The objective of this study was to explore the roles and perceptions of general practitioners (GPs) in the management of erectile dysfunction (ED). This qualitative study used focus group discussions and in-depth interviews. This study was conducted based on 28 GPs from an urban area in Malaysia who had managed patients with ED and prescribed anti-ED drugs. Main outcome measures included the roles of GPs in managing patients with ED (active or passive), perceptions regarding ED and the treatment, and factors influencing their decision to prescribe. Majority of the GPs assumed a passive role when managing patients with ED. This was partly due to their perception of the disease being nonserious. Some also perceived ED as mainly psychological in nature. The anti-ED drugs were often viewed as a lifestyle drug with potentially serious side effects. The fear of being perceived by patients as 'pushing' for the drug and being blamed if the patients were to develop serious side effects also hampered the management of this disease. GPs who participated in this study remained passive in identifying and treating patients with ED and this was attributed to their perception of the disease, drug treatment and patient's background.
Management of sexually transmitted diseases and human immunodeficiency virus is challenging due to the social stigma attached. We describe the development of a client-friendly sexually transmitted disease service in a primary care clinic in Malaysia with a special focus on key populations. Challenges and key lessons learnt from its development and implementation are discussed.
Classical dengue fever is characterized by the clinical features of fever, headache, severe myalgia and occasionally rash, which can also be caused by a number of other viral and bacterial infections. Five hundred and fifty eight patients who fulfilled the criteria of clinical diagnosis of acute dengue from 4 government outpatient polyclinics were recruited in this prospective field study. Of the 558 patients, 190 patients were categorized as acute dengue fever, 86 as recent dengue and 282 as non-dengue febrile illnesses based on the results of a number of laboratory tests. Epidemiological features of febrile patients showed that the mean age of patients in the dengue fever group was significantly younger in comparison with patients in the non-dengue group. There was no significant difference between the two groups with respect to gender but there was significant ethnic difference with foreign workers representing a higher proportion in the dengue fever group. Patients with acute dengue fever were more likely to have patient-reported rash and a history of dengue in family or neighbourhood but less likely to have respiratory symptoms, sore-throat and jaundice in comparison to patients with non-dengue febrile illnesses. As with patients with dengue fever, patients in the recent dengue group were more likely to have history of patient-reported rash and a history of dengue contact and less likely to have respiratory symptoms in comparison to patients with non-dengue febrile illnesses. In contrast to patients with dengue fever, patients in the recent dengue group were more likely to have abdominal pain and jaundice in comparison to non-dengue febrile patients. The finding strongly suggests that a proportion of patients in the recent dengue group may actually represent a subset of patients with acute dengue fever at the late stage of illness.
Study site: Klinik Kesihatan Seksyen 7, Shah Alam; Klinik Kesihatan Kelana Jaya, Petaling Jaya; Klinik Kesihatan Sg. Buloh; Klinik Kesihatan Jinjang, Selangor, Kuala Lumpur, Malaysia
This is a 10-year retrospective review of mucocutaneous infection by human herpesvirus 1 (HHV1) and human herpesvirus 2 (HHV2) carried out by the virus diagnostic unit of University Malaya Medical Centre (UMMC). A total of 504 specimens from UMMC and a private clinic in the same city (KLSC) were tested; 198 samples from patients with oral lesions and 306 from patients with genital lesions. HHV1 was found to be responsible for 98.4% of oral lesions whereas HHV2 was the cause of 83.6% of all genital lesions. Detailed analysis showed no statistical difference by age group, race or gender among the patients with oral and genital lesions. Two laboratory methods were used in this study. Of the total 504 specimens tested, 18.0% specimens were positive by direct immunofluorescence (IF), 55.0% by virus isolation and 56.5% when both methods were used in combination. Although IF can provide a more rapid diagnosis, it is, however, less sensitive and can be attributed partly to inadequate collection of specimens.
OBJECTIVE: To evaluate Malaysian patients' satisfaction levels and asthma control with Symbicort SMART® in the primary care setting.
METHOD: This is a cross-sectional, multicentre study involving adult patients with persistent asthma who were prescribed only Symbicort SMART in the preceding one month prior to recruitment. Patients' satisfaction with Symbicort SMART and asthma control were evaluated using the self-administered Satisfaction with Asthma Treatment Questionnaire (SATQ) and the Asthma Control Test (ACT).
