Knowledge and attitude towards home quarantine instructions and associations with history of Covid-19 infection in Malaysia.

INTRODUCTION: Although COVID-19 has entered the endemic phase, individuals infected with COVID-19 are required to adhere to home quarantine measures. By exploring the public's knowledge and attitude towards recommended home quarantine measures, their readiness in containing potential COVID-19 outbreak can be determined. This study aimed to assess the public knowledge and attitude towards home quarantine instructions and their association with history of COVID-19 infections. METHODS: This was a web-based cross-sectional study conducted among the public in Malaysia between August to October 2022. All Malaysian adults over 18 years of age were included. Knowledge on home quarantine instructions and COVID-19 warning signs were measured using "True," "False," or "I'm not sure", while attitude towards home quarantine instructions was measured using a five-point Likert Scale. The questionnaire was initially constructed in English and then translated into the national language, Bahasa Malaysia. Face and content validation were performed. The internal consistency of the questionnaire was found to be satisfactory. RESULTS: 1,036 respondents were analyzed, comprised mostly of females (743, 71.6%) with a history of COVID-19 (673, 64.9%). In the knowledge domain, more than 80% of the respondents answered 9 out of 11 home quarantine instructions statements correctly. 457 (44.1%) were unaware or unsure about the minimum distance of the infected individual's bed from the rest of the occupants in a shared bedroom. The respondents reported relatively weaker knowledge in identifying uncommon warning signs of COVID-19 deterioration, including anuria (162, 44.5%), ingestion problems (191, 52.5%), and immobility (195, 53.6%). In the attitude domain, more than 90% of respondents answered correctly in 8 out of 9 questions. Respondents with a previous history of COVID-19 infections had better knowledge than COVID-19 infection-naïve individuals towards both home quarantine instructions and COVID-19 warning signs. CONCLUSION: Most respondents had good knowledge and attitude towards home quarantine instructions, with those previously infected with COVID-19 showing greater awareness of uncommon warning signs. However, there was a notable lack of awareness regarding physical distancing within shared rooms, appropriate disinfectant use and mobility limitation within the household. This study highlights the knowledge gaps to be improved in future educational campaigns.

Awareness, expectation and satisfaction towards ward pharmacy services among patients in medical wards: a multi-centre study in Perak, Malaysia.

BACKGROUND: Patient's awareness and satisfaction towards ward pharmacy services may influence perception towards effectiveness and safety of drugs, affecting medication adherence and clinical outcome. Nevertheless, studies on local ward pharmacy services were lacking. This study evaluated awareness, expectation and satisfaction of ward pharmacy services among patients in medical wards and determined their association with demographic characteristics. METHODS: This was a cross-sectional study using self-administered questionnaire conducted in medical wards of fourteen Perak state public hospitals from September to October 2020. In-patients aged ≥18 years old were included. The validated questionnaire had four domains. The student's t-test, one-way analysis of variance (ANOVA) and multiple linear regression were was employed to evaluate the association between patients' demographic characteristics with their awareness, expectation and satisfaction towards ward pharmacy services. RESULTS: 467 patients agreed to participate (response rate = 83.8%) but only 441 were analysed. The mean age of the patients was 54.9 years. Majority was male (56.2%), Malay (77.3%), with secondary education (62.9%), rural resident (57.1%) and reported good medication adherence (61.6%). The mean awareness score was 49.6 out of 60. Patients were least aware about drug-drug interaction (3.85 ± 1.15) and proper storage of medications (3.98 ± 1.06). Elderly patients (ß = - 2.82, P < 0.001) obtained lower awareness score. Patients with tertiary education (ß = 3.87, P = 0.001), rural residents (ß = 3.65, P < 0.001) and with good medication adherence (ß = 2.55, P = 0.002) had higher awareness score. The mean expectation score was 44.0 out of 50. The patients had higher expectation to encounter a polite ward pharmacist (4.51 ± 0.56). Patients with tertiary education (ß = 1.86, P = 0.024), rural residents (ß = 1.79, P = 0.001) and with good medication adherence (ß = 1.48, P = 0.006) demonstrated higher expectation. The mean satisfaction score was 43.6 out of 50. The patients had high satisfaction in language used (4.45 ± 0.57) and level of knowledge demonstrated (4.41 ± 0.62) by the ward pharmacists. Patients with tertiary education (ß = 2.16, P = 0.009), rural residents (ß = 1.82, P = 0.001) and with good medication adherence (ß = 1.44, P = 0.009) demonstrated higher satisfaction, while elderly patients (ß = - 1.17, P = 0.031) had lower satisfaction towards ward pharmacy services. CONCLUSION: There was a high level of awareness, expectation and satisfaction towards ward pharmacy services in public hospitals of Perak, Malaysia.

Intravenous human immunoglobulin utilization patterns and cost analysis in a Malaysian tertiary referral hospital.

