mjphm supplement 1(2011)

Volume 11(Suppl 1) 2011

Official Journal of Malaysian

Public Health Physicians’ Association

EDITORIAL BOARD

Chief Editor

Prof. Dato’ Dr. Syed Mohamed Aljunid

(United Nations University – International Institute for Global Health)

Deputy Chief Editor

Assc. Prof. Dr. Sharifa Ezat Wan Puteh

(Universiti Kebangsaan Malaysia)

Members:

Assc. Prof. Sharifah Zainiyah Syed Yahya University Putra Malaysia

Dr. Lokman Hakim Sulaiman Ministry of Health Malaysia

Assc. Prof. Dr Retneswari Masilamani University Malaya

Assc Prof Dr. Mohamed Rusli Abdullah University Sains Malaysia

Assc. Prof. Saperi Sulong University Kebangsaan Malaysia Dr. Maznah Dahlui University Malaya Dr. Roslan Johari Ministry of Health Malaysia Dr. Othman Warijo Ministry of Health Malaysia Dr. Amrizal Muhd Nur United Nations University–International

Institute for Global Health (UNU-IIGH)

Chief Editor

Malaysian Journal of Public Health Medicine (MJPHM)

United Nations University - International Institute for Global Health (UNU-IIGH)

Universiti Kebangsaan Malaysia Medical Centre (UKMMC)

Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur

Malaysia

ISSN: 1675–0306

The Malaysian Journal of Public Health Medicine is published twice a year

Copyright reserved @ 2001

Malaysian Public Health Physicians’ Association

Secretariate Address:

The Secretariate

United Nations University - International Institute for Global Health (UNU-IIGH)

Universiti Kebangsaan Malaysia Medical Centre (UKMMC)

Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur

Malaysia

Tel: 03-91715394 Faks: 03-91715402 Email: [email protected]

Volume 11(Suppl 1) 2011

Official Journal of Malaysian

Public Health Physicians’ Association

4TH PERAK HEALTH CONFERENCE 2011

16 – 18th MAY 2011

IMPIANA CASUARINA HOTEL

IPOH, PERAK DARUL RIDZUAN

Organized by

Perak State Health Department

&

The Malaysian Public Health Physicians’ Association (Perak)

SCIENTIFIC COMMITTEE

& EDITORIAL BOARD

Chairman: Dr. Puvaneswari Subramaniam, MOH Perak

Secretar y: Mr. Paul Eruthiasamy, MOH Perak

Members:

Datin Dr. Ranjit Kaur, MOH Perak

Dr. Bernard Benedict, MOH Perak

Dr. Wardati Malek, MOH Perak

Dr. Ling He Mey, MOH Perak

Mr. Gilbert Santiago, MOH Perak

Mr. Ngarilah Mohd Ariff, MOH Perak

i

Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4th

Perak Health Conference 16-18th

May 2011

CONTENTS PAGES

PLENARY

PL1 ONE CARE FOR 1 MALAYSIA 1 Dr. Haji Nordin bin Saleh

PL2 EFFECTS OF WIRELESS COMMuNICATION ON HEALTH 2 Associate Professor Dr. Kwan Hoong Ng

PL3 INTEGRATED PRIMARY CARE - INTERGRATING VERTICAL 3 PROGRAMS FOR EFFECTIVENESS IN DELIVERY OF SERVICE Dr. Hjh. Safura bt Haji Jaafar

PL4 ENSURING CONTINUITY OF HEALTHCARE – A SHARED 4 RESPONSIBILTY Yg Bhg Dato’ Dr. Haji Ahmad Razin bin Dato’ Haji Ahmad Mahir

PL5 HEALTHCARE INTEGRATION – A PRIVATE PRACTITIONER’S VIEW 5 Dr. Steven Chow Kim Weng

SYMPOSIUM 1 COMBINED AND MuLTIDISCIPLINARY CARE

SYM I(1) LOOKING AT THE WHOLE CHILD 6 Dr. Aminah Bee bt. Mohd Kassim

SYM I(2) CONVERGING SHARED CARE IN MATERNAL AND CHILD HEALTH 7 Professor Dato’ Dr. N Sivalingam

SYM I(3) SUPPORT SERVICES FOR FAMILY NEEDS 8 Dr. Cheah Yee Chuang

SYMPOSIUM 2 ACHIEVEMENTS OF THE MILLENNIUM DEVELOPMENT GOALS

SYM II(1) IMPROVING CHILD HEALTH TOWARDS MILLENNIUM 9 DEVELOPMENT GOALS Yg Bhg Dato’ Dr. Amar Singh HSS

SYM II(2) MATERNAL HEALTH – MEETING THE MILLENNIUM DEVELOPMENT 10

GOALS Dr. Safiah bt. Bahrin

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May 2011

CONTENTS PAGES

SYM II(3) COMBATING HIV/AIDS, TUBERCULOSIS AND MALARIA - ARE WE 11

ON TRACK? Dr. Sha’ari bin Ngadiman

SYMPOSIUM 3 TECHNOLOGY AND HEALTH

SYM III(1) HEALTH DATA INTEGRATION 12 Dr. Md. Khadzir bin Sheikh Haji Ahmad

SYM III(2) ERGONOMICS IN HEALTH FACILITIES 13 Dr. Abu Hasan bin Samad

SYM III(3) SACKING THE PLASTIC 14

Ms. Mageswari Sangaralingam

SYMPOSIuM 4 HEALTH RISK MANAGEMENT

SYM IV(1) OUTBREAK RISK COMMUNICATION 15 Dr. Husnina bt. Ibrahim

SYM IV(2) IMPROVING PATIENT SAFETY 16 Dr. Hajah Kalsom bt. Maskon

SYM IV(3) OCCUPATIONAL RISK IN HEALTHCARE 17 Professor Dr. Rusli bin Nordin

FREE PAPERS

ORAL PRESENTATION

AP 1 PREVALENCE OF PATIENTS WITH CHRONIC PAIN AND ITS 18

ASSOCIATED FACTORS IN PRIMARY CARE ATTENDEES Subashini; EM Khoo; Hanafi NS

AP 2 FACTORS ASSOCIATED WITH STRESS AMONG PRIMARY 19 HEALTHCARE DOCTORS, ASSISTANT MEDICAL OFFICERS AND

NURSES IN GOVERNMENT HEALTH CLINICS IN KELANTAN, 2010. Asmah; Siti Raudzah

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May 2011

CONTENTS PAGES

AP 3 THE USAGE OF MATERIAL SAFETY DATA SHEET AMONG DENTAL 20 PERSONNEL IN PERAK Anna R; Bibi Saerah; Siriander D; Law C H; Rohana K et al

AP 4 PREVALENCE AND PREDICTORS OF RECENT RESPIRATORY ILLNESS 21 IN THE MALAYSIAN POPULATION Paramesarvathy R; Gurpreet K; Amal NM; Tee GH

AP 5 KNOWLEDGE, ATTITUDE AND PRACTICES ON DENGUE AMONG 22 RURAL COMMUNITIES IN REMBAU AND BUKIT PELANDUK, NEGERI SEMBILAN, MALAYSIA Tan KL

AP 6 SCREENING FOR PATHOGENIC LEPTOSPIRA FROM WATER 23 SAMPLES AT PUSAT LATIHAN KHIDMAT NEGARA (PLKN) IN

NORTHERN AND EASTERN REGION OF PENINSULAR MALAYSIA. Hasanatunnur Azmi; Norliziana MA; Roziah A; Zulhainan H; Naim AK

AP 7 KEJADIAN WABAK HEPATITIS A DI PERKAMPUNGAN MASYARAKAT 24 ORANG ASLI POS JERNANG, SUNGKAI, PERAK

Faizal; Azizi MZ; Azim RH

AP 8 PENILAIAN KEBERKESANAN PUNJUT TEMEPHOS 500 E DALAM 25 TANGKI SEPTIK INDIVIDU

Aslinda UAB; Mahani Y; Mohd NS; Noor RM; Hairul I

AP 9 A STUDY ON EMERGENCY CARE SERVICES AND EQUIPMENT IN 26 HEALTHCARE FACILITIES

Ch’ng ML; Benedict CTW; Amy CAL; Dang SB; Razin Mahir

POSTER PRESENTATION

PP 1 EXTERNAL QUALITY ASSESSMENT FOR DIRECT SPUTUM SMEAR 27

MICROSCOPY FOR ACID FAST BACILLI IN THE STATE OF PERAK

Lim JM; Tan KL; Murugan K; Akma I; Suhaila AR et al

PP 2 FLUORIDE IN DRINKING WATER AND DENTAL FLUOROSIS AMONG 28 MALAY SCHOOLCHILDREN IN KAMPUNG BAHARU LANJUT, SEPANG, SELANGOR: A PRELIMINARY STUDY Shaharuddin MS; Nurul Faiza OB

PP 3 FIRST DOCUMENTED CASE OF Q FEVER IN MALAYSIA IN THE 21ST 29 CENTURY – EPIDEMIOLOGY AND INVESTIGATIONS

Bina Rai; Fadzilah K; Chow TS; Chee KY

PP 4 OUTBREAK OF INFLUENZA LIKE ILLNESS IN SCHOOLS IN PERAK 30 TENGAH DISTRICT (FROM JANUARY - FEBRUARY 2011)

Adliah MS; Ariza AR

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May 2011

CONTENTS PAGES

PP 5 IS CRASH DIETING A CONCERN AMONG FEMALE STUDENTS IN A 31 MALAYSIAN PRIVATE UNIVERSITY? Sabernero I; Gurpreet Kaur

PP 6 HEALTH SEEKING BEHAVIOUR TOWARDS COMMUNICABLE 32 DISEASES AMONG FOREIGN WORKERS IN INDUSTIRAL AND AGRICULTURE SECTOR IN SELECTED DISTRICTS IN PERAK. Noor Asmah; Koh K; Ong KG; Wan Asmuni; Asmah ZA

PP 7 PREVALENCE OF HEARING IMPAIRMENT AND CARPAL TUNNEL 33 SYNDROME IN GRASS CUTTERS OF BAKAS UNIT BATANG PADANG DISTRICT HEALTH OFFICE

Azim RH; Aman S

PP 8 UNHYGENIC FOOD PRACTISES - STUDENTS SUFFER 34 Hasniza A; Fauziah M N; Zulkifli H; Roziyana I; Halzeri Z

PP 9 KEBERKESANAN MODuL PENDIDIKAN DIABETES TERHADAP 35 PESAKIT DIABETES DI KLINIK KESIHATAN TAIPING Bazariah Y; Amutha B; Sumathi M; Roziahwati A; Zuwariah AT et al

PP 10 EVALUATION OF PRESCRIBING PATTERNS AND COST ASSOCIATED 36 WITH THE USE OF ANTIHYPERTENSIVE AGENTS AT KLINIK KESIHATAN BAGAN SERAI Nurhani MA; Toh MJ

PP 11 TUBERCULOSIS IN THE DISTRICT OF LARUT MATANG AND 37 SELAMA, PERAK, MALAYSIA.

