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  1. van der Eng P, Sohn K
    Econ Hum Biol, 2019 08;34:216-224.
    PMID: 30551996 DOI: 10.1016/j.ehb.2018.11.004
    This article analyses long-term changes in the mean age at menarche (MAM) as a biological indicator of changes in the standard of living in Indonesia. It finds that MAM was about 15.5 for birth cohorts in the late-19th century, decreasing to 14.5 by the 1930s, at which level it stagnated until the gradual decrease resumed since the early 1960s to around 12.5 in the mid-2000s. The article considers that long-term improvements in nutrition, educational attainment and health care explain these trends. An international comparison of long-term changes finds that MAM in Indonesia was much lower than in Korea and China until respectively 1970 and 1990, but comparable to Japan until 1950 and to Malaysia until 1930. The article presents reasons why these differences are unlikely to be related to dissimilarities in climate and ethnicity, and concludes that they are indicative of relative standards of living.
    Matched MeSH terms: Health Services Accessibility/statistics & numerical data
  2. Schaubel DE, Stewart DE, Morrison HI, Zimmerman DL, Cameron JI, Jeffery JJ, et al.
    Arch. Intern. Med., 2000 8 6;160(15):2349-54.
    PMID: 10927733 DOI: 10.1001/archinte.160.15.2349
    BACKGROUND: Men in the United States undergoing renal replacement therapy are more likely than women to receive a kidney transplant. However, the ability to pay may, in part, be responsible for this finding.

    OBJECTIVE: To compare adult male and female transplantation rates in a setting in which equal access to medical treatment is assumed.

    METHODS: Using data from the Canadian Organ Replacement Register, the rate of first transplantations was computed for the 20, 131 men and the 13,458 women aged 20 years or older who initiated renal replacement therapy between January 1, 1981, and December 31, 1996. Poisson regression analysis was used to estimate the male-female transplantation rate ratio, adjusting for age, race, province, calendar period, underlying disease leading to renal failure, and dialytic modality. Actuarial survival methods were used to compare transplantation probability for covariable-matched cohorts of men and women.

    RESULTS: Men experienced 20% greater covariable-adjusted kidney transplantation rates relative to women (rate ratio, 1.20; 95% confidence interval, 1.13-1.27). The sex disparity was stronger for cadaveric transplants (rate ratio, 1.23) compared with those from living donors (rate ratio, 1.10). The 5-year probability of receiving a transplant was 47% for men and 39% for women within covariable-matched cohorts (P
    Matched MeSH terms: Health Services Accessibility/statistics & numerical data
  3. Kosiyaporn H, Julchoo S, Phaiyarom M, Sinam P, Kunpeuk W, Pudpong N, et al.
    Glob Health Res Policy, 2020 12 08;5(1):53.
    PMID: 33372646 DOI: 10.1186/s41256-020-00181-0
    BACKGROUND: In addition to healthcare entitlements, 'migrant-friendly health services' in Thailand include interpretation and cultural mediation services which aim to reduce language and cultural barriers between health personnel and migrants. Although the Thai Government started implementing these services in 2003, challenges in providing them still remain. This study aims to analyse the health system functions which support the interpretation and cultural mediation services of migrant health worker (MHW) and migrant health volunteer (MHV) programmes in Thailand.

    METHODS: In-depth interviews were conducted in two migrant-populated provinces using purposive and snowball sampling. A total of fifty key informants were recruited, including MHWs, MHWs, health professionals, non-governmental organisation (NGO) staff and policy stakeholders. Data were triangulated using information from policy documents. The deductive thematic analysis was classified into three main themes of evolving structure of MHW and MHV programmes, roles and responsibilities of MHWs and MHVs, and supporting systems.

    RESULTS: The introduction of the MHW and MHV programmes was one of the most prominent steps taken to improve the migrant-friendliness of Thai health services. MHWs mainly served as interpreters in public facilities, while MHVs served as cultural mediators in migrant communities. Operational challenges in providing services included insufficient budgets for employment and training, diverse training curricula, and lack of legal provisions to sustain the MHW and MHV programmes.

