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Fulltext Integrated approach to community wellness: has this been forgotten?

Sharifa Ezat Wan Puteh

Malaysian Journal of Medicine and Health Sciences, 2019;15(104):2-2.
MyJurnal

Many a times, community targeted strategy works in silo and done haphazardly without any long-term planning and impact to the community. This wayward fashion has cost us millions of dollars, lost resources and dimmed motiva-tion. Most of the time, incoherent planning and short-term targets are the motivators. Getting plans into policy is not a task to be taken lightly. Policies that are incoherent, disintegrated with organisational and national plans, will not be taken up as policy papers. Overcoming resistance is another method to ensure smoothness of policy acceptance. This involves enlisting communication with multiple stakeholders and hearing out qualms by community members. Community based insurance is an example. The initial social insurance has been in the agenda for multiple years already. In the past 3 years, this agenda has been sped up by political masterminds and NGOs. The Peka B40 and MySalam have been introduced in the Malaysian healthcare system. It is hoped that these two social health insurance will provide the much needed relief for community in the lower categories.
Fulltext Measures of population health: general perspective on quality adjusted life years (QALYs) and disability adjusted life years (DALYs)

Natrah, S., Sharifa Ezat, W.P.

Malaysian Journal of Public Health Medicine, 2011;11(2):27-31.
MyJurnal

Impact of health care on the population health has been measured in terms of morbidity and mortality but this measurement doesn’t distinguish between children, adults and the elderly. It does not also take into account the losses that occur because of handicap, pain, or other disability. Therefore, measures of population health which combine information on mortality and non-fatal healthboutcomes to represent the health of a particular population as a single number was introduced. QALYs and DALYs are both common outcome measures in economic evaluations of health interventions. QALYs is the comprehensive measure of health outcome because it can simultaneously capture gains from reduced morbidity (quality gains) and reduced mortality (quantity gains) and combine these into a single measure. DALYs is primarily a measure of disease burden where it combines losses from premature death and loss of healthy life resulting from disability. Although QALYs and DALYs are almost similar in their basic concept but there are few distinct differences which must be paid attention to in order to correctly utilize these measures.
Fulltext Public health inspectors enforcement in Selangor, Malaysia

Sharifa Ezat, A., Aljunid, S.M.

Malaysian Journal of Public Health Medicine, 2005;5(1):56-61.
MyJurnal

A cross·sectional study was done to determine the capacity of Public Health Inspectors in Selangor using a seh administered questionnaire and universal sampling, to determine the enforcement of public health legislation and its influencing factors. A total of 99 respondents from the District Health Offices and 100 respondents from the Local Health Departments participated. The level of enforcement is generally low in all the units except for the Food Unit and Sanitary and Hygiene Units. Factors influencing enforcement of Public Health Legislations are the unit where the respondents worlc and the length of service with the unit. Further analysis using multiple logistic regression, found that respondents from the Food Unit (OR ZZ; 95% C1: 7 .9-58.9 ) , being in the
U8 category (OR 5; 95% C1: l.4» 17.6), service offour years and above in the same unit (OR 6; 95% C1: 2.2»13.8) , received service rewards (OR 3; 95% C1 : 1.2· 6.9); low exposure to bribery (OR 46; 95% C1: 2.3·100.0) and offered bribes while on the field (OR 3; 95% C1: 1.02» 4.8) have higher kvel enforcement performance. Attention must be given to the enforcement organization with respect to duration of service, service awards and monitoring of bribes exposure to help develop the enforcement of public health legislations.
Fulltext Paper review of factors, surveillance and burden of food borne disease outbreak in Malaysia

Sharifa Ezat, W.P., Netty, D., Sangaran, G.

