Displaying publications 1 - 20 of 44 in total

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  1. Whittaker A, Chee HL
    Soc Sci Med, 2015 Jan;124:290-7.
    PMID: 25308233 DOI: 10.1016/j.socscimed.2014.10.002
    The growing trade in patients seeking health care in other countries, or medical travel, is changing the forms and experiences of health care seeking and producing changes to hospitals in terms of their design, organization and spaces. What is termed in marketing parlance in Thailand as an 'international hospital' oriented to attracting foreign patients, is a hotel-hospital hybrid that is locally produced through the inflexion of local practices to make a therapeutic space for international patients. The paper reports on work undertaken within a Thai hospital in 2012 which included observations and interviews with thirty foreign in-patients and nine informal interviews with hospital staff. Although theorized as a culturally neutral transnational 'space of connectivity', we show how cross-cultural tensions affect the experience of the hospital with implications for the organization of the hospital and notions of 'cultural competence' in care. There is no single universal experience of this space, instead, there are multiple experiences of the 'international hospital', depending on who patients are, where they are from, their expectations and relationships. Such hospitals straddle the expectations of both local patients and international clientele and present highly complex cross-cultural interactions between staff and patients but also between patients and other patients. Spatial organisation within such settings may either highlight cultural difference or help create culturally safe spaces.
  2. Mendelsohn JB, Rhodes T, Spiegel P, Schilperoord M, Burton JW, Balasundaram S, et al.
    Soc Sci Med, 2014 Nov;120:387-95.
    PMID: 25048975 DOI: 10.1016/j.socscimed.2014.06.010
    HIV-positive refugees confront a variety of challenges in accessing and adhering to antiretroviral therapy (ART) and attaining durable viral suppression; however, there is little understanding of what these challenges are, how they are navigated, or how they may differ across humanitarian settings. We sought to document and examine accounts of the threats, barriers and facilitators experienced in relation to HIV treatment and care and to conduct comparisons across settings. We conducted semi-structured interviews among a purposive sample of 14 refugees attending a public, urban HIV clinic in Kuala Lumpur, Malaysia (July-September 2010), and 12 refugees attending a camp-based HIV clinic in Kakuma, Kenya (February-March 2011). We used framework methods and between-case comparison to analyze and interpret the data, identifying social and environmental factors that influenced adherence. The multiple issues that threatened adherence to antiretroviral therapy or precipitated actual adherence lapses clustered into three themes: "migration", "insecurity", and "resilience". The migration theme included issues related to crossing borders and integrating into treatment systems upon arrival in a host country. Challenges related to crossing borders were reported in both settings, but threats pertaining to integration into, and navigation of, a new health system were exclusive to the Malaysian setting. The insecurity theme included food insecurity, which was most commonly reported in the Kenyan setting; health systems insecurity, reported in both settings; and emotional insecurity, which was most common in the Kenyan setting. Resilient processes were reported in both settings. We drew on the concept of "bounded agency" to argue that, despite evidence of personal and community resilience, these processes were sometimes insufficient for overcoming social and environmental barriers to adherence. In general, interventions might aim to bolster individuals' range of action with targeted support that bolsters resilient processes. Specific interventions are needed to address locally-based food and health system insecurities.
  3. Ormond M
    Soc Sci Med, 2015 Jan;124:305-12.
    PMID: 24947552 DOI: 10.1016/j.socscimed.2014.06.007
    Globally, more patients are intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel's (IMT) impacts on the people and places that receive medical travellers, study of its impacts on medical travellers' home contexts has been negligible and largely speculative. While proponents praise IMT's potential to make home health systems more responsive to the needs of market-savvy healthcare consumers, critics identify it as a way to further de-politicise the satisfaction of healthcare needs. This article draws from work on political consumerism, health advocacy and social movements to argue for a reframing of IMT not as a 'one-off' statement about or an event external to struggles over access, rights and recognition within medical travellers' home health systems but rather as one of a range of critical forms of on-going engagement embedded within these struggles. To do this, the limited extant empirical work addressing domestic impacts of IMT is reviewed and a case study of Indonesian medical travel to Malaysia is presented. The case study material draws from 85 interviews undertaken in 2007-08 and 2012 with Indonesian and Malaysian respondents involved in IMT as care recipients, formal and informal care-providers, intermediaries, promoters and policy-makers. Evidence from the review and case study suggests that IMT may effect political and social change within medical travellers' home contexts at micro and macro levels by altering the perspectives, habits, expectations and accountability of, and complicity among, medical travellers, their families, communities, formal and informal intermediaries, and medical providers both within and beyond the container of the nation-state. Impacts are conditioned by the ideological foundations underpinning home political and social systems, the status of a medical traveller's ailment or therapy, and the existence of organised support for recognition and management of these in the home context.
