Two hundred and sixty four samples of ready -to-eat foods (RTE) were obtained over a period of six months (April to September 2005) from 33 school hostel kitchens and canteens previously implicated in food poisoning outbreaks from 2000 to 2004. Sampling was done by food technologists and assistant environmental health ofhcers from various districts in Pahang while microbiological analysis was carried out at the Mentakab Food Quality Control Laboratory. The objective of the study was to obtain a comprehensive picture on the microbiological status of the foods that may have accounted for food poisoning outbreaks at school hostels and canteens in Pahang. Each food sample was analyzed for Total Plate Count (TPC), Salmonella, Coliform, Escheria coli, Staphylococcus aerus and Bacillus cereus. lt was found that none of the ready-to-eat foods sampled contained Salmonella although hve samples contained Bacillus cereus , four samples contained Staphylococcus aerus. High Coliform Counts were found in 15 food samples while Escheria coli was detected in two samples. Overall, it was found that 10.2 % of the samples had unsatisfactory counts.
Cervical cancer is preventable by detecting precancerous states through Pap smear screening, followed by appropriate treatment. In Malaysia, even with a high incidence of cervical cancer and accessible screening program, the uptake of Pap smear screening was still low. Lack of knowledge, embarrassment, fear for the test and results are the factors reducing participation. The aim of this study was to determine the change in knowledge and attitude regarding the Pap smear screening as well as knowledge on cervical cancer among women in Mukim ]aya Setia after educational intervention. A community trial was conducted in August 2005 where 80 women were randomly selected. The women were interviewed for assessment prior to the intervention, using a set of structured questionnaire. The women underwent educational intervention programmes on cervical cancer and Pap smear screening. After a week, the women were re-assessed using the same set of questionnaire for their post intervention knowledge and attitudes. Scores were given for each answer, which were totaled and analyzed. The mean (SD) age was 41.1 (10.37) years. Most were housewives (87.5%), within the low income group (91.2%), of less than RM 1000.00 income per household. Most of the women received their education up to the secondary level only (97.5%). Despite their poor economic status, most of them had more than three children (68.8%). There was a significant improvement in knowledge of Pap smear (mean difference= 4.3, 95% CI= 3.55, 5.10) and cervical cancer (mean difference= 10.7, 95% CI= 10.03, 11.37) as well as attitude to Pap smear (mean difference= 7.1, 95% CI= 5.72, 8.47) after educational intervention. The knowledge and attitudes towards Pap smear screening as well as knowledge on cervical cancer among rural women in Mukim ]aya Setia, Kota Bharu improved after educational intervention.
There is concern that shift workers are at higher risk for metabolic syndrome (MS) . The syndrome is characterized by a constellation of metabolic risk factors in one individual. A cross-sectional study of 148 workers in one factory in Kota Bharu, Kelarttan was conducted to examine relationships between shift work and five of the MS rnk factors namely high blood pressure, hyperglycemia, hypertriglyceridaemia, hypo·I·IDL-cholesterolaemia and high body mass index (BMI) . Data was collected through a questionnaire on psychosocial and life-style factors, anthropometric and blood pressure measurements, fasting blood sugar and fasting lipid profile. The National Cholesterol Education Program’s Adult Treatment Panel III Report (NCEPATP III) with some modifications was used to determine the presence of risk factors for the metabolic syndrome, The prevalence of high blood pressure, hypertriglyceridaemia and high BMI were significantly higher among shift workers compared to day workers. There was no difference in the prevalence of hyperglycemia and hypo-HDL-cholesterolaemia. When the shift workers were compared with the
day workers, the proportion of workers having three or more risk factors for the syndrome was higher among shift workers which were 15.8% and 5.6% respectively.
A cross»sectional study was undertaken between April 2005 to _1 uly 2005 to determine the extent of the health problems experienced by individuals involved in the December 2004 tsunami wave disaster in the Northeast District of Penang, Malaysia. The overall health status of the respondents were evaluated using the Short Form 36 (SF-36) questionnaire. Out of 171 respondents, 160(93 .6%) were Malays, 8(4.7%) were Chinese and 3(1.8%) were Indians. The mean age ofrespondents was 45.4 years, 15.9 years. Ninety-four of the respondents were males (55.0%) while 7 7(45.0%) were females. The overall mean physical component score was significantly lower (66.9:23 .O) amongst respondents with low education level compared with those with high education level (76.3:19.1, p=0.004). This mean score was also significantly much lower ( 68.7:22 .3) amongst those who are married compared to those who were not married (79.8:1 7.4, p=0.003) . The overall mental health score was significantly much higher (78.8:14.6) amongst those who were not married compared to those who were married (68.5:19.2, p=0.001). The overall mental health score was also significantly higher amongst those in the younger age»group (62.3:16.1) compared to those in the older age»group (72.4:18.9, p=0.005). Based on the scores obtained on the Physical Health and Mental Health dimensions of the SF-36 questionnaire, it can be concluded that the health of victims with low education, elderly and those who were married were more adversely affected than others. Therefore, it is vital that medical as well as psychological attention should be channeled to these risk groups who responded more adversely to disasters.