    CONCLUSION: Interpretation and cultural mediation services are hugely beneficial in addressing the health needs of migrants. To ensure the sustainability of current service provision, clear policy regulation and standardised training courses should be in place, alongside adequate and sustainable financial support from central government, NGOs, employers and migrant workers themselves. Moreover, regular monitoring and evaluation of the quality of services are recommended. Finally, a lead agency should be mandated to collaborate with stakeholders in planning the overall structure and resource allocation for the programmes.

    Matched MeSH terms: Health Services Accessibility/statistics & numerical data*
  4. Aidalina M, Syed Mohamed ASJ
    Med J Malaysia, 2018 08;73(4):202-211.
    PMID: 30121682 MyJurnal
    INTRODUCTION: This review aimed to summarise the trend of mammogram screening uptake published in local studies between years 2006 and 2015 among the Malaysian women aged 40 years and above, and identify the associated factors and barriers, as well as discuss limitations of the studies and research gaps.

    METHODS: A systematic review was conducted on breast cancer screening studies among Malaysian women, published between January 2006 and December 2015. Online databases were searched using keywords: "mammogram", "mammography", "uptake", "breast cancer screening" and "Malaysia".

    RESULTS: Thirteen original articles were reviewed. The rate of mammography uptake ranged between 3.6% and 30.9% among the general population, and 80.3% among personnel of a tertiary hospital. Factors associated with mammogram screening were clinical breast examination, age, income, knowledge on breast cancer and mammogram, perceived susceptibility to breast cancer, ethnicity and education level. Barriers to mammogram screening were lack of knowledge, embarrassment, fear of cancer diagnosis, perception that breast screening was unnecessary, lack of coping skills and pain during procedure. However, almost all of the studies could not be generalised beyond the study sample because of the limited number of sites and respondents; and most data were self-reported with no objective measures of the responses.

    CONCLUSION: Mammogram screening uptake among women in selected communities were generally low. Further studies involving the general population are essential. Future studies should also explore the availability, affordability and accessibility of this service especially in the pursuit of achieving universal health coverage in breast cancer management.

    Matched MeSH terms: Health Services Accessibility/statistics & numerical data
  5. Chuah FLH, Tan ST, Yeo J, Legido-Quigley H
    Int J Equity Health, 2018 08 15;17(1):120.
    PMID: 30111329 DOI: 10.1186/s12939-018-0833-x
    BACKGROUND: In Malaysia, refugees and asylum-seekers are a vulnerable group that often face circumstances in which their health and wellbeing can be compromised. This qualitative study sought to examine the key health concerns and barriers to healthcare access among refugees and asylum-seekers in Malaysia through the lens of healthcare professionals, program staff and experts on refugee and migrant health.

    METHODS: We conducted 20 semi-structured in-depth interviews with experts, healthcare professionals, program managers or executives from UN agencies, public healthcare facilities, civil society organizations, and academic institutions in Malaysia. Interviews were transcribed and analyzed both deductively and inductively using thematic analysis.

    RESULTS: Participant narratives highlight that the health needs of refugees and asylum-seekers in Malaysia are complex. As reported, access to healthcare is underpinned by numerous social, cultural and economic determinants compounded by a legal environment that lacks inclusivity of refugees and asylum-seekers. Apart from the health risks associated with the migration process, limited access to comprehensive healthcare post-arrival remain a problem for refugees and asylum-seekers in Malaysia. Key barriers to healthcare access are linked to poor health literacy and the lack of awareness on one's right to healthcare; language and cultural differences; protection issues resulting from a lack of legal status; and an inability to afford healthcare due to inadequate livelihoods. Overall, poor access to healthcare is perceived to have detrimental consequences on the health status of refugees, asylum-seekers and its host population, and may incur greater costs to the health system in the long run.

