Wen Ting Tong

Knowledge, attitudes and practices among people with chronic hepatitis B attending a hepatology clinic in Malaysia: A cross sectional study

BackgroundHepatitis B (HBV) is the leading cause of cirrhosis and hepatocellular carcinoma worldwide. This study assessed the knowledge, attitudes and practices of people with chronic HBV and the associated factors.MethodsThis cross-sectional study was conducted at an outpatient adult hepatology clinic at a tertiary hospital in Kuala Lumpur. A self-administered questionnaire was administered on a one-to-one basis to assess knowledge, attitudes, and lifestyle practices of people with chronic HBV.ResultsThe response rate was 89% (n = 483/543). Participants had a mean age of 46.3 (±14.7) years and the mean duration of HBV from time of diagnosis was 12.2 (±8.8) years. The mean knowledge score was 12.57/20 (standard deviation: ±4.4, range: 0–19). Participants aged 30–39 years, with higher educational attainment, employed in professional jobs, longer duration of diagnosis and those without cirrhosis had significantly higher knowledge scores. Age, education level and duration of diagnosis were significant predictors of the knowledge score on standard multiple regression analysis. More than half of the participants were worried of spreading HBV infection to family and friends and worried since the diagnosis. A third of the participants (33.5%) were embarrassed to reveal their diagnosis to the public but most of them (93.6%) would inform their family. Those who reported feeling worried since their diagnosis were more likely to be middle-aged, of Malay ethnicity, have shorter duration of diagnosis of less than 10 years and have received therapy. About half of the participants (50.6%) did not share dining utensils and the majority (93.2%) believed that HBV can be transmitted by sharing of eating and drinking utensils. Older patients were significantly less likely to share utensils. Those who felt worried since diagnosis had significant higher knowledge of HBV.ConclusionThe findings highlight the stigma and misconceptions that still exist among the HBV patients. More patient and public education about HBV and its prevention are essential to increase awareness and to demystify the disease.

Why do some people with type 2 diabetes who are using insulin have poor glycaemic control? A qualitative study

Objective To explore factors influencing poor glycaemic control in people with type 2 diabetes using insulin. Research design A qualitative method comprising in-depth individual interviews. A semistructured interview guide was used. The interviews were audiorecorded, transcribed verbatim and analysed using a thematic approach. Participants Seventeen people with type 2 diabetes using insulin with glycated haemoglobin (HbA1c) ≥9% for >1 year. Setting The Primary Care Clinic and Diabetes Clinic in the University of Malaya Medical Centre (UMMC), Malaysia. Results Data analysis uncovered four themes: lifestyle challenges in adhering to medical recommendations; psychosocial and emotional hurdles; treatment-related factors; lack of knowledge about and self-efficacy in diabetes self-care. Conclusions Factors that explain the poor glycaemic control in people with type 2 diabetes using insulin were identified. Healthcare providers could use these findings to address patients’ concerns during consultations and help to improve glycaemic control.

Exploring pregnancy termination experiences and needs among Malaysian women: A qualitative study

