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Fulltext A structural equation model of the determinants of malnutrition among children in rural Kelantan, Malaysia

Cheah WL, Wan Muda WAM, Zamh ZH

Rural Remote Health, 2010;10(1):1248.
PMID: 20184392

Many studies had shown that poor growth in children is associated with malnutrition. The underlying factors are diverse, multisectoral and interrelated, ranging from biological to social, cultural and economically related. Because the highest levels of under-nutrition worldwide are found in South Asia, it is essential that policymakers in the region understand the underlying determinants, in order to design effective public health intervention programs. This is especially so if public resources are limited. The purpose of this cross-sectional study was to examine causal relationships among the biological, behavioural and environmental factors related to malnutrition in children aged 5 years and under.
Development of a questionnaire for the study of malnutrition among children in rural Kelantan, Malaysia

Cheah W, Wan Abdul Manan W, Zabidi-Hussin Z, Chang C

Rural Remote Health, 2009 Jul-Sep;9(3):1155.
PMID: 19705956

Historical data have shown that the factors contributing to and underlying malnutrition among children are diverse, multisectoral and include interrelated biological, social, cultural and economic factors. To determine the these factors in a given population an accurate and reliable questionnaire is essential. This article concerns the process of questionnaire development and validation.
Fulltext Diagnostic delay among pulmonary tuberculosis patients in Sarawak, Malaysia: a cross-sectional study

Chang CT, Esterman A

Rural Remote Health, 2007 Apr-Jun;7(2):667.
PMID: 17511524

Delayed diagnosis of tuberculosis (TB) can lead to an increased period of infectivity in the community, a delay in treatment and a severe form of the disease. The objective of this study was to determine the length of delay, and factors linking the delay from the onset of symptoms of pulmonary tuberculosis (PTB) until the commencement of treatment in Sarawak, Malaysia.
Fulltext Anaphylactic shock following a bite of a wild Kayan slow loris (Nycticebus kayan) in rural Sarawak, Malaysian Borneo

Steve Utap M, Bin Mohd Jamal MS

Rural Remote Health, 2019 08;19(3):5163.
PMID: 31421666 DOI: 10.22605/RRH5163

Nycticebus spp, commonly known as the slow lorus, is a small nocturnal primate found mainly in Asia. The adult slow loris weighs between 265 g and 1150 g depending on the type of species. It has a characteristic round head with large, forward-facing eyes. Slow lorises are known for their poisonous bite and are the only venomous primates. To date, there have been two published cases of slow loris bite in humans. This case report illustrates a case of anaphylactic shock following a bite of a wild Kayan slow loris (Nycticebus kayan) to a young man at Mulu District, in a remote area of Sarawak, Malaysian Borneo. The patient developed dyspnoea, a feeling of suffocation, swollen lips and cramp-like sensations over both hands. He subsequently developed syncope and hypotension. The patient was clinically stable following intramuscular injection of adrenaline 0.5 mg stat dose.
Fulltext Perceptions of medical students regarding community-based teaching experiences: an observation from Bangladesh

Ahmed SMM, Hasan MN, Kabir R, Arafat SMY, Rahman S, Haque M, et al.

Rural Remote Health, 2019 08;19(3):4614.
PMID: 31400766 DOI: 10.22605/RRH4614

INTRODUCTION: Community orientation in medical education, which prepares medical students to become more effective practitioners, is now a global movement. Many medical schools around the world have adopted the concept as the main curricular framework in order to align learning programs with the needs of the community and the learner. Despite many changes over the past few decades, many improvements are still needed in medical education in Bangladesh. This study investigated medical students' perceptions of the community-based learning experiences incorporated into the Bachelor of Medicine, Bachelor of Surgery (MBBS) degree at Uttara Adhunik Medical College, Dhaka (UAMC), Bangladesh.
METHODS: A total of 135 students from three undergraduate year levels of the MBBS degree at UAMC, Dhaka, Bangladesh, undertook study tours (community-based teaching, CBT) as a part of a community medicine course and visited a medical college, two rural health centres and a meteorology centre in the Cox's Bazar district, 400 km from Dhaka city. A questionnaire was used to assess the perceptions of students regarding the administration, organisation and learning experiences of the study tours. Students were required to write reports, present their findings and answer questions in their examinations related to the study tours and CBT.
RESULTS: The majority of the students agreed or strongly agreed that the tour was a worthwhile (93%) and enjoyable (95%) learning experience that helped them to understand rural health issues (91%). More than half of the students reported that the study tours increased their awareness about common rural health problems (54%) and provided a wider exposure to medicine (61%). Only 41% of students reported that the study tour increased their interest in undertake training in a rural area. A substantial number of students also expressed their concerns about the planning, length, resources, finance and organisation of the study tours.
CONCLUSIONS: Overall, the study tours had a positive effect, enhancing students' awareness and understanding of common rural health problems. As study tours failed to increase the motivation of the students (approximately 60%) to work in rural areas, CBT in the medical curriculum should be reviewed and implemented using effective and evidence-based models to promote interest among medical students to work in rural and underserved or unserved areas.
Fulltext Applicability of the stages of change and Weight Efficacy Lifestyle Questionnaire with natives of Sarawak, Malaysia

