RESUMO
The development of the measles-containing vaccine (MCV) has rendered measles a largely preventable disease. In the state of Sabah in Malaysia, a complete course of measles immunisation for infants involves vaccinations at the ages of six, nine, and twelve months. However, it is difficult for marginalised populations to receive a complete course of measles immunisation. This present study used behavioural theory (BT) to examine the beliefs and perceptions of a marginalised population towards community volunteering as a method of increasing the immunisation coverage of measles. Marginalised populations living in Kota Kinabalu, Sabah, more specifically, Malaysian citizens living in urban slums and squatter areas, as well as legal and illegal migrants, were extensively interviewed in person for this qualitative study. The 40 respondents were either the parents or primary caregivers of at least one child under the age of five. The components of the Health Belief Model were then used to examine the collected data. The respondents had poor awareness of the measles disease and perceived the disease as not severe, with some even refusing immunisation. The perceived barriers to receiving vaccinations included a nomadic lifestyle; issues with finances, citizenship status, language, and weather; failing to remember immunisation schedules; a fear of health care personnel; having too many children; and a lack of female autonomy in vaccine decision-making. However, the respondents were receptive towards community-based programmes and many welcomed a recall or reminder system, especially when the volunteers were family members or neighbours who spoke the same language and knew their village well. A few, however, found it awkward to have volunteers assisting them. Evidence-based decision making may increase measles immunisation coverage in marginalised populations. The components of the Health Belief Model validated that the respondents lacked awareness of the measles disease and viewed it and its effects as not severe. Therefore, future volunteer programmes should prioritise increasing the receptivity and self-control of marginalised populations to overcome barriers that hinder community involvement. A community-based volunteer programme is highly recommended to increase measles immunisation coverage.
RESUMO
Background: Coronavirus disease 2019 (COVID-19) emerged with a wide range of clinical presentations; Malaysia was not spared from its impact. This study describes the clinical characteristics of COVID-19 patients admitted to intensive care unit, their clinical course, management, and hospital outcomes. Methods: COVIDICU-MY is a retrospective analysis of COVID-19 patients from 19 intensive care units (ICU) across Malaysia from 1 March 2020 to 31 May 2020. We collected epidemiological history, demographics, clinical comorbidities, laboratory investigations, respiratory and hemodynamic values, management, length of stay and survival status. We compared these variables between survival and non-survival groups. Results: A total of 170 critically ill patients were included, with 77% above 50 years of age [median age 60, IQR (51-66)] and 75.3% male. Hypertension, diabetes mellitus, hyperlipidemia, chronic cardiac disease, and chronic kidney disease were most common among patients. A high Simplified Acute Physiology Score (SAPS) II score [median 45, IQR (34-49)] and Sequential Organ Failure Assessment (SOFA) score [median 8, IQR (6-11)] were associated with mortality. Patients were profoundly hypoxic with a median lowest PaO2/FiO2 ratio of 150 (IQR 99-220) at admission. 91 patients (53.5%) required intubation on their first day of admission, out of which 38 died (73.1% of the hospital non-survivors). Our sample had more patients with moderate Acute Respiratory Distress Syndrome (ARDS), 58 patients (43.9%), compared to severe ARDS, 33 patients (25%); with both ARDS classification groups contributing to 25 patients (54.4%) and 11 patients (23.9%) of the non-survival group, respectively. Cumulative fluid balance over 24 h was higher in the non-survival group with significant differences on Day 3 (1,953 vs. 622 ml, p < 0.05) and Day 7 of ICU (3,485 vs. 830 ml, p < 0.05). Patients with high serum creatinine, urea, lactate dehydrogenase, aspartate aminotransferase and d-dimer, and low lymphocyte count throughout the stay also had a higher risk of mortality. The hospital mortality rate was 30.6% in our sample. Conclusion: We report high mortality amongst critically ill patients in intensive care units in Malaysia, at 30.6%, during the March to May 2020 period. High admission SAPS II and SOFA, and severe hypoxemia and high cumulative fluid balance were associated with mortality. Higher creatinine, urea, lactate dehydrogenase, aspartate aminotransferase and d-dimer, and lymphopenia were observed in the non-survival group.