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Fulltext Trends and estimation of hepatitis b infection cases in Malaysia, 2003–2030

Rajamoorth, Yogambigai, Niazlin Mohd Taib, Khalid Abdul Rahim, Munusamy, Subramaniam

Malaysian Journal of Public Health Medicine, 2016;16(1):113-120.
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Hepatitis B virus (HBV) infection is an upcoming public health problem in Malaysia. This study analysed the
trend of Hepatitis B (HB) cases from 2003 to 2012 and project the cases for an 18-year period (2013–2030).
Based on the national data of annual reported cases and the Malaysian population projections (2010–2040),
trend/regression lines were fitted to analyse the trend and estimated HB incidence. The number of HB
cases decreased for six consecutive years and began to increase from 2010 onwards. During the 10-year
period (2003–2012), the highest number of HB cases was reported in Sabah, followed by Pahang and
Wilayah Persekutuan; the lowest was reported in Perlis. The exponential curve shows a decrease of HB
cases by an average of 6.3%. However, the polynomial curve shows fluctuations in the trend, with a higher
degree of R-square (0.8655). Most states appear to be at moderate vulnerability to HBV infection (Kedah,
Perak, Negeri Sembilan, Terengganu, Sabah, and Sarawak), except for Melaka, Wilayah Persekutuan, and
Selangor, which were at high risk of HB incidences. Overall, the estimated HB cases indicate that the
number of cases and the incidence rates will increase in the future in all states, except for Penang. As the
estimated HB cases and incidence rates show an increasing pattern, the government should strengthen
their strategies in the management of HB and take preventive measures such as educating the public
through awareness programmes, conducting compulsory blood screening, and sustaining the Expanded
Programme on Immunization effectively.
Fulltext Application of the double bounded dichotomous choice model to the estimation of parent's willingness to pay for the hand foot mouth disease vaccination: A survey in Selangor, Malaysia

Rajamoorthy Y, Taib NM, Harapan H, Wagner AL, Munusamy S

PLoS One, 2023;18(6):e0286924.
PMID: 37307254 DOI: 10.1371/journal.pone.0286924

Hand foot and mouth disease (HFMD) is a notifiable viral disease in Malaysia, and is transmitted primarily among young children. Although vaccines for enteroviruses 71 (EV-71) were approved in China against HFMD, the availability and the acceptance of the vaccine in the Malaysia are unknown. This study investigated and ascertained the determinants of willingness-to-pay (WTP) for HFMD vaccination in Selangor Malaysia. This study adopted a cross-sectional, contingent valuation method involving 390 parents of young children aged six and below. The double bounded dichotomous choice (DBDC) approach was employed to assess the WTP for HFMD vaccine among respondents. A bivariate probit model was used to assess the key determinants of WTP for HFMD vaccine, while the mean WTP was measured using the Krinsky and Robb procedure. We found that 279 (71.5%) of parents were willing to pay for the HFMD vaccination. The estimated single bounded mean WTP was MYR460.23 (equivalent to US$ 102.17) for two doses of HFMD vaccination. The double bounded analysis revealed that the vaccine's price, poor education background and lower income were the key factors that significantly affected the WTP, with the estimated mean WTP being MYR394.00 (US$ 87.47). In conclusion, most Malaysian parents are willing to pay for the HFMD vaccination. The estimated WTP identifies the optimal price point for HFMD vaccination in Malaysia. Furthermore, the government should focus on an awareness programme for the HFMD vaccination among parents who have lower income or education level.
Fulltext The relationship between perceptions and self-paid hepatitis B vaccination: A structural equation modeling approach

Rajamoorthy Y, Radam A, Taib NM, Rahim KA, Wagner AL, Mudatsir M, et al.

PLoS One, 2018;13(12):e0208402.
PMID: 30521602 DOI: 10.1371/journal.pone.0208402

BACKGROUND: Malaysia has a comprehensive, publicly-funded immunization program for hepatitis B (HepB) among infants, but adults must pay for the vaccine. The number of HepB carriers among adults is expected to increase in the future; therefore, we examined the impact of five constructs (cues to action, perceived barriers, perceived benefit, perceived severity, and perceived susceptibility) on adults' willingness to pay (WTP) for HepB vaccine; secondarily, we examined the association between perceived barriers and perceived benefits.
METHODS: Adults were selected through a stratified, two-stage cluster community sample in Selangor, Malaysia. The reliability, convergent validity, and discriminant validity of the measurement model were assessed before implementing a partial least squares structural equation model (PLS-SEM) to evaluate the significance of the structural paths.
RESULTS: A total of 728 participants were enrolled. The five constructs all showed adequate internal reliability, convergent validity, and discriminant validity. There was a significant, positive relationship to WTP from constructs (perceived barriers [Path coefficient (β) = 0.082, P = 0.036], perceived susceptibility [β = 0.214, P<0.001], and cues to action [β = 0.166, P<0.001]), and the model all together accounted for 8.8% of the variation in WTP. There was a significant, negative relationship between perceived barriers and perceived benefit [β = -0.261, P<0.001], which accounted for 6.8% of variation in perceived benefit.
CONCLUSIONS: Policy and programs should be targeted that can modify individuals' thoughts about disease risk, their obstacles in obtaining the preventive action, and their readiness to obtain a vaccine. Such programs include educational materials about disease risk and clinic visits that can pair HepB screening and vaccination.
Fulltext Knowledge and awareness of hepatitis B among households in Malaysia: a community-based cross-sectional survey

Rajamoorthy Y, Taib NM, Munusamy S, Anwar S, Wagner AL, Mudatsir M, et al.

