Evaluation of awareness & utilisation of clinical practise guideline for management of adult Dengue infection among Malaysia doctors

[Evidence synthesis: guidelines for diagnosis and treatment of dengue, chikungunya, and zika in the Region of the AmericasSíntese de evidências: diretrizes para o diagnóstico e o tratamento da dengue, chikungunya e zika na Região das Américas]

Introduction

Dengue, chikungunya, and Zika are viral diseases that pose a constant threat to public health. These three arboviruses can produce very similar clinical pictures, which represents a challenge to achieving an accurate clinical diagnosis and can lead to inadequate management and even fatal outcomes. Guidelines for the Clinical Diagnosis and Treatment of Dengue, Chikungunya, and Zika is part of the effort by the Pan American Health Organization and the countries of the Region of the Americas to prevent severe cases and death from these diseases, in a complex epidemiological context in which multiple factors favor transmission dynamics and lead to outbreaks and epidemics in the countries of the Region.

Objectives

Synthesize the recommendations in the PAHO guidelines, published in 2022, in order to present appropriate diagnosis and treatment of these arboviruses, and to address aspects of implementation of the recommendations.

Methods

The guidelines and their recommendations were synthesized. In addition, a systematic search was conducted in PubMed, Lilacs, Health Systems Evidence, Epistemonikos, and gray literature for studies done in the Region of the Americas, in order to identify barriers, facilitators, and implementation strategies. Process and outcome indicators for implementation of the recommendations were identified and formulated.

Results

We present 12 recommendations applicable to adult and pediatric patients with suspected or confirmed dengue, chikungunya, or Zika, along with barriers, facilitators, and strategies for their implementation.

Conclusions

The recommendations provide strategies for timely diagnosis and treatment of acute cases of dengue, chikungunya, and Zika, as well as considerations for implementation of the strategies.

Different Domains of Dengue Research in Malaysia: A Systematic Review and Meta-Analysis of Questionnaire-Based Studies

This review provided a systematic overview of the questionnaire-related dengue studies conducted in Malaysia and evaluated their reliability and validity used in the questionnaires. An extensive literature search was conducted using various electronic databases, including PubMed, EMBASE, Medline, and ScienceDirect. Systematic reviews and meta-analysis (PRISMA) were selected as the preferred item reporting method. Out of 88 identified dengue-related, 57 published from 2000 to April 2020 met the inclusion criteria and were included. Based on the meta-analysis, a poor mean score was obtained for knowledge (49%), attitude (44%), and preventive practice (55%). The study showed that the level of knowledge on cardinal signs and modes of transmission for dengue virus were highest among health care workers, followed by students (international and local) and lastly community residents. In treatment-seeking behaviours, only half of the respondents (50.8%) would send their child to the nearest health clinics or hospitals when a child became restless or lethargic. The acceptance rate for dengue vaccine, bacteria (Wolbachia), as a vector for dengue control and self-test diagnostic kit for dengue showed considerably high (88.4%, 70%, and 44.8%, respectively). Health belief model (HBM) constructs, such as perceived barriers, perceived severity, perceived susceptibility, self-efficacy, and perceived benefit influence prevention practices. Lastly, only 23 articles (40.3%) had piloted or pretested the questionnaire before surveying, in which three reported Cronbach's alpha coefficient (0.70-0.90). A need for active participation of communities and healthcare personnel, promotion of awareness, and safe complementary medicines, as well as assessment of psychometric properties of questionnaire use in dengue surveys in Malaysia, in order for assessing dengue reliably and valid.

Health Technology Assessment in Malaysia: Past, Present, and Future

OBJECTIVES

The aim of this study was to provide a comprehensive overview of the evolution of health technology assessment (HTA) in Malaysia over the past decade.

METHODS

We described the evolution of HTA program in Malaysia based on review of administrative data, publicly available information and quantitative description of impact evaluation.

RESULTS

Health Technology Assessment HTA was formalized in Malaysia in 1995 as a central structure within the Ministry of Health, Malaysia in 1995. Expansion of activities demonstrated over the years including Horizon Scanning of health technologies and implementation of evidence-based Clinical Practice Guidelines. Improvement on the processes in terms of types of report, quality, monitoring, and impact evaluation as well as accessibility was also carried out. Examples of impact/influence of the reports have also been demonstrated.

CONCLUSIONS

HTA program in Malaysia has evolved over the past decades. Its role in policy formulation and decision making of health technologies has become more significant over the years and is foreseen to be bigger in the future. As a trusted source of evidence, HTA in Malaysia will continue to strengthen the health system by advocating informed decision making and value-based medicine. As other countries in this region is trying to establish their own HTA processes and procedures, this review on the evolution of the HTA program in Malaysia might give some insights on developing a sustainable HTA program.

Using clinical practice guidelines to manage dengue: a qualitative study in a Malaysian hospital

Background

Malaysia has rising dengue incidence. World Health Organization clinical practice guidelines for managing dengue have been adapted by the Ministry of Health in Malaysia, with evidence of good awareness by clinicians. However, dengue mortality has not reduced. This study aimed to explore the challenges of dengue management for Medical Officers, with a particular focus on use of clinical practice guidelines.

Methods

Qualitative study using six focus groups and 14 semi-structured interviews with doctors responsible for dengue management at a large tertiary hospital in Malaysia.

Results

Dengue was recognised as difficult to diagnose and manage. Wide awareness and use of both WHO and Ministry of Health guidelines was reported, but several limitations noted in their coverage of particular patient groups. However, the phrase ‘guidelines’ also referred to local algorithms for fluid management, which were less clinically evidence-based. Where Medical Officers were well trained in the appropriate use of evidence-based guidelines, barriers to use included: the potential for ‘following the algorithm’ to undermine junior clinicians’ claims to clinical expertise; inability to recognise the pattern of clinical progress; and lack of clinical experience. Other reported barriers to improved case management were resource constraints, poor referral practices, and insufficient awareness of the need for timely help seeking.

Conclusions

Awareness of clinical practice guidelines is a necessary, but not sufficient, condition for optimal dengue management. In high prevalence settings, all clinical staff would benefit from regular dengue management training which should include diagnosis, practice in monitoring disease progression and the use of clinical practice guidelines in a range of clinical contexts.

Electronic supplementary material

The online version of this article (10.1186/s12879-019-3680-5) contains supplementary material, which is available to authorized users.