  4. Shafie AA, Hassali MA
    Soc Sci Med, 2013 Nov;96:272-6.
    PMID: 23528670 DOI: 10.1016/j.socscimed.2013.02.045
    Health care in Malaysia is funded primarily through taxation and is no longer sustainable. One funding option is voluntary community-based health insurance (VCHI), which provides insurance coverage for those who are unable to benefit immediately from either a social or private health insurance plan. This study is performed to assess the willingness of Malaysians to participate in a VCHI plan. A cross-sectional study was performed in the state of Penang between August and mid-September 2009 with 472 randomly selected respondents. The respondents were first asked to select their preferred health financing plan from three plans (out-of-pocket payment, compulsory social health insurance and VCHI). The extent of the household's willingness to pay for the described VCHI plan was later assessed using the contingent valuation method in an ex-ante bidding game approach until the maximum amount they would be willing to pay to obtain such a service was agreed upon. Fifty-four per cent of the participants were female, with a mean age of 34 years (SD = 11.9), the majority of whom had a monthly income of Int$1157-2312. The results indicated that more than 63.1% of the respondents were willing to join and contribute an average of Int$114.38 per month per household towards VCHI. This amount was influenced by ethnicity, educational level, household monthly income, the presence of chronic disease and the presence of private insurance coverage (p 
  5. Momtaz YA, Hamid TA, Ibrahim R
    Soc Sci Med, 2012 Sep;75(5):859-63.
    PMID: 22632847 DOI: 10.1016/j.socscimed.2012.03.047
    Unmet need as a significant factor affecting quality of life in later life has recently received considerable attention in gerontological research. The main aim of this study was to identify the prevalence, predicting factors, and negative consequence of unmet need among older Malaysians. The findings may be useful to reduce unmet need and the burden of its adverse consequence. The sample for this study consists of 400 functionally disabled elderly people aged 60 and over was obtained from a large national survey. Unmet need was operationally defined based on Manton's (1989) criteria. The findings from the present study showed about 18.0% of functionally disabled older Malaysians suffer from unmet need. Logistic regression revealed that gender (being male) and chronic health conditions are statistically associated with increased odds of unmet need after adjusting for other possible risk factors. Further results indicated that unmet need statistically increases odds of fall as a negative consequence of unmet need. The high prevalence rates of unmet need among disabled elderly men and chronically ill older persons suggest that policy makers should pay more attention to this vulnerable group to achieve good quality of life. The implications and limitations of the present study are discussed.
  6. Khoo SM
    Soc Sci Med, 2012 Jan;74(1):14-9.
    PMID: 21570757 DOI: 10.1016/j.socscimed.2011.02.048
    Alternative Southern consumer activism, undertaken for example by the Consumers' Association of Penang (CAP) in Malaysia, presents significant sites of nodal governance through which local and global health rights are claimed. This alternative consumer approach distinctively integrates health with development, social justice and environmental issues. It has not always explicitly employed rights language, but consumer activism fits with rights-based approaches, emphasising entitlements, accountability and participation. This case-study traces the development of networked consumer campaigns to contest and shape global health governance. It highlights the important, yet under-researched role of Southern nodes within global networks mobilizing health rights and public health. Alternative consumer activism re-interprets the consumer as a countervailing force, collectively mobilizing citizens to claim their health rights.
  7. Dunn RA, Tan AKG
    Soc Sci Med, 2010 Sep;71(6):1089-93.
