Volume 11(Suppl 1) 2011
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
Dr. Lokman Hakim Sulaiman
Assc. Prof. Dr Retneswari Masilamani
Assc Prof Dr. Mohamed Rusli Abdullah
Assc. Prof. Saperi Sulong
Dr. Maznah Dahlui
Dr. Roslan Johari
Dr. Othman Warijo
Dr. Amrizal Muhd Nur
University Putra Malaysia
Ministry of Health Malaysia
University Malaya
University Sains Malaysia
University Kebangsaan Malaysia
University Malaya
Ministry of Health Malaysia
Ministry of Health Malaysia
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
Tel: 03-91715394 Faks: 03-91715402 Email: mjphm@pppkam.org.my
Volume 11(Suppl 1) 2011
Official Journal of Malaysian
Public Health Physicians’ Association
4TH PERAK HEALTH CONFERENCE 2011
16 – 18 th MAY 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:
Datin Dr. Ranjit Kaur, MOH Perak
Dr. Bernard Benedict, MOH Perak
Dr. Wardati Malek, MOH Perak
Dr. Ling He Mey, MOH Perak
Mr. Gilbert Santiago, MOH Perak
Mr. Ngarilah Mohd Ariff, MOH Perak
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
CONTENTS
PAGES
PLENARY
PL1
ONE CARE FOR 1 MALAYSIA
Dr. Haji Nordin bin Saleh
1
PL2
EFFECTS OF WIRELESS COMMuNICATION ON HEALTH
Associate Professor Dr. Kwan Hoong Ng
2
PL3
INTEGRATED PRIMARY CARE - INTERGRATING VERTICAL
PROGRAMS FOR EFFECTIVENESS IN DELIVERY OF SERVICE
Dr. Hjh. Safura bt Haji Jaafar
3
PL4
ENSURING CONTINUITY OF HEALTHCARE – A SHARED
RESPONSIBILTY
Yg Bhg Dato’ Dr. Haji Ahmad Razin bin Dato’ Haji Ahmad Mahir
4
PL5
HEALTHCARE INTEGRATION – A PRIVATE PRACTITIONER’S VIEW
Dr. Steven Chow Kim Weng
5
SYMPOSIUM 1 COMBINED AND MuLTIDISCIPLINARY CARE
SYM I(1)
LOOKING AT THE WHOLE CHILD
Dr. Aminah Bee bt. Mohd Kassim
6
SYM I(2)
CONVERGING SHARED CARE IN MATERNAL AND CHILD HEALTH
Professor Dato’ Dr. N Sivalingam
7
SYM I(3)
SUPPORT SERVICES FOR FAMILY NEEDS
Dr. Cheah Yee Chuang
8
SYMPOSIUM 2 ACHIEVEMENTS OF THE MILLENNIUM DEVELOPMENT GOALS
SYM II(1)
IMPROVING CHILD HEALTH TOWARDS MILLENNIUM
DEVELOPMENT GOALS
Yg Bhg Dato’ Dr. Amar Singh HSS
9
SYM II(2)
MATERNAL HEALTH – MEETING THE MILLENNIUM DEVELOPMENT
GOALS
Dr. Safiah bt. Bahrin
10
i
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
CONTENTS
SYM II(3)
th
4 Perak Health Conference 16-18 May 2011
PAGES
COMBATING HIV/AIDS, TUBERCULOSIS AND MALARIA - ARE WE
ON TRACK?
Dr. Sha’ari bin Ngadiman
11
SYMPOSIUM 3 TECHNOLOGY AND HEALTH
SYM III(1)
HEALTH DATA INTEGRATION
Dr. Md. Khadzir bin Sheikh Haji Ahmad
12
SYM III(2)
ERGONOMICS IN HEALTH FACILITIES
Dr. Abu Hasan bin Samad
13
SYM III(3)
SACKING THE PLASTIC
Ms. Mageswari Sangaralingam
14
SYMPOSIuM 4
HEALTH RISK MANAGEMENT
SYM IV(1)
OUTBREAK RISK COMMUNICATION
Dr. Husnina bt. Ibrahim
15
SYM IV(2)
IMPROVING PATIENT SAFETY
Dr. Hajah Kalsom bt. Maskon
16
SYM IV(3)
OCCUPATIONAL RISK IN HEALTHCARE
Professor Dr. Rusli bin Nordin
17
FREE PAPERS
ORAL PRESENTATION
AP 1
PREVALENCE OF PATIENTS WITH CHRONIC PAIN AND ITS
ASSOCIATED FACTORS IN PRIMARY CARE ATTENDEES
Subashini; EM Khoo; Hanafi NS
18
AP 2
FACTORS ASSOCIATED WITH STRESS AMONG PRIMARY
HEALTHCARE DOCTORS, ASSISTANT MEDICAL OFFICERS AND
NURSES IN GOVERNMENT HEALTH CLINICS IN KELANTAN, 2010.
Asmah; Siti Raudzah
19
ii
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
CONTENTS
PAGES
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
20
AP 4
PREVALENCE AND PREDICTORS OF RECENT RESPIRATORY ILLNESS
IN THE MALAYSIAN POPULATION
Paramesarvathy R; Gurpreet K; Amal NM; Tee GH
21
AP 5
KNOWLEDGE, ATTITUDE AND PRACTICES ON DENGUE AMONG
RURAL COMMUNITIES IN REMBAU AND BUKIT PELANDUK, NEGERI
SEMBILAN, MALAYSIA
Tan KL
22
AP 6
SCREENING FOR PATHOGENIC LEPTOSPIRA FROM WATER
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
23
AP 7
KEJADIAN WABAK HEPATITIS A DI PERKAMPUNGAN MASYARAKAT
ORANG ASLI POS JERNANG, SUNGKAI, PERAK
Faizal; Azizi MZ; Azim RH
24
AP 8
PENILAIAN KEBERKESANAN PUNJUT TEMEPHOS 500 E DALAM
TANGKI SEPTIK INDIVIDU
Aslinda UAB; Mahani Y; Mohd NS; Noor RM; Hairul I
25
AP 9
A STUDY ON EMERGENCY CARE SERVICES AND EQUIPMENT IN
HEALTHCARE FACILITIES
Ch’ng ML; Benedict CTW; Amy CAL; Dang SB; Razin Mahir
26
POSTER PRESENTATION
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
27
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 OB
28
PP 3
FIRST DOCUMENTED CASE OF Q FEVER IN MALAYSIA IN THE 21ST
CENTURY – EPIDEMIOLOGY AND INVESTIGATIONS
Bina Rai; Fadzilah K; Chow TS; Chee KY
29
PP 4
OUTBREAK OF INFLUENZA LIKE ILLNESS IN SCHOOLS IN PERAK
TENGAH DISTRICT (FROM JANUARY - FEBRUARY 2011)
Adliah MS; Ariza AR
30
iv
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
CONTENTS
PAGES
PP 5
IS CRASH DIETING A CONCERN AMONG FEMALE STUDENTS IN A
MALAYSIAN PRIVATE UNIVERSITY?
