1
|
Jayaraj VJ, Husin M, Suah JL, Tok PSK, Omar A, Rampal S, Sivasampu S. Effectiveness of COVID-19 vaccines among children 6-11 years against hospitalization during Omicron predominance in Malaysia. Sci Rep 2024; 14:5690. [PMID: 38454077 PMCID: PMC10920657 DOI: 10.1038/s41598-024-55899-5] [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: 12/04/2023] [Accepted: 02/28/2024] [Indexed: 03/09/2024] Open
Abstract
There is currently limited data on the effectiveness of COVID-19 vaccines for children aged 6-11 years in Malaysia. This study aims to determine vaccine effectiveness (VE) against COVID-19-related hospitalization after receipt of one- and two-doses of BNT162b2 mRNA (Comirnaty-Pfizer/BioNTech) vaccine over a duration of almost 1 year in the predominantly Omicron period of BA.4/BA.5 and X.B.B sub lineages. This study linked administrative databases between May 2022 and March 2023 to evaluate real-world vaccine effectiveness (VE) for the BNT162b2 mRNA (Comirnaty-Pfizer/BioNTech) vaccine against COVID-19-related hospitalization in the Omicron pre-dominant period with BA.4/BA.5 and X.B.B sub lineages. During the Omicron-predominant period, the cumulative hospitalization rate was almost two times higher for unvaccinated children (9.6 per million population) compared to vaccinated children (6 per million population). The estimated VE against COVID-19 hospitalization for one dose of BNT162b2 was 27% (95% CI - 1%, 47%) and 38% (95% CI 27%, 48%) for two doses. The estimated VE against hospitalization remained stable when stratified by time. VE for the first 90 days was estimated to be 45% (95% CI 33, 55%), followed by 47% (95% CI 34, 56%) between 90 and 180 days, and 36% (95% CI 22, 45%) between 180 and 360 days. Recent infection within 6 months does not appear to modify the impact of vaccination on the risk of hospitalization, subject to the caveat of potential underestimation. In our pediatric population, BNT162b2 provided moderate-non-diminishing protection against COVID-19 hospitalization over almost 1 year of Omicron predominance.
Collapse
Affiliation(s)
- Vivek Jason Jayaraj
- Sector for Biostatistics & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia.
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Jing Lian Suah
- Data, Analytics and Research, Central Bank of Malaysia, Kuala Lumpur, Malaysia
| | - Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Azahadi Omar
- Sector for Biostatistics & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Practice, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| |
Collapse
|
2
|
Tok PSK, Kang KY, Ng SW, Ab Rahman N, Syahmi MA, Pathmanathan MD, Appannan MR, Peariasamy KM, Sivasampu S. Post COVID-19 condition among adults in Malaysia following the Omicron wave: A prospective cohort study. PLoS One 2024; 19:e0296488. [PMID: 38181017 PMCID: PMC10769055 DOI: 10.1371/journal.pone.0296488] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/14/2023] [Indexed: 01/07/2024] Open
Abstract
Post COVID-19 condition is an important public health problem as we emerge from the COVID-19 pandemic. In this prospective cohort study, we aimed to determine the prevalence of this condition and assess its associated factors and impact on health-related quality of life in a population setting in Malaysia. Study was conducted from April to June 2022 when the Omicron variant predominated. All individuals testing positive for SARS-CoV-2 infection (RT-PCR, RTK-Ag) were invited for participation. Study questionnaires were delivered via the MySejahtera platform (mobile application). From the total of 44,386 participants who provided responses up to 3-months interval, 1,510 participants (3.4%) fulfilled the post COVID-19 condition criteria. Majority of the affected participants (83.8%, n = 1,265) experienced either cough, fatigue or forgetfulness-the three most common symptoms. Being females, having existing comorbidities, presence of symptoms and requiring hospital admission during the acute illness were associated with higher likelihoods of developing the post COVID-19 condition at 3-months interval. Amongst the 1,510 individuals, one in five had limitations in performing their usual daily activities while at least one in three expressed that their work was affected. Understanding this condition better is essential to guide strategic and responsive plans of action, which may require coordinated multidisciplinary interventions.
Collapse
Affiliation(s)
- Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Kong Yeow Kang
- Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia
| | - Sock Wen Ng
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | | | - Mohan Dass Pathmanathan
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | | | - Kalaiarasu M. Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| |
Collapse
|
3
|
Hwong WY, Ng SW, Tong SF, Ab Rahman N, Law WC, Wong SK, Puvanarajah SD, Mohd Norzi A, Lian FS, Sivasampu S. Identifying factors in the provision of intravenous stroke thrombolysis in Malaysia: a multiple case study from the healthcare providers' perspective. BMC Health Serv Res 2024; 24:34. [PMID: 38183003 PMCID: PMC10768456 DOI: 10.1186/s12913-023-10397-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/29/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Translation into clinical practice for use of intravenous thrombolysis (IVT) for the management of ischemic stroke remains a challenge especially across low- and middle-income countries, with regional inconsistencies in its rate. This study aimed at identifying factors that influenced the provision of IVT and the variation in its rates in Malaysia. METHODS A multiple case study underpinning the Tailored Implementation for Chronic Diseases framework was carried out in three public hospitals with differing rates of IVT using a multiple method design. Twenty-five in-depth interviews and 12 focus groups discussions were conducted among 89 healthcare providers, along with a survey on hospital resources and a medical records review to identify reasons for not receiving IVT. Qualitative data were analysed using reflective thematic method, before triangulated with quantitative findings. RESULTS Of five factors identified, three factors that distinctively influenced the variation of IVT across the hospitals were: 1) leadership through quality stroke champions, 2) team cohesiveness which entailed team dynamics and its degree of alignment and, 3) facilitative work process which included workflow simplification and familiarity with IVT. Two other factors that were consistently identified as barriers in these hospitals included patient factors which largely encompassed delayed presentation, and resource constraints. About 50.0 - 67.6% of ischemic stroke patients missed the opportunity to receive IVT due to delayed presentation. CONCLUSIONS In addition to the global effort to explore sustainable measures to improve patients' emergency response for stroke, attempts to improve the provision of IVT for stroke care should also consider the inclusion of interventions targeting on health systems perspectives such as promoting quality leadership, team cohesiveness and workflow optimisation.
Collapse
Affiliation(s)
- Wen Yea Hwong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia.
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Sock Wen Ng
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Seng Fah Tong
- Department of Family Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Wan Chung Law
- Neurology Unit, Department of Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
| | - Sing Keat Wong
- Department of Neurology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Santhi Datuk Puvanarajah
- Department of Neurology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Aisyah Mohd Norzi
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Fiona Suling Lian
- Clinical Research Centre, Penang General Hospital, Ministry of Health Malaysia, Penang, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| |
Collapse
|
4
|
Lim AH, Ab Rahman N, Nasarudin SNS, Velvanathan T, Fong MCC, Mohamad Yahaya AH, Sivasampu S. A comparison between antibiotic utilisation in public and private community healthcare in Malaysia. BMC Public Health 2024; 24:79. [PMID: 38172715 PMCID: PMC10762925 DOI: 10.1186/s12889-023-17579-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND There are two parallel systems in Malaysian primary healthcare services: government funded public primary care and privately-owned practices. While there have been several studies evaluating antibiotic utilisation in Malaysian public healthcare, there is a lack of literature on the use of antibiotics in the private sector. There is a dire need to evaluate the more recent performance of public vs. private community healthcare in Malaysia. As such, this study aimed at measuring and comparing the utilisation of antibiotics in the public and private community healthcare sectors of Malaysia in 2018-2021. METHODS This study was a retrospective analysis of antibiotic utilisation in Malaysian primary care for the period of 1 January 2018 until 31 December 2021 using the nationwide pharmaceutical procurement and sales data from public and private health sectors. Rates of antibiotic utilisation were reported as Defined Daily Doses per 1000 inhabitants per day (DID) and stratified by antibiotic classes. The secondary analysis included proportions of AWaRe antibiotic category use for each sector and proportion of antibiotic utilisation for both sectors. RESULTS The overall national antibiotic utilisation for 2018 was 6.14 DID, increasing slightly to 6.56 DID in 2019, before decreasing to 4.54 DID in 2020 and 4.17 DID in 2021. Private primary care antibiotic utilisation was almost ten times higher than in public primary care in 2021. The public sector had fewer (four) antibiotic molecules constituting 90% of the total antibiotic utilisation as compared to the private sector (eight). Use of Access antibiotics in the public sector was consistently above 90%, while use of Access category antibiotics by the private sector ranged from 64.2 to 68.3%. Although use of Watch antibiotics in the private sector decreased over the years, the use of Reserve and 'Not Recommended' antibiotics increased slightly over the years. CONCLUSION Antibiotic consumption in the private community healthcare sector in Malaysia is much higher than in the public sector. These findings highlight the need for more rigorous interventions targeting both private prescribers and the public with improvement strategies focusing on reducing inappropriate and unnecessary prescribing.
Collapse
Affiliation(s)
- Audrey Huili Lim
- Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia.
| | - Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia
| | - Siti Nur Su'aidah Nasarudin
- Pharmacy Research & Development Branch, Pharmacy Policy & Strategic Planning Division, Pharmaceutical Services Programme, Ministry of Health, Petaling Jaya, Malaysia
| | - Tineshwaran Velvanathan
- Pharmacy Research & Development Branch, Pharmacy Policy & Strategic Planning Division, Pharmaceutical Services Programme, Ministry of Health, Petaling Jaya, Malaysia
| | - Mary Chok Chiew Fong
- Pharmacy Research & Development Branch, Pharmacy Policy & Strategic Planning Division, Pharmaceutical Services Programme, Ministry of Health, Petaling Jaya, Malaysia
| | - Abdul Haniff Mohamad Yahaya
- Pharmacy Research & Development Branch, Pharmacy Policy & Strategic Planning Division, Pharmaceutical Services Programme, Ministry of Health, Petaling Jaya, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia
| |
Collapse
|
5
|
Lye CW, Sivasampu S, Mahmudiono T, Majid HA. A systematic review of the relationship between household food insecurity and childhood undernutrition. J Public Health (Oxf) 2023; 45:e677-e691. [PMID: 37291061 DOI: 10.1093/pubmed/fdad070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/21/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND This systematic review aims to investigate the association between household food insecurity (HFIS) and undernutrition in children under 5 years old, thereby informing policymakers on the vital factors needed to be considered in tailoring an effective strategy to tackle childhood undernutrition and ultimately HFIS. METHODS We performed a systematic review that examined household food insecurity among the undernourished under-five children. PubMed, Cochrane, EBSCO Host, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched from 1 January 2012 to 1 April 2022, for relevant articles. Outcome measures were stunting, underweight or wasting. Of the 2779 abstracts screened, 36 studies that fulfilled the inclusion and exclusion criteria were included. A range of tools had been used to measure HFIS, the most common being Household Food Insecurity Access Scale. HFIS has been found to be significantly associated with undernutrition, particularly stunting and underweight. This is observed proportionately across all national income levels. CONCLUSIONS Sustainable and inclusive economic growth, which aims to reduce income, education and gender inequality, should be a key policy goal in the minimizing food insecurity and childhood undernutrition. Multisectoral interventions are needed to address these issues.
