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Fulltext Assessing the unmet needs among caregivers of children with disabilities at the community-based rehabilitation centres in Selangor

Suriati, S., Sharifah Zainiyah, S.Y., Lye, M.S., Norlijah, O.

Malaysian Journal of Public Health Medicine, 2011;11(2):32-40.
MyJurnal

Caregivers may experience the need for information, social support, a range of services and financial support in caring for children with disabilities. However, some of these needs are unmet. This study aims to determine the perceived unmet needs among caregivers of children with disabilities at the Community-based Rehabilitation centre (CBR). A cross-sectional study was carried out among a total of 337 caregivers, who were recruited from 12 CBR centres in Selangor. The unmet needs were assessed using Family Needs Survey (FNS) questionnaire, which included six subscales of needs such as need for information, social support, community services, explaining to others, financial support and family functioning. Caregivers identified the need for information that the child might receive in the future as their greatest need (94.4%) and the least was the need for getting more counseling or help in getting a job (16.3%). The mean score for the overall unmet needs was 18.67 (SD=7.623). Out of six subscales of FNS, the need for information had the highest rating which was 98.3%, followed by need for social support (93.4%), need for community services (84.0%), need for financial support (79.9%), need for family functioning (61.8%) and need for explaining to others (46.2%). The unmet needs varied within the subscales. Therefore, more effective intervention programs are needed in community-based rehabilitation centres to match or reduce those varied unmet needs in order to allow caregivers to provide better care for their children with disabilities.
A pitfall in diagnosis: endobronchial tuberculosis as a cause of acute on chronic stridor

Norlijah, O., Abu, M.N., Mohd Nor, A., Yip, C.W.

Malaysian Journal of Paediatrics and Child Health, 2007;15(1):33-36.
MyJurnal

Endobronchial tuberculosis is an uncommon manifestation involving the tracheobronchial tree. The clinical presentation is typically non-specific. We report this unusual complication of pulmonary tuberculosis initially diagnosed as foreign body in a 16-month-old child.
Paediatric invasive pneumococcal disease from two tertiary hospitals in Malaysia

Sithra R, Jeyaseelan N, Rohaiza B, Norlijah O

Med J Malaysia, 2020 01;75(1):57-61.
PMID: 32008022

INTRODUCTION: Invasive pneumococcal disease (IPD) a leading cause of death and morbidity in children below five-yearsold. This study aims to compare the varied presentation and clinical course of IPD in two different tertiary hospitals in Malaysia.
METHODOLOGY: A retrospective study of all positive Streptococcus pneumoniae isolates consistent with invasive disease from children below 14 years of age hospitalised in two tertiary hospitals; between year 2012 and 2016 was conducted. IPD cases were defined as isolates of S. pneumoniae from a normally sterile body fluid site.
RESULTS: Fifty-four patients were identified in both centres, 35 (65%) from HRPB as compared to 19 (35%) from HS. Majority of cases (14/35, 40 %) in HRPB were of Orang Asli in comparison to Malay children (16/19, 84%) in HS. Septicaemia, pneumonia and meningitis were the most common clinical presentation of IPD in both centres. There was a noticeably higher percentage of isolates found to be non-susceptible (NS) in HS (62.5%) as compared to HRPB (37.5%) although of no statistical significance. Mortality rate was higher in HRPB (26%) in comparison to 11% in HS.
CONCLUSION: This study highlighted the varied presentation of IPD in two different hospital settings. Although both deemed as urban centres, this study emphasises the importance of understanding socio-demography, health facility availability and primary care practices as it significantly alters the clinical course of a disease.
Fulltext Prevalence of needle stick injuries and compliance to infection control guidelines among health care workers in a teaching hospital, Malaysia

Hamid, M.Z.A., Aziz, N.A., Lim, W.B., Salleh, S.L.M., Anita, R., Rahman, S.N.S., et al.