This survey was done to determine the knowledge, attitude and practice of preventive measures concerning Severe Acute Respiratory Syndrome (SARS) among Alor Gajah town community. The purpose of this study was to determine the knowledge level of SARS, to know their attitude towards SARS and health information provided, to know which sources that provide the best infomation about SARS and to identify the expectations and preferences of population on gaining health infomation. A cross-sectional study involving respondents age 18 and above staying in Alor Gajah town was done. The respondents were assessed using questionnaires comprising of 25 questions. A total 180 respondents had answered the questionnaire. All of them were aware of SARS with 93 .3% with high scores in the knowledge level. Furthermore, 9l .7% of respondents had high scores in their attitude towards SARS. About 98.9% of respondent got their information regarding SARS from television, and 83.9% of them believed the information given. Firty four percent choose television as the best method to convey information concerning SARS or other new emerging diseases. The knowledge and attitude of the respondents concerning SARS were good.
Several studies had shown that the problem of plate waste in hospitals ranged from 17% to 67%. This study aimed to determine the extent of plate waste in a district government hospital, the type of food item wasted and the factors contributing to food waste. A oross»sectional study was conducted in a district hospital, involving four third class wards. A total of 300 patients were included in the study. A plate waste was dehned as the proportion of edible portion of food served that was discarded by patients. The serving size was established by weighing each food item served over breakfast, lunch and dinner on a seven·day rotation menu, using the procedure recommended by the National Food Service Management, During the study period, the left over from each patient’s plate was weighed for all meals. The plate waste for each patient was determined by dividing the total weight of the left over with the average serving weight for the same serving in the same ward. Each patient was also given a self-administered questionnaire to obtain information on reasons or not consuming the ood items served. The overall mean ercentage plate waste of all food served in the four wards was 42.6%. Plate wastage occurred most at dinner (53.2%) and least at breakfast (31 .3%). Vegetables were the most wasted food items. Females wasted significantly higher than males for all meals. Food taste, portion size, appetite and staff service efficiency were factors found signihcantly contributing to plate waste. With almost half of the food served was wasted, hospital management need to direct more attention towards addressing the problem of plate waste since it has both nutritional and cost implications.
Despite awareness of the detrimental effects of smoking, many adolescents initiate or continue to smoke. One possible explanation for smoking 13 the belief that it can control body weight. The objective of this study was to determine the association between Body Mass Index and smoking among Malay adolescents in Kota Bharu, Kelantan. A cross·sectional study was conducted between January to June 2005 among 1364 students selected from ten co»educational government secondary schools in Kota Bharu using stratified multistage cluster sampling. Guided self-administered questionnaire and anthropometric measurement were taken. Data was entered using SPSS 12.0 and analysed using STATA 8.0. The overall prevalence of smoking was 6. 7%. The prevalence of smoking among boys was 13.8% and among girls was 1.1%. There was no association between Body Mass Index and smoking. However, the findings may not be generalized to out-of·school youth and other ethnic groups in this country. The study was not conducted anonymously and the use of questionnaire to report smoking status can lead to measurement bias. Strategies aimed at correcting the belief that smoking can reduce weight should be included as one of the components in the prevention of smoking.
