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Fulltext Clinical diagnosis of malaria by medical assistants in Sri Aman, Sarawak - necessary but of limited reliability

Chin ZH

Malaysian Journal of Public Health Medicine, 2004;4(2):34-38.
MyJurnal

Rural health clinics in Sri Aman Division in Sarawak, Malaysia lack diagnostic tests for malaria. Many of the medical assistants in the clinic diagnose malaria solely on clinical ground. The study was to determine the sensitivity, specificity and positive predictive value of clinical diagnosis of rnahtria made by medical assistants using results of microscopy examination as gold standard. The study period was from September to December 2003. Three rural clinics without laboratory or diagnostic tests services and one urban clinic with laboratory facility serving malarious areas were selected. All patients clinically diagnosed as malaria by the attending medical assistants were included as clinical malaria cases. Blood slides were taken for examination of malaria parasites. Non clinical malaria cases were all other patients without clinical malaria for whom blood slides were taken for malaria parasites. Out of 362 patients included in the study, 75 were clinically diagnosed as having mahria. The sensitivity of headache, history of fever and chills/rigors to detect malaria cases was above 90% but the specificity and positive predictive value was low, below 40% and 20% respectively. The sensitivity, specificity and positive predictive value of malaria clinical diagnosis made by medical assistants was 82.1 %, 84 .4% and 30.7% respectively. Clinical diagnosis of malaria increases the slide positive rate by four folds. However the sensitivity, specincity and positive predictive value of clinical diagnosis by medical assistant and clinical characteristics was insufficient to enable each of them to be used alone to differentiate true malaria cases from non mahiria cases.
Fulltext Reaching the last frontier: video conference clinic in Belaga health clinic using the tele-primary care®system

Ringga A, Ngian HU, Chin ZH, Toh TH

Int J Public Health Res, 2011;1(2):1-3.
MyJurnal

Belaga District, in the heart of Borneo, is probably the most remote district in Sarawak. Although Belaga town is now accessible by land (50% are timber camp unsealed road) from Bintulu, the journey takes 5 hours and transport cost is high. Accessibility to Belaga by river is also subject to weather conditions and the town often gets cut off during the dry season and also during the wet season. All these pose immense challenges to the delivery of health care services to the people of Belaga and greatly reduce their accessibility to even basic health services. Access to specialist services is even more challenging as it is only available in Sibu and Bintulu; and visiting clinics in Belaga are infrequent due to the shortage of specialists and difficult transport. (Copied from article).
Hospital survey on patient safety culture in Sarawak General Hospital: A cross sectional study

Alex Kim RJ, Chin ZH, Sharlyn P, Priscilla B, Josephine S

Med J Malaysia, 2019 Oct;74(5):385-388.
PMID: 31649213

INTRODUCTION: Patient safety is defined as 'the prevention of harm caused by errors of commission and omission'. Patient safety culture is one of the important determining factor in safety and quality in healthcare. The purpose of this study is to assess the views and perceptions of health care professionals about patient safety culture in Sarawak General Hospital (SGH).
METHODS: A cross-sectional study, using the 'Hospital Survey on Patient Safety Culture (HSOPSC)' questionnaire was carried out in 2018 in SGH. Random sampling was used to select a wide range of staff in SGH. A self-administered questionnaire was distributed to 500 hospital staff consisting of doctors, nurses, pharmacist and other clinical and non-clinical staff, conducted from March to April 2018. A total of 407 respondents successfully completed the questionnaire. Therefore, the final response rate for the survey was 81.4%. This study used SPSS 22.0 for Windows and Hospital Data Entry and Analysis Tool that works with Microsoft Excel developed by United States Agency for Healthcare Research and Quality (AHRQ) to perform statistical analysis on the survey data.
RESULTS: Majority of the respondents graded the overall patient safety as acceptable (63.1%) while only 3.4% graded as excellent. The overall patient safety score was 50.1% and most of the scores related to dimensions were lower than the benchmark scores (64.8%). Generally, the mean positive response rate for all the dimensions were lower than composite data of AHRQ, except for "Organizational Learning - Continuous Improvement", which is also the highest positive response rate (80%), higher than AHRQ data (73%). The result showed that SGH has a good opportunity to improve over time as it gains experience and accumulates knowledge. On the other hand, the lowest percentage of positive responses was "Non-punitive response to error" (18%), meaning that most of the staff perceived that they will be punished for medical error.
CONCLUSIONS: The level of patient safety culture in SGH is acceptable and most of the scores related to dimensions were lower than benchmark score. SGH as a learning organisation should also address the issues of staffing, improving handoff and transition and develop a non-punitive culture in response to error.

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