Malaysian Journal of Public Health Medicine, 2013;13(2):98-105.
MyJurnal

Food borne diseases like cholera, typhoid fever, hepatitis A, dysentery and food poisoning occur as the results of ingestion of foodstuffs contaminated with microorganisms or chemical. The true incidence of food borne disease in Malaysia is unknown, however the incidence is low ranging from 1.56 to 0.14 cases per 100,000 population and the food poisoning cases is on the rise as the evident by the incident rate of 62.47 cases per 100,000 population in 2008 and 36.17 in 2009. The rapid population growth and demographic shift toward ageing population, changing eating habit such as consumption of raw or lightly cooked food, long storage of such food, lack of education on basic rules of hygienic food preparation and food trading without appropriate microbiological safety procedure become contributing factors for food borne diseases. Food borne disease in Malaysia is in the rise and the direct and indirect cost management of FBD will become one of the most common issues to face by the government. The world is spending millions and millions in cost of treatment due to food borne diseases. The information on this paper was collected via findings of previous journals, data and statistics from the MOH of Malaysia and WHO websites. As a result, authors found that the prevention and management of the food borne disease outbreak needs to be addressed seriously.
Factors associated with the usage of health insurance among cancer patients in public hospitals in a middle-income country

Sharifa Ezat WP, Yang Rashidi A, Azimatun Noor A

Med J Malaysia, 2023 May;78(3):318-328.
PMID: 37271841

INTRODUCTION: Private health insurance (PHI) plays an important supplementary role on top of the existing subsidised health financing system to prevent heavy reliance on out-of-pocket (OOP) expenses, especially in diseases with high costly treatment. This study was done to examine the factors associated with PHI usage among cancer patients and its associated influencing factors in Malaysia.
MATERIALS AND METHODS: This cross-sectional study was conducted in three Malaysian public hospitals using a multilevel sampling technique to recruit 630 respondents. A validated self-developed four-domain questionnaire which includes one domain for health insurance was used to collect the relevant data.
RESULTS: Approximately 31.7% of the respondents owned PHI. The PHI usage was significantly higher among male respondents (p=0.035), those aged 18-40 years old (p<0.001), Indian and Chinese ethnicities (p=0.002), with tertiary education level (p<0.001), employed (p<0.001), working in the private sector (p<0.001), high household income (T20) (p<0.001), home near to the hospital (p=0.001) and medium household size (p<0.001). The significant predictive factors were age 18-40 years aOR 3.01 (95% CI: 1.67-5.41), age 41-60 years aOR 2.22 (95% CI 1.41-3.49), medium (M40) income aOR 2.90 (95% CI: 1.92-4.39) and high (T20) income aOR 3.86 (95% CI: 1.68-18.91), home near to the hospital aOR 1.68 (95% CI: 1.10-2.55), medium household size aOR 2.20 (95% CI: 1.30-3.72) and female head of household aOR 1.79 (95% CI: 1.01-3.16). The type of cancer treatment, the location of treatment, prior treatment in private healthcare facilities and existence of financial coping mechanisms also were significant factors in determining PHI usage among cancer patients in this study.
CONCLUSION: Several factors are significantly associated with PHI usage in cancer patients. The outcome of this study can guide policymakers to identify high-risk groups which need supplementary health insurance to bear the cost for their cancer treatment so that a better pre-payment health financing system such as a national health insurance can be formulated to cater for these groups.
Fulltext A psychosocial study on the effects of employee characteristics and workplace ergonomics on chronic back pain related to work

Tam, Jenn Zhueng, Sharifa Ezat Wan Putih, Noor Hassim

Journal of Occupational Safety and Health, 2018;15(2):2-11.
MyJurnal

The study objective is to examine the effects of the identified attributes (i.e. employee characteristics and ergonomics) that influences the chronic back pain disabilities acquired and benefits awarded via the recognition of workplace relatedness. As these factors are considered in work- related chronic back pain, we hypothesized that the ascertainment of work relatedness would depend on employees’ workplace conditions (poor ergonomic practices) and innate personal conditions (excellent pre-existing medical health). Two set of data was collected from a registry owned by a social security organization in 2012. Factor analysis and structural equation modeling (SEM) was used to analyze the data. As predicted, workplace conditions and employees’ pre- existing medical health status mediated occupational back pain to develop disability and monetary benefit relationships. In conclusion, the results support the importance of obtaining workplace evidence and employees’ pre- existing medical health status that produces stronger relationship in terms of the amount of benefits to be given compared to the lesser effects on disability. Both models with different samples showed consistent SEM results. The proposed model would be applicable in the heterogenous Asian setting and that occupational back pain consensus is the key element in providing effective social security protection.
Customers satisfaction towards Posyandu at urban and rural areas

