Contact time was defined as the time spent by health personnel with a patient. The study was conducted for four months in 2007 to assess the contact time and to determine the appropriate contact time as perceived by patients attending clinics of various clinical disciplines as well as Out-Patient Departments and Emergency Departments at Ministry of Health Hospitals. This study was a cross-sectional study carried out on out-patients who came to the hospitals’ clinics for treatment. Information was gathered through self-administered questionnaires, distributed at twenty-one hospitals. The respondents were selected using stratified random sampling method. Out of 21,750 questionnaires distributed, 13,463 patients responded, a response rate of 61.9%. This study shows that the average contact time increases from small hospitals (8 minutes) to bigger hospitals (15 minutes). The contact time also varies between the clinics of various disciplines. Obstetrics and Gynecology (O&G) clinics and Pediatric clinics had the longest average contact time of 20 minutes and 15 minutes respectively. The percentage of patients who were satisfied with the contact time corresponded with the type of clinics and hospitals which had the longest contact time. Thus, it is suggested that clinics and hospitals, whenever possible try their best to follow the duration of contact time as perceived appropriate by the patients.
Study site: Out-Patient Departments and Emergency Departments at Ministry of Health Hospitals (21)
Family planning is one of the main pillars of safe motherhood initiatives. It is therefore a very crucial area that needs continuous strengthening and improvement in order to reduce maternal morbidity and mortality which will ultimately improve the general condition of women. Findings from the Confidential Enquiries into Maternal Death (CEMD) Malaysia Report 2001 - 2005 revealed that up to 70% of the maternal deaths never practiced any form of family planning. The contraceptive prevalence rate (CPR) in Malaysia for the year 2004 was 51.7% compared to Thailand, Vietnam and Singapore which was 79%, 74% and 74% respectively. One neglected area that has never been emphasized seriously in the family planning programme in Malaysia is male participation, gender awareness and sharing of responsibility by both partners. In realizing this, efforts have been made to include men as target groups in the national family planning programme. This paper will highlight the importance of optimum gender relations and sharing of responsibility with special emphasis towards the role of husbands and male medical personnel in the effort to improve family planning activities. It will also discuss the efforts put by the Ministry of Health in order to create gender awareness and encourage male participation in family planning.
Hospital Information System (HIS) is a comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital. This study is to describe those aspects of the implementation of hospital information system in three tertiary hospitals in Klang Valley; Serdang Hospital, Selayang Hospital and University Kebangsaan Malaysia Medical Centre (UKMMC). A qualitative study was conducted to obtain views on information system development and implementation in the hospitals mentioned above. In-depth interviews with personnel representing both the system providers and the end-users were done guided by a questionnaire. The results of the interviews were categorized into few themes namely the system development, human resource, scope of implementation, support system, user-friendly, training, hardware and security. There were differences in hospital information system development and implementation in the three hospitals. Each system has its own strengths and weaknesses that make it unique. In developing HIS, its important to ensure the system can work effectively and efficiently. Quality human resource, good support system, user-friendly and adequate training of the end-user will determine the success of implementation of HIS. Upgrading of hardware and software as needed is the basis to keep up with the pace of technology advancement and increasing number of patients. It is hoped that HIS will be implemented in all other hospitals with effective integration and networking.
In a time of rising demands on hospital reimbursement levels, focus on efficient operations is becoming more imperative. In health care systems, the measurement of efficiency is usually the first step in auditing individual performance of production units, e.g. hospitals, health centers, etc. It constitutes the rational framework for the distribution of human and other resources between and within health care facilities. The term efficiency is broadly used in economics and refers to the best utilization of resources in production. Typical example of efficiency is technical efficiency, referring to the effective use of resources in producing outputs. In the Farrell framework, a hospital is judged to be technically efficient if it is operating on the best practice production frontier in its hospital industry. In general, there are two main frontier methods in measuring efficiency. The first is Data Envelopment Analysis (DEA), a linear programming method which enables the measurement of efficiency consistent with the theoretically based concept of production efficiency. DEA typically examines the relationship between inputs to a production process and the outputs of that process. The second technique for assessing efficiency that is employed is Stochastic Frontier Analysis (SFA). This is an econometric technique to estimate a conventional function; with the difference being that efficiency is measured using the residuals from the estimated equation. The error term is therefore divided into a stochastic error term and a systematic inefficiency term.
