Epidemiology (2012-2019) and costs (2009-2019) of dengue in Malaysia: a systematic literature review.

OBJECTIVES: A systematic literature review was conducted to assess the epidemiology and economic burden of dengue in Malaysia. METHODS: Embase, MEDLINE, Evidence-Based Reviews databases, and gray literature sources were searched for English and Malay studies and surveillance reports on the epidemiology (between 2012 and 2019) and costs (between 2009 and 2019) of dengue in Malaysia. Independent screening of titles/abstracts, followed by full texts was performed using prespecified criteria. RESULTS: A total of 198 publications were included (55 peer-reviewed and 143 gray literature). Dengue incidence has been increasing in recent years, with 130,101 cases (dengue fever 129,578 cases; dengue hemorrhagic fever 523 cases) reported in 2019, which is the highest since 2012. All dengue virus serotypes co-circulated between 2004 and 2017, and major outbreaks occurred in a cyclical pattern, often associated with a change in the predominant circulating serotype. Economic impacts are substantial, including the societal impact of lost work (7.2-8.8 days) and school days (3.2-4.1 days) due to dengue. CONCLUSION: The rising incidence and high cost of dengue, coupled with overlapping diseases, will likely result in further pressures on the healthcare system. To appropriately mitigate and control dengue, it is critical to implement integrated strategies, including vaccination, to reduce the burden of dengue.

The Covid Impact to Public Healthcare Utilization Among Urban Low-Income Subsidized Community in Klang Valley Malaysia.

BACKGROUND: Appropriate level of healthcare utilization is one of the aims in translating health system inputs into improving the outcome of population health. Healthcare utilization services in Malaysia remains relatively low as compared to the rate in most high-income countries and some gaps exist across socioeconomic status. After the financial handouts deemed Household Living Aid (HLA) to low-income earners, Malaysia has recently implemented a financial health protection scheme toward for low-income group known as PeKa B40 to improve their access for healthcare services. This study aims to determine the healthcare utilization among the low-income population living in urban Klang Valley, and to explore the relationship between healthcare utilization with the demographic characteristics of this population. MATERIAL AND METHODS: A cross-sectional study using face to face structured questionnaire. All 447 respondents included were low-income earners enrolled in the HLA. Chi-square analysis and multiple logistic regression were used to examine association between the risk factors and healthcare utilization. RESULTS: The response rate was 93.5%. The healthcare utilization among the respondents during the partial lockdown period was 19.5% and 33.1% during the recovery lockdown period. Enrollment in the PeKa B40 scheme among the 7.6% respondents was not associated with healthcare utilization. After controlling for the variables, those aged 60 years and above [AOR: 1.87; 95% (CI): (1.07; 3.27)], self-rated poor health status [AOR: 2.16; 95% (CI): (1.07; 4.34)], having NCDs [AOR: 4.21; 95% (CI): (2.23; 7.94)], and being hospitalized in the past 12 months [AOR: 3.54; 95% (CI): (1.46; 8.62)], were more likely to utilize healthcare services as compared to their counterparts. CONCLUSION: The results from this study is valuable for policy recommendations to improve on the coverage of the PeKa B40 scheme and healthcare access for the low-income population especially during the pandemic.

Body plethysmography for measuring airway resistance in patients with bilateral vocal fold immobility.

OBJECTIVE: This study investigated the reliability of body plethysmography in comparison to spirometry in objectively measuring upper airway functions. METHODS: The study population consisted of 53 participants, 23 patients with BVFI after endolaryngeal laser posterior cordectomy and 30 healthy volunteers. All of them had body plethysmography (airway resistance, Raw), spirometry (ratio of forced expiratory flow at 50% to forced inspiratory flow at 50%, FEF50/FIF50 and peak inspiratory flow, PIF), 6 min-walking-test (6MWT) and Medical Research Council (MRC) dyspnea scale measurements. The tests were repeated and reliability was evaluated using intraclass correlation (ICC) and Spearman correlation. RESULTS: The reliability of Raw was high with ICC of 0.92, comparable to the spirometry measurements: FEF50/FIF50(ICC = 0.72) and PIF (ICC = 0.97). The mean of Raw was significantly higher in patient group. A strong significant correlation between Raw and MRC dyspnea scale (r = 0.79; p<0.05) and a moderate negative correlation between Raw and 6MWT (r = 0.4; p<0.05) was demonstrated. CONCLUSION: Body plethysmography (Raw) is a reliable tool in objective measurement of upper airway resistance that reflects the patient's perception of breathlessness. A larger number of participants are necessary to confirm this finding.

