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Fulltext Closing the global cancer divide--performance of breast cancer care services in a middle income developing country

Lim GC, Aina EN, Cheah SK, Ismail F, Ho GF, Tho LM, et al.

BMC Cancer, 2014;14:212.
PMID: 24650245 DOI: 10.1186/1471-2407-14-212

BACKGROUND: Cancer is the leading cause of deaths in the world. A widening disparity in cancer burden has emerged between high income and low-middle income countries. Closing this cancer divide is an ethical imperative but there is a dearth of data on cancer services from developing countries.
METHODS: This was a multi-center, retrospective observational cohort study which enrolled women with breast cancer (BC) attending 8 participating cancer centers in Malaysia in 2011. All patients were followed up for 12 months from diagnosis to determine their access to therapies. We assess care performance using measures developed by Quality Oncology Practice Initiative, American Society of Clinical Oncology/National Comprehensive Cancer Network, American College of Surgeons' National Accreditation Program for Breast Centers as well as our local guideline.
RESULTS: Seven hundred and fifty seven patients were included in the study; they represent about 20% of incident BC in Malaysia. Performance results were mixed. Late presentation was 40%. Access to diagnostic and breast surgery services were timely; the interval from presentation to tissue diagnosis was short (median = 9 days), and all who needed surgery could receive it with only a short wait (median = 11 days). Performance of radiation, chemo and hormonal therapy services showed that about 75 to 80% of patients could access these treatments timely, and those who could not were because they sought alternative treatment or they refused treatment. Access to Trastuzumab was limited to only 19% of eligible patients.
CONCLUSIONS: These performance results are probably acceptable for a middle income country though far below the 95% or higher adherence rates routinely reported by centres in developed countries. High cost trastuzumab was inaccessible to this population without public funding support.

Matched MeSH terms: Health Services Accessibility/economics*
Primary health care: hope and challenges for public health in Maldives

Sulaiman AI, Abu Bakar SH, Wahab HA

J Community Health, 2014 Jun;39(3):627-31.
PMID: 24488646 DOI: 10.1007/s10900-013-9809-3

The government of Maldives considers that the enjoyment of the highest attainable level of health is a basic right of every citizen. Thus it lays emphasis on the accessibility and affordability of health care services. In order to achieve these objectives, it is very important to expand curative services as well as preventive services in the country. The major hurdles faced by the country are result of the inherent structural problem faced by the county which leads to sever diseconomies of scale in the provision of healthcare services. Community and individual involvement and self-reliance are very important to achieve Health for All by the Year 200 AD. Community participation is one of the domains of community capacity building in a small island country. It is one of the mechanisms to empower people to take part in community development. In this paper, the nature, the dimensions of community participation, and its role and scope in implementation of different components of primary health care have been described. The health services in public and curative care have been briefed. Some of the achievements in health sector have also been briefly presented.

Matched MeSH terms: Health Services Accessibility/trends*
Barriers to neonatal care in developing countries: parents' and providers' perceptions

Martinez AM, Khu DT, Boo NY, Neou L, Saysanasongkham B, Partridge JC

J Paediatr Child Health, 2012 Sep;48(9):852-8.
PMID: 22970681 DOI: 10.1111/j.1440-1754.2012.02544.x

Hospital care and advanced medical technologies for sick neonates are increasingly available, but not always readily accessible, in many countries. We characterised parents' and providers' perceptions of barriers to neonatal care in developing countries.

Matched MeSH terms: Health Services Accessibility*
Fulltext Malaysian primary care doctors' views on men's health: an unresolved jigsaw puzzle