RESULTS: Asthma was controlled (ACT score >20) in 189 (83%) of 228 patients. The mean overall SATQ score for patients with controlled asthma was 5.65 indicating a high satisfaction level, which was positively correlated with high ACT scores. There were differences in asthma control based on ethnicity, number of unscheduled visits and treatment compliance.
CONCLUSIONS: Symbicort SMART resulted in a high satisfaction level and asthma control among Malaysian patients treated in the primary care setting and it is an effective and appealing treatment for asthmatic patients.
Study site: General practice clinics, Malaysia
One hundred and twenty-four women from a semi-urban area who came for consultation for unplanned pregnancy during an eight month period are analysed. It is found that women with a high risk of unplanned pregnancy are mostly housewives, aged between 20 and 34, who have given birth to one or three children, the last of whom is usually below one or two years old. They belong to the lower socio-economic class and are lowly-educated. Most of them have not completed their families. Although most of them have either used or heard of contraceptives begore, the majority were not using any contraceptive at the time of consultation or were using an ineffective method. Their reasons for non-use or default are identified, many of which are related to the pill. Proper motivation of would-be contraceptive receptors and regular follow-up of acceptors by general practitioners or Family Planning Clinic Staff who are knwoledgable in all available methods of contraception are offered as a solutionto the problem of high rate of defaulting and consequent high rate of unplanned pregnancies.
Study site: private general practice clinic, Perak, Malaysia
BACKGROUND: To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm) and primary care physicians assisted by nurse educators (PCP-NE arm).
METHODS: This was a multi-centre, open label, randomised trial of a disease management programme (COACH) among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE) and 148 to care provided by primary care physicians (PCP) alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio), Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36.
RESULTS: Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS) mean change from baseline LDL-C were -30.09% and -27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288), with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had ended).
CONCLUSION: Patients who received coaching and advice from primary care physicians (with or without the assistance by nurse educators) showed improvement in LDL-cholesterol. Disease management services delivered by PCP-NE demonstrated a trend towards add-on improvements in cholesterol control compared to care delivered by physicians alone; however, the improvements were not maintained when the services were withdrawn.
TRIAL REGISTRATION:
National Medical Research Registration (NMRR) Number: NMRR-08-287-1442Trial Registration Number (ClinicalTrials.gov Identifier): NCT00708370.
BACKGROUND: Fall is a worldwide health problem among elderly people and a known leading cause of disabilities. Fall prevention programs have been implemented in various forms. The Otago exercise program (OEP) is one of the most recent home-base exercise training program.
OBJECTIVES: This study was conducted to examine the effectiveness of OEP to reduce falls among elderly people in Shahroud, IR Iran.
MATERIALS AND METHODS: This randomised control trial was conducted among the elderly community dwellers in Shahroud city of the Semnan province, IR Iran, with experience of falls in the last 12 months. Subjects of the study (n = 317) were recruited from elderly senior citizens at public health centers. Block systematic random sampling was applied to categorize the subjects in experimental and control groups. The experimental group (n = 160) received OEP for six months and was compared with the control group (n = 157) who received general health training. This study was registered with the following ID, IRCT2014012016285N1.
RESULTS: The findings of the study showed that OEP improved physical performance (Berg-Balance-Score with P > 0.025, and Timed-Up-Go-Test with P > 0.017) and functional capacity (Arm-Curl-Test with P > 0.00 and Chair-Stand-Test with P > 0.01). In addition, OEP significantly reduced the incidence of falls (P ≤ 0.00) among senior citizens in the experimental group.
DISCUSSION: The OEP as a home-based exercise is effective for the reduction of the incidence of falls among senior citizens with a history of falls. The OEP can be recommended for elderly homebound people who do not have access to facilities.
KEYWORDS: Community; Elderly; Falls; Otago Exercise
Objective: To assess the adequacy of antenatal care (ANC) and its association with pregnancy outcomes using an approach that includes adequacy of both utilization and content.
Design: Retrospective cohort study.
Setting and Participants: Women attending ANC at public-funded primary health clinics where data were extracted from individual records.
