Official Journal of Malaysian
Public Health Physicians’ Association
EDITORIAL BOARD
Chief Editor
Prof. Dato’ Dr. Syed Mohamed Aljunid
(United Nations University – International Institute for Global Health)
Deputy Chief Editor
Assc. Prof. Dr. Sharifa Ezat Wan Puteh
(Universiti Kebangsaan Malaysia)
Members:
Assc. Prof. Sharifah Zainiyah Syed Yahya University Putra Malaysia
Dr. Lokman Hakim Sulaiman Ministry of Health Malaysia Assc. Prof. Dr Retneswari Masilamani University Malaya
Assc Prof Dr. Mohamed Rusli Abdullah University Sains Malaysia Assc. Prof. Saperi Sulong University Kebangsaan Malaysia Dr. Maznah Dahlui University Malaya
Dr. Roslan Johari Ministry of Health Malaysia Dr. Othman Warijo Ministry of Health Malaysia
Dr. Amrizal Muhd Nur United Nations University–International Institute for Global Health (UNU-IIGH)
Chief Editor
Malaysian Journal of Public Health Medicine (MJPHM)
United Nations University - International Institute for Global Health (UNU-IIGH) Universiti Kebangsaan Malaysia Medical Centre (UKMMC)
Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur Malaysia
ISSN: 1675–0306
The Malaysian Journal of Public Health Medicine is published twice a year
Copyright reserved @ 2001
Malaysian Public Health Physicians’ Association
Secretariate Address:
The Secretariate
United Nations University - International Institute for Global Health (UNU-IIGH) Universiti Kebangsaan Malaysia Medical Centre (UKMMC)
Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur Malaysia
Volume 11(Suppl 1) 2011
Official Journal of Malaysian
Public Health Physicians’ Association
4
THPERAK HEALTH CONFERENCE 2011
16 – 18
thMAY 2011
IMPIANA CASUARINA HOTEL
IPOH, PERAK DARUL RIDZUAN
Organized by
Perak State Health Department
&
The Malaysian Public Health Physicians’ Association (Perak)
SCIENTIFIC COMMITTEE & EDITORIAL BOARD
Chairman: Dr. Puvaneswari Subramaniam, MOH Perak
Secretar y: Mr. Paul Eruthiasamy, MOH Perak
Members:
CONTENTS
PAGES
PLENARY
PL1 ONE CARE FOR 1 MALAYSIA
1
Dr. Haji Nordin bin Saleh
PL2 EFFECTS OF WIRELESS COMMuNICATION ON HEALTH
2
Associate Professor Dr. Kwan Hoong Ng
PL3 INTEGRATED PRIMARY CARE - INTERGRATING VERTICAL 3
PROGRAMS FOR EFFECTIVENESS IN DELIVERY OF SERVICE
Dr. Hjh. Safura bt Haji Jaafar
PL4 ENSURING CONTINUITY OF HEALTHCARE – A SHARED 4
RESPONSIBILTY
Yg Bhg Dato’ Dr. Haji Ahmad Razin bin Dato’ Haji Ahmad Mahir
PL5 HEALTHCARE INTEGRATION – A PRIVATE PRACTITIONER’S VIEW
5
Dr. Steven Chow Kim Weng
SYMPOSIUM 1 COMBINED AND MuLTIDISCIPLINARY CARE
SYM I(1) LOOKING AT THE WHOLE CHILD
6
Dr. Aminah Bee bt. Mohd Kassim
SYM I(2) CONVERGING SHARED CARE IN MATERNAL AND CHILD HEALTH
7
Professor Dato’ Dr. N Sivalingam
SYM I(3) SUPPORT SERVICES FOR FAMILY NEEDS
8
Dr. Cheah Yee Chuang
SYMPOSIUM 2 ACHIEVEMENTS OF THE MILLENNIUM DEVELOPMENT GOALS
SYM II(1) IMPROVING CHILD HEALTH TOWARDS MILLENNIUM 9
DEVELOPMENT GOALS
Yg Bhg Dato’ Dr. Amar Singh HSS
SYM II(2) MATERNAL HEALTH – MEETING THE MILLENNIUM DEVELOPMENT 10
GOALS
CONTENTS
PAGES
SYM II(3) COMBATING HIV/AIDS, TUBERCULOSIS AND MALARIA - ARE WE 11
ON TRACK?
Dr. Sha’ari bin Ngadiman
SYMPOSIUM 3 TECHNOLOGY AND HEALTH
SYM III(1) HEALTH DATA INTEGRATION
12
Dr. Md. Khadzir bin Sheikh Haji Ahmad
SYM III(2) ERGONOMICS IN HEALTH FACILITIES
13
Dr. Abu Hasan bin Samad
SYM III(3) SACKING THE PLASTIC
14
Ms. Mageswari Sangaralingam
SYMPOSIuM 4 HEALTH RISK MANAGEMENT
SYM IV(1) OUTBREAK RISK COMMUNICATION
15
Dr. Husnina bt. Ibrahim
SYM IV(2) IMPROVING PATIENT SAFETY
16
Dr. Hajah Kalsom bt. Maskon
SYM IV(3) OCCUPATIONAL RISK IN HEALTHCARE
17
Professor Dr. Rusli bin Nordin
FREE PAPERS
ORAL PRESENTATION
AP 1 PREVALENCE OF PATIENTS WITH CHRONIC PAIN AND ITS
18
ASSOCIATED FACTORS IN PRIMARY CARE ATTENDEES
CONTENTS
PAGES
AP 3 THE USAGE OF MATERIAL SAFETY DATA SHEET AMONG DENTAL
20
PERSONNEL IN PERAK
Anna R; Bibi Saerah; Siriander D; Law C H; Rohana K et al
AP 4 PREVALENCE AND PREDICTORS OF RECENT RESPIRATORY ILLNESS 21
IN THE MALAYSIAN POPULATION
Paramesarvathy R; Gurpreet K; Amal NM; Tee GH
AP 5 KNOWLEDGE, ATTITUDE AND PRACTICES ON DENGUE AMONG 22
RURAL COMMUNITIES IN REMBAU AND BUKIT PELANDUK, NEGERI SEMBILAN, MALAYSIA
Tan KL
AP 6 SCREENING FOR PATHOGENIC LEPTOSPIRA FROM WATER 23
SAMPLES AT PUSAT LATIHAN KHIDMAT NEGARA (PLKN) IN NORTHERN AND EASTERN REGION OF PENINSULAR MALAYSIA.