The population of the world is ageing and Malaysia is no exception. The proportion of those above 60 will be 9.5% by the year 2020. Cognitive impairment and depression are two common problems in this age group. The objective of this study was to determine the prevalence of cognitive impairment and depression and their associated factors in the elderly population in a rural community in Kedah. The study design was descriptive cross sectional study. A standardized questionnaire was used in two villages in Mukim Kota Kuala Muda. Barthels index, geriatric depression scale and elderly cognitive assessment questionnaire were also used. The prevalence rate of cognitive impairment was 18.5%. Cognitive impairment was higher among females (22.6%) than males (12.8%). 34.8% of the widowed were cognitively impaired and it increases with age 15.1% within age groups 60 to 69 years, 42.9% in age groups 80 to 89 years and the one and only participant above 90 years was cognitively impaired. Among those with disability, the only one with very severe disability had cognitive impairment, 40% among the severely disabled and 33. 3% among the moderately disabled (p<0.05). Those with cognitive impairment were living with some functional disabilities involving feeding (p<0.05), bathing (p<0.05), grooming (p<0.05), dressing (p<0.05), bladder control (p<0.05), toilet use (p<0.05), transfer from bed to chair (p<0.05), mobility on level surfaces (p<0.05) and climbing stairs (p<0.05). The prevalence of depression was found to be 46.4%. Higher among males (48.4%) as compared to females (44.7%). Depression was 50.0% among the age groups 80 to 89 and 52.4% among the age groups 70 to 79. 63.6% of those living alone were depressed as were 54.8% of the unemployed. 43.8% of those depressed had functional disability. The only one with severe disability was depressed and 66. 7% of those with severe disability were depressed. 47.5% of those with hypertension were depressed. It is a matter of concern that even in a small population the rate of cognitive impairment and mental depression is very high. Health screening is an important aspect of health promotion and disease prevention in people over 60 years. Although screening for many conditions cannot conclusively prove benefit, special attention to these factors can decrease morbidity and improve quality of life in aging population.
Key words: elderly, cognitive impairment, depression, rural community, Malaysia
Study site: Two villages in Mukim Kota Kuala Muda, Kuala Muda District, Kedah, Malaysia
Device, Questionnaire & Scale: Barthels index; Geriatric Depression Scale (GDS-30); Elderly Cognitive Assessment Questionnaire
This study was conducted to determine the patterns of disease and treatment at two disaster sites. Studies prior to this have shown that all natural disasters are unique in that each affected region of the world have different social, economic and health backgrounds. However, similarities exist among the health effects of different disasters which if recognized can ensure that health and emergency medical relief and limited resources are well managed. This study found that although Aceh and Balakot were two totally different areas with reference to locality and climate it was noticed that the patterns of disease two months post disaster are similar the commonest being respiratory conditions followed by musculoskeletal conditions and gastrointestinal conditions. For the treatment patterns it was observed that the two areas prescribed almost similar, types of medicine mainly for gastrointestinal and respiratory systems. However in Aceh, there were more skin treatment and in Balakot there was more usage of musculoskeletal drugs.
The knowledge, attitude and practice of breastfeeding among young mothers during pre-Baby Friendly Hospital Initiative implementation was conducted at seven private hospitals in Malaysia. A structured interviewer administered questionnaire was given to all mothers (n=Z52) visiting the antenatal/postnatal clinic of the hospitals. The main respondents were Malays (57.5%) and Chinese (35%) . For most mothers, breastfeeding was combined with supplementary feeds of formula milk, with only 30% breastfed exclusively. The majority of mothers knew that breast-milk contained antibodies and can prevent illness, however many were unaware of breastfeeding's contraceptive effect if practised exclusively. Most mothers did not relate breastfeeding as being environmental friendly. Generally, there was no knowledge gained from the experience of having more children with reference to breastfeeding. Most mothers were influenced by their own beliefs regarding choice of feeding method. Therefore, a mother was empowered with the knowledge of all practical aspects of breastfeeding, it would encourage her to breastfeed her baby.
Study site: seven private hospitals in Malaysia
The objective of this study was to evaluate compliance :0 the cliencs’ charter in a dental clinic and factors that may afect the updating of the charter. Our clients’ charter states that registration time is within IO minutes and waiting-mom time before being seen by the dentist is within 30 minutes. Convenience sampling was carried our over two weeks. Only patients above 12 years treated by dental officers were included. Data recorded included registration and wrziting-room time, treatment time, punctualiry afpaniems and workload of ajcicers. There were a total of 532 patients (407 walk»in/outpatients, 125 appointments). Results show that the mean waiting-mom time for all paticnm was nor compliant to the clients' charter (42.7 x 23.8 min for walking flll 44.9 : 32.7 min for appointments). Only 33% were seen within 30 min whilst about 23% waited for more than 60 minutes. All The mean registration time (17.9 1- 12.8 min) was ncmcomplianr everyday except on Thursdays where there were very few patients. Waiting time for elderly patients was not statistically significant from the younger patients. About 36% of appointment ariems were seen within 30 minutes; althou h hal 0 them were late, Exmzctivns, dentures and examination and diagnosis took the shortest time wrzh about 88%, 91% and 98% completed within 30 minutes respectwely. There was variable individual speed and number of patients managed by different operators, although the majority was flrsnyear dental officers. Factors that may contribute waiting time included number of patients per day, operator and punctualizy of patients.