Syed MP

PP 12 PENGGUNAAN APLIKASI ELETRONIK DALAM PENYEDIAAN KERTAS 38 SIASATAN DI UNIT INSPEKTORAT DAN PERUNDANGAN, PEJABAT KESIHATAN DAERAH KINTA Nurulhisham S; Asroyadi HA; Shahrul AD; Tajudin H; Samad M et al

PP 13 GESTATIONAL DIABETES MELLITUS (GDM) 39 Sumathi M; Rosni W; Malliga S

PP 14 FIELD STUDY ON THE DERMATITIS CAUSED BY A BEETLE 40 PAEDERUS FUSCIPES (ROVE BEETLE) AMONG SCHOOL CHILDREN AND TEACHERS IN TUNKU ABDUL RAHMAN (STAR) SCHOOL, IPOH. Izzati K; Ili DS; Mahani Y; Noor RM

PP 15 SPECIES COMPOSITION, DENSITY AND BITING ACTIVITY OF 41 ANOPHELES SPP. FROM TWO LOCATIONS IN PERAK

Mahani Y; Aslinda UAB; Nor SI; Izzati K; Noor RM et al

PP 16 PENYERTAAN OPTIMuM MASYARAKAT MELALuI PENGLIBATAN 42 PANEL PENASIHAT KLINIK KESIHATAN Othman BW; Jamal NS; Mohd Fauzi AB; Roslan H

PP 17 TO INCREASE PERCENTAGE OF THE DIABETIC PATIENTS WITH 43 GOOD CONTROL IN KLINIK KESIHATAN LENGGONG Sofiah ZA; Teh YS; Fauziah H; Wan TK; Azmi I et al

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May 2011

PL 1 Plenary I - One Care For 1 Malaysia

Dr. Haji Nordin bin Saleh Deputy Director Health Policy and Planning Unit Planning and Development Division Ministry of Health Malaysia

Malaysia’s health system has been recognised internationally as a good system. However, the current and future challenges will affect the sustainability and relevance of the present system. Therefore, readjustment of the country’s health system is critical. 1Care is the restructured national health system concept that would be responsive and provides choice of quality health care, ensuring universal coverage for the health care needs of the population through the spirit of solidarity and equity. The philosophy of the 1Care concept is that the health system will undergo a transformation to one that is comprehensive in terms of scope, equity, affordability, effectiveness and efficiency in terms of financing, integrated in terms of delivery and accountable in terms of governance (stewardship). The 1Care concept is in tandem with the 1Malaysia philosophy to foster greater cohesiveness of the Malaysian population through the national health system. The proposed restructured Malaysian Health System will retain the existing strengths of the current system. The concept focuses on three components which is streamlining of MOH’s governance and stewardship functions and restructuring of the delivery and financing system. To support the 1Care initiative and ensure effective integration of the public and private sector, it is proposed that the health system will also be financed in a more integrated manner. It is expected that with 1Care, the population will receive greater access to higher quality care which is affordable and sustainable through better cost containment.

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May 2011

PL II Effects Of Wireless Communication On Health

Professor Dr. Kwan Hoong Ng Department of Biomedical Imaging and Medical Physics Unit, University of Malaya, Kuala Lumpur

Mobile telephony is now ubiquitous around the world. This wireless technology relies upon an extensive network of antennas, or base stations, relaying information with radiofrequency (RF) waves. Wireless local area networks (WLANs) are also increasingly common in homes, offices and public places.

There has been a lot of concern about possible health consequences from exposure to the RF waves produced by wireless technologies. This talk reviews the scientific evidence on the health effects from continuous low-level human exposure to base stations and other local wireless networks. To date, the only health effect from RF radiation that has been identified is based on an increase in body temperature (greater than 1 °C) from exposure at very high field intensity found only in some industrial facilities, such as RF heaters. The levels of RF exposure from base stations and wireless networks are so low that the temperature increases are insignificant and do not affect human health.

The public are very worried by the media or anecdotal reports of cancer clusters around base stations. Since there are a large number of base stations in the vincinity, it is expected that possible cancer clusters will occur near base stations merely by chance. Moreover, the reported cancers in these clusters are often a collection of different types of cancer with no common characteristics and hence unlikely to have a common cause.

Over the past two decades, research studies examining a potential relationship between RF transmitters and cancer have not provided evidence that RF exposure from the transmitters increases the risk of cancer. Similarly, long-term animal studies have not established an increased cancer risk from exposure to RF fields, even at much higher levels than that produced by base stations and wireless networks.

There have been very few studies investigating health effects in individuals exposed to RF fields from base stations. This is because of the difficulty in distinguishing possible health effects from the very low signals emitted by base stations from other higher strength RF fields in the environment. Most studies have focused on the RF exposures of mobile phone users. Human and animal studies examining brain wave patterns, cardiovascular function, cognition and behaviour after exposure to RF fields have not identified adverse effects. Though there is no convincing scientific evidence that the RF fields from base stations and wireless networks cause adverse health effects, nevertheless further research is still needed to elucidate the basic interaction mechanisms and long-term health effects.

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May 2011

PL III Integrated Primary Care - Intergrating Vertical Programs For Effectiveness In Delivery of Service

Dr. Hjh. Safura bt. Haji Jaafar Director of Family Health Development Division Ministry of Health Malaysia

Integrated Primary care is the provision of services around individuals and families, restructuring today’s fragmented facilities into a system of community-focused family health providers so as to consolidate health gains, increase efficiency without sacrificing quality, and ensure sustainability of services.

The idea is not new. Thirty years ago, in 1978, the Alma-Ata Declaration pointed to the importance of community-oriented comprehensive primary health care for all nations. In this comprehensive or ‘horizontal’ healthcare concept, health care is also a basic human right that requires community participation. However strategies meanders on path that is least resistance and many chooses the “selective disease-oriented approach” to address the greatest disease burden. These two positions differ both philosophically and practically. The selective is short-term in outlook that solves a given health problem HIV/AIDS/TB and the like through the application of specific measures. However Comprehensive primary health care is carried out through a long-term process that seeks to tackle the overall health problems through the creation of an accessible permanent institutional infrastructure for ‘general health services, that ensure sustainable health.

Many countries have shown the failure of vertical programming to meet its main objective, ie: a better coverage of those with the highest needs. In addition, vertical programmes create duplication, whereby each disease control programme requires its own bureaucracy, leads to inefficient facility utilisation by recipients, and may lead to gaps in care especially in patients with multiple co-morbidities. It is easier to finance vertical programme presumably easier to account for. But such methodology of financing vertical programmes has ‘diverted’ skilled local health personnel away from the local (primary) healthcare system. As a result, the health sector became vertically organized, with staff moving from one section to the next, jeopardising access to overall health services and raising deep concerns regarding equity. This type of internal ‘brain drain’ has devastating consequences and undermines critical primary healthcare services,

With scarce resources in primary care, Malaysia has introduced the REAP or Reviewed Approach in Primary care focusing on Integration of the various vertical programs for the community to achieve sustainable disease control and to build systems that is more responsive to the needs of patients and communities. The challenges continue; to gain in capacity development from a vertical thought process to one that is horizontal, comprehensive and wholesome.

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May 2011

PL IV Ensuring Continuity Of Healthcare – A Shared

Responsibilty

Yg Bhg Dato’ Dr. Haji Ahmad Razin bin Dato’ Haji Ahmad Mahir Director Perak State Health Department

WHO had defined Health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity? This definition should be transformed into a shared goal i.e. the individual, family, community and society. There must be a political will and political directives to achieve this. The government had actually invested a lot of money into health care services and the health care cost continues to rise in tangent with the greater responsibility and accountability of the government to provide equity and quality in healthcare. At the same time the expectation of the “rakyat” is also increasing in fact they became more demanding and expressing health care is a basic right of the people.

However to achieve health as defined by WHO is not the sole responsibility of the Ministry Of Health and the government. The influence on health is multi factorial. Socio-economic and cultural factors play a big role. However there are a lot of gaps or fragmentation between government agencies, between public sector and private sector, between providers of health care and the “rakyat”. So much so that the shared goal of health is not translated as a shared mission of “shared responsibility”.

“Shared Responsibility” the magical word of togetherness that has been used in the slogan, is the basic foundation in implementing a triumphant work. Without a teamwork and devotedness spirit, it will be hard to achieve the shared goal. Many government agencies had also adopted “Shared Responsibility” in their slogan.

However there are still people who are being irresponsible and negligent. This negative attitude is contagious and has been infecting our society. It also mean that the Ministry Of Health had not achieve it mission to build partnerships to facilitate and support the people to attain fully their potential in health, to motivate them to appreciate health as a valuable asset and to take positive action to improve further and sustain their health status to enjoy a better quality of life

If this negative culture tend to continue in our society, our service sector will not continue to develop or grow but will always be left behind.The health service will be despised by the society. Being selfish is the root problem to an irresponsible culture in oneself. This attitude should be immediately expelled from our society. How can this be achieved?

Can this be achieved through further reinforcement of health education, strict enforcement of laws and regulation, innovative approach to tackle health problems like the use of “explore race” approach instead of “gotong-royong”? Perhaps the long term approach is to have a cultural change in a new era of responsibility – a recognition, on the part of every Malaysian, that we have duties to ourselves, our community, our country, duties that we do not grudgingly accept but rather seize gladly, firm in the knowledge that there is nothing so satisfying to the spirit, so defining of our character, than giving our all to a difficult task. The nature of “shared responsibility” should be cultivated in the community regardless of their backgrounds and positions. To fulfill this mission, basic components should be emphasized for the culture of “shared responsibility” to be practiced by all levels of society. To cultivate this culture, it must be born out from awareness and importance of health to our society. Starting from the beginning families and schools are important institutions for fertilizing an interest in the spirit of “shared responsibility”. It requires a process of education, upbringing and training.

Whateverisdone, every program needs support from government in theformofmoney,planning anddirection. Ministry of Health should act as a catalyst for realizing the culture of “shared responsibility” in the community with respect to health. The agencies from different departments and ministries together acknowledge responsibility for the realization of this dream in cultural change. Meetings and discussions should be made compulsory for the relevant agencies to discuss issues arising for businesses to run smoothly.

Hopefully one day, our society will be culturally competent to be equally responsible for their health and in everything else e.g. clean environment and clean river.

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May 2011

PLV Malaysian Healthcare Scenario –Private Practitioners’ Perspective

Dr. Steven Chow Kim Weng President Federation of Private Medical Practitioners’ Associations, Malaysia

Increasingly year by year we see the progressive commercialization of all aspects of healthcare starting from the medical education and all the way to delivery of tertiary and primary care. In tandem with this is the alarming rise in the cost of private medical care. Some private hospitals in Kuala Lumpur now quote patients from RM5000 to RM9000 for an open appendectomy and RM12000 to RM15000 for a laparoscopic appendectomy. On the other hand, the surgeon’s fee for both is capped at RM1370.

There is some fundamental issue regarding the way our healthcare system is been regulated. It is an important that this issue needs to be addressed urgently. Nowadays, private hospital bills reaching RM100K is not a rarity anymore. FPMPAM find this trend extremely alarming. The public is of the perception that a high hospital bill is due to hefty doctors’ fees. This is not true. It should be noted that the average doctor’s professional fees accounts for about 10-15% of the overall private hospital bill.

The provisions of the Private Healthcare Facilities and Services Act 1998 and Regulations 2006, has NO provisions to regulate hospital bills. As there is NO prescribed schedule for private hospital fees, private hospitals are free to charge as they see fit. Ultimately, they answer only to their shareholders.

The FPMPAM have made regular representation to the Ministry of Health on this matter. The usual response is that it is not possible to control hospital fees, as there were different classes of hospitals providing different class of services i.e. 3-star to 6-star hospitals. The situation in some hospitals has reached to a point where our members, the doctors themselves find it hard to advise patient on the cost of hospitalization. Often, the hospital bills end up way above what was originally estimated and the doctor is accused of over-charging.

Now that most of the major private hospital chains are owned and operated by GLCs, the boundary between the regulators and the operators of healthcare will clearly be blurred. GLCs are government – corporate owned and answerable to government. It is thus clear that not only are the hands of the doctor tied in this matter, even the MOH itself is in a quandary as to how it can act effectively in this matter.

Doctors in the private sector can urge the patients and the public to speak out against this disturbing trend. We can call upon our elected leaders and members of public office on both sides of the House to take heed and institute appropriate measures to protect the patients and the public. The commercialized corporate model private hospital will not benefit the majority of our population who are only able to afford basic healthcare needs.

The Federation is of the view that the healthcare must not be treated as a commercial commodity. The future healthcare system must prioritize and preserve the social obligation of providing quality affordable and compassionate patient care for the people of Malaysian over and the commercial agenda.