Hasanatunnur Azmi; Norliziana MA; Roziah A; Zulhainan H; Naim AK
AP 7 KEJADIAN WABAK HEPATITIS A DI PERKAMPUNGAN MASYARAKAT 24
ORANG ASLI POS JERNANG, SUNGKAI, PERAK
Faizal; Azizi MZ; Azim RH
AP 8 PENILAIAN KEBERKESANAN PUNJUT TEMEPHOS 500 E DALAM 25
TANGKI SEPTIK INDIVIDU
Aslinda UAB; Mahani Y; Mohd NS; Noor RM; Hairul I
AP 9 A STUDY ON EMERGENCY CARE SERVICES AND EQUIPMENT IN 26
HEALTHCARE FACILITIES
Ch’ng ML; Benedict CTW; Amy CAL; Dang SB; Razin Mahir
POSTER PRESENTATION
PP 1 EXTERNAL QUALITY ASSESSMENT FOR DIRECT SPUTUM SMEAR 27
MICROSCOPY FOR ACID FAST BACILLI IN THE STATE OF PERAK
Lim JM; Tan KL; Murugan K; Akma I; Suhaila AR et al
PP 2 FLUORIDE IN DRINKING WATER AND DENTAL FLUOROSIS AMONG 28
MALAY SCHOOLCHILDREN IN KAMPUNG BAHARU LANJUT, SEPANG, SELANGOR: A PRELIMINARY STUDY
Shaharuddin MS; Nurul Faiza OB
PP 3 FIRST DOCUMENTED CASE OF Q FEVER IN MALAYSIA IN THE 21ST 29
CENTURY – EPIDEMIOLOGY AND INVESTIGATIONS
Bina Rai; Fadzilah K; Chow TS; Chee KY
PP 4 OUTBREAK OF INFLUENZA LIKE ILLNESS IN SCHOOLS IN PERAK 30
TENGAH DISTRICT (FROM JANUARY - FEBRUARY 2011)
CONTENTS
PAGES
PP 5 IS CRASH DIETING A CONCERN AMONG FEMALE STUDENTS IN A
31
MALAYSIAN PRIVATE UNIVERSITY?
Sabernero I; Gurpreet Kaur
PP 6 HEALTH SEEKING BEHAVIOUR TOWARDS COMMUNICABLE 32
DISEASES AMONG FOREIGN WORKERS IN INDUSTIRAL AND AGRICULTURE SECTOR IN SELECTED DISTRICTS IN PERAK.
Noor Asmah; Koh K; Ong KG; Wan Asmuni; Asmah ZA
PP 7 PREVALENCE OF HEARING IMPAIRMENT AND CARPAL TUNNEL 33
SYNDROME IN GRASS CUTTERS OF BAKAS UNIT BATANG PADANG DISTRICT HEALTH OFFICE
Azim RH; Aman S
PP 8 UNHYGENIC FOOD PRACTISES - STUDENTS SUFFER
34
Hasniza A; Fauziah M N; Zulkifli H; Roziyana I; Halzeri Z
PP 9 KEBERKESANAN MODuL PENDIDIKAN DIABETES TERHADAP
35
PESAKIT DIABETES DI KLINIK KESIHATAN TAIPING
Bazariah Y; Amutha B; Sumathi M; Roziahwati A; Zuwariah AT et al
PP 10 EVALUATION OF PRESCRIBING PATTERNS AND COST ASSOCIATED 36
WITH THE USE OF ANTIHYPERTENSIVE AGENTS AT KLINIK KESIHATAN BAGAN SERAI
Nurhani MA; Toh MJ
PP 11 TUBERCULOSIS IN THE DISTRICT OF LARUT MATANG AND 37
SELAMA, PERAK, MALAYSIA.
Syed MP
PP 12 PENGGUNAAN APLIKASI ELETRONIK DALAM PENYEDIAAN KERTAS 38
SIASATAN DI UNIT INSPEKTORAT DAN PERUNDANGAN, PEJABAT KESIHATAN DAERAH KINTA
Nurulhisham S; Asroyadi HA; Shahrul AD; Tajudin H; Samad M et al
PP 13 GESTATIONAL DIABETES MELLITUS (GDM)
39
Sumathi M; Rosni W; Malliga S
PP 14 FIELD STUDY ON THE DERMATITIS CAUSED BY A BEETLE 40
PAEDERUS FUSCIPES (ROVE BEETLE) AMONG SCHOOL CHILDREN AND TEACHERS IN TUNKU ABDUL RAHMAN (STAR) SCHOOL, IPOH.
PL 1 Plenary I - One Care For 1 Malaysia
Dr. Haji Nordin bin Saleh Deputy Director
Health Policy and Planning Unit Planning and Development Division Ministry of Health Malaysia
PL II Effects Of Wireless Communication On Health
Professor Dr. Kwan Hoong Ng
Department of Biomedical Imaging and Medical Physics Unit, University of Malaya, Kuala Lumpur
Mobile telephony is now ubiquitous around the world. This wireless technology relies upon an extensive network of antennas, or base stations, relaying information with radiofrequency (RF) waves. Wireless local area networks (WLANs) are also increasingly common in homes, offices and public places.
There has been a lot of concern about possible health consequences from exposure to the RF waves produced by wireless technologies. This talk reviews the scientific evidence on the health effects from continuous low-level human exposure to base stations and other local wireless networks. To date, the only health effect from RF radiation that has been identified is based on an increase in body temperature (greater than 1 °C) from exposure at very high field intensity found only in some industrial facilities, such as RF heaters. The levels of RF exposure from base stations and wireless networks are so low that the temperature increases are insignificant and do not affect human health.
The public are very worried by the media or anecdotal reports of cancer clusters around base stations. Since there are a large number of base stations in the vincinity, it is expected that possible cancer clusters will occur near base stations merely by chance. Moreover, the reported cancers in these clusters are often a collection of different types of cancer with no common characteristics and hence unlikely to have a common cause.
Over the past two decades, research studies examining a potential relationship between RF transmitters and cancer have not provided evidence that RF exposure from the transmitters increases the risk of cancer. Similarly, long-term animal studies have not established an increased cancer risk from exposure to RF fields, even at much higher levels than that produced by base stations and wireless networks.
PL III
Integrated Primary Care - Intergrating Vertical
Programs For Effectiveness In Delivery of Service
Dr. Hjh. Safura bt. Haji Jaafar
Director of Family Health Development Division Ministry of Health Malaysia
Integrated Primary care is the provision of services around individuals and families, restructuring today’s fragmented facilities into a system of community-focused family health providers so as to consolidate health gains, increase efficiency without sacrificing quality, and ensure sustainability of services.
The idea is not new. Thirty years ago, in 1978, the Alma-Ata Declaration pointed to the importance of community-oriented comprehensive primary health care for all nations. In this comprehensive or ‘horizontal’ healthcare concept, health care is also a basic human right that requires community participation. However strategies meanders on path that is least resistance and many chooses the “selective disease-oriented approach” to address the greatest disease burden. These two positions differ both philosophically and practically. The selective is short-term in outlook that solves a given health problem HIV/AIDS/TB and the like through the application of specific measures. However Comprehensive primary health care is carried out through a long-term process that seeks to tackle the overall health problems through the creation of an accessible permanent institutional infrastructure for ‘general health services, that ensure sustainable health.
Many countries have shown the failure of vertical programming to meet its main objective, ie: a better coverage of those with the highest needs. In addition, vertical programmes create duplication, whereby each disease control programme requires its own bureaucracy, leads to inefficient facility utilisation by recipients, and may lead to gaps in care especially in patients with multiple co-morbidities. It is easier to finance vertical programme presumably easier to account for. But such methodology of financing vertical programmes has ‘diverted’ skilled local health personnel away from the local (primary) healthcare system. As a result, the health sector became vertically organized, with staff moving from one section to the next, jeopardising access to overall health services and raising deep concerns regarding equity. This type of internal ‘brain drain’ has devastating consequences and undermines critical primary healthcare services,
P
L
IV
Responsibilty
Ensuring Continuity Of Healthcare – A Shared
Yg Bhg Dato’ Dr. Haji Ahmad Razin bin Dato’ Haji Ahmad Mahir Director
Perak State Health Department
WHO had defined Health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity? This definition should be transformed into a shared goal i.e. the individual, family, community and society. There must be a political will and political directives to achieve this. The government had actually invested a lot of money into health care services and the health care cost continues to rise in tangent with the greater responsibility and accountability of the government to provide equity and quality in healthcare. At the same time the expectation of the “rakyat” is also increasing in fact they became more demanding and expressing health care is a basic right of the people.