    CONCLUSION: Comprehensive efforts in practice and research that tackle the social, cultural and economic determinants of health, and more inclusive health policies are crucial in strengthening healthcare access among refugees and asylum-seekers in Malaysia. Practical recommendations include improving the health literacy of refugees and asylum-seekers for better navigation of the health system; bridging language and cultural gaps through translation support and inter-cultural orientation; implementing policies grounded in the right to healthcare for all regardless of legal status and in the interest of public health; and establishing a larger evidence base to drive policy development and implementation for refugee health within the Malaysian context.

    Matched MeSH terms: Health Services Accessibility/statistics & numerical data*
  6. Ansari M, Ibrahim MI, Hassali MA, Shankar PR, Koirala A, Thapa NJ
    BMC Res Notes, 2012;5:576.
    PMID: 23095352 DOI: 10.1186/1756-0500-5-576
    In developing countries, mothers usually manage diarrhea at home with the pattern of management depending on perceived disease severity and beliefs. The study was carried out with the objective of determining mothers' beliefs and barriers about diarrhea and its management.
    Matched MeSH terms: Health Services Accessibility/statistics & numerical data
  7. Rhi BY, Ha KS, Kim YS, Sasaki Y, Young D, Woon, et al.
    Int J Soc Psychiatry, 1995;41(3):190-209.
    PMID: 8847200
    The patterns of health care seeking behavior of 1061 schizophrenics and the factors that affect the determination of the patterns were studied in 6 areas of 5 nations in east Asia: Hunan and Sichuan Provinces in China, Japan, Korea, Malaysia and the Philippines. The information was gathered through a structured questionnaire developed by the authors. The subjects generally favored psychiatry-oriented health care, but with frequent interruptions or combination with other types of managements. Most Japanese subjects sought care in western medicine, while subjects from Hunan, Sichuan and Korea alternated between western medicine and magicoreligious therapies or traditional herbal medicine. In the Philippines and Malaysia, the majority of the subjects sought magicoreligious therapies first, then later sought western psychiatric care. The choice of western psychiatric care was mostly influenced by the decision maker's knowledge and interpretation of the patient's illness. In determining the choice of management among various types of non-psychiatric management, cost, location, and societal attitudes played substantial roles as well as knowledge and interpretation. Suggestions and opinions were discussed to improve health care services for schizophrenic patients in each community.
    Matched MeSH terms: Health Services Accessibility/statistics & numerical data
  8. Wong WJ, Mosiun JA, Hidayati Z, Balkis R, Sharif SZ, Lee D, et al.
    Breast, 2019 Aug;46:136-143.
    PMID: 31176055 DOI: 10.1016/j.breast.2019.05.016
    INTRODUCTION: Breast-conserving surgery (BCS) with radiation therapy is the procedure of choice for early-stage breast cancer. Survival and locoregional recurrence is non-inferior to mastectomy, with superior cosmetic and psycho-social outcomes. Differing health systems have demonstrated a wide variation in the rate of BCS. Little is known about the rate of BCS and factors influencing its practice in middle resource countries. This study aims to examine the BCS rates in Malaysia and to identify factors influencing its uptake.

    METHODOLOGY: This is a multi-centre, cross-sectional study involving the University of Malaya Medical Centre (UMMC), Queen Elizabeth II Hospital (QEH), and Tengku Ampuan Rahimah Hospital (TARH). Patients diagnosed with invasive breast cancer from January 2014 to December 2015 were included, excluding stromal cancers and lymphomas. Univariate and multivariate analyses identified factors influencing BCS.

    RESULTS: A total of 1005 patients were diagnosed with breast cancer in the allocated time frame. Excluding incomplete records and those who did not have surgery, 730 patients were analysed. Overall BCS rate was 32.9%. The BCS rate was highest at QEH (54.1%), followed by UMMC (29.5%), and TARH (17.4%). 16.9% had BCS after neoadjuvant therapy. Factors influencing BCS uptake included age, ethnic group, breast-surgeon led services, AJCC Stage, tumour size, HER-2 expression, and tumour grade.

    CONCLUSIONS: The rate of BCS in Malaysia is low. A wide variation of rate exists among the studied hospitals. Younger age, earlier AJCC stage, and the presence of a Breast sub-specialist surgeon, would make it more likely that the patient has her breast conserved.

