A cross sectional study to determine general health and body composition was conducted for comparison between rural samples (Teluk Intan, Perak) and urban samples (Klang Valley, Selangor). Systematic random sampling was used in Z health clinics in Klang Valky and 4 health clinics in Telult Intan, Perak The results showed that urban population was more heterogeneous (Malay 63.7%, Indian 19.8%, Chinese 14.9%) compared with the rural population (Malay 75%, Indian 22.1%, Chinese 2.9%). Mean age for urban population was 44 2 1.6 years and for rural was 50 i 14.4 years. There was significant difference in the BMI (p < 0.05) between urban and rural populations where more people in the urban areas had higher BMI. There was a significant difference in the waist hip ratio (p < 0.05) between urban and rural areas where more people in the urban areas had above normal waist hip ratio. There was no significant difference in chronic diseases suffered and family medical history of the rural and urban samples.
Various studies have reported that excess body weight may increase the risk to various diseases and death. A study reported that adolescents who were overweight were almost 18 times more likely than their leaner peers to be obese in early adulthood and were 8.5 times more likely to have hypertension as young adults. Therefore, this study was conducted to determine the body composition and four dietary factors i.e., prudent diet habits, calorie control habits, dietary fat/ cholesterol and sodium/salt control which may affect blood pressure and the risk of heart disease among year 1 medical students in a public university in Selangor. Body composition was determined by measuring the body mass index (BMI) and body fat percentage. None of the female students showed excellent/good eating habits while majority were fair (37.7%) and poor/very poor (62.3%). Nearly half of the male students showed excellent/good eating habits (42.5%), but more than half (57.5%) were poor/very poor. Majority of the female (85.7%, 85.7% and 94.8% respectively) and male students (80.9%, 57.5% and 93.6% respectively) showed excellent/good eating habits in calorie, dietary fat and salt control. Majority of the students (64.9% female and 61.7% male) have normal BMI values while 24.7% of female and 10.6% of male students were underweight (BMI values less than 18.5). Only a small number of female students were overweight (5.2%) and obese (5.2%). However 14.9% of male students were overweight and another 12.8% were obese.
Employee satnfaction surveys can provide the information needed to improved levek of productivity, job and loyalty. Management can identify the factors of job issues and provide solutions to improve the working environment. A cross sectional descriptive study on employee satisfaction among a health care district office’s staff was conducted in Perak in March - April 2006. A total of 19 staff were randomly picked and interviewed in the data collection process. Almost all understand the objectives of the administration unit (94%) and were satisfied with the management leadership’s style (78%- l 00%) . Majority agreed that their relationship with immediate superior and within the group was harmonious and professional (89%) and they preferred an open problem solving method in handling conflict (72 %). The most common type of incentive rewarded by the administration to express gratitude to their staff was certificate (56%); bonus and medal (33%); and informal gesture (28%). Majority (83%) were also satisfied by the method used to disseminate the information in their units. Majority agreed that the working environment in the administration unit were conducive (72%), their ideas were equally considered during decision making sessions (89%) and training opportunities were similarly given to them by the management (72%). This study revealed that employee satisfaction was determined by several factors such as management leadership's style, opportunity to contribute skills and idea; reward and incentive; and conducive king environment.
A cross»sectional study was conducted to determine the knowledge on family planning among Malay women who delivered at Hospital Universiti Sains Malaysia (H USM), Kelantan and their husbands. Three hundred and fifty five women were selected by systematic random sampling. An interview-guided questionnaire that included infomation on socio-demographic, obstetric and knowledge on family planning was conducted to the women and self-administered questionnaire was given to their husbands. There were 15 questions on knowledge which were validated prior to the study. More than half of the women (53.5%) and the husbands (57.7%) had poor knowledge score (less than 75%) on family planning. A majority (86.8%) of the women and 87.9% of the husbands knew the optimal age of a woman to be pregnant, but very few (3.4%) of the women and Ss 1% of the husbands could answer correctly all the questions on the effects of poor spacing. The level of knowledge on family planning among Malay women who delivered at H USM and their husbands were poor. Therefore, new and improved health education materiab and programmes are needed, to target both the women and their husbands.