Tong SF, Low WY, Ismail SB, Trevena L, Willcock S

BMC Fam Pract, 2011;12:29.
PMID: 21569395 DOI: 10.1186/1471-2296-12-29

BACKGROUND: Men have been noted to utilise health care services less readily then women. Primary care settings provide an opportunity to engage men in health care activities because of close proximity to the target group (men in the community). Understanding attitudes towards men's health among Malaysian primary care doctors is important for the effective delivery of health services to men. We aimed to explore the opinions and attitudes of primary care doctors (PCDs) relating to men's health and help-seeking behaviour.
METHODS: A qualitative approach to explore the opinions of 52 PCDs was employed, using fourteen in-depth interviews and eight focus group discussions in public and private settings. Purposive sampling of PCDs was done to ensure maximum variation in the PCD sample. Interviews were recorded and transcribed verbatim for analysis. Open coding with thematic analysis was used to identify key issues raised in the interview.
RESULTS: The understanding of the concept of men's health among PCDs was fragmented. Although many PCDs were already managing health conditions relevant and common to men, they were not viewed by PCDs as "men's health". Less attention was paid to men's help-seeking behaviour and their gender roles as a potential determinant of the poor health status of men. There were opposing views about whether men's health should focus on men's overall health or a more focused approach to sexual health. There was also disagreement about whether special attention was warranted for men's health services. Some doctors would prioritise more common conditions such as hypertension, diabetes and hypercholesterolaemia.
CONCLUSIONS: The concept of men's health was new to PCDs in Malaysia. There was wide variation in understanding and opposing attitudes towards men's health among primary care doctors. Creating awareness and having a systematic approach would facilitate PCDs in delivering health service to men.

Matched MeSH terms: Health Services Accessibility/organization & administration
Fulltext Understanding the modifiable health systems barriers to hypertension management in Malaysia: a multi-method health systems appraisal approach

Risso-Gill I, Balabanova D, Majid F, Ng KK, Yusoff K, Mustapha F, et al.

BMC Health Serv Res, 2015;15:254.
PMID: 26135302 DOI: 10.1186/s12913-015-0916-y

The growing burden of non-communicable diseases in middle-income countries demands models of care that are appropriate to local contexts and acceptable to patients in order to be effective. We describe a multi-method health system appraisal to inform the design of an intervention that will be used in a cluster randomized controlled trial to improve hypertension control in Malaysia.

Matched MeSH terms: Health Services Accessibility*
Fulltext Factors affecting patient compliance with anti-tuberculosis chemotherapy using the directly observed treatment, short-course strategy (DOTS)

O'Boyle SJ, Power JJ, Ibrahim MY, Watson JP

Int J Tuberc Lung Dis, 2002 Apr;6(4):307-12.
PMID: 11936739

SETTING: Kota Kinabalu and surrounding communities in Sabah, Malaysia.
OBJECTIVES: To establish factors affecting compliance of patients with anti-tuberculosis chemotherapy, their knowledge of the disease, and views on improving the DOTS strategy.
DESIGN: Interviews with compliant patients attending clinics for DOTS treatment and with non-compliant patients in their homes, in August and September 2000.
RESULTS: A total of 63 compliant and 23 non-compliant patients were interviewed. For non-compliant patients, reaching the treatment centre entailed greater cost (P < 0.005) and travel time (P < 0.005) compared to compliant patients. Cost of transport was the reason most frequently given for non-attendance. Non-compliant patients were more likely to have completed secondary education (P < 0.05), and to be working (P < 0.01). More non-compliant patients had family members who had had the disease (P < 0.01). There was no difference between the groups for overall tuberculosis knowledge scores; however, non-compliant patients were more likely to think that treatment could be stopped once they were symptom free (P < 0.01). Most patients (73%) felt that the DOTS system could be improved by provision of more information about tuberculosis.
CONCLUSION: Compliance with DOTS in the Kota Kinabalu area is affected by travel expenses, time spent travelling to treatment centres, and having family members who have had the disease. Patients would like more information on tuberculosis.
Study site: Tuberculosis clinics, Kota Kinabalu, Malaysia

Matched MeSH terms: Health Services Accessibility/economics
Available, accessible and affordable. Malaysia. The Hague Forum

Ismail PZ

Integration, 1999.
PMID: 12322184
Matched MeSH terms: Health Services Accessibility*
Accessibility of breast and cervical cancer services in Malaysia

Arrows Change, 1997 Dec;3(3):3.
PMID: 12294552
Matched MeSH terms: Health Services Accessibility*
The health care seeking behavior of schizophrenic patients in 6 East Asian areas

Rhi BY, Ha KS, Kim YS, Sasaki Y, Young D, Woon, et al.