However to achieve health as defined by WHO is not the sole responsibility of the Ministry Of Health and the government. The influence on health is multi factorial. Socio-economic and cultural factors play a big role. However there are a lot of gaps or fragmentation between government agencies, between public sector and private sector, between providers of health care and the “rakyat”. So much so that the shared goal of health is not translated as a shared mission of “shared responsibility”.
“Shared Responsibility” the magical word of togetherness that has been used in the slogan, is the basic foundation in implementing a triumphant work. Without a teamwork and devotedness spirit, it will be hard to achieve the shared goal. Many government agencies had also adopted “Shared Responsibility” in their slogan.
However there are still people who are being irresponsible and negligent. This negative attitude is contagious and has been infecting our society. It also mean that the Ministry Of Health had not achieve it mission to build partnerships to facilitate and support the people to attain fully their potential in health, to motivate them to appreciate health as a valuable asset and to take positive action to improve further and sustain their health status to enjoy a better quality of life
If this negative culture tend to continue in our society, our service sector will not continue to develop or grow but will always be left behind.The health service will be despised by the society. Being selfish is the root problem to an irresponsible culture in oneself. This attitude should be immediately expelled from our society. How can this be achieved?
Can this be achieved through further reinforcement of health education, strict enforcement of laws and regulation, innovative approach to tackle health problems like the use of “explore race” approach instead of “gotong-royong”? Perhaps the long term approach is to have a cultural change in a new era of responsibility – a recognition, on the part of every Malaysian, that we have duties to ourselves, our community, our
country, duties that we do not grudgingly accept but rather seize gladly, firm in the knowledge that there
P
L
V
Perspective
Malaysian Healthcare Scenario –Private Practitioners’
Dr. Steven Chow Kim Weng President
Federation of Private Medical Practitioners’ Associations, Malaysia
Increasingly year by year we see the progressive commercialization of all aspects of healthcare starting from the medical education and all the way to delivery of tertiary and primary care. In tandem with this is the alarming rise in the cost of private medical care. Some private hospitals in Kuala Lumpur now quote patients from RM5000 to RM9000 for an open appendectomy and RM12000 to RM15000 for a laparoscopic appendectomy. On the other hand, the surgeon’s fee for both is capped at RM1370.
There is some fundamental issue regarding the way our healthcare system is been regulated. It is an important that this issue needs to be addressed urgently. Nowadays, private hospital bills reaching RM100K is not a rarity anymore. FPMPAM find this trend extremely alarming. The public is of the perception that a high hospital bill is due to hefty doctors’ fees. This is not true. It should be noted that the average doctor’s professional fees accounts for about 10-15% of the overall private hospital bill.
The provisions of the Private Healthcare Facilities and Services Act 1998 and Regulations 2006, has NO provisions to regulate hospital bills. As there is NO prescribed schedule for private hospital fees, private hospitals are free to charge as they see fit. Ultimately, they answer only to their shareholders.
The FPMPAM have made regular representation to the Ministry of Health on this matter. The usual response is that it is not possible to control hospital fees, as there were different classes of hospitals providing different class of services i.e. 3-star to 6-star hospitals. The situation in some hospitals has reached to a point where our members, the doctors themselves find it hard to advise patient on the cost of hospitalization. Often, the hospital bills end up way above what was originally estimated and the doctor is accused of over-charging.
Now that most of the major private hospital chains are owned and operated by GLCs, the boundary between the regulators and the operators of healthcare will clearly be blurred. GLCs are government – corporate owned and answerable to government. It is thus clear that not only are the hands of the doctor tied in this matter, even the MOH itself is in a quandary as to how it can act effectively in this matter.
Doctors in the private sector can urge the patients and the public to speak out against this disturbing trend. We can call upon our elected leaders and members of public office on both sides of the House to take heed and institute appropriate measures to protect the patients and the public. The commercialized corporate model private hospital will not benefit the majority of our population who are only able to afford basic healthcare needs.
SYM I (1) Looking At The Whole Child
Dr. Aminah Bee bt. Mohd Kassim Senior Principal Assistant Director Family Health Development Division Ministry of Health Malaysia
SYM I (2)
Converging Shared Care In Maternal And Child
Health
Professor Dato Dr Sivalingam Nalliah FRCOG, FAMM, MCGP, FICS, Med Clinical School, International Medical University, Kuala Lumpur
Conventional wisdom indicates the motive of any health delivery system is to sustain a healthy population. Indices for healthcare have been traditionally employed to indicate the achievement of health through strategies developed benchmarking against both national and international standards. The Milleneum Development Goals has been incorporated into the KPIs of the Perak Health Department. Three primary aims of the MDG are to reduce child mortality, improve maternal mortality and ensure environmental sustainability. All three are relevant to the discussion when one considers maternal and child health in Perak.
The objective of this paper is to review the maternal mortality and child health indices conventionally employed and induce a discussion on how the current healthcare delivery system has worked in attempting to achieve the three indices of the MDGs.
Data on mortality below 5 years of age in Perak is higher than the MDG target of 5.5 per 1000 LB. The Perinatal Mortality Rate in 2010 was much higher in Perak largely contributed by normally formed macerated stillbirths and prematurity. Both these factors contribute to fetal wastage and affect maternal health adversely. The stillbirth rate for Perak compared to national levels again reigns higher contributed largely by prematurity.
The MDGs aims to improve maternal health and reduce maternal deaths by three quarters. Here again Perak is lagging with MMR being 30.1/100,000 LB, much higher than the proposed 11.0/100,000 for the country.
To address the problems squarely there is a need to restructure the healthcare delivery system using the vital statistics available to ensure the current strategies remain relevant as the delivery rate in Perak has declined over the years while the health facilities have improved at an exponential rate. What needs to be re-looked is the quality of shared care in both maternal and child healthcare, Although it may not be possible to relate the causes of mortality to specific conditions one needs to review the quality of care by health care givers and how social factors and the environment contributes to some of the remediable factors like prematurity and childhood illness especially in the perinatal period.
Concerns have been expressed by the rapid introduction of technology with a shifted emphasis on specialized care by experts in both obstetrics and neonatalogy. Subspecialists in OBGYN have been focusing and utilizing available consultation time in detailed ultrasound care with less emphasis on case selection. The neonatologist has established standard of care on sustaining the low birth weight baby because of the possibility of maintaining life utilizing intensive care support systems. Both these experts have benchmarked their standard of care to international standards. But one now sees that maternal medicine, the cause of many of the mortalities, being shifted to other personnel. It is now evident that the divide between primary care and specialist care has blurred with high risk cases being managed in primary care because of the changed philosophy of care. It is time to re-look at the training of the primary care physician and the midwife to ensure their competency in caring for risk cases within their set up. Data need to be generated on competency in use of technology like the ultrasound and its applicability to manage risk cases in the primary care setting.
SYM I (3) Support Services For Family Needs
Dr. Cheah Yee Chuang Consultant Psychiatrist
Hospital Bahagia Ulu Kinta, Perak
SYM II (1)
Improving Child Health Towards Millennium
Development Goals (MDG)
Dato’ Dr. Amar Singh HSS
Cert Theology (Aust, Hons), MBBS (Mal), MRCP (UK), FRCP (Glasg), MSc Community Paediatrics (Ldn, dist.)