Collapse
Affiliation(s)
- Chuan Way Lye
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Sheamini Sivasampu
- Centre for Clinical Outcome Research, Institute for Clinical Research, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Trias Mahmudiono
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Hazreen Abdul Majid
- The Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
- School of Chiropractor, AECC University College, Parkwood Campus, Dorset BH5 2DF, UK
| |
Collapse
|
6
|
Ab Rahman N, Lim MT, Lee FY, Wo WK, Yeoh HS, Peariasamy KM, Sivasampu S. Thrombocytopenia and venous thromboembolic events after BNT162b2, CoronaVac, ChAdOx1 vaccines and SARS-CoV-2 infection: a self-controlled case series study. Sci Rep 2023; 13:20471. [PMID: 37993548 PMCID: PMC10665324 DOI: 10.1038/s41598-023-47486-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
This study assessed the association between COVID-19 vaccines, SARS-CoV-2 infection and the risk of thrombocytopenia and venous thromboembolism (VTE). This self-controlled case series study used hospital records between 1st February 2021 and 28th February 2022 linked to the national immunisation registry and COVID-19 surveillance data in Malaysia. Conditional Poisson regression was used to estimate incidence rate ratios (IRR) of events in the risk period (day 1-21 post-exposure) relative to control period with the corresponding 95% confidence interval (CI) adjusted for calendar period. We found no significant increased risk of thrombocytopenia in 1-21 days following BNT162b2, CoronaVac and ChAdOx1 vaccines while the risk was increased following SARS-CoV-2 infection (IRR 15.52, 95% CI 13.38-18.00). Similarly, vaccination with BNT162b2, CoronaVac, or ChAdOx1 was not associated with an increased risk of VTE during the 1-21 days risk period. SARS-CoV-2 infection was associated with increased risk of VTE (IRR 39.84, 95% CI 27.45-32.44). Our findings showed low event rates of thrombocytopenia and VTE following booster vaccination with comparable safety profiles between those who received homologous and heterologous booster combinations. Our findings showed the risk of thrombocytopenia and VTE was not increased after COVID-19 vaccination while the risks were substantially higher after SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia.
| | - Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Fei Yee Lee
- Clinical Research Centre, Selayang Hospital, Ministry of Health, Kepong, Selangor, Malaysia
| | - Wee Kee Wo
- National Pharmaceutical Regulatory Agency, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Hee Sheong Yeoh
- National Pharmaceutical Regulatory Agency, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| |
Collapse
|
7
|
Ab Rahman N, Lim MT, Lee FY, Anak Jam EB, Peariasamy KM, Sivasampu S. Myocarditis/pericarditis following vaccination with BNT162b2, CoronaVac, and ChAdOx1 among adolescent and adult in Malaysia. Vaccine X 2023; 14:100303. [PMID: 37091730 PMCID: PMC10104785 DOI: 10.1016/j.jvacx.2023.100303] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023] Open
Abstract
This study evaluates 21-day risk of myocarditis/pericarditis following COVID-19 vaccination among those aged 12 years and older in Malaysia. We used data from nationwide COVID-19 vaccine registry linked to hospital episode database to identify individuals vaccinated with BNT162b2, CoronaVac, or ChAdOx1 and hospitalised for myocarditis/pericarditis between 1 February 2021 and 28 February 2022. There were 87 myocarditis/pericarditis cases identified within 1-21 days after vaccination. Most cases were reported following BNT16262 vaccination (77.0%) with absolute risk of 0.33 cases/100,000 vaccinated persons or 1.73 per million doses administered. Highest risk was observed following second dose and in younger, male individuals. The risk of myocarditis/pericarditis following CoronaVac and ChAdOx1 were much lower compared to BNT162b2. The findings on higher risk observed among younger following mRNA vaccine were consistent with literature and important for targeted surveillance.
Collapse
Affiliation(s)
- Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia
| | - Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia
| | - Fei Yee Lee
- Clinical Research Centre, Selayang Hospital, Ministry of Health, Selangor, Malaysia
| | - Emelyne Bani Anak Jam
- Clinical Research Centre, Queen Elizabeth II Hospital, Ministry of Health, Sabah, Malaysia
| | | | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia
| |
Collapse
|
8
|
Husin M, Teh XR, Ong SM, Lim YMF, Ang SH, Chan CL, Lim MT, Shanmugam S, Khamis N, Jaafar FSA, Ibrahim NI, Nasir NH, Kusuma D, Wagner AK, Ross-Degnan D, Atun R, Sivasampu S. The Effectiveness of Enhanced Primary Healthcare (EnPHC) interventions on Type 2 diabetes management in Malaysia: Difference-in-differences (DID) analysis. Prim Care Diabetes 2023; 17:260-266. [PMID: 36932012 DOI: 10.1016/j.pcd.2023.03.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
AIMS To evaluate the effectiveness of the Enhanced Primary Healthcare (EnPHC) interventions on process of care and intermediate clinical outcomes among type 2 diabetes patients. METHODS This was a quasi-experimental controlled study conducted in 20 intervention and 20 control public primary care clinics in Malaysia from November 2016 to June 2019. Type 2 diabetes patients aged 30 years and above were selected via systematic random sampling. Outcomes include process of care and intermediate clinical outcomes. Difference-in-differences analyses was conducted. RESULTS We reviewed 12,017 medical records of patients with type 2 diabetes. Seven process of care measures improved: HbA1c tests (odds ratio (OR) 3.31, 95% CI 2.13, 5.13); lipid test (OR 4.59, 95% CI 2.64, 7.97), LDL (OR 4.33, 95% CI 2.16, 8.70), and urine albumin (OR 1.99, 95% CI 1.12, 3.55) tests; BMI measured (OR 15.80, 95% CI 4.78, 52.24); cardiovascular risk assessment (OR 174.65, 95% CI 16.84, 1810.80); and exercise counselling (OR 1.18, 95% CI 1.04, 1.33). We found no statistically significant changes in intermediate clinical outcomes (i.e. HbA1c, LDL, HDL and BP control). CONCLUSIONS EnPHC interventions was successful in enhancing the quality of care, in terms of process of care, by changing healthcare providers behaviour.
Collapse
Affiliation(s)
- Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia.
| | - Xin Rou Teh
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Su Miin Ong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Yvonne Mei Fong Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Swee Hung Ang
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Chee Lee Chan
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Sunita Shanmugam
- Institute for Health Management, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Noraziani Khamis
- Institute for Health Management, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Faeiz Syezri Adzmin Jaafar
- Institute for Health Management, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Nor Idawaty Ibrahim
- Family Health Development Division, Ministry of Health Malaysia, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Putrajaya, Malaysia
| | - Nazrila Hairizan Nasir
- Family Health Development Division, Ministry of Health Malaysia, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Putrajaya, Malaysia
| | - Dian Kusuma
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Department of Health Services Research and Management, School of Health & Psychological Sciences, City University of London, London, United Kingdom
| | - Anita Katharina Wagner
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Dr #401, Boston, MA 02215, United States
| | - Dennis Ross-Degnan
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Dr #401, Boston, MA 02215, United States
| | - Rifat Atun
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| |
Collapse
|
9
|
Lim AH, Ab Rahman N, Hashim H, Kamal M, Velvanathan T, Chok MCF, Sivasampu S. Impact of COVID-19 Pandemic on Antibiotic Utilisation in Malaysian Primary Care Clinics: An Interrupted Time Series Analysis. Antibiotics (Basel) 2023; 12:antibiotics12040659. [PMID: 37107021 PMCID: PMC10135109 DOI: 10.3390/antibiotics12040659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/23/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023] Open
Abstract
The COVID-19 pandemic has resulted in a dramatic change in the delivery of primary healthcare across the world, presumably changing trends in consultations for infectious diseases and antibiotic use. This study aimed at describing and evaluating the impact of COVID-19 on antibiotic use in public primary care clinics in Malaysia between 2018 and 2021. Data from the nationwide procurement database of systemic antibiotics from public primary care clinics in Malaysia between January 2018 and December 2021 were analysed using interrupted time series analysis. The monthly number of defined daily doses per 1000 inhabitants per day (DID) was calculated and grouped by antibiotic class. The trend of antibiotic utilisation rates had been decreasing by 0.007 DID monthly before March 2020 (p = 0.659). With the introduction of national lockdown due to COVID-19 beginning March 2020, there was a significant reduction in the level of antibiotic utilisation rates of 0.707 (p = 0.022). Subsequently, the monthly trend showed a slight upward change until the end of the study period (p = 0.583). Our findings indicate that there was a significant decrease in antibiotic utilisation for systemic use in primary care following the COVID-19 pandemic compared with the preceding years (January 2018–March 2020).
Collapse
|
10
|
Suah JL, Tng BH, Tok PSK, Husin M, Thevananthan T, Peariasamy KM, Sivasampu S. Real-world effectiveness of homologous and heterologous BNT162b2, CoronaVac, and AZD1222 booster vaccination against Delta and Omicron SARS-CoV-2 infection. Emerg Microbes Infect 2022; 11:1343-1345. [PMID: 35499301 PMCID: PMC9132393 DOI: 10.1080/22221751.2022.2072773] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Given emerging evidence of immune escape in the SARS-CoV-2 Omicron viral variant, and its dominance, effectiveness of heterologous and homologous boosting schedules commonly used in low-to-middle income countries needs to be re-evaluated. We conducted a test-negative design using consolidated national administrative data in Malaysia to compare the effectiveness of homologous and heterologous BNT162b2, CoronaVac, and AZD1222 booster vaccination against SARS-CoV-2 infection in predominant-Delta and predominant-Omicron periods. Across both periods, homologous CoronaVac and AZD1222 boosting demonstrated lower effectiveness than heterologous boosting for CoronaVac and AZD1222 primary vaccination recipients and homologous BNT162b2 boosting. Broadly, marginal effectiveness was smaller by 40–50 percentage points in the Omicron period than the Delta period. Without effective and accessible second-generation vaccines, heterologous boosting using BNT162b2 for inactivated and vectored primary vaccination recipients is preferred.
Collapse
Affiliation(s)
- Jing Lian Suah
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Boon Hwa Tng
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | | | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| |
Collapse
|
11
|
Hwong WY, Ng SW, Tong SF, Ab Rahman N, Law WC, Kaman Z, Wong SK, Puvanarajah SD, Sivasampu S. Stroke thrombolysis in a middle-income country: A case study exploring the determinants of its implementation. Front Neurol 2022; 13:1048807. [PMID: 36504666 PMCID: PMC9729841 DOI: 10.3389/fneur.2022.1048807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Translation of evidence into clinical practice for use of intravenous thrombolysis in acute stroke care has been slow, especially across low- and middle-income countries. In Malaysia where the average national uptake was poor among the public hospitals in 2018, one hospital intriguingly showed comparable thrombolysis rates to high-income countries. This study aimed to explore and provide in-depth understanding of factors and explanations for the high rates of intravenous stroke thrombolysis in this hospital. Methods This single case study sourced data using a multimethod approach: (1) semi-structured in-depth interviews and focus group discussions, (2) surveys, and (3) review of medical records. The Tailored Implementation of Chronic Diseases (TICD) framework was used as a guide to understand the determinants of implementation. Twenty-nine participants comprising the Hospital Director, neurologists, emergency physicians, radiologists, pharmacists, nurses and medical assistants (MAs) were included. Thematic analyses were conducted inductively before triangulated with quantitative analyses and document reviews. Results Favorable factors contributing to the uptake included: (1) cohesiveness of team members which comprised of positive interprofessional team dynamics, shared personal beliefs and values, and passionate leadership, and (2) facilitative work process through simplification of workflow and understanding the rationale of the sense of urgency. Patient factors was a limiting factor. Almost two third of ischemic stroke patients arrived at the hospital outside the therapeutic window time, attributing patients' delayed presentation as a main barrier to the uptake of intravenous stroke thrombolysis. One other barrier was the availability of resources, although this was innovatively optimized to minimize its impact on the uptake of the therapy. As such, potential in-hospital delays accounted for only 3.8% of patients who missed the opportunity to receive thrombolysis. Conclusions Despite the ongoing challenges, the success in implementing intravenous stroke thrombolysis as standard of care was attributed to the cohesiveness of team members and having facilitative work processes. For countries of similar settings, plans to improve the uptake of intravenous stroke thrombolysis should consider the inclusion of interventions targeting on these modifiable factors.
Collapse
Affiliation(s)
- Wen Yea Hwong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands,*Correspondence: Wen Yea Hwong ;
| | - Sock Wen Ng
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Seng Fah Tong
- Department of Family Medicine, Universiti Kebangsaan Malaysia, Selangor, Malaysia
| | - Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Wan Chung Law
- Neurology Unit, Department of Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Malaysia
| | - Zurainah Kaman
- Neurology Unit, Department of Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Malaysia
| | - Sing Keat Wong
- Department of Neurology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Santhi Datuk Puvanarajah
- Department of Neurology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| |
Collapse
|
12
|
Ong SM, Lim MT, Fah Tong S, Kamaliah MN, Groenewegen P, Sivasampu S. Comparative performance of public and private primary care service delivery in Malaysia: An analysis of findings from QUALICOPC. PLoS One 2022; 17:e0276480. [PMID: 36269717 PMCID: PMC9586414 DOI: 10.1371/journal.pone.0276480] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/07/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Primary care services are essential in achieving universal health coverage and Malaysia is looking into public-private partnership to overcome resource constraints. The study aims to compare the performance of primary care service delivery dimensions between public and private sector. METHODS This cross-sectional study used the data from the Malaysian International Quality and Costs of Primary Care (QUALICOPC) study conducted in 2015-2016. The relative performance of each sector in four dimensions was compared using multi-level linear regression by incorporating a dummy variable indicating public sector in the model. RESULTS The public sector was shown to have higher performance in comprehensiveness and coordination, while the private sector was better in continuity. There was no significant difference in accessibility. The public primary care services were better in serving primary care sensitive conditions, better informational continuity, and with better skill-mix and inter- and intra- professional relationship. Meanwhile, the private sector was stronger in referral decision making process, specialist feedback and greater out of hours facilities access. CONCLUSIONS The public and private sectors differ in their strengths, which the government may tap into to strengthen primary care services. Other areas for improvement include seamless care strategies that promote good referral, feedback, and information continuity.