Int J Soc Psychiatry, 1995;41(3):190-209.
PMID: 8847200

The patterns of health care seeking behavior of 1061 schizophrenics and the factors that affect the determination of the patterns were studied in 6 areas of 5 nations in east Asia: Hunan and Sichuan Provinces in China, Japan, Korea, Malaysia and the Philippines. The information was gathered through a structured questionnaire developed by the authors. The subjects generally favored psychiatry-oriented health care, but with frequent interruptions or combination with other types of managements. Most Japanese subjects sought care in western medicine, while subjects from Hunan, Sichuan and Korea alternated between western medicine and magicoreligious therapies or traditional herbal medicine. In the Philippines and Malaysia, the majority of the subjects sought magicoreligious therapies first, then later sought western psychiatric care. The choice of western psychiatric care was mostly influenced by the decision maker's knowledge and interpretation of the patient's illness. In determining the choice of management among various types of non-psychiatric management, cost, location, and societal attitudes played substantial roles as well as knowledge and interpretation. Suggestions and opinions were discussed to improve health care services for schizophrenic patients in each community.

Matched MeSH terms: Health Services Accessibility/statistics & numerical data
Rights of patients: comparative perspectives from five countries

Blum JD, Talib N, Carstens P, Nasser M, Tomkin D, McAuley A

Med Law, 2003;22(3):451-71.
PMID: 14626880

Recognition and articulation of patient rights are core issues in the medical jurisprudence of most nations. While the nature of rights in medical care may vary from country to country, reflecting the idiosyncrasies of domestic law and health delivery, there are commonalities in this area of law that cut across borders. This paper presents five case studies in the patient rights area from Malaysia, Ireland, South Africa, Indonesia and the United States, respectively. The case discussions range from ongoing and fundamental concerns over broad patient rights issues, such as access to health care and informed consent, to rights concerns of those suffering from HIV/AIDS, to a novel consideration over ethical and legal issues concerning ownership of infant organs. It is the hope of the authors that individually, and collectively, the cases will provide helpful insights into this core area of medical law.

Matched MeSH terms: Health Services Accessibility/legislation & jurisprudence*
Strengthening acute coronary syndrome referral network: Insights from initiatives of Penang General Hospital cardiology centre

Abdul Kader MAS

Med J Malaysia, 2019 08;74(4):355-358.
PMID: 31424052

The importance of networking for the management of acute coronary syndrome (ACS) has been emphasised in the 2012 guidelines by the European Society of Cardiology (ESC) on ST-segment elevation myocardial infarction (STEMI). In Penang, the ACS referral network has the Penang General Hospital (PGH), a percutaneous coronary intervention (PCI)- capable hospital, with 14 other hospitals referring their patients for PCI to PGH on a daily basis. In one of its review regarding the referral methodology in the network, PGH's Cardiology centre observed gaps in the referral systems, which was leading to poor quality of referrals. To address these issues, the PGH Cardiology centre developed a standardised protocol and conducted a one-day workshop to educate medical officers about the standardised protocol. This commentary piece is a proof of this concept, and aims to share the experience and provide an overview on the initiatives by the PGH, which has resulted in improved quality of PCI referrals.

Matched MeSH terms: Health Services Accessibility/organization & administration*
Expanding Access: Cost-effectiveness of Cochlear Implantation and Deaf Education in Asia

Emmett SD, Sudoko CK, Tucci DL, Gong W, Saunders JE, Global HEAR (Hearing Loss Evaluation, Advocacy, and Research) Collaborative:, et al.

Otolaryngol Head Neck Surg, 2019 10;161(4):672-682.
PMID: 31210566 DOI: 10.1177/0194599819849917

OBJECTIVE: To determine the cost-effectiveness of cochlear implantation (CI) with mainstream education and deaf education with sign language for treatment of children with profound sensorineural hearing loss in low- and lower-middle income countries in Asia.
STUDY DESIGN: Cost-effectiveness analysis.
SETTING: Bangladesh, Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, and Sri Lanka participated in the study.
SUBJECTS AND METHODS: Costs were obtained from experts in each country with known costs and published data, with estimation when necessary. A disability-adjusted life-years model was applied with 3% discounting and 10-year length of analysis. A sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost-effectiveness was determined with the World Health Organization standard of cost-effectiveness ratio per gross domestic product (CER/GDP) per capita <3.
RESULTS: Deaf education was cost-effective in all countries except Nepal (CER/GDP, 3.59). CI was cost-effective in all countries except Nepal (CER/GDP, 6.38) and Pakistan (CER/GDP, 3.14)-the latter of which reached borderline cost-effectiveness in the sensitivity analysis (minimum, maximum: 2.94, 3.39).
CONCLUSION: Deaf education and CI are largely cost-effective in participating Asian countries. Variation in CI maintenance and education-related costs may contribute to the range of cost-effectiveness ratios observed in this study.