Malaysian Journal of Medicine and Health Sciences, 2011;7(1):-.
MyJurnal

Health care workers (HCW) are constantly exposed to blood-borne illnesses through needle stick injuries (NSI). Despite the increasing trend of NSI, evidence regarding the actual practice of universal precautions among these HCWs is lacking. This study assessed the practice of universal precautions towards prevention of NSI among HCWs in a teaching hospital setting.
Methods: This cross-sectional survey involved a newly-designed self-completed questionnaire assessing demographic data, exposure to NSI and practice of universal precautions. Questionnaires were distributed to every ward and completed questionnaires were collected after a period of 7 days.
Results: A total of 215 HCWs responded to the survey. 35.8% were exposed to bodily fluid, with 22.3% had NSI in the last 12 months. Blood taking was the commonest procedure associated with NSI. Of practices of universal precautions, recapping needle and removing needle from syringe were still wrongly practiced by the HCWs assessed.
Conclusion: NSI among HCW are still common despite the introduction of universal precautions in our hospital. Incorrect practices in handling sharps should be looked into in order to reduce the incidence of blood-borne illnesses through NSI in the hospital.
Fulltext Obesity and associated health related factors among university staff in Serdang, Malaysia

Rampal, L., Saeedi, P., Aminizadeh Bazenjani, S., Salmiah, M.S., Norlijah, O.

Malaysian Journal of Medicine and Health Sciences, 2012;8(2):23-32.
MyJurnal

Obesity is a well-established risk factor for coronary heart disease, ischemic stroke, type 2 diabetes, cancers of the breast, colon, prostate and other organs. Objectives: To determine the prevalence of obesity and associated factors among university staffs. Methods: A cross sectional study was carried out among university staffs of University Putra Malaysia using a self-administered validated pre-tested questionnaire. Weight was measured using a digital bathroom scale (TANITA Model HD 319) and height was measured using a SECA Body Meter Model 206. Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m2). A p value of
Late onset group b beta-hemolytic streptococcus infection in a neonate manifesting as a urinary tract infection: a rare clinical presentation

Zurina Z, Rohani A, Neela V, Norlijah O

Southeast Asian J Trop Med Public Health, 2012 Nov;43(6):1470-3.
PMID: 23413711

Group B beta-hemolytic streptococcus (GBS) sepsis is a serious bacterial infection in neonates, with significant morbidity and mortality. We report here a neonate with late onset GBS infection manifesting as a urinary tract infection (UTI) in an infant presenting with prolonged neonatal jaundice. The pathogenesis of this late onset is postulated.
Fulltext Dapsone syndrome--first Malaysian paediatric case report

Zurina Z, Elizawaty O, Thevarajah S, Norlijah O

Med J Malaysia, 2012 Feb;67(1):105-7.
PMID: 22582558

Dapsone syndrome is a potentially fatal hypersensitivity reaction to sulphone. We report a 12-year-old girl who developed high grade fever associated with intense jaundice, exfoliative skin rash and hepatomegaly after five weeks of starting the multidrug regimen for the treatment of Hansen's disease. Laboratory investigations revealed presence of leucocytosis with eosinophilia, deranged liver enzymes and an abnormal coagulation profile. Immediate cessation of the offending drug and administration of steroid proved successful. A high level of clinical awareness is fundamental for early diagnosis of dapsone syndrome as initiation of a prompt treatment may lead to rapid recovery.
Fulltext Reliability and validity of the instrument used in the HELIC (healthy lifestyle in children) study of primary school children's nutrition knowledge, attitude and practice

Siti Sabariah, B., Zalilah, M.S., Norlijah, O., Normah, H., Maznah, I., Laily, P., et al.

Malays J Nutr, 2006;12(1):33-44.
MyJurnal

The objective of this paper is to report on the reliability and validity of a knowledge, attitude and practice instrument used among young primary school children. The instrument was developed as an evaluation tool in the HELIC study and consisted of 23 knowledge, 11 attitude and 10 practice items. A total of 335 Year 2 students from 4 randomly selected primary schools in Selangor and Wilayah Persekutuan participated in the HELIC study. Students were divided into small groups and an enumerator verbally administered the instrument to each group. Reliability for each construct (knowledge, attitude and practice) was estimated as item to total score correlation and internal consistency (Cronbach's alpha). Construct validity was determined through factor analysis and Pearson correlation. Results indicated that 3 attitude and 3 practice items did not correlate significantly to the total score (p>0.05). However, the deletion of these items did not significantly alter the Cronbach's alpha coefficients. Internal consistency was good for knowledge (a=0.68) but low for attitude (a=0.37) and practice (a=0.36) constructs. Based on factor analysis, 5 factor-solutions emerged for knowledge and 4 factor solutions for attitude and practice. Sufficient variance was obtained for the factors in knowledge (51.7%), attitude (51.2% and practice (51.0%). There were also significant positive correlations among the constructs ( ~ 4 . 0 1 ) . In conclusion, the instrument was valid and reliable, especially for the knowledge construct. Further improvements, particularly on the attitude and practice constructs, are needed in order for the instrument to be an effective assessment or evaluation tool in various settings.
Pneumococcal sepsis presenting as purpura fulminans in a healthy infant