Sharifa Ezat, W.P., Aniza, I., Jamiah, M., Khalib, L., Dwiyanti

Journal of Health Management, 2008;4(1):88-95.
MyJurnal

Customer satisfaction is one of the main priority to any service provider. It indicates process and quality involved in delivering of services. However, satisfaction level varies from one service to another. In Indonesia, satisfaction study is seldom done on Posyandu activity. This study tries to understanding this issue. A cross sectional study was conducted on Posyandu services located in urban and rural areas of South Sumatera, Indonesia from November 2005 until January 2006 with 125 respondents in urban area and 123 respondents in rural area using multi stages random sampling. Data was collected via structured questionnaires using SERVQUAL score method based on five dimensions : tangible, reliability, responsiveness, assurance and empathy. The results showed that the proportion of satisfied customers was higher at 74% particularly in the rural area. Satisfied respondents were significantly associated with age, education, income and distance to Posyandu services. The most satisfying dimension were tangible and reliability especially in the urban area, but not for responsive and empathy dimension. Overall, the mean SERVQUAL score of all dimension was higher for the urban as compared to the rural area, implying that customer perceptions are much better from what was expected.
Responsive and empathy dimension were the main barrier affecting customer satisfaction. Staff development efforts such as training, refreshing and others form of organizational development strategies, therefore, need to be incorporated into its current managerial practice in order to improve the health services delivery and increase customers' satisfaction.
Fulltext Healthcare inequalities: the United States vs India

Mohamad Nasaruddin Mahdzir, Izwan Effendy Zainuddin, Sharifa Ezat Wan Puteh

Int J Public Health Res, 2012;2(2):177-183.
MyJurnal

The relationship between healthcare services and inequalities is more likely when a group that shares a salient identity faces severe inequalities of various kinds. Such inequalities may be catalyzed by economic, social, political or concern cultural status. The objectives of this review are to identify the issues and challenges involve in healthcare inequalities, to compare factors contributes to healthcare inequalities and to purpose suggestions and recommendations for improvement based on issues and challenges between United States and India. Comparing annual year healthcare report, documentation of healthcare institutional, Ministry of Health's report and circular, official institutional website, scientific healthcare journals, articles and reports published in 1994 until 2011 regarding healthcare inequalities between United States and India. Health inequalities in the healthcare system contributed by the different in socioeconomic status and accessibility to the healthcare facility due to high cost of treatment has been common risk 'Catastrophic' factors to the inequalities in both countries. Health financing system and resource allocation that benefit only the upper class social spectrum of the population. Disparities occur due to the imbalance in distribution of wealth, discrimination and change in the world economy. Adapting healthcare system that provides care to all classes of people need improvement as no healthcare system is perfect. This matter must be tackle urgently as it's a matter of national concern.
Fulltext Amalan senaman dan faktor-faktor yang mempengaruhinya di kalangan penduduk Kg. Bangi, Daerah Hulu Langat, Selangor D.E. Malaysia

Jamsiah, M., Md Idris, M.N., Sharifa Ezat, W.P., Norfazilah, A.