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May 2011

SYM I (1) Looking At The Whole Child

Dr. Aminah Bee bt. Mohd Kassim Senior Principal Assistant Director Family Health Development Division Ministry of Health Malaysia

Multidisciplinary approach draws appropriately from multiple disciplines to redefine problems and reach solutions based on a new understanding of complex situations. Multidisciplinary approach is holistic care. What are pro and cons of multidisciplinary care? Can be it carried out effectively? Can it be implemented at the primary care level? How can it be applied in the holistic care of the child?

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May 2011

SYM I (2) Converging Shared Care In Maternal And Child Health

Professor Dato Dr Sivalingam Nalliah FRCOG, FAMM, MCGP, FICS, Med Clinical School, International Medical University, Kuala Lumpur

Conventional wisdom indicates the motive of any health delivery system is to sustain a healthy population. Indices for healthcare have been traditionally employed to indicate the achievement of health through strategies developed benchmarking against both national and international standards. The Milleneum Development Goals has been incorporated into the KPIs of the Perak Health Department. Three primary aims of the MDG are to reduce child mortality, improve maternal mortality and ensure environmental sustainability. All three are relevant to the discussion when one considers maternal and child health in Perak.

The objective of this paper is to review the maternal mortality and child health indices conventionally employed and induce a discussion on how the current healthcare delivery system has worked in attempting to achieve the three indices of the MDGs.

Data on mortality below 5 years of age in Perak is higher than the MDG target of 5.5 per 1000 LB. The Perinatal Mortality Rate in 2010 was much higher in Perak largely contributed by normally formed macerated stillbirths and prematurity. Both these factors contribute to fetal wastage and affect maternal health adversely. The stillbirth rate for Perak compared to national levels again reigns higher contributed largely by prematurity.

The MDGs aims to improve maternal health and reduce maternal deaths by three quarters. Here again Perak is lagging with MMR being 30.1/100,000 LB, much higher than the proposed 11.0/100,000 for the country.

To address the problems squarely there is a need to restructure the healthcare delivery system using the vital statistics available to ensure the current strategies remain relevant as the delivery rate in Perak has declined over the years while the health facilities have improved at an exponential rate. What needs to be re-looked is the quality of shared care in both maternal and child healthcare, Although it may not be possible to relate the causes of mortality to specific conditions one needs to review the quality of care by health care givers and how social factors and the environment contributes to some of the remediable factors like prematurity and childhood illness especially in the perinatal period.

Concerns have been expressed by the rapid introduction of technology with a shifted emphasis on specialized care by experts in both obstetrics and neonatalogy. Subspecialists in OBGYN have been focusing and utilizing available consultation time in detailed ultrasound care with less emphasis on case selection. The neonatologist has established standard of care on sustaining the low birth weight baby because of the possibility of maintaining life utilizing intensive care support systems. Both these experts have benchmarked their standard of care to international standards. But one now sees that maternal medicine, the cause of many of the mortalities, being shifted to other personnel. It is now evident that the divide between primary care and specialist care has blurred with high risk cases being managed in primary care because of the changed philosophy of care. It is time to re-look at the training of the primary care physician and the midwife to ensure their competency in caring for risk cases within their set up. Data need to be generated on competency in use of technology like the ultrasound and its applicability to manage risk cases in the primary care setting.

The vital statistics clearly indicates that maternal mortality is not declining in spite of introduction of technology and increasing numbers of health care givers. The need to converge primary care and hospitalist care is urgent as the MDGs set out will not achieved if the current health care strategies continues to prevail. Transformation is not more a catchword but need to be realized through healthcare engineering.

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May 2011

SYM I (3) Support Services For Family Needs

Dr. Cheah Yee Chuang Consultant Psychiatrist Hospital Bahagia Ulu Kinta, Perak

Care for persons with serious mental illness (SMI) has moved from custodial to community settings. Individuals with SMI require treatment, rehabilitation and support to function in the community. There are two types of burden on family members, i.e objective burden and subjective burden. Family require appropriate and sufficient education, training and emotional support for their care-giving role.

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May 2011

SYM II (1) Improving Child Health Towards Millennium Development Goals (MDG)

Dato’ Dr. Amar Singh HSS Cert Theology (Aust, Hons), MBBS (Mal), MRCP (UK), FRCP (Glasg), MSc Community Paediatrics (Ldn, dist.) Senior Consultant Paediatrician (Community) and Head of Paediatric Department, Hospital RPB Ipoh Head Clinical Research Centre Perak

Abstract There has been a dramatic decline in child mortality in past few decades with under 5 mortality (U5M) declining from 25.7 per 1000 life births in 1980 to 7.9 in 2007. Historically, tends in childhood mortality have largely focused on the absolute rate and its reduction. It is important to look at sub-analysis of the mortality to derive strategies for the prevention of childhood deaths. An evaluation of the childhood mortality trends shows 4 key issues.

Firstly the decline in childhood mortality has levelled off in the past 8-10 years and it is unlikely that Malaysia will achieve the MDG4 goal. Secondly the vast number of under 5 deaths occur in the first year of life and in particular the first month of life (neonatal deaths account for 60% of under 5 deaths). Thirdly segments of the population and sub-groups still have very high child mortality. In particular the remote rural communities (Orang Asli, Interior Sarawak and Sabah). We are an emerging and developing economy but have pockets of extreme third world. Fourthly some regions in the country are still underreporting childhood deaths and accurate detection and documentation will significant rise our mortality rate.

To significantly impact child health towards achieving the millennium development goals we will have to recognise that health needs and challenges have dramatically changed in the past three decades. And that health care professionals and health care systems have changed much slower to meet these challenges. It is important to note that the Malaysian performance is comparable with neighbouring and developed countries but is not uniform. It is important that managers and those in political power appreciate that further reduction in mortality will require enormous effort/resources. Our current expenditure on health is very low compared to developed and some developing countries.

5 immediate and key strategies we can use to impact child health include the following. Firstly putting in place a mortality system that evaluates, monitors U5M to identify areas for intervention. Secondly target currently known vulnerable populations/pockets where care is suboptimal. Thirdly improve skills training to identify ill children and effectively resuscitate them. Fourthly continue with existing services but consolidate key areas especially intensive care (NICU/PICU) and Retrieval services. Fifthly considerably strengthen MCH services including health education to parents.

In recent decades there has been an “explosion” of tertiary level specialised services as means to meet the health needs of the community. The forces that drive the provision of health care are often other than true health needs - whether those perceived by the public, professionals or governments. Often “market forces” determine how such services develop. It is vital that the heath care service move to accelerate the development of “wellness” services and focus on the communities and not the hospitals or the health professionals. To move forward, we must “Make the Right Real”, which means address the reality that we see before us and act accordingly. If we continue to deviate our focus from the true health needs of children and communities we will fail to make further significant impact on child health. Strong advocacy is required and this will require not just a transformation of our work but more importantly our hearts.

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May 2011

SYM II (2) Maternal Health – Meeting The Millennium Development Goals

Dr. Safiah bt. Bahrin Senior Principal Assistant Director Family Health Development Division Ministry of Health Malaysia

Improving maternal health is a vital economic and social investment and is one of the Eight Millennium Development Goals (MDG). The original target consist of two indicators for monitoring progress which is reducing maternal mortality ratio by three quarters between 1990 and 2015, and increasing the proportion of births attended by skilled health personnel to more than ninety per cent. However, in year 2005, due to the slow reduction in maternal mortality ratio (MMR) globally, world leaders recognized that sexual reproductive health is a prerequisite for achieving MDG 5, it also contributes significantly to reducing poverty and hunger (MDG 1), promoting gender equality and empowerment of women (MDG 3) and combating HIV and other diseases (MDG 6). In order to achieve MDG 5, programs and initiatives will need to expand beyond maternal health. An accelerated action towards universal access to reproductive health (an additional target in MDG 5) enhances the progress towards achieving the Millennium Development Goal by 2015.

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May 2011

SYM II (3) Combating HIV/AIDS, Tuberculosis and Malaria- Are We On Track?

Dr. Sha’ari bin Ngadiman Deputy Director of Disease Control (Infectious Disease) Ministry of Health Malaysia

HIV/AIDS, Tuberculosis and Malaria are among communicable diseases that taken millions of lives. HIV/AIDS has taken more than 20 million lives and may take millions more if trends continue. Malaria kills a child in the world every 45 seconds and close to 90% of malaria deaths occur in Africa, where it accounts for a fifth of childhood mortality. About 1.8 million people died from tuberculosis in 2008, about 500,000 of whom were HIV-positive. United Nation put target to reduce these diseases in the Millennium Development Goals.

The global response to AIDS has demonstrated tangible progress. The new HIV infections fell steadily from a peak of 3.5 million in 1996 to 2.7 million in 2008. Deaths from AIDS-related illnesses also dropped from 2.2 million in 2004 to two million in 2008. Tuberculosis prevalence is falling in most regions except Asia and estimated that 11 million people suffered from tuberculosis in 2008. Half the world’s population is at risk of malaria and estimated 243 million cases of malaria in 2008, causing 863,000 deaths, in which 89% of them in Africa. With the assistance of Global fund, it helped to control malaria and hope to achieve the MDG target.

Malaysia has achieved considerable success in controlling many infectious diseases over time. A shift in disease pattern from communicable to non-communicable diseases tends to occur as a nation progresses from a developing to developed status. This changing disease pattern has occurred in Malaysia. Since 1970, infectious diseases, such as tuberculosis (TB) and malaria, have declined sharply.

In Malaysia, the main driver of the HIV epidemic was among injecting drug users. From 1990 to 1996, the number of annual newly detected HIV cases attributed to injecting drug use rose from 60 per cent (in 1990) to 83 per cent (in 1996). Since 2002, new cases detected have continually declined, despite a substantial increase in the number of screenings. Tuberculosis remains a significant health issue. The number of notified cases (all forms) increased from 10,873 in 1990 to 18,102 in 2009. The notification rate has fluctuated slightly since 1990, although the trend from the past six years is showing a slow increase. The number of reported tuberculosis-related deaths in 2009 was 1,582, up from 942 in 2000. For malaria, the country is currently progressing towards the MDG-Plus complete elimination by 2020. Since the implementation of the Malaria Eradication Programme in 1967 (later to become the Malaria Control Programme in 1982) the number of malaria cases has declined significantly.

In managing the HIV/AIDS, tuberculosis and malaria situation, the new national strategic plans were drafted. These strategic plans will be use in implementation activities, direction for the country to achieve MDG target for HIV/AIDS and tuberculosis and MDG-plus for malaria.

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May 2011

SYM III (1) Health Data Integration

Dr. Md. Khadzir bin Sheikh Haji Ahmad Deputy Director, Planning and Development Division Ministry of Health Malaysia

Introduction The evolution of Health Information Management System in Malaysia started from a basic paper-based statistical reporting system to an ICT enabled Health Information Management system. Since colonial times, health information was collected and collated for statistical reports, which in general is not adequate and not timely for effective and efficient management. The Health Information Management System (HIMS) was developed with the intention to gather information required for programme planning, monitoring and evaluation. The deployment of Hospital Information Systems was intended to enable healthcare providers to produce efficient and timely report. However these gave rise to issues of interoperability of disparate systems, which resulted in the production of reports of variable quality and timeliness. A seamless integration, where information can be exchanged and readily used, between Health Information Systems and the HIMS is therefore crucial.

Methodology The use of Health Informatics Standards is the building blocks to facilitate the implementation of an interoperable system. Steps were taken to ensure that these standards were chosen, developed and adopted in current Health Information Systems. A web-based Business Intelligence (BI) application such as Sistem Maklumat Rawatan Perubatan (SMRP) was developed based on the existing manual reports with a focus at a granular level to enable effective data mining and analysis. Integration between SMRP and HIS was tested. A benchmarking criteria for Interoperability and Health Information Systems was also developed through a consensus between relevant stakeholders to ensure proper implementation of Health Information Systems.