    PMID: 20685019 DOI: 10.1016/j.socscimed.2010.06.016
    This study examines the determinants of Papanicolaou Smear Test (PST) screening for cervical cancer among women in Malaysia. Attention is focused on the reasons different population subgroups give for non-screening. We find that Indian women are the least likely to have had a PST and also the least likely to know the reasons why one is screened. Malay women are less likely than Chinese women to have received a PST and are more likely to report embarrassment as the reason for not being tested. Urban women are less likely than rural women to have been tested and more likely to state lack of time as the reason. These results suggest targeted interventions may be necessary to increase screening rates in Malaysia.
    Study name: Malaysia Non-Communicable Disease Surveillance-1 (MyNCDS-1) survey
  8. Yong HH, Hamann SL, Borland R, Fong GT, Omar M, ITC-SEA project team
    Soc Sci Med, 2009 Oct;69(7):1025-31.
    PMID: 19695758 DOI: 10.1016/j.socscimed.2009.07.042
    In recent years, attempts have been made to incorporate religion into tobacco control efforts, especially in countries like Malaysia and Thailand where religion is central to the lives of people. This paper is a prospective examination of the perceived relevance and role of religion and religious authorities in influencing smoking behaviour among Muslims in Malaysia and Buddhists in Thailand. Data were collected from 1482 Muslim Malaysian and 1971 Buddhist Thai adult smokers who completed wave 1 (early 2005) of the International Tobacco Control Southeast Asia Survey (ITC-SEA). Respondents were asked about the role of religion and religious leadership on smoking at Wave 1 and among those recontacted, quitting activity at Wave 2. Results revealed that over 90% of both religious groups reported that their religion guides their day-to-day behaviour at least sometimes, but Malaysian Muslims were more likely to report that this was always the case. The majority (79% Muslims and 88% Buddhists) of both groups believed that their religion discourages smoking. About 61% of the Muslims and 58% of the Buddhists reported that their religious leaders had encouraged them to quit before and a minority (30% and 26%, respectively) said they would be an influential source to motivate them to quit. Logistic regression models suggest that these religious factors had a clear independent association with making quitting attempts in both countries and this translated to success for Malaysian Muslims but not for the Thai Buddhists. Taken together, results from this study indicate that religion and religious authorities are both relevant and important drivers of quitting, but whether this is always enough to guarantee success is less clear. Religion can be a culturally relevant vehicle to complement other tobacco control efforts.
  9. Chee HL
    Soc Sci Med, 2008 May;66(10):2145-56.
    PMID: 18329149 DOI: 10.1016/j.socscimed.2008.01.036
    The recent history of healthcare privatisation and corporatisation in Malaysia, an upper middle-income developing country, highlights the complicit role of the state in the rise of corporate healthcare. Following upon the country's privatisation policy in the 1980s, private capital made significant inroads into the healthcare provider sector. This paper explores the various ownership interests in healthcare provision: statist capital, rentier capital, and transnational capital, as well as the contending social and political forces that lie behind state interests in the privatisation of healthcare, the growing prominence of transnational activities in healthcare, and the regional integration of capital in the healthcare provider industry. Civil society organizations provide a small but important countervailing force in the contention over the future of healthcare in the country. It is envisaged that the healthcare financing system will move towards a social insurance model, in which the state has an important regulating role. The important question, therefore, is whether the Malaysian government, with its vested interests, will have the capacity and the will to play this role in a social insurance system. The issues of ownership and control have important implications for governance more generally in a future healthcare system.
  10. Barraclough S, Morrow M
    Soc Sci Med, 2008 Apr;66(8):1784-96.