Undergoing a Pap smear screening is widely accepted as a costeffective screening for detection of cervical abnormalities. In Peninsular Malaysia, cervical cancer was the second commonest cancer among women with incidence rate of 17.8 per 100,000 populations in 2002. Despite the high incidence of cervical cancer, only 26% of eligible woman had undergone Pap smear screening. To determine the prevalence of Pap smear screening, reasons for not undergoing the screening as well as the associated sociodemographic factors among women in Mukim Jaya Setia, a crass-sectional study was conducted in ]anuary 2005. Two hundred and ninety five from 350 households were randomly selected by using a Random Digit Table. Two hundred and eighty consented married women, aged 18 years and above were interviewed by the trained interviewers using structured
questionnaires. The questionnaires consisted of socio-demographic characteristic, Pap smear screening practice and risk factors of cervical cancer. There were 280 women who responded to the questionnaires. Majority of them were housewives (75%) and with low income (84.3%). Most ofthe women completed their education up to lower secondary school only (95%). Only 144 (51.4%) women undergo Pap smear screening but not on a regular basis. Most of them were screened only once, which was more than 3 years ago. Lack of knowledge, no accommodation, feel unnecessary and shy and no time were among the reasons that deterred the women from Pop smear screening. Women who were younger and with higher education level had more Pap smear screening compared to the older and with low education level. The practices of Pap smear screening among women in these villages were still low and was associated with age and educational level.
To examine the reliability and construct validity of the Malay Version of the Depression Anxiety Stress Scales (DASS), a validation study was conducted in 184 automotive assembly workers. The internal consistency and construct validity were assessed using Cronlaach's alpha coeffcient
and exploratory factor analysis. The Cronliachls alpha coefficients for DASS-Depression, DASS·An.xiety and DASS·Stress were 0.91, 0.88 and j 0.89, respectively, indicating satisfactory internal consistenqi Exploratory factor analysis showed three meaningful common factors that could
l expbin the three theoretical constructs of this instrument. These results suggested that the Malay version DASS is reliable and valid for assessing , the selfperceived depression, anxiety and stress among Malaysian automotive workers.
Public health care programme evaluation includes determining the programme effectiveness (outcome assessment), efficiency (economic evaluation), accessibility (reachability of services) and equity (equal provision for equal needs). The purpose of this study was to make comparison on cost·( efficiency and costeffectiveness in managing type 2 diabetes between the Ministry of Health (MOH) health clinics with family medicine specialist (FMS) and health clinics without FMS. A costeffectiveness analysis was conducted alongside across-sectional study at two government health clinics in Machang, Kelantan, one with FMS and the other without FMS. A total of 300 patients, of which 155 from the health clinic without FMS and 145 from the other group were evaluated for sociodemographic and clinical characteristics from August 2005 to May 2006. HbA1c
analysis was measured for each patient during the study period. Macrocosting and microcosting were used to determine costs. The provider cost for diabetic management ranged from RM270.56 to RM4533.04 per diabetic patient per year, withla mean cost of RM1127.91(t906.08) per diabetic patient per year in health clinic with FMS. In health clinic without FMS, the provider cost ranged from RM225.93 to RM4650.13, with a mean cost of RM802.15 (:626.26). Proportion ofgood HbA1c was 17.2% for health clinic with FMS and 10.3% for the health clinic without FMS. The annual mean provider cost per proportion of good HbA1c control (< 7%) (Costefkctiveness ratio/ CER) was RM6557.65.for health clinic with FMS and RM7787.88 for health clinic without FMS. This provider cost-epfectiveness ratio was not different statistically between the health clinic with FMS and health clinic without FMS (p=0.063). The cost of building, equipments, overheads, staff and consumables were higher for FMS group. Sensitivity analysis was performed for three discount rates (0, 5 and 7%). Relative cost-effectiveness of diabetes management in health clinic with FMS and health clinic without FMS was unchanged in all sensitivity scenarios. Even though, there was no significantly difference in provider CER in type 2 diabetes management at Malaysian MOH health clinics, but the provider CER in health clinic with FMS was lower compared to health clinic without FMS. Therefore, we can conclude that the presence of FMS in the health clinic will effectively improved the management of type 2 diabetes.