Results Promising results were demonstrated during the implementation of the recent HIS project. Currently, one hospital has achieved interoperability between HIS and SMRP.

Analysis The adherence to data definitions in the development of Health Information Systems with the involvement of the correct stakeholders have contributed to enabling interoperability.

Discussion Health informatics standards in particular the National Health Data Dictionary and proper adherence in data definitions is essential towards achieving interoperability. Data collected should be at a granular level to enable effective data mining and analysis.

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May 2011

SYM III (2) Ergonomics In Health Facilities

Dr. Abu Hasan bin Samad Medical Advisor & Country Occupational Health Manager ExxonMobil Subsidiaries in Malaysia

Health care facilities in both public and private sectors are no different from the other traditional workplaces. More than a quarter million workers in Malaysia are directly or indirectly involved in the health care services delivery. Various occupational hazards are present in the health care sectors including the traditional physical, chemical, biological, psychosocial and ergonomics hazards. Ergonomics hazard in particular is gradually becoming more important as we continue to use ICT (Information and Communication Technology) as the backbone of health care delivery at various levels throughout the country ranging from the small primary clinic in the rural area to the big tertiary hospital in the city. The long working hours and demanding duties around the clock are additional concerns. Furthermore there are still a number of manual activities being done by the health care personnel at the various levels of services in the different disciplines.

This paper will cover various aspects of ergonomics hazards including the office ergonomics and field ergonomics at the various health care settings. It will focus more on the importance of creating awareness among the health care personnel, prevention and early detection and treatment of ergonomics-related illnesses or injuries. The roles of individual employee, supervisor or manager in the implementation of ergonomics program will be emphasized. Various tools used in the implementation of a good ergonomics program and learnings from other successful program will also be shared.

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May 2011

SYM III (3) Sacking The Plastic

Mageswari Sangaralingam Research Officer Consumers’ Association of Penang

Plastics have become a bane in our society, causing environmental pollution and adverse health effects. We must reject this toxic substance that is problematic throughout its lifecycle, from production, use to disposal. This presentation will encompass an introduction to plastics, some common plastics and why we need to sack the plastic. All types of plastics are harmful in some way but this presentation will focus on sacking polystyrene, plastic bags and Polyvinyl Chloride (PVC) from healthcare. Several tips are given to avoid exposure to the toxins and sack plastics.

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May 2011

SYM IV (1) Outbreak / Risk Communication

Dr. Husnina bt. Ibrahim Public Health Specialist (Epidemiology) Senior Principal Assistant Director Disease Control Division Ministry of Health Malaysia

In the current response to pandemic (H1N1) 2009 influenza, Malaysia was able to build upon the communication strategy and activities which was conducted for avian influenza outbreak and pandemic preparedness. It is important to find a balance between working rapidly to implement the communication necessary for the response while also respecting the fundamentals of effective social and behavior change communication. In order to find this balance, it is useful to rely on existing resources as much as possible.

Communication objectives

For communication to be effective, especially at time of pandemic when there is uncertainty about how it will affect a country, key partners and stakeholders should reach consensus at the national level on the objectives of communication. This should happen before an outbreak occurs in the country. On generic level, these objectives include the following:

• Help to reduce transmission of disease • Mitigate health impact • Minimize panic and social disruption • Help Government provide credible information during response

Risk / outbreak Communication:

As there are many ideas and concepts on this issue, the term used basically for the communication between health and Government authorities and the population of a country in a pandemic situation before and in response to an outbreak in that country.

It is well documented that when Government and other stakeholders are transparent by providing timely and correct information to the population, their effort to reduce transmission and mitigate the impact of the pandemic are more successful.

Effective risk communication, however takes planning and capacity building which includes:

• Identifying and training of spokesperson from Government and other relevant stakeholders in

view of providing coordinated and consistent messaging. • Media training and continued orientation in order to have an informed and balanced reporting • During response, regular updates to the public from relevant stakeholders via mass media,

maintenance of quality websites and other information sources as well as monitoring for rumors and surveys.

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May 2011

SYM IV (2) Improving Patient Safety

Dr. Hajah Kalsom bt. Maskon Senior Deputy Director Medical Development Division Ministry of Health Malaysia

Patient safety is a public health issue. Patient safety is a fundamental principle of health care. “FIRST DO NO HARM”. In every point of care-giving contains a certain degree of inherent potential of adverse events which may result from problems in practice, products, procedures or systems. Patient safety improvements demand a complex system-wide effort, involving a wide range of actions in performance improvement, environmental safety and risk management, including infection control, safe use of medicines, equipment safety, safe clinical practice and safe environment of care.

Recognizing this, Malaysia health care, through the Patient Safety Council Malaysia has initiated a number of patient safety actions which aims to coordinate, disseminate and accelerate improvements in patient safety nationwide. Some of the initiatives are strengthening of clinical governance and the implementation the WHO World Alliance for Patient Safety Programmes, which include Clean Care Is Safer Care, Safer Surgery Through Better Communication, Reducing Antimicrobial Resistance, Research in Patient Safety and Reporting and Learning. There is a need of a concerted effort from all healthcare givers, patients as well as the community so as to ensure improvements in patient safety.

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May 2011

SYM IV (3) Occupational Risk In Healthcare

Prof. Dr. Rusli bin Nordin MBBS; MPH; PhD; FFOMI; FAOEMM; AM Professor of Public Health & Head Clinical School Johor Bahru Jeffrey Cheah School of Medicine and Health Sciences Monash University Sunway Campus

The healthcare environment, like any other workplaces, has its own sets of hazards and risks to the health of healthcare workers and patients. Managing occupational risk in healthcare depends on the collective responsibility of management (employer) and healthcare workers (employees) as well as the cooperation of patients.Safety and Health Committee has the responsibility to ensure that OSH activities are diligently observed and in compliance with the prevailing OSH laws, regulations, guidelines and approved industry codes of practices. Health risk assessment activities must be carried out when there are changes to the work processes or when new technologies and procedures are adopted. Health risk management is aimed at ensuring that the workplace is safe and that each healthcare worker is fit for work. Employee assistance program is an important component of the OSH program.

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May 2011

AP 1 Prevalence Of Patients With Chronic Pain And Its Associated Factors In Primary Care Attendees

Subashini; EM Khoo; Hanafi NS

Introduction Chronic pain is a major healthcare problem worldwide and a common reason for seeking health services in primary care.

Objective To determine the prevalence of chronic pain and factors associated with it.

Methods A cross-sectional quantitative study on randomly sampled patients aged 21 years and above attending

primary care clinic at the University Malaya Medical Center was conducted. Patients with diagnosed acute psychosis, dementia and mental retardation were excluded. Face to face interviews were done. Case screening questionnaires (self-administered) were used to identify patients with chronic pain, and demographic data and causes of chronic pain were collected.

Results 490 patients were approached and 465 consented (95% response rate). The prevalence of chronic pain was 54.8%. The prevalence was higher among Indians (63.6%), followed by Malays (54.0%) and Chinese (47.2%). Common causes of chronic pain include arthritis (22.4%), followed by limb pain (19.6%), back pain (16.9%) and headache (16.9%). There was significant association between chronic pain and ethnicity (x2=8.450, p=0.038), marital status (x2=6.974, p=0.031), education levels (x2=7.359, p=0.025) and co-morbidities such as stroke (x2=4.693, p=0.030), ischaemic heart disease (x2=6.279, p=0.012) and arthritis (x2=34.909, p<0.001). Multivariate analysis showed Indian ethnicity (OR=1.737, 95%CI: 1.141, 2.644) and patients with arthritis (OR=4.413, 95%CI: 2.635, 7.390) were predictive of chronic pain.

Conclusion Chronic pain is common in primary care attendees. Early identification of these patients can help in better chronic pain management.

Keywords: chronic pain, University Medical Center, age

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May 2011

AP 2 Factors Associated With Stress Among Primary Healthcare doctors, assistant medical officers and nurses In government Health Clinics In Kelantan, 2010

Asmah; Siti Raudzah Department of Community Medicine and Health Sciences, University Malaysia Sarawak, Kuching

Introduction Stress is experienced by everyone in their daily life including the healthcare providers.

Objective The main objective of this study was to determine the prevalence and its associated factors of stress among primary healthcare doctors, assistant medical officers and staff nurses at government health clinics in Kelantan.

Method This was a cross sectional study conducted from 1st June until 31st August 2010. Total of 248 respondents (responds rate 84.9%) were selected through stratified random sampling. The Malay version of the validated Depression, Anxiety and Stress Scale and Karasek’s Job Content Questionnaire were used as research instruments.

Results The prevalence of stress was 7.3% (95% CI 4.06, 10.54). The study among doctors showed that supervisor support (adj b = -0.74, 95% CI -0.98, -0.50, P <0.001) and hazardous condition (adj b = 0.86, 95% CI 0.58, 1.15, P <0.001) were significant associated factors for stress. For assistant medical officers, study revealed that co-worker support (adj b = -1.45, 95% CI -1.77, -1.12 P = 0.002), job insecurity (adj b= 0.89, 95% CI 0.61, 1.16, P <0.001) and supervisor support (adj b= 0.44, 95% CI 0.17, 0.71, P = 0.002) were the significant associated factors for stress. Whilst among nurses, study showed that duration of employment (adj b = 0.30, 95% CI 0.24, 0.36, P <0.001), number of children (adj b= -0.95, 95% CI -1.25,- 0.65 P<0.001), decision authority (adj b= -0.19, 95% CI -0.33, -0.06, P =0.005), psychological job demand (adj b= -0.33, 95% CI -0.44, -0.22, P <0.001), physical exertion (adj b= 2.81, 95% CI 1.78, 3.84, P <0.001) and job insecurity (adj b= 0.45, 95% CI 0.04, 0.87, P =0.033) were the significant associated factors for stress.

Conclusion Finding of this study may be useful for health promotion program of preventing stress among healthcare providers in the country.

Keywords: stress, primary healthcare workers, job content questionnaire, Kelantan

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May 2011

AP 3 The usage Of Material Safety Data Sheet Among Dental Personnel In Perak

Anna R ; Bibi Saerah; Siriander D; Law C H; Rohana K et al Perak Oral Health Division

Introduction

The MSDS is an important source of information for all health care workers while handling the concerned materials within their working environment. The aim of this study is to review and asses the present status of the usage and level of knowledge of MSDS among the dental personnel in the Oral Health Division of Perak.

Objective The objectives were to determine the present status of MSDS usage among Dental Personnel in the Oral Health Division of Perak, secondly to assess and compare the level of knowledge on MSDS usage and thirdly to determine the barriers for usage of MSDS.

Method This cross-sectional study involved a total of 244 Dental personnel randomly selected from the Oral Health Division of Perak. Self-administered questionnaire was used. Data were analyzed using SPSS version 15.0.

Results The mean (sd) knowledge score was 77.9% (9.15%). There were significant differences in the mean knowledge score between DO and DSA as well as between DN/DT and DSA. Highest proportion of DT (56.5%) reported that understanding of language was a barrier followed by DN (50.7%), DSA (44.4%) and DO (15.2%). This study also revealed that there is still poor usage of MSDS among more than half of all the categories of dental personnel.

Conclusion This study revealed that there is poor usage of MSDS among more than half of all the categories of dental personnel. Awareness training, filing and labeling system for easier retrieval of MSDS as well as the translation of important information into simple Malay language were recommended to make MSDS more user-friendly.

Keywords: Dental personnel, MSDS, usage

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May 2011

AP 4 Prevalence and Predictors Of Recent Respiratory Illness In The Malaysian Population

Paramesarvathy R; Gurpreet K; Amal NM; Tee GH Kuala Lumpur City Council, Institute for PH, Institute for Medical Research

Introduction Recent illness related to the respiratory system has been the leading cause of outpatient attendance in many countries. Recent respiratory illness in this study was defined by symptoms such as cough, cold, fever and difficulty in breathing reported in the last 14 days from the date of interview. Recent respiratory illness (RRI) imposes a big load on the burden of disease in Malaysia.

