Prospective Memory (PM) is a cognitive function affected by aging. PM is the memory of future intentions and is significantly involved in everyday life, especially among older adults. Nevertheless, there are a few studies focused on PM training among healthy older adults and these studies did not report the optimal duration of training regarding improving PM performance among older adults. The present study aimed to determine the effective duration for training PM performance among healthy older adults. The current study was a randomized, controlled, single-blind, within-participants crossover trial including a training program with a duration of 12 h. The sample of 25 older adults aged 55 to 74 years recruited from the active members of the University of the Third Age (U3A), Kuala Lumpur/Selangor, their family members, and friends. The study design ensured some participants would receive the training after baseline while others would wait for 6 weeks after the baseline before receiving the training. All participants were evaluated five times: at baseline, 6, 12, 16, and at 24 weeks post-baseline. Moreover, the training program ensured all participants were assessed after each training session. The minimum number of hours to achieve training effects for this multi-component training program was eight. Results supported the efficacy of the training program in improving PM performance among healthy older adults. Also, the optimal duration for the multicomponent training program on PM performance among healthy older adults was obtained. This trial is registered at isrctn.com (#ISRCTN57600070).
Deterioration in muscle mass and muscle strength is common among the frail older persons, cause functional dependence and decrease in the quality of life. Therefore, the identification of cost-effective interventions to prevent or ameliorate frailty is crucially needed. The aim of this study is to determine the effectiveness of a Community-based Muscle Strengthening Exercise (COME) program to increase muscle strength among pre-frail older persons. This study was a quasi-experimental study. A total of 32 older persons aged 60 years and older with pre-frail symptoms were recruited from the community center. The COME was developed based on the Growing Stronger program and the Otago Home Exercise Program. COME was designed to strengthen all of the major muscle groups in the upper and lower extremities. The exercise program was conducted for 12 weeks and divided into 3 parts; (1) to strengthen the body slowly and gently, using only body weight, (2) to introduce dumbbells and ankle weights to increase strength and (3) to add various new ways to boost strength even more. Functional tests were measured before and after the intervention. The results revealed non-significant p-value for pre- and post-intervention comparison for all study outcomes. Observing the values of mean difference, the study intervention was shown to have slightly improved the time up and go (Mean difference = -0.25), and sit-to-stand duration (Mean difference = -0.41) as well as the handgrip strength (Mean difference = 0.68) among the participants. On the assessment of Cohen ES, all three improvements exhibited small effect sizes. Sit-to-stand duration was shown to have most benefited from the intervention with highest ES among the outcome variables (ES = 0.20). COME intervention program among pre-frail older persons showed favorable trend toward improvement of upper and lower extremities muscle strength. This study should be further tested in randomized control trial to confirm its effectiveness.
This study investigates the asymmetric effects of business cycles (measured by real GDP per capita) on population health (measured by life expectancy at birth) from the ASEAN countries, namely, Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam. The panel vector error correction model, together with various panel unit root tests and cointegration tests, suggested a hidden cointegrated relationship between life expectancy at birth and the positive and negative components of real GDP per capita, and the asymmetric effects of business cycles on population health were identified in both in the short run and in the long run. Policymakers should focus on the harmful effects of business cycles on population health, and government interventions should be more forceful in times of economic expansion than during periods of economic recession.