BackgroundMalaysia has relatively liberal abortion laws in that they permit abortions for both physical and mental health cases. However, abortion remains a taboo subject. The stagnating contraceptive prevalence rate combined with the plunging fertility rate suggests that abortion might be occurring clandestinely. This qualitative study aimed to explore the experiences of women and their needs with regard to abortion.MethodsWomen from diverse backgrounds were purposively selected from an urban family planning clinic in Penang, Malaysia based on inclusion criteria of being aged 21 and above and having experienced an induced abortion. A semi-structured interview guide consisting of open ended questions eliciting women’s experiences and needs with regard to abortion were utilized to facilitate the interviews. Audio recordings were transcribed verbatim and analyzed thematically.ResultsThirty-one women, with ages ranging from 21–43 years (mean 30.16 ±6.41), who had induced surgical/medical abortions were recruited from an urban family planning clinic. Ten women reported only to have had one previous abortion while the remaining had multiple abortions ranging from 2–8 times. The findings revealed that although women had abortions, nevertheless they faced problems in seeking for abortion information and services. They also had fears about the consequences and side effects of abortion and wish to receive more information on abortion. Women with post-abortion feelings ranged from no feelings to not wanting to think about the abortion, relief, feeling of sadness and loss. Abortion decisions were primarily theirs but would seek partner/husband’s agreement. In terms of the women’s needs for abortion, or if they wished for more information on abortion, pre and post abortion counseling and post-abortion follow up.ConclusionsThe existing abortion laws in Malaysia should enable the government to provide abortion services within the law. Unfortunately, the study findings show that this is generally not so, most probably due to social stigma. There is an urgent need for the government to review its responsibility in providing accessible abortion services within the scope of the law and to look into the regulatory requirements for such services in Malaysia. This study also highlighted the need for educational efforts to make women aware of their reproductive rights and also to increase their reproductive knowledge pertaining to abortion. Besides the government, public education on abortion may also be improved by efforts from abortion providers, advocacy groups and related NGOs.

A Qualitative Exploration of Contraceptive Practice and Decision Making of Malaysian Women Who Had Induced Abortion A Case Study

This study explores contraceptive practice and decision making of women who have experienced abortion in Malaysia. In-depth interviews were carried out with 31 women who had abortions. Women in this study did adopt some method of modern contraception prior their abortion episodes. However, challenges to use a method consistently were experiences and fear of side effects, contraceptive failure, partner’s influence, lack of confidence, and cost. The decision to adopt contraception was theirs but the types of contraceptive methods to adopt were influenced by their spouses/partners. The women wanted to use modern contraception but were faced with challenges that hampered its use. More proactive contraceptive promotion is needed to educate people on the array of contraceptive methods available and made accessible to them, to correct misconceptions on safety of modern contraception, to increase men’s involvement in contraceptive choices, and to encourage consistent contraceptive use to prevent unintended pregnancies.

Migrant Workers in Asia Pacific and Their Rights to Health

The movement of human populations from place to place has been a part of human history since time immemorial, within and between countries. There are also large numbers of people who have been forced from their homes by insecurity, famine, and ethnic and religious pressures. Each group presents public health issues, which as the numbers increase, present escalating challenges. The Asia-Pacific Academic Consortium for Public Health (APACPH) is concerned about health access and equity for all, including the most disadvantaged groups such as refugees.1 A joint OECD and United Nations study estimated that there are 232 million international migrants living in a country other than their own has remained relatively stable in the past decades at 3.2% of the world’s population.2,3 The Asia-Pacific region contains 3 of the 4 world’s most populous nations, China, India, and Indonesia, which are also major sources of migrants. In 2010, there were 27.5 million international migrants in Asia and the Asia-Pacific region, which has both major migrant countries of origin such as India, Indonesia, the Philippines and Vietnam, as well as destination countries for migrants such as Japan, Korea, Hong Kong, Singapore, and China, which have labor shortages and offer higher wage opportunities.4 By 2013, the International Labour Organization estimated that there were 30 million migrant workers in the region, with women making up 42% of migrants in Asia and 50% in Oceania.4-6 These workers leave their countries to seek for better economic prospects in order to improve their families’ livelihoods as documented or undocumented migrants. In the Asia-Pacific region, a significant proportion of migration is irregular and undocumented. In Thailand, approximately 3.1 million migrants are from the neighboring countries of Myanmar, Cambodia, and Laos and half of them are unregistered. In 2010, Indonesians accounted for half of the 1.8 million registered migrants in Malaysia and it is estimated that the number who are undocumented is about the same.6 Migration of labor makes a major contribution to the economy and in the Philippines, the region’s largest labor-sending country, remittance inflows accounted for 12.2% of GDP in 2009, while they reached 22% in Nepal.4 In the Asia-Pacific region, economic change has also led to massive internal migration and in China there were 211 million migrants driving rapid urbanization and creating many public health issues.7 Internal migrants may not have access to the same health services as them would in their home towns and may have higher rates of infectious diseases.8 The mobility of students and retirees and, increasing international marriages are also important trends in the region. Migration of highly skilled professionals and wealthy citizens to Western Countries continues and often deprives the country that provided their education of much needed professional skills.