    PMID: 18304713 DOI: 10.1016/j.socscimed.2008.01.001
    In the wake of the World Health Organization Framework Convention on Tobacco Control, corporate social responsibility (CSR) is among the few remaining mechanisms for tobacco corporations publicly to promote their interests. Health advocates may be unaware of the scale, nature and implications of tobacco industry CSR. This investigation aimed to construct a typology of tobacco industry CSR through a case study of the evolution and impact of CSR activities of a particular tobacco corporation in one country - British American Tobacco, Malaysia (BATM), the Malaysian market leader. Methods included searching, compiling and critically appraising publicly available materials from British American Tobacco, BATM, published literature and other sources. The study examined BATM's CSR strategy, the issues which it raises, consequences for tobacco control and potential responses by health advocates. The investigation found that BATM's CSR activities included assistance to tobacco growers, charitable donations, scholarships, involvement in anti-smuggling measures, 'youth smoking prevention' programs and annual Social Reports. BATM has stated that its model is predominantly motivated by social and stakeholder obligations. Its CSR activities have, however, had the additional benefits of contributing to a favourable image, deflecting criticism and establishing a modus vivendi with regulators that assists BATM's continued operations and profitability. It is imperative that health advocates highlight the potential conflicts inherent in such arrangements and develop strategies to address the concerns raised.
  11. Aborigo RA, Allotey P, Reidpath DD
    Soc Sci Med, 2015 May;133:59-66.
    PMID: 25841096 DOI: 10.1016/j.socscimed.2015.03.046
    Traditional medical systems in low income countries remain the first line service of choice, particularly for rural communities. Although the role of traditional birth attendants (TBAs) is recognised in many primary health care systems in low income countries, other types of traditional practitioners have had less traction. We explored the role played by traditional healers in northern Ghana in managing pregnancy-related complications and examined their relevance to current initiatives to reduce maternal morbidity and mortality. A grounded theory qualitative approach was employed. Twenty focus group discussions were conducted with TBAs and 19 in-depth interviews with traditional healers with expertise in managing obstetric complications. Traditional healers are extensively consulted to manage obstetric complications within their communities. Their clientele includes families who for either reasons of access or traditional beliefs, will not use modern health care providers, or those who shop across multiple health systems. The traditional practitioners claim expertise in a range of complications that are related to witchcraft and other culturally defined syndromes; conditions for which modern health care providers are believed to lack expertise. Most healers expressed a willingness to work with the formal health services because they had unique knowledge, skills and the trust of the community. However this would require a stronger acknowledgement and integration within safe motherhood programs.
  12. Marnoch G, Lian PC
    Soc Sci Med, 2002 Mar;54(6):869-77.
    PMID: 11996021
    This paper considers the subject of managed care in Malaysia, providing a questionnaire-based analysis of the position adopted by private medical practitioners. Managed care is now seen as the dominant health care system in the United States, with many other countries around the world including Malaysia beginning to selectively use component parts to tackle particular health care problems. In this survey it was found that three out of four respondents have concerns regarding the implementation of managed care. The survey was used to identify and categorise these concerns. At the same time, three out of four respondents held the opinion that principles of managed care were already a reality or would be in the next 5 years. This group expressed an eagerness to be trained in managed care principles and be given the opportunity to be part of managed care organisations. It is argued that clinicians' knowledge and interest perceptions are an important influence on the implementation of managed care based systems. The survey-based evidence presented in this article is intended as a measure of current understandings and beliefs, in relation to clinical micro-management process associated with managed care.
  13. Brehm U
    Soc Sci Med, 1993 May;36(10):1331-4.
    PMID: 8511619
    In Peninsular Malaysia child mortality rates (5q0) vary from 13 to 63 per thousand at district level. The spatial pattern is closely associated with the regional distribution of socio-economic factors. But due to multicollinearity it is difficult to isolate the influence of socio-economic variables from other variables by employing aggregated data. However, individual data collected in a case-control-study that was conducted in Perlis and Kuala Terengganu confirm the important role of socio-economic factors. So it should be possible to achieve a further reduction of child mortality by raising the income and educational level of the under-privileged groups. Apart from that, as the case of Perlis shows, the provision of family planning and preventive medical services may also contribute to lower child mortality independent from socio-economic changes. But, as the comparison with Kuala Terengganu shows, the utilization of family planning and preventive medical services is not only influenced by the accessibility to, but also by the socio-culturally determined acceptability of such services.
  14. Kliks MM, Palumbo NE
    Soc Sci Med, 1992 Jan;34(2):199-212.