The Universal Declaration of Human Rights, 1948 stated that everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international cooperation and in accordance with the organization and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the free development of his personality. Equity, solidarity and social justice are understood as basic characteristics of universal access to social health protection founded on burden sharing, risk pooling, empowerment and participation. It is up to national governments and institutions to put these values into practice. The financing of social health protection can be through a mixture of taxation and contributions to public and mandated private insurance. Through risk pooling, these funds provide for equity, solidarity and affordability of services. According to International Labour Organization (ILO), ultimate objective in social health protection is to achieve universal social health protection coverage defined as effective access to affordable health care of adequate quality and financial protection. Social protection plays a vital part in reducing the vulnerability of the poor so that they can fruitfully access health and education services.
Cat fleas were reported to attack human in RPR Batu Kawa, a housing area about 3 km from Kuching town, resulting in an outbreak. A total of 19 people (10 adults and 9 children) were attacked by fleas. They presented with red spots, slightly raised (swollen) and irritation of skin, mostly found on the ankles and legs. The first 4 cases were reported on 29 September 2007 and the last case was on 17 November 2007. The remaining 12 cases which represent the majority of cases reported on 4th October 2007. The study conducted based mainly on field investigation and flea sampling from animals on field at that moment to find out the causes of the disease spread. Flea samples from human and cats were found to be Ctenocephalides felis; which is the most prevalent species in the world. However, no fleas were found on dog, rabbit and rat. This is the first reported case in Kuching; the study was carried out to determine the cause and the epidemiological pattern of the disease. This is important, because cat flea might attack human especially if house owners fail to monitor their pets and practice proper sanitation method to avoid the presence of cat flea larvae at home.
On 24th April 2009 the World Health Organisation (WHO) announced Pandemic Influenza A (H1N1) alert phase 4 which was later raised to phase 6 on 11th June 2009. By 11th October 2009, 199 countries were affected with 399,232 laboratory confirmed cases resulting in 4735 death. In Pahang, the state and district operation rooms were activated on the 28th April and 5th May 2009 respectively to monitor surveillance, control and preventives measures carried out. This study was done to describe the situation of Pandemic Influenza A (H1N1) in Pahang from 28th April 2009 till 10th October 2009 in terms of laboratory confirmed cases and clusters reported, Influenza-Like Illness (ILI) surveillance, Severe Acute Respiratory Infection (sARI) surveillance and health education activities. During the period, 490 laboratory confirmed Influenza A (H1N1) cases were registered with 5 deaths. The age ranges from less than 1 year to 76 years with median of 16 years old. 207 ILI clusters were recorded, 139 (67.5%) were Influenza A (H1N1) clusters. For surveillance activity, 11,570 (2.2%) of outpatient attendances were ILI cases while 966 (2.0 %) of total admissions were sARI cases. There were 14,927 health education activities carried out during the period. The number of people affected by Pandemic Influenza A (H1N1) in Pahang reached its peak in mid August 2009 and later showed a downward trend. ILI surveillance was a useful tool to detect Influenza A (H1N1) activity in Pahang.
