Background: Household ability to pay (ATP) and public willingness to pay (WTP) for cataract surgery and obstetric consultation, the two commonly utilised private healthcare services in Malaysian public hospitals are largely unknown. This study assessed the patients’ ATP and the WTP for these services. Methods: A cross-sectional study was conducted among respondents visiting outpatient clinics in an urban tertiary public hospital. Source of payment for healthcare used by the World Health Survey was used to assess ATP, while contingent valuation was used to elicit respondents’ WTP by asking their WTP for a shorter waiting time for cataract surgery or an obstetric consultation. Chi-square test, Fisher’s exact tests, and binary logistic regression were performed in the analyses. Results: No significant differences were observed for ATP between public and private respondents. Almost one quarter (23.5%) of total respondents used unaffordable sources for their healthcare services. More than a quarter (26.7%) of the public respondents were willing to pay for private user fees or higher and a proportion of them (14.8%) reported using unaffordable sources for healthcare services. Logistic regression showed that respondents reporting multiple affordable sources of payment were 3.7 times more likely to be willing to pay for these services after adjusting for other factors, compared with the use of a single affordable source. Conclusion Although the majority reported using affordable sources of payment for health services, a small fraction claimed the use of unaffordable resources. The use of multiple affordable sources for healthcare payment influences WTP in seeking private services for cataract surgery and obstetric consultation.

Objective: Effective prevention and control measures are essential to contain outbreaks of infectious diseases, such as coronavirus disease (COVID-19). Understanding the characteristics of case clusters can contribute to determining which prevention and control measures are needed. This study describes the characteristics of COVID-19 case clusters in Malaysia, the method used to detect a cluster’s index case and the mode of early transmission, using the seven cluster categories applied in Malaysia. Methods: This cross-sectional study collected publicly available data on COVID-19 clusters occurring in Malaysia from 1 March 2020 to 31 May 2021. The characteristics of cases were described by category, and their associations with several outcomes were analysed. Descriptive analyses were performed to explore the method used to detect the index case and the mode of early transmission, according to cluster category. Results: A total of 2188 clusters were identified. The workplace cluster category had the largest proportion of clusters (51.5%, 1126/2188 clusters), while the custodial settings category had the largest median cluster size (178 cases per cluster) and longest median duration of cluster (51 days). The high-risk groups category had the highest mortality. There were significant differences in cluster size, duration and rate of detection across the categories. Targeted screening was most commonly used to detect index cases, especially in custodial settings, and in imported and workplace clusters. Household–social and social–workplace contacts were the most common modes of early transmission across most categories. Discussion: Targeted screening might effectively reduce the size and duration of COVID-19 clusters. Measures to prevent and control COVID-19 outbreaks should be continually adjusted based on ongoing assessments of the unique context of each cluster.

Grey literature is a valuable source of information for evidence synthesis in public health, particularly when swift action is needed to address issues. In 2020, the COVID-19 pandemic was an example where rapid knowledge sharing was quintessential as the world grappled with the management of a novel coronavirus that was spreading at an alarming rate. To document and contextualise the health systems strategies used to address the COVID-19 pandemic in Malaysia from January 2020 to April 2020, we conducted a rapid review of publicly available documents from WHO Global Research on Coronavirus Disease (COVID-19) (WHO database), official government websites and local newspapers. This paper aims to describe the methods and discuss the lessons learnt from the review. In the early stage of the pandemic, published articles in the WHO database focused on clinical knowledge, hence we relied on grey literature as a primary source of information, mainly official government websites, which provided real-time information relevant to our study. Grey literature can be a good source of information for a rapid review of nascent and urgent topics particularly in the area of public health, however, a trade-off between comprehensiveness and efficiency has to be considered.
Gray Literature