Governance has been highlighted as an important building block underpinning the process of mental health integration into primary healthcare. This qualitative systematic review aims to identify the governance issues faced by countries in the Sub-Saharan Africa and South Asia Region in the implementation of integrated primary mental healthcare. PRISMA guideline was used to conduct a systematic search of relevant studies from 4 online databases that were filtered according to inclusion and exclusion criteria. Using the Critical Appraisal Skills Program (CASP) Qualitative Checklist, a quality appraisal of the selected articles was performed. By drawing upon institutional theory, data was extracted based on a pre-constructed matrix. The CERQual approach synthesized evidence and rank confidence level as low, moderate or high for 5 key findings. From 567 references identified, a total of 8 studies were included. Respondents were policymakers or implementers involved in integrated primary mental healthcare from the national, state, and district level. Overall, the main governance issues identified were a lack of leadership and mental health prioritization; inadequate financing and human resource capacity; and negative mental health perceptions/attitudes. The implication of the findings is that such issues must be addressed for long-term health system performance. This can also improve policymaking for better integration of primary mental health services into the health systems of countries in the Sub-Saharan and South Asia region.
Understanding attitudes toward suicide, especially among healthcare personnel, is an important step in both suicide prevention and treatment. We document the adaptation process and establish the validity and reliability of the Attitudes Toward Suicide (ATTS) questionnaire among 262 healthcare personnel in 2 major public hospitals in the Klang Valley, Malaysia. The findings indicate that healthcare personnel in Malaysia have unique constructs on suicide attitude, compared with the original study on a Western European sample. The adapted Malay ATTS questionnaire demonstrates adequate reliability and validity for use among healthcare personnel in Malaysia.
This study evaluated the effectiveness of a depression literacy program on depression literacy, mental health stigma, and help-seeking attitude among adolescents with a monthly household income of RM3900 a month or less (B40) in Malaysia. The program included a lecture, mental awareness activities, and a short video on depression. Residents from a boarding school for lower income families were involved in this study (N = 101); 53 of them underwent the program and another 48 served as the control group. There were significant improvements for all variables in the intervention group (better depression literacy, reduced self-stigma, reduced negative beliefs on mental health, and increased help-seeking) at posttest. However, the results were sustained at 3-month follow-up only for the depression literacy, mental help-seeking attitude, and self-stigma of seeking help variables when compared with the control group. The findings highlight the need to improve the program to enhance the effectiveness and sustainability of the outcomes.
COVID-19 pandemic raises various challenges faced by health workers in hospitals. This study explored strategies for overcoming challenges in caring for COVID-19 patients at hospitals in Indonesia based on healthcare workers' experience. In-depth interviews were employed with 28 healthcare workers (physicians and nurses) who were purposively sampled. Data were collected via phone and analysed using the Colaizzi method. Five following challenges were found: difficulties in working with personal protective equipment (PPE), offline training for handling Covid and using PPE not being implemented evenly for all health workers, physical and psychological fatigue, difficulties in carrying out health education and assessment towards patients and families, and limited resources to cope with the COVID-19 pandemic. Meanwhile, some barriers require support from the government, public and hospital managers. The information gained from research on the strategies for caring for COVID-19 patients can contribute to better preparedness for hospitals and health workers facing the COVID-19 pandemic.
The objective of this article is to examine the impact of coronavirus disease 2019 (COVID-19) upon university students' anxiety level and to find the factors associated with the anxiety level in Malaysia. We collected data from 958 students from 16 different universities using an originally designed questionnaire. The Generalized Anxiety Disorder Scale 7-item (GAD-7) was used to estimate the anxiety. Then we applied the ordered logit model to calculate the odds ratios (OR) and factors associated with the anxiety level. We find that 12.3% of students were normal, whereas 30.5% were experiencing mild anxiety, 31.1% moderate anxiety, and 26.1% severe anxiety. Surprisingly, only 37.2% of students were aware of mental health support that was provided by their universities. However, age above 20 years (OR = 1.30), ethnicity Chinese (OR = 1.72), having any other disease (OR = 2.0), decreased family income (OR = 1.71), more time spent on watching COVID-19-related news (OR = 1.52), and infected relative or friends (OR = 1.62) were risk factors for anxiety among students. We conclude that the government of Malaysia should monitor the mental health of the universities' students more closely and universities should open online mental health support clinics to avoid the adverse impacts of anxiety.