Sabernero I; Gurpreet Kaur
31
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 ZA
32
PP 7
PREVALENCE OF HEARING IMPAIRMENT AND CARPAL TUNNEL
SYNDROME IN GRASS CUTTERS OF BAKAS UNIT BATANG PADANG
DISTRICT HEALTH OFFICE
Azim RH; Aman S
33
PP 8
UNHYGENIC FOOD PRACTISES - STUDENTS SUFFER
Hasniza A; Fauziah M N; Zulkifli H; Roziyana I; Halzeri Z
34
PP 9
KEBERKESANAN MODuL PENDIDIKAN DIABETES TERHADAP
PESAKIT DIABETES DI KLINIK KESIHATAN TAIPING
Bazariah Y; Amutha B; Sumathi M; Roziahwati A; Zuwariah AT et al
35
PP 10
EVALUATION OF PRESCRIBING PATTERNS AND COST ASSOCIATED
WITH THE USE OF ANTIHYPERTENSIVE AGENTS AT KLINIK
KESIHATAN BAGAN SERAI
Nurhani MA; Toh MJ
36
PP 11
TUBERCULOSIS IN THE DISTRICT OF LARUT MATANG AND
SELAMA, PERAK, MALAYSIA.
Syed MP
37
PP 12
PENGGUNAAN APLIKASI ELETRONIK DALAM PENYEDIAAN KERTAS
SIASATAN DI UNIT INSPEKTORAT DAN PERUNDANGAN, PEJABAT
KESIHATAN DAERAH KINTA
Nurulhisham S; Asroyadi HA; Shahrul AD; Tajudin H; Samad M et al
38
PP 13
GESTATIONAL DIABETES MELLITUS (GDM)
Sumathi M; Rosni W; Malliga S
39
PP 14
FIELD STUDY ON THE DERMATITIS CAUSED BY A BEETLE
PAEDERUS FUSCIPES (ROVE BEETLE) AMONG SCHOOL CHILDREN
AND TEACHERS IN TUNKU ABDUL RAHMAN (STAR) SCHOOL, IPOH.
Izzati K; Ili DS; Mahani Y; Noor RM
40
PP 15
SPECIES COMPOSITION, DENSITY AND BITING ACTIVITY OF
ANOPHELES SPP. FROM TWO LOCATIONS IN PERAK
Mahani Y; Aslinda UAB; Nor SI; Izzati K; Noor RM et al
41
PP 16
PENYERTAAN OPTIMuM MASYARAKAT MELALuI PENGLIBATAN
PANEL PENASIHAT KLINIK KESIHATAN
Othman BW; Jamal NS; Mohd Fauzi AB; Roslan H
42
PP 17
TO INCREASE PERCENTAGE OF THE DIABETIC PATIENTS WITH
GOOD CONTROL IN KLINIK KESIHATAN LENGGONG
Sofiah ZA; Teh YS; Fauziah H; Wan TK; Azmi I et al
43
iv
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PL 1
th
th
4 Perak Health Conference 16-18 May 2011
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
Malaysia’s health system has been recognised internationally as a good system. However, the current
and future challenges will affect the sustainability and relevance of the present system. Therefore,
readjustment of the country’s health system is critical. 1Care is the restructured national health system
concept that would be responsive and provides choice of quality health care, ensuring universal coverage
for the health care needs of the population through the spirit of solidarity and equity. The philosophy of
the 1Care concept is that the health system will undergo a transformation to one that is comprehensive
in terms of scope, equity, affordability, effectiveness and efficiency in terms of financing, integrated in
terms of delivery and accountable in terms of governance (stewardship). The 1Care concept is in tandem
with the 1Malaysia philosophy to foster greater cohesiveness of the Malaysian population through the
national health system. The proposed restructured Malaysian Health System will retain the existing
strengths of the current system. The concept focuses on three components which is streamlining of
MOH’s governance and stewardship functions and restructuring of the delivery and financing system.
To support the 1Care initiative and ensure effective integration of the public and private sector, it is
proposed that the health system will also be financed in a more integrated manner. It is expected that
with 1Care, the population will receive greater access to higher quality care which is affordable and
sustainable through better cost containment.
1
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PL II
th
th
4 Perak Health Conference 16-18 May 2011
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.
There have been very few studies investigating health effects in individuals exposed to RF fields from
base stations. This is because of the difficulty in distinguishing possible health effects from the very low
signals emitted by base stations from other higher strength RF fields in the environment. Most studies
have focused on the RF exposures of mobile phone users. Human and animal studies examining brain
wave patterns, cardiovascular function, cognition and behaviour after exposure to RF fields have not
identified adverse effects. Though there is no convincing scientific evidence that the RF fields from base
stations and wireless networks cause adverse health effects, nevertheless further research is still needed
to elucidate the basic interaction mechanisms and long-term health effects.
2
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PL III
th
th
4 Perak Health Conference 16-18 May 2011
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,
With scarce resources in primary care, Malaysia has introduced the REAP or Reviewed Approach in
Primary care focusing on Integration of the various vertical programs for the community to achieve
sustainable disease control and to build systems that is more responsive to the needs of patients and
communities. The challenges continue; to gain in capacity development from a vertical thought process
to one that is horizontal, comprehensive and wholesome.
3
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PL IV
th
th
4 Perak Health Conference 16-18 May 2011
Ensuring Continuity Of Healthcare – A Shared
Responsibilty
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
is nothing so satisfying to the spirit, so defining of our character, than giving our all to a difficult task. The
nature of “shared responsibility” should be cultivated in the community regardless of their backgrounds
and positions. To fulfill this mission, basic components should be emphasized for the culture of “shared
responsibility” to be practiced by all levels of society. To cultivate this culture, it must be born out
from awareness and importance of health to our society. Starting from the beginning families and schools
are important institutions for fertilizing an interest in the spirit of “shared responsibility”. It requires a
process of education, upbringing and training.