Senior Consultant Paediatrician (Community) and Head of Paediatric Department, Hospital RPB Ipoh Head Clinical Research Centre Perak
Abstract
There has been a dramatic decline in child mortality in past few decades with under 5 mortality (U5M) declining from 25.7 per 1000 life births in 1980 to 7.9 in 2007. Historically, tends in childhood mortality have largely focused on the absolute rate and its reduction. It is important to look at sub-analysis of the mortality to derive strategies for the prevention of childhood deaths. An evaluation of the childhood mortality trends shows 4 key issues.
Firstly the decline in childhood mortality has levelled off in the past 8-10 years and it is unlikely that Malaysia will achieve the MDG4 goal. Secondly the vast number of under 5 deaths occur in the first year of life and in particular the first month of life (neonatal deaths account for 60% of under 5 deaths). Thirdly segments of the population and sub-groups still have very high child mortality. In particular the remote rural communities (Orang Asli, Interior Sarawak and Sabah). We are an emerging and developing economy but have pockets of extreme third world. Fourthly some regions in the country are still underreporting childhood deaths and accurate detection and documentation will significant rise our mortality rate.
To significantly impact child health towards achieving the millennium development goals we will have to recognise that health needs and challenges have dramatically changed in the past three decades. And that health care professionals and health care systems have changed much slower to meet these challenges. It is important to note that the Malaysian performance is comparable with neighbouring and developed countries but is not uniform. It is important that managers and those in political power appreciate that further reduction in mortality will require enormous effort/resources. Our current expenditure on health is very low compared to developed and some developing countries.
5 immediate and key strategies we can use to impact child health include the following. Firstly putting in place a mortality system that evaluates, monitors U5M to identify areas for intervention. Secondly target currently known vulnerable populations/pockets where care is suboptimal. Thirdly improve skills training to identify ill children and effectively resuscitate them. Fourthly continue with existing services but consolidate key areas especially intensive care (NICU/PICU) and Retrieval services. Fifthly considerably strengthen MCH services including health education to parents.
SYM II (2)
Maternal Health – Meeting The Millennium
Development Goals
Dr. Safiah bt. Bahrin
Senior Principal Assistant Director Family Health Development Division Ministry of Health Malaysia
SYM II (3)
Combating HIV/AIDS,
Are We On Track?
T
uberculosis and
Malaria-Dr. Sha’ari bin Ngadiman
Deputy Director of Disease Control (Infectious Disease) Ministry of Health Malaysia
HIV/AIDS, Tuberculosis and Malaria are among communicable diseases that taken millions of lives. HIV/AIDS has taken more than 20 million lives and may take millions more if trends continue. Malaria kills a child in the world every 45 seconds and close to 90% of malaria deaths occur in Africa, where it accounts for a fifth of childhood mortality. About 1.8 million people died from tuberculosis in 2008, about 500,000 of whom were HIV-positive. United Nation put target to reduce these diseases in the
Millennium Development Goals.
The global response to AIDS has demonstrated tangible progress. The new HIV infections fell steadily from a peak of 3.5 million in 1996 to 2.7 million in 2008. Deaths from AIDS-related illnesses also dropped from 2.2 million in 2004 to two million in 2008. Tuberculosis prevalence is falling in most regions except Asia and estimated that 11 million people suffered from tuberculosis in 2008. Half the world’s population is at risk of malaria and estimated 243 million cases of malaria in 2008, causing 863,000 deaths, in which 89% of them in Africa. With the assistance of Global fund, it helped to control malaria and hope to achieve the MDG target.
Malaysia has achieved considerable success in controlling many infectious diseases over time. A shift in disease pattern from communicable to non-communicable diseases tends to occur as a nation progresses from a developing to developed status. This changing disease pattern has occurred in Malaysia. Since 1970, infectious diseases, such as tuberculosis (TB) and malaria, have declined sharply.
In Malaysia, the main driver of the HIV epidemic was among injecting drug users. From 1990 to 1996, the number of annual newly detected HIV cases attributed to injecting drug use rose from 60 per cent (in 1990) to 83 per cent (in 1996). Since 2002, new cases detected have continually declined, despite a substantial increase in the number of screenings. Tuberculosis remains a significant health issue. The number of notified cases (all forms) increased from 10,873 in 1990 to 18,102 in 2009. The notification rate has fluctuated slightly since 1990, although the trend from the past six years is showing a slow increase. The number of reported tuberculosis-related deaths in 2009 was 1,582, up from 942 in 2000. For malaria, the country is currently progressing towards the MDG-Plus complete elimination by 2020. Since the implementation of the Malaria Eradication Programme in 1967 (later to become the Malaria Control Programme in 1982) the number of malaria cases has declined significantly.
SYM III (1) Health Data Integration
Dr. Md. Khadzir bin Sheikh Haji Ahmad
Deputy Director, Planning and Development Division Ministry of Health Malaysia
Introduction
The evolution of Health Information Management System in Malaysia started from a basic paper-based statistical reporting system to an ICT enabled Health Information Management system. Since colonial times, health information was collected and collated for statistical reports, which in general is not adequate and not timely for effective and efficient management. The Health Information Management System (HIMS) was developed with the intention to gather information required for programme planning, monitoring and evaluation. The deployment of Hospital Information Systems was intended to enable healthcare providers to produce efficient and timely report. However these gave rise to issues of interoperability of disparate systems, which resulted in the production of reports of variable quality and timeliness. A seamless integration, where information can be exchanged and readily used, between Health Information Systems and the HIMS is therefore crucial.
Methodology
The use of Health Informatics Standards is the building blocks to facilitate the implementation of an interoperable system. Steps were taken to ensure that these standards were chosen, developed and adopted in current Health Information Systems. A web-based Business Intelligence (BI) application such as Sistem Maklumat Rawatan Perubatan (SMRP) was developed based on the existing manual reports
with a focus at a granular level to enable effective data mining and analysis. Integration between SMRP
and HIS was tested. A benchmarking criteria for Interoperability and Health Information Systems was also developed through a consensus between relevant stakeholders to ensure proper implementation of Health Information Systems.
Results
Promising results were demonstrated during the implementation of the recent HIS project. Currently, one hospital has achieved interoperability between HIS and SMRP.
Analysis The adherence to data definitions in the development of Health Information Systems with the
involvement of the correct stakeholders have contributed to enabling interoperability.
Discussion
SYM III (2) Ergonomics In Health Facilities
Dr. Abu Hasan bin Samad
Medical Advisor & Country Occupational Health Manager ExxonMobil Subsidiaries in Malaysia
Health care facilities in both public and private sectors are no different from the other traditional workplaces. More than a quarter million workers in Malaysia are directly or indirectly involved in the health care services delivery. Various occupational hazards are present in the health care sectors including the traditional physical, chemical, biological, psychosocial and ergonomics hazards. Ergonomics hazard in particular is gradually becoming more important as we continue to use ICT (Information and Communication Technology) as the backbone of health care delivery at various levels throughout the country ranging from the small primary clinic in the rural area to the big tertiary hospital in the city. The long working hours and demanding duties around the clock are additional concerns. Furthermore there are still a number of manual activities being done by the health care personnel at the various levels of services in the different disciplines.