Malaysian Journal of Community Health, 2007;13(1):38-43.
MyJurnal

Satu kajian keratan rentas telah dijalankan ke atas 285 orang penduduk yang berumur 18 tahun dan ke atas di Kg. Bangi Daerah Hulu langat, Selangor D.E. dari 6-12 Mac 2006. Objektif kajian ini adalah untuk melihat prevalens senaman dan faktor yang mempunyai hubungan dengannya. Kaedah persampelan universal telah digunakan dan pengumpulan data melalui borang soalselidik berpandu. Alatan yang digunakan termasuk penimbang berat Seca dan sfigmomanometer yang telah di kalibrasi, stateskop dan pita pengukur ketinggian. Hasil kajian menunjukkan hanya 13.7% daripada responden yang di kaji di dalam kategori cukup bersenam mengikut definisi kajian. Antara faktor-faktor yang mempunyai hubungan yang signifikan dengan prevalens cukup bersenam adalah jantina (p=0.004), tahap pendidikan (p=0.02) dan status perkahwinan (p
Fulltext A cross sectional study on job satisfaction level and the influencing factors among public health specialists in the Ministry of Health Malaysia, September 2004 - October 2004

Aniza, I., Syed Mohamed Al Junid, Sharifa Ezat

Malaysian Journal of Public Health Medicine, 2005;5(2):25-31.
MyJurnal

Job satisfaction level of workers is among the important factors influencing the performance and productivity of an organization. A cross sectional study was conducted among Public Health Specialists in the Ministry of Health of Malaysia to identify their job satisfaction level and the factors influencing it. The respondents are from the Association of Public Health Specialists of Malaysia. A working in Ministry of Health. Focus group discussions were conducted in four states to develop a relevant and comprehensive questionnaire. Survey questionnaires were then mailed to the respondents. The response rate was 7 2.3%. In measuring the job satisfaction level seven aspects were studied. The study showed that ‘job and workload` is the main contributor to job dissatisfaction followed by ’management and policy aspect’, 'salary and remuneration: aspect’ and resources and facilities aspect. Most of the respondents (94.0%) were dissatisfied with their job. Gender and income were the predictors of general job satisfaction. As a conclusion, the management, policy and remuneration shouM be revised in order to overcome the problems identified and subsequently increase job satisfaction levels among Public Health Specialists in the Ministry of Health, Malaysia.
Fulltext Factors affecting motivation level among public health specialists in the Ministry of Health Malaysia

Aniza, I., Syed Mohamed Al Junid, Sharifa Ezat

Malaysian Journal of Public Health Medicine, 2006;6(1):17-22.
MyJurnal

Employee motivation affects productivity and need to be channeled towards the accomplishment of organizational goals. A cross sectional study was conducted among Public Health Specialists (PHS) in the Ministry of Health Malaysia to study their motivation level and the factors influencing this. The respondents were from the Association of Public Health Specialists of Malaysia working in the Ministry of Health. Quantitative Technique self-administered questionnaires were used in this study and the questionnaires were mailed to the respondents. The response rate for this study was 72.3%. In measuring the motivation level, five (5) aspects were studied. The social aspect, self -achievement aspect and autonomy aspect were found to be the main aspects that motivated the respondents. With regard to motivation level, 55.8 % respondents had low motivation level. In order to improve the motivation level among PHS, the aspect of self actualization and autonomy required serious attention. In the future, PHS are expected to play a major role in controlling, promoting, preventing, maintaining, restoring and solving problems in order to enhance the health of the Malaysian population.
Fulltext Integrated Care Pathway (ICP) on management of Occupational Related Chronic Low Back Pain (OCLBP) in Malaysia: a critical review

Shahruz Idzwan Azmi, Sharifa Ezat Wan Puteh, Noor Hassim Ismail

Malaysian Journal of Public Health Medicine, 2015;15(2):60-68.
MyJurnal

Occupational Related Chronic Low Back Pain (OCLBP) is a globally recognized illness that causes reduction in productivity and substantial economic burden to the countries. It requires a multidisclipinary approach involving employer, healthcare provider, compensatory and enforcement agencies. However there is no specific guideline or pathway that has integrated the roles of each responsible agency. The objective of this article is to highlight the need and to propose a coordinated approach through the concept of Integrated Care Pathway (ICP). Therefore, we reviewed international and local guidelines as well as published articles on chronic low back pain and care pathway. We believed that development of a pathway will be able to organize the role of management at every level, reducing the variations in the management, addressing issues of communicating the findings between the responsible stakeholders, fulfilling the requirements as the laws, allows effective and feasible approaches to take place in terms of cost and practicality, and increase the awareness on occupational diseases. Expected challenges such as limitation of resources, unawareness and lack of understanding on OCLBP from every level are issue that we agreed can be bridged through ICP.
Fulltext Kualiti dalam penjagaan kesihatan

Jannatul Madihah, A.B., Natrah, M.S., Jamsiah, M., Sharifa Ezat, W.P.

