INTRODUCTION: Malaysia participated in the second phase of the Global Adult Tobacco Survey (GATS) in 2011. GATS, a new component of the Global Tobacco Surveillance System, is a nationally representative household survey of adults 15 years old or above. The objectives of GATS Malaysia were to (i) systematically monitor tobacco use among adults and track key indicators of tobacco control and (ii) track the implementation of some of the Framework Convention of Tobacco Control (FCTC)-recommended demand related policies.
METHODS: GATS Malaysia 2011 was a nationwide cross-sectional survey using multistage stratified sampling to select 5112 nationally representative households. One individual aged 15 years or older was randomly chosen from each selected household and interviewed using handheld device. GATS Core Questionnaire with optional questions was pre-tested and uploaded into handheld devices after repeated quality control processes. Data collectors were trained through a centralized training. Manuals and picture book were prepared to aid in the training of data collectors and during data collection. Field-level data were aggregated on a daily basis and analysed twice a week. Quality controls were instituted to ensure collection of high quality data. Sample weighting and analysis were conducted with the assistance of researchers from the Centers for Disease Control and Prevention, Atlanta, USA.
RESULTS: GATS Malaysia received a total response rate of 85.3% from 5112 adults surveyed. Majority of the respondents were 25-44 years old and Malays.
CONCLUSIONS: The robust methodology used in the GATS Malaysia provides national estimates for tobacco used classified by socio-demographic characteristics and reliable data on various dimensions of tobacco control.
Study name: Global Adults Tobacco Survey (GATS-2011)
Emotional and behavioural problems among children have been increasing in many western as
well as the eastern countries. Although the problem has been given attention and priority in
terms of early detection, many children with early symptoms of emotional and behavioural
problems has still not been detected at the early stages. This phenomenon is worrying as mental
health problems were shown to be stable in the long run and if left undetected it may manifest
into various problems in adulthood. This paper explores the issues on emotional and
behavioural problems in terms of its definition, prevalence, aetiology, long term consequences
and treatment. It also explores on mental health problems in a non-western country, i.e.
Malaysia including its prevalence and intervention strategies which has been carried out in
overcoming this worrying issue. Finally this review paper stresses the importance of providing
a well-designed epidemiological study in Malaysia in assessing the current prevalence of
emotional and behavioural problems in young children and adolescent
Introduction A study was conducted to determine the level of mothers' perception on children with cleft deformity and its associated factors
Methods This was a cross sectional study involving 110 mothers with children attending the Plastic And Reconstructive Surgery Clinic. Data was gathered from a face to face interview based on a questionnaire that assesses the level of perception and its associated factors. The level of perception was evaluated from a scoring method and divided into four domains namely psychosocial, care management, treatment and education.
Results The level of perception was high in all four domains ranged from 62% for treatment and 80% for education. Factors that were significantly associated with the level of perception were ethnicity, religion, type of cleft deformity and level of information.
Conclusions Information regarding cleft deformity must be tailored toward mothers’ personal characteristics and type of cleft deformity to improve mothers' perception on this problem.
Study site: Plastic And Reconstructive Surgery Clinic, Hospital Kuala Lumpur, Malaysia
Introduction The quality of education is one of the controversial topics and vital issues that
requires more emphases from researchers due to the current challenges in
education at the university level. Involvement and participation from the
studentis essential to implement quality assurance and to reach for academic
accreditation. The aim of this study is to assess knowledge, attitudes, and
practices (KAP) of students towards TQM in education and its influencing
factorsatHigh Institute of Health Sciences (HIHS) in Sana'a, Yemen.
Methods A cross-sectional study using a self-administered questionnaire was
conducted in 2016. A total of 208 students from second and third study levels
in HIHS had participated from 268 students were observed (study
population). Descriptive statistics, chi-square, and one-way ANOVA were
used to determine the association between students’ KAP towards TQM in
education with its influencing factors.
Results Mean age of the students were 22.44(SD±2.027) year old. Majority of HIHS
students were male 135 (64.9%) and 108 (51.9%) were from the third
studying level. The highest students' KAP scores were 53.4%, 65.4%, and
41.3% for good knowledge, good attitudes, and moderate practices
respectively. Education Department was found to be significantly associated
with students' knowledge and practices with p
Introduction Tong Nibong is a Bidayuh village located at Sarawak Kalimantan border.