SYM III (3) Sacking The Plastic
Mageswari Sangaralingam Research Officer
Consumers’ Association of Penang
SYM IV (1) Outbreak /
R
isk Communication
Dr. Husnina bt. Ibrahim
Public Health Specialist (Epidemiology) Senior Principal Assistant Director Disease Control Division
Ministry of Health Malaysia
In the current response to pandemic (H1N1) 2009 influenza, Malaysia was able to build upon the communication strategy and activities which was conducted for avian influenza outbreak and pandemic preparedness. It is important to find a balance between working rapidly to implement the communication necessary for the response while also respecting the fundamentals of effective social and behavior change communication. In order to find this balance, it is useful to rely on existing resources as much as possible.
Communication objectives
For communication to be effective, especially at time of pandemic when there is uncertainty about how it will affect a country, key partners and stakeholders should reach consensus at the national level on the objectives of communication. This should happen before an outbreak occurs in the country. On generic level, these objectives include the following:
• Help to reduce transmission of disease
• Mitigate health impact
• Minimize panic and social disruption
• Help Government provide credible information during response
Risk / outbreak Communication:
As there are many ideas and concepts on this issue, the term used basically for the communication between health and Government authorities and the population of a country in a pandemic situation before and in response to an outbreak in that country.
It is well documented that when Government and other stakeholders are transparent by providing timely and correct information to the population, their effort to reduce transmission and mitigate the impact of the pandemic are more successful.
Effective risk communication, however takes planning and capacity building which includes:
• Identifying and training of spokesperson from Government and other relevant stakeholders in
view of providing coordinated and consistent messaging.
• Media training and continued orientation in order to have an informed and balanced reporting
• During response, regular updates to the public from relevant stakeholders via mass media,
SYM IV (2) Improving Patient Safety
Dr. Hajah Kalsom bt. Maskon Senior Deputy Director Medical Development Division Ministry of Health Malaysia
Patient safety is a public health issue. Patient safety is a fundamental principle of health care. “FIRST DO NO HARM”. In every point of care-giving contains a certain degree of inherent potential of adverse events which may result from problems in practice, products, procedures or systems. Patient safety improvements demand a complex system-wide effort, involving a wide range of actions in performance improvement, environmental safety and risk management, including infection control, safe use of medicines, equipment safety, safe clinical practice and safe environment of care.
Recognizing this, Malaysia health care, through the Patient Safety Council Malaysia has initiated a number of patient safety actions which aims to coordinate, disseminate and accelerate improvements in patient safety nationwide. Some of the initiatives are strengthening of clinical governance and the
implementation the WHO World Alliance for Patient Safety Programmes, which include Clean Care Is
SYM IV (3) Occupational Risk In Healthcare
Prof. Dr. Rusli bin Nordin
MBBS; MPH; PhD; FFOMI; FAOEMM; AM Professor of Public Health & Head Clinical School Johor Bahru
Jeffrey Cheah School of Medicine and Health Sciences Monash University Sunway Campus
AP 1
Prevalence Of Patients With Chronic Pain And Its
Associated Factors In Primary Care Attendees
Subashini; EM Khoo; Hanafi NS
Introduction
Chronic pain is a major healthcare problem worldwide and a common reason for seeking health services in primary care.
Objective
To determine the prevalence of chronic pain and factors associated with it.
Methods
A cross-sectional quantitative study on randomly sampled patients aged 21 years and above attending primary care clinic at the University Malaya Medical Center was conducted. Patients with diagnosed acute psychosis, dementia and mental retardation were excluded. Face to face interviews were done. Case screening questionnaires (self-administered) were used to identify patients with chronic pain, and demographic data and causes of chronic pain were collected.
Results
490 patients were approached and 465 consented (95% response rate). The prevalence of chronic pain was 54.8%. The prevalence was higher among Indians (63.6%), followed by Malays (54.0%) and Chinese (47.2%). Common causes of chronic pain include arthritis (22.4%), followed by limb pain (19.6%), back pain (16.9%) and headache (16.9%). There was significant association between chronic pain and
ethnicity (x2=8.450, p=0.038), marital status (x2=6.974, p=0.031), education levels (x2=7.359, p=0.025)
and co-morbidities such as stroke (x2=4.693, p=0.030), ischaemic heart disease (x2=6.279, p=0.012) and
arthritis (x2=34.909, p<0.001). Multivariate analysis showed Indian ethnicity (OR=1.737, 95%CI: 1.141,
2.644) and patients with arthritis (OR=4.413, 95%CI: 2.635, 7.390) were predictive of chronic pain.
Conclusion
Chronic pain is common in primary care attendees. Early identification of these patients can help in better chronic pain management.
AP 2
Factors Associated With Stress Among Primary
Healthcare doctors, assistant medical officers and
nurses In government Health Clinics In Kelantan, 2010
Asmah; Siti RaudzahDepartment of Community Medicine and Health Sciences, University Malaysia Sarawak, Kuching
Introduction
Stress is experienced by everyone in their daily life including the healthcare providers.
Objective
The main objective of this study was to determine the prevalence and its associated factors of stress among primary healthcare doctors, assistant medical officers and staff nurses at government health clinics in Kelantan.
Method
This was a cross sectional study conducted from 1st June until 31st August 2010. Total of 248 respondents
(responds rate 84.9%) were selected through stratified random sampling. The Malay version of the validated Depression, Anxiety and Stress Scale and Karasek’s Job Content Questionnaire were used as research instruments.
Results
The prevalence of stress was 7.3% (95% CI 4.06, 10.54). The study among doctors showed that
supervisor support (adj b = -0.74, 95% CI -0.98, -0.50, P <0.001) and hazardous condition (adj b = 0.86,
95% CI 0.58, 1.15, P <0.001) were significant associated factors for stress. For assistant medical officers,
study revealed that co-worker support (adj b = -1.45, 95% CI -1.77, -1.12 P = 0.002), job insecurity (adj
b= 0.89, 95% CI 0.61, 1.16, P <0.001) and supervisor support (adj b= 0.44, 95% CI 0.17, 0.71, P = 0.002)
were the significant associated factors for stress. Whilst among nurses, study showed that duration of
employment (adj b = 0.30, 95% CI 0.24, 0.36, P <0.001), number of children (adj b= -0.95, 95% CI
-1.25,-0.65 P<0.001), decision authority (adj b= -0.19, 95% CI -0.33, -0.06, P =0.005), psychological job demand
(adj b= -0.33, 95% CI -0.44, -0.22, P <0.001), physical exertion (adj b= 2.81, 95% CI 1.78, 3.84, P <0.001)
and job insecurity (adj b= 0.45, 95% CI 0.04, 0.87, P =0.033) were the significant associated factors for
stress.
Conclusion
Finding of this study may be useful for health promotion program of preventing stress among healthcare providers in the country.
AP 3
The usage Of Material Safety Data Sheet Among Dental
Personnel In Perak
Anna R ; Bibi Saerah; Siriander D; Law C H; Rohana K et al Perak Oral Health Division
Introduction
The MSDS is an important source of information for all health care workers while handling the concerned materials within their working environment. The aim of this study is to review and asses the present status of the usage and level of knowledge of MSDS among the dental personnel in the Oral Health Division of Perak.
Objective
The objectives were to determine the present status of MSDS usage among Dental Personnel in the Oral
Health Division of Perak, secondly to assess and compare the level of knowledge on MSDS usage and thirdly to determine the barriers for usage of MSDS.
Method
This cross-sectional study involved a total of 244 Dental personnel randomly selected from the Oral Health Division of Perak. Self-administered questionnaire was used. Data were analyzed using SPSS version 15.0.
