Yut-Lin Wong

Cervical cancer screening attitudes and beliefs of Malaysian women who have never had a pap smear: a qualitative study.

Background: Attitudes toward cervical cancer and participation in early detection and screening services are well known to be profoundly affected by cultural beliefs and norms.Purpose: This study explored the attitudes and sociocultural beliefs on cervical cancer screening among Malaysian women.Method: In this qualitative study, in-depth interviews were conducted with 20 Malaysian women, ages 21 to 56 years, who have never had a Papanicolaou (Pap) smear.Results: Respondents generally showed a lack of knowledge about cervical cancer screening using Pap smear, and the need for early detection for cervical cancer. Many believed the Pap smear was a diagnostic test for cervical cancer, and since they had no symptoms, they did not go for Pap screening. Other main reasons for not doing the screening included lack of awareness of Pap smear indications and benefits, perceived low susceptibility to cervical cancer, and embarrassment. Other reasons for not being screened were related to fear of pain, misconceptions about cervical cancer, fatalistic attitude, and undervaluation of own health needs versus those of the family.Conclusion: Women need tobe educated about the benefits of cervical cancer screening. Health education, counseling, outreach programs, and community-based interventions are needed to improve the uptake of Pap smear in Malaysia.

Victimization Experiences of Adolescents in Malaysia

PURPOSE There has been little community-based research regarding multiple-type victimization experiences of young people in Asia, and none in Malaysia. This study aimed to estimate prevalence, explore gender differences, as well as describe typical perpetrators and family and social risk factors among Malaysian adolescents. METHODS A cross-sectional survey of 1,870 students was conducted in 20 randomly selected secondary schools in Selangor state (mean age: 16 years; 58.8% female). The questionnaire included items on individual, family, and social background and different types of victimization experiences in childhood. RESULTS Emotional and physical types of victimization were most common. A significant proportion of adolescents (22.1%) were exposed to more than one type, with 3% reporting all four types. Compared with females, males reported more physical, emotional, and sexual victimization. The excess of sexual victimization among boys was due to higher exposure to noncontact events, whereas prevalence of forced intercourse was equal for both genders (3.0%). Although adult male perpetrators predominate, female adults and peers of both genders also contribute substantially. Low quality of parent-child relationships and poor school and neighborhood environments had the strongest associations with victimization. Family structure (parental divorce, presence of step-parent or single parent, or household size), parental drug use, and rural/urban location were not influential in this sample. CONCLUSION This study extends the analysis of multiple-type victimization to a Malaysian population. Although some personal, familial, and social factors correlate with those found in western nations, there are cross-cultural differences, especially with regard to the nature of sexual violence based on gender and the influence of family structure.

Malaysian cultural differences in knowledge, attitudes and practices related to erectile dysfunction: focus group discussions

This qualitative study aimed to examine cultural differences in knowledge, attitudes and practices related to erectile dysfunction (ED) utilizing focus group discussion. Six focus groups consisting of 66 men, 45–70-y-old were conducted—two Malay groups (n=18), two Chinese groups (n=25) and two Indian groups (n=23). Participants were purposively recruited from the general public on a voluntary basis with informed consent. Transcripts were analyzed using qualitative data analysis software ATLASti. The Malay and Chinese traditional remedies for preventing or treating ED are commonly recognized among all races. Many have a negative perception of someone with ED. Malay and Chinese men tended to blame their wife for their problem and thought that the problem might lead to extra-marital affairs, unlike the Indian men who attributed their condition to fate. Malays would prefer traditional medicine for the problem. The Chinese felt they would be more comfortable with a male doctor whilst this is not so with the Malays or Indians. Almost all prefer the doctor to initiate discussion on sexual issues related to their medical condition. There is a need for doctors to consider cultural perspectives in a multicultural society as a lack of understanding of this often contributes to an inadequate consultation.