Since the year 2004 to 2009, a total of 537 cases of malaria were recorded in
Serian District of which 14 cases were reported from Kampung Tong
Nibong. Community empowerment programme for malaria infection
prevention showed tremendous improvement in implementation. This
intervention study aims to gauge the effectiveness of community
empowerment approach in malaria elimination programme in Kampung Tong
Nibong Serian.
Methods An intervention study was conducted with pre and post data collection. Data
was collected using validated questionnaire by face to face interview.
Universal sampling method was used to select respondents from head of
household and post data was collected after intervention activities were
carried out within a year of study period.
Results The study showed significant difference on level of knowledge of
respondents on vector of malaria between pre and post data with a P < 0.05.
There was significant difference between pre and post data on practices on
control and prevention of malaria with a P < 0.05. The same goes to level of
positive attitude of respondents towards malaria control.
Conclusions In conclusion, the study can be considered successful because there is
significant difference in knowledge, attitude and practice among the
respondents between pre and post data. This indicates that community
empowerment (voluntary participation) measures can be implemented in high
risk or endemic areas where malaria is a persistent problem to the community
and health institutions faces many limiting factors.
Introduction: Most health advisories related to outdoor physical activity during haze are general in nature. The advisories normally advise everyone to reduce or limit prolonged exertion or heavy exertion without mentioning the acceptable duration for performing outdoor physical activity causing difficulty for public to decide to stop or cancel a particular outdoor or sport event. The aim of this paper is to determine the acceptable duration for performing outdoor physical activity pattern during haze based on API level.
Methods: Health risk assessment approach that comprises of hazard identification, exposure assessment, dose-response, and risk characterization steps was used to determine the potential inhaled dose and risk associated with performing the physical activity during haze. We have considered many factors that include time spent for physical activity patterns for Malaysian adult, age and physical intensity-specific inhalation rate (m3/min), and the indoor/outdoor ratio of PM10. A hypothetical exposure scenario of PM10 was created using the breakpoints of PM10 concentration for the calculation of respective API levels during haze.
Results: The association between physical activity pattern, API level and risk quotient were presented in the form of risk radar diagram. Based on the 50th percentile inhalation rate, all prolonged exertion and heavy exertion should be avoided when API reach >201 (very unhealthy) and >175 (unhealthy) respectively. Below the said API, the duration for performing prolonged exertion and heavy exertion should be reduced according to the API level. When API reaches 140, high intensity physical activity should be limited to < 90 minutes. A football match which requires 90 minutes, should be postponed of cancelled if API > 140. Whereas, for the same API level, prolonged exertion (moderate intensity physical activity) should be limited to 4 hours.
Conclusions: Reducing the physical activity is an effective strategy to lower the dose of inhaled pollutants and reduce the health risk during poor air quality. Based on the assessment, taking into account the uncertainty of risk assessment methodology, we proposed all prolonged exertion should be avoided when API reach very unhealthy status (>201). Below the said API level, outdoor physical activity should be reduced according to the level of API respectively. The recommendation is not applicable for the sensitive groups. The computed risk radar provide a valuable guide for the public to organize or considering postponing an outdoor event during haze.
Introduction The most effective and affordable public health strategy to prevent
hypertension, stroke and renal disease is by reducing daily salt consumption.
Therefore, this study aims to determine the association of knowledge, attitude
and practice on salt diet intake and to identify foods contributing to high
sodium intake.
Methods Secondary data analysis was performed on MySalt 2016 data. It was
conducted from November 2015 until January 2016 which involving Ministry
of Health Staff worked at 16 study sites in Malaysia. Salt intake was
measured using 24 hours urinary sodium excretion. Food frequency
questionnaire was used to determine the sodium sources. Knowledge, attitude
and practice of salt intake were assessed using a validated questionnaire
adapted from WHO. Demographic data and anthropometric measures also
were collected. Sodium levels of more than 2400mg/day was categorised as
high sodium intake. Data were analysed using SPSS software version 21.