Methods: Adequacy of utilization assessment was based on the concept of Adequacy of Prenatal Care Utilization index; adequacy of content assessed the recommended routine care received by the women according to local guidelines. Association between adequacy and pregnancy outcomes was examined using binary logistic regression.
Main Outcome Measures: Pregnancy outcomes included preterm birth and low birth weight.
Results: Sixty-three percent of women showed higher than recommended ANC utilization; 52% had <80% of recommended routine care content. Although not statistically significant, the odds of preterm birth was lower among women with adequate level of utilization compared with inadequate (adjusted odds ratios (aOR) = 2.34, 95% confidence interval (CI) 0.45-12.16) and intensive levels (aOR = 3.27, 95% CI 0.73-14.60). Regarding adequacy of content, women who received inadequate level of care content were associated with higher prevalence of preterm birth (aOR = 3.69, 95% CI 1.60-8.55).
Conclusion: The study shows inadequate content is associated with higher prevalence of preterm birth and suggests that inadequate utilization increases the risk of preterm birth. It demonstrates the relevance of using both utilization and content assessment in evaluating quality of ANC. Further studies are encouraged to review the methods used.
BACKGROUND: Opioid misuse and dependence is a global issue with a huge negative impact. In Malaysia, heroin is still the main illicit drug used, and methadone maintenance treatment (MMT) has been used since 2005.
OBJECTIVE: To evaluate the effectiveness of MMT.
METHODS: This was a cross-sectional study conducted in 103 treatment centers between October and December 2014 using a set of standard questionnaires. Data were analyzed using SPSS Statistics 20.
RESULTS: There were 3254 respondents (93.6% response rate); of these 17.5% (n = 570) transferred to another treatment center, 8.6% (n = 280) died, 29.2% (n = 950) defaulted, and 7.6% (n = 247) were terminated for various reasons. Hence, 1233 (37%) respondents' baseline and follow-up data were further analyzed. Respondents had a mean age of 39.2 years old and were mainly male, Malay, Muslim, married (51.1%, n = 617), and currently employed. Few showed viral seroconversion after they started MMT (HIV: 0.5%, n = 6; Hepatitis B: 0.3%, n = 4; Hepatitis C: 2.7%, n = 29). There were significant reductions in opioid use, HIV risk-taking score (p < 0.01), social functioning (p < 0.01), crime (p < 0.01), and health (p < 0.01). However, there were significant improvements in quality of life in the physical, psychological, social, and environmental domains. Factors associated with change were being married, employed, consuming alcohol, and high criminality at baseline. Lower methadone dosage was significantly associated with improvements in the physical, psychological, and environmental domains.
Conclusion/Importance: The MMT program was found to be successful; hence, it should be expanded.
Objective: Primary care management of knee osteoarthritis (OA) has received little attention in the scientific literature and the main reason for this survey is to study and explore the variations and patterns of primary care management and assess both conventional and complementary therapy usage in knee OA in the primary care setting.
Methods: A cross-sectional survey of 200 randomly selected general practitioners (GPs) in the peninsular states of Malaysia was undertaken using a questionnaire. The GPs involved were asked about basic knowledge of OA in terms of diagnosis, investigation, and treatment. They were also asked about their usage of conventional and complementary medication.
Results: One hundred and eighty (90%) GPs responded to the questionnaires sent: 77% were in solo practice and 33% in group practice. Most of the GPs surveyed (60%) had been in practice for more than 10 years, 30% for 5-10 years and 10% were in practice for less than 5 years. Of GPs surveyed, 55% saw an average of more than 20 patients per week, 35% about 10-20 patients and 10% less than 10 patients per week. Of GPs surveyed, 65% would arrange an X-ray, 55% would arrange a blood test, mostly serum uric acid, rheumatoid factor and erythrocyte sedimentation rate. Pharmacological management consists of first-line treatment with non-steroidal anti-inflammatory drugs (NSAIDs) (61%), analgesics (35%) or a combination of the two (4%). Non-pharmacological management consisted of advice on exercise (27%), weight reduction (33%) and referral to physiotherapy (10%). Of GPs surveyed, 85% prescribed some form of complementary medications, 60% prescribed glucosamine sulphate, 21% chondroitin sulphate, 11% cod liver oil and 9% evening primrose oil. Only 10% of GPs surveyed perform intra-articular injections.