Evaluation of Selected Outcomes of Combination Antiretroviral Therapy: Yemen Cohort Retrospective Descriptive Studies.

In 2007, HIV treatment services were established in five main governorates out of twenty-two which resulted in low access to services and poor treatment outcomes. The main goal of this study was to evaluate and analyse the selected treatment outcomes of eight cohorts of PLHIV who were treated with cART during 2007-2014. The method used was a retrospective descriptive study of 1,703 PLHIV who initiated cART at five public health facilities. The results: Retention rate was less than 80%, male: female ratio 1.661, with a mean age of 35 years (±9.2 SD), 85% had been infected with HIV via heterosexual contact. 65% of patients presented with clinical stages 3 and 4, and 52% of them were initiated cART at a CD4 T-cell count ≤200 cells/mm. 61% of cART included Tenofovir and Efavirenz. TB treatment started for 5% of PLHIV, and 22% developed HIV-related clinical manifestations after cART initiation. 67% of PLHIV had experienced cART substitution. The mean AIDS-mortality rate was 15% and the mean LTFU rate was 16%. Conclusion: Although cART showed effectiveness in public health, mobilization of resources and formulation of better health policies are important steps toward improving access to cART and achieving the desired treatment outcomes.

Health, access and nutritional issues among low-income population in Malaysia: introductory note.

The current issue of BMC Public Health presents work by the Consortium of Low Income Population Research (CB40R), highlighting a comprehensive aspect of health, i.e., physical health, mental health, health behaviour and health financing; and also nutrition involving all stages of lifespan of the socioeconomic deprived group in Malaysia.Consortium of B40 Research (CB40R) reposited and harmonised shared, non-identifiable data from epidemiological studies involving low income population (B40) in Malaysia. CB40R also performed joint or mega-analyses using combined, harmonised data sets that yield collated results with enhanced statistical power, more variabilities (study population, geographical regions, ethnicities and sociocultural groups) to better understand the needs, characteristics and issues of B40 groups in Malaysia. It also aimed to develope a system/framework of minimum/standard variables to be collected in research involving B40 in future. For this special issues, members of the consortium have been invited to contribute an original article involving analysis of the health aspects, access to health and nutritional issues of the B40 samples.All the papers in this special issue have successfully highlighted the health and nutritional issues (i.e., non-communicable disease (NCD), inflammatory bowel disease (IBD), knowledge towards sexually transmitted disease (STD), low birth weight, Motoric Cognitive Risk (MCR) syndrome, urinary incontinence), mental health, oral health and inequalities among the low-income group in Malaysia, including the rural population and also the urban poor. The low-income population in Malaysia is also at risk of both under- and over nutrition, of which specific cost effective strategies are indeed needed to improve their quality of life.The low income population in Malaysia is facing various health challenges, particularly related to NCD and poor mental health, nutritional and physical function. There is a need for a sustainable intervention model to tackle the issues. It is also important to highlight that reducing SES disparities in health will require policy initiatives addressing the components of socioeconomic status (income, education, and occupation) as well as the pathways by which these affect health.

Potential loss of revenue due to errors in clinical coding during the implementation of the Malaysia diagnosis related group (MY-DRG®) Casemix system in a teaching hospital in Malaysia.

