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Chong DWQ, Jayaraj VJ, Ab Rahim FI, Syed Soffian SS, Azmi MF, Mohd Yusri MY, Mohamed Sidek AS, Azmi N, Md Said R, Md Salleh MF, Abu Bakar N, Shahar H, Abdul Rashid RM, Samad SA, Ahmad Z, Ismail MS, A. Bakar A, Hj Jobli NM, Sararaks S. Study protocol for a mixed methods approach to optimize colorectal cancer screening in Malaysia: Integrating stakeholders insights and knowledge-to-action framework. PLoS One 2024; 19:e0299659. [PMID: 38593177 PMCID: PMC11003698 DOI: 10.1371/journal.pone.0299659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Colorectal cancer is a growing global health concern and the number of reported cases has increased over the years. Early detection through screening is critical to improve outcomes for patients with colorectal cancer. In Malaysia, there is an urgent need to optimize the colorectal cancer screening program as uptake is limited by multiple challenges. This study aims to systematically identify and address gaps in screening service delivery to optimize the Malaysian colorectal cancer screening program. METHODS This study uses a mixed methods design. It focuses primarily on qualitative data to understand processes and strategies and to identify specific areas that can be improved through stakeholder engagement in the screening program. Quantitative data play a dual role in supporting the selection of participants for the qualitative study based on program monitoring data and assessing inequalities in screening and program implementation in healthcare facilities in Malaysia. Meanwhile, literature review identifies existing strategies to improve colorectal cancer screening. Additionally, the knowledge-to-action framework is integrated to ensure that the research findings lead to practical improvements to the colorectal cancer screening program. DISCUSSION Through this complex mix of qualitative and quantitative methods, this study will explore the complex interplay of population- and systems-level factors that influence screening rates. It involves identifying barriers to effective colorectal cancer screening in Malaysia, comparing current strategies with international best practices, and providing evidence-based recommendations to improve the local screening program.
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Affiliation(s)
- Diane Woei-Quan Chong
- Institute for Health Systems Research, National Institutes of Health, Centre for Health Services Research, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Vivek Jason Jayaraj
- National Institutes of Health, Sector for Biostatistics and Data Repository, NIH Manager’s Office, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Fathullah Iqbal Ab Rahim
- Institute for Health Systems Research, National Institutes of Health, Centre for Health Equity Research, Ministry of Health Malaysia, Shah Alam, Malaysia
| | | | | | - Mohd Yusaini Mohd Yusri
- Bandar Sri Jempol Health Clinic, Ministry of Health Malaysia, Bandar Seri Jempol, Negeri Sembilan, Malaysia
| | - Ahmad Shanwani Mohamed Sidek
- Department of General Surgery, Hospital Raja Perempuan Zainab II, Ministry of Health Malaysia, Kota Bahru, Kelantan, Malaysia
| | - Norfarizan Azmi
- Department of General Surgery, Hospital Tuanku Ja’afar, Ministry of Health Malaysia, Seremban, Negeri Sembilan, Malaysia
| | - Rosaida Md Said
- Department of Medicine, Hospital Serdang, Ministry of Health Malaysia, Kajang, Selangor, Malaysia
| | - Muhammad Firdaus Md Salleh
- Department of Medicine, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor, Malaysia
| | - Norasiah Abu Bakar
- Department of Medicine, Hospital Raja Perempuan Zainab II, Ministry of Health Malaysia, Kota Bahru, Kelantan, Malaysia
| | - Hamiza Shahar
- Department of Medicine, Hospital Tengku Ampuan Rahimah, Ministry of Health Malaysia, Klang, Selangor, Malaysia
| | | | - Shazimah Abdul Samad
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Zanita Ahmad
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Mohd Safiee Ismail
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Adilah A. Bakar
- Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | | | - Sondi Sararaks
- Institute for Health Systems Research, National Institutes of Health, Director’s Office, Ministry of Health Malaysia, Shah Alam, Malaysia
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Jayaraj VJ, Ng CW, Hoe VCW, Chong DWQ, Rampal S. Rapidly scalable and low-cost public health surveillance reporting system for COVID-19. BMJ Health Care Inform 2024; 31:e100759. [PMID: 38238022 DOI: 10.1136/bmjhci-2023-100759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 11/23/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE Data-driven innovations are essential in strengthening disease control. We developed a low-cost, open-source system for robust epidemiological intelligence in response to the COVID-19 crisis, prioritising scalability, reproducibility and dynamic reporting. METHODS A five-tiered workflow of data acquisition; processing; databasing, sharing, version control; visualisation; and monitoring was used. COVID-19 data were initially collated from press releases and then transitioned to official sources. RESULTS Key COVID-19 indicators were tabulated and visualised, deployed using open-source hosting in October 2022. The system demonstrated high performance, handling extensive data volumes, with a 92.5% user conversion rate, evidencing its value and adaptability. CONCLUSION This cost-effective, scalable solution aids health specialists and authorities in tracking disease burden, particularly in low-resource settings. Such innovations are critical in health crises like COVID-19 and adaptable to diverse health scenarios.