Study site: Klinik kesihatan, outpatient clinics, hospitals, Pahang, Malaysia
The maternal health status of Orang Asli women in Malaysia was noted to be lower as compared to other groups of population in the country. This study aimed to determine the level of knowledge, attitude and practice on antenatal care, which is a vital component of maternal health among the Orang Asli women in three Orang Asli villages in Jempol District, Negeri Sembilan. All women aged between 15 to 49 years old who had at least one antenatal experience were interviewed using a structured, pretested questionnaire. A total of 104 women were interviewed. Among them, 92.3% admitted attending antenatal clinic during their previous pregnancies while only 48.1% came early for their first check-up. About 70% of the women had history of home delivery and 44.2% had experienced at least one high risk pregnancy before. Study revealed that 44.2% (95% CI, 34.7 – 53.7%) of the women have good knowledge regarding antenatal care while 53.8% (95% CI, 44.3 – 63.1%) of them noted to have positive attitude regarding antenatal care. However, result showed that the level of knowledge regarding the importance of early antenatal care, screening test and complications of diabetes and hypertension in pregnancy were poor. In conclusion, the rate of home delivery and late antenatal booking was still high among the Orang Asli women and it is significantly associated with their attitude regarding antenatal care. These findings can be used to plan a customized health intervention program aiming to improve the maternal health practices and eventually improve the health status of the Orang Asli women
Study site: Orang Asli village, Jempol, Negeri Sembilan, Malaysia
Adolescents who overestimate the prevalence of smoking among their peers or other teens are at higher risk to take up smoking. The purpose of this study is to elucidate the factors which are related to adolescents’ overestimation of smoking. We surveyed form four (16 years old) students in Petaling District, Selangor. A sample was selected using two-stage stratified sampling, and data were collected using standardised, self-administered questionnaires. A response rate of 80.4% (n=1045/1298) was obtained, and a total of 943 students were included in the final analysis. About 73 percent (n=688/943) of the respondents overestimated the prevalence of smoking among their peers. The odds of overestimating increased as the number of close friends who smoke increased [Two close friends, OR=3.10(1.67-5.75), three close friends OR=10.81(4.44-26.3) and four-five close friends OR= 12.91(5.31-31.43)]. Those who had an elder brother who smoked (OR=1.95 (1.18-3.24)) and females [2.08(1.37-3.33) were more likely to overestimate peer smoking prevalence. Intervention programmes to correct the misperception of peer smoking prevalence are recommended, in addition to measures to modify the other factors that are amenable to intervention, so as to reduce the risk of smoking initiation among adolescents.
Impact of health care on the population health has been measured in terms of morbidity and mortality but this measurement doesn’t distinguish between children, adults and the elderly. It does not also take into account the losses that occur because of handicap, pain, or other disability. Therefore, measures of population health which combine information on mortality and non-fatal healthboutcomes to represent the health of a particular population as a single number was introduced. QALYs and DALYs are both common outcome measures in economic evaluations of health interventions. QALYs is the comprehensive measure of health outcome because it can simultaneously capture gains from reduced morbidity (quality gains) and reduced mortality (quantity gains) and combine these into a single measure. DALYs is primarily a measure of disease burden where it combines losses from premature death and loss of healthy life resulting from disability. Although QALYs and DALYs are almost similar in their basic concept but there are few distinct differences which must be paid attention to in order to correctly utilize these measures.
A study was conducted at Greentown Health Clinic, Ipoh to assess and classify asthma by levels of control based on the Global Initiative for Asthma (GINA). The secondary objective was to identify those patients whose control was suboptimal. A total of 102 patients were included in this study based on random sampling between 25th April 2008 and 6th June 2008. Standard Asthma Control Questionnaires were used to classify asthma and levels of control. Baseline Peak Expiratory Flow Rate (PEFR) measurements and PEFR at audit visits were also recorded. All data were analysed using SPSS version 13. The study showed that only 39.2 % of the patients were classified as having controlled asthma, 34.3 % had asthma that was partly controlled and 26.5 % of the patients had uncontrolled asthma. Among those patients who had inadequate asthma control, more than half of them had nocturnal attacks and exacerbations. These findings demonstrate the need by the attending doctor to improve assessment of the patient’s control of asthma by actively questioning the patients and subsequently improving management to achieve optimal control of asthma.