Prevention of needle stick injuries (NSI) remained a challenge to the health care workers throughout the world. In Malaysia, efforts to prevent NSI among health care workers has been one ofthe emphases as these injuries may cause serious and potential fatal infections such as Hepatitis B, Hepatitis C and HIV. This retrospective cohort study was done to determine factors related to prevalence of NSI among health care workers in government health facilities in Negeri Sembilan that were reported from 2001 until 2003. There were 101 cases of NSI reported affecting various categories of health staff and also paramedical trainees and medical students. The NSI occurs mostly in females (72.35%), age 30 years or less (73.2%), and trainees of medical or paramedical courses (45.4%). Other characteristics found are as follows: cases had attended SP courses (60.4%) , had less than 5 years in service (78.1%) and mostly never had NSI before (93.1%), However 84.2% of N SI among the respondents that have good and very good knowledge levels on NSI prevention. It is recommended that follow-up or audit on the practice of the Standard Precautions (SP) should be implemented following the training of staff. It is also important that medical trainees or paramedical students be adequately trained on SP before entering the clinical environment.
This is a cross-sectional study to determine the association between religious perception and smoking behavior of secondary male students in Kota Bharu, Kelantan. A self-administered questionnaire survey was conducted on 526 secondary four male students from eight randomly selected schools in Kota Bharu. There were 182 (34.6%) students who were current smokers, 12 (2.3%) were ex-smokers and 332 (63.1%) were non·smokers. More than half of the current smokers (53.4%) smoked regularly. Student’s perceptions on the religious opinion on smoking were signihcantly associated with smoking behavior. Other significant risk factors were having close friends who smoke, their perceptions on benefits and negative effects of smoking and the level of
y relationship with their fathers. These factors were also found to be good predictors of student's smoking status. Health education programs to control smoking should include the religious aspect of smoking to improve it’s effectiveness.
Penyakit tifoid adalah penyakit berjangkit bawaan air dan makanan yang disebabkan oleh Salmonella typhii. Penyakit ini berlaku di seluruh durtia dan endemik di Kelantan. Pada April 2005, terdapat peningkatan kes tifoid yang dinotifikasi di daerah Bachok dan wabak telah diistiharkan. Pasukan siasatan telah dibentuk di mana setiap kes telahydisiasat dengan segera dan tindakan kawalan telah diambil seperti pemeriksaan dan penutupan premis makanan, kerja-kerja sanitasi dan pendidikan kesihatan. Pengesanan kes secara aktifjuga telah dilakukan. Mukim Gunong mencatatkan jumlah kes tertinggi iaitu 46.3%. Majoriti daripada kes terdiri daripadapelajar. Dua pembawa dari kalangan kontek juga turut dikesan. Lekuk epidemik menggambarkan berlakunya wabak purtca lazim. Lima daripada 1 1 1 bilangan sampel air dan dua daripada 146 bilangan sampel makanart yang diperiksa adalah positif terhadap Salmonella species tetapi tiada yang positif terhadap Salmonella typhii. Meskipun Pasar Jelawat merupakan lokasi yang disyakki sebagai punca utama jangkitan, ianya tidak dapat disahkan melalui penyiasatan dan ujan makmal.
Hospital UKM is the first hospital to implement case·mix system in Malaysia. The objective of the programme is to utilise case-mix system as a tool in improving efficiency and quality of care. From July 2002 to June 2004, a total of 35,568 cases were grouped using IRDRG-Version 1.1 case-mix grouper. Out of these, 3,622 cases or 10.2 % were cardiology cases in MDC 05 (Diseases and Disorders of the Circulatory System). Medical Cardiology cases consist of 86.5% and the remaining 13.5% were Surgical Cardiology. Most of the cases were in severity level one (43.4%), 29.5 % in severity level two and 27.1% in severity level three. The mortality rates for severity level one, two and three were 1.0%, 2.6% and 11.5% respectively. Top three cardiology cases were Acute Myocardial Infarction Without Comorbidity and Complication (IRDRG 05331) (8.4%), Acute Myocardial Infarction With Major Comorbidity and Complication (IRDRG 05333) (7.6%) and Cardiac Catheterization for Ischemic Heart Disease Without Comorbidity and Complication (IRDRG 05311) (7.4%). Step-down costing was carried out to obtain the cost for each DRG group. The mean cost per episode of care for Medical Cardiology cases was RM 3,562 (SD= RM 2, 1 19) with average LOS of 6.4 days (SD= 3 .8days) . For the Surgical Cardiology cases, the mean cost per episode ofcare was RM 6,526 (SD= RM 4,585) and average LOS of5.8 days (SD= 4.1 days). The main components of cost for Medical Cardiology cases are ICU cost (28.8%), pharmacy (17.3%) and Ward Services (15.3%). In Surgical Cardiology, the biggest component of cost was for Operation Theatre (27.9%), followed by Ward Services (25 .4%) and pharmacy (8.5%). Multivariate analysis using multiple linear regression showed that factors which significantly influence the treatment cost of cardiology cases were length of stay, age of the patient, discharge outcome, case type ('surgical partition') and severity level.