Matched MeSH terms: Health Services Accessibility/economics*
Fulltext Perception of Health Conditions and Test Availability as Predictors of Adults' Mental Health during the COVID-19 Pandemic: A Survey Study of Adults in Malaysia

Dai H, Zhang SX, Looi KH, Su R, Li J

Int J Environ Res Public Health, 2020 07 30;17(15).
PMID: 32751459 DOI: 10.3390/ijerph17155498

Research identifying adults' mental health during the coronavirus disease 2019 (COVID-19) pandemic relies solely on demographic predictors without examining adults' health condition as a potential predictor. This study aims to examine individuals' perception of health conditions and test availability as potential predictors of mental health-insomnia, anxiety, depression, and distress-during the COVID-19 pandemic. An online survey of 669 adults in Malaysia was conducted during 2-8 May 2020, six weeks after the Movement Control Order (MCO) was issued. We found adults' perception of health conditions had curvilinear relationships (horizontally reversed J-shaped) with insomnia, anxiety, depression, and distress. Perceived test availability for COVID-19 also had curvilinear relationships (horizontally reversed J-shaped) with anxiety and depression. Younger adults reported worse mental health, but people from various religions and ethnic groups did not differ significantly in reported mental health. The results indicated that adults with worse health conditions had more mental health problems, and the worse degree deepened for unhealthy people. Perceived test availability negatively predicted anxiety and depression, especially for adults perceiving COVID-19 test unavailability. The significant predictions of perceived health condition and perceived COVID-19 test availability suggest a new direction for the literature to identify the psychiatric risk factors directly from health-related variables during a pandemic.

Matched MeSH terms: Health Services Accessibility*
Islam and harm reduction

Kamarulzaman A, Saifuddeen SM

Int J Drug Policy, 2010 Mar;21(2):115-8.
PMID: 20006483 DOI: 10.1016/j.drugpo.2009.11.003

Although drugs are haram and therefore prohibited in Islam, illicit drug use is widespread in many Islamic countries throughout the world. In the last several years increased prevalence of this problem has been observed in many of these countries which has in turn led to increasing injecting drug use driven HIV/AIDS epidemic across the Islamic world. Whilst some countries have recently responded to the threat through the implementation of harm reduction programmes, many others have been slow to respond. In Islam, The Quran and the Prophetic traditions or the Sunnah are the central sources of references for the laws and principles that guide the Muslims' way of life and by which policies and guidelines for responses including that of contemporary social and health problems can be derived. The preservation and protection of the dignity of man, and steering mankind away from harm and destruction are central to the teachings of Islam. When viewed through the Islamic principles of the preservation and protection of the faith, life, intellect, progeny and wealth, harm reduction programmes are permissible and in fact provide a practical solution to a problem that could result in far greater damage to the society at large if left unaddressed.

Matched MeSH terms: Health Services Accessibility/trends
Priorities for the global advancement of care for older adults with cancer: an update of the International Society of Geriatric Oncology Priorities Initiative

Extermann M, Brain E, Canin B, Cherian MN, Cheung KL, de Glas N, et al.

Lancet Oncol, 2021 01;22(1):e29-e36.
PMID: 33387502 DOI: 10.1016/S1470-2045(20)30473-3

In 2011, the International Society of Geriatric Oncology (SIOG) published the SIOG 10 Priorities Initiative, which defined top priorities for the improvement of the care of older adults with cancer worldwide.1 Substantial scientific, clinical, and educational progress has been made in line with these priorities and international health policy developments have occurred, such as the shift of emphasis by WHO from communicable to non-communicable diseases and the adoption by the UN of its Sustainable Development Goals 2030. Therefore, SIOG has updated its priority list. The present document addresses four priority domains: education, clinical practice, research, and strengthening collaborations and partnerships. In this Policy Review, we reflect on how these priorities would apply in different economic settings, namely in high-income countries versus low-income and middle-income countries. SIOG hopes that it will offer guidance for international and national endeavours to provide adequate universal health coverage for older adults with cancer, who represent a major and rapidly growing group in global epidemiology.

Matched MeSH terms: Health Services Accessibility/standards*
Fulltext The Kuala Pilah cluster cataract study: Accessible eye care reduces cataract blindness

Nur Hanis Y, Raman P, Premala Devi S, Mohd Khalid KH

Med J Malaysia, 2019 08;74(4):296-299.
PMID: 31424036

OBJECTIVE: The Ministry of Health introduced the cluster hospital project in Kuala Pilah district in 2016 to allow sharing of resources between the hospitals in the same vicinity. The aim of this study is to compare the demographic profile, prevalence of cataract blindness and low vision among patients who presented for cataract surgery before and after the programme.

