciplinary approach for early recognition of mucopolysaccharidosis VI (MPS VI)

Choy YS, Bhattacharya K, Balasubramaniam S, Fietz M, Fu A, Inwood A, et al.

Mol Genet Metab, 2015 May;115(1):41-7.
PMID: 25892708 DOI: 10.1016/j.ymgme.2015.03.005

Mucopolysaccharidosis VI (MPS VI, Maroteaux-Lamy syndrome) is caused by deficient activity of the enzyme, N-acetylgalactosamine-4-sulfatase, resulting in impaired degradation of the glycosaminoglycan dermatan sulfate. Patients experience a range of manifestations including joint contractures, short stature, dysostosis multiplex, coarse facial features, decreased pulmonary function, cardiac abnormalities, corneal clouding and shortened life span. Recently, clinicians from institutions in the Asia-Pacific region met to discuss the occurrence and implications of delayed diagnosis and misdiagnosis of MPS VI in the patients they have managed. Eighteen patients (44% female) were diagnosed. The most common sign presented by the patients was bone deformities in 11 patients (65%). Delays to diagnosis occurred due to the lack of or distance to diagnostic facilities for four patients (31%), alternative diagnoses for two patients (15%), and misleading symptoms experienced by two patients (15%). Several patients experienced manifestations that were subtler than would be expected and were subsequently overlooked. Several cases highlighted the unique challenges associated with diagnosing MPS VI from the perspective of different specialties and provide insights into how these patients initially present, which may help to elucidate strategies to improve the diagnosis of MPS VI.

Matched MeSH terms: Health Personnel/education
Fulltext Effect of online formative assessment on summative performance in integrated musculoskeletal system module

Mitra NK, Barua A

BMC Med Educ, 2015;15:29.
PMID: 25884641 DOI: 10.1186/s12909-015-0318-1

BACKGROUND: The impact of web-based formative assessment practices on performance of undergraduate medical students in summative assessments is not widely studied. This study was conducted among third-year undergraduate medical students of a designated university in Malaysia to compare the effect, on performance in summative assessment, of repeated computer-based formative assessment with automated feedback with that of single paper-based formative assessment with face-to face feedback.
METHODS: This quasi-randomized trial was conducted among two groups of undergraduate medical students who were selected by stratified random technique from a cohort undertaking the Musculoskeletal module. The control group C (n = 102) was subjected to a paper-based formative MCQ test. The experimental group E (n = 65) was provided three online formative MCQ tests with automated feedback. The summative MCQ test scores for both these groups were collected after the completion of the module.
RESULTS: In this study, no significant difference was observed between the mean summative scores of the two groups. However, Band 1 students from group E with higher entry qualification showed higher mean score in the summative assessment. A trivial, but significant and positive correlation (r(2) = +0.328) was observed between the online formative test scores and summative assessment scores of group E. The proportionate increase of performance in group E was found to be almost double than group C.
CONCLUSION: The use of computer based formative test with automated feedback improved the performance of the students with better academic background in the summative assessment. Computer-based formative test can be explored as an optional addition to the curriculum of pre-clinical integrated medical program to improve the performance of the students with higher academic ability.

Matched MeSH terms: Education, Medical, Undergraduate/organization & administration*
Health beliefs in oral cancer: Malaysian estate Indian scenario

Tan BS, Ng KH, Esa R

Patient Educ Couns, 2001 Mar;42(3):205-11.
PMID: 11164319

This is a study to describe the health beliefs related to oral cancer (OC) in a high-risk group in Malaysia, a predominantly Indian community living in an agricultural setting called an estate. The study population was a convenient sample of 112 adults, above 20 years of age, attending oral cancer screening in two estates. The subjects consisted of 106 (94.6%) Indians and six (5.4%) Malays. Using the Health Belief Model, the perceptions of susceptibility to OC, its severity, and the benefits of and barriers to preventive actions, as well as beliefs underlying OC aetiology were investigated. About half of the subjects (n=57, 50.9%) felt susceptible to oral cancer. A majority of subjects (n=93, 83.0%) felt that oral cancer is a severe disease. Thirty four people (30.4%) perceived OC as a preventable disease, while 56 (50%) did not, and the remaining 22 (19.6%) did not know if OC was preventable or not. The majority of subjects (84.8%) believed that modifications to the betel quid habit could be beneficial. The information solicited can be used as a starting point to design health-education activities aimed at this group in particular and the population in general.

Matched MeSH terms: Health Education*
The impact of urbanization on family structure: the experience of Sarawak, Malaysia

Sim HC

Sojourn, 2003;18(1):89-109.
PMID: 21853623

This paper argues that women and men encounter the processes of migration and urbanization in very gendered ways. It examines state development policies and their role in accelerating the pace of urbanization, Using material from a recently concluded study on single mothers in the lower socio-economic strata, this paper explores the impact of these wider processes on the structure of the family and women from this strata specifically.

Matched MeSH terms: Women's Rights/education

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