Collapse
Affiliation(s)
- Su Miin Ong
- Centre for Clinical Outcomes Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia
- * E-mail:
| | - Ming Tsuey Lim
- Centre for Clinical Outcomes Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia
| | - Seng Fah Tong
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz UKM, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - M. N. Kamaliah
- Faculty of Medicine, University of Cyberjaya, Cyberjaya, Selangor, Malaysia
| | - Peter Groenewegen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Departments of Human Geography and Department of Sociology, Utrecht University, Utrecht, The Netherlands
| | - Sheamini Sivasampu
- Centre for Clinical Outcomes Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia
| |
Collapse
|
13
|
Lim AH, Ng SW, Teh XR, Ong SM, Sivasampu S, Lim KK. Conjoint analyses of patients’ preferences for primary care: a systematic review. BMC Prim Care 2022; 23:234. [PMID: 36085032 PMCID: PMC9463739 DOI: 10.1186/s12875-022-01822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
While patients’ preferences in primary care have been examined in numerous conjoint analyses, there has been little systematic effort to synthesise the findings. This review aimed to identify, to organise and to assess the strength of evidence for the attributes and factors associated with preference heterogeneity in conjoint analyses for primary care outpatient visits.
Methods
We searched five bibliographic databases (PubMed, Embase, PsycINFO, Econlit and Scopus) from inception until 15 December 2021, complemented by hand-searching. We included conjoint analyses for primary care outpatient visits. Two reviewers independently screened papers for inclusion and assessed the quality of all included studies using the checklist by ISPOR Task Force for Conjoint Analysis. We categorized the attributes of primary care based on Primary Care Monitoring System framework and factors based on Andersen’s Behavioural Model of Health Services Use. We then assessed the strength of evidence and direction of preference for the attributes of primary care, and factors affecting preference heterogeneity based on study quality and consistency in findings.
Results
Of 35 included studies, most (82.4%) were performed in high-income countries. Each study examined 3–8 attributes, mainly identified through literature reviews (n = 25). Only six examined visits for chronic conditions, with the rest on acute or non-specific / other conditions. Process attributes were more commonly examined than structure or outcome attributes. The three most commonly examined attributes were waiting time for appointment, out-of-pocket costs and ability to choose the providers they see. We identified 24/58 attributes with strong or moderate evidence of association with primary care uptake (e.g., various waiting times, out-of-pocket costs) and 4/43 factors with strong evidence of affecting preference heterogeneity (e.g., age, gender).
Conclusions
We found 35 conjoint analyses examining 58 attributes of primary care and 43 factors that potentially affect the preference of these attributes. The attributes and factors, stratified into evidence levels based on study quality and consistency, can guide the design of research or policies to improve patients’ uptake of primary care. We recommend future conjoint analyses to specify the types of visits and to define their attributes clearly, to facilitate consistent understanding among respondents and the design of interventions targeting them.
Word Count: 346/350 words.
Trial registration
On Open Science Framework: https://osf.io/m7ts9
Collapse
|
14
|
Lim AH, Ab Rahman N, Ong SM, Paraja J, Rashid R, Parmar IS, Dahlan SN, Tan ZSS, Bohari I, Peariasamy KM, Sivasampu S. Evaluation of BNT162b2 vaccine effectiveness in Malaysia: test negative case-control study. Vaccine 2022; 40:5675-5682. [PMID: 36030123 PMCID: PMC9399819 DOI: 10.1016/j.vaccine.2022.08.032] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/13/2022] [Accepted: 08/15/2022] [Indexed: 12/01/2022]
Abstract
There is a notable lack of vaccine effectiveness studies using test-negative case-controlled approach in low- and middle-income countries which have different logistic, demographic and socio-economic conditions from high-income countries. We aimed to estimate the effectiveness of BNT162b2 vaccine against COVID-19 infection over time, intensive care unit admission, severe or critical disease and death due to COVID-19. This study was conducted in the resident population of Labuan aged ≥18 years who had been tested for SARS-CoV-2 by Reverse-Transcriptase Polymerase Chain Reaction between 1 March 2021 and 31 October 2021. We used a test-negative case-control design where 2644 pairs of cases and controls were matched by age, sex, testing date, nationality and testing reason. Analysis was stratified by age group to estimate age effect (<60 years and ≥60 years). Of 22217 individuals tested by Reverse-Transcriptase Polymerase Chain Reaction, 5100 were positive for SARS-CoV-2 and aged 18 years and above. Overall vaccine effectiveness ≥ 14 days after the second dose was 65.2% (95% CI: 59.8–69.9%) against COVID-19 infection, 92.5% (95% CI: 72.3–98.8%) against intensive care unit admission, and 96.5% (95% CI: 82.3–99.8%) against COVID-19 deaths. Among infected individuals, vaccine effectiveness was 79.2% (95% CI: 42.3–94.1%) in preventing severe or critical disease due to COVID-19. Vaccine effectiveness for ≥60 years was 72.3% (95% CI: 53.4–83.9%) in fully vaccinated individuals, higher than 64.8% (95% CI: 49.3–59.1%) for those <60 years. Two doses of BNT162b2 were highly effective against COVID-19 infection, severe or critical disease, intensive care unit admission and death due to COVID-19. This study addresses a gap in literature on BNT162b2 vaccine effectiveness in low- and middle-income populations and demonstrates the feasibility of such a study design in a resource limited setting while supporting evidence of waning immunity.
Collapse
Affiliation(s)
- Audrey Huili Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia.
| | - Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Su Miin Ong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | | | - Rahmah Rashid
- Labuan State Health Department, Ministry of Health, Malaysia
| | | | | | | | - Ismuni Bohari
- Labuan State Health Department, Ministry of Health, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| |
Collapse
|
15
|
Low EV, Tok PSK, Husin M, Suah JL, Tng BH, Thevananthan T, Appannan MR, Yahaya H, Mohd Zin S, Muhamad Zin F, Sivasampu S, Peariasamy KM. Assessment of Heterologous and Homologous Boosting With Inactivated COVID-19 Vaccine at 3 Months Compared With Homologous Boosting of BNT162b2 at 6 Months. JAMA Netw Open 2022; 5:e2226046. [PMID: 35947381 PMCID: PMC9366545 DOI: 10.1001/jamanetworkopen.2022.26046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Evidence for the timing of booster vaccination after completion of BNT162b2 and CoronaVac primary vaccination is crucial to guide policy recommendations. OBJECTIVE To compare the odds of symptomatic SARS-CoV-2 infection and COVID-19-related outcomes after heterologous and homologous boosting of CoronaVac at 3-month intervals and homologous boosting of BNT162b2 at 6-month intervals, with BNT162b2 primary series (2 doses) as the reference group. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used national data for Malaysia. Participants included all individuals aged 18 years and older who received a complete primary series of CoronaVac or BNT162b2 vaccine and were eligible for a booster dose between November 21, 2021, and December 28, 2021. Data were analyzed from November 21, 2021, to January 7, 2022. EXPOSURES Receipt of a booster vs no booster and categorized into primary series BNT162b2 (2 doses of BNT162b2), primary series CoronaVac (2 doses of CoronaVac), 3 doses of BNT162b2, primary series CoronaVac plus a BNT162b2 booster, and 3 doses of CoronaVac. MAIN OUTCOMES AND MEASURES The primary outcome was symptomatic SARS-CoV-2 infection. The secondary outcomes were COVID-19-related intensive care unit admission and death. All outcomes were observed from the day an individual was considered fully boosted (≥14 days after booster dose). RESULTS Our cohort included 13 840 240 individuals (mean [SD] age, 39.9 [15.5] years; 7 040 298 [50.9%] men; 4 451 180 individuals [32.2%] with ≥1 comorbidities), of whom 5 081 641 individuals (36.7%) had received a booster dose. Using the primary series BNT162b2 recipients as reference, the adjusted odds against symptomatic SAR-CoV-2 infection were lower for individuals who received the primary series CoronaVac plus a BNT162b2 (adjusted odds ratio [aOR], 0.06 [95% CI, 0.05-0.06]), 3 doses of CoronaVac (aOR, 0.08 [95% CI, 0.06-0.10]), or 3 doses of BNT162b2 (aOR, 0.01 [95% CI, 0.00-0.01]). Receipt of heterologous booster (primary series of CoronaVac plus a BNT162b2 booster) was associated with lower odds of SARS-CoV-2 infection (aOR, 0.17 [95% CI, 0.17-0.18]) compared with homologous booster (3 doses of CoronaVac) for individuals aged 60 years and older (aOR, 0.19 [95% CI, 0.19-0.20]). CONCLUSIONS AND RELEVANCE In this cohort study, for individuals who received the CoronaVac primary series and a booster dose of BNT162b2 or CoronaVac at 3 months, the observed odds of symptomatic SARS-CoV-2 infection were similar to individuals who received the BNT162b2 primary series plus a third dose of BNT162b2 at 6 months. Heterologous booster is recommended for individuals aged 60 years or older who received the CoronaVac primary series, given the lower observed odds against symptomatic SARS-CoV-2 infection among those who received a BNT1612b2 booster.
Collapse
Affiliation(s)
- Ee Vien Low
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Jing Lian Suah
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Boon Hwa Tng
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | | | | | - Hazlina Yahaya
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Shahanizan Mohd Zin
- Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Faizah Muhamad Zin
- Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Kalaiarasu M. Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| |
Collapse
|
16
|
Ab Rahman N, Lim MT, Lee FY, Ong SM, Peariasamy KM, Sivasampu S. A Case-Based Monitoring Approach to Evaluate Safety of COVID-19 Vaccines in a Partially Integrated Health Information System: A Study Protocol. Front Pharmacol 2022; 13:834940. [PMID: 35910370 PMCID: PMC9328743 DOI: 10.3389/fphar.2022.834940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
In response to Coronavirus disease 2019 (COVID-19) global pandemic, various COVID-19 vaccines were rapidly administered under emergency use authorization. Rare outcomes associated with COVID-19 vaccines might be less likely to be captured in clinical trials, leading to a knowledge gap in real-world vaccine safety. In contrast with high-income countries, many low-to-middle income countries have limited capacity to conduct active surveillance, owing to the absence of large and fully-integrated health information databases. This paper describes the study protocol, which aims to investigate risk of prespecified adverse events of special interests following COVID-19 vaccination in a partially integrated health information system with non-shareable electronic health records. The SAFECOVAC study is a longitudinal, observational retrospective study of active safety surveillance using case-based monitoring approach. This involves linkage of several administrative databases and hospitalization data monitoring to identify adverse events of special interests following administration of COVID-19 vaccines in Malaysia. The source population comprises of all individuals who received at least one dose of COVID-19 vaccine. Self-controlled design and vaccinated case-coverage design will be employed to assess risk of adverse events of special interests and determine the association with vaccine exposure. Data on vaccination records will be obtained from the national COVID-19 vaccination register to identify the vaccination platforms, doses and the timing of vaccinations. The outcome of this study is hospitalization for the adverse events of special interests between March 2021 and June 2022. The outcomes will be obtained through linkage with hospital admission database and national pharmacovigilance database. Findings will provide analysis of real-world data which can inform deliberations by government and public health decision makers relative to the refinement of COVID-19 vaccination recommendations.