METHODOLOGY: This is a retrospective cohort study of patients who underwent cataract surgery in Kuala Pilah Cluster Hospitals between 2010 and 2017. A total of 2539 records of patients were reviewed. Patients were assigned into two groups: Group 1 (2010-2012)- before the programme (2010-2012) and Group 2 (2015-2017) after the introduction of the programme.

RESULTS: There was a significant increase in number of cataract cases in the district hospital after the cluster initiative. The mean age of patients undergoing cataract surgery was similar in both groups. The common comorbidities were hypertension (Group 1=57.3%; Group 2=70.8%) and diabetes mellitus (Group 1=40.6%; Group 2=51.1%). In 2010-2012, most of the patients were one eye blind (34.4%), whereas in 2015-2017 majority of patients presented with vision better than 6/18 (43.5%). The proportion of patients with cataract blindness reduced from 6% in 2010-2012 to 4.3% in 2015-2017 (p<0.01).

CONCLUSION: There is a significant decrease in percentage of patients with cataract blindness and low vision after the introduction of Kuala Pilah Cluster Hospital Program. We believe that that cluster hospital system is effective in improving accessibility to eye care and therefore increases the cataract detection rate.

Matched MeSH terms: Health Services Accessibility/organization & administration*
Seeking medical help for cancer among urban dwellers in Malaysia-Emotional barriers and awareness of cancer symptoms

Su TT, Azzani M, Donnelly M, Majid HA

Eur J Cancer Care (Engl), 2020 Jul;29(4):e13232.
PMID: 32050305 DOI: 10.1111/ecc.13232

OBJECTIVES: The main aims of the study were to identify barriers to seeking help for cancer, appraise demographic and socio-economic differences in relation to barriers and evaluate the association between barriers and cancer symptoms awareness and delayed help-seeking.
METHODS: A total of 2,360 adults (18 years and above) from randomly selected households in metropolitan Kuala Lumpur completed face-to-face interviews with trained research assistants that incorporated the validated Malay version of the Cancer Awareness Measure (CAM). Logistic regression was the main statistical technique that was used to investigate the study objectives and relationships (noted above).
RESULTS: The most commonly reported barriers to help-seeking were emotional barriers. The probability of delaying seeking help was 49% higher in participants who reported emotional barriers (OR = 1.49; CI: 1.32-1.68; p health education campaigns or programme should address emotional barriers and encourage early seeking help.

Matched MeSH terms: Health Services Accessibility*
Predictors of midwives' intention to provide planned home birth services to low-risk women: A theory of planned behaviour approach

Muhammed A, Khuan L, Shariff-Ghazali S, Said SM, Hassan M

Midwifery, 2019 Jun;73:62-68.
PMID: 30884373 DOI: 10.1016/j.midw.2019.03.004

OBJECTIVE: Planned home birth may increase women's access to skilled midwives in all settings. Using theory to understand and predict midwives' intention regarding planned home birth services is rare. Therefore, using the theory of planned behaviour, we determined the factors associated with midwives' intention to provide planned home birth services to low-risk women.
DESIGN: This cross-sectional study adopted a quantitative approach and a survey. Stratified random sampling was used to recruit 226 midwives in Sokoto, Nigeria. Data-including descriptive statistic and multiple linear regression analyses-were analysed using SPSS 23 and significant was set at 0.05.
SETTING: Ten public health facilities in Sokoto, northwestern Nigeria.
PARTICIPANTS: Among all 460 midwives (women aged 20-60 years), working in the maternity wards of health facilities in Sokoto, a sample of 226 midwives was calculated using a power of 0.80 and a 95% confidence interval.
FINDINGS: The multiple linear regression analyses confirmed that the major factors associated with midwives' intention to provide planned home birth services were midwives' attitude towards planned home birth (p < .001) and midwives' previous experience with planned home birth practice (p = .008).
CONCLUSIONS AND IMPLICATIONS: The theory of planned behaviour is a useful framework for identifying factors that affect midwives' intention to provide planned home birth services. While future research may employ a qualitative approach to explore other factors, planned home birth education campaigns should target information that enhances positive attitude and encourages midwives to provide planned home birth services.