Whateverisdone, every program needs support from government in theformofmoney,planning
anddirection. Ministry of Health should act as a catalyst for realizing the culture of “shared responsibility” in
the community with respect to health. The agencies from different departments and ministries
together acknowledge responsibility for the realization of this dream in cultural change. Meetings and
discussions should be made compulsory for the relevant agencies to discuss issues arising for businesses
to run smoothly.
Hopefully one day, our society will be culturally competent to be equally responsible for their health and
in everything else e.g. clean environment and clean river.
4
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PLV
th
th
4 Perak Health Conference 16-18 May 2011
Malaysian Healthcare Scenario –Private Practitioners’
Perspective
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.
The Federation is of the view that the healthcare must not be treated as a commercial commodity.
The future healthcare system must prioritize and preserve the social obligation of providing quality
affordable and compassionate patient care for the people of Malaysian over and the commercial
agenda.
5
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
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
Multidisciplinary approach draws appropriately from multiple disciplines to redefine problems and
reach solutions based on a new understanding of complex situations. Multidisciplinary approach is
holistic care. What are pro and cons of multidisciplinary care? Can be it carried out effectively? Can it be
implemented at the primary care level? How can it be applied in the holistic care of the child?
6
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
SYM I (2)
th
th
4 Perak Health Conference 16-18 May 2011
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.
The vital statistics clearly indicates that maternal mortality is not declining in spite of introduction
of technology and increasing numbers of health care givers. The need to converge primary care and
hospitalist care is urgent as the MDGs set out will not achieved if the current health care strategies
continues to prevail. Transformation is not more a catchword but need to be realized through healthcare
engineering.
7
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
SYM I (3) Support Services For Family Needs
Dr. Cheah Yee Chuang
Consultant Psychiatrist
Hospital Bahagia Ulu Kinta, Perak
Care for persons with serious mental illness (SMI) has moved from custodial to community settings.
Individuals with SMI require treatment, rehabilitation and support to function in the community. There
are two types of burden on family members, i.e objective burden and subjective burden. Family require
appropriate and sufficient education, training and emotional support for their care-giving role.
8
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
SYM II (1)
th
th
4 Perak Health Conference 16-18 May 2011
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.
In recent decades there has been an “explosion” of tertiary level specialised services as means to meet
the health needs of the community. The forces that drive the provision of health care are often other than
true health needs - whether those perceived by the public, professionals or governments. Often “market
forces” determine how such services develop. It is vital that the heath care service move to accelerate
the development of “wellness” services and focus on the communities and not the hospitals or the health
professionals. To move forward, we must “Make the Right Real”, which means address the reality that
we see before us and act accordingly. If we continue to deviate our focus from the true health needs of
children and communities we will fail to make further significant impact on child health. Strong advocacy
is required and this will require not just a transformation of our work but more importantly our hearts.
9
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
SYM II (2)
th
th
4 Perak Health Conference 16-18 May 2011
Maternal Health – Meeting The Millennium
Development Goals
Dr. Safiah bt. Bahrin
Senior Principal Assistant Director
Family Health Development Division
Ministry of Health Malaysia
Improving maternal health is a vital economic and social investment and is one of the Eight Millennium
Development Goals (MDG). The original target consist of two indicators for monitoring progress which
is reducing maternal mortality ratio by three quarters between 1990 and 2015, and increasing the
proportion of births attended by skilled health personnel to more than ninety per cent. However, in year
2005, due to the slow reduction in maternal mortality ratio (MMR) globally, world leaders recognized
that sexual reproductive health is a prerequisite for achieving MDG 5, it also contributes significantly
to reducing poverty and hunger (MDG 1), promoting gender equality and empowerment of women
(MDG 3) and combating HIV and other diseases (MDG 6). In order to achieve MDG 5, programs and
initiatives will need to expand beyond maternal health. An accelerated action towards universal access
to reproductive health (an additional target in MDG 5) enhances the progress towards achieving the
Millennium Development Goal by 2015.
10
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
SYM II (3)
th
th
4 Perak Health Conference 16-18 May 2011
Combating HIV/AIDS, Tuberculosis and MalariaAre We On Track?
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.
In managing the HIV/AIDS, tuberculosis and malaria situation, the new national strategic plans were
drafted. These strategic plans will be use in implementation activities, direction for the country to
achieve MDG target for HIV/AIDS and tuberculosis and MDG-plus for malaria.
11
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
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
Health informatics standards in particular the National Health Data Dictionary and proper adherence
in data definitions is essential towards achieving interoperability. Data collected should be at a granular
level to enable effective data mining and analysis.
12
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
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.
This paper will cover various aspects of ergonomics hazards including the office ergonomics and
field ergonomics at the various health care settings. It will focus more on the importance of creating
awareness among the health care personnel, prevention and early detection and treatment of
ergonomics-related illnesses or injuries. The roles of individual employee, supervisor or manager in the
implementation of ergonomics program will be emphasized. Various tools used in the implementation
of a good ergonomics program and learnings from other successful program will also be shared.
13
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
SYM III (3) Sacking The Plastic
Mageswari Sangaralingam
Research Officer
Consumers’ Association of Penang
Plastics have become a bane in our society, causing environmental pollution and adverse health effects.
We must reject this toxic substance that is problematic throughout its lifecycle, from production, use to
disposal. This presentation will encompass an introduction to plastics, some common plastics and why
we need to sack the plastic. All types of plastics are harmful in some way but this presentation will focus
on sacking polystyrene, plastic bags and Polyvinyl Chloride (PVC) from healthcare. Several tips are given
to avoid exposure to the toxins and sack plastics.
14
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
SYM IV (1) Outbreak / Risk 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,
maintenance of quality websites and other information sources as well as monitoring for rumors
and surveys.
15
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
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
Safer Care, Safer Surgery Through Better Communication, Reducing Antimicrobial Resistance, Research
in Patient Safety and Reporting and Learning. There is a need of a concerted effort from all healthcare
givers, patients as well as the community so as to ensure improvements in patient safety.