    Matched MeSH terms: Health Services Accessibility/statistics & numerical data
  9. Almualm Y, Alkaff SE, Aljunid S, Alsagoff SS
    Glob J Health Sci, 2013 May 14;5(5):1-10.
    PMID: 23985101 DOI: 10.5539/gjhs.v5n5p1
    This study was carried out to determine the level of support towards the proposed National Health Insurance scheme among Malaysian patients attending specialist clinics at the National University of Malaysia Medical centre and its influencing factors. The cross sectional study was carried out from July-October 2012. 260 patients were selected using multistage sampling method. 71.2% of respondents supported the proposed National Health insurance scheme. 61.4% of respondents are willing to pay up to RM240 per year to join the National Health Insurance and 76.6% of respondents are of the view that enrollment in NHI should be made compulsory. Knowledge had a positive influence on respondent's support towards National Health Insurance. National Health Insurance when implemented in Malaysia can be used to raise funds for health care financing, increase access to health services and achieve the desired health status. More efforts should be taken to promote the scheme and educate the public in order to achieve higher support towards the proposed National Health Insurance. The cost to enroll in NHI as well as services to be included under the scheme should be duly considered.
    Matched MeSH terms: Health Services Accessibility/statistics & numerical data
  10. Gibson BA, Ghosh D, Morano JP, Altice FL
    Health Place, 2014 Jul;28:153-66.
    PMID: 24853039 DOI: 10.1016/j.healthplace.2014.04.008
    We mapped mobile medical clinic (MMC) clients for spatial distribution of their self-reported locations and travel behaviors to better understand health-seeking and utilization patterns of medically vulnerable populations in Connecticut. Contrary to distance decay literature, we found that a small but significant proportion of clients was traveling substantial distances to receive repeat care at the MMC. Of 8404 total clients, 90.2% lived within 5 miles of a MMC site, yet mean utilization was highest (5.3 visits per client) among those living 11-20 miles of MMCs, primarily for those with substance use disorders. Of clients making >20 visits, 15.0% traveled >10 miles, suggesting that a significant minority of clients traveled to MMC sites because of their need-specific healthcare services, which are not only free but available at an acceptable and accommodating environment. The findings of this study contribute to the important research on healthcare utilization among vulnerable population by focusing on broader dimensions of accessibility in a setting where both mobile and fixed healthcare services coexist.
    Matched MeSH terms: Health Services Accessibility/statistics & numerical data*
  11. TREAT Asia Pediatric HIV Observational Database (TApHOD), International Epidemiologic Databases to Evaluate AIDS (IeDEA) Southern Africa Paediatric Group
    J Int AIDS Soc, 2011 Feb 09;14:7.
    PMID: 21306608 DOI: 10.1186/1758-2652-14-7
    BACKGROUND: To better understand the need for paediatric second-line antiretroviral therapy (ART), an ART management survey and a cross-sectional analysis of second-line ART use were conducted in the TREAT Asia Paediatric HIV Observational Database and the IeDEA Southern Africa (International Epidemiologic Databases to Evaluate AIDS) regional cohorts.

    METHODS: Surveys were conducted in April 2009. Analysis data from the Asia cohort were collected in March 2009 from 12 centres in Cambodia, India, Indonesia, Malaysia, and Thailand. Data from the IeDEA Southern Africa cohort were finalized in February 2008 from 10 centres in Malawi, Mozambique, South Africa and Zimbabwe.

    RESULTS: Survey responses reflected inter-regional variations in drug access and national guidelines. A total of 1301 children in the TREAT Asia and 4561 children in the IeDEA Southern Africa cohorts met inclusion criteria for the cross-sectional analysis. Ten percent of Asian and 3.3% of African children were on second-line ART at the time of data transfer. Median age (interquartile range) in months at second-line initiation was 120 (78-145) months in the Asian cohort and 66 (29-112) months in the southern African cohort. Regimens varied, and the then current World Health Organization-recommended nucleoside reverse transcriptase combination of abacavir and didanosine was used in less than 5% of children in each region.