Health care systems aim to deliver high-quality medical care while considering efficient resource usage and cost-effective forms of interventions. Such purposes require scientific tools or mechanisms which aid in cost assessment before the efforts of cost reduction are considered. Diagnosis-related groups based costing methodology (Case-mix) is considered one of the preferred costing approaches in the health care sector. King Fahd Central hospital Jazan, the only tertiary hospital in the Jazan region, was selected for case-mix system-based patient-level costing of health services. The study's objective was to estimate the cost per Diagnosis-Related Group (DRG) per inpatient admission and compare it with the already established average cost of health care services for inpatients. We applied a cross-sectional retrospective approach to categorize the inpatients based on their diagnosis and procedures and then estimate the actual cost of health care services provided to inpatients during 2018 and compared it with the average cost of the health services. There was a considerable difference between DRG-based costing (SAR 269,663,897) and average costing (SAR 247,035,938). The Diagnosis Related Group costing was found to be more reliable and representative of the services provided to the patients and is recommended to be used for reimbursement purposes.
We examine the evidence from the long-run abnormal returns using data for 76 health care and biopharmaceutical initial public offerings (IPOs) listed in a 29-year period between 1986 and 2014 in the Association of Southeast Asian Nations (ASEAN) countries such as Indonesia, Malaysia, Singapore, Thailand, the Philippines, Vietnam, Myanmar, and Laos. Based on the event-time approach, the 3-year stock returns of the IPOs are investigated using cumulative abnormal return (CAR) and buy-and-hold abnormal return (BHAR). As a robustness check, the calendar-time approach, related to the market model as well as Fama-French and Carhart models, was applied for verifying long-run abnormal returns. We found evidence that the health care IPOs overperform in the long-run, irrespective of the alternative benchmarks and methods. In addition, when we divide our sample into 5 groups by listing countries, our results show that the health care stock prices of the Singaporean firms behaved differently from those of most of the other firms in ASEAN. The Singaporean IPOs are characterized by a worse post-offering performance, whereas the IPOs of Malaysian and Thai health care companies performed better in the long-run.
The steady growth of pharmaceutical expenditures is a major concern for health policy makers and health care managers in Malaysia. Our study examined the factors affecting the total inpatient pharmacy cost (TINPC) at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). In this retrospective study, we used 2011 administration electronic prescriptions records and casemix databases at UKMMC to examine the impact of sociodemographic, diagnostic, and drug variables on the TINPC. Bivariate and multivariate analyses of the factors associated with TINPC were conducted. The mean inpatient pharmacy cost per patient was USD 102.07 (SD = 24.76). In the multivariate analysis, length of stay (LOS; B = 0.349, P < .0005) and severity level III ( B = 0.253, P < .0005) were the primary factors affecting the TINPC. For each day increase in the LOS and each increase of a case of severity level III, there was an increase of approximately USD 11.97 and USD 171.53 in the TINPC per year, respectively. Moreover, the number of prescribed items of drugs and supplies was positively associated with the TINPC ( B = 0.081, P < .0005). Gender appears to have affected the TINPC; male patients seem to be associated with a higher TINPC than females (mean = 139.55, 95% confidence interval [CI]: 112.97-166.13, P < .001). Surgical procedures were associated with higher cost than medical cases (mean = 87.93, 95% CI: 61.00-114.85, P < .001). Malay (MYR 242.02, SD = 65.37) and Chinese (MYR 214.66, SD = 27.99) ethnicities contributed to a lower TINPC compared with Indian (MYR 613.93, SD = 98.41) and other ethnicities (MYR 578.47, SD = 144.51). A longer hospitalization period accompanied by major complications and comorbidities had the greatest influence on the TINPC.
While monkeypox virus (MPXV) remained endemic in central and western African countries, a sudden unusual spike of global cases among non-endemic countries is an enigma for scientists. With 257 cases reported as of 26th May 2021, a multi-country outbreak of monkeypox has been declared in countries including the UK, EU/EEA states, and North America. Even though the likelihood of transmissibility of MPXV is limited compared to COVID-19, yet a coordinated multidisciplinary effort is required to prevent any further global expansion. Few appropriate responsive approaches to contain the infection could be; limiting the contact with potential animal reservoirs, isolation of confirmed cases, using PPEs to prevent human-human transmission, awareness activities, and administration of pre and post prophylactic vaccination. In this review, we have discussed the previous and current outbreaks of MPXV along with the abrupt actions that are needed to address the situation.
