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.
A cross-sectional study was conducted in May 2007 on stress and stress self management among the prisoners and wardens of a prison in Selangor. This study was conducted as part of an elective posting for second year medical students and the topic was chosen to add on to the body of knowledge on stress among prisoners and wardens. A self administered questionnaire was distributed by random sampling and the respondents consisted of 100 prisoners and 97 wardens. Majority of the prisoners did not have stress with reference to interpersonal factors such as conflict with cellmates, conflict with wardens and conflict with inmates, For interpersonal factors, majority of the prisoners experienced stress because they felt bored (78%), thought they had no bright future (63%) and they also had no visitors (61%). Stress resulted in physical effects, whereby 67% admitted that they experienced health problems and 64% experienced sleep disturbance. Emotional effects of stress experienced by the prisoners were sadness (67%), anxiousness (63%) and confusion (56%). The major spiritual effect was regret (84%) followed by feeling closer to God (78%) and feeling high spirited (59%). The major social effects experienced by
the prisoners were low self esteem (63%) and embarrassment (58%). Methods of stress self management were prayers and conduct of religious activities (87%), sharing problems with friends (78%), doing recreational activities (77%), sleeping (72%) , doing a hobby (68) and seeking help from doctors (57%). As for the wardens, with reference to interpersonal factors, high level of stress was experience with reference ta prisoners behavior (82.5%) and problems with higher authorities (83.5 %), For intrapersonal factors, sleep disturbances (64%), career problems (76.3%), financial problems (73.2%) and feeling bored (75.3%) highly contributed to stress. Wardens physical effects were 38.1% health problems and 29.9% sleep disturbances. For emotional effects, must of them were depressed (54.6%), anxious (67%), angry (63.9%), confused (64.9%), frustrated (59.8%), threatened (53.6%) and patriotic (51.5%). The spiritual effect were feeling closer to God (86.6%), feeling responsible for duties (82.5%), regret doing the job (74.2%), feeling high spirited (58.8%). For social effects, low self esteem is the highest effect experienced (68%). Wardens managed stress by praying and conducting religious activities (91.8%), recreational activities (88.7%), doing a hobby (85.6%), sleeping (74.2%), and sharing problems (68%).
Home phototherapy treatment has been available in the Klang Valley (comprising Petaling ]aya, Kuala Lumpur; Shah Alam and Klang) since 2003. This study was conducted to create awareness of the existence of home phototherapy and its usage in Malaysia. This was a retrospective study using 1297 informed consent forms that parents had to read and sign prior to the commencement of home phototherapy. lt was found that the majority ofthe babies was males (41.2%), at or over 36 weelds gestation (97.2%), from areas in Selangor (57.4%), fully breastfed (53 %) and referred by doctors (98%). The mean age of the babies at initiation of lwme phototherapy was 6. 7 days. The mean bilirubin level at the start of home phototherapy was 243.8 umoVL and the mean bilirubin level at the end of home phototherapy 5 was 139.3 umoVL. The mean decrease in bilirubin level was 103.12 umoVL and the mean number of days of usage was 3.5 days which is a daily decrement of about 29 umoVL (29.46 + 13.8). Home phototherapy remains a viable clinical option for full term babies with physiological jaundice.
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
Smoking among school children is becoming a serious problem in developing countries, including Bangladesh. The early initiation of smoking needs urgent intervention to protect this vulnerable group and preventing them to be addicted. This study aims to determine the age at initiation of smoking and factors affecting it. A two-stage cluster sampling was used with a selection of schools on probability proportional to enrolment size followed by stratified random sampling of government and private schools and then a random start in classes VIII, IX and X of each school targeting the students aged 13 years and above. Data collected from secondary school students using self-administered structured questionnaire. All analyses were performed with SPSS version 20.0. Missing value was treated by multiple imputations. A total of 6877 data were analysed in which 84.7% were non-smoker, 9.5% were ever smoker and 5.8% were current smokers. Among the ever smoker (n=823), 38% were current smokers, 56.5% former and 5.5% were recent quitters. The mean (SD) age at initiation of smoking was 10.9 (0.2) years. Multinomial regression analysis revealed that class grade, peer pressure and offered free cigarette appeared to be significant predictors of smoking initiation (p0.05). Promotion of smoking resistance skills among children and teens through comprehensive approaches designed to enhance general personal competence by teaching an array of personal and social life skills is recommended.