16
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
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
The healthcare environment, like any other workplaces, has its own sets of hazards and risks to the
health of healthcare workers and patients. Managing occupational risk in healthcare depends on the
collective responsibility of management (employer) and healthcare workers (employees) as well as the
cooperation of patients.Safety and Health Committee has the responsibility to ensure that OSH activities
are diligently observed and in compliance with the prevailing OSH laws, regulations, guidelines and
approved industry codes of practices. Health risk assessment activities must be carried out when there
are changes to the work processes or when new technologies and procedures are adopted. Health risk
management is aimed at ensuring that the workplace is safe and that each healthcare worker is fit for
work. Employee assistance program is an important component of the OSH program.
17
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
AP 1
th
th
4 Perak Health Conference 16-18 May 2011
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.
Keywords: chronic pain, University Medical Center, age
18
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
AP 2
th
th
4 Perak Health Conference 16-18 May 2011
Factors Associated With Stress Among Primary
Healthcare doctors, assistant medical officers and
nurses In government Health Clinics In Kelantan, 2010
Asmah; Siti Raudzah
Department 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.
Keywords: stress, primary healthcare workers, job content questionnaire, Kelantan
19
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
AP 3
th
th
4 Perak Health Conference 16-18 May 2011
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.
Keywords: Dental personnel, MSDS, usage
20
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
AP 4
th
th
4 Perak Health Conference 16-18 May 2011
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 selfreported 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.
Keywords: Recent respiratory illiness, outpatient, survey
21
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
AP 5
th
th
4 Perak Health Conference 16-18 May 2011
Knowledge, Attitude And Practices On Dengue
Among Rural Communities In Rembau 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.
Keywords: dengue, knowledge, practice, rural population
22
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
AP 6
th
th
4 Perak Health Conference 16-18 May 2011
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 AK
Ipoh 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.
Keywords: leptospira, water samples, PLKN
23
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
AP 7
th
th
4 Perak Health Conference 16-18 May 2011
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.
Katakunci: Hepatitis A, Punca Jangkitan, Pencegahan dan Kawalan
24
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
AP 8
th
th
4 Perak Health Conference 16-18 May 2011
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.
Katakunci: Aedes, Culex, Armigeres, tangki septik, denggi, temephos 500E
25
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
AP 9
th
th
4 Perak Health Conference 16-18 May 2011
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.
Keywords: emergency care services, equipment, private healthcare facilities
26
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 1
th
th
4 Perak Health Conference 16-18 May 2011
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.
Keywords: EQA, agreement, false reading, AFB smear
27
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 2
th
th
4 Perak Health Conference 16-18 May 2011
Fluoride In Drinking Water And Dental Fluorosis Among
Malay Schoolchildren In Kampung baharu Lanjut,
Sepang, Selangor: A Preliminary Study
Shaharuddin MS; Nurul Faiza OB
Department 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.
Keywords: fluoride, dental fluorosis, Malay schoolchildren, drinking water, urine
28
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 3
th
th
4 Perak Health Conference 16-18 May 2011
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.
Keywords: Q fever, goat farm, livestock
29
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 4
th
th
4 Perak Health Conference 16-18 May 2011
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.
Keywords: Outbreak in schools, Influenza like illness, cross-sectional study
30
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 5
th
th
4 Perak Health Conference 16-18 May 2011
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.
Keywords: Crash dieting; female students
31
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 6
th
th
4 Perak Health Conference 16-18 May 2011
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 ZA
Objective
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.
Keywords: Health seeking behavior, foreign workers, illness
32
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 7
th
th
4 Perak Health Conference 16-18 May 2011
Prevalence Of Hearing Impairment And Carpal Tunnel
Syndrome In Grass Cutters Of Bakas Unit Batang Padang
District Health Office
Azim RH; Aman S
Batang Padang District Health Office, Occupational Health Clinic Tanjong Malim
Introduction
Grass-cutting activity by using shoulder-mounted grass-cutting machine exposes an individual to
physical hazards i.e. noise and vibration. Noise is unwanted sound. Vibration is mechanical oscillations
about an equilibrium point. Hearing impairment (HI) is when the capability of hearing threshold is
above 25dB at any frequency. Carpal tunnel syndrome (CTS) is the situation when the median nerve is
compressed within the carpal tunnel and causes the signs and symptoms.
Objective
The aim of this study was to determine the prevalence of HI and CTS in grass cutters of the BAKAS Unit
in Batang Padang District Health Office.
Methodology
A cross sectional study was carried out at Batang Padang District Health Office, from November till
December 2010. Prevalence of HI and CTS secondary to vibration was identified in grass cutters.
Hearing was assessed by audiometric test, done by trained operators. Exposure to CTS was assessed by
worker’s responses on self-administered questionnaire. CTS status was confirmed by history, that was
suggestive of the syndrome and provocative test was performed by an occupational health physician.
Data was analyzed by using Microsoft Office Excel 2007 in descriptive statistics.
Results
A total of 19 male grass cutters from BAKAS Unit participated in the study. The mean age was 41.2
years old, weight was 71.5 kg and height was 163.3 cm. The percentage of smokers was 47.4% and those
having medical problems were 15.8%. Workers with hearing impairment were 12 (63.2%), out of which
4 (33.3%) were having noise-induced hearing loss, where else CTS was present in 1 (5.3%).
Conclusion
The prevalence of HI in grass cutters was high, indicating high morbidity due to noise where else CTS
was low, indicating low morbidity due to vibration in this occupation. The need for use of ear-protecting
device is mandatory and periodical medical surveillance is advised. Health programmes especially
health education and promotion should be delivered to the workers in view of their risk in developing
hearing problems and the importance of wearing personal protective equipment.
Keywords: Grass cutters, Hearing impairment, Carpal tunnel syndrome, Prevalence
33
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 8
th
th
4 Perak Health Conference 16-18 May 2011
Unhygenic Food Practises - Students Suffer
Hasniza A; Fauziah M N; Zulkifli H; Roziyana I; Halzeri Z et al
Bachok District Health Office, Kelantan
Introduction
Occurrence of food poisoning is notifiable under schedule 6 of the Communicable Disease Control Act
1988. Bachok District Health Office received a notification of suspected food poisoning on the 11th
January involving a group of students after eating at a hostel at SK Kandis, Bachok, Kelantan.
Objective
An investigation was undertaken to determine source of outbreak, identify the causative agents and
recommend control measures.
Methodolgy
Cases were those who ate at the hostel between 9 to 11, January 2011 and developed an acute onset of
abdominal pain and diarrhea. Activities were carried out to determine more cases. HACCP inspection
was carried out which included testing the water supply for coliform.