Results The mean sodium intake estimated by 24 hours urinary sodium excretion was
2853.23 + 1275.8 mg/day. Food groups namely rice/noodles (33.8%),
sauces/seasoning (20.6%), meat and poultry (12.6%) and fish/seafoods
(9.3%) were the major contributors of dietary sodium. In multiple logistic
regression analysis, being a male (aOR=2.83, 95% CI 2.02 – 3.96) and obese
(aOR=6.78, 95% CI 1.98 – 23.18) were significantly associated with high
urinary sodium excretions. In addition, those who were unsure that high salt
intake can cause hypertension (aOR=1.24, 95% CI 0.65 – 2.36), those who
think that they consumed too much salt (aOR=2.10, 95% CI 1.13 – 3.87) and
those who only use salt rather than other spices for cooking (aOR=2.07, 95%
CI 1.29 – 3.30) were significantly associated with high urinary sodium
excretion.
Conclusions This study showed that the main sources of sodium among Malay healthcare
staff is cooked food. Poor knowledge and practice towards reducing salt
consumption among them contributes to the high sodium consumption. The
practice of healthy eating among them together with continuous awareness
campaign is essential in order to educate them to minimize sodium
consumption and to practice healthy eating.
Introduction: Congenital malformations (CM) comprise a wide range of abnormalities of body structure or function that are present at birth and are of prenatal origin. It has contributed to a significant proportion of infant morbidity and mortality. The aims of this study were to determine the extent and investigate the relationship between CM and its associated demographic variables.
Methods: Data was extracted from Ministry of Health (MOH) database compiled from the reports on Stillbirth & Under 5 Mortality from year 2013 to 2014.
Results Out of 9,827 child death, 2,840 (28.9%) were classified under CM as defined under ICD-10 classification. Majority of those with CMs died at neonatal stage (62.7%) and among mothers aged between 20 to 35 years old (67.3%). The mean age of mothers among CM children was 30.8±6.5 years old. Approximately 5.8%, 6.7% and 3.3 % of total CM were neural tube defects, heart defects and hydrops fetalis respectively. The prevalence of CM in males was 15% higher than females. The difference were evident between CM and age of death of children under 5 years old (p<0.001) as well as between CM and maternal age groups (p<0.001).
Conclusions: CM is responsible for 28.9% of total causes of child death with higher occurrence of malformation in males. A significantly higher risk of CMs among mother aged between 20 to 35 years old was observed. This emphasises the importance of raising awareness and the need to strengthen appropriate response for surveillance and prevention program of common CM in Malaysia.
Keywords: Congenital malformations - Child death - Neonatal - Neural tube defects - ICD-10.
Introduction. In light of the important role of health-promoting expenditure in health, the objective of this study was to investigate the socio-demographic determinants of health-promoting expenditure such as purchase of medical equipment and services, food supplements and health education services and products among Malaysian adults.
Methods Third National Health and Morbidity Survey (NHMS III) consisting of 28771 observations was used for analysis. It was the latest nationally representative cross-sectional population-based survey conducted by the Ministry of Health Malaysia from April 2006 to January 2007. A censored regression model
(Tobit) was applied to examine the factors affecting health-promoting expenditure.
Results The results showed that age, income, gender, ethnicity, education, marital status, employment status and location of residence were able to affect health promoting expenditure. In particular, individuals who were younger, poor, males, Indian/others, less educated, unmarried, unemployed and residing in rural areas tended to spend less money on health promotion compared to others.
Conclusions This study reached a conclusion that socio-demographic factors were significantly associated with individual’s preferences for health promotion. Therefore, the government should devote its attention to these factors when
formulating nationwide health policies.
Study name: National Health and Morbidity Survey III (NHMS-2006)
Introduction Food labeling regulation has been implemented to enable consumers, including those with chronic diseases to make healthy informed choices before purchasing pre-packaged foods. The purpose of this study is to determine the prevalence of obese adults in Malaysia who practice reading food labels. It explored types of labels read and understanding of the information.
Methods Findings presented in this study were captured from the secondary analysis of National Health and Morbidity Survey’s (NHMS, 2006) food label study which focused only on obese adults (BMI > 30 kg/m2) aged 18 and above. This nation-wide cross sectional study was conducted from April to August 2006 using an interview-based questionnaire. Complex data analysis was done using Stata version 12.0.