Study site: Klinik Kesihatan Greentown, Ipoh, Perak, Malaysia
Top-down costing and activity based costing are the most frequent costing methodologies used for analyzing cost. Top-down costing is accomplished by assigning total expenditure of hospital to patient by apportioning the expenditure of cost centers (unit of service) in hospital to give the cost per patient per visit, per day or per admission. Conversely, activity based costing is accomplished by tracking every resource used by patient individually. Since this study started in 2009, Top-down costing calculation was based on financial year in 2009 with adjusted up to 12.6% from 2008 data. This percentage was taken based on the trend of hospital expenditure during 2005 till 2008. An assumption was made that non-financial data (performance and administrative data) for 2009 was similar to 2008. Top-down costing was calculated using Clinical Cost Modeling Software developed by Unit Case-mix of UKMMC to obtain cost of elective lower segment caesarean section (LSCS) per day at ward which was RM922. Whereas activity based costing was calculated using clinical pathway of elective LSCS. Given the average length of stay in 2009 was 4 days, the cost of elective LSCS according to top-down costing was RM3, 688 and activity based costing was RM1774. As a result, cost of elective LSCS is 108% higher using top-down costing.
Adolescents are known to obtain information regarding sexual and reproductive health from a variety of sources and not just during formal lessons in schools. This cross-sectional descriptive study was carried out to determine the source of information on sexual and reproductive health among Form four secondary schools girls in the Klang Valley as well as parents’ relationship profile. A total of 520 secondary school girls were recruited for the study. In this study, the source of information on puberty and sexual topics were categorized as follows: first level of importance - mothers, second level of importance - siblings, third level of importance - fathers, fourth level of importance - friends, fifth level of importance - teachers and sixth level of importance - books/internet. A majority of respondents agreed that their mothers were the first level of importance they sought for information on puberty (74.8%) and sexual topics (53.8%). Thirty nine point three percent (39.3%) of respondents reported it was very easy to have a dialogue with their mothers while only 10.0% of the respondents said it was very easy to have a dialogue with their fathers. While this was the case, only 6.3% of the respondents reported discussing sex-related matter with their mothers.
Satu kajian keratan rentas telah dijalankan untuk melihat kesan pendedahan haba ke atas perubahan fisiologi di kalangan pekerja lelaki sebuah kilang pembuatan komponen otomotif di Shah Alam, Selangor. Seramai 46 orang yang berkerja di bahagian foundri telah dipilih sebagai responden kajian. Pemboleh ubah yang dikaji adalah WBGT Dalaman, kadar haba metabolik, suhu teras badan, tekanan darah, denyutan nadi dan kadar denyutan nadi. Hasil kajian mendapati nilai min WBGT Dalaman di bahagian operasi foundri adalah sebanyak 28.96 0C. Pekerja foundri terdedah kepada haba semasa
proses peleburan besi, proses memasukkan silika dah debu besi ke dalam acuan pembentukan, dan pembentukan teras. Purata masa pengukuran yang paling singkat adalah selama 2 jam dan 8 jam untuk keseluruhan tempoh pendedahan. Ujian Bonferroni menunjukkan terdapat perbezaan yang signifikan di antara suhu teras badan sebelum syif bermula dengan 2 jam selepas syif bermula (p = 0.05) dan di antara sebelum syif bermula dengan selepas tamat syif 8 jam bekerja (p < 0.001). Terdapat perkaitan yang lemah di antara suhu teras badan dengan kadar denyutan nadi sebelum syif bermula (r = 0.293, p = 0.048) dan di antara suhu teras badan dengan tekanan darah sistolik selepas tamat syif 8 jam bekerja (r = 0.309, p =0.036). Kadar denyutan nadi responden adalah berada di antara julat 51 hingga 98 denyutan perminit, menunjukkan tidak terdapat tuntutan aktiviti kerja yang berlebihan ke atas fisiologi. Min suhu teras badan (36.37 ± 0.53 0C) dan kadar denyutan nadi (74.50 ± 10.10 per minit) selepas tamat syif 8 jam menunjukkan pekerja mempunyai kawalan
tubuh badan yang baik terhadap pendedahan haba. Tiga daripada empat seksyen kerja yang dikaji mempunyai bacaan WBGT Dalaman melebihi 28 0C (ACGIH TLV). Pekerja terdedah kepada tegasan haba yang sederhana sepanjang kajian ini berlangsung, walaubagaimanapun, suhu teras badan, kadar denyutan nadi dan tekanan darah masih tidak mencapai tahap tegangan kepada fisiologi.