Results
It was a common source outbreak with an attack rate of 10.9% involving all the female students aged
12 years who stayed at the hostel. There was no reported similar cases from the other students. The
incubation period ranged from 45 minutes to 3 hours and the implicated food was “kuih buah melaka”.
Cohort study revealed RR for “kuih buah melaka” was 1.77 (1.24 < RR < 2.53). HACCP inspection
showed several violations; contamination of raw materials, holding time of more than 4 hours, crosscontamination of water supply, improper food storage, unsanitary premise and unhygienic food handlers.
Raw food such raw coconut and coconut milk were contaminated with coagulase positive staphylococci.
Food handlers were positive for coagulase positive Stapylococci. Rating of food premise under Food Act,
1983 was 83.5%. The hostel kitchen was closed under the CDC act 1988.
Conclusion
Unhygienic food practices observed at the hostel kitchen had lead to the outbreak of food poisoning
among the students.
Keywords: food poisoning, coagulase positive Staphyloocci, Bachok District health Office, SK Kandis
34
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 9
th
th
4 Perak Health Conference 16-18 May 2011
Keberkesanan Modul Pendidikan Diabetes Terhadap
Pesakit Diabetes Di Klinik Kesihatan Taiping
Bazariah Y; Amutha B; Sumathi M; Roziahwati A; Zuwariah AT et al
Tujuan
Meningkatkan tahap pengetahuan pesakit diabetes mengunakan modul pendidikan diabetes yang
standard di Klinik kesihatan Taiping
Methodologi
Kajian ini dijalankan melibatkan 2 kumpulan. Kumpulan pertama terdiri dari 30 responden “control
group” iaitu pesakit yang mendapat rawatan susulan sementara kumpulan kedua merupakan 30
responden “study group “ dimana pesakit yang mendapat rawatan susulan serta diberikan intervensi
pendidikan kesihatan menggunakan Modul Pendidikan Diabetes. Tahap pengetahuan kumpulan
responden dinilai mengunakan soal selidik yang terdiri dari 20 soalan, merangkumi 4 modul pendidikan
diabetes. Pada “control group”. responden perlu menjawab “pre test” sahaja, manakala “study group”
perlu menjawab “pre – test” dan mengikuti kelas pendidikan diabetes dan seterusnya menjawab “post
– test”.
Keputusan
Hasil kajian mendapati tahap pengetahuan “control group” adalah sebanyak 16.7% (5 responden) yang
capai kriteria lulus, manakala “study group” menunjukkan pre – test 6 pesakit (20%) lulus. “Post – test”
menunjukkan peningkatan iaitu 19 orang pesakit 63.33%) lulus.
Rumusan
Hasil kajian mendapati Pendidikan kesihatan mengunakan Modul diabetes dapat meningkatkan tahap
pengetahuan pesakit.
Katakunci : pesakit diabetes, modul pendidikan diabetes
35
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
Evaluation Of Prescribing Patterns And Cost Associated
PP 10 With The Use Of Antihypertensive Agents At Klinik
Kesihatan Bagan Serai
Nurhani MA; Toh MJ
Pharmacy Unit, District Health Office Kerian.
Objective
The current study was designed to evaluate pattern of hypertensive agents prescribed and to investigate
drug utilization and the pharmaco-economics of hypertension in the government health clinic.
Methods
A descriptive, cross-sectional and retrospective analysis of prescriptions received by the Pharmacy Unit,
KK Bagan Serai was conducted. Prescriptions received in a month were screened and data collected from
all prescriptions which met the inclusion criteria.
Results
A total of 3,249 prescriptions were screened and 662 of the prescriptions met the inclusion criteria,
meanwhile 2,587 prescriptions were excluded. The rate of prevalence of hypertension is higher in
women (58.3%) than men (47%). The race with the highest prevalence was in Malays (61.5%), Chinese
(19.6%) and Indians (18.9%). Meanwhile, the age of hypertension patients ranged from 26 to 92 years
old with mean age 59 years old. The evaluation of prescribing patterns show beta-adrenoceptorblocking agents (25.1%), thiazides diuretic (22.9%), calcium channel blocker (21.4%) and angiotensinconverting enzyme inhibitors (21.1%%) were the most popular antihypertensive drugs used. 55.4% of
the patients were treated with combination therapy and 44.6% treated with monotherapy. Combination
of two-drug was the most commonly used (37.8%), followed by three-drug combination (13.3%) and
four-drug combination (4.4%). About 58.2% of the prescriptions had at least one brand-name drug and
78.1% prescriptions were written with at least one drug in short form. Estimated monthly cost (direct
medication cost) of hypertension treatment was approximately RM 9,321.92, estimated annual cost
was approximately RM 111,862.99 and average cost for each hypertension patient was RM14.08. In KK
Bagan Serai, 25.33% of total drugs expenditure in 2010 were spent on antihypertensive agents.
Conclusion
In conclusion, the prevalence of hypertension is KK Bagan Serai was different in terms of age, gender
and race. The pattern of antihypertensive drug prescribed depends on co-morbidities and guidelines for
treating patients with antihypertensive agents. The cost of treatment for hypertension could describe
partly the drug utilization and expenditure on drugs by PKD Kerian.
Keyword: Hypertensive agents, prescriptions cost
36
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 11
th
th
4 Perak Health Conference 16-18 May 2011
Tuberculosis In The District Of Larut Matang And
Selama, Perak, Malaysia
Syed MP
LMS District Health Office
Introduction
Next to dengue fever, tuberculosis (TB)causes the highest morbidity in Malaysia. The incidence rate is
approximately 65 per 100,000 population. Larut, Matang and Selama (LMS) is a district in Perak, Malaysia
where the incidence of TB is high (59.7-60.8/100,000) compared to the overall incidence in the State of
Perak (50.7-52.3/100,000). A review was carried out to describe the trend of TB, the epidemiology and
its management in the district between 2006 to 2008 with the aim to better control TB in the district
Methods
A cross sectional descriptive study was done by reviewing data in the TB registry (TBIS) and returns
from the TB program. Data were retrieved from notification forms upon diagnosis, treatment data in
patient’s treatment folder, investigation of cases notes, lab data with regards to TB and investigation of
TB death data. These data were analyze using SPSS version 14
Results
There were 1842 TB cases reported between 2006 and 2008 with an incidence of 60.1, 59.7 and 59.4
per 100,000 population respectively. The incidence of TB among males was twice as high. The highest
incidence was among the Chinese (103-111/100,000 population), followed by Indians (70.5-76/100,000
population) and the Malays (59.0-66.3/ 100,000 population). The incidence of TB was found to increase
with age. There is variation in the incidence of TB in the sub districts with some areas having higher
incidence through out the three year period.