Objective The aim of the study was to determine the prevalence and predictors of recent respiratory illness in the Malaysian population.

Methods A cross-sectional population-based household survey, as part of the Third National Health and Morbidity Survey was conducted between April and August 2006 to obtain community-based data and information on the prevalence of RRI. Face to face interview was carried out to collect data on self- reported RRI over a two-week recall period.

Results A total of 55,660 respondents were interviewed with a response rate of 98.2%. The overall prevalence of recent respiratory illness was 42.0%. The highest reported RRI was significant among the 10–19 years age group (19.5%), females (52.6%), Malays (62.5%), those with secondary educational level (40.29%), those earning less than RM2000 per month (25.90%), among Malaysians (96.9%), those married (61.8%), housewives ( 21.8%) and urban dwellers (60.0%). Age, sex, ethnicity, marital status, citizenship, occupation, education and residence were significantly associated with RRI. In the multivariate analysis, only ethnicity and citizenship were significantly associated with RRI.

Conclusion The information obtained from this survey is useful to policy makers in the Ministry of Health to review and strengthen existing health programmes towards achieving the goal of Health for All by 2020.

Keywords: Recent respiratory illiness, outpatient, survey

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May 2011

AP 5 Knowledge, Attitude And Practices On Dengue Among Rural Communities In Rembau And Bukit Pelanduk, Negeri Sembilan, Malaysia

Tan KL Community Medicine Division, International Medical University

Objective World Health Organization declares dengue to be endemic in South East Asia. The aim of the study was to assess the level of knowledge, attitude and practice concerning dengue among rural communities in Negeri Sembilan.

Methodology A cross-sectional study involving 400 respondents from Rembau and Bukit Pelanduk, which represents a rural community, was conducted in August 2010. Data was collected by face-to-face interview using a structured questionnaire on knowledge, attitude and practice of dengue. All respondents aged 18 years and over were interviewed. Each question was analyzed individually. Knowledge, attitude and practice were assessed using a scoring system and grouped as ‘good’ or ‘poor’ based on an arbitrary cut-off point.

Results Majority of the respondents were females (58.0%), Malays (68.0%) and had secondary level education (59.5%). It was found that 58% of the community had good knowledge. Out of the 400 respondents, 88.5% cited that their main source of information on dengue was from television or radio. Over 80% of the community had good attitude and most of them were supportive of Aedes control measures. In the community, 76% had good practice with 84.3% of respondents practicing some form of preventive measures against mosquito bite.

Conclusion Television and radio are important means of conveying health messages to the public among rural population. More research and development of educational strategies designed to improve behaviour and practice of effective control measures among the rural community are recommended.

Keywords: dengue, knowledge, practice, rural population

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May 2011

AP 6 Screening For Pathogenic Leptospira From Water Samples At Pusat Latihan Khidmat Negara (Plkn) In Northern And Eastern Region Of Peninsular Malaysia

Hasanatunnur A; Norliziana MA; Roziah A; Zulhainan H; Naim AK Ipoh Public Health Laboratory (IPHL)

Introduction Recent local outbreaks of leptospirosis among athletes, military personnel and civilians have highlighted the importance of screening for pathogenic leptospira from water samples related to water recreational activities.

Objective Methods for detection of pathogenic leptospira in water samples specifically related to water recreational activities at all Pusat Latihan Khidmat Negara (PLKN) were established as one of the Ministry of Health (MOH) strategy based on the guidelines for diagnosis, management, prevention and control of leptospirosis in Malaysia.

Methods Two series of screening programmes were carried out in 2010, February-March 2010 (1st series) and June-August 2010 (2nd series). All water samples were collected accordingly, filtered and cultured into both EMJH and Fletcher media. Incubation of both media was carried out at 30°C in shaking incubator for 2 weeks. In the presence of any motile spirochete leptospira-like organism, cultured samples were subjected to DNA extraction followed by Polymerase chain reaction (PCR) to determine the presence of pathogenic leptospira.

Results In the first screening program, a total of 115 water samples were collected from 29 PLKNs. 21 samples (18%) from 13 PLKNs were found positive for pathogenic leptospira (10 PLKNs from northern region and 3 PLKNs from eastern region). Out of the 123 water samples collected from 30 PLKNs in the second screening program, 16 samples (13%) from 9 PLKNs were found positive for pathogenic leptospira (8 PLKNs from northern region and 1 PLKN from eastern region).

Conclusion The presence of pathogenic leptospira in facilities related to water activities at PLKNs may indicate and highlight the importance of maintaining all water related facilities in order to minimize any chances of leptospira infection. The authority must also strictly ensure that no activities are conducted if pathogenic leptospira are detected. This is to prevent any possibility of human infection by pathogenic leptospira.

Keywords: leptospira, water samples, PLKN

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May 2011

AP 7 Kejadian Wabak Hepatitis A Di Perkampungan Masyarakat orang Asli Pos Jernang, Sungkai, Perak

Faizal; Azizi MZ; Azim RH Pejabat Kesihatan Daerah Batang Padang, Perak

Pengenalan Hepatitis A merupakan salah satu penyakit bawaan air dan makanan yang disebabkan oleh Virus Hepatitis A (HAV). Pada umumnya penyakit ini adalah berlaku di negara-negara yang sedang membangun di mana tahap kebersihan dan sanitasi adalah rendah. Wabak ini telah berlaku di Pos Jernang, Sungkai, Perak pada 24 Ogos hingga 26 Disember 2010.

Objektif Untuk mengenalpasti punca jangkitan HAV dan cadangan langkah kawalan dan pencegahan yang perlu

dilakukan dalam membendung wabak.

Metodologi Kajian wabak secara retrospektif telah dijalankan dengan mengenalpasti punca jangkitan dan menilai aspek-aspek persekitaran dan tingkahlaku yang mendorong berlakunya wabak ini. Analisa menggunakan program Microsoft Office Excel 2007 secara diskriptif statistik melalui format line listing Kementerian Kesihatan Malaysia.

Keputusan Sejumlah 6 kanak-kanak masyarakat asli telah dijangkiti HAV iaitu 3 lelaki dan 3 perempuan dengan bilangan orang terdedah seramai 950 menjadikan kadar serangan 0.6%. Bilangan kes mengikut kumpulan umur adalah 4 (66.7%) bagi 1 hingga 7 tahun, manakala 2 (33.3%) bagi 7 hingga 13 tahun. Bilangan kes mengikut gejala adalah cirit birit 6 (100%), demam 6 (100%), Jaundis 6 (100%) dan ‘Dark urine’ 6(100 %). Keluk Epidemik menunjukkan ’Propagated source’. Punca jangkitan adalah daripada persekitaran yang tidak bersih di mana tabiat membuang air besar (najis) di merata tempat, tempat permainan kanak-kanak juga didapati berdekatan dengan air limbah yang tidak terurus dengan baik dan dicemari dengan najis.

Kesimpulan Punca penyakit ini di sebabkan oleh pencemaran daripada tanah/tempat permainan (persekitaran) secara fecal-oral. Kawalan telah dibuat dan berjaya membendung jangkitan daripada terus merebak. Pencegahan dan kawalan seperti menjaga kebersihan diri, teknik membasuh tangan yang betul dan makan makanan yang bersih (tidak tercemar) adalah kunci kepada kesihatan.

Katakunci: Hepatitis A, Punca Jangkitan, Pencegahan dan Kawalan

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May 2011

AP 8 Penilaian Keberkesanan Punjut Temephos 500 E Dalam Tangki Septik Individu

Aslinda UAB; Mahani Y; Mohd NS; Noor RM; Hairul I Kinta HD, Perak Health Department

Pengenalan Tangki septik individu didapati kondusif bagi pembiakan vektor denggi dan merupakan penyebab utama kejadian wabak di negeri Perak. Bagi mengawal pembiakan Aedes dalam tangki septik, punjut Temephos 500 E telah mula digunakan secara meluas di negeri Perak mulai tahun 2008, walaubagaimanapun beberapa aduan penduduk mengatakan masih terdapat banyak nyamuk di persekitaran rumah mereka.

Objektif Menilai keberkesanan punjut Temephos 500E dalam tangki septik yang dirawat dalam tempoh 6 bulan.

Kaedah Sebanyak 80 tangki septik diperiksa, 46 didapati sesuai untuk pembiakan nyamuk di Kg. baru Batu 10, Chemor. Semua tangki septik yang berpotensi dibahagikan kepada empat kumpulan iaitu 13 tangki dirawat dengan 4 punjut, 13 dirawat dengan 3 punjut, 10 dirawat dengan 2 punjut, 10 tangki septik tidak dirawat dan bertindak sebagai kawalan. Pensampelan larva di lapangan, kajian biosai di makmal, sukatan pH air telah dijalankan pada setiap minggu selama 3 bulan.

Keputusan Kajian awal sebelum rawatan punjut Temephos 500E dimulakan, mendapati spesies nyamuk dalam tangki septik didominasi oleh Amigeres spp. (70-80%), Culex spp. (15-20%) dan Aedes albopictus (5-10%). Hasil kajian mendapati dalam tempoh 3 bulan, tiada larva nyamuk dikesan dalam tangki septik yang diletakkan 4 punjut temephos 500E , sebanyak 25% tangki septik yang dirawat dengan 3 punjut positif pembiakan Amigeres spp. dan Culex spp. bermula pada minggu keduabelas. Manakala 63% tangki septik yang dirawat dengan 2 punjut, positif pembiakan Amigeres spp. dan Culex spp. bermula pada minggu kelima. Tangki septic yang tidak rawat, 100% didapati positif sejak minggu pertama.

Rumusan Tiada pembiakan Aedes untuk keseluruhan tangki septik yang dirawat sehingga 3 bulan. Kajian bioasai juga mendapati kadar mortaliti larva Aedes albopictus adalah 100% dalam tempoh 24 jam bagi semua tangki septik yang dirawat.

Katakunci: Aedes, Culex, Armigeres, tangki septik, denggi, temephos 500E

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May 2011

AP 9 A Study On Emergency Care Services And Equipment In Healthcare Facilities

Ch’ng ML; Benedict CTW; Amy CAL; Dang SB; Razin Mahir Hospital Raja Permaisuri Bainun, Ipoh; Perak State Health Department; Ministry of Health, Putrajaya, Malaysia

Introduction The importance of emergency care services and availability of equipment in healthcare facilities can never be understated. Their availability is crucial to reduce morbidity and save lives.

Objectives To study the availability of basic emergency care services and equipment in private healthcare facilities and the types of basic emergency care equipment made available.

Materials And Methods This is a cross-sectional study carried out involving 485 private healthcare facilities at various locations in the 9 districts in the State of Perak.

Results The results show that out of the 485 private healthcare facilities studied, 78.4% of the total number of private healthcare facilities had a low score. The remaining 21.6% of the total number of private healthcare facilities studied had a high score. The results also show a statistically significant difference (p< 0.05) between various types of private healthcare facilities with regards to the availability of basic emergency care services and equipment.

Conclusions Different types of private healthcare facilities have been found to fare significantly different when it comes to their providing of basic emergency care services and equipment. Only about a quarter of private healthcare facilities scored high. The majority i.e. about three-quarters of private healthcare facilities scored poorly.

Recommendations It is strongly recommended that equipment should be made available in healthcare facilities as they are essential to reduce morbidity and save lives. Not only should these equipment be made available but they should also be properly maintained and at optimal working conditions.

Keywords: emergency care services, equipment, private healthcare facilities

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May 2011

PP 1 External Quality assessment For Direct Sputum Smear Microscopy For Acid Fast Bacilli In The State Of Perak

Lim JM; Tan KL; Murugan K; Akma I; Suhaila AR et al Ipoh Public Health Laboratory (IPHL); TB / Leprosy Control Unit, Perak

Introduction EQA identifies inappropriate procedures, out-of-date reagents, uncontrolled instrumentation, and /or training needs of incompetent or untrained staff.