Results
The mean (sd) knowledge score was 77.9% (9.15%). There were significant differences in the mean knowledge score between DO and DSA as well as between DN/DT and DSA. Highest proportion of DT (56.5%) reported that understanding of language was a barrier followed by DN (50.7%), DSA (44.4%) and DO (15.2%). This study also revealed that there is still poor usage of MSDS among more than half of all the categories of dental personnel.
Conclusion
This study revealed that there is poor usage of MSDS among more than half of all the categories of dental personnel. Awareness training, filing and labeling system for easier retrieval of MSDS as well as the translation of important information into simple Malay language were recommended to make MSDS more user-friendly.
AP 4
Prevalence and Predictors Of Recent Respiratory
Illness In The Malaysian Population
Paramesarvathy R; Gurpreet K; Amal NM; Tee GH
Kuala Lumpur City Council, Institute for PH, Institute for Medical Research
Introduction
Recent illness related to the respiratory system has been the leading cause of outpatient attendance in many countries. Recent respiratory illness in this study was defined by symptoms such as cough, cold, fever and difficulty in breathing reported in the last 14 days from the date of interview. Recent respiratory illness (RRI) imposes a big load on the burden of disease in Malaysia.
Objective
The aim of the study was to determine the prevalence and predictors of recent respiratory illness in the Malaysian population.
Methods
A cross-sectional population-based household survey, as part of the Third National Health and Morbidity Survey was conducted between April and August 2006 to obtain community-based data and information on the prevalence of RRI. Face to face interview was carried out to collect data on self- reported RRI over a two-week recall period.
Results
A total of 55,660 respondents were interviewed with a response rate of 98.2%. The overall prevalence of recent respiratory illness was 42.0%. The highest reported RRI was significant among the 10–19 years age group (19.5%), females (52.6%), Malays (62.5%), those with secondary educational level (40.29%), those earning less than RM2000 per month (25.90%), among Malaysians (96.9%), those married (61.8%), housewives ( 21.8%) and urban dwellers (60.0%). Age, sex, ethnicity, marital status, citizenship, occupation, education and residence were significantly associated with RRI. In the multivariate analysis, only ethnicity and citizenship were significantly associated with RRI.
Conclusion
The information obtained from this survey is useful to policy makers in the Ministry of Health to review and strengthen existing health programmes towards achieving the goal of Health for All by 2020.
AP 5
Knowledge, Attitude And Practices On Dengue
Among
R
ural Communities In
R
embau And Bukit
Pelanduk, Negeri Sembilan, Malaysia
Tan KL
Community Medicine Division, International Medical University
Objective
World Health Organization declares dengue to be endemic in South East Asia. The aim of the study was to assess the level of knowledge, attitude and practice concerning dengue among rural communities in Negeri Sembilan.
Methodology
A cross-sectional study involving 400 respondents from Rembau and Bukit Pelanduk, which represents a rural community, was conducted in August 2010. Data was collected by face-to-face interview using a structured questionnaire on knowledge, attitude and practice of dengue. All respondents aged 18 years and over were interviewed. Each question was analyzed individually. Knowledge, attitude and practice were assessed using a scoring system and grouped as ‘good’ or ‘poor’ based on an arbitrary cut-off point.
Results
Majority of the respondents were females (58.0%), Malays (68.0%) and had secondary level education (59.5%). It was found that 58% of the community had good knowledge. Out of the 400 respondents, 88.5% cited that their main source of information on dengue was from television or radio. Over 80% of the community had good attitude and most of them were supportive of Aedes control measures. In the community, 76% had good practice with 84.3% of respondents practicing some form of preventive measures against mosquito bite.
Conclusion
Television and radio are important means of conveying health messages to the public among rural population. More research and development of educational strategies designed to improve behaviour and practice of effective control measures among the rural community are recommended.
AP 6
Screening For Pathogenic Leptospira From Water
Samples At Pusat Latihan Khidmat Negara (Plkn) In
Northern And Eastern Region Of Peninsular Malaysia
Hasanatunnur A; Norliziana MA; Roziah A; Zulhainan H; Naim AKIpoh Public Health Laboratory (IPHL)
Introduction
Recent local outbreaks of leptospirosis among athletes, military personnel and civilians have highlighted the importance of screening for pathogenic leptospira from water samples related to water recreational activities.
Objective
Methods for detection of pathogenic leptospira in water samples specifically related to water
recreational activities at all Pusat Latihan Khidmat Negara (PLKN) were established as one of the
Ministry of Health (MOH) strategy based on the guidelines for diagnosis, management, prevention and control of leptospirosis in Malaysia.
Methods
Two series of screening programmes were carried out in 2010, February-March 2010 (1st series) and
June-August 2010 (2nd series). All water samples were collected accordingly, filtered and cultured into
both EMJH and Fletcher media. Incubation of both media was carried out at 30°C in shaking incubator for 2 weeks. In the presence of any motile spirochete leptospira-like organism, cultured samples were subjected to DNA extraction followed by Polymerase chain reaction (PCR) to determine the presence of pathogenic leptospira.
Results
In the first screening program, a total of 115 water samples were collected from 29 PLKNs. 21 samples (18%) from 13 PLKNs were found positive for pathogenic leptospira (10 PLKNs from northern region and 3 PLKNs from eastern region). Out of the 123 water samples collected from 30 PLKNs in the second screening program, 16 samples (13%) from 9 PLKNs were found positive for pathogenic leptospira (8 PLKNs from northern region and 1 PLKN from eastern region).
Conclusion
The presence of pathogenic leptospira in facilities related to water activities at PLKNs may indicate and highlight the importance of maintaining all water related facilities in order to minimize any chances of leptospira infection. The authority must also strictly ensure that no activities are conducted if pathogenic leptospira are detected. This is to prevent any possibility of human infection by pathogenic leptospira.
AP 7
Kejadian Wabak Hepatitis A Di Perkampungan
Masyarakat orang Asli Pos Jernang, Sungkai, Perak
Faizal; Azizi MZ; Azim RH
Pejabat Kesihatan Daerah Batang Padang, Perak
Pengenalan
Hepatitis A merupakan salah satu penyakit bawaan air dan makanan yang disebabkan oleh Virus Hepatitis A (HAV). Pada umumnya penyakit ini adalah berlaku di negara-negara yang sedang membangun di mana tahap kebersihan dan sanitasi adalah rendah. Wabak ini telah berlaku di Pos Jernang, Sungkai, Perak pada 24 Ogos hingga 26 Disember 2010.
Objektif
Untuk mengenalpasti punca jangkitan HAV dan cadangan langkah kawalan dan pencegahan yang perlu dilakukan dalam membendung wabak.
Metodologi
Kajian wabak secara retrospektif telah dijalankan dengan mengenalpasti punca jangkitan dan menilai aspek-aspek persekitaran dan tingkahlaku yang mendorong berlakunya wabak ini. Analisa
menggunakan program Microsoft Office Excel 2007 secara diskriptif statistik melalui format line listing
Kementerian Kesihatan Malaysia.
Keputusan
Sejumlah 6 kanak-kanak masyarakat asli telah dijangkiti HAV iaitu 3 lelaki dan 3 perempuan dengan bilangan orang terdedah seramai 950 menjadikan kadar serangan 0.6%. Bilangan kes mengikut kumpulan umur adalah 4 (66.7%) bagi 1 hingga 7 tahun, manakala 2 (33.3%) bagi 7 hingga 13 tahun.
