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Quality management in Malaysian public health care

Manaf NH

Int J Health Care Qual Assur Inc Leadersh Health Serv, 2005;18(2-3):204-16.
PMID: 15974516

The main aim of the study is to provide an empirical analysis of quality management practice among Malaysian Ministry of Health hospital employees, ranging from medical specialists to health attendants.
Healthcare utilisation among elderly in Malaysia: The mediating role of health literacy

Mohamad Yunus M, Abd Manaf NH, Omar A, Juhdi N

Med J Malaysia, 2021 03;76(2):218-222.
PMID: 33742631

BACKGROUND: The relationship between the sociodemographic characteristics of the older persons and healthcare utilisation is well established. However, the process underlying this relationship is poorly understood particularly in the Malaysian context.
MATERIALS AND METHODS: A cross-sectional study was conducted from February to April in 2016 to examine the mediating effect of health literacy on the relationship between age and healthcare utilisation. A total of 452 older persons were recruited from 14 public hospitals in Malaysia.
RESULTS: The average age of the respondents was 66.69 years old, with an age range between 60 to 105 years. The findings reveal that the relationship between age and healthcare utilisation was mediated by health literacy.
CONCLUSION: The results help to improve the understanding of healthcare utilisation among the older persons in Malaysia, which is beneficial to the healthcare provider and policymakers.
Effect of Lean Six Sigma on quality performance in Malaysian hospitals

Ahmed S, Abd Manaf NH, Islam R

Int J Health Care Qual Assur, 2018 Oct 08;31(8):973-987.
PMID: 30415620 DOI: 10.1108/IJHCQA-07-2017-0138

PURPOSE: The purpose of this paper is to investigate the effects of Lean Six Sigma (LSS) and workforce management on the quality performance of Malaysian hospitals. This paper also investigates the direct and indirect relationships between top management commitment and quality performance of the healthcare organisations in Malaysia.
DESIGN/METHODOLOGY/APPROACH: This study applied stratified random sampling to collect data from 15 different hospitals in Peninsular Malaysia. The self-administered survey questionnaires were distributed among 673 hospital staff (i.e. doctors, nurses, pharmacists, and medical laboratory technologists) to obtain 335 useful responses with a 49.47 per cent valid response rate. The research data were analysed based on confirmatory factor analysis and structural equation modelling by using AMOS version 23 software.
FINDINGS: The research findings indicated that LSS and workforce management have a significant impact on quality performance of the Malaysian hospitals, whereas senior management commitment was found to have an insignificant relationship with quality performance. The research findings indicate that senior management commitment has no direct significant relationship with quality performance, but it has an indirect significant relationship with quality performance through the mediating effects of LSS and workforce management.
RESEARCH LIMITATIONS/IMPLICATIONS: This research focussed solely on healthcare organisations in Malaysia and thus the results might not be applicable for other countries as well as other service organisations.
ORIGINALITY/VALUE: This research provides theoretical, methodological, and practical contributions for the LSS approach and the research findings are expected to provide guidelines to enhance the level of quality performance in healthcare organisations in Malaysia as well as other countries.
Fulltext Sociodemographic, Lifestyle, and Health Factors Associated With Depression and Generalized Anxiety Disorder Among Malaysian Adults

Cheah YK, Azahadi M, Phang SN, Abd Manaf NH

J Prim Care Community Health, 2020 5 27;11:2150132720921738.
PMID: 32450747 DOI: 10.1177/2150132720921738

Objectives: Lowering the prevalence of mental health illness is one of the main public health concerns. The objective of the present study was to examine factors associated with depression and generalized anxiety disorder (GAD) among adults in Malaysia. Methods: Data were extracted from the National Health and Morbidity Survey 2011 (NHMS 2011), which is a nationally representative sample collected using a 2-stage stratified sampling method. A bivariate probit model was utilized to examine the influences of sociodemographic, lifestyle, and health factors on the likelihood of suffering from depression and GAD. Results: Age, gender, ethnicity, education, marital status, and self-rated health were significantly associated with depression and GAD. In particular, there were positive relationships between depression and GAD, and younger adults, females, Indian ethnic group, lower level of education, being unmarried, and self-rated poor health. Conclusions: Sociodemographic and health factors were associated with determining the risks of depression and GAD in Malaysia. With this information, future policies (eg, screening and treatment) could be targeted at those at most risk to develop depression and GAD.
Fulltext Association of suicidal ideation with demographic, lifestyle and health factors in Malaysians