Intan IH, Rozita AR, Norlijah O

Ann Trop Paediatr, 2009 Sep;29(3):235-8.
PMID: 19689868 DOI: 10.1179/027249309X12467994694139

The majority of cases of purpura fulminans are associated with Neisseria meningitidis sepsis. However, other bacteria, including Streptococcus pneumoniae, can also be the cause. Underlying predisposing conditions are immunodeficiencies and splenic dysfunction, the latter being the most frequent in the paediatric age group. Purpura fulminans secondary to pneumococcal sepsis in a healthy infant is described.
Fulltext Repeated tourniquet testing as a diagnostic tool in dengue infection

Norlijah O, Khamisah AN, Kamarul A, Mangalam S

Med J Malaysia, 2006 Mar;61(1):22-7.
PMID: 16708730 MyJurnal

Prospective evaluation of repeated standard tourniquet testing as a diagnostic indicator of dengue infection was done. Included were patients admitted to a children's hospital in Kuala Lumpur on a clinical suspicion of dengue infection based on the World Health Organization (WHO) criteria. A standard method of tourniquet was performed on 79 patients on a daily basis following admission. subjects and negative in the remaining 14 subjects. Fifty-eight subjects were serologically confirmed cases, 4 indeterminate and the remaining 17 subjects had negative serology. For diagnostic classification, 13 had dengue fever, 49 with dengue haemmorhagic fever (DHF) while 17 had non-dengue infection. The sensitivity and specificity of the tourniquet test was 82.8% and 23.5% respectively. The positive predictive value (PPV) was 78.7% while the negative predictive value (NPV) was 28.6%. In addition, the tourniquet test aided in the diagnosis of one-fifth of patients with DHF, who presented with a positive tourniquet test as the only bleeding manifestation. It seems that in a hospital setting, the tourniquet test adds little to the diagnosis of dengue infection/DHF. A positive tourniquet test, repeatedly performed, was found clinically useful as a preliminary screening test in dengue infection as recommended by WHO. However, it was not very specific and had a high false positive rate.
Fulltext Risk factors associated with incomplete immunisation in hospitalised infants

Norlijah O, Menon BS, Azlyna MYY

Med J Malaysia, 2005 Dec;60(5):563-9.
PMID: 16515106

To determine the immunisation status of hospitalised infants and to examine the potential risk factors associated with incomplete immunisation. Prospective study of infants admitted to a paediatric hospital in Kuala Lumpur, conducted by interviewing carers. Twenty-two percent of infants had incomplete immunisation. The most significant factor that was associated with incomplete immunisation was the carer's lack of knowledge on the timing of the next immunisation (p = 0.005). Other factors that had significant association were the presence of a previous admission to hospital (p = 0.03) and the infant's age of more than 6 months (p = 0.025). The rate of incomplete immunisation in the study population was 22%. An admission to hospital of an infant should be taken as an opportunity to update their immunisation in order to improve the rate of uptake.
Fulltext Subdural collections due to non-typhi Salmonella infections in two Malaysian children

Intan HI, Zubaidah CD, Norazah A, Norlijah O

Singapore Med J, 2008 Jul;49(7):e186-9.
PMID: 18695854

Subdural collections caused by Salmonella infection are rarely encountered in children. We present two cases caused by non-typhi Salmonella, one a four-and-a-half-month-old boy presenting with subdural effusion, and the other, a 16-month-old boy with empyema. The diagnosis was confirmed on blood and subdural pus cultures. One patient had status epilepticus following focal fit, and the other had prolonged fever without any localising signs of infection on admission. They responded well to prompt surgical drainage and prolonged systemic antibiotic therapy. Contrary to previous reports, both patients showed favourable outcome in terms of neurological sequelae.
Salmonella enteritidis ventriculitis