Objectives: To determine the temporal relationship between the presence of knee pain and knee pain severity identified at baseline with fall risk, fear of falling and changes in instrumental activity of daily living at 12-months follow-up. Methods: This was a prospective study from the Malaysian Elders Longitudinal Research (MELoR) study involving community dwelling older persons aged 55 years and older. The presence of one fall in the preceding 12 months, knee pain, and functional capacity were determined at baseline (2013-2015) and follow-up (2015-2016). Function was determined as loss of at least one of seven instrumental activities of daily living (IADL). Physical performance was evaluated at baseline using the timed-up-and-go (TUG) test. Fear of falling (FoF) was determined using the single question "Are you afraid of falling?" Results: Data were available for 605 participants, mean (SD) age = 69.10 (7.24) years. Knee pain was present in 30.2% at baseline. Neither the presence of knee pain nor knee pain severity at baseline were associated with falls at 1-year follow-up. Knee pain was significantly associated with FoF at follow-up [aRR (95%CI) = 1.76 (1.02-3.04)] but not changes in IADL. Among individuals with no falls at baseline, the presence of knee pain was protective of falls at follow-up after adjustment for baseline physical performance [adjusted rate ratio, aRR (95% confidence interval, CI) = 0.35 (0.13-0.97)]. Conclusion: Knee pain is associated with increased FoF at 1.5 years' follow-up within a multi-ethnic population aged 55 years, residing in an urban location in a middle-income South East Asian nation. Interestingly, after differences in muscle strength was accounted for, knee pain was protective against falls at follow-up. Our findings challenge previous assumptions on joint pain and falls and highlights the importance of large prospective studies and further mechanistic research incorporating psychological factors in this area of increasing prominence.
About three quarters of the Malaysian adult population are physically active. There has been growth in physical activity and health research since 2010, with most studies being observational in design and few included objective measures of physical activity. The Malaysian Ministry of Health has published physical activity guidelines, strategies and action plans aimed at promoting physical activity. Physical activity promotion activities have included national campaigns and programmes which target different populations. Further work that incorporates the WHO Global Action Plans on Physical Activity (GAPPA), as well as a more systemic approach is needed, to promote physical activity and a healthy lifestyle. High-level multi-stakeholder collaboration is required for continuing expansion and strengthening of research capacity, and for bridging the physical activity policy gaps in Malaysia.
Objective: Medical device development, from the product's conception to release to market, is very complex and relies significantly on the application of exact processes. This paper aims to provide an analysis and summary of current research in the field of medical device development methodologies, discuss its phases, and evaluate the associated legislative and risk aspects. Methods: The literature search was conducted to detect peer-reviewed studies in Scopus, Web of Science, and Science Direct, on content published between 2007 and November 2019. Based on exclusion and inclusion criteria, 13 papers were included in the first session and 11 were included in the second session. Thus, a total of 24 papers were analyzed. Most of the publications originated in the United States (7 out of 24). Results: The medical device development process comprises one to seven stages. Six studies also contain a model of the medical device development process for all stages or for just some of the stages. These studies specifically describe the concept stage during which all uncertainties, such as the clinical need definition, customer requirements/needs, finances, reimbursement strategy, team selection, and legal aspects, must be considered. Conclusion: The crucial factor in healthcare safety is the stability of factors over a long production time. Good manufacturing practices cannot be tested on individual batches of products; they must be inherently built into the manufacturing process. The key issues that must be addressed in the future are the consistency in the classification of devices throughout the EU and globally, and the transparency of approval processes.
Background: Stroke is highly prevalent globally and is an important cause of cognitive impairment and dementia. Aims: We determined the frequency of post-stroke cognitive impairment (PSCI) at 1, 3, and 6 months among patients with first clinical ischemic stroke compared to risk and age-matched controls. Methods: This study involved 32 cases and 32 controls, and was conducted over 6 months. Cases were inpatients aged >60 with first clinical ischemic stroke. Controls were age-matched subjects without prior stroke. Montreal Cognitive Assessment (MoCA) was performed in all patients at 1, 3, and 6 month post stroke. A MoCA score of <26 was used for mild PSCI and <22 for moderate PSCI (post stroke dementia). Results: Post-stroke dementia was detected in 12 patients (37.5%) at 1st month, in 13 (40.6%) at 3rd month and 15 (48.4%) at 6th months. Mild PSCI was present in 7 patients (21.6%) at 1 month, 16 patients (50%) at 3 months, and 15 patients (48%) at 6 months. The odds ratio (OR) for post-stroke dementia was 3.2 (95%CI 0.98-10.68; p = 0.05) at 1 month; 3.69(95% CI 1.13-12.11; p = 0.031) at 3 months, and 4.88 (95% CI 1.49-15.99; p = 0.009) at 6 months. Years of education was an independent predictor for dementia (OR 0.60; p = 0.046). The OR for post-stroke dementia at 6th month was 7.23 with education level adjusted (95%CI 1.46-35.86, p = 0.015). Conclusion: The frequency of PSCI was high as early as 1 month after stroke. Stroke alone conferred a 7.2 times risk for post-stroke dementia compared to controls.
