The Epidemiology of COVID-19 in Malaysia

BACKGROUND

COVID-19 has rapidly spread across the globe. Critical to the control of COVID-19 is the characterisation of its epidemiology. Despite this, there has been a paucity of evidence from many parts of the world, including Malaysia. We aim to describe the epidemiology of COVID-19 in Malaysia to inform prevention and control policies better.

METHODS

Malaysian COVID-19 data was extracted from 16 March 2020 up to 31 May 2021. We estimated the following epidemiological indicators: 7-day incidence rates, 7-day mortality rates, case fatality rates, test positive ratios, testing rates and the time-varying reproduction number (Rt).

FINDINGS

Between 16 March 2020 and 31 May 2021, Malaysia has reported 571,901 cases and 2,796 deaths. Malaysia's average 7-day incidence rate was 26•6 reported infections per 100,000 population (95% CI: 17•8, 38•1). The average test positive ratio and testing rate were 4•3% (95% CI: 1•6, 10•2) and 0•8 tests per 1,000 population (95% CI: <0•1, 3•7), respectively. The case fatality rates (CFR) was 0•6% (95% CI: <0•1, 3•7). Among the 2,796 cases who died, 87•3% were ≥ 50 years.

INTERPRETATION

The public health response was successful in the suppression of COVID-19 transmission or the first half of 2020. However, a state election and outbreaks in institutionalised populations have been the catalyst for more significant community propagation. This rising community transmission has continued in 2021, leading to increased incidence and strained healthcare systems. Calibrating NPI based on epidemiological indicators remain critical for us to live with the virus. (243 words).

FUNDING

This study is part of the COVID-19 Epidemiological Analysis and Strategies (CEASe) Project with funding from the Ministry of Science, Technology and Innovation (UM.0000245/HGA.GV).

1492Ordering the chaos: The global clustering of COVID-19 incidence and mortality

Background

The propagation of COVID-19 has been dynamic across countries and time. We utilised a temporal clustering approach in exploring trends of incidence and mortality across 202 countries.

Methods

COVID-19 case and death data between 1 January 2020 and 30 April 2021 were extracted from open-source data repositories. A partitional clustering algorithm, using Euclidean distances and partition around medoids, was utilised in exploring 14-day incidence and mortality rates across 202 countries. Inter-cluster comparisons were carried out using the 14-day incidence and mortality rates across clusters.

Results

Country-specific trends of incidence and mortality across the study period were agglomerated into one of six clusters. The overall trend of incidence and mortality during this period peaked between November 2020 and January 2021. However, four of the six clusters have an upward trajectory. Countries in cluster four, mostly situated in Europe, reported the highest overall incidence of 192 cases per 100,000 population (95% CI: 166, 220). Countries in cluster three, a mix of countries from South America, Eastern Europe, and Africa, were observed to have the highest overall mortality rate of 32 deaths per 1,000,000 population (95% CI: 23, 45).

Conclusions

The high global burden of disease and inequity in vaccine access highlights the need for a consolidated global effort in mitigating the pandemic.

Key messages

Increasing trajectories of incidence and mortality in Asia, South America, and Africa suggest that the worst of the pandemic may be ahead of us.

1483A meta-analysis of the serial interval and generation time of COVID-19 transmission

Background

Variation of the estimated serial interval and generation time introduces heterogeneity in COVID-19 transmission models. We conducted a systematic review and meta-analysis to estimate more precise serial intervals and generation times of COVID-19.

Methods

A literature search was conducted using the WHO Global COVID-19 Literature database from 1 January 2020 to 30 April 2021. A single reviewer performed the data extraction. A random-effects model was used to pool the estimates. Subgroup analysis was performed to check the estimates for heterogeneity by geographical region and the presence of lockdown measures.

Results

A total of 222 articles were retrieved of which 73 articles were included based on the selection criteria. Serial intervals were reported in 65 articles that provided 75 unique estimates from 16,805 transmission pairs. Generation intervals were reported in 9 articles that provided 9 unique estimates from 1,150 transmission pairs. The pooled serial interval was 5.00 days (95% CI: 4.68, 5.33). The pooled generation time was 4.37 days (95% CI: 3.58, 5.16). The serial interval estimates did not vary by either geographical region (P &gt; 0.05) or the presence of lockdown measures (P &gt; 0.05).

Conclusions

This analysis provides more precise pooled serial and generation intervals that may decrease misspecifications of future transmission models.

Key messages

Epidemiological parameters are crucial components in estimating the dynamics of COVID-19 transmission. Periodically updating serial and generation time intervals are important to reduce model misspecification for a new disease such as COVID-19.