What Malaysian women believe about Viagra: a qualitative inquiry

This paper highlights womens perceptions of sildenafil citrate (Viagra®, Pfizer). It is based on a qualitative study on perceptions of erectile dysfunction in the Malaysian multicultural society. Six focus groups were conducted, consisting of 69 women, aged between 40 and 70 years, recruited from the general public and who had given informed consent. The findings revealed that the women were aware of erectile dysfunction and Viagra. Due to their concern about the negative aspects of Viagra, the Chinese and Malay traditional methods of treatment were commonly mentioned. The women from three ethnic groups viewed the possibility of their husband starting to take Viagra with lots of suspicion, mistrust and fear. They would prefer their husband discussing with them the issue of resorting to taking Viagra. The Chinese and Indian women perceived that if a man takes Viagra, it will boost his ego and he will feel more manly. Indian women felt that a man taking Viagra is proof of his love for his wife. The Malay women felt that a man would be ashamed and have a low self-esteem if he were to resort to taking Viagra. Although Viagra is meant for the male, understanding of womens perception of it is beneficial for a couples sexual relationship.

Correlates between risk perceptions of cervical cancer and screening practice

OBJECTIVES To identify the correlates between risk perceptions and cervical cancer screening among urban Malaysian women. METHOD A cross-sectional household survey was conducted among 231 women in Petaling Jaya city in 2007. The association of risk perceptions of cervical cancer and screening practice was analyzed using Poisson regression. RESULTS 56% of the respondents ever had a Pap smear test. Knowledge of signs and symptoms (aPR=1.11, 95% CI=1.03-1.19), age (aPR=1.02, 95% CI=1.01-1.03), number of pregnancies (aPR=1.06, 95% CI=1.01-1.11), marital status, education level and religion were found to be significant correlates of Pap smear screening. Respondents who were never married were less likely to have had a Pap smear. Those who had no education or primary education were less likely to have had a Pap smear compared to those with degree qualification. The prevalence of screening was significantly higher among Christians and others (aPR=1.35; 95% CI=1.01-1.81) and Buddhists (aPR=1.38; 95% CI=1.03-1.84), compared to Muslims. CONCLUSION Eliminating anecdotal beliefs as risks via targeted knowledge on established risk factors and culturally sensitive screening processes are strategic for increasing and sustaining uptake of Pap smear screening versus current opportunistic screening practices.

Review Paper: Gender Competencies in the Medical Curriculum: Addressing Gender Bias in Medicine

Gender inequalities in health and gender bias in medicine are interrelated challenges facing health care providers and educators. Women and girls are disadvantaged in accessing health care because of their low social status and unequal treatment in medical care. Gender bias has long been inherent in clinical practice, medical research, and education. This can be traced to the medical curriculum that shapes the perceptions, attitudes, and behavior of the future doctor. The author advocates medical curricula change to address gender inequalities in health and gender bias in medicine. She analyses the reasons for integration of gender competencies in the medical curriculum, discusses what gender competencies are, and reviews ways to in-build gender competencies and their assessment. Efforts to change and gender sensitize medical curricula in developed and developing countries are also reviewed. The review hopes to contribute to strategic medical curriculum reform, which would lead to gender-sensitive health services and equity in health.

Taking Stock of Alma-Ata Primary Health Care/Health for All: Moving Toward New Directions in Global Preventive Health