Introduction: School environments can influence students' dietary habits. Hence, implementing a healthy canteen intervention programme in schools is a recommended strategy to improve students' dietary intake. This study will evaluate the feasibility of providing healthier food and beverage options in selected secondary schools in Malaysia by working with canteen vendors. It also will assess the changes in food choices before and after the intervention. Methods: A feasibility cluster randomised controlled study will be conducted in six secondary schools (intervention, n = 4; control, n = 2) comprising of rural and urban schools located in Selangor and Perak states in Malaysia. Four weeks of intervention will be conducted among Malaysian adolescents aged 15 years old. Two interventions are proposed that will focus on providing healthier food options in the canteen and convenience shops in the selected schools. Interventions 1 and 2 will entail training the canteen and school convenience shop operators. Intervention 2 will be applied to subsidise the cost of low energy-dense kuih (traditional cake), vegetables, and fruits. The control group will continue to sell the usual food. Trained dietitians will audit the canteen menu and food items sold by the school canteen and convenience shops in all schools. Anthropometric measurements, blood pressure and dietary assessment will be collected at baseline and at the end of 4-week intervention. Focus group discussions with students and in-depth interviews with headmasters, teachers, and school canteen operators will be conducted post-intervention to explore intervention acceptability. Under this Healthy School Canteen programme, school canteens will be prohibited from selling "red flag" foods. This refers to foods which are energy-dense and not nutritious, such as confectionery and deep-fried foods. They will also be prohibited from selling soft drinks, which are sugar-rich. Instead, the canteens will be encouraged to sell "green flag" food and drinks, such as fruits and vegetables. Conclusion: It is anticipated that this feasibility study can provide a framework for the conception and implementation of nutritional interventions in a future definitive trial at the school canteens in Malaysia.
Introduction: The trends of tuberculosis (TB) treatment success rate among children in Malaysia plateaued at 90% from 2014 to 2017. Malaysia sets a higher treatment success target of 95% to be achieved in line with an affordable, accessible, and holistic approach in managing TB among children. Objective: This study aims to explore the parents' experiences and perspectives toward achieving treatment success among children who were diagnosed with TB in two districts in Selangor state, Malaysia. Methods: The study was conducted using phenomenology study design via an in-depth interview of 15 mothers who were purposively sampled from the list of pediatric TB cases in the MyTB version 2.1 database in Klang and Petaling Districts of Selangor state. The R-based qualitative data analysis package of R version 0.2-8 was used to perform the thematic analysis. Results: Two main themes were identified from this study. The first theme was trust toward the healthcare services with the subthemes of acceptance, self-efficacy, holistic care, and perceived benefits. The second theme was the motivation to take or continue medication. The subthemes were support from family, healthcare workers' (HCWs') support, the convenience of healthcare services, community support, personal strength, and child's character. Conclusion: TB treatment success for children can be achieved when parents develop trust in healthcare services and have strong motivational factors to remain steadfast in achieving a successful treatment goal. Psychosocial support should be provided to the primary caregiver who faced any difficulty, while good relationships between parents and HCWs should be maintained. These results will inform the TB program managers to strengthen the holistic approach and identify the motivational factors among parents of children with TB disease.