Stress has been recognized one of the factors causing disease. About 70-80% of all diseases may be stress related. Thus, stress management can be a part of an early measure of disease prevention. A descriptive cross sectional, randomized study was conducted to determine the stress inducing factors among preclinical students (universal sampling) in a public university in Selangor, Malaysia from 24th April to May 2005. A total of 163 students (52.8% year 1, 36.8% year 2 and 10.4% year 3) were interviewed in the data collection process. The main reasons students entered - medical school was because of their own interest or ambition (65%) and family influence (20.9%). Majority (76.4%) suffered moderate to great stress over hot conditions in lecture hall, tutoriaV small group session rooms and laboratories while 53.4% suffered when using the other facilities like cafeteria, toilet and transportation:. Almost all (95.1%) felt that examination was the most stressful, followed by early clinical exposure sessions (68.1%), problem·based learning sessions (62.5%), hospital visitations (59.7%), tutoriay small group sessions (49.3%), practical class (44.5%) and attending lectures (3 8.5%). Musculoskeletal System was the most stressful module among the first year students, followed by Nervous System and Gastrointestinal System with the percentage of 94.2%, 90.7% and 88.4% respectively while, 95% of the second year students felt that General, Hemopoietic ci? Lymphoid and Nervous System are the most stressful modules. This study revealed that academic sessions and lack of conducive teaching and learning environment as the main stress inducing contributors to preclinical medical students.
The purpose of this study was to determine the quality of counter service at the Ministry of Health hospitals as perceived by patients. This was a cross sectional study using selfadrninistered questionnaires distributed to patients at the outpatient departments in all Ministry of Health Hospitals. By the end ofthe data collection period, 118 of 121 hospitals (total number of MOH Hospitals) participated with 93.2% response rate., The hospitals were divided into four categories, for the purpose of this study 1000 sample size were needed in each category, the number of sample size were obtained using Epi Info Program based on assumption that 30% Of patients were dissatisyded with the services provided and with a precision of 10%. In this study the quality were based on clarity and provision of services based on Client Charten deliverance of clear infomation by the healthcare personnel, priority treatment given to urgency of the cases, cleanliness of the facilities and teamwork among the staff This study revealed about 64% of patients perceived that the hospitals had provided quality services at the counter: Only about 11% of patients were not happy with the quality of the services given at the counter. The proportion of happy patients increased from the smaller to the bigger hospitals. In terms of delivering services according to the Client Charter; only about 15% said that service was not provided by the counter staff according to the Client’s Charter On the aspect of priority on the urgent cases, about 64% of the patients perceived that urgent cases were not seen immediately. About 64% of the respondents felt that the hospitah do provide quality services. Strategies should focus on the bigger hospitals because non conformance to quality occurs more frequently there. The post of Counter Supervisor should be created to ensure that quality services are delivered.
Study site: outpatient departments in all Ministry of Health Hospitals
The aim of the study is to describe the usage of dietary supplemenu among doctors working in the hospitals in Kota Bharu, Kelantan. The method used was a postal questionaire survey of the doctors, both specialists and medical officers working in these hospitals. The results showed that
only 28.7% of the doctors are taking dietary supplements. Significantly more female doctors and doctors on long term medication, were taking these supplements. The dietary supplements commonly used were multivitamins and minerals (92.3%), garlic (26.9%), vitamin C (26.9%) and
lecithin (15.4%). The majority of the doctors who took dietary supplements (60%) felt their health status have improved. These supplements were mostly obtained from hospital pharmacies. Doctors who puchase their own supplements spend between RMIO to RMIZO per month. The main reasons given for taking these supplements were that the doctors jfelt healthier' and to ‘prevent or as a supplementary treatment’ for conditions like hypercholesterolaemia, hypertension, ischaemic heart disease and cancers. There were four doctors who regularly use traditional dietary supplements. Most doctors will generally advice their patients and children to take dietary supplements regularly, as they felt that it is important for health.