Objective Considering the importance of EQA, we evaluated the performance of AFB sputum smear microscopy carried out in 2010 for State of Perak, Malaysia.

Methods A total of 9,587 AFB slides were collected based on statistically valid sampling procedure - Lot Quality Assurance Sampling (LQAS) from 81,744 AFB sputum smears prepared in 86 microscopic centres in the year 2010. EQA was carried out as described in the External Quality Assessment for AFB Smear Microscopy Manual (EQA-IUATLD/WHO).

Results Overall, a total of 9,574 or 99.87% of AFB slides analyzed were in good agreement and only 13 slides (0.13%) were considered as false reading, of which 2 slides (0.02%) were considered as false positive reading, while another 11 slides (0.11%) were false negative. Assessment on general quality, cleanliness and proper staining of AFB slides showed an average of > 75% of the slides were prepared accordingly. In addition, the quality of smear size, evenness and thickness of AFB sputum smear prepared, showed an average of < 55% in quality.

Conclusion The overall performance of direct smear sputum microscopic examinations in the peripheral laboratories of the State of Perak was satisfactory. However, the low percentage of quality for smear size, evenness and thickness of AFB smear prepared must be overcome in great efforts. A proper and regular on-the-job training of staffs at the peripheral laboratory coupled with supportive supervision by Ipoh Public Health Laboratory would greatly help to improve the DSSM performance.

Keywords: EQA, agreement, false reading, AFB smear

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May 2011

PP 2 Fluoride In Drinking Water And Dental Fluorosis Among Malay Schoolchildren In Kampung baharu Lanjut, Sepang, Selangor: A Preliminary Study

Shaharuddin MS; Nurul Faiza OB Department of Community Health, Universiti Putra Malaysia

Objective A study was conducted in November, 2010 to assess dental fluorosis occurrence and its relationship with fluoride in both drinking water and urine among 69 Malay schoolchildren aged 12-years-old, studying in a primary school at Kampung Baharu Lanjut in Sepang, Selangor.

Methodology Both drinking water and urine samples were collected and analysed using a direct reading spectrophotometer based on the SPADNS method. Samples were collected for two consecutive days and then cooled to 4oC before being transported to the laboratory for analysis. EDTA was used to preserve urine samples.

Results From the 69 respondents, 40 (58%) were males and 29 (42%) were females. Fluoride levels in drinking water ranged from 0.27 to 0.70 mg/L with a mean of 0.521 + SD 0.1004 mg/L, while urinary fluoride levels ranged from 0.36 to 2.70 mg/L, with a mean of 1.818 + SD 0.466 mg/L. Prevalence of dental fluorosis was 53.6% (37 respondents), with a minimum score of 1 to a maximum score of 4. Mean score was 0.824. Most (42%) respondents with dental fluorosis had a score of 1. Dental fluorosis occurred more in females (51.4%) than in males (48.6%). There was no significant difference in score of fluorosis between males and females (p>0.05). There was no relationship between score of fluorosis with fluoride in both drinking water and urine (p>0.05).

Conclusion Fluoride levels in drinking water and urine were within the standard set by the relevant authorities, while dental fluorosis in the study population was very mild.

Keywords: fluoride, dental fluorosis, Malay schoolchildren, drinking water, urine

29



May 2011

PP 3 First documented Case of Q Fever In malaysia InThe

21st Century – Epidemiology And Investigations

Bina Rai; Fadzilah K; Chow TS; Chee KY Penang State Health Department

Introduction Q fever, caused by Coxiella Burnetti has never been routinely screened among livestock in Malaysia. In April 2007, a private doctor managing a goat farm in Penang developed fever of 2 weeks duration. He presented with history of handling the abortus of goats and was admitted for investigation of fever of unknown origin. He was notified as suspected brucellosis but was later confirmed as Q fever

Objective An investigation was initiated to find more cases, early treatment and prevent the chain of transmission.

Methods This is a descriptive study. Epidemiological investigations included a site visit to the farm. An interview of patients, farm workers, family members and veterinary staff was done. Laboratory investigations were carried out. The State veterinary department investigated the animals. The veterinary workers in the State and farm workers were screened for Q fever.

Results The goat farm had about 100 goats including imported goats. All the people interviewed were asymptomatic. Patients interviewed were tested positive for IgM and IgG for Q fever. 25.4% of goats tested had antibody positive for Q fever and were treated. Out of 54 people screened, 19 were IgM positive (7 both IgG and IgM positive) and 2 IgG positive only. All are under regular follow-up. The doctor recovered completely.

Conclusion It is now compulsory for livestock from endemic countries to be screened for Q fever. Veterinary staff are also advised to use adequate protective gear while handling livestock. This is a first documented case of Q fever in Malaysia. The source is likely to be from imported goats.

Keywords: Q fever, goat farm, livestock

30



May 2011

PP 4 Outbreak Of Influenza Like Illness In Schools In Perak

Tengah District (From January - February 2011)

Adliah MS; Ariza AR Perak Tengah Health Office, Bandar Seri Iskandar, Perak

Introduction Influenza A (H1N1) infection had become a major public health problem in Malaysia after World Health Organization announced pandemic Influenza A (H1N1) which started in Mexico April 2009.

Objective The aim of the study is to describe the situation of Influenza like Illness (ILI) infection in the district from 1 January 2011 until 28 February 2011.

Methods This study is a cross sectional study from secondary data that was obtained from all cases registered with the Perak Tengah Health District. Secondary data collection was obtained from a registry of cases fulfilling criteria of Influenza-Like Illness (ILI) that was compiled from Crisis and Preparedness Response Centre (CPRC) Perak Tengah District Health Office from 1 January 2011 until 28 February 2011. A total of 163 cases were selected and SPSS version 11.5 software was used for data entry and analysis.

Results Results showed that median age of the participants is 14 years (IQR: 13-15), and the highest percentage was in the age group of 14-18 years. Most of the participants are Malays (98.2%). Prevalence of symptoms of ILI was 23.9% and from 24 throat swab sample sent and analyzed for laboratory confirmation, 14 (58.3%) were positive. Bivariet analysis showed that there were no association between age, gender and staying in the hostel with ILI incident.

Conclusion Our findings support the previous study that influenza A (H1N1) virus predominantly affects younger population age group. Prevalence of infection is high in school going group (14 – 18 years). This group of youths are highly exposed in the population and may pose as the source of transmission to the community. There is a need for the Ministry of Health to consider giving vaccination for school children to control the spread of the disease.

Keywords: Outbreak in schools, Influenza like illness, cross-sectional study

31



May 2011

PP 5 Is Crash Dieting A Concern Among Female Students In A Malaysian Private University?

Sabernero I; Gurpreet K Faculty of Health & Life Science, Management & Science University, Institute for Pulic Health

Introduction Crash dieting is a diet practice that cuts back on the amount of calories and fats that a person consumes daily. It is recognized by health care professionals as a dangerous way to lose weight.

Objective The main objective of the study was to determine dietary practices among female students in a local private university in relation to weight lost desire.

Methodology The study was cross sectional in design. A hundred questionnaires were distributed randomly among female students in the university. Those who were pregnant or suffering from diabetes, hypertension or other metabolic disorders were excluded. Verbal consent was obtained from potential respondents before answering a self-administered questionnaire in English. Data was collected from July-August 2010 and analyzed using SPSS version 17.

Results The response rate was 99%. Majority of respondents were Malay (72.7%), non-smokers (86.9%) and had a Body Mass Index (BMI) between 18.5-22.9 kg/m2 (59.6%). The mean age and BMI were 22.5 years and 22.2 kg/m2 respectively. Majority reported to practicing crash diets (41.6%), skipping meals occasionally (61.4%) and exercising 3 times or less per week (82.2%). At every BMI category, majority admitted to wanting to lose 5-10 kgs in weight in the next few months.

Conclusion Crash dieting was found to be a common practice among majority of the females in this institution. This raises concern, as regular practice can have detrimental physical and mental consequences. The implications are significant especially when the respondents are highly educated women who will become future leaders, career women and mothers.

Keywords: Crash dieting; female students

32



May 2011

PP 6 Health Seeking Behaviour Towards Communicable Diseases Among Foreign Workers In Industiral And Agriculture Sector In Selected Districts In Perak

Noor Asmah; Koh K; Ong KG; Wan Asmuni; Asmah ZA

Objective The objective of the study is to determine the health seeking behavior towards communicable diseases among foreign workers in the industrial and agriculture sectors in Perak.

Methodology A cross sectional community survey was done to look at health seeking behaviour towards communicable diseases among foreign workers in the agriculture and industrial sectors from Perak, Malaysia. Two staged random stratified sampling method was conducted to ensure that all relevant sectors and ethnic groups were included. The study gathered information through interviews and self administrated using a standardized, pre-tested questionnaire.

Results 710 foreign workers were interviewed. A total of 338 (47.9%) workers were from agricultural sector and 372 (52.4%) were from industrial sector. Most respondents were legal workers (90.3%), and only 9.7 % (69) were illegal. Seventy respondents (9.85%) had experienced serious illnesses and another 209 respondents (29.4%) had experienced mild illnesses. For those who had experienced serious illnesses, 68 out of 70 (97.14%) respondents sought medical treatment as compared to only 172 out of 209 (82.3%) for respondents with mild illnesses. In response to 4 clinical scenarios (PTB, Malaria, Cholera and Typhoid symptoms), they would seek appropriate healthcare.

Conclusion This study shows that foreign workers do not seem to have problems in seeking health care. Access to health care is a problem in the plantation sector in term of geographical location. Both legal and illegal foreign workers appear to understand serious illness and take appropriate action accordingly. Therefore, there is a need to improve access to health care for plantation workers.

Keywords: Health seeking behavior, foreign workers, illness

33



May 2011

PP 7 Prevalence Of Hearing Impairment And Carpal Tunnel Syndrome In Grass Cutters Of Bakas Unit Batang Padang District Health Office

Azim RH; Aman S Batang Padang District Health Office, Occupational Health Clinic Tanjong Malim

Introduction Grass-cutting activity by using shoulder-mounted grass-cutting machine exposes an individual to physical hazards i.e. noise and vibration. Noise is unwanted sound. Vibration is mechanical oscillations about an equilibrium point. Hearing impairment (HI) is when the capability of hearing threshold is above 25dB at any frequency. Carpal tunnel syndrome (CTS) is the situation when the median nerve is compressed within the carpal tunnel and causes the signs and symptoms.

Objective The aim of this study was to determine the prevalence of HI and CTS in grass cutters of the BAKAS Unit in Batang Padang District Health Office.

Methodology A cross sectional study was carried out at Batang Padang District Health Office, from November till December 2010. Prevalence of HI and CTS secondary to vibration was identified in grass cutters. Hearing was assessed by audiometric test, done by trained operators. Exposure to CTS was assessed by worker’s responses on self-administered questionnaire. CTS status was confirmed by history, that was suggestive of the syndrome and provocative test was performed by an occupational health physician. Data was analyzed by using Microsoft Office Excel 2007 in descriptive statistics.

Results A total of 19 male grass cutters from BAKAS Unit participated in the study. The mean age was 41.2 years old, weight was 71.5 kg and height was 163.3 cm. The percentage of smokers was 47.4% and those having medical problems were 15.8%. Workers with hearing impairment were 12 (63.2%), out of which 4 (33.3%) were having noise-induced hearing loss, where else CTS was present in 1 (5.3%).

Conclusion The prevalence of HI in grass cutters was high, indicating high morbidity due to noise where else CTS was low, indicating low morbidity due to vibration in this occupation. The need for use of ear-protecting device is mandatory and periodical medical surveillance is advised. Health programmes especially health education and promotion should be delivered to the workers in view of their risk in developing hearing problems and the importance of wearing personal protective equipment.