Johan AJ, Hung LC, Norlijah O

Southeast Asian J Trop Med Public Health, 2013 May;44(3):456-9.
PMID: 24050077

Salmonella sp are important causes of meningitis among neonates and young children in Malaysia. We present a case of Salmonella enteritidis meningitis in a six week old female who presented with a one week history of fever, diarrhea and seizures which was unsuccessfully treated with a third generation cephalosporin. She had a relapse of meningitis complicated with ventriculitis and hydrocephalus, requiring an eleven week course of meropenem. She improved clinically, but did not have improvement in the cerebrospinal fluid (CSF) glucose level despite prolonged antibiotic use. This case illustrates the dilemma in determining the duration of antibiotic needed to successfully treat Salmonella enteritidis ventriculitis.
Fulltext Immunisation status in hospitalised infants: reasons for incomplete immunisation

Norlijah O, Menon BS, Azlyna Nur Yanty MY, Noranida S

Malaysian Journal of Medicine and Health Sciences, 2005;1(1):51-59.

Objective: Immunisation is known to be an effective health intervention that protects children from infectious diseases. Of all children, infants are the most vulnerable if they experience a vaccine preventable disease. The aim of the study was to determine the immunisation status of hospitalised infants, to obtain the reasons of incomplete immunisation and to assess carers' knowledge on immunisation.
Methods: This was a cross-sectional study conducted in the Institute of Paediatrics at Hospital Kuala Lumpur over a 2-month period from June to August 2001. Data were collected through an interview using a structured questionnaire, with the carer of the infant. Questions pertaining to the immunisation status of the infant, reasons of incomplete immunisation and the carer's knowledge of immunisation were assessed.
Results: 115 infants were admitted during the study period; however, only 100 carers of the infants were available for an interview. The average age of the infants was 5.7 months. 22% of the infants had incomplete immunisation. 64% of them had missed more than one vaccine. The commonest missed vaccine was the 3'4 dose of diptheria-pertussistetanus (DP1) and polio vaccine. Reasons of incomplete immunisation include misconception on contraindication of immunisation perceived by both parents and health providers, missed appointment and communication breakdown with health facilities regarding appointment dates. The under-immunisation rate in the study population was 22%. The underimmunisation rate in the study population was 22%.
Conclusion: Health providers and the public need to be educated on the importance of immunisation and the associated valid contraindications.
Keywords: Infants, carer, under-immunisation, incomplete immunisation
Knowledge of blood-borne infectious diseases and the practice of universal precautions amongst health-care workers in a tertiary hospital in Malaysia

Hamid MZ, Aziz NA, Anita AR, Norlijah O

Southeast Asian J Trop Med Public Health, 2010 Sep;41(5):1192-9.
PMID: 21073041

This study aimed to assess the knowledge of blood-borne diseases transmitted through needle stick injuries amongst health-care workers in a tertiary teaching hospital. We also aimed to assess the practices of universal precautions amongst these workers and its correlation with the facts. We carried out a cross-sectional study from January to July 2008 involving various levels of health-care workers in Serdang Hospital, Selangor, Malaysia. A self-administered questionnaire assessing knowledge of blood-borne diseases and universal precautions, and actual practice of universal precautions was used. Two hundred fifteen respondents participated in this study; 63.3% were staff nurses. The mean knowledge score was 31.84 (SD 4.30) and the mean universal practice score was 9.0 (SD 2.1). There was a small, positive correlation between knowledge and actual practice of universal precautions (r = 0.300, n = 206, p < 0.001) amongst the cohort studied. Factors such as age and years of experience did not contribute towards acquisition of knowledge about blood-borne illnesses or the practice of universal precautions.
Clinical features and risk factors for HIV encephalopathy in children