This study was conducted to study the blood pressure pattern and the prevalence of hypertension and its associated factors in a rural community in two coastal villages in rural Kedah, Mahysia. Out of the total population 504 were above 20 years of age and were eligible to participate. There were 227 males and 252 females. The mean systolic blood pressure was found to rise with age, peaking in the 6l·70 years age group, For women the mean blood pressure rose earlier from the age group of 4-l· 50 years. Mean blood pressures rose with increasing body mass index. lt also varied with occupation and education. The retired and unemployed had a higher blood pressure than those employed and there was an inverse relationship with increasing education. The prevalence of hypertension was 33.6%. More females were hypertensive (36.5%) as compared to males (3 0.4%) and this finding was the same for both systolic and diastolic hypertension. Majority (71.4%) of the hypertensives were undiagnosed. 72.5% of hypertensives who were on treatment were not under control. Hypertension was more prevalent among retirees and illiterates. Prevalence of hypertension increased correspondingly with age. Obesity was associated with hypertension. There was no association with family history of hypertension. Multiple logistic regression showed a positive association only for obesity. ln conclusion, given the high prevalence of hypertension at
present, it appears that the prevalence will increase as each age cohort grows older. Obesity, especially among housewives is a significant assorted factor.
Merokok merupakan amalan yang dimulakan sewaktu usia remaja. Beberapa kajian yang dijalankan terdahulu di negara maju mendapati keluarga mernpakan faktor penyumbang kepada amalan ini. Meskipun pelbagai kajian di negara·negara rnaju, namun tidak banyak kajian berkaitan aspek ini yang dilaporkan di negara ini. Data kajian lverkait dengan pembolehubah kekeluargaan iaitu hubungan kekeluargaan, pandangan remaja tentang reaksi ibu bapa terhadap amalan rnerokok, struktur keluarga, jumlah ahli keluarga, status merokok di kalangan ibu bapa dan jantina dengan amalan merokok diperolehi dari 251 pelajarpelajar sekolah menengah (Tingkatan 5) (48.2% lelaki dan 51.8%
perempuan} di Daerah Kota Ting?. Johon Kajian ini mendapati sikap ibu bapa yang negatif dan bapa yang tidak merokok merupakan faktor pelindung dari amalan merokok. Hasil kajian mencadangkan faktor kekeluargaan memainkan peranan dalam mempengaruhi amalan merokok di kalangan jantina. Institusi kekeluargaan hendaklah dilibatkan dalam program pencegahan amalan merokok di kalangan remaja.
A qualitative research was carried out in Besut and Kuala Terengganu to identyy adolescents’ health problems and needs jiom adolescent perspective, and to establish a priority area in the development of Adolescent Health Clinic in the district. A total of 61 adolescents were selected and divided into four groups and stratified according to age, 13-15 years old and 16 - 17 years old. Generally all participants wished to live in an environment free hom negative health risk factors. The obstacles they perceived were mainly related to lack of care or too much control by their parents. Some of them perceived that their parents in general had inadequate knowledge and skills on parenting. Among local behavioural problems mentioned were loafing, running away from home, vandalism, school absenteeism, aggressive behaviour, substance abuse, pre-marital sexual activities, "bohsia", “bohjan" and even involvement in crimes. More than hah' agreed that counselling service is important for adolescents, and it should be made available in the community preferably outside the schools. They perceived an adolescent friendly health clinic concept as an important concept that should be introduced. To them adolescent friendly health clinic is a clinic run by professionals who are knowledgeable, caring, good listeners, non—judgemental, and who exercise confidentiality. The clinic preferably should be situated in a location which is away from the present health facilities to avoid the image of a place for sick people. Clinic hours preferably during weekends, should provide appropriate technologies and situated in a comfortable ambience. Adolescent participation in the clinic was also mentioned as an important entity for adolescent friendly health services.