Cervical cancer is the seventh most common cancer among women in Iraq. This study aimed to assess the factors influencing Pap smear practice among married primary school teachers in Diyala City, Iraq. A total of 222 teachers (aged 20 years to 63 years) residing in Diyala City were enrolled in a cross sectional study from 1st August till 30th September 2012. The sampling method was a self-administered survey using a multistage sampling technique. The prevalence of Pap smear practice was very low (12.6%). Relatives and friends were the main source of information about the Pap smear test for more than one third (41.9%) of the respondents. However, the medical doctor’s advice was the most important reason for undergoing a Pap smear test in more than two third (60.7%) of respondents. Only 32.4% of the teachers have good knowledge about cervical cancer and Pap smear test, but 76.1% of them showed a positive attitude toward learning about cervical cancer and Pap smear. Based on multiple logistic regression analysis results only the husband’s encouragement (p= 0.003, prevalence odds ratio [POR] = 0.256, 95%CI 0.10-0.63) was significantly associated with Pap smear practice. A more effective educational program is needed to educate Iraqi women about cervical cancer and screening tests, including Pap smear.
A cross sectional study was carried out to determine the relationship between dust exposure and pulmonary function in male steel workers in Terengganu, Malaysia. The investigation included spirometric testing and detailed personal interviews using a structured questionnaire adopted from British Medical Research Council (BRMC) Questionnaire on respiratory symptoms. Respiratory symptoms commonly reported by the male workers were morning phlegm (33.1%), shortness of breath (31.9%), chest tightness (30.4%), and morning cough (17.8%). Age and duration of employment were among the factors associated with respiratory symptoms (p
Pre-hypertension increased the risk of morbidity and mortality from non-communicable diseases. Whereas, psychological factors such as depression, anxiety and stress have been associated with increased in blood pressure. However, previous studies more focuses on psychological determinants of hypertension than prehypertension. Thus, this study aims to determine the association between these psychological factors with pre-hypertension. A cross-sectional study was conducted in 2012 among first year students of a public Malaysian university. A random cluster sampling was used to select 5 out of 15 faculties and a total of 495 students participated in this study. The Malay version of DASS-21 was used to elicit their levels of depression, anxiety and stress. Blood pressures were measured twice using sphygmomanometer and the averages were taken. Data analyses used chi-square test and binary multiple logistic regression. The prevalence of pre-hypertension was 30.1%. The percentage of severe and extremely severe depression was 3.8% and 1.2%; both severe and extremely severe anxiety was 16.4%; and severe and extremely severe stress was 4.2% and 0.2% respectively. Severe/extremely severe depression had more than 3 times higher in getting pre-hypertension than no depression. In conclusions, almost one third of respondents had pre-hypertension and only severe/extremely depression was associated with pre-hypertension.
The Short Form Health Survey SF-36 is a well-known generic health-related quality of life measure that has widely been used worldwide. However, given the cultural, social and ethnic differences in some countries, it might not follow the intended structure of the instrument. Hence, this study aims to determine the psychometric properties of the Malay version of Short Form Health Survey (SF-12) among postpartum mothers. A cross-sectional study was conducted among 1-month postpartum mothers attending Obstetric and Gynecology clinic, Universiti Sains Malaysia Hospital, Kelantan, Malaysia. Reliability was estimated using internal consistency and the factor structure was extracted by performing confirmatory factor analysis using SPSS v. 20 and AMOS v. 20. A total of 108 women responded. The mean (SD) score for the Physical Component Summary (PCS) score and Mental Component Summary (MCS) score were 43.3 (7.08) and 42.4 (6.87) respectively. The Cronbach alpha for PCS-12 was 0.749 and MCS-12 was 0.701. Spearman correlations of individual items and the SF-12 component summary scores showed PF, RP, BP and GH items correlated higher with the PCS score, whereas the VT, SF, RE, and MH items correlated higher with the MCS score lending support to its good convergent validity. The confirmatory factor solution showed final model with two factors structure and six items each with acceptable factor loadings, satisfactory absolute and parsimonious fitness (RMSEA=0.1, x2/df=2.4). The psychometric tests of the Malay version of SF-12 generally showed acceptable validity and reliability among postpartum women.