Cheah YK, Azahadi M, Phang SN, Abd Manaf NH

East Asian Arch Psychiatry, 2018 Sep;28(3):85-94.
PMID: 30146496

OBJECTIVE: To determine the association of suicidal ideation with demographic, lifestyle, and health factors, using data from National Health and Morbidity Survey 2011 (NHMS 2011) of Malaysia.
METHODS: The NHMS 2011 included 10,141 respondents. Independent variables of suicidal ideation were income, age, household size, sex, ethnicity, education, marital status, smoking, physical activity, and self-rated health. The risk factors of suicidal ideation were determined using logistic regression analysis.
RESULTS: In the pooled sample, suicidal ideation was associated with age, sex, ethnicity, and self-rated health, but not associated with income, household size, education, physical activity, or smoking.
CONCLUSION: The likelihood of having suicidal ideation is positively associated with young adults, women, Indians, and those with poor self-rated health.
Study name: National Health and Morbidity Survey (NHMS-2011)
Sociodemographic, lifestyle and health determinants of suicidal behaviour in Malaysia

Cheah YK, Azahadi M, Phang SN, Abd Manaf NH

Psychiatry Res, 2018 03;261:319-324.
PMID: 29331849 DOI: 10.1016/j.psychres.2017.12.086

Suicide has become a serious matter in both developed and developing countries. The objective of the present study is to examine the factors affecting suicidal behaviour among adults in Malaysia. A nationally representative data which consists of 10,141 respondents is used for analysis. A trivariate probit model is utilised to identify the probability of having suicide ideation, suicide plan and suicide attempt. Results of the regression analysis show that to ensure unbiased estimates, a trivariate probit model should be used instead of three separate probit models. The determining factors of suicidal behaviour are income, age, gender, ethnicity, education, marital status, self-rated health and being diagnosed with diabetes and hypercholesterolemia. The likelihood of adopting suicidal behaviour is lower among higher income earners and older individuals. Being male and married significantly reduce the propensity to engage in suicidal behaviour. Of all the ethnic groups, Indian/others displays the highest likelihood of adopting suicidal behaviour. There is a positive relationship between poor health condition and suicide. Policies targeted at individuals who are likely to adopt suicidal behaviour may be effective in lowering the prevalence of suicide.
Country perspective on medical tourism: the Malaysian experience

Abd Manaf NH, Hussin H, Jahn Kassim PN, Alavi R, Dahari Z

Leadersh Health Serv (Bradf Engl), 2015;28(1):43-56.
PMID: 25751248 DOI: 10.1108/LHS-11-2013-0038

The study seeks to explore the perception of international patients on Malaysia as a medical tourism destination country, as well as overall patient satisfaction, perceived value and future intention for repeat treatment and services.
Micro-solid phase extraction with liquid chromatography-tandem mass spectrometry for the determination of aflatoxins in coffee and malt beverage

Khayoon WS, Saad B, Salleh B, Manaf NH, Latiff AA

Food Chem, 2014 Mar 15;147:287-94.
PMID: 24206720 DOI: 10.1016/j.foodchem.2013.09.049

A single step extraction-cleanup procedure using porous membrane-protected micro-solid phase extraction (μ-SPE) in conjunction with liquid chromatography-tandem mass spectrometry for the extraction and determination of aflatoxins (AFs) B1, B2, G1 and G2 from food was successfully developed. After the extraction, AFs were desorbed from the μ-SPE device by ultrasonication using acetonitrile. The optimum extraction conditions were: sorbent material, C8; sorbent mass, 20mg; extraction time, 90 min; stirring speed, 1,000 rpm; sample volume, 10 mL; desorption solvent, acetonitrile; solvent volume, 350 μL and ultrasonication period, 25 min without salt addition. Under the optimum conditions, enrichment factor of 11, 9, 9 and 10 for AFG2, AFG1, AFB2 and AFB1, respectively were achieved. Good linearity and correlation coefficient was obtained over the concentration range of 0.4-50 ng g(-1) (r(2) 0.9988-0.9999). Good recoveries for AFs ranging from 86.0-109% were obtained. The method was applied to 40 samples involving malt beverage (19) and canned coffee (21). No AFs were detected in the selected samples.
A reversed phase high performance liquid chromatography method for the determination of fumonisins B1 and B2 in food and feed using monolithic column and positive confirmation by liquid chromatography/tandem mass spectrometry