Bilangan kes mengikut gejala adalah cirit birit 6 (100%), demam 6 (100%), Jaundis 6 (100%) dan ‘Dark
urine’ 6(100 %). Keluk Epidemik menunjukkan ’Propagated source’. Punca jangkitan adalah daripada persekitaran yang tidak bersih di mana tabiat membuang air besar (najis) di merata tempat, tempat permainan kanak-kanak juga didapati berdekatan dengan air limbah yang tidak terurus dengan baik dan dicemari dengan najis.
Kesimpulan
Punca penyakit ini di sebabkan oleh pencemaran daripada tanah/tempat permainan (persekitaran)
secara fecal-oral. Kawalan telah dibuat dan berjaya membendung jangkitan daripada terus merebak.
Pencegahan dan kawalan seperti menjaga kebersihan diri, teknik membasuh tangan yang betul dan makan makanan yang bersih (tidak tercemar) adalah kunci kepada kesihatan.
AP 8
Penilaian Keberkesanan Punjut Temephos 500 E Dalam
Tangki Septik Individu
Aslinda UAB; Mahani Y; Mohd NS; Noor RM; Hairul I Kinta HD, Perak Health Department
Pengenalan
Tangki septik individu didapati kondusif bagi pembiakan vektor denggi dan merupakan penyebab utama kejadian wabak di negeri Perak. Bagi mengawal pembiakan Aedes dalam tangki septik, punjut Temephos 500 E telah mula digunakan secara meluas di negeri Perak mulai tahun 2008, walaubagaimanapun beberapa aduan penduduk mengatakan masih terdapat banyak nyamuk di persekitaran rumah mereka.
Objektif
Menilai keberkesanan punjut Temephos 500E dalam tangki septik yang dirawat dalam tempoh 6 bulan.
Kaedah
Sebanyak 80 tangki septik diperiksa, 46 didapati sesuai untuk pembiakan nyamuk di Kg. baru Batu 10, Chemor. Semua tangki septik yang berpotensi dibahagikan kepada empat kumpulan iaitu 13 tangki dirawat dengan 4 punjut, 13 dirawat dengan 3 punjut, 10 dirawat dengan 2 punjut, 10 tangki septik tidak dirawat dan bertindak sebagai kawalan. Pensampelan larva di lapangan, kajian biosai di makmal, sukatan pH air telah dijalankan pada setiap minggu selama 3 bulan.
Keputusan
Kajian awal sebelum rawatan punjut Temephos 500E dimulakan, mendapati spesies nyamuk dalam
tangki septik didominasi oleh Amigeres spp. (70-80%), Culex spp. (15-20%) dan Aedes albopictus
(5-10%). Hasil kajian mendapati dalam tempoh 3 bulan, tiada larva nyamuk dikesan dalam tangki septik yang diletakkan 4 punjut temephos 500E , sebanyak 25% tangki septik yang dirawat dengan 3 punjut positif pembiakan Amigeres spp. dan Culex spp. bermula pada minggu keduabelas. Manakala 63% tangki septik yang dirawat dengan 2 punjut, positif pembiakan Amigeres spp. dan Culex spp. bermula pada minggu kelima. Tangki septic yang tidak rawat, 100% didapati positif sejak minggu pertama.
Rumusan
Tiada pembiakan Aedes untuk keseluruhan tangki septik yang dirawat sehingga 3 bulan. Kajian bioasai
juga mendapati kadar mortaliti larva Aedes albopictus adalah 100% dalam tempoh 24 jam bagi semua
tangki septik yang dirawat.
AP 9
A Study On Emergency Care Services And Equipment In
Healthcare Facilities
Ch’ng ML; Benedict CTW; Amy CAL; Dang SB; Razin Mahir
Hospital Raja Permaisuri Bainun, Ipoh; Perak State Health Department; Ministry of Health, Putrajaya, Malaysia
Introduction
The importance of emergency care services and availability of equipment in healthcare facilities can never be understated. Their availability is crucial to reduce morbidity and save lives.
Objectives
To study the availability of basic emergency care services and equipment in private healthcare facilities and the types of basic emergency care equipment made available.
Materials And Methods
This is a cross-sectional study carried out involving 485 private healthcare facilities at various locations in the 9 districts in the State of Perak.
Results
The results show that out of the 485 private healthcare facilities studied, 78.4% of the total number of private healthcare facilities had a low score. The remaining 21.6% of the total number of private healthcare facilities studied had a high score. The results also show a statistically significant difference (p< 0.05) between various types of private healthcare facilities with regards to the availability of basic emergency care services and equipment.
Conclusions
Different types of private healthcare facilities have been found to fare significantly different when it comes to their providing of basic emergency care services and equipment. Only about a quarter of private healthcare facilities scored high. The majority i.e. about three-quarters of private healthcare facilities scored poorly.
Recommendations
It is strongly recommended that equipment should be made available in healthcare facilities as they are essential to reduce morbidity and save lives. Not only should these equipment be made available but they should also be properly maintained and at optimal working conditions.
PP 1
External Quality assessment For Direct Sputum Smear
Microscopy For Acid Fast Bacilli In The State Of Perak
Lim JM; Tan KL; Murugan K; Akma I; Suhaila AR et al
Ipoh Public Health Laboratory (IPHL); TB / Leprosy Control Unit, Perak
Introduction
EQA identifies inappropriate procedures, out-of-date reagents, uncontrolled instrumentation, and /or training needs of incompetent or untrained staff.
Objective
Considering the importance of EQA, we evaluated the performance of AFB sputum smear microscopy carried out in 2010 for State of Perak, Malaysia.
Methods
A total of 9,587 AFB slides were collected based on statistically valid sampling procedure - Lot Quality Assurance Sampling (LQAS) from 81,744 AFB sputum smears prepared in 86 microscopic centres in the year 2010. EQA was carried out as described in the External Quality Assessment for AFB Smear Microscopy Manual (EQA-IUATLD/WHO).
Results
Overall, a total of 9,574 or 99.87% of AFB slides analyzed were in good agreement and only 13 slides (0.13%) were considered as false reading, of which 2 slides (0.02%) were considered as false positive reading, while another 11 slides (0.11%) were false negative. Assessment on general quality, cleanliness and proper staining of AFB slides showed an average of > 75% of the slides were prepared accordingly. In addition, the quality of smear size, evenness and thickness of AFB sputum smear prepared, showed an average of < 55% in quality.
Conclusion
The overall performance of direct smear sputum microscopic examinations in the peripheral laboratories of the State of Perak was satisfactory. However, the low percentage of quality for smear size, evenness and thickness of AFB smear prepared must be overcome in great efforts. A proper and regular on-the-job training of staffs at the peripheral laboratory coupled with supportive supervision by Ipoh Public Health Laboratory would greatly help to improve the DSSM performance.
PP 2
Fluoride In Drinking Water And Dental Fluorosis Among
Malay Schoolchildren In Kampung baharu Lanjut,
Sepang, Selangor: A Preliminary Study
Shaharuddin MS; Nurul Faiza OBDepartment of Community Health, Universiti Putra Malaysia
Objective
A study was conducted in November, 2010 to assess dental fluorosis occurrence and its relationship with fluoride in both drinking water and urine among 69 Malay schoolchildren aged 12-years-old, studying in a primary school at Kampung Baharu Lanjut in Sepang, Selangor.