    PMID: 1738873 DOI: 10.1016/0277-9536(92)90097-A
    The principal etiologic agent of human eosinophilic meningitis, Angiostrongylus cantonensis, was first detected in rats in Canton, China in 1933. The first human case was detected on Taiwan in 1944. Epidemic outbreaks were noted on Ponape (E. Caroline Is.) from 1944 to 1948. The disease may present as transient meningitis or a more severe disease involving the brain, spinal cord and nerve roots, with a characteristic eosinophilia of the peripheral blood and CSF. Since 1961 it has been known that human infections are usually acquired by purposeful or accidental ingestion of infective larvae in terrestrial mollusks, planaria and fresh-water crustacea. There is no effective specific treatment. The African land snail, Achatina fulica played an important role in the panpacific dispersal of the organism: it will be important in Africa in the future as well. Rats were, and will continue to be the principal agents of expansion of the parasite beyond the Indopacific area. During and just after WWII the parasite was introduced, and/or spread passively from South and Southeast Asia into the Western Pacific islands and eastward and southward through Micronesia, Melanesia, Australia and into Polynesia, sequestered in shipments of war material and facilitated by post-war commerce. In the 1950s numerous cases were identified for the first time on Sumatra, the Philippines, Taiwan, Saipan, New Caledonia, and as far east as Rarotonga and Tahiti. Then cases were detected in Vietnam, Thailand, Cambodia, Java, Sarawak, the New Hebrides, Guam and Hawaii during the 1960s. Subsequently in the Pacific Basin the disease has appeared on Okinawa, other Ryukyu islands, Honshu, Kyushu, New Britain, American Samoa and Western Samoa, Australia, Hong Kong, Bombay, India, Fiji and most recently in mainland China. The parasite in rats now occurs throughout the Indopacific Basin and littoral. Beyond the Indopacific region, the worm has been found in rodents in Madagascar (ca 1963), Cuba (1973), Egypt (1977), Puerto Rico (1984), New Orleans, Louisiana (1985) and Port Harcourt, Nigeria (1989). Human infections have now been detected in Cuba (1973), Réunion Island (1974) and Côte d'Ivoire (1979) and should be anticipated wherever infected rats of mollusks have been introduced. Caged primates became infected in zoos in Hong Kong (1978) and New Orleans and Nassau, Bahamas (1987). The use of mollusks and crustacea as famine foods, favored delicacies and medicines has resulted in numerous outbreaks and isolated infections. Economic and political instability, illicit trade, unsanitary peridomestic conditions and lack of health education promote the local occurrence and insidious global expansion of parasitic eosinophilic meningitis.(ABSTRACT TRUNCATED AT 400 WORDS)
  15. Bin Juni MH
    Soc Sci Med, 1996 Sep;43(5):759-68.
    PMID: 8870140
    Within the current exercise of reforming the health care system, underlying all issues, is the reassessment of the role of government. It is a government's responsibility and concern that the health sector be accessible and equitable to the population, and more important that the health sector be more efficient and affordable. Many governments in the world attempt to provide universal health care services to their population through public health care provisions. This paper reviews and analyses the experience of the Malaysian health system, focusing on the performance of the system in relation to access and equity. The performance of the Malaysian health system has been impressive. At minimum cost it has achieved virtually accessible and equitable health care to the entire population. This is evident by analysing almost all the commonly used indicators. These clearly show that when matched to comparable countries, health outcome is even better than predicted value.
  16. Harkness S, Super CM
    Soc Sci Med, 1994 Jan;38(2):217-26.
    PMID: 8140448
    Recent efforts to promote child survival and development internationally have focused new attention on the importance of the household as a mediator of both environmental risks and programmatic interventions to promote better health. In this paper, we introduce a theoretical framework, the 'developmental niche,' derived from studies of children's behavior and development in different cultural contexts, as a tool for analyzing the household production of health. The developmental niche is conceptualized in terms of three basic components: (1) the physical and social settings of the child's everyday life; (2) culturally regulated customs of child care and child rearing; and (3) the psychology of the caretakers. The relevance of each of these components to the household production of health is illustrated through examples from research in several cultures, including Malaysia, Kenya, Bangladesh, India, and the U.S. Further discussion centers on three corollaries of the developmental niche framework that point to the interactive relationships among the three components, between the niche and the larger environment, and between the niche and the child (or any individual seen from a developmental perspective). It is suggested that this approach is useful for identifying and collecting relevant information on household-level factors that affect health outcomes, and thus for organizing more effective interventions. At a theoretical level, the developmental niche framework also facilitates understanding processes of mutual adaptation between the individual and the environment as they are filtered through the constraints of household settings, customs and caretaker psychologies.