Study site: Obstretic and gynecology Hospital Universiti Sains Malaysia (HUSM)
Adherence to antiretroviral therapy (ART) plays an important role in the treatment outcomes of human immunodeficiency virus (HIV) infection. Poor adherence would result in failure to prevent viral replication as well as an increased risk of developing drug resistance. Adherence to a life long treatment such as antiretroviral therapy is usually a complicated issue that requires careful and continuous collaboration of patient, family and healthcare provider. The objective of this study was to assess adherence to antiretroviral therapy and its associated factors among people living with HIV. This is a health facility-based cross sectional study conducted among adults’ people living with HIV in Omdurman HIV/AIDS centre, Sudan. Data was collected through direct interview using semi-structured questionnaire. There were only 144/846 (17.02%) who adhered to antiretroviral therapy as prescribed by their doctors. The remaining 51.18% were taking the therapy but not regularly, 31.21% were taking it but currently not and 0.59% stated that they have never taken any antiretroviral therapy. Factors associated with poor adherence that have been identified include female gender (Adj. OR = 3.46 (95%CI: 1.46-8.21), P = 0.005), younger age (Adj. OR = 1.14 (95%CI: 1.02-1.28), P = 0.022), being unemployed (Adj. OR = 5.94 (95%CI: 1.51-23.40), P = 0.011), those who were divorced, separated or widowed (Adj. OR = 11.35 (95%CI: 1.74-73.96), P = 0.011) and respondents who perceived that their health status is poor (Adj. OR = 5.21 (95%CI: 1.44-18.81), P = 0.012) or very poor (Adj. OR = 4.04 (95%CI: 1.27-12.81), P = 0.018). Educational level and social support against HIV-related stigma and discrimination were not significantly associated with adherence. Adherence to antiretroviral therapy among the respondents is very poor. Urgent interventions based on modifiable factors and mainly targeting females and younger age group are needed to improve adherence to antiretroviral therapy among people living with HIV.
Occupational stress is one of the major health hazards among blue and white-collar workers. However there is no data on occupational stress among white-collar workers in Iran. Aim of this study was to investigate occupational stress among white collar employees in Esfahan Steel Company organization (ESCO), Iran. A cross-sectional survey was conducted through face to face interview using validated standardized questionnaire on occupational stress among 200 white-collar workers from ESCO who agreed to participate in the study, the response rate of participation was 100%. The logistic regression test was used to determine significant associated factors of occupational stress among the study sample.. It is found that among the six items measuring source of stress, the highest source of stress related to economic problem, 117 (59.7%). The statistical analysis showed sources of stress such as task type (p=0.0001), economic problem (p=0.0001), work environment (p=0.0001) and children problem (p=0.05) were significantly associated with having stress among the workers. We found that around half of the white collar workers were under stress at ESCO. Main sources of the occupational stress of white colour workers related to their work environment, economic problem; task type, and related their children.
Falls are the most common injury causing death or long term disability particularly among children. This study aimed to identify the risk factors of the unintentional injuries due to falls in children aged less than five years in Yemen. This cross sectional study enrolled a total of 439 children under five years old from the emergency department of 6 hospitals in Sana'a city. Multistage sampling was used to select six hospitals from public and private sectors in Sana'a city. Face to face interviews were conducted by using a structured questionnaire. Simple logistic regression and multiple logistic regression were used in the analysis. The prevalence of falls among children under five years old was 21.2%. In the multivariate analysis, factors associated with falls among children were young mother (aOR= 0.9, 95% CI 0.81-0.91), working of mother (aOR= 4.5 95% CI 2.40-7.65), frequent family social gatherings (aOR= 2.7, 95% CI 1.54-4.61), number of children at home (aOR= 2.6, 95% CI 1.43-4.64), chewing khat by father (aOR= 2.4, 95% CI 1.38-4.10), presence of staircase in the house (aOR= 2.1, 95% CI 1.24-3.70), number of rooms at home (aOR= 2.2, 95% CI 1.17-3.99) and disabled children (aOR= 3.3, 95% CI 1.20-9.27). In the study, socio-economic and cultural factors such as family gathering and chewing khat were associated with home fall injury among children under 5 years old in Yemen. Health promotion program should take place to reduce the occurrence of fall injury.