Chang CT

Rural Remote Health, 2007 Oct-Dec;7(4):864.
PMID: 18076311

INTRODUCTION: There is an increase in the prevalence of overweight and obesity in Malaysia. Besides prevalence studies, not much is known about either overweight or obese individuals. The objective of this study was to determine the stages of change in losing weight and the self-efficacy in eating control of three indigenous groups of overweight and obese adults in Sarawak, Malaysia.
METHODS: A cross-sectional study was conducted in one rural region in Sarawak using a purposive sample. A structured questionnaire, which included two scales: (1) Weight: Stages of change (SOC) to assess readiness to change; and (2) Weight Efficacy Lifestyle Questionnaire (WEL) (both adopted from the transtheoretical model of change); and a set of pre-tested questionnaires on socio-demographic data, the presence of health problems and self-assessment of weight appropriateness, was used to interview respondents.
RESULTS: The stage distribution for weight loss of these adults respondents (n = 271) showed that 60.5% (n = 164) were in the pre-contemplation stage, 20.7% (n = 56) were in the contemplation stage, 8.5% (n = 23) were in the preparation stage, and 8.9% (n = 24) were in the action stage, while only 1.5% (n = 4) were in the maintenance stage. Except for education, the stage differences were generally stable across age, sex, race, household income, presence or absence of health problem, self-perceived weight and presence of overweight or obesity. Respondents were least able to control their eating under social pressure and food availability, according to their WEL score.
CONCLUSION: A large proportion of the overweight or obese adults was not intending to lose weight. The factor structure of the two WEL original subscales enabled partial differentiation between respondents who were able or unable to resist eating in situations where there were availability of food and experienced physical discomfort. The study results indicate the importance of assessing individuals' SOC score in order to implement stage-matched intervention strategies. More studies should be performed in order to validate the WEL questionnaire for use with a Malaysian sample.
Fulltext Building a local medical workforce in Tasmania: where are international fee-paying medical graduates likely to work?

Cheek C, Hays R, Allen P, Walker G, Shires L

Rural Remote Health, 2017 Jul-Sep;17(3):4292.
PMID: 28846850 DOI: 10.22605/RRH4292

INTRODUCTION: Much of regional Australia continues to face challenges in recruitment and retention of medical practitioners, despite the apparently successful rural medical education initiatives funded by the Commonwealth Government. International fee-paying (IFP) medical students are a significant component of Australian medical education, contributing additional income and more diverse learning environments for universities. Their contribution to the Australian medical workforce is harder to determine. After obtaining registration, IFP graduates may apply to remain in Australia as skilled migrants. Since 1999 there has been a 325% increase in the number of international medical students in Australia, with approximately 73% of IFP graduates remaining in Australia for at least some postgraduate training. Recognising the potential contribution of IFP students to the Tasmanian medical workforce, the authors sought better understanding of the career intentions and work locations of IFP graduates from the medical program in Tasmania, Australia, through two studies. Firstly, a quantitative study was conducted of the locations of all IFP graduates from the Tasmanian medical program, and then a qualitative study exploring graduating students' intentions and factors that contribute to their decisions about work location choices.

METHODS: This was a cohort study of IFP students who graduated from the University of Tasmania School of Medicine over the period 2000-2015. Work locations for 2016 were mapped to a Modified Monash rurality classification. Semi-structured interviews were held with 15 final year IFP medical students, exploring career intentions and location preferences.

RESULTS: There were 261 IFP graduates, 54.4% male. The most common country of origin was Malaysia (55.2%). In 2016, 189 (72.4 %) were working in Australia, 42 (16.1%) in Tasmania and 126 (66.7%) in areas categorised as Modified Monash 1. Recent graduates in postgraduate year 1/2 (71.3%) were more likely to be working in Tasmania but most left for specialty training. All 15 interview participants intended to remain in Australia for at least their intern year, although at enrolment only six had planned to remain. Factors influencing workplace location decisions were (1) 'professional': greater appeal of Australian medical workplaces, intention to pursue a speciality, and to complete this at an Australian metropolitan hospital; (2) 'social': proximity to family/partner or opportunity to meet a prospective partner, family obligations, positive rural experiences; and (3) 'location': direct travel access to family.

CONCLUSIONS: IFP graduates from the Tasmanian medical program make an important contribution to the Australian mainland metropolitan medical workforce, but play only a small role in workforce development for both Tasmania and the broader Australian rural and remote context. Most IFPs do not choose to work rurally. Rurally focused medical programs need to consider how they place IFP students to meet both the learning and career needs of IFP students and the goal of the rural medical programs in developing a rural workforce.