INTRODUCTION: While intravenous human immunoglobulin therapy is potentially lifesaving for rare diseases, the significant costs associated with its usage warrant due attention. This study evaluated the costs and prescribing patterns of IVIg. METHODS: This was a retrospective analysis of medical records in a tertiary hospital. The evidence category IIA and below, as well as strength of recommendations level B and below were classified as lower evidence category and lower strength of recommendation, respectively. Patients' demographic data, indications, dosing regimen, physician specialty were retrieved from medical records, while the cost was derived based on total prescribed doses. RESULTS: Out of 78 patients, more than half of the patients were prescribed with off-label IVIg based on MOHM Formulary (52, 66.7%), FDA indications (52, 66.7%) and EMA indications (46, 59.0%). 37 (47.4%) cases used IVIg for indications with lower evidence category and 52 (66.7%) cases with lower strength of recommendation. The total cost of IVIg use within the 2-year period was RM 695,426.36, with RM267,993.40 (38.5%) spent for indications with lower evidence category. Immunoglobulin use in rheumatology and neurology cases were associated with lower evidence category (p < 0.001). CONCLUSIONS: A high proportion of off-label immunoglobulin use was observed. A timely update of prescribing policy, standardization of prescribing guidelines may promote appropriate immunoglobulin prescribing and justify expenses.

Abstinence Rate, Adverse Events and Withdrawal Symptoms after Varenicline Use and Predicting Factors of Smoking Abstinence: A Multicentre Single-State Study in Malaysia.

(1) Background: Varenicline is a widely prescribed agent in smoking cessation. However, the abstinence rate, the incidence of adverse events and withdrawal symptoms, have not been widely studied locally. This study aimed to determine the prevalence of smoking abstinence, adverse events and withdrawal symptoms associated with varenicline use, as well as possible factors contributing to successful smoking abstinence. (2) Methods: This was a retrospective, cohort study conducted in twenty-two government-operated smoking cessation clinics across the state of Perak, Malaysia. The medical records of adult smokers (age ≥ 18 years old) who were prescribed with varenicline between January 2017 and June 2018 were traced. The medical records of smokers who used pharmacotherapy other than varenicline, those who received less than four weeks of varenicline treatment, and with missing data were excluded. (3) Results: Sixty-eight out of 114 subjects (59.6%) successfully achieved smoking abstinence. Probable varenicline-induced chest pain was documented in three subjects. Altered behaviour (n = 2) and auditory hallucinations (n = 1) were also reported. Varenicline treatment duration is a significant predictive factor for successful smoking abstinence (odds ratio (OR) = 2.45; 95% confidence interval (CI) 1.74−3.45; p < 0.001), followed by age (OR = 1.25; 95% CI 1.005−1.564; p = 0.045), the presence of adverse events (OR = 0.096; 95% CI 0.014−0.644; p = 0.016) and withdrawal symptoms (OR = 0.032; 95% CI 0.016−0.835; p = 0.032). (4) Conclusion: Almost two-thirds of the subjects achieved smoking abstinence with varenicline. The duration of the treatment, as well as the patients' ages had a significant influence on successful smoking abstinence. Rare cases of cardiovascular and neuropsychiatric-related adverse events were reported, warranting continuous surveillance and adverse drug reaction reporting.

A cross-sectional study on public belief, knowledge and practice towards antibiotic use in the state of Perak, Malaysia.

INTRODUCTION: Inappropriate use of antibiotics has led to antimicrobial resistance, a major public health challenge worldwide. This study aimed to explore beliefs, knowledge, and practice on antibiotic use among general public. METHODOLOGY: Cross-sectional study was conducted at 13 hospitals and 44 primary health clinics in Perak from May to July 2017. Adults above 18 years, literate, and had experience in antibiotics consumption were selected through sequential sampling method. Data was collected using a self-administered questionnaire which included the three study domains i.e. belief, knowledge and practice. The questionnaire was pilot on 30 subjects. RESULTS: Out of 2850 distributed questionnaires, 2773 returned and 2632 were included for analysis. Mean age of the respondents was 39.7 ± 14.5 years old. Most respondents were female (58.6%), Malay (74.7%) and underwent upper secondary school (45.6%). Mean score were generated for each domain with belief: 5.87 ± 3.00 (total score: 12), knowledge: 15.82 ± 3.85 (total score: 24), practice: 6.91 ± 2.07 (total score: 12). In the belief domain, 63.2% of respondents believed that antibiotics would help them to recover faster. In the knowledge domain, 52.7% of respondents inappropriately thought that antibiotics could work on viral infections. In the practice domain, 70% of respondents expected doctors to prescribe antibiotics if suffered from symptoms. CONCLUSION: Majority of the respondents expect doctors to prescribe antibiotics for their illness, and most believes that antibiotics can speed up recovery of illness. Lack of awareness on antibiotic resistance was found to be a significant factor associated with inappropriate antibiotic use.