Hamid MZ, Aziz NA, Zulkifli ZS, Norlijah O, Azhar RK

Southeast Asian J Trop Med Public Health, 2008 Mar;39(2):266-72.
PMID: 18564712

A prospective cohort study was conducted to determine the incidence of progressive encephalopathy (PE) and its associated clinical manifestations amongst a cohort of HIV infected children attending the HIV/AIDS clinic of the Pediatric Institute, Kuala Lumpur Hospital, Malaysia. Neurological and neurobehavioral assessments were performed in 55 children with HIV over a 24-month study period. Parameters assessed were physical and neurological assessments, CD4 counts, CD4 percentages, RNA viral loads and an IQ assessment at four monthly intervals. PE was diagnosed when patient developed at least one of the definitive criteria for PE based on the Consensus of Pediatric Neurology/Psychology Working Group, AIDS Clinical Trial 1996. The incidence of encephalopathy was 18.2% (n = 10) in 2002. All the patients had hepatosplenomegaly, lymphadenopathy, abnormal deep tendon reflexes and five had impairment in brain growth. The CD4 counts and CD4 percentages were more likely to be associated with PE compared to the non-PE group.
Near miss diagnosis of childhood tuberculosis

Norlijah O, Intan HI, Feizel AM, Kasim MS, Noh LM

Southeast Asian J Trop Med Public Health, 2006 Sep;37(5):953-7.
PMID: 17333739

Tuberculosis (TB) remains a public health problem in Malaysia. We describe three atypical cases of serious tuberculosis in children. The potential diagnostic pitfall in these cases is highlighted by its unusual presentation in a setting of culture-negative infection. A positive polymerase chain reaction (PCR) in each case assists in gauging the diagnosis in concordance with appropriate clinical findings.
Fulltext Deaths in children during an outbreak of hand, foot and mouth disease in Peninsular Malaysia--clinical and pathological characteristics

Shekhar K, Lye MS, Norlijah O, Ong F, Looi LM, Khuzaiah R, et al.

Med J Malaysia, 2005 Aug;60(3):297-304.
PMID: 16379183

From July through December 1997, 11 previously healthy children in Peninsular Malaysia succumbed to an illness clinically characterised by an acute severe refractory left-ventricular failure, following a brief prodromal illness, in the midst of an outbreak of hand, foot and mouth disease (HFMD), similar to the reported experience in Sarawak and Taiwan. Retrospective reviews of the clinical features and results of laboratory, pathological and virological investigations of cases were conducted. The median age of the 11 case-patients was 31 months (range, 13 to 49 months); 6 were males. A brief prodromal illness of 3 days (range, 2 to 5 days) was characterised by fever (axillary temperature > 38 degrees C) (100%), oral ulcers (72%), extremity rashes (45%) and significant vomiting (55%). Upon hospitalisation, 7 of 11 case-patients had features suggestive of cardiogenic shock, while 4 of 11 case-patients developed shock during hospitalisation as evidenced by marked sustained tachycardia (heart rate > or = 180 beats per minute), poor peripheral pulses and peripheral perfusion, mottled extremities, pulmonary oedema (haemorrhagic pulmonary secretions in 8 of 11 cases during tracheal intubation, often precipitated by conservative crystalloid boluses, and radiographic evidence of acute pulmonary oedema in 5 of 7 cases) and markedly impaired left ventricular function on echocardiographic examination (7 of 7 cases). Three of 4 case-patients had aseptic meningitis while one case-patient also had an acute flaccid paraparesis. Despite supportive therapy, death occurred within a median of 13.4 hours following hospitalization. Post-mortem findings (all 8 specimens examined) consistently demonstrated brain-stem encephalitis with foci of neuronal necrosis and micro-abscesses. None of the 11 specimens examined revealed histological evidence of myocarditis. Enterovirus 71 (EV71) was detected in 10 of 11 case-patients, many (7) from various sterile tissue sites (5 from central nervous tissues). No other viruses were isolated or identified. Clinical features and pathological studies closely paralleled the reported experience in Sarawak and Taiwan. The uniform necropsy findings of necrotizing brain-stem encephalitis coupled with essentially normal myocardial histology, in concert with the concurrent and consistent detection of EV71 points to a primary EV71 encephalitis; as yet unclear neurogenic mechanisms may account for the cardiovascular manifestations.

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