Malaysian Journal of Community Health, 2009;15(2):67-76.
MyJurnal

Introduction : Quality is an important aspect in health care delivery not only because it is one of the most important factors in individual and community health, but it also influences lives in improving lifespan, health status and also reduction in disease and the burden of diseases.
Methodology : This is a systematic review on various papers, studies and articles based on studies and researches done by a few scholars, experts and organizations involved in quality, quality assessment and monitoring.
Results : Quality in health care delivery involves six main aspects including access to services, suitability to the needs, effectiveness, equity, social acceptance and efficiency. Quality is taken from the perspective of the consumers and the providers. Some of the issues surrounding quality assessment are identifying and balancing between the difference perspective among the stakeholders, producing accountable framework of assessment and also finding suitable criteria for outcome assessment. Health care services in Malaysia are provided both by the government and the private sector with each sector has its own advantages, disadvantages and challenges.
Conclusion : The challenges in improving and maintaining quality include balancing advances in science and technology with the available brainpower and human resources. Therefore all agencies should work together in order to provide the best health care delivery and to keep improving the quality in health care services.
Fulltext Challenges in determining occupational related chronic low back pain among employees: a review of the literature

Tam, Jenn Zhueng, Sharifa Ezat Wan Puteh, Noor Hassim Ismail

Malaysian Journal of Public Health Medicine, 2014;14(3):0-0.
MyJurnal

Chronic low back pain is a common preventable occupational health illness affecting most workers. Large amount of financial and benefit cost had been spent by the developed countries to prevent, treat and rehabilitate a large number of workers who are exposed to hazards that are attributed to low back pain. Efforts on primary prevention of low back pain had been challenging due to difficulties in affirming work- relatedness of chronic back pain among workers. As such, efforts have to be focused on existing literatures to propose acceptable variables to develop the definition of workrelatedness specific to chronic low back pain. Such identified variables or factors could be used to develop a set of criteria in defining work- related chronic back pain. Literature search using specific work- related and chronic low back pain key words were used. Comparable articles were judged and a summarized result was obtained. These variables could be grouped into individual characteristics, health behaviours, physical conditions at work, work organizations and ergonomic factors. With proper methodology and statistical analysis, tools could be developed to aid physicians in determining work- related chronic low back pain among employees.
Fulltext Cost-effectiveness of HPV vaccination in the prevention of cervical cancer in Malaysia

Wan Puteh WP, Aljunid S

Asian Pac J Cancer Prev, 2010;11(1):79-90.
PMID: 20593935

INTRODUCTION: Cervical cancers (CC) demonstrate the second highest incidence of female cancers in Malaysia. The costs of chronic management have a high impact on nation's health cost and patient's quality of life that can be avoided by better screening and HPV vaccination.

METHODOLOGY: Respondents were interviewed from six public Gynecology-Oncology hospitals. Methods include experts' panel discussions to estimate treatment costs by severity and direct interviews with respondents using costing and SF-36 quality of life (QOL) questionnaires. Three options were compared i.e. screening via Pap smear; quadrivalent HPV Vaccination and combined strategy (screening plus vaccination). Scenario based sensitivity analysis using screening population coverage (40-80%) and costs of vaccine (RM 300-400/dose) were calculated.