Matched MeSH terms: Health Services Accessibility/standards
Fulltext Moving towards culturally competent health systems for migrants? Applying systems thinking in a qualitative study in Malaysia and Thailand

Pocock NS, Chan Z, Loganathan T, Suphanchaimat R, Kosiyaporn H, Allotey P, et al.

PLoS One, 2020;15(4):e0231154.
PMID: 32251431 DOI: 10.1371/journal.pone.0231154

BACKGROUND: Cultural competency describes interventions that aim to improve accessibility and effectiveness of health services for people from ethnic minority backgrounds. Interventions include interpreter services, migrant peer educators and health worker training to provide culturally competent care. Very few studies have focussed on cultural competency for migrant service use in Low- and Middle-Income Countries (LMIC). Migrants and refugees in Thailand and Malaysia report difficulties in accessing health systems and discrimination by service providers. In this paper we describe stakeholder perceptions of migrants' and health workers' language and cultural competency, and how this affects migrant workers' health, especially in Malaysia where an interpreter system has not yet been formalised.
METHOD: We conducted in-depth interviews with stakeholders in Malaysia (N = 44) and Thailand (N = 50), alongside policy document review in both countries. Data were analysed thematically. Results informed development of Systems Thinking diagrams hypothesizing potential intervention points to improve cultural competency, namely via addressing language barriers.
RESULTS: Language ability was a core tenet of cultural competency as described by participants in both countries. Malay was perceived to be an easy language that migrants could learn quickly, with perceived proficiency differing by source country and length of stay in Malaysia. Language barriers were a source of frustration for both migrants and health workers, which compounded communication of complex conditions including mental health as well as obtaining informed consent from migrant patients. Health workers in Malaysia used strategies including google translate and hand gestures to communicate, while migrant patients were encouraged to bring friends to act as informal interpreters during consultations. Current health services are not migrant friendly, which deters use. Concerns around overuse of services by non-citizens among the domestic population may partly explain the lack of policy support for cultural competency in Malaysia. Service provision for migrants in Thailand was more culturally sensitive as formal interpreters, known as Migrant Health Workers (MHW), could be hired in public facilities, as well as Migrant Health Volunteers (MHV) who provide basic health education in communities.
CONCLUSION: Perceptions of overuse by migrants in a health system acts as a barrier against system or institutional level improvements for cultural competency, in an already stretched health system. At the micro-level, language interventions with migrant workers appear to be the most feasible leverage point but raises the question of who should bear responsibility for cost and provision-employers, the government, or migrants themselves.

Matched MeSH terms: Health Services Accessibility*
Fulltext Factors associated with health services financier among temporary sheltered homeless in urban Malaysia

Aizuddin AN, Abdul Jabar SW, Idris IB

BMC Public Health, 2019 Jun 13;19(Suppl 4):548.
PMID: 31196020 DOI: 10.1186/s12889-019-6871-5

BACKGROUND: The presence of homelessness in Malaysia is not a new issue. The existence of homeless population is growing, along with the development of this country. With the increasing number of homelessness, the range of issues, such as health services financier among them, has surfaced. However, there was limited study conducted on this subject. The main objective of this study was thus, to identify the financier of health services among the homelessness in Kuala Lumpur and factors associated with it.
METHODS: In this cross-sectional study, we include 196 homeless people aged above 18 years, Malaysian who were able to communicate with interviewers, and respondents who were not aggressive. These respondents were transits at Pusat Transit Gelandangan Kuala Lumpur and Anjung Singgah Kuala Lumpur and were available during interview sessions. They were selected via simple random sampling and were interviewed via face to face guided interviews using a validated structured questionnaire. Data were analysed descriptively, as well as using bivariate and multivariate analysis to explore the associated factors.
RESULTS: The study showed that 57.7% homeless utilized the health services with only 37.8% assessed government health services. Only 42.5% of the respondents use their own money and 46.9% received aids to finance their health. Major influencing factors that influence homeless people to use their own money for health services were education level, income and disability, with adjusted OR (95% CI) of 3.15 (1.07-9.25), 0.08 (0.029-3.07) and 0.05 (0.003-0.88) while p value was 0.037, health services were income and those who took drugs with adjusted OR (95% CI) of 6.50 (2.30-18.39), and 0.33 (0.11-0.95) while p value was health care accessibility in Malaysia.

Matched MeSH terms: Health Services Accessibility/economics*

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