Keywords: Grass cutters, Hearing impairment, Carpal tunnel syndrome, Prevalence

34



May 2011

PP 8 Unhygenic Food Practises - Students Suffer

Hasniza A; Fauziah M N; Zulkifli H; Roziyana I; Halzeri Z et al Bachok District Health Office, Kelantan

Introduction Occurrence of food poisoning is notifiable under schedule 6 of the Communicable Disease Control Act 1988. Bachok District Health Office received a notification of suspected food poisoning on the 11th January involving a group of students after eating at a hostel at SK Kandis, Bachok, Kelantan.

Objective An investigation was undertaken to determine source of outbreak, identify the causative agents and recommend control measures.

Methodolgy Cases were those who ate at the hostel between 9 to 11, January 2011 and developed an acute onset of abdominal pain and diarrhea. Activities were carried out to determine more cases. HACCP inspection was carried out which included testing the water supply for coliform.

Results It was a common source outbreak with an attack rate of 10.9% involving all the female students aged 12 years who stayed at the hostel. There was no reported similar cases from the other students. The incubation period ranged from 45 minutes to 3 hours and the implicated food was “kuih buah melaka”. Cohort study revealed RR for “kuih buah melaka” was 1.77 (1.24 < RR < 2.53). HACCP inspection showed several violations; contamination of raw materials, holding time of more than 4 hours, cross- contamination of water supply, improper food storage, unsanitary premise and unhygienic food handlers. Raw food such raw coconut and coconut milk were contaminated with coagulase positive staphylococci. Food handlers were positive for coagulase positive Stapylococci. Rating of food premise under Food Act, 1983 was 83.5%. The hostel kitchen was closed under the CDC act 1988.

Conclusion Unhygienic food practices observed at the hostel kitchen had lead to the outbreak of food poisoning among the students.

Keywords: food poisoning, coagulase positive Staphyloocci, Bachok District health Office, SK Kandis

35



May 2011

PP 9 Keberkesanan Modul Pendidikan Diabetes Terhadap Pesakit Diabetes Di Klinik Kesihatan Taiping

Bazariah Y; Amutha B; Sumathi M; Roziahwati A; Zuwariah AT et al

Tujuan Meningkatkan tahap pengetahuan pesakit diabetes mengunakan modul pendidikan diabetes yang standard di Klinik kesihatan Taiping

Methodologi Kajian ini dijalankan melibatkan 2 kumpulan. Kumpulan pertama terdiri dari 30 responden “control group” iaitu pesakit yang mendapat rawatan susulan sementara kumpulan kedua merupakan 30 responden “study group “ dimana pesakit yang mendapat rawatan susulan serta diberikan intervensi pendidikan kesihatan menggunakan Modul Pendidikan Diabetes. Tahap pengetahuan kumpulan responden dinilai mengunakan soal selidik yang terdiri dari 20 soalan, merangkumi 4 modul pendidikan diabetes. Pada “control group”. responden perlu menjawab “pre test” sahaja, manakala “study group” perlu menjawab “pre – test” dan mengikuti kelas pendidikan diabetes dan seterusnya menjawab “post – test”.

Keputusan

Hasil kajian mendapati tahap pengetahuan “control group” adalah sebanyak 16.7% (5 responden) yang capai kriteria lulus, manakala “study group” menunjukkan pre – test 6 pesakit (20%) lulus. “Post – test” menunjukkan peningkatan iaitu 19 orang pesakit 63.33%) lulus.

Rumusan Hasil kajian mendapati Pendidikan kesihatan mengunakan Modul diabetes dapat meningkatkan tahap pengetahuan pesakit.

Katakunci : pesakit diabetes, modul pendidikan diabetes

36



May 2011

PP 10 Evaluation Of Prescribing Patterns And Cost Associated With The Use Of Antihypertensive Agents At Klinik Kesihatan Bagan Serai

Nurhani MA; Toh MJ Pharmacy Unit, District Health Office Kerian.

Objective The current study was designed to evaluate pattern of hypertensive agents prescribed and to investigate drug utilization and the pharmaco-economics of hypertension in the government health clinic.

Methods A descriptive, cross-sectional and retrospective analysis of prescriptions received by the Pharmacy Unit, KK Bagan Serai was conducted. Prescriptions received in a month were screened and data collected from all prescriptions which met the inclusion criteria.

Results A total of 3,249 prescriptions were screened and 662 of the prescriptions met the inclusion criteria, meanwhile 2,587 prescriptions were excluded. The rate of prevalence of hypertension is higher in women (58.3%) than men (47%). The race with the highest prevalence was in Malays (61.5%), Chinese (19.6%) and Indians (18.9%). Meanwhile, the age of hypertension patients ranged from 26 to 92 years old with mean age 59 years old. The evaluation of prescribing patterns show beta-adrenoceptor- blocking agents (25.1%), thiazides diuretic (22.9%), calcium channel blocker (21.4%) and angiotensin- converting enzyme inhibitors (21.1%%) were the most popular antihypertensive drugs used. 55.4% of the patients were treated with combination therapy and 44.6% treated with monotherapy. Combination of two-drug was the most commonly used (37.8%), followed by three-drug combination (13.3%) and four-drug combination (4.4%). About 58.2% of the prescriptions had at least one brand-name drug and 78.1% prescriptions were written with at least one drug in short form. Estimated monthly cost (direct medication cost) of hypertension treatment was approximately RM 9,321.92, estimated annual cost was approximately RM 111,862.99 and average cost for each hypertension patient was RM14.08. In KK Bagan Serai, 25.33% of total drugs expenditure in 2010 were spent on antihypertensive agents.

Conclusion In conclusion, the prevalence of hypertension is KK Bagan Serai was different in terms of age, gender and race. The pattern of antihypertensive drug prescribed depends on co-morbidities and guidelines for treating patients with antihypertensive agents. The cost of treatment for hypertension could describe partly the drug utilization and expenditure on drugs by PKD Kerian.

Keyword: Hypertensive agents, prescriptions cost

37



May 2011

PP 11 Tuberculosis In The District Of Larut Matang And Selama, Perak, Malaysia

Syed MP LMS District Health Office

Introduction Next to dengue fever, tuberculosis (TB)causes the highest morbidity in Malaysia. The incidence rate is approximately 65 per 100,000 population. Larut, Matang and Selama (LMS) is a district in Perak, Malaysia where the incidence of TB is high (59.7-60.8/100,000) compared to the overall incidence in the State of Perak (50.7-52.3/100,000). A review was carried out to describe the trend of TB, the epidemiology and its management in the district between 2006 to 2008 with the aim to better control TB in the district

Methods A cross sectional descriptive study was done by reviewing data in the TB registry (TBIS) and returns from the TB program. Data were retrieved from notification forms upon diagnosis, treatment data in patient’s treatment folder, investigation of cases notes, lab data with regards to TB and investigation of TB death data. These data were analyze using SPSS version 14

Results There were 1842 TB cases reported between 2006 and 2008 with an incidence of 60.1, 59.7 and 59.4 per 100,000 population respectively. The incidence of TB among males was twice as high. The highest incidence was among the Chinese (103-111/100,000 population), followed by Indians (70.5-76/100,000 population) and the Malays (59.0-66.3/ 100,000 population). The incidence of TB was found to increase with age. There is variation in the incidence of TB in the sub districts with some areas having higher incidence through out the three year period.

77- 89% of the TB cases were of pulmonary type with nearly a quarter having moderate lung lesions. Co infection with HIV was minimal. Sputum conversion rate was more than 85% and cure rate more than 93%. Contract tracing did not reach the target of at least four contacts per case. Outpatient screening did not reach the 3% target.

Conclusions Incidence of TB was high among the Chinese, older age group and certain sub districts. We have now taken measures to focus on this . Efforts have also been taken to improve contact tracing and screening of outpatients.

Keywords: Tuberculosis, sputum conversion rate, cure rate, lung lesion

38



May 2011

PP 12 Penggunaan Aplikasi Eletronik Dalam Penyediaan Kertas Siasatan di Unit Inspektorat Dan Perundangan, Pejabat Kesihatan Daerah Kinta

Nurulhisham S; Shahrul AD; Tajudin H; Samad M; Asroyadi HA et al Unit Inspektorat & Perundangan PK D Kinta; UIP JKNP

Pengenalan Daerah Kinta merupakan sebuah daerah yang tinggi jumlah pembiakan nyamuk aedes yang dijumpai iaitu purata bagi tahun 2005 hingga 2009 sebanyak 716 pembiakan. Semua pembiakan dijumpai diambil tindakan perundangan iaitu dikompaun. Sebanyak 60% (450) daripada kompaun tidak dibayar dan perlu dibuka kertas siasatan bagi kes didakwa di mahkamah.

Objektif Aplikasi ini dihasilkan untuk mencapai objektif berikut iaitu, memastikan semua kesalahan di bawah Undang-Undang Kesihatan Awam diambil tindakan perundangan, tindakan perundangan diambil dalam masa yang ditetapkan, dan mewujudkan pengkalan data yang bersistematik dan mesra pengguna.

Metodologi Aplikasi diasaskan melalui dua komponen iatu peranti keras (hardware) menggunakan satu set komputer bersama-sama mesin cetak dan komponen kedua ialah perisian (software) minima Microsoft Office 2003. Terdapat 11 dokumen yang perlu disediakan bagi setiap kertas siasatan.

Keputusan Hasil daripada transformasi aplikasi KS e ini, tugasan berjaya disempurnakan dalam masa yang singkat iaitu kurang dari sepuluh minit bagi setiap kertas siasatan berbanding 120 minit sebelum ini. Selain daripada itu, aplikasi ini juga berjaya mewujudkan pengkalan data yang sistematik dan kemaskini serta mudah akses. Aplikasi ini sedang digunakan dalam penyediaan kertas siasatan bagi kes-kes Akta Pemusnahan Serangga Pembawa Penyakit 1975 dan Peraturan-Peraturan Kawalan Hasil Tembakau 2004. Usaha sedang dilakukan bagi meningkatkan keupayaan aplikasi dalam menyediakan kertas siasatan kes di bawah Akta Makanan 1983.

Kesimpulan Kesimpulannya, aplikasi ini telah membantu pegawai di Unit Inspektorat & Perundangan (UIP) Pejabat Kesihatan Daerah Kinta dalam menyelesaikan tugasan dengan berkesan, kemas, tepat, cepat, dan bermutu. Aplikasi ini juga sesuai untuk digunakan oleh semua daerah di Negeri Perak.

Katakunci : Unit Inspektorat dan Perundangan, Kertas Siasatan, Undang-Undang Kesihatan Awam

39



May 2011

PP 13 Gestational Diabetes Mellitus (GDM)

Sumathi M; Rosni W; Malliga S

Introduction Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. According to the American Diabetes Association, approximately 3-8% of pregnant mothers are diagnosed with GDM annually and 50-60% of women with GDM will develop Type 2 Diabetes (T2DM) in 10 years time. Following up these patients is important for preventing adverse outcomes. The Gestational Diabetes Mellitus (GDM) Register was established in Larut Matang and Selama in January 2008 in response to the lack of a systematic, centralised long term follow up of women who have had GDM.

Aim The purpose of the GDM Registry is to follow up these women annually to ensure continuous monitoring and to remind them that them that they should have their diabetes status checked because they are at increased risk of developing type 2 diabetes. In addition the registry complements the pre pregnancy care to prepare them for the next pregnancy.

Methodology A cross sectional study was carried out in all 12 clinics in LMS. All women diagnosed as GDM from 2008 are followed up at six weeks post partum and annually using the registry.

Results In 2008 a total of 508 women were diagnosed as GDM of which 69.5 % (353) came at six weeks postpartum to screen for diabetes. At six weeks postpartum 5.7 % (20) were diagnosed as Type 2 diabetes. In 2009 and only 130 (26.6%) came for the annual follow up of 1.5% (2) were diagnosed as Type 2 Diabetes. In 2010, 61 (12%) came for their second annual follow up of which 1 (1.6%) was diagnosed as type 2 diabetes.