RESULTS: 502 cervical pre invasive and invasive cervical cancer (ICC) patients participated in the study. Mean age was 53.3 +/- 11.2 years, educated till secondary level (39.4%), Malays (44.2%) and married for 27.73 +/- 12.1 years. Life expectancy gained from vaccination is 13.04 years and average Quality Adjusted Life Years saved (QALYs) is 24.4 in vaccinated vs 6.29 in unvaccinated. Cost/QALYs for Pap smear at base case is RM 1,214.96/QALYs and RM 1,100.01 at increased screening coverage; for HPV Vaccination base case is at RM 35,346.79 and RM 46,530.08 when vaccination price is higher. In combined strategy, base case is RM 11,289.58; RM 7,712.74 at best case and RM 14,590.37 at worst case scenario. Incremental cost-effectiveness ratio (ICER) showed that screening at 70% coverage or higher is highly cost effective at RM 946.74 per QALYs saved and this is followed by combined strategy at RM 35,346.67 per QALYs saved.

CONCLUSION: Vaccination increase life expectancy with better QOL of women when cancer can be avoided. Cost effective strategies will include increasing the Pap smear coverage to 70% or higher. Since feasibility and long term screening adherence is doubtful among Malaysian women, vaccination of young women is a more cost effective strategy against cervical cancers.
Fulltext An overview of civil society organizations' roles in health project sustainability in Bauchi State, Nigeria

Ibrahim U, Wan-Puteh SE

Pan Afr Med J, 2018;30:150.
PMID: 30374396 DOI: 10.11604/pamj.2018.30.150.15851

Introduction: This study sets out to assess the roles of Civil Society Organizations (CSOs) in post donor health project sustainability in Low and Middle Income Countries (LMICs), the case of the Bauchi State, Nigeria. This study equally investigated the CSOs strategies and roles in health project sustainability.
Methods: For quantitative data collection, the random, purposive, and convenient sampling techniques were used and 156 respondents selected from relevant organizations operating in Bauchi state, Nigeria, and 15 respondents for Key Informant Interviews (KIIs). A Semi-structured questionnaire was the study instrument, and consent from the participants as well as ethical clearances were duly obtained.
Results: The study revealed that 87.8% of the respondents indicate un-friendly operational policies, while 88.9% of them identified lack of resources (human, money and machineries) as impediments to project sustainability. Also, 74.3% of the respondents said partnership among key stakeholders and 86.6% of them affirmed that community participation and use of available (local) resources ensure health project sustainability. The study further revealed that CSOs fund health projects, support government efforts and encourage development of project sustainability road map in the state.
Conclusion: Hence, health project sustainability plan should form part of a project right from inception through the donor period and thereafter. In addition to the above, internal income framework, community involvement, enabling policies and partnership among stakeholders, especially with the host government, should always guide project implementation, because without these in place, project sustainability will remain a mirage.
Empirical treatment with pantoprazole as a diagnostic tool for symptomatic adult laryngopharyngeal reflux

Masaany M, Marina MB, Sharifa Ezat WP, Sani A

J Laryngol Otol, 2011 May;125(5):502-8.
PMID: 21356141 DOI: 10.1017/S0022215111000120

To determine the sensitivity and specificity of intensive empirical treatment with pantoprazole in diagnosing laryngopharyngeal reflux in adults.
Fulltext Compliance towards methadone maintenance therapy and its associated factors in Selangor primary care centers and Kuala Lumpur hospital

Sharifa Ezat WP, Noor Azimah H, Rushidi R, Raminder K, Ruhani I

Med J Malaysia, 2009 Mar;64(1):65-70.
PMID: 19852326 MyJurnal

This paper seeks to determine the client's compliance level towards Methadone Maintenance Therapy (MMT) and identify its associated factors. A cross sectional study was conducted from June to September 2007 where 288 samples were interviewed. The outcomes were divided into good compliance and partial compliance categories. Overall client's compliance level is good at 86.1%. There are significant difference between mean age of groups (t = -2.041, p = 0.04); and significant associations of job's status (chi2 = 9.54, p = 0.008); client's confident score (t = -3.12, p = 0.023), client'ssocial function score (t = -2.308, p = 0.002) and client's social function level (chi2 = 5.43, p = 0.02) with compliance toward program. With multivariate analysis, only client's age, client's confidence score and client's job status were related to compliance status. It was concluded that there is high compliance rate among client's who received the program. Younger clients, low scores on client's confident and social function, and clients with unsteady jobs are at risk not to comply with treatment.
Fulltext A comparison between private clinic in urban and rural area in Selangor, 2009. [Perbandingan klinik swasta di bandar dan luar bandar di negeri Selangor, 2009]