Conclusion: The data suggest that in the primary care setting, the majority of GPs over-investigate the diagnosis of OA. Pharmacological interventions largely concentrate on analgesics and NSAIDs. The use of physiotheraphy and non-drug approaches were significantly under-utilized. There is a need to further educate GPs in the management of OA.
In response to a recorded increasing incidence of diarrhoea in Tumpat District, Malaysia, a case-control study was performed to identify modifiable risk factors for the transmission of diarrhoea, in children aged 4-59 months. Ninety-eight pairs of children, matched on age and sex, were recruited prospectively from health centres. Exposure status was determined during a home visit. Interviewers were 'blinded' as to the disease status of each child. Odds ratios were measured through matched pair analysis and conditional logistic regression. Risk factors for diarrhoea identified were: reported--drinking of unboiled water, storage of cooked food before consumption and bottle feeding; and observations--animals inside the house and absence of washing water in latrines. Water quality, source of drinking water, reported hand washing behaviour, indiscriminate defecation by children, cup use and the absence of a functional latrine were not associated with diarrhoea. Nonsignificant associations were found for: accessibility of washing water source, type of water storage container and use of fly covers for food.
The diagnosis of rheumatologic problem can be difficult, especially if not all the diagnostic criteria or typical clinical features are seen. This includes conditions such as rheumatoid arthritis which needs early diagnosis to start disease modifying drugs (DMARDs) which can improve the prognosis and prevent further joint erosion and organ damage. This case report focused on a similar scenario in an elderly woman initially thought to have osteoarthritis but was diagnosed later with rheumatoid arthritis which brought much relief to her current predicament.
Introduction: In first six months of life, breastfeeding is the recommended form of feeding by the World Health Organisation for the growing child. To enable the working mother to continue this noble practice, adequate workplace breastfeeding support and self- efficacy is needed. This study aims to determine the prevalence of breastfeeding among working mothers of children aged three months to two years and factors associated with breastfeeding practice including workplace support and mother’s self-efficacy. Method: This is a cross sectional questionnaire study carried out in a rural Health Clinic in Selangor using socio-demographic data, Workplace Breastfeeding Support Scale (WBSS), and the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF). This study was conducted for a period of three months from April to June 2015. The respondents were employed Malaysian mothers of healthy infants aged three months to two years. A total of 84 participants were involved in the study. Data analysis was done with SPSS 22.Results: The prevalence of breastfeeding among working mothers were high at 97.6%. We found significant association of breastfeeding practice with workplace breastfeeding support (p=0.005) and self-efficacy (p= 0.017). We also noted a significant correlation between breastfeeding workplace support and breast feeding self-efficacy (r= 0.40, p
A serosurvey was conducted in 1995-97 among 1596 febrile patients from 8 health centres in Malaysia for antibodies against Orientia tsutsugamushi (OT), Rickettsia typhi (RT) and TT118 spotted fever group rickettsiae (SFGR) by using an indirect immunoperoxidase assay. A total of 51.4% patients had antibody against at least 1 of those rickettsiae. Antibody to SFGR was most prevalent (42.5%), followed by RT (28.1%) and OT (24.9%). The seroprevalences of antibodies to SFGR, RT or OT alone were 12.4, 3.6 and 4.3%, respectively. Antibodies against more than 1 species of rickettsiae were presence in 31.1% of the patients, suggesting the possibility of co-infection, previous exposures or serological cross-reactivities. Seroprevalence of the various rickettsiae varied according to locality, with SFGR antibodies being the most prevalent in most areas. There was no significant association of prevalence of rickettsial antibody with gender. The seroprevalence of OT, SFGR and RT increased with patient age but an increase of antibody titre with age was not significant. Those working in the agricultural sectors had significantly higher seroprevalence of OT, SFGR and RT than those not related with agricultural activities. Scrub typhus remains a public health problem with an estimated annual attack rate of 18.5%. Tick typhus and murine typhus as shown in this serosurvey appear much more widespread than scrub typhus in this country.