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.
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.
A cross-sectional study of 71 laboratory technicians in Ministry of Health Malaysia (MOH) Hospitals (response rate 89.9%) was conducted from September ZOO1 till February 2002. Seven MOH Hospitals in Kelantan were chosen. Karase job Content — Questionnaire (Malay Version) was used as research instrument in this study. There were five scales in the questionnaire; two scales were used to dehne job strain - decision latitude and psychological demands. Results showed that the majority of laboratory technicians in MOH Hospitah were classified as passive. However, the proportion of high strain group was the second highest after passive group. The percentage of laboratory technicians in MOH Hospitals which was classified as having a high job strain was 26.8%. The “high strain" group scored significantly higher for hazardous conditions, toxic exposures, total psychological stressors, total physical hazard, and total physical stressors as compared to the “non»high strain” group. Laboratory technicians in “high strain" group had significantly younger in age (18-34 years) group (42.1%) compared to those in “non·high strain" group (7.7%) and shorter total duration of employment (yr) ( 15 .3 x 6.8) compared to those in “non»high strain" group (19.2 x 6.7). We therefore conclude that less experienced and higher psychosocial factors at work experiencing higher job strain compared to those who were more experienced and less psychosocial factors.
Peningkatan mutu penjagaan kesihatan menyaksikan peningkatan populasi wargatua di Malaysia. Antara gejab yang menjejaskan taraf kesihatan wargatua adalah rnorbiditi akibat amalan merokok. Meskipun pelbagai kajian tentang merokok telah dijalankan di negara ini, namun ttclak banyak yang berkaitan dengan amalan merokok di kalangan wargatua di Malaysia. Perbezaan faktor sosio ekonomi dan pengetahuan tentang amalan merolook di kalangan 850 responden lelaki berusia 60 tahun dan ke atas yang mengambil bahagian di dalam kajian peringkat kebangsaan sempena Kempen Cara Hidup Sihat 2002 dikaji. Maklumat tentang status merokok, pengetahuan dan sikap diperolehi melalui temubual bersemuka menggunakan borang soal selidik berstruktur. Prevalen merokok di kalangan responden adalah 39.2%. Prevalen diclapati paling tinggi di kalangan golongan bertaraf sosio ekonomirendah. Pengetahuan tentang bahaya amalan merokok berbeza mengikut status perokok. Perokok mempunyai pengetahuan yang lebih rendah, sikap yang lebih negatif tentang amalan merokok serta tanggapan risiko penyakit akibat amalan merokok yang lebih rentlah berbanding dengan bekas perokok dan yang tidak pemah rnerokok. Amalan merokok merupakan masalah yang masih membelenggu wargatua lelaki di negara ini. Prevalen merokok di kalangan wargatua Malaysia pada kadar 39 .2% adalah birth tinggi jikidibandingkanhdengan Amerika Syarikat (12%) dan China (26%). Program anti merokok yang mementingkan peningkatan pengetahuan dan sokongan kepada mereka yang ingin berhenti merokok dasar wargatua. Ini untuk meningkatkan kualiti kehidupan wargatua dengan mencegah penyakit kronik berkaitan dengan merokok.
Hysterectomy is one of the most common non-obstetric surgical procedures performed on women. Little is known about the factors affecting decision making process regarding hysterectomy in Malaysia. The study aimed to explore factors affecting women decision regarding hysterectomy among Malaysian women. This study has enrolled 100 women eligible for hysterectomy in the department of general gynecology ward in the university of Malaya hospital, Malaysia. A structured questionnaire was administered by interview. Descriptive analysis was used to obtain the frequencies. Chi square test and simple logistic regression test were performed to assess the association between variables. The majority of participants aged 41-50 years (52%) and married (74%). Twenty seven out of 100 participants made their decision on the operation within one month while 73 women decided after one month. Some complications were only known by the minority of patients such as injury to ureter (47%), injury to nerve (8%), incision hernia (18%), vault prolapse (21 %), and deep vein thrombosis (43%). Most of women delay their decision on the surgery (73%). Factors associated significantly with decision were ethnicity, religion, knowledge on complication, discussion with spouse and doctor.. Cultural factors, opinion of husband and doctors and knowledge of the complication play an important role in the decision of women. It is important to provide suitable information and social support for patients to help them in their decision-making. Participation and support from spouses and doctors should also be encouraged.