Results There were 4565 obese respondents with the mean age of 33 ± 9.7 (18-60 years old). About 54.7% completed high-school and 9.9% were higher degree
holders. Prevalence of obese adults who claimed to read label was 80.5% (95%CI: 79.3, 81.6). Findings showed significant results in reading and understanding labels among all age group categories, Malay, Indian and other Bumiputras, all education categories and married respondents. Expiry date was the highest percentage being read (74.5%), followed by fat content (15.3%), vitamin (11.8%) and carbohydrate (10.9%).
Conclusions The obese population in Malaysia claimed to read and understand the food label but did not focus on specific macronutrients related to their health
condition. Findings can be used to implement effective education programmes targeting the relevant groups to instill an awareness to read, understand and use the label information as one of the means in combating obesity.
Study name: National Health and Morbidity Survey (NHMS-2006)
Introduction Community-based health promotion programme has been recognised to reduce modifiable lifestyle risk behaviours for non-communicable diseases. The aim of this study was to evaluate the proportion of the awareness, knowledge and acceptance of a community-based intervention programme, “Komuniti Sihat, Pembina Negara“ (KOSPEN) (Healthy Community, Developed Nation). This cross-sectional study employed a two-stage proportionate sampling method to select a representative sample of communities in the Southern states of Peninsular Malaysia, Negeri Sembilan, Malacca, and Johor. Face-to-face interviews by trained research assistants using pre-validated questionnaires was the study tool applied. The study revealed that approximately two thirds of respondents were aware of the KOSPEN programme (65.5%) and almost half (45.4%) of them were involved in the health promotion activities, namely health screenings (84.8%), health talks (66.4%), and providing plain water in formal occasion (52.9%). About two thirds and one-quarter of them have a very good (73.4%) and good (24.1%) general view on this programme. Four out of ten respondents faced difficulties joining the activities. Lack of time (83.0%) was reported as the main barrier. The KOSPEN programme in overall was moderately accepted by the community. However, the need for future improvement has to be highlighted in order to enhance the involvement and participation of the communities.
Dengue fever is an illness by arthropod-borne viral disease that become known pandemic to the most tropical countries. In 2014, Malaysia reported 108 698 cases of dengue fever with 215 deaths which increased tremendously compared to 49 335 cases with 112 deaths in 2008 and 30 110 cases with 69 deaths in 2009. This study aimed to identify the best method in determining dengue outbreak threshold for Negeri Sembilan and hopefully these methods can be standardized as it can help to send uniform messages to inform the general public and make the outbreak analysis comparable within and between countries. Methodology : Using retrospective Negeri Sembilan country dataset from 1st epid week of 2011 till the 52nd epid week of 2016. The data were split into two periods: 1) a 3-year historic period (2011–2013), used to calibrate and parameterise the model, and a 1-year evaluation period (2014); 2) a 2-year historic period (2014–2016), used to calibrate and parameterise the model, and a 1-year evaluation period (2016), used to test the model. E-dengue is a registration system for confirm case dengue by Ministry of Health. Data include details of cases, district locality, records on the outbreak and epidemiological week (Sunday to Saturday). The variables were captured using the Excel spreadsheet. Analysis method included endemic channel method, moving average or deviation bar chart and recent mean. Result: Seremban as big district and facing with heavy dengue cases, all three methods (endemic curve, current mean and moving mean) showed promising results. Meanwhile comparing with small district of Port Dickson and Tampin with fewer dengue cases and outbreak recorded, the suitable method is by using endemic channel for epidemic threshold. Conclusion: Simpler methods such as the endemic channel, recent mean and moving mean may be more appropriate in urban district. Whereas in rural or district with minimal dengue cases, Endemic Channel would be the most suitable method for epidemic threshold. However, both methods require a consistent updated graph threshold as time progress.
In 2015, almost half of low birth weight babies in the world were born in Southern Asia. It is contributed by multiple factors including maternal exposure to the elements in the environment during the antenatal period. Particulate matter (PM10) pollution in Southeast Asian region have been extensively studied with known attributions and sources. It is also known that PM10 is able to restrict foetal growth at molecular level. This review intends to investigate if the unborn in Asia are affected by air pollutants indirectly through their mothers. Methods Publications from Scopus and Science Direct digital databases in Asian region from 2015 onwards were reviewed. Details collected were the year of publication and study location, the study design, investigated air pollutants, exposure estimation methods used, the timing of exposure in relation to pregnancy, pregnancy outcome measured and the relative risk or odds of effect. Results A total of eight full text articles were included. Most of the studies were of cohort and quasi experimental designs, involving local air monitoring measurements to assign exposure. Conclusions There were more studies considered multiple air pollutants as contributing risk rather than a single pollutant. The exposure was measured according to stages of pregnancy and the trimester stratification is the most often method used. Modalities used in representing birth outcomes were not confined to birth weight alone but also included the length of gestation. Exposure to PM10 have been found to be associated with reduction in birth weight and increased risk for preterm birth in Asia.