BMC Public Health, 2019 Jan 10;19(1):47.
PMID: 30630464 DOI: 10.1186/s12889-018-6375-8

BACKGROUND: Hepatitis B (HepB) is a major public health concern in Malaysia yet little is known about knowledge and awareness of this infection in the country. Such information is essential for designing effective intervention strategies for HepB prevention and control. The aim of this study was to characterize knowledge and awareness regarding HepB in Malaysia and to identify their associated sociodemographic determinants.
METHODS: A community-based cross-sectional survey was conducted between January and May 2016 in Selangor state of Malaysia. A two-stage cluster random sampling design was used and one adult member of selected households was interviewed face-to-face. Logistic regression was used to estimate the differences in knowledge and awareness between groups.
RESULTS: A total of 764 households completed the interviews and were included in the final analysis. Only 36.9 and 38.8% of the participants had good knowledge and awareness, respectively. The factors associated with good knowledge were being in the 35-44 year age group, Malay ethnicity, high educational attainment and high family income. Being Chinese, being older and having high educational attainment were determinants of having good awareness towards HepB. Participants who had good knowledge were 2.5 times more likely to also have good awareness (OR: 2.41, 95% CI: 1.78-3.26, p
Fulltext Willingness to pay for hepatitis B vaccination in Selangor, Malaysia: A cross-sectional household survey

Rajamoorthy Y, Radam A, Taib NM, Rahim KA, Munusamy S, Wagner AL, et al.

PLoS One, 2019;14(4):e0215125.
PMID: 30964934 DOI: 10.1371/journal.pone.0215125

BACKGROUND: In Malaysia, one million individuals are estimated to be infected with the hepatitis B virus. A vaccine for infants has been compulsory since 1989, whereas those born before 1989 need to spend their own money to be vaccinated in private clinics or hospitals. The aim of this study was to investigate and ascertain the determinants of willingness to pay (WTP) for adult hepatitis B vaccine in Selangor, Malaysia.
METHODS: In 2016, 728 households were selected through a stratified, two stage cluster sample and interviewed. Willingness to pay for hepatitis B vaccine was estimated using the Contingent Valuation Method, and factors affecting WTP were modelled with logit regression.
RESULTS: We found that 273 (37.5%) of the households were willing to pay for hepatitis B vaccination. The mean and median of WTP was estimated at Ringgit Malaysia (RM)303 (approximately US$73) for the three dose series. The estimated WTP was significantly greater in those with higher levels of education, among Malays and Chinese (compared to others, predominantly Indians), and for those with greater perceived susceptibility to hepatitis B virus infection. Other factors-perceived severity, barriers, benefits and cues to action-were not significantly associated with WTP for adult hepatitis B vaccination.
CONCLUSION: Additional resources are needed to cover the households that are not willing to pay for hepatitis B vaccination. More awareness (particularly in regards to hepatitis B virus susceptibility) could change the national perception towards self-paid hepatitis B virus vaccination and increase hepatitis B vaccine coverage.
Parents' willingness to pay for COVID-19 vaccination for children in Malaysia using the contingent valuation method

Rajamoorthy Y, Wagner AL, Kumaran VV, Munusamy S, Taib NM, Tin OH, et al.

Narra J, 2023 Dec;3(3):e187.
PMID: 38450341 DOI: 10.52225/narra.v3i3.187

Children are susceptible and a potential source of transmission for coronavirus disease 2019 (COVID-19). However compulsory COVID-19 vaccination programs among children have not been a focus in Malaysia. The aim of this study was to measure parents' willingness to pay (WTP) for the COVID-19 vaccine and analyze the effects of socioeconomic variables on parents' WTP. An online cross-sectional study was conducted in Malaysia with two waves of surveys (i.e., different samples for each wave), March and June 2021. The study participants were Malaysian parents above 18 years old. Parents were randomized between two vaccine effectiveness profiles (95% and 50% effectiveness) and two risk levels of an adverse event (5% and 20% risk of fever). The WTP was estimated using a double-bounded dichotomous choice. Socioeconomic variables such as age of parent, gender, insurance, income, and education were examined. A total of 292 parents in March 2021 and 271 in June 2021 were included in the study. The vaccine safety and effectiveness profile did not significantly impact the WTP. In March 2021, the estimated WTP ranged from RM344.74 to RM399.64 (US$82.5 to US$95.6) across vaccine profiles and between RM377.55 and RM444.33 (US$90.3 to US$106.3) in June. Insurance status was associated with the parents' WTP, and during the June wave, the age of parents influenced the WTP. Implementing subsidies or free vaccinations is considerable to increase herd immunity and prevent transmission of COVID-19 in Malaysia.