“Health for All by 2000,” first declared at Alma-Ata in 1978, revolutionized primary health care (PHC) policy and planning based on a set of guiding values and principles of health services organization: equity, social justice, and health for all; community participation; appropriate use of resources; and intersectoral action. Primarily, the historic significance of the Alma-Ata/Health for All (HFA) was to put preventive health on equal footing as curative medicine. A decade into the new millennium, it is time to take stock of the infamous Primary Health Care and Health for All policy, as more than 30 years after, we are confronted with almost similar challenges that plagued health policy makers in 1978. Emerging and reemerging infectious diseases (eg, H5N1 avian influenza and HIV/AIDS), political instability/conflict, and worsening poverty as indicated by the world’s 1.4 million poor and their impact on primary health care are some of the pressing challenges currently. Since 1978, health policy priorities have shifted toward the poverty elimination Millennium Development Goals (MDG) set in 2000. The healthrelated MDGs being MDG 4, Child Survival; MDG 5, Maternal Health; MDG 6, HIV, TB, and Malaria. Yet progress toward MDGs has faltered. For instance, weak health systems have affected efforts to improve maternal, newborn, and child health. New epidemics of chronic diseases reverse the small gains achieved as it increases the burden of long-term care on health systems and budgets. Increasingly, disease prevention and public health promotion are in settings where most risk factors lie outside the direct control of biomedicine and the health sector that require equity, efficiency, and intersectoral action. Such trends have underscored the relevance of the 1978 HFA and Alma-Ata values. In 2008, the director general of the World Health Organization, in a revisit of HFA, reiterated that any “gaps or inequalities in health outcomes are indicators of policy failure” and stressed the relevance of “HFA/PHC—a model for health system that acts on underlying social, economic, and political causes of ill health.” To achieve the MDGs by 2015, and time is fast running out, countries need to strengthen their health systems through implementation of effective PHC. Interest in HFA and PHC have thus been reawakened by health experts and global health institutions to seek for reforms that can equip health systems to respond to health challenges of unparalleled complexity today.

Child Care Services in Malaysia: An Overview:

In 1982, under the patronage of the Ministry of Social Welfare and with financial aid from UNICEF, three consultants from the University of Malaya conducted a National Child Care Survey to: provide an overview of child care services in Malaysia; to design a monitoring system to help child minders and relevant personnel to assess the standards of child care at the centres; and to develop a series of policy recommendations for implementing “better child care” in the country. This paper presents the first part of the National Child Care Survey, that is, an overview of child care services available in Malaysia. The survey was conducted in five states in Peninsular Malaysia — Penang, Perak, Selangor, Kelantan and Melaka — and in two cities — Kuching and Kota Kinabalu — in East Malaysia. The national survey studied the type of care found at 537 centres where 824 minders looked after 7, 884 children. Four major aspects of child care were identified and subsequently examined: the physical conditions and environmental hygiene of the premises; profile of children under care; daily practices; and the personnel in the three basic types of centres, i.e., Institution-based, plantation-or estate-based and home-based.

Access to Safe Legal Abortion in Malaysia Women’s Insights and Health Sector Response

Malaysia has an abortion law, which permits termination of pregnancy to save a woman’s life and to preserve her physical and mental health (Penal Code Section 312, amended in 1989). However, lack of clear interpretation and understanding of the law results in women facing difficulties in accessing abortion information and services. Some health care providers were unaware of the legalities of abortion in Malaysia and influenced by their personal beliefs with regard to provision of abortion services. Accessibility to safer abortion techniques is also an issue. The development of the 2012 Guidelines on Termination of Pregnancy and Guidelines for Management of Sexual and Reproductive Health among Adolescents in Health Clinics by the Ministry of Health, Malaysia, is a step forward toward increasing women’s accessibility to safe abortion services in Malaysia. This article provides an account of women’s accessibility to abortion in Malaysia and the health sector response in addressing the barriers.

Girl child abuse: the Malaysian situation

The incidence of child abuse in Malaysia is escalating. Its severity also is increasing. Female children outnumber male children in being abused, especially sexually abused. Both physical and sexual abuse of children tend to be inflicted over time and very rarely occur only once. There is still a general lack of public awareness and cooperation in the detection and reporting of child abuse. Detection is still at the level of the hospital when the child is brought for treatment. Thus, intervention very often is late. These are the present trends of child abuse in Malaysia. There are numerous definitions of child abuse. A broader definition is adopted in this paper. Hence, child abuse and neglect include any condition injurious to the childs physical, emotional and mental health and development that has been inflicted by parents, step-parents, guardians or other caregivers. In Malaysia, a child is any person below the age of fourteen years according to the Children and Young Persons Act. This papcr will focus mainly on physical and sexual child abuse. Other forms of child abuse such as child labor, child trafficking and prostitution are not within the scope of this paper. Child sexual abuse specifically refers to the exploitation of a child for the sexual gratification of an adult. It occurs when an adult uses his power or authority and takes advantage of a childs trust and respect to involve the child in sexual activity that is inappropriate for his/her age. Incidence and Present Trends