Redesigning a Healthcare Demand Questionnaire for National Population Survey: Experience of a Developing Country

Since its inception in 1986, the contents of the National Health and Morbidity Survey (NHMS) have been periodically updated to support emerging health data needs for evidence-based policy and program development. In 2018, the healthcare demand questionnaire was redesigned to capture diverse and changing population demand for healthcare services and their utilization pattern. This paper describes the methods and processes undertaken in redesigning the questionnaire. We aim to highlight the systematic and inclusive approach, enabling all potential evidence users to be involved, indirectly encouraging research evidence uptake for policy and program planning. We applied a systematic approach of comprehensive literature search for national-level population survey instruments implemented globally and translated non-English tools to English. The development phases were iterative, conducted in parallel with active stakeholder engagements. Here, we detailed the processes in the planning and exploratory phase as well as a qualitative assessment of the questionnaire. We included instruments from 45 countries. The majority were from the Organisation for Economic Co-operation and Development (OECD) countries and focused on perceived health, health-related behavior, and healthcare use. Thirty-four stakeholders from 14 areas of expertise were involved. Stakeholders identified additional content areas required, such as chronic pain, alternative use of healthcare services (community pharmacy, home-visit, and private medical laboratory), family doctor, and informal caregiving. The questionnaire, redesigned based on existing literature with concordant involvement and iterative feedback from stakeholders, improved the choice of health topics through the identification of new topics and modification of existing questions to better meet future evidence needs on health problems, strategy, and program planning towards strengthening the nation’s health systems.

Perceptions of nurses on inter-shift handover: A descriptive study in Hospital Kuala Lumpur, Malaysia

INTRODUCTION

The quality of information and efficiency in the practice and care environments are important aspects of nursing care. The use of a reliable and valid scale can monitor the quality of handover and provide information for continuous improvement of practice. This study aims to describe the perception of nurses, on the domains of quality of information, efficiency, interaction and support and patient involvement.

METHOD

A cross-sectional descriptive study was conducted among 450 nurses from 37 wards in Hospital Kuala Lumpur. Nurses on shift duty were recruited by convenience sampling from the Medical, Surgery, Obstetrics & Gynaecology, Orthopaedic and Paediatric wards. Using a validated questionnaire (Handover Evaluation Scale), nurses self-rated their perceptions using a 7-point scale and provided open-ended responses to the strengths and challenges that they faced. Descriptive and inferential analyses were done while open-ended questions were summarised based on key themes.

RESULTS

A total of 414 nurses completed the survey (92.0% response rate). Nurses had an overall mean (SD) perception score of 5.01 (SD 0.56). They perceived good interaction and support during handover and on the quality of information that they received, with mean scores of 5.54 (SD 0.79) and 5.19 (SD 0.69), respectively. There was an association between the departments where the nurses worked and their overall perceptions on nursing handover (p<0.001). Interruptions being the most common theme emerged from the open-ended section.

CONCLUSION

Despite having substantial interaction and support amongst nurses, opportunities for improvements were noted. Improvements in the quality of handover information and reducing interruptions should be the main emphases as these were perceived to be essential in the current handover practices by nurses.

Research funding impact and priority setting - advancing universal access and quality healthcare research in Malaysia

BACKGROUND

Health Research Priority Setting (HRPS) in the Ministry of Health (MOH) Malaysia was initiated more than a decade ago to drive effort toward research for informed decision and policy-making. This study assessed the impact of funded prioritised research and identified research gaps to inform future priority setting initiatives for universal access and quality healthcare in Malaysia.

METHODS

Research impact of universal access and quality healthcare projects funded by the National Institutes of Health Malaysia were assessed based on the modified Payback Framework, addressing categories of informing policy, knowledge production, and benefits to health and health sector. For the HRPS process, the Child Health and Nutrition Research Initiative methodology was adapted and adopted, with the incorporation of stakeholder values using weights and monetary allocation survey. Workshop discussions and interviews with stakeholders and research groups were conducted to identify research gaps, with the use of conceptual frameworks to guide the search.

RESULTS

Seventeen ongoing and 50 completed projects were identified for research funding impact analysis. Overall, research fund allocation differed from stakeholders' expectation. For research impact, 48 out of 50 completed projects (96.0%) contributed to some form of policy-making efforts. Almost all completed projects resulted in outputs that contributed to knowledge production and were expected to lead to health and health sector benefits. The HRPS process led to the identification of research priority areas that stemmed from ongoing and new issues identified for universal access and quality healthcare.

CONCLUSION

The concerted efforts of evaluation of research funding impact, prioritisation, dissemination and policy-maker involvement were valuable for optimal health research resource utilisation in a resource constrained developing country. Embedding impact evaluation into a priority setting process and funding research based on national needs could facilitate health research investment to reach its potential.