The number of deliveries increased very signdicantly in all hospitals in Terengganu since 1986. It is in line with the promotion of Safe Motherhood Initiative' with the aim to reduce maternal mortality and morbidity in a Terengganu. The aim of the study was to determine the pattern of choice for place of deliveries by local people in Terengganu and also to identdy risk factors related to their place of choice. A total of 9741 deliveries home January 1999 to 30”’ of June 1999 were included in the study. About 46% delivered in Hospital Kuala Terengganu, where 72% of them were high-risk mothers. Whereas deliveries in the district hospitals were 9.9% in Kemaman Hospital, 9.7% in Besut Hospital, 7.2% in Dungun Hospital and 3.4% in Hulu Terengganu Hospital. About 67% of district hospital deliveries were high-risk mothers. Only 12.4% of deliveries were home deliveries, however 49% of them were high-risk mothers. Utilization of alternative birthing centre in health clinics was only 1.7%. The study revealed that mothers’ risk factors are the factors signaicantly influence the place of choice for deliveries. The study jindings call for an urgent need of three essential services, Firstly an urban birthing centre conducted by obstetrician or the medical ojicers to be developed at the vicinity of the present general hospital to cater for the high percentage of high—risk pregnancies in the state. Secondly, all or selected district hospital to be given post for obstetrician, and thirdly it is a need to evaluate the current ‘High Risk Checklist for Antenatal Mothers’ to ensure treatment priority is indeed given to those really in need based on appropriate risk factors.
The objectives of this study were to determine the prevalence of HI V iryfection, risk factors and to measure the knowledge on AIDS among fishermen in Terengganu. In this survey fishermen registered with the Malaysian Fishery Development Board in Terengganu were studied. There were 600 eligible fishermen based on a list provided by the Malaysian Fishery Development Board (MFDB). Study sites were at 6 loading centres where health personnel awaited returning fishermen between 4. 00pm —7. 00 pm during a period of one month, A total of 542 registeredfshermen were studied and this corresponded to a response rate of 90.3 %. The majority of the fishermen were Malays (98.6%}, Nine fishermen were tested positive to HIV antibody and this corresponds to a
g prevalence of I. 7%. Prevalence of HIV is higher among those with a positive history of drug use, single marital status and also among the unskilled workers who represented the socio-economically poorer group of fishermen. Almost 89% of respondents have heard about HIV/AIDS and among these, 93% received information through TV and radio. The mean knowledge score was significantly higher among fishermen admitting to drug taking, sex with prostitutes, and those who have had at least a secondary school education. The Prevalence of HIV infection among fishermen is higher than in the general population. Risk characterisation of HI V injection was statistically signyicant onlv among fishermen who gave positive history of drug used. Findings also suggest that poorer fishermen based on multiple indicators to socioeconomic status had a higher risk of being HIV positive as well as being less knowledgeable about AIDS, Health promotion strategies should focus on the use of TV and radio as an interactive medium to reach out to risk groups among fishermen as its popularity has been determined by this study.
The Ministry of Health had instructed all state hospitals to go for Accreditation. Accreditation is considered to be a more appropriate tool forquality assurance in a hospital setting than ISO 9000.The objective of this research was to study doctors perception towards the implementation of Accreditation in state hospital. Self-administered questionnaires were sent through mail to doctors in eight clinical departments of all state hospitals. From 832 questionnaires sent, 297 responded (36%),i.e. 84 specialists and 2/2 medical officers. The study showed that 69% doctors knew that their hospital was implementing Accreditation. There were more clinical specialist (9I%) who were involved in accreditation as compared to Medical Ojicers (73%). 83% of doctors believed that accreditation can assist in assuring quality in their hospital. Those who do not, thought that quality can be assured stajfing was adequate (67%) and accreditation does not assess patient care
(33%). The study also showed that 7I% of doctors knew that their hospital was implementing MS ISO 9000. A 77% of doctors believed that ISO 9000 can assist in assuring quality in their hospital. Those who do not, thought that quality can onhi be assured Jstajfng was adequate (27%) and ISO 9000 was only meant for industry (8%). In conclusion, doctors believed that Accreditation and MS ISO 9000 can assist in assuring quality in their hospitals. Amongst, those who do not, majority thought that quality can only be assured staffing was adequate.
