1.Cervical screening uptake and its predictors among rural women in Malaysia.
Daniel Eng Hwee GAN ; Maznah DAHLUI
Singapore medical journal 2013;54(3):163-168
INTRODUCTIONCervical cancer is the third most common cancer among Malaysian women. However, the uptake of cervical cancer screening--Pap smear--by women in Malaysia has been low and remains a challenge. This study was conducted to assess the cervical screening practices of rural women in Malaysia and to examine the factors associated with such practices.
METHODSA cross-sectional survey was conducted in five rural districts in Perak, Malaysia. 1,000 households were selected through multistage random sampling. Women aged 20-64 years were interviewed by trained enumerators using structured questionnaires. Binomial logistic regression was used to identify predictors of cervical screening through univariate and multivariate analyses.
RESULTSAmong the 959 respondents, only 48.9% had undergone Pap smear at least once in the past three years. Women in the age group 40-49 years (odds ratio 3.027, 95% confidence interval 1.546-5.925; p < 0.005) were found to be significantly more likely to attend cervical cancer screening as compared to those in the age group 20-29 years. Other significant predictors were being married with children, having knowledge of cervical cancer symptoms, receiving relevant information regarding cervical cancer from health personnel or campaigns, being engaged in family planning and receiving encouragement from husbands.
CONCLUSIONEfforts to boost the uptake of Pap smear screening among the rural population should be targeted toward the predictors of positive uptake.
Adult ; Cross-Sectional Studies ; Early Detection of Cancer ; statistics & numerical data ; Female ; Health Education ; Health Knowledge, Attitudes, Practice ; Humans ; Malaysia ; Mass Screening ; methods ; Middle Aged ; Papanicolaou Test ; utilization ; Patient Acceptance of Health Care ; statistics & numerical data ; Risk Factors ; Rural Population ; Social Class ; Uterine Cervical Neoplasms ; diagnosis ; epidemiology ; Vaginal Smears ; utilization ; Young Adult
2.Long-term socioeconomic impact of the Nipah Virus encephalitis outbreak in Bukit Pelanduk, Negeri Sembilan, Malaysia: A mixed methods approach
Chiu Wan NG, Wan Yuen Choo ; Heng Thay Chong ; Maznah Dahlui ; Khean Jin Goh ; Chong Tin Tan
Neurology Asia 2009;14(2):101-107
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.
3.Determinants of sexual intercourse initiation among incarcerated adolescents: a mixed-method study.
Nik Daliana Nik FARID ; Sulaiman Che' RUS ; Maznah DAHLUI ; Nabilla AL-SADAT
Singapore medical journal 2013;54(12):695-701
INTRODUCTIONThis study aimed to investigate the determinants of sexual intercourse initiation among incarcerated adolescents aged 12-19 years in Malaysia.
METHODSThis was a sequential mixed-method research project that was conducted in two phases. Quantitative and qualitative methods were used in the first and second phases, respectively. Data was collected via a survey using self-reported questionnaires from 1,082 adolescents, and from in-depth interviews and the written essays of 29 participants. The participants were recruited from 22 welfare institutions in peninsular Malaysia.
RESULTSAmong the study participants, 483 were male and 599 were female. Overall, 62.3% of the incarcerated adolescents had initiated sexual intercourse at least once. The mean age at first sexual intercourse for both genders was 14.0 years. Individual factors found to be associated with previous sexual intercourse were the female gender (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.11-2.74), previous alcohol use (OR 1.80; 95% CI 1.10-2.94), previous illicit drug use (OR 1.85; 95% CI 1.07-3.22), permissive attitude toward premarital sex (OR 4.34; 95% CI 2.17-8.70), and sexual abuse during childhood (OR 5.41; 95% CI 3.52-8.32). Qualitative findings revealed that the reasons for initiation of sexual intercourse among these adolescents were partner influence, inability to control sex drive, family issues, and the perception of sex as an expression of love.
CONCLUSIONThe determinants of sexual intercourse initiation among incarcerated Malaysian adolescents are comparable to those of developed countries. However, in Malaysia, sexual and reproductive health programmes for such adolescents should be tailored to address their specific needs.