The burden of hypertension has been growing over recent decades. In addition to risk of stroke and cardiovascular disease development, data indicates that hypertension may also pose a hazard to the quality of life (QoL) of individuals. Patient reported outcomes such as QoL are often overlooked, with physicians and healthcare professionals not routinely evaluating or customizing treatments according to QoL. In this study we aimed to assess the QoL of hypertensive men (n = 500) undergoing treatment who visited a charitable hospital in Pune, India. Clinic blood pressure was determined and the Mini Cuestionario de Calidad de Vida en Hipertensión Arterial (MINICHAL) scale was used to assess the health-related (HR)-QoL of patients. More than half of the participants (62%) had uncontrolled hypertension, with a mean systolic blood pressure (BP) of 151 ± 12 mmHg and diastolic blood pressure of 87 ± 6 mmHg as compared to those with controlled blood pressure (mean systolic blood pressure 123 ± 6 mmHg and diastolic blood pressure 84 ± 5 mmHg; P
Over the years, several developing countries have been suffering from high infant and child mortality rates, however, according to the recent statistics, Pakistan falls high on the list. Our narrative review of copious research on this topic highlights that several factors, such as complications associated with premature births, high prevalence of birth defects, lack of vaccination, unsafe deliveries, poor breastfeeding practices, complications during delivery, sudden infant death syndrome (SIDS), poor socioeconomic conditions, and a struggling healthcare system, have influenced these rates. Bearing in mind the urgency of addressing the increased infant and child mortality rate in Pakistan, multiple steps must be taken in order to prevent unnecessary deaths. An effective initiative could be spreading awareness and education among women, as a lack of education among women has been indirectly linked to increased child mortality in Pakistan across many researches conducted on the issue. Furthermore, the government should invest in healthcare by hiring more physicians and providing better supplies and improving infrastructure, especially in underdeveloped areas, to decrease child mortality due to lack of clean water and poor hygiene. Lastly, telemedicine should be made common in order to provide easy access to women who cannot visit the hospital.
Monkeypox (MPX) is a zoonotic disease caused by the MPX virus from the poxviridae family of orthopoxviruses. Typically, endemic in central and west Africa, it has now become a matter of concern since cases have been reported in non-endemic countries around mid-June 2022, especially in the European region, with the transmission not related to travel. The diagnosis is made by PCR testing of the skin lesions. Even though treatment is symptomatic, antiretrovirals, such as tecovirimat, are used in severe cases. Vaccination with second and third generation vaccines is approved for prophylaxis in high risk individuals. Unfortunately, these options of treatment and prevention are only available in high income countries at the moment. This review, through a thorough literature search of articles from 2017 onward, focuses on epidemiology, clinical manifestations, challenges, treatment, prevention and control of MPX virus and how they can be corelated with other viral outbreaks including COVID-19, Acute Hepatitis of unknown origin, Measles and Dengue, to better predict and therefore prevent its transmission. The previous COVID-19 pandemic increased the disease burden on healthcare infrastructure of low-middle income countries, therefore, this recent MPX outbreak calls for a joint effort from healthcare authorities, political figures, and NGOs to combat the disease and prevent its further spread not only in high income but also in middle- and low-income countries.
The COVID-19 pandemic presented significant challenges for individuals who experienced stroke and their caregivers. It is essential to understand the factors affecting preventive behavior in these populations. Therefore, the present study examined the factors that influenced COVID-19 preventive behavior and motivation for COVID-19 vaccine uptake among patients with stroke and their caregivers. A cross-sectional study comprising 191 participants (81 patients with stroke and 110 caregivers) was carried out. Participants completed a survey assessing fear of COVID-19, stress, perceived susceptibility, problematic social media use, preventive behaviors, and motivation for vaccine uptake. Statistical analyses included descriptive statistics, Pearson correlations, and multiple linear regressions. Motivation for COVID-19 vaccine uptake was significantly positively correlated with problematic social media use (r = 0.225, P = .002), perceived susceptibility (r = 0.197, P = .008), and fear of COVID-19 (r = 0.179, P = .015), but negatively correlated with stress (r = -0.189, P = .010). Caregivers, compared to patients, showed a lower level of preventive behavior (standardized coefficient = -0.23, P = .017). Furthermore, higher levels of fear were associated with increased preventive behavior (standardized coefficient = 0.22, P = .006), while greater stress correlated with lower preventive behavior (standardized coefficient = -0.38, P
COVID-19 infection resulted in significant economic implications to patients as well as a considerable financial burden to the general population for preventive measures. A descriptive study was conducted among staff at one of the public universities in Malaysia to estimate the monthly out-of-pocket expenditures for preventive measures used for COVID-19 infection. The study tool includes questions on household out-of-pocket expenditure and the measurements of the impact of the expenditure on household income. It was found that the average cumulative monthly expenditures related to the preventive measures were US$ 45.90 (Ringgit Malaysia 187.77), which was 4.3% of the household income. The highest expenditures were for traditional and complementary medicine followed by nutraceutical/supplements and disposable facemask. 8% of the households in this study incurred more than ten per cents of their monthly household income for expenditures related to COVID-19 preventive measures. Several households are experiencing substantial financial implications for preventive measures related to COVID-19 infection. This study highlights the out-of-pocket expenditures incurred for preventive measures were substantial for certain households. Effective initiatives from the government on providing subsidized protective personal equipment and a cost-sharing approach could help to alleviate the household financial burden.