Botulinum toxin injection is an effective treatment for hemifacial spasm by causing pre-synaptic block at the neuromuscular junction. Its effects are temporary and repeated injections are required to maintain benefi t. Mild, permanent facial weakness is often thought to be due to prolonged nerve compression. To investigate the possibility of a chronic and persistent effect of botulinum toxin on neuromuscular transmission, we carried out stimulated single-fi bre electromyography to compare jitter of the affected orbicularis oculi in previously treated and treatment naïve hemifacial spasm patients. Previously treated patients were studied when the acute effects of the last botulinum toxin injection had worn off. We found mean jitter was signifi cantly higher in previously treated patients. Although, treated patients had longer duration of hemifacial spasm, mean jitter was dependent only on the number of previous botulinum injections and independent of the duration of hemifacial spasm and time from the last injection. This suggests a persistent and cumulative effect of botulinum toxin on neuromuscular transmission in patients treated for hemifacial spasm.

Background and Objective: In 1998/99, an outbreak of Nipah virus encephalitis occurred in several pig-farming communities in Malaysia. It was associated with a high mortality rate and persistent neurological defi cits among many survivors. This mixed method study aimed to examine the longterm socio-economic consequences of the illness on affected pig farmers and their families in Bukit Pelanduk, Negeri Sembilan. Methods: A quantitative cross sectional survey was conducted in 2008 on 78 former patients or their kin from 61 households (46.2% males, mean age = 48.7 years) in Bukit Pelanduk via face-to-face interviews. This was followed by qualitative in-depth interviews with 20 respondents. Results: The immediate treatment costs were not a major burden to most households. Majority of the patients (92%) required inpatient care and most obtained free care from public hospitals. Households relied mainly on savings and support provided by the public and family members during the outbreak. However, many former patients found their low educational qualifi cations prevented them from obtaining good alternative employment after their recovery. This had negatively affected their households’ living standards. As a result, there had been a renewed appreciation of the value of education for their young, and one of their main concerns was the fi nancial burden of educating their children. Conclusion: Free public health care protected most households from high medical costs. However, household living standards had dropped due to limited alternative employment opportunities. Education has been identifi ed as a key to improving the long term welfare of affected households.

Introduction: This study aimed to determine the views and practices of healthcare providers and barriers they encountered when implementing the national health screening program for men in a public primary care setting in Malaysia. Methods: An online survey was conducted among healthcare providers across public health clinics in Malaysia. All family medicine specialists, medical officers, nurses and assistant medical officers involved in the screening program for adult men were invited to answer a 51-item questionnaire via email or WhatsApp. The questionnaire comprised five sections: participants’ socio-demographic information, current screening practices, barriers and facilitators to using the screening tool, and views on the content and format of the screening tool. Results: A total of 231 healthcare providers from 129 health clinics participated in this survey. Among them, 37.44% perceived the implementation of the screening program as a “top-down decision.” Although 37.44% found the screening tool for adult men “useful,” some felt that it was “time consuming” to fill out (38.2%) and “lengthy” (28.3%). In addition, ‘adult men refuse to answer’ (24.1%) was cited as the most common patient-related barrier. Conclusions: This study provided useful insights into the challenges encountered by the public healthcare providers when implementing a national screening program for men. The screening tool for adult men should be revised to make it more user-friendly. Further studies should explore the reasons why men were reluctant to participate in health screenings, thus enhancing the implementation of screening programs in primary care.

Background: Dengue patients in Malaysia have the choice to seek care from either public or private sector providers. This study aims to analyse the pattern of health facility use among dengue patients to provide input for the ongoing policy discussion regarding public–private integration. The focus of this study is in the Klang Valley, which has a high dengue burden as well as a high number of private facilities. Methods: This is a cross-sectional study using an available secondary data source – the Malaysian national dengue passive surveillance system, e-Dengue registry. A total of 61 455 serologically confirmed dengue cases from the Klang Valley, registered in year 2014, were included. We retrospectively examined the relationship between demographic factors and the choice of health-care sector by logistic regression. Results: The median age of the cohort was 26 (interquartile range: 17 to 37) years. More private facilities (54.4%) were used for inpatient care; more public facilities (68.2%) were used for outpatient care. The Chinese and urban populations showed significantly higher use of the private health-care sector with an adjusted odds ratio of 4.8 [95% confidence interval (CI): 4.6–5.1] and 2.3 (95% CI: 2.2–2.4), respectively. Conclusion Both public and private health facilities bear significant responsibilities in delivering health-care services to dengue patients. The workload of both sectors should be included in future health policy planning by public agencies.