Comparison of rates of smoking across countries revealed that students are more likely to begin smoking in medical school than to give it up and increase their cigarette consumption rather than decrease it. A cross-sectional survey of all consenting medical students in a private medical university in north Malaysia was conducted in 2008 to determine the prevalence and smoking habits among them. A self administered questionnaire which was returned to the investigators in a sealed envelope was used. Results were tabulated and analysed with SPSS version 13.0 software. The response rate was 83.3% (508/610). The prevalence rate for current smokers was 5.3% (27/508) and for ever smokers 9.3% (47/508). Factors significantly associated with smoking were gender (p<0.001), age group (p<0.001) and family income (p=0.003). The odds of being a smoker was 14 folds high when a family member smoked and the odds of being an ever smoker was almost 6 folds more when a family member smoked. Friends were the most common influence to start smoking and the most common reason to stop smoking among ever smokers. The reasons for not smoking among the never smokers were health concerns and the distasteful smell of cigarettes. A module on how to help medical students to stop smoking should be included in the curriculum of every medical school. This will not only help them become good educators but will prevent them from picking up the habit. Educational intervention should also include family members who smoke.
Key words: smoking, medical students, university, Malaysia
Patient waiting time was introduced to orthodontic clinics in 2009 as a Key Performance Indicator (KPI) in the Ministry of Health Malaysia (MOH) as a measure of client satisfaction. A cross-sectional pilot study was carried out in 2009 in all four main government orthodontic clinics in Selangor. The objectives were to measure patient actual waiting time and evaluate conformance to this KPI. The sample comprised of 5,286 patients; 9.2% from Tanjung Karang, 37.1% Kajang, 29.3% Klang and 24.4% Shah Alam. There were 33.8% punctual, 44.2% early and 21.9% late patients. The mean actual waiting time (AWT) in Selangor was 30 min (SD 24.7); shortest in Tanjung Karang (16.5min, SD 15.3) and longest in Shah Alam (47.9min, SD29.6). AWT was 21.9 min (SD 17.4) for patients punctual for appointments, 40.3 min (SD 40.3) for early patients and 21.9min (SD19.8) for late patients respectively. Although the mean AWT was long for early patients, 20% of them were seen earlier than their appointment time. All four clinics complied with the MOH KPI performance target (>50%) with a mean compliance of 87.5% for Selangor. There is statistically significant difference in punctuality of patients in different clinics (p
Treating tuberculosis (TB) remains a public health challenge in many developing countries. Treatment success rate in Malaysia is on declining pattern from 78% in 2000 to 48% in 2006. This study will determine factors associated with unsuccessful treatment among pulmonary TB patients. A retrospective cohort study was conducted on notified and treated pulmonary TB cases in Kota Bharu district Kelantan between January 2006 and December 2007. To identify the associated factors, univariate comparison and multiple logistic regressions were performed. Among the 765 patients identified, 472 (61.7%) cases fulfilled the criteria and were analyzed. There were 316 males and 156 females and their mean (SD) age was 45 (17.9) years. In univariable analysis, age, gender, educational level, employment status, family incomes as well as coexistence of extra-pulmonary TB, smoking, co-morbid disease (diabetes mellitus), HIV status, sputum cultures, chest X-ray findings and duration of delay for diagnosis were all found to have significant relationship with unsuccessful pulmonary TB treatment outcome. After adjusted for the confounders, the significant predictors for unsuccessful tuberculosis treatment were age (Adj. OR 1.09; 95% CI: 1.03-1.15), HIV positive (Adj. OR 23.04; 95% CI: 3.01-176.22) and advanced chest X-ray findings (Adj. OR 6.51; 95% CI: 1.50-28.23). A large proportion of unsuccessfully treated cases could be identified at entry
by screening for age, chest X-rays and HIV status and specially targeted measures could be taken. The use of directly observed treatment short-course (DOTS) should be given more focus and priority among this high risk group of patients.