77- 89% of the TB cases were of pulmonary type with nearly a quarter having moderate lung lesions. Co
infection with HIV was minimal. Sputum conversion rate was more than 85% and cure rate more than
93%. Contract tracing did not reach the target of at least four contacts per case. Outpatient screening did
not reach the 3% target.
Conclusions
Incidence of TB was high among the Chinese, older age group and certain sub districts. We have now
taken measures to focus on this . Efforts have also been taken to improve contact tracing and screening
of outpatients.
Keywords: Tuberculosis, sputum conversion rate, cure rate, lung lesion
37
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 12
th
th
4 Perak Health Conference 16-18 May 2011
Penggunaan Aplikasi Eletronik Dalam Penyediaan
Kertas Siasatan di Unit Inspektorat Dan Perundangan,
Pejabat Kesihatan Daerah Kinta
Nurulhisham S; Shahrul AD; Tajudin H; Samad M; Asroyadi HA et al
Unit Inspektorat & Perundangan PK D Kinta; UIP JKNP
Pengenalan
Daerah Kinta merupakan sebuah daerah yang tinggi jumlah pembiakan nyamuk aedes yang dijumpai
iaitu purata bagi tahun 2005 hingga 2009 sebanyak 716 pembiakan. Semua pembiakan dijumpai diambil
tindakan perundangan iaitu dikompaun. Sebanyak 60% (450) daripada kompaun tidak dibayar dan
perlu dibuka kertas siasatan bagi kes didakwa di mahkamah.
Objektif
Aplikasi ini dihasilkan untuk mencapai objektif berikut iaitu, memastikan semua kesalahan di bawah
Undang-Undang Kesihatan Awam diambil tindakan perundangan, tindakan perundangan diambil dalam
masa yang ditetapkan, dan mewujudkan pengkalan data yang bersistematik dan mesra pengguna.
Metodologi
Aplikasi diasaskan melalui dua komponen iatu peranti keras (hardware) menggunakan satu set
komputer bersama-sama mesin cetak dan komponen kedua ialah perisian (software) minima Microsoft
Office 2003. Terdapat 11 dokumen yang perlu disediakan bagi setiap kertas siasatan.
Keputusan
Hasil daripada transformasi aplikasi KS e ini, tugasan berjaya disempurnakan dalam masa yang singkat
iaitu kurang dari sepuluh minit bagi setiap kertas siasatan berbanding 120 minit sebelum ini. Selain
daripada itu, aplikasi ini juga berjaya mewujudkan pengkalan data yang sistematik dan kemaskini
serta mudah akses. Aplikasi ini sedang digunakan dalam penyediaan kertas siasatan bagi kes-kes Akta
Pemusnahan Serangga Pembawa Penyakit 1975 dan Peraturan-Peraturan Kawalan Hasil Tembakau 2004.
Usaha sedang dilakukan bagi meningkatkan keupayaan aplikasi dalam menyediakan kertas siasatan kes
di bawah Akta Makanan 1983.
Kesimpulan
Kesimpulannya, aplikasi ini telah membantu pegawai di Unit Inspektorat & Perundangan (UIP) Pejabat
Kesihatan Daerah Kinta dalam menyelesaikan tugasan dengan berkesan, kemas, tepat, cepat, dan
bermutu. Aplikasi ini juga sesuai untuk digunakan oleh semua daerah di Negeri Perak.
Katakunci : Unit Inspektorat dan Perundangan, Kertas Siasatan, Undang-Undang Kesihatan Awam
38
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
PP 13 Gestational Diabetes Mellitus (GDM)
Sumathi M; Rosni W; Malliga S
Introduction
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first
recognition during pregnancy. According to the American Diabetes Association, approximately 3-8% of
pregnant mothers are diagnosed with GDM annually and 50-60% of women with GDM will develop
Type 2 Diabetes (T2DM) in 10 years time. Following up these patients is important for preventing
adverse outcomes. The Gestational Diabetes Mellitus (GDM) Register was established in Larut Matang
and Selama in January 2008 in response to the lack of a systematic, centralised long term follow up of
women who have had GDM.
Aim
The purpose of the GDM Registry is to follow up these women annually to ensure continuous monitoring
and to remind them that them that they should have their diabetes status checked because they are at
increased risk of developing type 2 diabetes. In addition the registry complements the pre pregnancy
care to prepare them for the next pregnancy.
Methodology
A cross sectional study was carried out in all 12 clinics in LMS. All women diagnosed as GDM from 2008
are followed up at six weeks post partum and annually using the registry.
Results In 2008 a total of 508 women were diagnosed as GDM of which 69.5 % (353) came at six weeks
postpartum to screen for diabetes. At six weeks postpartum 5.7 % (20) were diagnosed as Type 2
diabetes. In 2009 and only 130 (26.6%) came for the annual follow up of 1.5% (2) were diagnosed as
Type 2 Diabetes. In 2010, 61 (12%) came for their second annual follow up of which 1 (1.6%) was
diagnosed as type 2 diabetes.
Conclusions
The GDM Registry is effective in providing a baseline data on the number of women diagnosed with
GDM. The Registry helps us identify retention of women over the first six weeks and annually. With the
registry, Type 2 diabetics are diagnosed and managed early. The drop out rate in LMS was found to be
high hence a recall system has been introduced to remind them about their screening.
Keywords: GDM, registry
39
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
Field Study On Dermatitis Caused By The Beetle Paederus
PP 14 Fuscipes (Rove Beetle) Amongst School Children And
Teachers In Tunku Abdul Rahman (Star) School, Ipoh
Izzati K; Ili DS; Mahani Y; Noor RM
Kuala Kangsar HD, Batang Padang HD, Perak Health Deapartment
Introduction
Paederus dermatitis is a perculiar irritant contact dermatitis characterised by erythemato-bullous
lesions of sudden onset on exposed areas of the body. This disease was reported amongst students and
teachers from Tunku Abdul Rahman School (SMART) Ipoh.