  17. Barrett RJ, Lucas RH
    Soc Sci Med, 1994 Jan;38(2):383-93.
    PMID: 8140465
    Iban categories of hot and cold are examined in the context of humoral medical systems in southeast Asia. These categories are more than binary and oppositional: they are also contradictory and can only be understood in terms of their capacity for transformation in 'depth'. Analysis of the Iban epistemology of temperature sensation reveals the limitations of reductionist empirical approaches to hot and cold. Illness is apprehended, at one level, in terms of unusual conjunctions of opposite temperatures which signify a deeper disturbance in the relationship between body and soul, humans and spirits. Iban therapy redefines and relocates these categories in their proper place and at their appropriate level. It progresses from hot lay treatments to cool ritual treatments, yet cannot be accounted for within a limited framework of homeostatic balance. This paper develops an ethnographically grounded definition of humoralism which emphasizes non-reductive logic, cultural practice and transformation. The key element, transformation, is defined as a transition between categories and a shift in the level of interpretation which fundamentally alter the Iban experience of body and illness.
  18. Lonergan S, Vansickle T
    Soc Sci Med, 1991;33(8):937-46.
    PMID: 1745918
    Due to the increasingly documented prevalence of diarrhoeal diseases in Malaysia, a number of water-related programmes have been implemented in an attempt to improve health status through the reduction of incidence of waterborne communicable diseases associated with poor public water supplies. The implicit assumption underlying these projects is that the enhancement of the physical infrastructure, and subsequent improvements in the quality of the water supply, will substantially reduce water-related disease. The present study questions this hypothesis and uses a socio-ecological model as a framework to assess risk factors associated with the increased probability of waterborne disease. Research is centred on Port Dickson, a district which typifies existing water and sanitation conditions in much of semi-rural Malaysia. Health services utilization data and a 268-household diarrhoeal morbidity survey were used to measure the burden of illness of waterborne disease within the district and to identify predictors of morbidity. It was concluded that although treatment facilities will reduce the health burden in the region, a number of behavioural and sanitation factors may be more important and could act to minimize the potential impacts of improved water quality.
  19. Dentan RK
    Soc Sci Med, 1988;27(8):857-77.
    PMID: 3227382
    Semai descriptions of their beliefs about health and disease vary from person to person. Moreover, at different times the same person expresses mutually incongruent beliefs. This amorphousness and fluidity merit analysis rather than neatening. This paper details Semai beliefs, loose ends and all, and suggests that their formal peculiarities are due to the prevalence of synecdoche in conceptual organization. Their inconsistency and fluidity may stem from individualistic egalitarianism within Semai society and powerlessness in the face of nonSemai attack. Finally, it is suggested that construing indigenous medicine as a crude form of Western medicine leads to overtidiness and consequent error.
  20. Laderman C
    Soc Sci Med, 1988;27(8):799-810.
    PMID: 3227379 DOI: 10.1016/0277-9536(88)90232-8
    In comparing shamanistic healing with Western psychotherapy, the principal distinctions advanced by psychiatrists and psychologists have been: (1) that the shaman's patients receive 'remission without insight' while Western psychotherapy provides patients with a learning experience; and (2) that Western psychotherapy is based upon rational theory, whereas psychotherapeutic elements in shamanistic rituals are by-products of irrational magical activity. Anthropologists, on the other hand, have demonstrated the logic behind the shaman's seance, and its uses as a projective system which locates the patient's problems in external entities rather than within his own psyche. An investigation of the Malay shamanistic ritual (Main Peteri) expands the scope of discussion, since it reveals that embedded within this exorcistic spirit-raising seance is a nonprojective indigenous theory of psychic functioning, employing symbols internal to the patient, which is comparable to, and no more nor less rational than, mainstream Western theories.
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