Khayoon WS, Saad B, Salleh B, Ismail NA, Abdul Manaf NH, Abdul Latiff A

Anal Chim Acta, 2010 Oct 29;679(1-2):91-7.
PMID: 20951862 DOI: 10.1016/j.aca.2010.09.008

The development of a reversed phase high performance liquid chromatography fluorescence method for the determination of the mycotoxins fumonisin B(1) and fumonisin B(2) by using silica-based monolithic column is described. The samples were first extracted using acetonitrile:water (50:50, v/v) and purified by using a C(18) solid phase extraction-based clean-up column. Then, pre-column derivatization for the analyte using ortho-phthaldialdehyde in the presence of 2-mercaptoethanol was carried out. The developed method involved optimization of mobile phase composition using methanol and phosphate buffer, injection volume, temperature and flow rate. The liquid chromatographic separation was performed using a reversed phase Chromolith(®) RP-18e column (100 mm × 4.6 mm) at 30 °C and eluted with a mobile phase of a mixture of methanol and phosphate buffer pH 3.35 (78:22, v/v) at a flow rate of 1.0 mL min(-1). The fumonisins separation was achieved in about 4 min, compared to approximately 20 min by using a C(18) particle-packed column. The fluorescence excitation and emission were at 335 nm and 440 nm, respectively. The limits of detections were 0.01-0.04 μg g(-1) fumonisin B(1) and fumonisin B(2), respectively. Good recoveries were found for spiked samples (0.1, 0.5, 1.5 μg g(-1) fumonisins B(1) and B(2)), ranging from 84.0 to 106.0% for fumonisin B(1) and from 81.0 to 103.0% for fumonisin B(2). Fifty-three samples were analyzed including 39 food and feeds and 14 inoculated corn and rice. Results show that 12.8% of the food and feed samples were contaminated with fumonisin B(1) (range, 0.01-0.51 μg g(-1)) and fumonisin B(2) (0.05 μg g(-1)). The total fumonisins in these samples however, do not exceed the legal limits established by the European Union of 0.8 μg g(-1). Of the 14 inoculated samples, 57.1% contained fumonisin B(1) (0.16-41.0 μg g(-1)) and fumonisin B(2) (range, 0.22-50.0 μg g(-1)). Positive confirmation of selected samples was carried out using liquid chromatography-tandem mass spectrometry, using triple quadrupole analyzer and operated in the multiple reaction monitoring mode.
Sociodemographic factors associated with consumption of confectionery among obese and non-obese adults: A secondary analysis

Cheah YK, Azahadi M, Mohamad Nor NS, Phang SN, Abd Manaf NH

Obes Res Clin Pract, 2020 08 09;14(5):428-436.
PMID: 32782176 DOI: 10.1016/j.orcp.2020.07.008

The objective of the present study is to examine sociodemographic factors associated with consumption of confectionery among obese and non-obese adults in Malaysia. Secondary analysis of the Malaysian Adult Nutrition Survey (MANS) 2014 was performed. The survey was conducted in urban and rural areas in the 14 states of Malaysia, including the Federal Territory of Kuala Lumpur. Adults aged 18 years and above (n = 2696) were interviewed. The dependent variable was the total servings of confectionery consumed per week. An ordered logistic regression model was used to examine the associated sociodemographic factors in the decision of people to consume 0, 1-2, 3-5 and ≥6 servings of confectionery. Marginal effects of sociodemographic variables on confectionery consumption were calculated. Analyses stratified by bodyweight group were conducted. The results showed that income, education, gender, ethnicity, and employment status were significantly associated with consumption of confectionery. In particular, income, education, gender, ethnicity and employment status affected confectionery consumption, but not the other way around. However, no relationship was evidenced between age, marital status, household location and confectionery consumption. In conclusion, sociodemographic factors were related to consumption of confectionery. Policies aimed at discouraging consumption of confectionery should focus primarily on high income earners, well-educated individuals and Bumiputera.
Hospital waiting time: the forgotten premise of healthcare service delivery?

Pillay DI, Ghazali RJ, Manaf NH, Abdullah AH, Bakar AA, Salikin F, et al.

Int J Health Care Qual Assur, 2011;24(7):506-22.
PMID: 22204085

This is a national study which aims to determine the average waiting time in Malaysian public hospitals and to gauge the level of patient satisfaction with the waiting time. It also aims to identify factors perceived by healthcare providers which contribute to the waiting time problem.