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Affiliation(s)
- Vivek Jason Jayaraj
- Sector for Biostatistics & Data Repository, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia
| | - Chiu-Wan Ng
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Victor Chee-Wai Hoe
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Diane Woei-Quan Chong
- Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia
| | - Sanjay Rampal
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chong DWQ, Jayaraj VJ, Ng CW, Sam IC, Said MA, Ahmad Zaki R, Hairi NN, Nik Farid ND, Hoe VCW, Isahak M, Ponnampalavanar S, Syed Omar SF, Kamaruzzaman SB, Ong HC, Hasmukharay K, Hasnan N, Kamarulzaman A, Chan YF, Chong YM, Rampal S. Propagation of a hospital-associated cluster of COVID-19 in Malaysia. BMC Infect Dis 2021; 21:1238. [PMID: 34886794 PMCID: PMC8655495 DOI: 10.1186/s12879-021-06894-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hospitals are vulnerable to COVID-19 outbreaks. Intrahospital transmission of the disease is a threat to the healthcare systems as it increases morbidity and mortality among patients. It is imperative to deepen our understanding of transmission events in hospital-associated cases of COVID-19 for timely implementation of infection prevention and control measures in the hospital in avoiding future outbreaks. We examined the use of epidemiological case investigation combined with whole genome sequencing of cases to investigate and manage a hospital-associated cluster of COVID-19 cases. METHODS An epidemiological investigation was conducted in a University Hospital in Malaysia from 23 March to 22 April 2020. Contact tracing, risk assessment, testing, symptom surveillance, and outbreak management were conducted following the diagnosis of a healthcare worker with SARS-CoV-2 by real-time PCR. These findings were complemented by whole genome sequencing analysis of a subset of positive cases. RESULTS The index case was symptomatic but did not fulfill the initial epidemiological criteria for routine screening. Contact tracing suggested epidemiological linkages of 38 cases with COVID-19. Phylogenetic analysis excluded four of these cases. This cluster included 34 cases comprising ten healthcare worker-cases, nine patient-cases, and 15 community-cases. The epidemic curve demonstrated initial intrahospital transmission that propagated into the community. The estimated median incubation period was 4.7 days (95% CI: 3.5-6.4), and the serial interval was 5.3 days (95% CI: 4.3-6.5). CONCLUSION The study demonstrated the contribution of integrating epidemiological investigation and whole genome sequencing in understanding disease transmission in the hospital setting. Contact tracing, risk assessment, testing, and symptom surveillance remain imperative in resource-limited settings to identify and isolate cases, thereby controlling COVID-19 outbreaks. The use of whole genome sequencing complements field investigation findings in clarifying transmission networks. The safety of a hospital population during this COVID-19 pandemic may be secured with a multidisciplinary approach, good infection control measures, effective preparedness and response plan, and individual-level compliance among the hospital population.
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Affiliation(s)
- Diane Woei-Quan Chong
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Ministry of Health Malaysia, 62590 Putrajaya, Malaysia
| | - Vivek Jason Jayaraj
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Ministry of Health Malaysia, 62590 Putrajaya, Malaysia
| | - Chiu-Wan Ng
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - I-Ching Sam
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mas Ayu Said
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Rafdzah Ahmad Zaki
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Noran Naqiah Hairi
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Nik Daliana Nik Farid
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Victor Chee-Wai Hoe
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Marzuki Isahak
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | | | | | | | - Hang-Cheng Ong
- Ministry of Health Malaysia, 62590 Putrajaya, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Kejal Hasmukharay
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yoke Fun Chan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yoong Min Chong
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Sanjay Rampal
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Chong DWQ, Jayaraj VJ, Rampal S, Said MA, Farid NDN, Zaki RA, Hairi NN, Hoe VCW, Isahak M, Ponnampalavanar S, Omar SFS, Sam IC, Hasnan N, Ong HC, Kamarulzaman A, Ng CW. Establishment of a hospital-based health care workers surveillance programme to keep them safe during the COVID-19 pandemic. J Glob Health 2020; 10:0203100. [PMID: 33304566 PMCID: PMC7714316 DOI: 10.7189/jogh.10.0203100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Diane Woei-Quan Chong
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Vivek Jason Jayaraj
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Sanjay Rampal
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mas Ayu Said
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nik Daliana Nik Farid
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rafdzah Ahmad Zaki
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Noran Naqiah Hairi
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Victor Chee-Wai Hoe
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Marzuki Isahak
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - I-Ching Sam
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hang-Cheng Ong
- Ministry of Health Malaysia, Putrajaya, Malaysia.,Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chiu-Wan Ng
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chong DWQ, Iqbal AR, Kaur Jaj B, Zainab A, Nordin A, Abd Majid ND, Jusoh A. Perceptions of nurses on inter-shift handover: A descriptive study in Hospital Kuala Lumpur, Malaysia. Med J Malaysia 2020; 75:691-697. [PMID: 33219179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- D W Q Chong
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Malaysia
| | - A R Iqbal
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Malaysia.
| | - B Kaur Jaj
- Hospital Kuala Lumpur, Department of General Surgery, Kuala Lumpur, Malaysia
| | - A Zainab
- Hospital Kuala Lumpur, Department of Anaesthesia and Intensive Care, Kuala Lumpur, Malaysia
| | - A Nordin
- Nursing Practices Control Unit (Hospital), Nursing Division, Ministry of Health Malaysia, Malaysia
| | - N D Abd Majid
- Hospital Kuala Lumpur, Department of General Medicine, Kuala Lumpur, Malaysia
| | - A Jusoh
- Dato' Keramat (Setiawangsa) Health Clinic, Federal Territories of Kuala Lumpur and Putrajaya Health Department, Malaysia
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