Uncontrolled drug pricing in the private healthcare system in Malaysia leads to high drug prices; however, its impact on employee drug utilization and employer reimbursement coverage is unclear. This study examined patterns of drug pricing and drug utilization among employees covered by employer medical insurance. A drug price control mechanism was also devised for the employer to ensure fair benefits to all parties without compromising the quality of patient care. This retrospective study was conducted among International Islamic University Malaysia (IIUM) community members who sought outpatient treatment at the IIUM panel of health clinics serviced by general practitioners from January 2016 to September 2019. Prescription data (drug type, dose, quantity, duration, price, and manufacturer), patient characteristics (age, sex, and diagnosis) and total charges were extracted from the claims database of PMCare, the insurance company managing IIUM medical claims. Patterns of commonly prescribed drugs, drug pricing, profit margins, and total charges per clinic visit were evaluated. Descriptive statistics were used, and all analyses were performed using Stata v15.1. There were a total of 161,146 prescriptions for 10,150 patients in the IIUM community during the study period (48.85% women, mean ± standard deviation; age: 26.33 ± 17.63 years). The most commonly prescribed drug was paracetamol (25.3%), followed by chlorpheniramine (9.46%), cetirizine (7.3%), diphenhydramine (6.13%), loratadine (4.57%), and diclofenac (4.36%). Generic paracetamol (500 mg), which serves as a prime example for details on drug pricing, is commonly charged between Ringgit Malaysia (RM) 5 and 10 for 10 tablets with a profit between 2,400 and 4,900% according to the average cost price of RM 0.20 per 10 tablets. Most patients were charged within the approved coverage limit of RM 45 per clinic visit, with only 2.41% of patients being charged with costs that exceeded this limit. Uncontrolled drug pricing in the private healthcare system in Malaysia indicates that drug prices differ greatly across private healthcare providers most of the prices were charged with high profit margins. Employers may consider a multilayer capping system to prevent inappropriate drug pricing, which will inevitably benefit patients clinically and economically and provide greater patient access to better drug treatment.
Introduction: Green spaces support people mentally in their everyday life. Perceived restorativeness and Perceived Sensory Dimension (PSD) have been addressed as optimal environmental related characteristics with regards to psychological restoration. However, relatively little research has investigated how the perception of these characteristics, directly and indirectly, affects restoration experience, particularly in a sample of university students within the area of green outdoor campus landscapes. Methods: This study hypothesizes these associations through application of partial least squares structural equation modeling (PLS-SEM), inputting data from a sample of university students in Malaysia. In the hypothesized model, we examine the degree of restoration that is enjoyed by subjects within landscapes through the effects of these characteristics. Indirect effects of perceived restorativeness via evaluation of mediation effects associated with perception of landscape characteristics and restoration experience are also investigated. Results: Through validation of the measurement model, we find significant positive coefficient paths with adequate predictive abilities in the hypothesized model. Findings suggest the effect of PSD on perceived restorativeness leads to a better explanation of restoration experience. In addition, perceived landscape characteristics of PSD enhance restoration experience in alignment with perceived restorativeness characteristics. Conclusions: Greater effects on restoration experience come through perceived restorativeness that is affected by PSD, which itself is capable of promoting favorable experiences of restorativeness in a green space and facilitating psychological restorative outcomes. The mechanistic effect of emotional regulation implies a distinct role of green spaces in maintaining good mental health and has relevance to public health models that promote independence and well-being through preventative approaches. The work paves the way for further studies that examine which dimensions of PSD support perceived restorativeness and restoration experience more than others, and the wider psycho-social value of green spaces through the application of mediation effects and personal sensory dimensions in the development of mental health.
Hypertension is a worldwide problem and a major global health burden with high salt intake as one of the factors often related to it. Public exposure to a high salt diet has contributed to the increase in prevalence of hypertension among the Malaysian population. Improving the knowledge, attitudes and practices (KAP) related to salt intake is a key component of effective blood pressure control. Therefore, this study was aimed to determine the association of KAP of healthy salt intake toward blood pressure among the elderly residing in a semi urban area of Klang Valley Malaysia. A cross-sectional study using convenience sampling was conducted among Malay elderly, aged 60-81 years old residing in Bandar Baru Bangi. Subjects were required to answer the questionnaire via face to face interview regarding KAP of Salt Intake, together with sociodemographic and health profiles. Anthropometry parameters and blood pressure were measured. A total of 94 elderly [57.5% women with mean Body Mass Index (BMI) of 26. 46 ± 4.16, 42.5% men with mean BMI of 27.31 ± 5.19] have participated in the study. Results indicated that the overall KAP score was average (57.4%). However, majority showed a positive attitude toward reducing the salt intake. BMI was found to have significant correlation with blood pressure (r = 0.278, p < 0.05). Higher education level was significantly (p < 0.05) associated with good knowledge scores while younger subjects have a positive attitude toward healthy intake of salt (p < 0.05). Subjects with higher knowledge scores were also observed to have the more controlled blood pressure compared to those who scored less. Attitude and practices score showed no significance difference (p > 0.05) with blood pressure. Younger age, higher level of education and living partner or elderly was significantly (p < 0.05) associated with lower systolic and diastolic blood pressure. Overall, this study showed that knowledge toward healthy salt intake, BMI, education level, and living with others were significantly associated with the blood pressure among the elderly. Further education and intervention is required to improve knowledge on healthy salt intake among elderly as part of the prevention from hypertension.