Methodology
Both drinking water and urine samples were collected and analysed using a direct reading spectrophotometer based on the SPADNS method. Samples were collected for two consecutive days
and then cooled to 4oC before being transported to the laboratory for analysis. EDTA was used to
preserve urine samples.
Results
From the 69 respondents, 40 (58%) were males and 29 (42%) were females. Fluoride levels in drinking water ranged from 0.27 to 0.70 mg/L with a mean of 0.521 + SD 0.1004 mg/L, while urinary fluoride levels ranged from 0.36 to 2.70 mg/L, with a mean of 1.818 + SD 0.466 mg/L. Prevalence of dental fluorosis was 53.6% (37 respondents), with a minimum score of 1 to a maximum score of 4. Mean score was 0.824. Most (42%) respondents with dental fluorosis had a score of 1. Dental fluorosis occurred more in females (51.4%) than in males (48.6%). There was no significant difference in score of fluorosis between males and females (p>0.05). There was no relationship between score of fluorosis with fluoride in both drinking water and urine (p>0.05).
Conclusion
Fluoride levels in drinking water and urine were within the standard set by the relevant authorities, while dental fluorosis in the study population was very mild.
PP 3 First documented Case of Q Fever In malaysia InThe
21st Century – Epidemiology And Investigations
Bina Rai; Fadzilah K; Chow TS; Chee KY Penang State Health Department
Introduction
Q fever, caused by Coxiella Burnetti has never been routinely screened among livestock in Malaysia. In
April 2007, a private doctor managing a goat farm in Penang developed fever of 2 weeks duration. He presented with history of handling the abortus of goats and was admitted for investigation of fever of unknown origin. He was notified as suspected brucellosis but was later confirmed as Q fever
Objective
An investigation was initiated to find more cases, early treatment and prevent the chain of transmission.
Methods
This is a descriptive study. Epidemiological investigations included a site visit to the farm. An interview of patients, farm workers, family members and veterinary staff was done. Laboratory investigations were carried out. The State veterinary department investigated the animals. The veterinary workers in the State and farm workers were screened for Q fever.
Results
The goat farm had about 100 goats including imported goats. All the people interviewed were asymptomatic. Patients interviewed were tested positive for IgM and IgG for Q fever. 25.4% of goats tested had antibody positive for Q fever and were treated. Out of 54 people screened, 19 were IgM positive (7 both IgG and IgM positive) and 2 IgG positive only. All are under regular follow-up. The doctor recovered completely.
Conclusion
It is now compulsory for livestock from endemic countries to be screened for Q fever. Veterinary staff are also advised to use adequate protective gear while handling livestock. This is a first documented case of Q fever in Malaysia. The source is likely to be from imported goats.
PP 4
Outbreak Of Influenza Like Illness In Schools In Perak
Tengah District (From January - February 2011)
Adliah MS; Ariza AR
Perak Tengah Health Office, Bandar Seri Iskandar, Perak
Introduction
Influenza A (H1N1) infection had become a major public health problem in Malaysia after World Health Organization announced pandemic Influenza A (H1N1) which started in Mexico April 2009.
Objective
The aim of the study is to describe the situation of Influenza like Illness (ILI) infection in the district from 1 January 2011 until 28 February 2011.
Methods
This study is a cross sectional study from secondary data that was obtained from all cases registered with the Perak Tengah Health District. Secondary data collection was obtained from a registry of cases fulfilling criteria of Influenza-Like Illness (ILI) that was compiled from Crisis and Preparedness Response Centre (CPRC) Perak Tengah District Health Office from 1 January 2011 until 28 February 2011. A total of 163 cases were selected and SPSS version 11.5 software was used for data entry and analysis.
Results
Results showed that median age of the participants is 14 years (IQR: 13-15), and the highest percentage was in the age group of 14-18 years. Most of the participants are Malays (98.2%). Prevalence of symptoms of ILI was 23.9% and from 24 throat swab sample sent and analyzed for laboratory confirmation, 14 (58.3%) were positive. Bivariet analysis showed that there were no association between age, gender and staying in the hostel with ILI incident.
Conclusion
Our findings support the previous study that influenza A (H1N1) virus predominantly affects younger population age group. Prevalence of infection is high in school going group (14 – 18 years). This group of youths are highly exposed in the population and may pose as the source of transmission to the community. There is a need for the Ministry of Health to consider giving vaccination for school children to control the spread of the disease.
PP 5
Is Crash Dieting A Concern Among Female Students In
A Malaysian Private University?
Sabernero I; Gurpreet K
Faculty of Health & Life Science, Management & Science University, Institute for Pulic Health
Introduction
Crash dieting is a diet practice that cuts back on the amount of calories and fats that a person consumes daily. It is recognized by health care professionals as a dangerous way to lose weight.
Objective
The main objective of the study was to determine dietary practices among female students in a local private university in relation to weight lost desire.
Methodology
The study was cross sectional in design. A hundred questionnaires were distributed randomly among female students in the university. Those who were pregnant or suffering from diabetes, hypertension or other metabolic disorders were excluded. Verbal consent was obtained from potential respondents before answering a self-administered questionnaire in English. Data was collected from July-August 2010 and analyzed using SPSS version 17.
Results
The response rate was 99%. Majority of respondents were Malay (72.7%), non-smokers (86.9%) and
had a Body Mass Index (BMI) between 18.5-22.9 kg/m2 (59.6%). The mean age and BMI were 22.5
years and 22.2 kg/m2 respectively. Majority reported to practicing crash diets (41.6%), skipping meals
occasionally (61.4%) and exercising 3 times or less per week (82.2%). At every BMI category, majority admitted to wanting to lose 5-10 kgs in weight in the next few months.
Conclusion
Crash dieting was found to be a common practice among majority of the females in this institution. This raises concern, as regular practice can have detrimental physical and mental consequences. The implications are significant especially when the respondents are highly educated women who will become future leaders, career women and mothers.
PP 6
Health Seeking Behaviour Towards Communicable
Diseases Among Foreign Workers In Industiral And
Agriculture Sector In Selected Districts In Perak
Noor Asmah; Koh K; Ong KG; Wan Asmuni; Asmah ZAObjective
The objective of the study is to determine the health seeking behavior towards communicable diseases among foreign workers in the industrial and agriculture sectors in Perak.
Methodology
A cross sectional community survey was done to look at health seeking behaviour towards communicable diseases among foreign workers in the agriculture and industrial sectors from Perak, Malaysia. Two staged random stratified sampling method was conducted to ensure that all relevant sectors and ethnic groups were included. The study gathered information through interviews and self administrated using a standardized, pre-tested questionnaire.
Results
710 foreign workers were interviewed. A total of 338 (47.9%) workers were from agricultural sector and 372 (52.4%) were from industrial sector. Most respondents were legal workers (90.3%), and only 9.7 % (69) were illegal. Seventy respondents (9.85%) had experienced serious illnesses and another 209 respondents (29.4%) had experienced mild illnesses. For those who had experienced serious illnesses, 68 out of 70 (97.14%) respondents sought medical treatment as compared to only 172 out of 209 (82.3%) for respondents with mild illnesses. In response to 4 clinical scenarios (PTB, Malaria, Cholera and Typhoid symptoms), they would seek appropriate healthcare.
Conclusion
This study shows that foreign workers do not seem to have problems in seeking health care. Access to health care is a problem in the plantation sector in term of geographical location. Both legal and illegal foreign workers appear to understand serious illness and take appropriate action accordingly. Therefore, there is a need to improve access to health care for plantation workers.