Medical and health insurance provides financial protection against the consequences of the occurrences of health risks. Different perceptions have led to resistance to change, as well as the acceptance level from Malaysians. It is fundamental to study the reception and acceptance of all types of insurance schemes by Malaysians and to identify the knowledge and information pertaining to reception by Malaysians. A systematic search was performed from six major search engines from 2013– 2018 in searches of published articles on factors that influence the demand or willingness to pay for health insurance among Malaysians. There were nine articles included, in which personal factor was found to influence the most when demanding for health insurance. Higher education level, younger age group, and good knowledge were associated with higher demand for health insurance. Higher household monthly income and the cost to pay were among the positively significant economic determinant factors to demand for medical insurance. Education and promotion are important to understand why such policies were introduced and how they intend to serve the public before implementing major policies. These elements capture the essence of ‘health promotion’, which is about enabling people to take control over their health and thereby, improving their health.
Pediatric epilepsy is one of the common illness in children. Pediatric epilepsy has significant impact not only to the patient, but also to the care takers. Furthermore, the disease could potentially cause strain in the limited resources of the healthcare system which is preventable. A search was conducted to review relevant published studies on factors affecting seizure control using PubMed/MEDLINE, Google Scholar and also Science Direct searching engines databases using keywords: paediatric seizure, seizure control, side effects, antiepileptic, adherence and quality of life. In this review, we found that many factors contribute to the pediatric epilepsy, namely; compliance, genetic, age, socioeconomic factors, parental health literacy and numbers and side effects of the medications. Furthermore, there is certain factors that need to be explored in the future, such as unaddressed parental concern on treatment/medication, denial of disease and drug-drug interactions. Factors that had been identified can be used in the prevention and control programs, while factors which is less studied should be further studied in the future.
Physical activity is important for our health. Physical activity is well known and proven to prevent non-communicable diseases. In a report by WHO, it is the 4th leading risk factor of mortality globally. 1 A review showed that, physical activity has positive impact on 26 diseases. 2 The important of physical activity as important risk factor of chronic diseases is undeniable. The evidence of the impact of physical activity on health outcome is overwhelming. Why is this not a common knowledge among healthcare professional and why it is hard to translate it into action?
Introduction: Validation of instruments is essential when assessing physical activity (PA). The aim of this study was to validate a Malay language version of the International Physical Activity Questionnaire (IPAQ-M) against Actical accelerometer and to determine its reliability and validity.
Methods: A total of 90 Malay adults aged 35-65 years old participating in The Malaysian Cohort project were recruited for this study. The IPAQ-M is comprised of 12 items, covering vigorous, moderate, walking, sitting and sleeping activities, and was administered on two occasions (Day 1 and Day 9) by interviewing the participants. Participants wore the Actical accelerometer for seven consecutive days between the two interview sessions. Results Validity tests showed that time spent in moderate-vigorous physical activity (MVPA) (min/wk) from IPAQ-M was significantly correlated with MVPA from accelerometer (rho=0.32, p<0.01). Time spent in vigorous activity (rho=0.44) and total activity (rho=0.36) from IPAQ-M were significantly correlated (p<0.01) with that measured by accelerometer, but no correlation was observed for sedentary behaviour. Reliability tests revealed significant correlations between the two interview sessions for all intensities of PA (rho=0.55 to 0.71, p<0.01). Bland-Altman plots showed that time spent in MVPA for IPAQ-M was significantly different from that measured by accelerometer (mean difference: 98.02 min/wk; 95% limits of agreement: -785.33 to 1317.83 min/wk; p<0.01). When classifying people into meeting PA recommendation, the agreement between the two instruments was fair (κ=0.22).