Sharifa Ezat WP, Natrah MS, Khalib AL, Hasni H

Malaysian Journal of Community Health, 2009;15(2):9-16.
MyJurnal

Introduction : Selangor’s private clinic registry system had been introduced in 2006 following gazettment of The Private Healthcare Facilities and Services Act. Through the act, data’s from the private clinics can be obtained and its characteristics can be compared between the urban and rural private clinic. An overview of the services can be known and an appropriate action can be planned.
Methodology : A cross-sectional study was done on private clinics registered in state of Selangor. Using databased known as MedPCs (Medical Practice Control System), a purposive sampling was used to select four districts – two urban and two rural. All private clinics in the selected districts were studied and all details shall be collected online.
Result : District of Gombak and Klang were selected as urban and Sabak Bernam and Kuala Selangor represented rural area. Of a total 625 clinics selected, 90.0% (562) from urban and 10.0% (63) rural. Distributions of clinic were in line with the act. The most prominent services were general treatment (89.4%) and ability to serve more than eight hours daily (89.4%). Medical clinic still dominated at 84.0% compared to dentistry at 16.0%. About 70.6% were operated by male doctors. Though clinic services in rural were relatively as good as urban, the different were significantly observed to the ethnicity of the doctor. Indian doctors more in rural (46.03%), whilst in urban, Malay doctors were more dominant (39.50%). Followed closely by seniority, where rural doctors were much senior (51.02 years old), however, most of the doctors in rural private clinics experienced less exposure in government sectors, compared to those in urban areas.
Conclusion : There were obvious difference in terms of distribution, where more clinics were located in urban compared to rural, but all were still in line to the act and their services were comparable. Most noticeable differences were ethnicity, seniority and past experience working in the public sector. Indian doctors were dominant in rural and Malay in urban. Although rural doctors were more senior, relatively they were less experienced working in the government sector.
The prevalence of Dysphagia among head and neck cancer patients in tertiary public hospitals in Malaysia

Husmeela H, Kartini A, Zakinah Y, Sharifa Ezat WP, Hasherah MI

Med J Malaysia, 2021 Nov;76(6):837-844.
PMID: 34806670

INTRODUCTION: Dysphagia is the most common problem among head and neck cancer patients. It can occur before, during, and/or after cancer treatment due to cancer growth or side effects from cancer treatment. To date, the data on the prevalence of dysphagia in Malaysia is very limited. Therefore, the present study aimed to examine the prevalence and contributing factors of dysphagia.
MATERIALS AND METHODS: A total of 240 patients (mean age 53.1, 167 males and 73 females) from Hospital Kuala Lumpur and the National Cancer Institute were enrolled in this research. All patients were interviewed individually in which they completed a thorough case history and swallowing screening test, including the water swallow test.
RESULTS: The results revealed that 43.3% of patients had dysphagia. In multivariate logistic regression, occupation of the patients was found to be associated with dysphagia, i.e., working in service and sales sector (adjusted Odds Ratio, aOR=0.36, 95% Confidence Interval, 95%CI: 0.13, 0.99). Compared to patients without treatment, those who had chemoradiotherapy (aOR=4.45; 95%CI: 1.10, 17.99) were at an increased odd of developing dysphagia.
DISCUSSION: This study showed that occupation, cancer stage, and type of treatment received by the head and neck cancer patients were crucial factors associated with the development of dysphagia. These findings guide the clinicians in identifying head and neck cancer patients who are at greater risks of developing dysphagia.

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