BACKGROUND: The accuracy of clinical coding is crucial in the assignment of Diagnosis Related Groups (DRGs) codes, especially if the hospital is using Casemix System as a tool for resource allocations and efficiency monitoring. The aim of this study was to estimate the potential loss of income due to an error in clinical coding during the implementation of the Malaysia Diagnosis Related Group (MY-DRG®) Casemix System in a teaching hospital in Malaysia. METHODS: Four hundred and sixty-four (464) coded medical records were selected, re-examined and re-coded by an independent senior coder (ISC). This ISC re-examined and re-coded the error code that was originally entered by the hospital coders. The pre- and post-coding results were compared, and if there was any disagreement, the codes by the ISC were considered the accurate codes. The cases were then re-grouped using a MY-DRG® grouper to assess and compare the changes in the DRG assignment and the hospital tariff assignment. The outcomes were then verified by a casemix expert. RESULTS: Coding errors were found in 89.4% (415/424) of the selected patient medical records. Coding errors in secondary diagnoses were the highest, at 81.3% (377/464), followed by secondary procedures at 58.2% (270/464), principal procedures of 50.9% (236/464) and primary diagnoses at 49.8% (231/464), respectively. The coding errors resulted in the assignment of different MY-DRG® codes in 74.0% (307/415) of the cases. From this result, 52.1% (160/307) of the cases had a lower assigned hospital tariff. In total, the potential loss of income due to changes in the assignment of the MY-DRG® code was RM654,303.91. CONCLUSIONS: The quality of coding is a crucial aspect in implementing casemix systems. Intensive re-training and the close monitoring of coder performance in the hospital should be performed to prevent the potential loss of hospital income.

The use of e-cigarettes among university students in Malaysia.

INTRODUCTION: E-cigarette use is an emerging phenomenon with increasing recognition and acceptance globally. This study aims to create a profile of e-cigarette users among university students in Malaysia. METHODS: The study was conducted using a cross-sectional research involving six universities in Malaysia. A semi-structured questionnaire was distributed to 1302 randomly selected students, who either smoked cigarettes and/or e-cigarettes. The 2011 version of Global Adult Tobacco Surveys (GATS) tool was used to record the respondents' sociodemographic data. RESULTS: The study revealed that 74.9% of the respondents smoked e-cigarettes; 40.3% used both cigarettes and e-cigarettes (dual users), and 34.5% were exclusive e-cigarette users. The exclusive use of e-cigarettes was related to gender (OR=0.18, 95% CI: 0.09-0.39). Also, male respondents were the majority users (95%). Of the respondents, 75.2 % were Malays, 98.0% single and most believed they have no health problems (92.1%). Further findings revealed the occurrence of adverse effects, dizziness 14.4%, cough 14.1%, and headaches 12.4%. Overall, 57.8% of the respondents used e-cigarettes as a smoking cessation tool, while others consider e-cigarettes a self-image enhancing tool or as part of social activities. CONCLUSIONS: Further research on the use of e-cigarettes should be conducted on a large number of respondents in other settings to augment the findings of this study, and also guide policy making on and prevention practice of e-cigarette use, among the general student population in Malaysia.

Patients' willingness to pay for their drugs in primary care clinics in an urbanized setting in Malaysia: a guide on drug charges implementation.

BACKGROUND: Malaysia is an upper middle income country that provides subsidized healthcare to ensure universal coverage to its citizens. The challenge of escalating health care cost occurs in most countries, including Malaysia due to increase in disease prevalence, which induced an escalation in drug expenditure. In 2009, the Ministry of Health has allocated up to Malaysian Ringgit (MYR) 1.402 billion (approximately USD 390 million) on subsidised drugs. This study was conducted to measure patients' willingness to pay (WTP) for treatment of chronic condition or acute illnesses, in an urbanized population. METHODS: A cross-sectional study, through face-to-face interview was conducted in an urban state in 2012-2013. Systematic random sampling of 324 patients was selected from a list of patients attending ten public primary cares with Family Medicine Specialist service. Patients were asked using a bidding technique of maximum amount (in MYR) if they are WTP for chronic or acute illnesses. RESULTS: Patients are mostly young, female, of lower education and lower income. A total of 234 respondents (72.2%) were not willing to pay for drug charges. WTP for drugs either for chronic or acute illness were at low at median of MYR10 per visit (USD 3.8). Bivariate analysis showed that lower numbers of dependent children (≤3), higher personal and household income are associated with WTP. Multivariate analysis showed only number of dependent children (≤3) as significant (p = 0.009; 95% CI 1.27-5.44) predictor to drugs' WTP. CONCLUSION: The result indicates that primary care patients have low WTP for drugs, either for chronic condition or acute illness. Citizens are comfortable in the comfort zone whereby health services are highly subsidized through universal coverage. Hence, there is a resistance to pay for drugs.