Conclusions The IPAQ-M has acceptable validity for MVPA, vigorous and total physical activity, and was reliable for assessing the physical activity of Malay adults.
Keywords Health care workers - Knowledge - Practice - Universal precaution - Health center.
Study name: The Malaysian Cohort (TMC) Project
Introduction Hepatitis C Virus (HCV) recently was identified as a major cause of post transfusion hepatitis world wide. To evaluate the role of blood transfusion on the prevalence of HCV infection, by testing antibody and RNA as well as the genotypes of HCV .Also to detect if Blood transfusion acts as unconfounding risk factor for HCV infection.
Methods Sera from 3491 pregnant women were investigated for the presence of HCV antibodies (anti-HCV) by using third generation enzyme immunoassay (EIA-3) as screening test, followed by immunoblot assay (Lia Tek-III). In addition 94 sera of studied women were subjected to molecular analysis (at laboratories of Sorin BioMedica - Italy) for the detection of viral RNA and genotypes of HCV. Using RT-PCR & DNA Enzyme immunoassay (DEIA) method.
Results Our study revealed, that seroprevalence rate of HCV specific Ab & RNA were significantly higher (16.32 %, 80% respectively) among women with a history of blood transfusion, compared to those (2.53%, 56.5%) with no such history P=0.0001, P=0.01. And there is a significant direct linear correlation between number of blood transfused and the seropositive rate of anti-HCV (r=0.7, p=0.046). Based on multivariate analysis, interestingly, this study confirmed that, blood transfusion significantly acting as unconfounding risk factor for acquiring HCV infection (Adjusted OR=1.938,95% C.I=1.646-2.28). And the risk of exposure is increases with increased number of blood transfused. Although, we found no significant association between, HCV genotypic distribution and history of blood transfusion. However, high proportion of women with a history of blood transfusion were harboring HCV genotype -4 or 1b, 50%,40%, resepctively.
Conclusions Our study shows, evidence that, blood transfusion acts as unconfounding risk factor for acquiring and in a mode of transmission of HCV infection. Therefore strict screening of blood donor for HCV-Abs and / or RNA is highly recommended.
Introduction Neonatal jaundice occurs in about 60% of newborns. If not managed properly, it can progress to severe neonatal jaundice (SNNJ) leading to death or permanent disability. The incidence of SNNJ in Kuching District increased from 119.3 per 100,000 live births in 2005 to 123.3 per 100,000 live births in 2008, which was above the Standard National QAP Indicator of 100 per 10,000 live births. SNNJ can be prevented by early detection and proper management of neonatal jaundice. The objective is to increase the knowledge and practise of early detection of neonatal jaundice by nurses in Kuching District. Methods This was an interventional study covering a period of six months. The sample comprised 113 nurses of all categories working in urban and rural maternal and child health clinics in Kuching District. Tools used in the study were self-administered questionnaires in English and Bahasa Malaysia. The preintervention survey started in July 2009 while the post-intervention survey was done in January 2010. The interventions were done through Continuing Nursing Education sessions and included new nursing formats and new reporting procedures. New vehicles were also provided for home nursing. Data was collected and analyzed using MS Excel program. Results The pre-intervention survey on nurses showed that only 56.6% were able to identify the risk of factors causing jaundice; 94.6% able to define jaundice; 41.5% able to detect jaundice while 70.8% knew sign of Kernicterus. In term of recommended post natal nursing schedule only 40.7% able to practice the schedule while only 69.0% able to give advice on management of jaundice. Post intervention; 63.2% of nurses were able to identify the risk factors causing jaundice; 97.2% able to define jaundice while 97.2% were able to detect jaundice and 88.6% know sign of Kernicterus. On recommended post natal nursing schedule, 49.9 % practice the recommended schedule while 92.0% were able to give advice to mother on management of jaundice. The incident of jaundice of Severe Neonatal Jaundice dropped to 78 per 100,000 live births in 2010.
Conclusions The study shows that the interventions taken helped to improve the knowledge and practice of recommended measures to detect neonatal jaundice early. Stronger emphasis must be placed on using the new reporting procedures and new nursing sheets. Continuous monitoring through regular nursing audits by clinic supervisors is also essential to reduce the incidence of SNNJ. Provision of vehicles for all busy maternal and child health clinics for home nursing care is highly recommended.
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).