Objective
The objective of the study was to identify the causative agent, to determine the most attractive places,
and to recommend preventive measures.
Method
Students and teachers were examined and interviewed to detect the area of infestation. Samples of bugs
found were collected and identified.
Results
A total of 7 students and 3 teachers had symptoms of dermatitis. Paederus fuscipes were found highly
concentrated (25-30 bugs) on the walls and ceiling of the hostel toilets during the day. From observation,
aged structure of the school building like wood frame doors and windows, poor ventilation of toilets
that were dilapidated and always in a moist state, due to rain and frequent use of water in the toilet are
suitable breeding sites for these beetles. Boarding the ventilation panes, use of insecticide residual spray
and ULV at night were successfully implemented to control the beetles.
Conclusion: Rove beetle can cause an outbreak of bizarre dermatitis, diagnosis of blistering beetle
dermatitis should be kept in mind. Timely diagnosis, epidemiological investigation and insecticide
spraying bring down the incidence of new cases.
Keywords: Rove beetle, Paederus fuscipes, dermatitis
40
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 15
th
th
4 Perak Health Conference 16-18 May 2011
Species Composition, Density And Biting Activity Of
Anopheles Spp. From Two Locations In Perak
Mahani Y; Aslinda UAB; Nor SI; Izzati K; Noor RM et al
Perak Health Department, Kinta HD, LMS HD, Kuala Kangsar HD, Batang Padang HD
Introduction
Malaria is still a public health problem especially among arborigines living near the Titiwangsa
Range in Perak. It is essential to collect data from several areas within the region due to the
microepidemiological nature of malarious areas where settlements within close proximity can vary
dramatically in transmission dynamics (Greenwood 1989).
Objective
To observe species composition, density and biting activities of Anopheles species.
Method
Collections of antrophilic Anopheles spp. were conducted monthly at Kg. Terhem, Kuala Kangsar and Kg.
Sahom, Kampar from June 2009 to December 2010. Control activities were done regularly in Kg. Terhem
whereas in Kg. Sahom, control activities were done only when a case was reported. Both areas are located
inland at the foothills of the Titiwangsa Range and the distance between these areas is 51 km.
Results
An. maculatus (90% - 96%) which is the primary vector for malaria was the most abundant species
throughout the year followed by An. barbirotris (4% - 7%) at both area. An. hycanus (2%) and An. kochi
(1%) were found only in Kg. Terhem. The highest peak of An. maculatus collected in Terhem was bimodal
(October 2009 & May 2010) while in Sahom, An. maculatus distribution showed the highest trend in
October for both years(2009 & 2010). Human bait landing collections outdoor showed biting of An.
maculatus for both location occurred almost the same period at 20.00 - 22.00 hours. Outdoor biting of
An. barbirotris were also observed throughout the night with several peaks after the second half of the
night.
Conclusion
These findings showed that despite regular contol activities done in Terhem, Kuala Kangsar the density
of malaria vector is still high compared to Sahom, Kampar. Thus, regular vector control activities and
health education to the community should be in place without failure in Kg. Terhem, Kuala Kangsar.
Keywords: Malaria, Anopheles maculatus, Anopheles barbirostris
41
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 16
th
th
4 Perak Health Conference 16-18 May 2011
Penyertaan Optimum Masyarakat Melalui Penglibatan
Panel Penasihat Klinik Kesihatan
Othman BW; Jamal NS; Mohd Fauzi AB; Roslan H
Pejabat Kesihatan WP Putrajaya; Klinik Kesihatan Putrajaya Presint 9 Putrajaya.
Pengenalan
Panel Penasihat Klinik Kesihatan (PPKK) ditubuhkan untuk berperanan sebagai penghubung dengan
mendekatkan klinik kesihatan kepada masyarakat. Selaras dengan mandat tersebut, PPKK di KK
Putrajaya Presint 9 telah melaksanakan pelbagai aktiviti dalam masyarakat, antaranya penyertaan
proaktif dalam sambutan Hari Jantung Sedunia 2010 (HJ 2010).
Objektif
Sambutan HJ 2010 bertujuan mempromosi kepentingan amalan Gaya Hidup Sihat sebagai pencegahan
penyakit jantung koronari. PPKK mengambil bahagian aktif menjayakan sambutan anjuran Pejabat
Kesihatan WP Putrajaya kerana bebanan kedatangan klinik untuk rawatan darah tinggi dan diabetes
terus meningkat, menandakan pencegahan di peringkat individu dan masyarakat adalah kritikal.
Metodologi
HJ 2010 dijalankan selama sebulan (26 September hingga 23 Oktober 2010) merangkumi pameran
dan khidmat nasihat kesihatan di pelbagai jabatan, kursus CPR masyarakat dan kemuncaknya Berjalan
Untuk kesihatan Anda dan perasmian penutup. PPKK terlibat sebagai 1) Penggalak dengan mengedarkan
risalah dan poster mengenai acara-acara HJ 2010, 2) Penggerak dengan mendapatkan kerjasama
Kelab Warga Emas Putrajaya dan persatuan penduduk bersama-sama mendapatkan penyertaan dan
menjaga pameran, dan 3) Pembimbing dengan bertindak menyampaikan nasihat kesihatan kepada para
pengunjung.
Keputusan
Hasilnya, HJ 2010 telah mencapai kejayaan menggalakkan di mana peserta Berjalan Untuk Kesihatan
telah melebihi 1000 peserta, lebih 1000 pengunjung menerima khidmat nasihat melalui semua acara
dan 1200 risalah kesihatan diedarkan oleh PPKK. Penglibatan PPKK juga telah menjimatkan kira-kira
RM 16,000 kos penganjuran.
Kesimpulan
Kesimpulannya, penglibatan aktiviti PPKK telah berjaya mendapatkan penyertaan optimum masyarakat
serta menjimatkan kos HJ 2010 di Putrajaya.