Adolescent ; Adolescent Behavior ; Alcohol Drinking ; Child ; Data Collection ; Female ; Humans ; Malaysia ; Male ; Odds Ratio ; Prisoners ; statistics & numerical data ; Prisons ; Risk-Taking ; Sexual Behavior ; Surveys and Questionnaires ; Young Adult
4.Provider Costs of Treating Colorectal Cancer in Government Hospital of Malaysia
Meram Azzani ; Maznah Dahlui ; Wan Zamaniah Wan Ishak ; April Camilla Roslani ; Tin Tin Su
Malaysian Journal of Medical Sciences 2019;26(1):73-86
Background: The incidence of colorectal cancer (CRC) is rapidly rising in several Asian
countries, including Malaysia, but there is little data on health care provider costs in this region.
The aim of this study was to estimate the cost of CRC management from the perspective of the
health care provider, based on standard operating procedures.
Methods: A combination of top-down approach and activity-based costing was applied.
The standard operating procedure (SOP) for CRC was developed for each stage according to
national data and guidelines at the University of Malaya Medical Centre (UMMC). The unit cost
was calculated and incorporated into the treatment pathway in order to obtain the total cost of
managing a single CRC patient according to the stage of illness. The cost data were represented by
means and standard deviation and the results were demonstrated by tabulation. All cost data are
presented in Malaysian Ringgit (RM). The cost difference between early stage (Stage I) and late
stage (Stage II–IV) was analysed using independent t-test.
Results: The cost per patient increased with stage of CRC, from RM13,672 (USD4,410.30)
for stage I, to RM27,972 (USD9,023.20) for Stage IV. The early stage had statistically significant
lower cost compared to late stage t(2) = −4.729, P = 0.042. The highest fraction of the cost was
related to surgery for Stage I, but was superseded by oncology day care treatment for Stages II–IV.
CRC is a costly illness. From a provider perspective, the highest cost was found in Stages III and IV.
The early stages conserved more resources than did the advanced stages of cancer.
Conclusion: Early diagnosis and management of CRC, therefore, not only affects oncologic
prognosis, but has implications for health care costs. This adds further justification to develop and
implement CRC screening programmes in Malaysia.
5.THE IMPACT OF MOVEMENT CONTROL ORDER DURING COVID-19 PANDEMIC ON HEALTHCARE UTILISATION: HOW DOES THE PROJECTED PATIENT WORKLOAD COMPARED TO THE ACTUAL NUMBER OF PATIENTS IN CARE?
Amirah binti Azzeri ; Nur Farhan Abdul Hakim ; Hafiz Jaafar ; Maznah Dahlui ; Sajaratulnisah Othman ; Tunku Kamarul Zaman Tunku Zainol Abidin
Journal of University of Malaya Medical Centre 2021;24(SPECIAL ISSUE):22-25
The rising healthcare demand during COVID-19 outbreak may endanger patients and forces hospital to plan for future needs. Predictive analyses were conducted to monitor hospital resources at one of the gazetted COVID-19 hospitals in Malaysia. Simultaneously, a real-time observation on patient’s volume was conducted to understand the actual trend of healthcare resource utilisations. All the projections were directly compared to the actual number of patients in-care. This predictive study was done at University Malaya Medical Centre (UMMC) using various sources of data. The projections revealed a steady increase in the number of cumulative cases until April 2020 followed by an exponential increase in the number of cumulative positive cases in Malaysia. When a comparison between the projection and actual data was done, it was found that the initial projections estimated a range that is 50% to 70% higher during the first three phases of Movement Control Order (MCO) compared to the actual number of COVID-19 patients at UMMC. Subsequent projections were done by using recent estimations from the national database and it was estimated that the number of patients treated will be less than 10 each day up until the end of May 2020. The accuracy of this estimation is 95% when compared to the actual number of COVID-19 patients in care. In conclusion, the practice of continuous projections and real-time observation through predictive analysis using mathematical calculations and algorithms is one of the useful tools to facilitate hospital management to allocate adequate resource allocations.
COVID-19