Conclusions The GDM Registry is effective in providing a baseline data on the number of women diagnosed with GDM. The Registry helps us identify retention of women over the first six weeks and annually. With the registry, Type 2 diabetics are diagnosed and managed early. The drop out rate in LMS was found to be high hence a recall system has been introduced to remind them about their screening.

Keywords: GDM, registry

40



May 2011

PP 14 Field Study On Dermatitis Caused By The Beetle Paederus Fuscipes (Rove Beetle) Amongst School Children And Teachers In Tunku Abdul Rahman (Star) School, Ipoh

Izzati K; Ili DS; Mahani Y; Noor RM Kuala Kangsar HD, Batang Padang HD, Perak Health Deapartment

Introduction Paederus dermatitis is a perculiar irritant contact dermatitis characterised by erythemato-bullous lesions of sudden onset on exposed areas of the body. This disease was reported amongst students and teachers from Tunku Abdul Rahman School (SMART) Ipoh.

Objective The objective of the study was to identify the causative agent, to determine the most attractive places,

and to recommend preventive measures.

Method Students and teachers were examined and interviewed to detect the area of infestation. Samples of bugs found were collected and identified.

Results A total of 7 students and 3 teachers had symptoms of dermatitis. Paederus fuscipes were found highly concentrated (25-30 bugs) on the walls and ceiling of the hostel toilets during the day. From observation, aged structure of the school building like wood frame doors and windows, poor ventilation of toilets that were dilapidated and always in a moist state, due to rain and frequent use of water in the toilet are suitable breeding sites for these beetles. Boarding the ventilation panes, use of insecticide residual spray and ULV at night were successfully implemented to control the beetles.

Conclusion: Rove beetle can cause an outbreak of bizarre dermatitis, diagnosis of blistering beetle dermatitis should be kept in mind. Timely diagnosis, epidemiological investigation and insecticide spraying bring down the incidence of new cases.

Keywords: Rove beetle, Paederus fuscipes, dermatitis

41



May 2011

PP 15 Species Composition, Density And Biting Activity Of

Anopheles Spp. From Two Locations In Perak

Mahani Y; Aslinda UAB; Nor SI; Izzati K; Noor RM et al Perak Health Department, Kinta HD, LMS HD, Kuala Kangsar HD, Batang Padang HD

Introduction Malaria is still a public health problem especially among arborigines living near the Titiwangsa Range in Perak. It is essential to collect data from several areas within the region due to the microepidemiological nature of malarious areas where settlements within close proximity can vary dramatically in transmission dynamics (Greenwood 1989).

Objective To observe species composition, density and biting activities of Anopheles species.

Method Collections of antrophilic Anopheles spp. were conducted monthly at Kg. Terhem, Kuala Kangsar and Kg. Sahom, Kampar from June 2009 to December 2010. Control activities were done regularly in Kg. Terhem whereas in Kg. Sahom, control activities were done only when a case was reported. Both areas are located inland at the foothills of the Titiwangsa Range and the distance between these areas is 51 km.

Results An. maculatus (90% - 96%) which is the primary vector for malaria was the most abundant species throughout the year followed by An. barbirotris (4% - 7%) at both area. An. hycanus (2%) and An. kochi (1%) were found only in Kg. Terhem. The highest peak of An. maculatus collected in Terhem was bimodal (October 2009 & May 2010) while in Sahom, An. maculatus distribution showed the highest trend in October for both years(2009 & 2010). Human bait landing collections outdoor showed biting of An. maculatus for both location occurred almost the same period at 20.00 - 22.00 hours. Outdoor biting of An. barbirotris were also observed throughout the night with several peaks after the second half of the night.

Conclusion These findings showed that despite regular contol activities done in Terhem, Kuala Kangsar the density of malaria vector is still high compared to Sahom, Kampar. Thus, regular vector control activities and health education to the community should be in place without failure in Kg. Terhem, Kuala Kangsar.

Keywords: Malaria, Anopheles maculatus, Anopheles barbirostris

42



May 2011

PP 16 Penyertaan Optimum Masyarakat Melalui Penglibatan Panel Penasihat Klinik Kesihatan

Othman BW; Jamal NS; Mohd Fauzi AB; Roslan H Pejabat Kesihatan WP Putrajaya; Klinik Kesihatan Putrajaya Presint 9 Putrajaya.

Pengenalan Panel Penasihat Klinik Kesihatan (PPKK) ditubuhkan untuk berperanan sebagai penghubung dengan mendekatkan klinik kesihatan kepada masyarakat. Selaras dengan mandat tersebut, PPKK di KK Putrajaya Presint 9 telah melaksanakan pelbagai aktiviti dalam masyarakat, antaranya penyertaan proaktif dalam sambutan Hari Jantung Sedunia 2010 (HJ 2010).

Objektif Sambutan HJ 2010 bertujuan mempromosi kepentingan amalan Gaya Hidup Sihat sebagai pencegahan penyakit jantung koronari. PPKK mengambil bahagian aktif menjayakan sambutan anjuran Pejabat Kesihatan WP Putrajaya kerana bebanan kedatangan klinik untuk rawatan darah tinggi dan diabetes terus meningkat, menandakan pencegahan di peringkat individu dan masyarakat adalah kritikal.

Metodologi HJ 2010 dijalankan selama sebulan (26 September hingga 23 Oktober 2010) merangkumi pameran dan khidmat nasihat kesihatan di pelbagai jabatan, kursus CPR masyarakat dan kemuncaknya Berjalan Untuk kesihatan Anda dan perasmian penutup. PPKK terlibat sebagai 1) Penggalak dengan mengedarkan risalah dan poster mengenai acara-acara HJ 2010, 2) Penggerak dengan mendapatkan kerjasama Kelab Warga Emas Putrajaya dan persatuan penduduk bersama-sama mendapatkan penyertaan dan menjaga pameran, dan 3) Pembimbing dengan bertindak menyampaikan nasihat kesihatan kepada para pengunjung.

Keputusan Hasilnya, HJ 2010 telah mencapai kejayaan menggalakkan di mana peserta Berjalan Untuk Kesihatan telah melebihi 1000 peserta, lebih 1000 pengunjung menerima khidmat nasihat melalui semua acara dan 1200 risalah kesihatan diedarkan oleh PPKK. Penglibatan PPKK juga telah menjimatkan kira-kira RM 16,000 kos penganjuran.

Kesimpulan Kesimpulannya, penglibatan aktiviti PPKK telah berjaya mendapatkan penyertaan optimum masyarakat serta menjimatkan kos HJ 2010 di Putrajaya.

Katakunci: Panel penasihat, sambutan, pameran, kursus

43



May 2011

PP 17 To Increase Percentage of The Diabetic Patients With Good Control In Klinik Kesihatan Lenggong

Sofiah ZA; Teh YS; Fauziah H; Wan TK; Azmi I et al

Introduction Diabetes is a chronic diseases with multiple serious complications including blindness, ischaemic heart disease, stroke, kidney failure and ultimately death. The National Health Morbidity Survey (NHMS) III done in 2006 showed there was increased prevalence of diabetic patients which were 14.9% as compared to only 8.3% NHMS II done in 1996. The new diabetic patients registered in Klinik Kesihatan Lenggong (KK Lenggong) are about 30 -50 patients each year. To date the total number of registered diabetic patients in KK Lenggong are 776 patients. An audit on diabetic patients done in KK Lenggong showed the rate of controlled diabetic patients is less than 20%.

Objective To increase the percentage of diabetic patients with good control in KK Lenggong.

Methodology This is a cross-sectional study. The data were collected before intervention which was from February 2008 till April 2008 and after intervention which were in June 2009. The study population was all diabetic patients in KK Lenggong who fulfill the criteria. The variables measured are the knowledge of the patients and the health care providers and the HbA1c. This study emphasized on the health education on diabetes for the patients and health care providers. A flow chart of ‘Process of Care’ and ‘Model of Good Care’ were used in this study. There will be a dedicated person to do triaging to ensure the ‘Process of Care’ is being followed.

Results There were only 8.1% of diabetic patients with good control before the intervention took place. There were only 5.4% of diabetic patients and 51.7% of health care providers who answered the questionnaire had good knowledge about the diabetes. After the health education on diabetes done, the percentage of the diabetic patients and the health care providers with good knowledge were increased to 41.5% to 91.4% respectively. The percentage of diabetic patients with good control has increased to 32.9%.

Conclusion The percentage of good controlled diabetic patients can be increased by improving the knowledge amongst the patients and healthcare providers and also by implementation of ‘Process of Good Care’ and the used of ‘Model of Good care’. Providing the health education and following the ‘Process of Care’ are not costly.

Keywords: Diabetes, Good control, knowledge, attitude, practice

47



May 2011

SYM III (1) Health Data Integration

Dr. Md. Khadzir bin Sheikh Haji Ahmad Deputy Director, Planning and Development Division Ministry of Health Malaysia

Introduction The evolution of Health Information Management System in Malaysia started from a basic paper-based statistical reporting system to an ICT enabled Health Information Management system. Since colonial times, health information was collected and collated for statistical reports, which in general is not adequate and not timely for effective and efficient management. The Health Information Management System (HIMS) was developed with the intention to gather information required for programme planning, monitoring and evaluation. The deployment of Hospital Information Systems was intended to enable healthcare providers to produce efficient and timely report. However these gave rise to issues of interoperability of disparate systems, which resulted in the production of reports of variable quality and timeliness. A seamless integration, where information can be exchanged and readily used, between Health Information Systems and the HIMS is therefore crucial.

Methodology The use of Health Informatics Standards is the building blocks to facilitate the implementation of an interoperable system. Steps were taken to ensure that these standards were chosen, developed and adopted in current Health Information Systems. A web-based Business Intelligence (BI) application such as Sistem Maklumat Rawatan Perubatan (SMRP) was developed based on the existing manual reports with a focus at a granular level to enable effective data mining and analysis. Integration between SMRP and HIS was tested. A benchmarking criteria for Interoperability and Health Information Systems was also developed through a consensus between relevant stakeholders to ensure proper implementation of Health Information Systems.

Results Promising results were demonstrated during the implementation of the recent HIS project. Currently, one hospital has achieved interoperability between HIS and SMRP.

Analysis The adherence to data definitions in the development of Health Information Systems with the involvement of the correct stakeholders have contributed to enabling interoperability.

Discussion Health informatics standards in particular the National Health Data Dictionary and proper adherence in data definitions is essential towards achieving interoperability. Data collected should be at a granular level to enable effective data mining and analysis.



May 2011

SYM III (2) Ergonomics In Health Facilities

Professor Abu Hassan Director of Exxon Mobil



May 2011

MJPHM

NOTICE TO CONTRIBUTORS

The Malaysian Journal of Public Health Medicine (MJPHM) welcomes articles of interest on all aspects of public health medicine in the art form of original papers, research communications and epidemic reports. Articles are accepted for publication on condition that they are contributed solely to the MJPHM. Neither are Editorial Board nor the Publishers accept responsibility for the views and statements of authors expressed in their contributions.

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May 2011

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Standard Journal Article

1. Fungladda W, Sornmani S. Health behaviour, treatment for patients visiting malaria clinics in Western Thailand. Southest Asian J Trop Med Pub Hth 1986; 17(3): 379-381. 2. Bundy DAP, Hall A, Adjei S, et al. Better health, nutrition and education for the school-aged children.

Trans R Soc Trop Med Hyg 1997; 91: 1-2. Books and Other Monographs Personal Author(s) 1. Colton T. Statistics in medicine. Little, Brown and Company: Boston, 1974. Chapter in Book 1. DeFronzo RA. Diabetic Nephropathy. In: Junior DP, Sherwin RS. (eds). Diabetes Mellitus. Connecticut: Appleton and Lange, 1997. Agency Publication 1. Ministry of Health. Annual Report, 1999.

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mjphm supplement 1(2011)

Health & Medicine