Katakunci: Panel penasihat, sambutan, pameran, kursus
42
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
PP 17
th
th
4 Perak Health Conference 16-18 May 2011
To Increase Percentage of The Diabetic Patients With
Good Control In Klinik Kesihatan Lenggong
Sofiah ZA; Teh YS; Fauziah H; Wan TK; Azmi I et al
Introduction
Diabetes is a chronic diseases with multiple serious complications including blindness, ischaemic heart
disease, stroke, kidney failure and ultimately death. The National Health Morbidity Survey (NHMS)
III done in 2006 showed there was increased prevalence of diabetic patients which were 14.9% as
compared to only 8.3% NHMS II done in 1996. The new diabetic patients registered in Klinik Kesihatan
Lenggong (KK Lenggong) are about 30 -50 patients each year. To date the total number of registered
diabetic patients in KK Lenggong are 776 patients. An audit on diabetic patients done in KK Lenggong
showed the rate of controlled diabetic patients is less than 20%.
Objective
To increase the percentage of diabetic patients with good control in KK Lenggong.
Methodology
This is a cross-sectional study. The data were collected before intervention which was from February
2008 till April 2008 and after intervention which were in June 2009. The study population was all
diabetic patients in KK Lenggong who fulfill the criteria. The variables measured are the knowledge of
the patients and the health care providers and the HbA1c. This study emphasized on the health education
on diabetes for the patients and health care providers. A flow chart of ‘Process of Care’ and ‘Model of
Good Care’ were used in this study. There will be a dedicated person to do triaging to ensure the ‘Process
of Care’ is being followed.
Results
There were only 8.1% of diabetic patients with good control before the intervention took place. There
were only 5.4% of diabetic patients and 51.7% of health care providers who answered the questionnaire
had good knowledge about the diabetes. After the health education on diabetes done, the percentage of
the diabetic patients and the health care providers with good knowledge were increased to 41.5% to
91.4% respectively. The percentage of diabetic patients with good control has increased to 32.9%.
Conclusion
The percentage of good controlled diabetic patients can be increased by improving the knowledge
amongst the patients and healthcare providers and also by implementation of ‘Process of Good Care’
and the used of ‘Model of Good care’. Providing the health education and following the ‘Process of Care’
are not costly.
Keywords: Diabetes, Good control, knowledge, attitude, practice
43
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
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
Health informatics standards in particular the National Health Data Dictionary and proper adherence
in data definitions is essential towards achieving interoperability. Data collected should be at a granular
level to enable effective data mining and analysis.
47
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
SYM III (2) Ergonomics In Health Facilities
Professor Abu Hassan
Director of Exxon Mobil
th
4 Perak Health Conference 16-18 May 2011
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
MJPHM
NOTICE TO CONTRIBUTORS
The Malaysian Journal of Public Health Medicine (MJPHM) welcomes articles of interest on all
aspects of public health medicine in the art form of original papers, research communications and
epidemic reports. Articles are accepted for publication on condition that they are contributed solely
to the MJPHM. Neither are Editorial Board nor the Publishers accept responsibility for the views and
statements of authors expressed in their contributions.
Manuscripts: All manuscripts should be submitted in triplicate to:
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
Manuscripts should be typed on one side of A4 paper and double-spaced throughout (including tables,
legends and references). The first page should state the title of the paper; write appropriate name(s) of
the author(s), degree and the name of address of the author for correspondence, abstract, introduction,
methods, results and discussion (IMRAD) should follow. Paper may be submitted in Bahasa Melayu and
must be accompanied by an abstract in English.
Abstract: A summary of not more than 250 words should be provided in the second page. Below the
abstract, provide 3 to 10 keywords that will assist indexes in cross-indexing the article.
Introduction: State the purpose of the article, the rationale for the study or observation and the general
objectives. Do not review the subject extensively.
Material and Methods: Describe your selection of the observational of experimental subjects. Identify
the methods, tools and apparatus (manufacturer’s name and address) and procedures in sufficient
detail to allow other researchers to repeat the study. Identify all drugs and chemicals used including
generic name(s), dosage(s) and route(s) of administration. Statistical tests used should be given in
sufficient detail and the use of any computer software should also be mentioned. For studies with ethical
consideration such as clinical trials, studies done among minorities etc, the statement of approval from
relevant ethical committee has to be mentioned as set by the Helsinki Declaration.
Results: Present your results in logical sequences. If necessary, use appropriate tables or illustrations.
Check the readability and accuracy of the statistical tests calculation.
Discussion: Emphasize the new and important aspects of the study. Discuss the implications of the
findings, their limitations and relate the observations to other relevant studies.
Conclusion: Relate the conclusions with the objectives of the study but avoid conclusions nor supported
by data.
Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011
th
th
4 Perak Health Conference 16-18 May 2011
Acknowledgement: Acknowledge grants awarded in aid of the study case (state in number of the grant,
name and location of the institution or organization) as well as person who have contributed significantly
to the study.
References: Use the form of reference adopted for the National Library of Medicine and used in Index
Medicus. The citation is done by using the superscript Arabic numeral at the end of sentence. Try to avoid
using abstracts as references. Unpublished observation, in press, accepted for publication and personal
communication may not be used as references. List all authors when six or less, when seven or more list
only first three and add et al.
Standard Journal Article
1. Fungladda W, Sornmani S. Health behaviour, treatment for patients visiting malaria clinics in
Western Thailand. Southest Asian J Trop Med Pub Hth 1986; 17(3): 379-381.
2.
Bundy DAP, Hall A, Adjei S, et al. Better health, nutrition and education for the school-aged children.
Trans R Soc Trop Med Hyg 1997; 91: 1-2.
Books and Other Monographs
Personal Author(s)
1. Colton T. Statistics in medicine. Little, Brown and Company: Boston, 1974.
Chapter in Book
1. DeFronzo RA. Diabetic Nephropathy. In: Junior DP, Sherwin RS. (eds). Diabetes Mellitus. Connecticut:
Appleton and Lange, 1997.
Agency Publication
1. Ministry of Health. Annual Report, 1999.
Tables and Illustrations: Arabic numerals should be used when numbering tables, illustrations and
diagrams should be fully labeled and self-explanatory. All measurements should be reported using,
metric system. Each table should be typed on a separated sheet of paper, doubles-spaced and numbered
consecutively. Omit internal horizontal and vertical rules. The contents of all tables should be carefully
checked to ensure that all the total and subtotal tally. Illustrations and diagrams should be referred to
as “Figures” and numbered consecutively. Their approximate position in the text should be indicated.
Legends and captions should be typed on separate sheets and diagrams are reproduced in black and
white only.
Abbreviations: Use only standard abbreviations. The full term for which an abbreviation stands precede
its first use in the text, unless it is a standard unit of measurement.
Copy of Journal: A copy of journal will be supplied free of charge to all authors.