Collapse
Affiliation(s)
- Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
- *Correspondence: Norazida Ab Rahman,
| | - Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Fei Yee Lee
- Clinical Research Centre, Selayang Hospital, Ministry of Health, Selangor, Malaysia
| | - Su Miin Ong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Kalaiarasu M. Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| |
Collapse
|
17
|
Chuenkitmongkol S, Solante R, Burhan E, Chariyalertsak S, Chiu NC, Do-Van D, Husin M, Hwang KP, Kiertiburanakul S, Kulkarni PS, Lee PI, Lobo RC, Nghia CH, Ong-Lim A, Sivasampu S, Suah JL, Tok PSK, Thwaites G. Expert Review on global real-world vaccine effectiveness against SARS-CoV-2. Expert Rev Vaccines 2022; 21:1255-1268. [PMID: 35748494 DOI: 10.1080/14760584.2022.2092472] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION COVID-19 vaccines have been highly effective in reducing morbidity and mortality during the pandemic. While primary series vaccination rates are generally high in Southeast Asian (SEA) countries, various factors have limited the rollout and impact of booster doses. AREAS COVERED We reviewed 79 studies in the publicly available International Vaccine Access Center (IVAC) VIEW-hub platform on vaccine effectiveness (VE) after primary immunizations with two-dose schedules. VE data were reported for SARS-CoV-2 infection, COVID-19-related hospitalizations and deaths, and stratified across variants of concern (VOC), age, study design and prior SARS-CoV-2 infection for mRNA vaccines (BNT162b2, mRNA-1273 and combinations of both), vector vaccines (AstraZeneca, AZD1222 "Vaxzevria") and inactivated virus vaccines (CoronaVac). EXPERT OPINION The most-studied COVID-19 vaccines provide consistently high (>90%) protection against serious clinical outcomes like hospitalizations and deaths, regardless of variant. Additionally, this protection appears equivalent for mRNA vaccines and vector vaccines like AZD1222, as supported by our analysis of local Asian and relevant international data, and by insights from SEA experts. Given the continued impact of COVID-19 hospitalizations and deaths on healthcare systems worldwide, encouraging vaccination strategies that can reduce this burden is more relevant than attempting to prevent broader but milder infections with specific variants, including Omicron.
Collapse
Affiliation(s)
| | | | - Erlina Burhan
- Faculty of Medicine Universitas Indonesia, RSUP Persahabatan, Jakarta, Indonesia
| | | | | | - Dung Do-Van
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Kao-Pin Hwang
- China Medical University Children's Hospital, Taichung, Taiwan
| | | | | | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | | | - Anna Ong-Lim
- College of Medicine - Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Jing Lian Suah
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, and The Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
| |
Collapse
|
18
|
Ab Rahman N, Lim MT, Lee FY, Lee SC, Ramli A, Saharudin SN, King TL, Anak Jam EB, Ayub NA, Sevalingam RK, Bahari R, Ibrahim NN, Mahmud F, Sivasampu S, Peariasamy KM. Risk of serious adverse events after the BNT162b2, CoronaVac, and ChAdOx1 vaccines in Malaysia: A self-controlled case series study. Vaccine 2022; 40:4394-4402. [PMID: 35667917 PMCID: PMC9163997 DOI: 10.1016/j.vaccine.2022.05.075] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND Rapid deployment of COVID-19 vaccines is challenging for safety surveillance, especially on adverse events of special interest (AESIs) that were not identified during the pre-licensure studies. This study evaluated the risk of hospitalisations for predefined diagnoses among the vaccinated population in Malaysia. METHODS Hospital admissions for selected diagnoses between 1 February 2021 and 30 September 2021 were linked to the national COVID-19 immunisation register. We conducted self-controlled case-series study by identifying individuals who received COVID-19 vaccine and diagnosis of thrombocytopenia, venous thromboembolism, myocardial infarction, myocarditis/pericarditis, arrhythmia, stroke, Bell's Palsy, and convulsion/seizure. The incidence of events was assessed in risk period of 21 days postvaccination relative to the control period. We used conditional Poisson regression to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI) with adjustment for calendar period. RESULTS There was no increase in the risk for myocarditis/pericarditis, Bell's Palsy, stroke, and myocardial infarction in the 21 days following either dose of BNT162b2, CoronaVac, and ChAdOx1 vaccines. A small increased risk of venous thromboembolism (IRR 1.24; 95% CI 1.02, 1.49), arrhythmia (IRR 1.16, 95% CI 1.07, 1.26), and convulsion/seizure (IRR 1.26; 95% CI 1.07, 1.48) was observed among BNT162b2 recipients. No association between CoronaVac vaccine was found with all events except arrhythmia (IRR 1.15; 95% CI 1.01, 1.30). ChAdOx1 vaccine showed significant association for thrombocytopenia (IRR 2.67; 95% CI 1.21, 5.89) and venous thromboembolism (IRR 2.22; 95% CI 1.17, 4.21). CONCLUSION This study shows acceptable safety profiles of COVID-19 vaccines among recipients of BNT162b2, CoronaVac, and ChAdOx1 vaccines. This information can be used together with effectiveness data for risk-benefit analysis of the vaccination program. Further surveillance with more data is required to assess AESIs following COVID-19 vaccination in short- and long-term.
Collapse
Affiliation(s)
- Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia.
| | - Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia
| | - Fei Yee Lee
- Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia
| | - Sing Chet Lee
- National Pharmaceutical Regulatory Agency, Selangor, Malaysia
| | - Azuana Ramli
- National Pharmaceutical Regulatory Agency, Selangor, Malaysia
| | | | - Teck Long King
- Clinical Research Centre, Sarawak General Hospital, Sarawak, Malaysia
| | | | - Nor Aliya Ayub
- Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | | | - Rashidah Bahari
- Clinical Research Centre, Putrajaya Hospital, Putrajaya, Malaysia
| | | | - Fatihah Mahmud
- Clinical Research Centre, Tengku Ampuan Afzan Hospital, Pahang, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia
| | | | | |
Collapse
|
19
|
Husin M, Tok PSK, Suah JL, Thevananthan T, Tng BH, Peariasamy KM, Sivasampu S. Real-world effectiveness of BNT162b2 vaccine against SARS-CoV-2 infection among adolescents (12 to 17-year-olds) in Malaysia. Int J Infect Dis 2022; 121:55-57. [PMID: 35500793 PMCID: PMC9055416 DOI: 10.1016/j.ijid.2022.04.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES In this study, we aimed to investigate vaccine effectiveness (VE) against SARS-CoV-2 infections among adolescents aged 12 to 17 years in Malaysia and examine potential VE differences after full vaccination. METHODS We consolidated data on COVID-19 testing, vaccination, and outcomes for all public school-going adolescents in Malaysia from September 1, 2021, to December 31, 2021, and estimated the VE against SARS-CoV-2 infections during this period. Cases were defined as positive tests, either by reverse transcriptase- PCR (RT-PCR) or rapid antigen (RTK-Ag) testing, while controls were negative tests. Secondarily, we restricted the analysis to all tests performed in December 2021 and compared VE by month of full vaccination. RESULTS A total of 175,880 eligible tests (53.4% or 93,995 RT-PCR tests) were included. After full vaccination with BNT162b2, VE against SARS-CoV-2 infections was 65.7% (95% confidence interval [CI] 64.4, 66.9) over the study period. When restricted to tests in December 2021, VEs for those fully vaccinated in September 2021, October 2021, and November 2021 were comparable (60.6% [95% CI 23.7, 81.5], 56.9% [95% CI 51.1, 62.0], and 65.7% [95% CI 59.8, 70.7] respectively). CONCLUSIONS Among adolescents, full vaccination with BNT162b2 offered considerable protection against SARS-CoV-2 infections over at least three months without substantial evidence of waning.
Collapse
Affiliation(s)
- Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Malaysia.
| | - Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Malaysia.
| | - Jing Lian Suah
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Malaysia
| | - Thevesh Thevananthan
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, 62590, Malaysia
| | - Boon Hwa Tng
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Malaysia
| |
Collapse
|
20
|
Ab Rahman N, Lim MT, Thevendran S, Ahmad Hamdi N, Sivasampu S. Medication Regimen Complexity and Medication Burden Among Patients With Type 2 Diabetes Mellitus: A Retrospective Analysis. Front Pharmacol 2022; 13:808190. [PMID: 35387353 PMCID: PMC8978326 DOI: 10.3389/fphar.2022.808190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/28/2022] [Indexed: 12/19/2022] Open
Abstract
Introduction: Most type 2 diabetes mellitus (T2DM) patients with chronic conditions require multiple medications to achieve and maintain good glycemic control. Objective: This study assessed medication burden, regimen complexity, and adherence among T2DM patients and evaluate its association with glycemic control. Method: We analyzed data of 2,696 T2DM patients at public health clinics in Malaysia from January 2018 until May 2019. Medication burden was based on medication count, regimen complexity was measured using the validated Medication Regimen Complexity Index (MRCI) tool, and adherence was measured using proportion of days covered (PDC) formula. Logistic regression models were used to compute unadjusted and adjusted odds ratio (aOR) with 95% confidence interval (CI) for association between the medication parameters and glycemic control (HbA1c ≤ 7.0%) over a 90-day period. Results: The cohort mean age was 60.4 years old (±10.8) and 62.9% were female. Overall, the average medication count was 4.8 with MRCI score of 15.1. Mean adherence score (PDC) was 90%. High medication count and MRCI scores were associated with lower odds of achieving good glycemic control (aOR 0.88; 95% CI 0.82, 0.94 and aOR 0.89; 95% CI 0.87, 0.92, respectively) while inverse association was observed between adherence and HbA1c level (aOR 2.7, 95% CI 1.66, 5.19). Similar findings were observed for diabetes-specific measures. Conclusions: High medication count, high regimen complexity, and low medication adherence were associated with poor glycemic control over the 3-month follow-up period. These parameters could be used to identify patients with complex pharmacotherapy regimens so that targets for intervention can be taken to achieve optimum outcomes and ease of self-care.
Collapse
Affiliation(s)
- Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | | | - Najwa Ahmad Hamdi
- Public Health Development Division, Ministry of Health, Putrajaya, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| |
Collapse
|
21
|
Suah JL, Husin M, Keng PS, Hwa B, Thevananthan T, Low EV, Appannan MR, Zin FM, Zin SM, Yahaya H, Peariasamy KM, Sivasampu S. Waning COVID-19 Vaccine Effectiveness for BNT162b2 and CoronaVac in Malaysia: An Observational Study. Int J Infect Dis 2022; 119:69-76. [PMID: 35331933 PMCID: PMC8938298 DOI: 10.1016/j.ijid.2022.03.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We aimed to investigate and compare waning vaccine effectiveness (VE) against COVID-19 infection, COVID-19 related ICU admission and COVID-19 related death for BNT162b2 and CoronaVac vaccines. METHODS We consolidated national data on COVID-19 vaccination and outcomes, and used cases from 1 to 30 September 2021 to compare VE between the 'early' (fully vaccinated in April to June 2021) and 'late' (July to August 2021) groups. We estimated VE against COVID-19 infection with a negative binomial regression, and VE against ICU admission and death among confirmed COVID-19 cases with a logistic regression. RESULTS For BNT162b2, VE against COVID-19 infections declined from 90•8% (95% CI 89•4, 92•1) in the 'late' group to 79•3% (95% CI 76•1, 82•1) in the 'early' group. VE for BNT162b2 against ICU admission and death were stable. For CoronaVac, VE waned against COVID-19 infections from 74•5% (95% CI 70•6, 78•0) to 30•4% (95% CI 18•8, 40•3). Effectiveness against ICU admission waned from 56•0% (95% CI 51•2, 60•2) to 28•7% (95% CI 12•2, 42•1). CoronaVac's effectiveness against death remained stable. CONCLUSION VE against COVID-19 infection waned after three to five months of full vaccination for both BNT162b2 and CoronaVac vaccines in Malaysia. For CoronaVac, protection against ICU admission also declined.
Collapse
Affiliation(s)
- Jing Lian Suah
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia.