    CONCLUSIONS: In order to provide life-long ART for children, better use of current first-line regimens and broader access to heat-stable, paediatric second-line and salvage formulations are needed. There will be limited benefit to earlier diagnosis of treatment failure unless providers and patients have access to appropriate drugs for children to switch to.

    Matched MeSH terms: Health Services Accessibility/statistics & numerical data*
  12. Martis R, Ho JJ, Crowther CA, SEA-ORCHID Study Group
    PMID: 18680603 DOI: 10.1186/1471-2393-8-34
    Evidence-based practice (EBP) can provide appropriate care for women and their babies; however implementation of EBP requires health professionals to have access to knowledge, the ability to interpret health care information and then strategies to apply care. The aim of this survey was to assess current knowledge of evidence-based practice, information seeking practices, perceptions and potential enablers and barriers to clinical practice change among maternal and infant health practitioners in South East Asia.
    Matched MeSH terms: Health Services Accessibility/statistics & numerical data*
  13. Asawa K, Bhanushali NV, Tak M, Kumar DR, Rahim MF, Alshahran OA, et al.
    Rocz Panstw Zakl Hig, 2015;66(3):275-80.
    PMID: 26400125
    Oral health care services are often sparse and inconsistent in India therefore it is often difficult for poor people to get access to the oral health care services. The approach by dental institutions with the help of community outreach programs is a step ahead in overcoming this situation.
    Matched MeSH terms: Health Services Accessibility/statistics & numerical data*
  14. Loganathan T, Chan ZX, de Smalen AW, Pocock NS
    PMID: 32722563 DOI: 10.3390/ijerph17155376
    Providing sexual and reproductive health (SRH) services to migrant workers is key to fulfilling sustainable developmental goals. This study aims to explore key informants' views on the provision of SRH services for migrant women in Malaysia, exploring the provision of SRH education, contraception, abortion, antenatal and delivery, as well as the management of gender-based violence. In-depth interviews of 44 stakeholders were conducted from July 2018 to July 2019. Data were thematically analysed. Migrant workers that fall pregnant are unable to work legally and are subject to deportation. Despite this, we found that insufficient SRH information and contraceptive access are provided, as these are seen to encourage promiscuity. Pregnancy, rather than sexually transmitted infection prevention, is a core concern among migrant women, the latter of which is not adequately addressed by private providers. Abortions are often seen as the only option for pregnant migrants. Unsafe abortions occur which are linked to financial constraints and cultural disapproval, despite surgical abortions being legal in Malaysia. Pregnant migrants often delay care-seeking, and this may explain poor obstetric outcomes. Although health facilities for gender-based violence are available, non-citizen women face additional barriers in terms of discrimination and scrutiny by authorities. Migrant women face extremely limited options for SRH services in Malaysia and these should be expanded.
    Matched MeSH terms: Health Services Accessibility/statistics & numerical data*
  15. Schröeder SE, Pedrana A, Scott N, Wilson D, Kuschel C, Aufegger L, et al.
    Liver Int, 2019 10;39(10):1818-1836.
    PMID: 31433902 DOI: 10.1111/liv.14222
    Viral hepatitis is a leading cause of morbidity and mortality worldwide, but has long been neglected by national and international policymakers. Recent modelling studies suggest that investing in the global elimination of viral hepatitis is feasible and cost-effective. In 2016, all 194 member states of the World Health Organization endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, but complex systemic and social realities hamper implementation efforts. This paper presents eight case studies from a diverse range of countries that have invested in responses to viral hepatitis and adopted innovative approaches to tackle their respective epidemics. Based on an investment framework developed to build a global investment case for the elimination of viral hepatitis by 2030, national activities and key enablers are highlighted that showcase the feasibility and impact of concerted hepatitis responses across a range of settings, with different levels of available resources and infrastructural development. These case studies demonstrate the utility of taking a multipronged, public health approach to: (a) evidence-gathering and planning; (b) implementation; and (c) integration of viral hepatitis services into the Agenda for Sustainable Development. They provide models for planning, investment and implementation strategies for other countries facing similar challenges and resource constraints.
    Matched MeSH terms: Health Services Accessibility/statistics & numerical data*
  16. Lai SL, Tey NP, Mahmud A, Ismail N
    Int Q Community Health Educ, 2021 Jul;41(4):395-403.
    PMID: 33167794 DOI: 10.1177/0272684X20972864
    BACKGROUND: The private sector is playing an increasingly important role in family planning services globally. The active participation of private providers is associated with a higher contraceptive prevalence rate.