Four hundred and thirty five (435) cases 0f sexually transmitted infections (STIs) were notified from 20 (twenty) primary care clinics throughout Malaysia from June 1999 till September 2000 using the syndromic approach of STI management, adapted by the Ministry of Health based upon the criteria set by the World Health Organisation (WHO). Gonorrhoea was the most prevalent STI reported (30.34 %), followed by candidiasis (28.05%), syphilis (15.17%) and non-specific urethritis (NSU) — 14.02%) . As seen in most other parts of the world, the younger age groups (those between twenty and thirty nine years old) were found to be more commonly infected with STIs. Initial analysis shows that systematic data collection based on the syndromes and clear—case definitions (algorithms for the syndromic approach} need to be developed and added further to the current manual that is being developed for the health and medical staff at the operational it level. Exploration and expansion of behavioural surveillance research, management information systems of the syndromic approach, and development of new or additional strategies in the manual for the staff too, also need improvement. The Ministry of Health is also concerned about the quantity and quality of the available data based upon syndromic management of STI as compared to laboratory based criteria. Since this programme is very much client centered, the adoption of this approach generally might offer substantial improvements in the quality and effectiveness of STI care, either within the public or the private health care settings in Malaysia.
The aim of this study was to identify the problems of stress and health effect among the office computer users. A total of 41 office workers whose job required the use of computers. A set of constructed questionnaire were use to measure the work stress and health problems among workers. The data was analyzed by using of descriptive and inference statistic. The result showed that subjects who use computer for more than 2 hours would experienced work stress such as fatigue 29(70.7%), eye and visual symptoms such as blurring of vision 27(65.9%) and musculoskeletal pain at neck 32( 78.6%). However most of symptoms were moderate. There were a significant relationship between the time spent of using computer with problem of stress (r= 0.440, p<0.05) and eyes and visual problem (r=0.319, p<0.05). However there was no significant relationship between the work station design with stress, musculoskeletal, eye and visual problems. Therefore the longer time spent using computer will lead to health problems. Using the safety operating procedure will reduce the work stress problems.
Keys word: Work stress, health problems, computer users
In July 1997 at 7 pm , 49 members 0f the public complained of dizziness, sore throat, eyes irritation and tightness of chest after exposed to sulphur dioxide while traveling on the road about 100 meter 90m the sulphuric acid factory in Teluk Kalong Kemaman. The incident was caused by leaking sulfur dioxide from return pipe of scrubber circulation. tank in the factory. The problem had occurred due to carelessness of the operator to inspect the level of water in the scrubber circulation tank during the operation.
Food poisoning is still a major problem in the state of Terengganu. The study was conducted during an episode of food poisoning outbreak which occurred in October, 1999, at Universiti Tekonologi Mara (UiTJ1rO, Dungun to determine the etiology, mode of transmission, source and the risk factors of the outbreak and hence to take appropriate remedial actions and preventive measures. A retrospective cohort study was conducted amongst 925 students using a standard questionnaire as well as environmental investigation and bacterial subtyping. All the samples were Malay females, age ranging jrom /9 — 22 years. It was found that majority ofthe victims (72 %) presented with abdominal cramp, 68.5% headache, 60.0% diarrhea, 55.2% fever, 45.0% nausea, 39.0% muscle
ache and 3]. 7% vomiting. The epidemic curve suggested of a common source of infection and the most probable food that has been contaminated was taken during lunch hour on October 20'I'1999, Statistical analysis showed that spices jiied chicken and "nasi minyak" were significantly associated with the illness (p < 0. 05). The most likely causative organism was Salmonella spp as supported by the clinical presentation and incubation period of the disease, identdication of contaminated food, bacterial subtyping result and environmental findings. Following the outbreaks, several remedial actions were taken including immediate close—up ofthe canteen for I4 days, treatment for the cases and health examination and typhoid immunization for all food handlers.