Cognitive Impairment is common in late life and may be due to the normal process of ageing, or associated with physical or mental disorder which contributes to a decrease in quality of life, neuropsychiatric symptoms, increased disability and increased healthcare cost. The aim of this study is to determine the prevalence of cognitive impairment among the elderly members in NACSCOM in Day Care Centres within the Klang Valley and its associated socio-demographic factors such as age, gender and educational level. This cross-sectional study was conducted on 101 members of NACSCOM in Day Care Centres of Damansara,Subang Jaya and Setapak using assisted questionnaires as the research tool. The questionnaire comprising of a total of 10 questions based on Elderly Cognitive Assessment Questionnaires (ECAQ), consisted of three parts, memory, orientation and recall. One correctly answered question earned the respondent one mark. The total score for ECAQ is 10 where respondents with scores of 5 and below were identified as having cognitive impairment. Data collected was analyzed using Chi-square test (SPSS version 18). The prevalence of cognitive impairment among the elderly members of NACSCOM in Day Care Centres within the Klang Valley was 4.0%. This study also showed that there was no statistically significant association between cognitive impairment and sociodemographic factors such as age, gender and education. Prevalence of cognitive impairment among the members of NACSCOM in Day Care Centres within the Klang Valley was found to be low. This could be attributed to the fact that members actively participated in activities organized by NACSCOM. The study also did not find any statistically significant association between cognitive impairment and age, gender and education.
Caregivers may experience the need for information, social support, a range of services and financial support in caring for children with disabilities. However, some of these needs are unmet. This study aims to determine the perceived unmet needs among caregivers of children with disabilities at the Community-based Rehabilitation centre (CBR). A cross-sectional study was carried out among a total of 337 caregivers, who were recruited from 12 CBR centres in Selangor. The unmet needs were assessed using Family Needs Survey (FNS) questionnaire, which included six subscales of needs such as need for information, social support, community services, explaining to others, financial support and family functioning. Caregivers identified the need for information that the child might receive in the future as their greatest need (94.4%) and the least was the need for getting more counseling or help in getting a job (16.3%). The mean score for the overall unmet needs was 18.67 (SD=7.623). Out of six subscales of FNS, the need for information had the highest rating which was 98.3%, followed by need for social support (93.4%), need for community services (84.0%), need for financial support (79.9%), need for family functioning (61.8%) and need for explaining to others (46.2%). The unmet needs varied within the subscales. Therefore, more effective intervention programs are needed in community-based rehabilitation centres to match or reduce those varied unmet needs in order to allow caregivers to provide better care for their children with disabilities.
The quality of the health care services has been always a big responsibility and sensitive issue. Health care delivery is complex and critical for many reasons related to management and organizational planning and development. Health system reorganization is one of the approaches that health care managers adopt to overcome dysfunction. Clinical Microsystems (CM) is believed to be a one of vital steps in providing a high quality of patient care through system reorganization. CM has the potential to drive the health care to greater success through proper understanding, process and resource planning and health outcomes continuous assessment and improvements. CM integrate patients, providers and family needs and roles to form a vision of community system that cooperate for better outcomes .The components of an effective CM are produce quality, patient safety, and cost outcomes at the front line of care. This article aims to explore the concept, characteristics models and components of these Clinical Microsystems. It also highlights the steps to initiate, plan and sustain this innovation in hospitals in a systematic manner.