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia.
| | - Peter Seah Keng
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia
| | - Boon Hwa
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia
| | - Thevesh Thevananthan
- Disease Control Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia
| | - Ee Vien Low
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia
| | | | - Faizah Muhamad Zin
- Medical Development Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia
| | - Shahanizan Mohd Zin
- Medical Development Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia
| | - Hazlina Yahaya
- Disease Control Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia
| |
Collapse
|
22
|
Suah JL, Tok PSK, Ong SM, Husin M, Tng BH, Sivasampu S, Thevananthan T, Appannan MR, Muhamad Zin F, Mohd Zin S, Yahaya H, Rusli N, Ujang MF, Mohd Ibrahim H, Abdullah NH, Peariasamy KM. PICK-ing Malaysia's Epidemic Apart: Effectiveness of a Diverse COVID-19 Vaccine Portfolio. Vaccines (Basel) 2021; 9:vaccines9121381. [PMID: 34960126 PMCID: PMC8706086 DOI: 10.3390/vaccines9121381] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 01/14/2023] Open
Abstract
Malaysia rolled out a diverse portfolio of predominantly three COVID-19 vaccines (AZD1222, BNT162b2, and CoronaVac) beginning 24 February 2021. We evaluated vaccine effectiveness with two methods, covering 1 April to 15 September 2021: (1) the screening method for COVID-19 (SARS-CoV-2) infection and symptomatic COVID-19; and (2) a retrospective cohort of confirmed COVID-19 cases for COVID-19 related ICU admission and death using logistic regression. The screening method estimated partial vaccination to be 48.8% effective (95% CI: 46.8, 50.7) against COVID-19 infection and 33.5% effective (95% CI: 31.6, 35.5) against symptomatic COVID-19. Full vaccination is estimated at 87.8% effective (95% CI: 85.8, 89.7) against COVID-19 infection and 85.4% effective (95% CI: 83.4, 87.3) against symptomatic COVID-19. Among the cohort of confirmed COVID-19 cases, partial vaccination with any of the three vaccines is estimated at 31.3% effective (95% CI: 28.5, 34.1) in preventing ICU admission, and 45.1% effective (95% CI: 42.6, 47.5) in preventing death. Full vaccination with any of the three vaccines is estimated at 79.1% effective (95% CI: 77.7, 80.4) in preventing ICU admission and 86.7% effective (95% CI: 85.7, 87.6) in preventing deaths. Our findings suggest that full vaccination with any of the three predominant vaccines (AZD1222, BNT162b2, and CoronaVac) in Malaysia has been highly effective in preventing COVID-19 infection, symptomatic COVID-19, COVID-19-related ICU admission, and death.
Collapse
Affiliation(s)
- Jing Lian Suah
- COVID-19 Immunisation Task Force, Government of Malaysia, Putrajaya 62000, Malaysia; (B.H.T.); (T.T.)
- Correspondence:
| | - Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia; (P.S.K.T.); (S.M.O.); (M.H.); (S.S.); (K.M.P.)
| | - Su Miin Ong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia; (P.S.K.T.); (S.M.O.); (M.H.); (S.S.); (K.M.P.)
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia; (P.S.K.T.); (S.M.O.); (M.H.); (S.S.); (K.M.P.)
| | - Boon Hwa Tng
- COVID-19 Immunisation Task Force, Government of Malaysia, Putrajaya 62000, Malaysia; (B.H.T.); (T.T.)
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia; (P.S.K.T.); (S.M.O.); (M.H.); (S.S.); (K.M.P.)
| | - Thevesh Thevananthan
- COVID-19 Immunisation Task Force, Government of Malaysia, Putrajaya 62000, Malaysia; (B.H.T.); (T.T.)
| | - Maheshwara Rao Appannan
- Disease Control Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia; (M.R.A.); (H.Y.); (N.R.)
| | - Faizah Muhamad Zin
- Medical Development Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia; (F.M.Z.); (S.M.Z.); (M.F.U.)
| | - Shahanizan Mohd Zin
- Medical Development Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia; (F.M.Z.); (S.M.Z.); (M.F.U.)
| | - Hazlina Yahaya
- Disease Control Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia; (M.R.A.); (H.Y.); (N.R.)
| | - Norhayati Rusli
- Disease Control Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia; (M.R.A.); (H.Y.); (N.R.)
| | - Mohd Fikri Ujang
- Medical Development Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia; (F.M.Z.); (S.M.Z.); (M.F.U.)
| | - Hishamshah Mohd Ibrahim
- Office of Director-General, Ministry of Health Malaysia, Putrajaya 62590, Malaysia; (H.M.I.); (N.H.A.)
| | - Noor Hisham Abdullah
- Office of Director-General, Ministry of Health Malaysia, Putrajaya 62590, Malaysia; (H.M.I.); (N.H.A.)
| | - Kalaiarasu M. Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia; (P.S.K.T.); (S.M.O.); (M.H.); (S.S.); (K.M.P.)
| |
Collapse
|
23
|
Ng SW, Hwong WY, Husin M, Ab Rahman N, Nasir NH, Juval K, Sivasampu S. Assessing the availability of teleconsultation and the extent of its use in Malaysian public primary care clinics: a cross-sectional study (Preprint). JMIR Form Res 2021; 6:e34485. [PMID: 35532973 PMCID: PMC9127641 DOI: 10.2196/34485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 01/27/2023] Open
Abstract
Background The integration of teleconsultation into health care systems as a complement to existing approaches to care is growing rapidly. There is, however, limited information on the extent of its implementation across low- and middle-income countries. Objective The aim of this study was to determine the availability and the extent of teleconsultation in Malaysian primary care clinics. Methods A cross-sectional study of public primary care clinics in Malaysia was conducted between November 2020 and December 2020. All clinics in Malaysia that see more than 300 daily patients were recruited. A web-based, self-administered questionnaire including questions on availability of the service, whether it uses video or telephone, and the types of services it provides was distributed to the medical officer in charge of each clinic. Results In total, 97.6% (249/255) of the clinics responded. Out of these clinics, 45.8% (114/249) provided teleconsultation. A majority of the clinics providing consultation (69/114, 60.5%) provided only telephone consultation, while 24.6% (28/114) of the clinics offered video and telephone consultation, and 14.9% (17/114) offered only video consultation. Eighty percent (92/114) of the clinics were located in urban areas. A breakdown by state showed that 17.5% (20/114) and 16.7% (19/114) of the clinics were from two larger states; other states comprised less than 10% each (range 7-9/114). For the clinics providing video consultation, funding for the service came mostly (42/45, 93%) from the Ministry of Health. Conversely, nearly 1 out of 4 (23/97) clinics that provided telephone consultation funded the service either from donations or through self-funding. Most of the clinics provided teleconsultation for diabetes and hypertension. Less than 50% of the clinics with teleconsultation used it for follow up with allied health care providers or pharmacists (video consultation, 20/45; telephone consultation, 36/97). Conclusions Our findings show that telephone consultation is more widely used than video consultation, despite a quarter of its funding being self-subsidized or obtained through donations. Also, teleconsultation was less utilized by allied health care providers and pharmacists. Plans for the expansion of teleconsultation in Malaysian primary health care should take into consideration these findings to ensure a better and more cost-effective implementation of the service.
Collapse
Affiliation(s)
- Sock Wen Ng
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Wen Yea Hwong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Kawselyah Juval
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| |
Collapse
|
24
|
Lim MT, Ong SM, Tong SF, Groenewegen P, Sivasampu S. Comparison between primary care service delivery in Malaysia and other participating countries of the QUALICOPC project: a cross-sectional study. BMJ Open 2021; 11:e047126. [PMID: 33952553 PMCID: PMC8103403 DOI: 10.1136/bmjopen-2020-047126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Most countries including Malaysia have set goals to incorporate a strong primary care into the healthcare system. The aim of this study was to evaluate the strength of service delivery process dimensions in Malaysia and compare it with England, the Netherlands, Spain, North Macedonia, Romania and Turkey which participated in the Quality and Costs of Primary Care (QUALICOPC) study. METHODS This cross-sectional study utilised the QUALICOPC study data on primary care performance, which was conducted in 2011-2013 (QUALICOPC in Europe Australia, New Zealand and Canada) and 2015-2016 (Malaysia). A standardised questionnaire was completed by primary care practitioners from participating countries. Multilevel regression analysis and composite scores were constructed to compare the performance of primary care on four process dimensions: accessibility, comprehensiveness, continuity of care and coordination. RESULTS The high-income countries with strong primary care performed better in comprehensiveness, continuity and coordination but poorer in accessibility to services compared with upper-middle-income countries. Among the upper-middle-income countries, Malaysia scored the best in comprehensiveness and coordination. None of the studied countries were having consistent performance over all indicators either in their respective best or worst primary care services delivery dimensions. CONCLUSIONS There is a wide variation in primary care services delivery across and within the studied countries. The findings indicate room for quality improvement activities to strengthen primary healthcare services. This includes addressing current healthcare challenges in response to the population health needs which are essential for more integrated and efficient primary care services delivery.
Collapse
Affiliation(s)
- Ming Tsuey Lim
- Centre for Clinical Outcome Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia
| | - Su Miin Ong
- Centre for Clinical Outcome Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia
| | - Seng Fah Tong
- Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Peter Groenewegen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Departments of Human Geography and Department of Sociology, Utrecht University, Utrecht, The Netherlands
| | - Sheamini Sivasampu
- Centre for Clinical Outcome Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia
| |
Collapse
|
25
|
Lim MT, Ab Rahman N, Teh XR, Chan CL, Thevendran S, Ahmad Hamdi N, Lim KK, Sivasampu S. Optimal cut-off points for adherence measure among patients with type 2 diabetes in primary care clinics: a retrospective analysis. Ther Adv Chronic Dis 2021; 12:2040622321990264. [PMID: 33643600 PMCID: PMC7894582 DOI: 10.1177/2040622321990264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/05/2021] [Indexed: 12/28/2022] Open
Abstract
Background Medication adherence measures are often dichotomized to classify patients into those with good or poor adherence using a cut-off value ⩾80%, but this cut-off may not be universal across diseases or medication classes. This study aimed to examine the cut-off value that optimally distinguish good and poor adherence by using the medication possession ratio (MPR) and proportion of days covered (PDC) as adherence measures and glycated hemoglobin (HbA1c) as outcome measure among type 2 diabetes mellitus (T2DM) patients. Method We used pharmacy dispensing data of 1461 eligible T2DM patients from public primary care clinics in Malaysia treated with oral antidiabetic drugs between January 2018 and May 2019. Adherence rates were calculated during the period preceding the HbA1c measurement. Adherence cut-off values for the following conditions were compared: adherence measure (MPR versus PDC), assessment period (90-day versus 180-day), and HbA1c target (⩽7.0% versus ⩽8.0%). Results The optimal adherence cut-offs for MPR and PDC in predicting HbA1c ⩽7.0% ranged between 86.1% and 98.3% across the two assessment periods. In predicting HbA1c ⩽8.0%, the optimal adherence cut-offs ranged from 86.1% to 92.8%. The cut-off value was notably higher with PDC as the adherence measure, shorter assessment period, and a stricter HbA1c target (⩽7.0%) as outcome. Conclusion We found that optimal adherence cut-off appeared to be slightly higher than the conventional value of 80%. The adherence thresholds may vary depending on the length of assessment period and outcome definition but a reasonably wise cut-off to distinguish good versus poor medication adherence to be clinically meaningful should be at 90%.
Collapse
Affiliation(s)
- Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Block B4, No. 1, Jalan Setia Murni U13/52, Shah Alam, Selangor, 40170, Malaysia
| | - Xin Rou Teh
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Chee Lee Chan
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | | | | | - Ka Keat Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| |
Collapse
|
26
|
Ang SH, Hwong WY, Bots ML, Sivasampu S, Abdul Aziz AF, Hoo FK, Vaartjes I. Risk of 28-day readmissions among stroke patients in Malaysia (2008-2015): Trends, causes and its associated factors. PLoS One 2021; 16:e0245448. [PMID: 33465103 PMCID: PMC7815148 DOI: 10.1371/journal.pone.0245448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Risk of readmissions is an important quality indicator for stroke care. Such information is limited among low- and middle-income countries. We assessed the trends for 28-day readmissions after a stroke in Malaysia from 2008 to 2015 and evaluated the causes and factors associated with readmissions in 2015. METHODS Using the national hospital admission records database, we included all stroke patients who were discharged alive between 2008 and 2015 for this secondary data analysis. The risk of readmissions was described in proportion and trends. Reasons were coded according to the International Classification of Diseases, 10th Edition. Multivariable logistic regression was performed to identify factors associated with readmissions. RESULTS Among 151729 patients, 11 to 13% were readmitted within 28 days post-discharge from their stroke events each year. The trend was constant for ischemic stroke but decreasing for hemorrhagic stroke. The leading causes for readmissions were recurrent stroke (32.1%), pneumonia (13.0%) and sepsis (4.8%). The risk of 28-day readmission was higher among those with stroke of hemorrhagic (adjusted odds ratio (AOR): 1.52) and subarachnoid hemorrhage (AOR: 2.56) subtypes, and length of index admission >3 days (AOR: 1.48), but lower among younger age groups of 35-64 (AORs: 0.61-0.75), p values <0.001. CONCLUSION The risk of 28-day readmission remained constant from 2008 to 2015, where one in eight stroke patients required readmission, mainly attributable to preventable causes. Age, ethnicity, stroke subtypes and duration of the index admission influenced the risk of readmission. Efforts should focus on minimizing potentially preventable admissions, especially among those at higher risk.