The unstable living situation in Iraq in the last 10 years after 2003 war affected the daily life of most Iraqis, and especially the children. The objective of this study was to explore the effects of an unstable living environment on children’s health. A community-based qualitative study was done to collect data from 20 mothers of children (age 7 to 8years old) through in-depth interview (IDI). Data was recorded using tape recorders and was later transcribed and analyzed using qualitative thematic analysis techniques. The majority of mothers interviewed said the past nine years of unstable security in the capital had affected their daily life; some mothers also expressed concern about their child’s nutritional status, their eating habits during the school day, and the unhealthy food being sold at school canteens. As a conclusion, the unstable living situations in Baghdad city after the last war had affected the cognitive and nutritional development of children. More precautions should be taken by parents to ensure their children safety in the future.
Diversified leisure involvement pose various health benefits to the elderly population. However, some elderly are too focus on doing a particular type of activity during their leisure time such as religious activity. This study aims to explore factors that could possibly contribute to the higher involvement in religious activity among the Malay ethnic elderly in Malaysia. In depth interviews were conducted, involving a total of 20 elderly aged 60 years and above with stratification by background characteristics. Each interview was conducted for an average of 15 to 30 minutes. They were purposively selected from two health clinics located in two different districts in the state of Selangor, representing an urban and a rural area. Majority of the elderly interviewed perceived that by engaging in religious activities such as prayer and reciting the Holy Quran or old Islamic scripture gives them serenity or calmness. Additionally, they also felt that involvement in such activities is very synonymous with being old and therefore one should be actively involved in religious activities with increasing age. In view of the lack of diversity of leisure involvement among the elderly and the passive and solitary nature of some of the religious activities, the elderly should be made aware of the importance of participating in other types of leisure activities especially physical activities. Although, they gain spiritual and social benefits from involving in religious activities, they also need to perform other form of activities that can improve the physical health status.
Women and elderly are often linked to several disadvantages and constraints in many aspects of life. The scenario could be even worse for an elderly woman. Participating in leisure has proven to be beneficial for elderly in general. Yet little is known about the pattern of leisure and constraints faced by elderly women in order for them to pursue leisure activities. This study aims to explore the various leisure constraints faced by the elderly women. A total of 20 elderly women were involved in this study, which were selected purposively and also by snowballing technique. An in-depth interview was conducted with each respondent lasted approximately 15 to 30 minutes. The identified constraints were categorized into three main themes, which were structural, intrapersonal and interpersonal constraints. Among factors that had been identified were preoccupation with domestic affairs, the unavailability of appropriate space or area to perform desired leisure activities, lack or unavailability of transportation, safety issue, misperceptions that being old should focus on religious activity and becoming effortless, domestic activities are comparable to exercise and lacking of elderly people to perform certain activities together. In view of the modifiable nature of most of constraints faced by the elderly women to pursue leisure activities, necessary actions should be taken by the relevant authorities in tackling the constraints and at the same time developing a more active and healthy elderly women society. The right of the elderly women and women in general should be acknowledged, including their desire to actively involve in certain leisure activities. They should also appropriately educate on the importance of leisure and involvement in other type of leisure activities other than religious activities.
Minamata disease is a well-known mercury contamination that happened in Japan in 1953. Due to demand during world war, second mercury disaster occurred in Niigata Prefecture in 1965. This is a review on the Niigata Minamata disease based on available documents and local expert opinions on the disaster. The aims of this paper are to record exposure history like the source of mercury in Agano River and specific fish that was associated with the disease. It is for an appraisal of the basic mercury exposure control, particularly to protect Japanese and world population during that time. There was indication that initial exposure limit for mercury was calculated incorrectly, and higher safe dose was applied. This epidemiological study is very useful and significant in comprehend the correct estimation of the human exposure to any hazardous substances.