Factors influencing implementation of a patient decision aid in a developing country: an exploratory study

BackgroundMost studies on barriers and facilitators to implementation of patient decision aids (PDAs) are conducted in the west; hence, the findings may not be transferable to developing countries. This study aims to use a locally developed insulin PDA as an exemplar to explore the barriers and facilitators to implementing PDAs in Malaysia, an upper middle-income country in Asia.MethodsQualitative methodology was adopted. Nine in-depth interviews (IDIs) and three focus group discussions (FGDs) were conducted with policymakers (n = 6), medical officers (n = 13), diabetes educators (n = 5) and a nurse, who were involved in insulin initiation management at an academic primary care clinic. The interviews were conducted with the aid of a semi-structured interview guide based on the Theoretical Domains Framework. The interviews were audio-recorded, transcribed verbatim and analyzed using a thematic approach.ResultsFive themes emerged, and they were lack of shared decision-making (SDM) culture, role boundary, lack of continuity of care, impact on consultation time and reminder network. Healthcare providers’ (HCPs) paternalistic attitude, patients’ passivity and patient trust in physicians rendered SDM challenging which affected the implementation of the PDA. Clear role boundaries between the doctors and nurses made collaborative implementation of the PDA challenging, as nurses may not view the use of insulin PDA to be part of their job scope. The lack of continuity of care might cause difficulties for doctors to follow up on insulin PDA use with their patient. While time was the most commonly cited barrier for PDA implementation, use of the PDA might reduce consultation time. A reminder network was suggested to address the issue of forgetfulness as well as to trigger interest in using the PDA. The suggested reminders were peer reminders (i.e. HCPs reminding one another to use the PDA) and system reminders (e.g. incorporating electronic medical record prompts, displaying posters/notices, making the insulin PDA available and visible in the consultation rooms).ConclusionsWhen implementing PDAs, it is crucial to consider the healthcare culture and system, particularly in developing countries such as Malaysia where concepts of SDM and PDAs are still novel.

Awareness, perception and barriers to seeking information from online academic databases and medical journals as sources of information

ABSTRACT Medical students’ use of online medical journals as a source of information is crucial in the learning pathway to become medical doctors. We conducted a cross-sectional survey study among University medical students between December 2012 and March 2013 to assess their awareness, perceived usefulness, practices, and barriers to seeking information from online academic databases and medical journals. The response rate was 67.53%. The majority of the students knew of the availability of online academic databases and medical journals. The mean score for awareness (4.25 of possible 11.0), perceived usefulness (13.95 of possible 33.0), and practice (10.67 of possible 33.0) were low. The mean barrier score toward using online academic databases and medical journals was 25.41 (of possible 45.0). Multivariate findings showed that significant barriers associated with overall usage of online databases and medical journals were 1) not knowing where or how to locate databases and 2) unsureness of using the Boolean operators. Availability of full text subscriptions was found to be an important factor in using online databases. Study findings highlighted the need to increase awareness of academic databases’ availability and increase training on ways to search online academic databases and medical journals.

Climate Change and Health: The Malaysia Scenario

Malaysia, located in Southeast Asia, has a tropical climate and abundant rainfall (2000–4000 mm annually). Malaysia faces weather‐related disasters such as floods, landslides and tropical storm attributed to the cyclical monsoon seasons, which cause heavy and regular downpours. Storms, floods and droughts lead to the rise and emergence of climate‐sensitive diseases due to contamination of water, environment and creation of breeding sites for disease-carrying vector mosquitoes. The effect of climate change on health is an area of substantial concern in Malaysia. This chapter examines the trends of six prominent climate-sensitive diseases in Malaysia, namely, cholera, typhoid, hepatitis A, malaria, dengue and chikungunya followed by the environmental and public health policies, programmes and plans to battle the impact on health from the climate change.