Collapse
Affiliation(s)
- Swee Hung Ang
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Wen Yea Hwong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Selangor, Malaysia
| | - Fan Kee Hoo
- Neurology Unit, Department of Medicine, Faculty of Medicine, Universiti Putra Malaysia, Selangor, Malaysia
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
27
|
Lee YL, Lim YMF, Law KB, Sivasampu S. Correction to: Intra-cluster correlation coefficients in primary care patients with type 2 diabetes and hypertension. Trials 2020; 21:778. [PMID: 32912297 PMCID: PMC7488537 DOI: 10.1186/s13063-020-04715-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yi Lin Lee
- Centre for Clinical Trial, Institute for Clinical Research, Ampang Hospital, Ministry of Health, Jalan Mewah Utara, Pandan Mewah, 68000, Ampang, Selangor, Malaysia.
| | - Yvonne Mei Fong Lim
- Centre for Clinical Outcome Research, Institute for Clinical Research, National Institute of Health, Ministry of Health, Kompleks Institut Kesihatan Negara (NIH), No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Kian Boon Law
- Centre for Clinical Trial, Institute for Clinical Research, Ampang Hospital, Ministry of Health, Jalan Mewah Utara, Pandan Mewah, 68000, Ampang, Selangor, Malaysia
| | - Sheamini Sivasampu
- Centre for Clinical Outcome Research, Institute for Clinical Research, National Institute of Health, Ministry of Health, Kompleks Institut Kesihatan Negara (NIH), No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| |
Collapse
|
28
|
Teh XR, Lim MT, Tong SF, Husin M, Khamis N, Sivasampu S. Quality of hypertension management in public primary care clinics in Malaysia: An update. PLoS One 2020; 15:e0237083. [PMID: 32780769 PMCID: PMC7418969 DOI: 10.1371/journal.pone.0237083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 07/20/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Adequate control of hypertension is a global challenge and is the key to reduce cardiovascular disease risk factors. This study evaluates management of hypertensive patients in primary care clinics in Malaysia. METHODS A cross-sectional analysis of 13 784 medical records from 20 selected public primary care clinics in Malaysia was performed for patients aged ≥30 years old who were diagnosed with hypertension and had at least one visit between 1st November 2016 and 30th June 2019. Multivariable logistic regression adjusted for complex survey design was used to determine the association between process of care and blood pressure (BP) control among the hypertensive patients. RESULTS Approximately 50% of hypertensive patients were obese, 38.4% of age ≥65 years old, 71.2% had at least one comorbidity and approximately one-third were on antihypertensive monotherapy. Approximately two-third of the hypertensive patients with diabetic proteinuria were prescribed with the appropriate choice of antihypertensive agents. Approximately half of the patients received at least 70% of the target indicated care and 42.8% had adequately controlled BP. After adjusting for covariates, patients who received counseling on exercise were positively associated with adequate BP control. Conversely, patients who were prescribed with two or more antihypertensive agents were negatively associated with good BP control. CONCLUSIONS These findings indicated that BP control was suboptimal and deficient in the process of care with consequent gaps in guidelines and actual clinical practices. This warrants a re-evaluation of the current strategies and approaches to improve the quality of hypertension management and ultimately to improve outcome.
Collapse
Affiliation(s)
- Xin Rou Teh
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institute of Health (NIH), Ministry of Health, Selangor, Malaysia
| | - Ming Tsuey Lim
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institute of Health (NIH), Ministry of Health, Selangor, Malaysia
| | - Seng Fah Tong
- Department of Family Medicine, University Kebangsaan Malaysia, Selangor, Malaysia
| | - Masliyana Husin
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institute of Health (NIH), Ministry of Health, Selangor, Malaysia
| | - Noraziani Khamis
- Center for Clinical Governance Development, Institute for Health Management, National Institutes of Health, Ministry of Health (NIH), Selangor, Malaysia
| | - Sheamini Sivasampu
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institute of Health (NIH), Ministry of Health, Selangor, Malaysia
| |
Collapse
|
29
|
Wong WJ, Mohd Norzi A, Ang SH, Chan CL, Jaafar FSA, Sivasampu S. The effects of enhanced primary healthcare interventions on primary care providers' job satisfaction. BMC Health Serv Res 2020; 20:311. [PMID: 32293446 PMCID: PMC7158075 DOI: 10.1186/s12913-020-05183-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background In response to the rising burden of cardiovascular risk factors, the Malaysian government has implemented Enhanced Primary Healthcare (EnPHC) interventions in July 2017 at public clinic level to improve management and clinical outcomes of type 2 diabetes and hypertensive patients. Healthcare providers (HCPs) play crucial roles in healthcare service delivery and health system reform can influence HCPs’ job satisfaction. However, studies evaluating HCPs’ job satisfaction following primary care transformation remain scarce in low- and middle-income countries. This study aims to evaluate the effects of EnPHC interventions on HCPs’ job satisfaction. Methods This is a quasi-experimental study conducted in 20 intervention and 20 matched control clinics. We surveyed all HCPs who were directly involved in patient management. A self-administered questionnaire which included six questions on job satisfaction were assessed on a scale of 1–4 at baseline (April and May 2017) and post-intervention phase (March and April 2019). Unadjusted intervention effect was calculated based on absolute differences in mean scores between intervention and control groups after implementation. Difference-in-differences analysis was used in the multivariable linear regression model and adjusted for providers and clinics characteristics to detect changes in job satisfaction following EnPHC interventions. A negative estimate indicates relative decrease in job satisfaction in the intervention group compared with control group. Results A total of 1042 and 1215 HCPs responded at baseline and post-intervention respectively. At post-intervention, the intervention group reported higher level of stress with adjusted differences of − 0.139 (95% CI -0.266,-0.012; p = 0.032). Nurses, being the largest workforce in public clinics were the only group experiencing dissatisfaction at post-intervention. In subgroup analysis, nurses from intervention group experienced increase in work stress following EnPHC interventions with adjusted differences of − 0.223 (95% CI -0.419,-0.026; p = 0.026). Additionally, the same group were less likely to perceive their profession as well-respected at post-intervention (β = − 0.175; 95% CI -0.331,-0.019; p = 0.027). Conclusions Our findings suggest that EnPHC interventions had resulted in some untoward effect on HCPs’ job satisfaction. Job dissatisfaction can have detrimental effects on the organisation and healthcare system. Therefore, provider experience and well-being should be considered before introducing healthcare delivery reforms to avoid overburdening of HCPs.
Collapse
Affiliation(s)
- Wen Jun Wong
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia. .,Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52 Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
| | - Aisyah Mohd Norzi
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Swee Hung Ang
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia.,Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Lee Chan
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Faeiz Syezri Adzmin Jaafar
- Institute for Health Management, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Sheamini Sivasampu
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| |
Collapse
|
30
|
Chin MC, Sivasampu S, Wijemunige N, Rannan-Eliya RP, Atun R. The quality of care in outpatient primary care in public and private sectors in Malaysia. Health Policy Plan 2020; 35:7-15. [PMID: 31625556 DOI: 10.1093/heapol/czz117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 11/13/2022] Open
Abstract
In Malaysia, first-contact, primary care is provided by parallel public and private sectors, which are completely separate in organization, financing and governance. As the country considers new approaches to financing, including using public schemes to pay for private care, it is crucial to examine the quality of clinical care in the two sectors to make informed decisions on public policy. This study intends to measure and compare the quality of clinical care between public and private primary care services in Malaysia and, to the extent possible, assess quality with the developed economies that Malaysia aspires to join. We carried out a retrospective analysis of the National Medical Care Survey 2014, a nationally representative survey of doctor-patient encounters in Malaysia. We assessed clinical quality for 27 587 patient encounters using data on 66 internationally validated quality indicators. Aggregate scores were constructed, and comparisons made between the public and private sectors. Overall, patients received the recommended care just over half the time (56.5%). The public sector performed better than the private sector, especially in the treatment of acute conditions, chronic conditions and in prescribing practices. Both sectors performed poorly in the indicators that are most resource intensive, suggesting that resource constraints limit overall quality. A comparison with 2003 data from the USA, suggests that performance in Malaysia was similar to that a decade earlier in the USA for common indicators. The public sector showed better performance in clinical care than the private sector, contrary to common perceptions in Malaysia and despite providing worse consumer quality. The overall quality of outpatient clinical care in Malaysia appears comparable to other developed countries, yet there are gaps in quality, such as in the management of hypertension, which should be tackled to improve overall health outcomes.
Collapse
Affiliation(s)
- May Chien Chin
- Institute of Clinical Research, Ministry of Health Malaysia, Block B4, National Institutes of Health (NIH), No.1, Jalan Setia Murni U13/52, Seksyen U13, Shah Alam, 40170 Selangor Darul Ehsan, Malaysia
| | - Sheamini Sivasampu
- Institute of Clinical Research, Ministry of Health Malaysia, Block B4, National Institutes of Health (NIH), No.1, Jalan Setia Murni U13/52, Seksyen U13, Shah Alam, 40170 Selangor Darul Ehsan, Malaysia
| | | | | | - Rifat Atun
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| |
Collapse
|
31
|
Hwong WY, Lim YMF, Khoo EM, Sivasampu S. High-risk nonsteroidal anti-inflammatory drugs prescribing in primary care: results from National Medical Care Survey Malaysia. Int J Clin Pharm 2020; 42:489-499. [PMID: 31960271 DOI: 10.1007/s11096-020-00966-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
Abstract
Background Information on the extent of high-risk prescribing for nonsteroidal anti-inflammatory drugs (NSAIDs) across developing countries is scarce. Objectives This study examines the prescribing pattern for NSAIDs in primary care, assesses the extent of high-risk NSAIDs prescribing and identifies associated factors. Setting 129 public and 416 private primary care clinics in Malaysia. Methods Data were derived from the National Medical Care Survey 2014, a cross-sectional survey on primary care morbidity patterns and clinical activities in Malaysia. Types of NSAIDs, indications for NSAIDs use and proportion of high-risk NSAIDs prescribing were assessed. Factors associated with high-risk NSAIDs prescribing were identified with a multivariable logistic regression. Weighted results, adjusted for sampling design and non-response were presented. Main outcome measures Prescribing pattern of NSAIDs, proportion of high-risk NSAIDs prescribing and its associated factors. Results Among the 55,489 patients who received NSAIDs, diclofenac was the most frequently prescribed NSAID (40.5%, 95% CI 40.1-40.9%), followed by mefenamic acid (29.2%, 95% CI 28.8-29.6%). The commonest indications for NSAIDs use were musculoskeletal condition and respiratory tract infection, both at 17.8% (95% CI 17.4-18.1%). A total of 22.9% (95% CI 22.6-23.3%) patients received high-risk NSAID prescriptions. Of these, 47.8% (95% CI 46.9-48.7%) did not receive adequate gastroprotection despite being at risk, 24.8% (95% CI 24.0-25.5%) were prescribed NSAIDs despite having cardiovascular comorbidities and 22.4% (95% CI 21.7-23.2%) were prescribed high-dose NSAIDs. The odds of receiving high-risk NSAID prescriptions increased with the number of drugs prescribed (OR 1.23, 95% CI 1.06-1.43) and the number of diagnoses in one visit (OR 2.21, 95% CI 1.71-2.86). The odds of being prescribed high-risk NSAID prescriptions were lower in patients with secondary (OR 0.52, 95% CI 0.35-0.77) and tertiary education (OR 0.39, 95% CI 0.22-0.68) compared to patients without formal education. Patients' citizenship, indication for NSAID prescriptions and whether a medical certificate was issued were also significantly associated with the likelihood of receiving high-risk NSAID prescriptions. Conclusions A quarter of NSAIDs prescribed in Malaysian primary care setting is categorised as high-risk prescribing. Targeted strategies are necessary to improve patient safety.