In African countries, antimicrobial resistance (AMR) issue remains pertinent. Despite this, little efforts have been made to assess the future veterinary prescribers on their knowledge, attitudes and practices (KAP) related to antimicrobial usage. This multi-country survey attempts to explore the KAP of future veterinarians on stewardship of antimicrobial and identify knowledge gaps. Eight veterinary schools participated from Nigeria, Sudan and South Africa. Data regarding perceptions and knowledge were analyzed using Chi-square χ2 test, Spearman's (Rho) Rank order correlation and factor analysis using principal component factoring extraction method. Fifty-two percent of the study participants were final year veterinary students, respectively, and majority (77.2%) had no previous knowledge of biomedical sciences. Majority age were 22-27 years (24.7 ± 2.8) 79% and multiple career fields post-graduation were preferred. Overall, poor perceptions and knowledge of antimicrobial stewardship were observed with variations among countries and only 36.3% (n = 123) of the students were confident in their ability to choose the ideal antimicrobial agents for a specific patient/group of animals. The majority of the final year students were confident of their knowledge regarding AMR (68%), making of Gram staining (69.2%) and in choosing the most ideal route for administering a specific antimicrobial (74.7%). The final year students had significantly (p < 0.05) higher confidence level for knowledge compared with the pre-final year students. Tetracyclines, penicillins, and sulphonamides represent the three most abused veterinary antimicrobials with similar ranking across countries. South African (69.7 ± 20.5) and Sudanese (68.1 ± 15.4) had significantly (p < 0.0001) higher mean scores compared to the Nigerian students (44.3 ± 6.8) in the student's ability to correctly match some specific antimicrobials against their classes but Nigerian students performed better in ranking antimicrobials. This survey revealed poor to average knowledge of antimicrobial stewardship among veterinary students with significant knowledge gaps across the countries. It is recommended that the relevant regulatory and standardization authorities should make concerted efforts and interventions to regularly review curricula to ensure the delivery of targeted formative and normative training, and improved lectures on antimicrobial usage and stewardship in order to improve the awareness and behaviors of future prescribers. The identified knowledge gaps of veterinary medical students on antimicrobial stewardship must be bridge to safeguard the future.
Falls are major issues affecting the older population with potentially serious complications, including fractures, head injury, institutionalization, fear of falling and depression. While risk factors for falls have been established across Western Europe and North America, geographical differences in falls risk have not been well researched. We aim to examine the clinical and physical risk factors for falls in a middle-income South East Asian country. Cross-sectional data from the Malaysian Elders Longitudinal Research (MELoR) study involving 1,362 community dwelling individuals aged 55 years and above was utilized. Information on sociodemographic and medical history was obtained by computer-assisted questionnaires completed during home visits and hospital-based detailed health checks. Univariate and multivariate analyses compared non-fallers and fallers in the previous 12 months. Urinary incontinence, hearing impairment, depression, arthritis and cognitive impairment were risk factors for falls in the past 12 months after adjustment for age in our study population. Awareness about the risk factors in a population helps the design of fall prevention strategies that target specific or multiple risk factors.