    OBJECTIVES: To examine the differentials and determinants of the utilization of private providers for family planning services.

    METHOD: This study used the 2014 Malaysian Population and Family Survey data. Cross-tabulations and logistic regression were performed on 1,817 current users of modern methods.

    RESULTS: Overall, 26% of modern method users obtained their supplies from private clinics/pharmacies and 15.2% from other sources, such as drug stores and sundry shops. The odds of utilizing the private sector for family planning services differ significantly across regions and socio-economic groups. The odds of obtaining supply from the private clinics/pharmacies were higher among the Chinese and urban women (AOR > 1), and it was lower among those from the eastern region (AOR = 0.47, 95% CI = 0.30-0.73). Non-Bumiputera, urban, higher educated, and working women, and those whose husbands decided on family planning had higher odds of obtaining the supply from the other sources (AOR > 1).

    CONCLUSION: The private sector complements and supplements the public sector in providing family planning services to the public.

    Matched MeSH terms: Health Services Accessibility/statistics & numerical data*
  17. Khan MU, Ahmad A, Salman S, Ayub M, Aqeel T, Haq NU, et al.
    J Relig Health, 2017 Apr;56(2):635-648.
    PMID: 27640195 DOI: 10.1007/s10943-016-0308-6
    Pakistan is one of the two countries where polio remains endemic. Among multiple reasons of polio prevalence, false religious beliefs are accounted as major barriers towards polio immunization in Pakistan. Within this context, religious scholars are now engaged in polio immunization campaigns to dismantle the myths and battle the resurgence of polio in Pakistan. The objective of this study was to assess knowledge, attitudes and perceived barriers of Muslim scholars towards polio immunization in Pakistan. A descriptive, cross-sectional survey of Muslim scholars was conducted in Quetta and Peshawar divisions of Pakistan. From October to December 2015, a convenience sample of 770 Muslim scholars was recruited from the local mosques and religious institutions to participate in this study. Knowledge, attitudes, and perceived barriers were assessed by using self-administered, anonymous and pretested questionnaire. Descriptive and regression analyses were used to express the results with p 
    Matched MeSH terms: Health Services Accessibility/statistics & numerical data*
  18. Razali SM, Mohd Yasin MA
    Epilepsy Behav, 2008 Aug;13(2):343-9.
    PMID: 18514034 DOI: 10.1016/j.yebeh.2008.04.009
    The objective of this study was to describe and compare the pathways followed by Malay patients with psychoses (schizophrenia and schizophreniform disorder) and Malay patients with epilepsy to a tertiary health center in the northeastern area of peninsular Malaysia. There were 60 patients in each group. The most popular pathway for both groups was first contact with traditional or alternative healers. Consultation with Malay traditional healers (bomohs) and/or homeopathic practitioners (44.2%) was significantly higher for psychotic patients (61.7%) than for patients with epilepsy (26.7%) (chi(2)(2)=15.609, P<0.001). Direct access (24.2%) was the second most popular pathway and almost equally followed by both groups of patients. The third and last pathway was initial contact with private general practitioners and government doctors, respectively. Patients with epilepsy dominated the last two pathways. The treatment delay (TD) was significantly longer in epileptic than psychotic patients regardless of their visit to a bomoh and/or homeopathic practitioner (P<0001) or not (p<0.01). The socioeconomic status of psychotic patients also was significantly better than people with epilepsy (chi(2)=9.957, chi(2)(4), p=0.041).

    Study site: Psychiatric clinic, Hospital Universiti Sains Malaysia HUSM
    Matched MeSH terms: Health Services Accessibility/statistics & numerical data
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