Collapse
Affiliation(s)
- Wen Yea Hwong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Setia Alam, Selangor, Malaysia. .,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Yvonne Mei Fong Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Setia Alam, Selangor, Malaysia.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Setia Alam, Selangor, Malaysia
| |
Collapse
|
32
|
Lim YMF, Ang SH, Nasir NH, Ismail F, Ismail SA, Sivasampu S. Clinic and patient variation in intermediate clinical outcomes for type 2 diabetes: a multilevel analysis. BMC Fam Pract 2019; 20:158. [PMID: 31729951 PMCID: PMC6857311 DOI: 10.1186/s12875-019-1045-1] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 10/29/2019] [Indexed: 11/12/2022]
Abstract
Background Variation at different levels of diabetes care has not yet been quantified for low- and middle-income countries. Understanding this variation and its magnitude is important to guide policy makers in designing effective interventions. This study aims to quantify the variation in the control of glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) for type 2 diabetes (T2D) patients at the clinic and patient level and determine patient and clinic factors associated with control of these outcomes in T2D. Methods This is a cross-sectional study within the baseline data from the impact evaluation of the Enhanced Primary Health Care (EnPHC) intervention on 40 public clinics in Malaysia. Patients aged 30 and above, diagnosed with T2D, had a clinic visit for T2D between 01 Nov 2016 and 30 April 2017 and had at least one HbA1c, SBP and LDL-C measurement within 1 year from the date of visit were included for analysis. Multilevel linear regression adjusting for patient and clinic characteristics was used to quantify variation at the clinic and patient levels for each outcome. Results Variation in intermediate clinical outcomes in T2D lies predominantly (93% and above) at the patient level. The strongest predictors for poor disease control in T2D were the proxy measures for disease severity including duration of diabetes, presence of microvascular complications, being on insulin therapy and number of antihypertensives. Among the three outcomes, HbA1c and LDL-C results provide greatest opportunity for improvement. Conclusion Clinic variation in HbA1c, SBP and LDL-C accounts for a small percentage from total variation. Findings from this study suggest that standardised interventions need to be applied across all clinics, with a focus on customizing therapy based on individual patient characteristics.
Collapse
Affiliation(s)
- Yvonne Mei Fong Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Setia Alam, Selangor, Malaysia. .,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Swee Hung Ang
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Setia Alam, Selangor, Malaysia.,Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nazrila Hairizan Nasir
- Family Health Development Division, Public Health Department, Ministry of Health Malaysia, Level 4, Block E6, Complex E, 62590, Putrajaya, Malaysia
| | - Fatanah Ismail
- Family Health Development Division, Public Health Department, Ministry of Health Malaysia, Level 4, Block E6, Complex E, 62590, Putrajaya, Malaysia
| | - Siti Aminah Ismail
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Setia Alam, Selangor, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, No.1, Jalan Setia Murni U13/52, Setia Alam, Selangor, Malaysia
| |
Collapse
|
33
|
Ab Rahman N, Husin M, Dahian K, Mohamad Noh K, Atun R, Sivasampu S. Job satisfaction of public and private primary care physicians in Malaysia: analysis of findings from QUALICO-PC. Hum Resour Health 2019; 17:82. [PMID: 31684972 PMCID: PMC6829856 DOI: 10.1186/s12960-019-0410-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Job satisfaction of doctors is an important factor determining quality and performance of a health system. The aim of this study was to assess job satisfaction among doctors of the public and private primary care clinics in Malaysia and evaluate factors that could influence the job satisfaction rating. METHODS This study was part of the Quality and Costs of Primary Care (QUALICOPC) Malaysia, a cross-sectional survey conducted between August 2015 and June 2016 in Malaysia. Data was collected from doctors recruited from public and private primary care clinics using a standardised questionnaire. Comparisons were made between doctors working in public and private clinics, and logistic regression analysis was used to determine factors influencing the likelihood of job satisfaction outcomes. RESULTS A total of 221 doctors from the public and 239 doctors from the private sector completed the questionnaire. Compared to private doctors, a higher proportion of public doctors felt they were being overloaded with the administrative task (59.7% vs 36.0%) and part of the work does not make sense (33.9% vs 18.4%). Only 62.9% of public doctors felt that there was a good balance between effort and reward while a significantly higher proportion (85.8%) of private doctors reported the same. Over 80% of doctors in both sectors indicated continued interest in their job and agreed that being a doctor is a well-respected job. Logistic regression analysis showed public-private sector and practice location (urban-rural) to be significantly associated with work satisfaction outcomes. CONCLUSION A higher proportion of public doctors experienced pressure from administrative tasks and felt that part of their work does not make sense than their colleague in the private sector. At the same time, the majority of private doctors reported positive outcome on effort-and-reward balance compared to only one third of public doctors. The finding suggests that decreasing administrative workload and enhancing work-based supports might be the most effective ways to improve job satisfaction of primary care doctors because these are some of the main aspects of the job that doctors, especially in public clinics, are most unhappy with.
Collapse
Affiliation(s)
- N. Ab Rahman
- Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Block B4, No. 1, Jalan Setia Murni U13/52, 40170 Shah Alam, Selangor Malaysia
| | - M. Husin
- Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Block B4, No. 1, Jalan Setia Murni U13/52, 40170 Shah Alam, Selangor Malaysia
| | - K. Dahian
- Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak Malaysia
| | - K. Mohamad Noh
- Faculty of Medicine, Cyberjaya University College of Medical Sciences, Cyberjaya, Selangor Malaysia
| | - R. Atun
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA United States of America
| | - S. Sivasampu
- Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Block B4, No. 1, Jalan Setia Murni U13/52, 40170 Shah Alam, Selangor Malaysia
| |
Collapse
|
34
|
Lim MT, Lim YMF, Tong SF, Sivasampu S. Age, sex and primary care setting differences in patients' perception of community healthcare seeking behaviour towards health services. PLoS One 2019; 14:e0224260. [PMID: 31634373 PMCID: PMC6802842 DOI: 10.1371/journal.pone.0224260] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/26/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Understanding the potential determinants of community healthcare seeking behaviour helps in improving healthcare utilisation and health outcomes within different populations. This in turn will aid the development of healthcare policies and planning for prevention, early diagnosis and management of health conditions. OBJECTIVE To evaluate patients' perception of community healthcare seeking behaviour towards both acute and preventive physical and psychosocial health concerns by sex, age and type of primary care setting (as a proxy for affordability of healthcare). METHODS A total of 3979 patients from 221 public and 239 private clinics in Malaysia were interviewed between June 2015 and February 2016 using a patient experience survey questionnaire from the Quality and Cost of Primary Care cross-sectional study. Multivariable logistic regression analysis adjusted for the complex survey design was used. RESULTS After adjusting for covariates, more women than men perceived that most people would see their general practitioners for commonly consulted acute and preventive physical and some psychosocial health concerns such as stomach pain (adjusted odds ratio (AOR), 1.64; 95% confidence interval (CI), 1.22-2.21), sprained ankle (AOR, 1.29; 95% CI, 1.06-1.56), anxiety (AOR, 1.32; 95% CI, 1.12-1.55), domestic violence (AOR, 1.35; 95% CI, 1.13-1.62) and relationship problems (AOR, 1.24; 95% CI, 1.02-1.51). There were no significant differences in perceived healthcare seeking behaviour by age groups except for the removal of a wart (AOR, 1.41; 95% CI, 1.12-1.76). Patients who visited the public clinics had generally higher perception of community healthcare seeking behaviour for both acute and preventive physical and psychosocial health concerns compared to those who went to private clinics. CONCLUSIONS Our findings showed that sex and healthcare affordability differences were present in perceived community healthcare seeking behaviour towards primary care services. Also perceived healthcare seeking behaviour were consistently lower for psychosocial health concerns compared to physical health concerns.
Collapse
Affiliation(s)
- Ming Tsuey Lim
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, Shah Alam, Selangor, Malaysia
- * E-mail:
| | - Yvonne Mei Fong Lim
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, Shah Alam, Selangor, Malaysia
| | - Seng Fah Tong
- Department of Family Medicine, Universiti Kebangsaan Malaysia, UKM, Bangi Selangor, Malaysia
| | - Sheamini Sivasampu
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, Shah Alam, Selangor, Malaysia
| |
Collapse
|
35
|
Lim MT, Lim YMF, Teh XR, Lee YL, Ismail SA, Sivasampu S. Patient experience on self-management support among primary care patients with diabetes and hypertension. Int J Qual Health Care 2019; 31:37-43. [PMID: 30608582 PMCID: PMC6839370 DOI: 10.1093/intqhc/mzy252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/20/2018] [Accepted: 12/14/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine the extent of self-management support (SMS) provided to primary care patients with type 2 diabetes (T2D) and hypertension and its associated factors. DESIGN Cross-sectional survey conducted between April and May 2017. SETTING Forty public clinics in Malaysia. PARTICIPANTS A total of 956 adult patients with T2D and/or hypertension were interviewed. MAIN OUTCOME MEASURES Patient experience on SMS was evaluated using a structured questionnaire of the short version Patient Assessment of Chronic Illness Care instrument, PACIC-M11. Linear regression analysis adjusting for complex survey design was used to determine the association of patient and clinic factors with PACIC-M11 scores. RESULTS The overall PACIC-M11 mean was 2.3(SD,0.8) out of maximum of 5. The subscales' mean scores were lowest for patient activation (2.1(SD,1.1)) and highest for delivery system design/decision support (2.9(SD,0.9)). Overall PACIC-M11 score was associated with age, educational level and ethnicity. Higher overall PACIC-M11 ratings was observed with increasing difference between actual and expected consultation duration [β = 0.01; 95% CI (0.001, 0.03)]. Better scores were also observed among patients who would recommend the clinic to friends and family [β = 0.19; 95% CI (0.03, 0.36)], when health providers were able to explain things in ways that were easy to understand [β = 0.34; 95% CI (0.10, 0.59)] and knew about patients' living conditions [β = 0.31; 95% CI (0.15, 0.47)]. CONCLUSIONS Our findings indicated patients received low levels of SMS. PACIC-M11 ratings were associated with age, ethnicity, educational level, difference between actual and expected consultation length, willingness to recommend the clinic and provider communication skills.
Collapse
Affiliation(s)
- Ming Tsuey Lim
- Healthcare Statistics Unit, National Clinical Research Centre, Ministry of Health, 3rd Floor, MMA House, 124 Jalan Pahang, Kuala Lumpur, Malaysia
| | - Yvonne Mei Fong Lim
- Healthcare Statistics Unit, National Clinical Research Centre, Ministry of Health, 3rd Floor, MMA House, 124 Jalan Pahang, Kuala Lumpur, Malaysia
| | - Xin Rou Teh
- Healthcare Statistics Unit, National Clinical Research Centre, Ministry of Health, 3rd Floor, MMA House, 124 Jalan Pahang, Kuala Lumpur, Malaysia
| | - Yi Lin Lee
- Clinical Research Ward, Ampang Hospital, Ministry of Health, Jalan Mewah Utara, Pandan Mewah, Ampang, Selangor, Malaysia
| | - Siti Aminah Ismail
- Healthcare Statistics Unit, National Clinical Research Centre, Ministry of Health, 3rd Floor, MMA House, 124 Jalan Pahang, Kuala Lumpur, Malaysia
| | - Sheamini Sivasampu
- Healthcare Statistics Unit, National Clinical Research Centre, Ministry of Health, 3rd Floor, MMA House, 124 Jalan Pahang, Kuala Lumpur, Malaysia
| |
Collapse
|
36
|
Hwong WY, Bots ML, Selvarajah S, Sivasampu S, Reidpath DD, Law WC, Musa KI, Vaartjes I. Sex differences in stroke metrics among Southeast Asian countries: Results from the Global Burden of Disease Study 2015. Int J Stroke 2019; 14:826-834. [PMID: 30843480 DOI: 10.1177/1747493019832995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sex differences in cardiovascular diseases generally disadvantage women, particularly within developing regions. AIMS This study aims to examine sex-related differences in stroke metrics across Southeast Asia in 2015. Furthermore, relative changes between sexes are compared from 1990 to 2015. METHODS Data were sourced from the Global Burden of Disease Study. Incidence and mortality from ischemic and hemorrhagic strokes were explored with the following statistics derived: (1) women-to-men incidence/mortality ratio and (2) relative percentage change in rate. RESULTS Women had lower incidence and mortality from stroke compared to men. Notable findings include higher ischemic stroke incidence for women at 30-34 years in high-income countries (women-to-men ratio: 1.3, 95% CI: 0.1, 16.2 in Brunei and 1.3, 95% CI: 0.5, 3.2 in Singapore) and the largest difference between sexes for ischemic stroke mortality in Vietnam and Myanmar across most ages. Within the last 25 years, greater reductions for ischemic stroke metrics were observed among women compared to men. Nevertheless, women below 40 years in some countries showed an increase in ischemic stroke incidence between 0.5% and 11.4%, whereas in men, a decline from -4.2% to -44.2%. Indonesia reported the largest difference between sexes for ischemic stroke mortality; a reduction for women whereas an increase in men. For hemorrhagic stroke, findings were similar: higher incidence among young women in high-income countries and greater reductions for stroke metrics in women than men over the last 25 years. CONCLUSIONS Distinct sex-specific differences observed across Southeast Asia should be accounted in future stroke preventive guidelines.