Background: Cardiovascular disease (CVD) risk factors tend to cluster and progress from adolescence to young adulthood. Reliable and meaningful clustering of CVD risk factors is essential to circumvent loss of information. Tracking adverse and high-risk profiles of adolescents is hoped to curb CVD progression later in life. The study aims to investigate the clustering of biological CVD risk factor among adolescents in Malaysia and the transitions between clusters over time. Method: The Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs) examined school students aged 13 in 2012 and re-examined them in 2014 and 2016. In a two-stage stratified cluster sampling, 1,361 students were recruited, of which, 1,320 had complete data. In the follow-up, there were 881 and 637 students in 2014 and in 2016, respectively. Pearson's correlation coefficients were used to identify and remove highly correlated CVD risk factors. All risk factors were standardized into z-scores. The hierarchical and non-hierarchical (k-means) cluster analyses were used to classify students into high, medium and low risk clusters in each screening year. The tracking and stability of cluster transitions through cross-classification were enumerated with Pearson's inter-age correlations and percentages. Results: Three significant clusters of high, medium and low risk groups were derived from the clustering of eight biological CVD risk factors. The transitions between risk clusters from one screening year to the other were categorized as either stagnant, improved or adverse. The number of students who had adverse transitions increased from 15.5% (13-15 year) to 19.5% (15-17 year), 13.8 to 18.2% among the girls and 19.9 to 22.8% among the boys. For girls, the number of them who remained at high risk over the two transition periods were about the same (13.6 vs. 13.8%) whereas for boys, the percentage reduced from 14.6 to 12.3%. Conclusion: Over time, more than 12% of adolescents remained in the high risk cluster. There were sizable adverse transitions over time as more adolescents appear to be shifting toward an increased risk of having CVD. Collaborative and constant measures should be taken by parents, school, health promotion boards and policy makers to curb the multiplicative effect of clustering CVD risk factors among adolescents.
Background: Unnecessary antimicrobial use is an emerging problem throughout the world. To design future interventions to ensure rational antimicrobial use and decrease the risk of antimicrobial resistance, physician's knowledge and prescribing practices of antimicrobials should be assessed. Therefore, the main objective of this study is to investigate the physician's knowledge along with their prescribing patterns of antimicrobials in their health care system. Methods: The present qualitative study was conducted in a tertiary care public hospital located at Penang island, situated in Northwest of Malaysia. A total of 12 semi-structured, face to face interviews were conducted with purposive sampling technique. Physicians recruited had different specialties. All interviews were audio recorded, then transcribed into English language and analyze by thematic content analysis. Results: Four major themes were identified: (1) prescribing patterns of physicians regarding antimicrobials; (2) physician's knowledge about antimicrobials; (3) antimicrobial resistance; (4) satisfaction with management of infections. Physicians believed in regular educational activities and updates about the latest antimicrobial guidelines may change the prescribing behavior of physicians to optimize the use of antimicrobials. This may lead to decrease in burden of antimicrobial resistance in their health care system. Physicians emphasized that stricter rules and regular monitoring of antimicrobial use should be implemented to overcome the main challenges of antimicrobial resistance. Conclusion: Different factors were identified to assist optimized use of antimicrobials and decrease the risk of antimicrobial resistance. The present study helps to design targeted future interventions to ensure rational antimicrobial use and decrease the impact of antimicrobial resistance in Malaysia.
Introduction: Medication error is unintentional and can be reduced by reducing the risk factors. Patients suffering from chronic diseases are at an increased risk of medication errors. Objective: This work aims to assess the risk factors associated with medication errors among patients suffering from chronic disorders in hospitals of South Punjab, Pakistan. Methodology: Multiple logistic regression analysis was used to assess the impact of different risk factors on the prevalence of medication errors in patients suffering from chronic diseases. Results: A greater risk for the occurrence of medication errors was associated with age ≥60 years (odds ratio, OR = 1.9; 95% CI = 1.3-3.1; p = 0.001), overburdened healthcare system (OR = 2.2; 95% CI = 1.64-3.56; p < 0.000), number of prescribed drugs ≥5 (OR = 1.74; 95% CI = 1.02-2.64; p < 0.000), comorbidities (OR = 2.6; 95% CI = 1.72-3.6; p = 0.003), Charlson comorbidity index (OR = 1.31; 95% CI = 0.49-1.84; p = 0.004), and multiple prescribers to one patient (OR = 1.12; 95% CI = 0.64-1.76; p = 0.001). Conclusion: Older age, overburdened healthcare system, number of prescribed drugs, comorbidities, Charlson comorbidity index, and multiple prescribers to one patient are significant risk factors for the occurrence of medication errors.