Human Immunodeficiency Virus (HIV) epidemic remains a significant burden in Malaysia. Stigma related to HIV and its effect on the quality of life (QOL) of persons living with HIV (PLHIV) remains under-reported. The aim of the present study was to assess self-perceived stigma amongst PLHIV attending an urban community clinic and its influence on their QOL. Data was collected using HIV Stigma Scale and WHO-QOL HIV BREF Scale. The overall stigma experienced by PLHIV in this community was higher than previous studies (mean ± SD; 103.37 ±18.14). Majority participants had fear disclosing their disease status, while personalized stigma or the experience of prejudice and rejection was the least experienced. The overall QOL was low and was significantly impaired in social relationship domain (mean ± SD; 12.72 ± 3.59). However, their ability to perform daily activities was not affected by the illness (mean ± SD; 14.48 ± 2.91). PLHIV with higher spiritual values demonstrate lower perception of negative self-image and inferiority (r= -0.54). This finding was unique to PLHIV in this study and suggested the importance of spirituality and personal beliefs on their self-esteem. In conclusion, stigma remains as a significant problem among PLHIV in this community. Primary care offers the best platform to promote a holistic management of PLHIV, where the integration between counselors, religious experts, family and non-governmental associations could come together. The management of PLHIV is unique in every community, hence individualized approach based on cultural norms and beliefs could assist in the overall management of PLHIV.
Keywords: HIV, quality of life, social stigma
A study was undertaken amongst private primary care providers in three urban centres of Malaysia to understand the organizational structure of the facilities and to assess the cost of running such services. A total of 150 clinics were involved in the study. Data was collected through interviews with owners of the clinics using semi-structured questionnaires. Solo-practitioners owned 64.7% of the clinics while 35.3% of them were owned by group practice. This study showed that the mean number of patients visited the clinics daily was 49.3 with the average operating hours of 79.4 hours/week (range 28.0 - 168.0 hours/week). Group practice clinics operates 23.9 hours longer than solo-practice clinics. Group practice clinics were more likely to offer 24 hours service than solo-practice clinics. Most of the clinics were manned by a single doctor (57.3%), 30.0 % had two doctors and only 12.7% were run by more than two doctors. On average, group practice employed greater number of supporting staff than solo-practice clinics (6.0 vs 4.3 people). The mean annual cost to run each facility was found to be RM 444,698. The mean cost per patient was found to be RM 32.09 for solo-practice clinics and RM 38.55 for group practice. Wages represented the highest proportion in the recurrent cost (61.1%) followed by drugs (29.2%) and consumables (2.7%). Building cost (67.9%) and equipment cost (25.9%) were the major capital costs for the clinics. This study could serve as a basis to reimburse private primary care providers in the future health financing scheme in Malaysia. To improve efficiency and contain cost in primary care settings, efforts should be targeted towards cost of wages and drugs utilised by the providers in their daily practice.
Key words: Private practice; primary care; costs; Malaysia.
Introduction: Cervical cancer ranks as the second most frequent cancer among women in Malaysia. Although a cervical screening program has been introduced since 1960s and is provided free of charge in all government health facilities, the coverage and adherence rate to recommendation among Malaysian women remains low.
Objectives: To determine the proportion of non-adherence to Pap smear screening guidelines and its associated factors among women attending a health clinic in Malaysia.
Method: A cross sectional study involving 316 women aged 20 to 65 years who had undergone a Pap smear. Universal sampling method was applied to select participants among women who attended the selected health clinic from January 2013 to May 2013. A self-administered questionnaire was used to obtain the socio-demographic characteristics, socio-health data and perceptions about cervical cancer and Pap smear screening. The data was analysed using descriptive statistics and multiple logistic regression.
Result: The proportion of non-adherence to Pap smear screening was 90.5%. Age, marital status, duration of marriage, education level, employment, household income and number of children were not significantly associated with non-adherence. Perceived severity, perceived susceptibility, perceived benefit, perceived barrier and cues to action did not show significant association with non-adherence to Pap smear screening.
Conclusion: Non-adherence to Pap smear screening was high among Malaysian women. Measures should be taken to increase Pap smear screening coverage in our country. Other factors beyond Health Belief Model that influence Pap smear screening practice among Malaysian women should be explored.