Background: The outbreak of Coronavirus disease (COVID-19) caused by a novel coronavirus (named SARS-CoV-2) has gained attention globally and has been recognized as a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) due to the rapidly increasing number of deaths and confirmed cases. Health care workers (HCWs) are vulnerable to this crisis as they are the first frontline to receive and manage COVID-19 patients. In this multicenter multinational survey, we aim to assess the level of awareness and preparedness of hospital staff regarding COVID-19 all over the world. Methods: From February to March 2020, the web-based or paper-based survey to gather information about the hospital staff's awareness and preparedness in the participants' countries will be carried out using a structured questionnaire based on the United States Centers for Disease Control and Prevention (CDC) checklist and delivered to participants by the local collaborators for each hospital. As of March 2020, we recruited 374 hospitals from 58 countries that could adhere to this protocol as approved by their Institutional Review Boards (IRB) or Ethics Committees (EC). Discussion: The awareness and preparedness of HCWs against COVID-19 are of utmost importance not only to protect themselves from infection, but also to control the virus transmission in healthcare facilities and to manage the disease, especially in the context of manpower lacking and hospital overload during the pandemic. The results of this survey can be used to inform hospitals about the awareness and preparedness of their health staff regarding COVID-19, so appropriate policies and practice guidelines can be implemented to improve their capabilities of facing this crisis and other future pandemic-prone diseases.
Screening of high-risk groups for Tuberculosis (TB) is considered as the cornerstone for TB elimination but the measure of cost-effectiveness is also crucial in deciding the strategy for TB screening. This study aims to measure the cost-effectiveness of TB screening between the various high-risk groups in Malaysia. A decision tree model was developed to assess the cost-effectiveness of TB screening among the high-risk groups from a provider perspective using secondary data from the year 2016 to 2018. The results are presented in terms of an Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per TB case detected. Deterministic and Probabilistic Sensitivity Analysis was also performed to measure the robustness of the model. TB screening among Person Living with Human Immunodeficiency Virus (PL HIV) was the most cost-effective strategy, with MYR 2,597.00 per TB case detected. This was followed by elderly, prisoners and smokers with MYR 2,868.62, MYR 3,065.24, and MYR 4,327.76 per one TB case detected, respectively. There was an incremental cost of MYR 2.49 per screening, and 3.4 TB case detection per 1,000 screening for TB screening among PL HIV in relation to TB screening among prisoners. The probability of symptomatic cases diagnosed as TB was the key driver for increasing cost-effectiveness efficacy among PL HIV. Results of the study suggest prioritization of high-risk group TB screening program by focusing on the most cost-effective strategy such as screening among PL HIV, prisoners and elderly, which has a lower cost per TB case detected.
In 2012, the World Health Organization (WHO) set a comprehensive set of nine global voluntary targets, including the landmark "25 by 25" mortality reduction target, and 25 indicators. WHO has also highlighted the importance of Non-Communicable Disease (NCD) surveillance as a key action by Member States in addressing NCDs. This study aimed to examine the current national NCD surveillance tools, activities and performance in Malaysia based on the WHO Global Monitoring Framework for NCDs and to highlight gaps and priorities moving forward. A desk review was conducted from August to October in 2020, to examine the current national NCD surveillance activities in Malaysia from multiple sources. Policy and program documents relating to NCD surveillance in Malaysia from 2010 to 2020 were identified and analyzed. The findings of this review are presented according to the three major themes of the Global Monitoring Framework: monitoring of exposure/risk factor, monitoring of outcomes and health system capacity/response. Currently, there is a robust monitoring system for NCD Surveillance in Malaysia for indicators that are monitored by the WHO NCD Global Monitoring Framework, particularly for outcome and exposure monitoring. However, Malaysia still lacks data for the surveillance of the health system indicators of the framework. Although Malaysia has an NCD surveillance in place that is adequate for the WHO NCD Global Monitoring Framework, there are areas that require strengthening. The country must also look beyond these set of indicators in view of the increasing burden and impact of the COVID-19 pandemic. This includes incorporating mental health indicators and leveraging on alternate sources of data relating to behaviors.