Collapse
Affiliation(s)
- Wen Yea Hwong
- National Clinical Research Centre, Ministry of Health Malaysia, Selangor, Malaysia.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sharmini Selvarajah
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,Sharmini Selvarajah Consulting, Selangor, Malaysia
| | - Sheamini Sivasampu
- National Clinical Research Centre, Ministry of Health Malaysia, Selangor, Malaysia
| | - Daniel D Reidpath
- Jeffery Cheah School of Medicine and Health Sciences, Monash University, Selangor, Malaysia
| | - Wan Chung Law
- Neurology Unit, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
37
|
Woon YL, Lim MF, Tg Abd Rashid TR, Thayan R, Chidambaram SK, Syed Abdul Rahim SS, Mudin RN, Sivasampu S. Zika virus infection in Malaysia: an epidemiological, clinical and virological analysis. BMC Infect Dis 2019; 19:152. [PMID: 30760239 PMCID: PMC6375198 DOI: 10.1186/s12879-019-3786-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 02/06/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND A major outbreak of the Zika virus (ZIKV) has been reported in Brazil in 2015. Since then, it spread further to other countries in the Americas and resulted in declaration of the Public Health Emergency of International Concern (PHEIC) by World Health Organization. In 2016, Singapore reported its first minor ZIKV epidemic. Malaysia shares similar ecological environment as Brazil and Singapore which may also favor ZIKV transmission. However, no ZIKV outbreak has been reported in Malaysia to date. This study aimed to discuss all confirmed ZIKV cases captured under Malaysia ZIKV surveillance system after declaration of the PHEIC; and explore why Malaysia did not suffer a similar ZIKV outbreak as the other two countries. METHODS This was an observational study reviewing all confirmed ZIKV cases detected in Malaysia through the ZIKV clinical surveillance and Flavivirus laboratory surveillance between June 2015 and December 2017. All basic demographic characteristics, co-morbidities, clinical, laboratory and outcome data of the confirmed ZIKV cases were collected from the source documents. RESULTS Only eight out of 4043 cases tested positive for ZIKV infection during that period. The median age of infected patients was 48.6 years and majority was Chinese. Two of the subjects were pregnant. The median interval between the onset of disease and the first detection of ZIKV Ribonucleic Acid (RNA) in body fluid was 3 days. Six cases had ZIKV RNA detected in both serum and urine samples. Phylogenetic analysis suggests that isolates from the 7 cases of ZIKV infection came from two clusters, both of which were local circulating strains. CONCLUSION Despite similar ecological background characteristics, Malaysia was not as affected by the recent ZIKV outbreak compared to Brazil and Singapore. This could be related to pre-existing immunity against ZIKV in this population, which developed after the first introduction of the ZIKV in Malaysia decades ago. A serosurvey to determine the seroprevalence of ZIKV in Malaysia was carried out in 2017. The differences in circulating ZIKV strains could be another reason as to why Malaysia seemed to be protected from an outbreak.
Collapse
Affiliation(s)
- Yuan Liang Woon
- Clinical Epidemiology Unit, National Clinical Research Centre, Ministry of Health Malaysia, Level 2, Block B4, National Institute of Health, Jalan Setia Murni U13/52, Seksyen U13, 40170, Shah Alam, Selangor Darul Ehsan, Malaysia.
| | - Mei Fong Lim
- Healthcare Statistics Unit, National Clinical Research Centre, Ministry of Health Malaysia, Level 4, Block B4, National Institute of Health, Jalan Setia Murni U13/52, Seksyen U13, 40170, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Tg Rogayah Tg Abd Rashid
- Virology Unit, Infectious Disease Research Centre, Institute for Medical Research, Jalan Pahang, 50588, Kuala Lumpur, Malaysia
| | - Ravindran Thayan
- Virology Unit, Infectious Disease Research Centre, Institute for Medical Research, Jalan Pahang, 50588, Kuala Lumpur, Malaysia
| | - Suresh Kumar Chidambaram
- Department of General Medicine, Hospital Sungai Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor Darul Ehsan, Malaysia
| | | | - Rose Nani Mudin
- Sector of Vector-Borne Disease, Disease Control Division, Ministry of Health Malaysia, 62590, Putrajaya, Malaysia
| | - Sheamini Sivasampu
- Healthcare Statistics Unit, National Clinical Research Centre, Ministry of Health Malaysia, Level 4, Block B4, National Institute of Health, Jalan Setia Murni U13/52, Seksyen U13, 40170, Shah Alam, Selangor Darul Ehsan, Malaysia
| |
Collapse
|
38
|
Abstract
Purpose The purpose of this paper is to assess National Medical Care Survey data quality. Design/methodology/approach Data completeness and representativeness were computed for all observations while other data quality measures were assessed using a 10 per cent sample from the National Medical Care Survey database; i.e., 12,569 primary care records from 189 public and private practices were included in the analysis. Findings Data field completion ranged from 69 to 100 per cent. Error rates for data transfer from paper to web-based application varied between 0.5 and 6.1 per cent. Error rates arising from diagnosis and clinical process coding were higher than medication coding. Data fields that involved free text entry were more prone to errors than those involving selection from menus. The authors found that completeness, accuracy, coding reliability and representativeness were generally good, while data timeliness needs to be improved. Research limitations/implications Only data entered into a web-based application were examined. Data omissions and errors in the original questionnaires were not covered. Practical implications Results from this study provided informative and practicable approaches to improve primary health care data completeness and accuracy especially in developing nations where resources are limited. Originality/value Primary care data quality studies in developing nations are limited. Understanding errors and missing data enables researchers and health service administrators to prevent quality-related problems in primary care data.
Collapse
Affiliation(s)
- Yvonne Mei Fong Lim
- Healthcare Statistics Unit, Clinical Research Centre, Kuala Lumpur, Malaysia
| | - Maryati Yusof
- Faculty of Information Science and Technology, National University of Malaysia , Bangi, Malaysia
| | - Sheamini Sivasampu
- Healthcare Statistics Unit, Clinical Research Centre, Kuala Lumpur, Malaysia
| |
Collapse
|
39
|
Abstract
BACKGROUND Polypharmacy is particularly important in older persons as they are more likely to experience adverse events compared to the rest of the population. Despite the relevance, there is a lack of studies on the possible association of patient, prescriber and practice characteristics with polypharmacy. Thus, the aim of this study was to determine the rate of polypharmacy among older persons attending public and private primary care clinics, and its association with patient, prescriber and practice characteristics. METHODS We used data from The National Medical Care Survey (NMCS), a national cross-sectional survey of patients' visits to primary care clinics in Malaysia. A weighted total of 22,832 encounters of patients aged ≥65 years were analysed. Polypharmacy was defined as concomitant use of five medications and above. Multilevel logistic regression was performed to examine the association of polypharmacy with patient, prescriber and practice characteristics. RESULTS A total of 20.3% of the older primary care attenders experienced polypharmacy (26.7%% in public and 11.0% in private practice). The adjusted odds ratio (OR) of polypharmacy were 6.37 times greater in public practices. Polypharmacy was associated with patients of female gender (OR 1.49), primary education level (OR 1.61) and multimorbidity (OR 14.21). The variation in rate of polypharmacy was mainly found at prescriber level. CONCLUSION Polypharmacy is common among older persons visiting primary care practices. Given the possible adverse outcomes, interventions to reduce the burden of polypharmacy are best to be directed at individual prescribers.
Collapse
Affiliation(s)
- Su Miin Ong
- Healthcare Statistics Unit, National Clinical Research Centre, 3rd floor, MMA House, 124, Jalan Pahang, 53000 Kuala Lumpur, Malaysia
| | - Yvonne Mei Fong Lim
- Healthcare Statistics Unit, National Clinical Research Centre, 3rd floor, MMA House, 124, Jalan Pahang, 53000 Kuala Lumpur, Malaysia
| | - Sheamini Sivasampu
- Healthcare Statistics Unit, National Clinical Research Centre, 3rd floor, MMA House, 124, Jalan Pahang, 53000 Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| |
Collapse
|
40
|
Hwong WY, Abdul Aziz Z, Sidek NN, Bots ML, Selvarajah S, Kappelle LJ, Sivasampu S, Vaartjes I. Prescription of secondary preventive drugs after ischemic stroke: results from the Malaysian National Stroke Registry. BMC Neurol 2017; 17:203. [PMID: 29169331 PMCID: PMC5701494 DOI: 10.1186/s12883-017-0984-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/15/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Evaluation of secondary stroke prevention in low and middle-income countries remains limited. This study assessed the prescription of secondary preventive drugs among ischemic stroke patients upon hospital discharge in Malaysia and identified factors related to the prescribing decisions. METHODS From Malaysian National Stroke Registry, we included patients with non-fatal ischemic stroke. Prescriptions of antiplatelet, anticoagulants, antihypertensive drugs and lipid-lowering drugs were assessed. Multi-level logistic regressions were performed to determine the relation between potential factors and drug prescriptions. RESULTS Of 5292 patients, 48% received antihypertensive drugs, 88.9% antiplatelet and 88.7% lipid-lowering drugs upon discharge. Thirty-three percent of patients with an indication for anticoagulants (n = 391) received it. Compared to patients <=50 years, patients above 70 years were less likely to receive antiplatelet (OR: 0.72, 95% CI: 0.50-1.03), lipid-lowering drugs (OR: 0.66, 95% CI: 0.45-0.95) and anticoagulants (OR: 0.27, 95% CI: 0.09-0.83). Patients with moderate to severe disability upon discharge had less odds of receiving secondary preventive drugs; an odds ratio of 0.57 (95% CI: 0.45-0.71) for antiplatelet, 0.86 (95% CI: 0.75-0.98) for antihypertensive drugs and 0.78 (95% CI: 0.63-0.97) for lipid-lowering drugs in comparison to those with minor disability. Having prior specific comorbidities and drug prescriptions significantly increased the odds of receiving these drugs. No differences were found between sexes and ethnicities. CONCLUSIONS Prescription of antihypertensive drugs and anticoagulants among ischemic stroke patients in Malaysia were suboptimal. Efforts to initiate regular clinical audits to evaluate the uptake and effectiveness of secondary preventive strategies are timely in low and middle-income settings.
Collapse
Affiliation(s)
- Wen Yea Hwong
- National Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia. .,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Zariah Abdul Aziz
- Department of Neurology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
| | - Norsima Nazifah Sidek
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sharmini Selvarajah
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Sharmini Selvarajah Consulting, Selangor, Malaysia
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sheamini Sivasampu
- National Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
41
|
Foo CY, Reidpath DD, Sivasampu S. The Association Between Hospital Characteristics and Nonresponse in Organization Survey: An Analysis of the National Healthcare Establishment and Workforce Survey in Malaysia. Eval Health Prof 2017; 42:163278717713569. [PMID: 29179560 DOI: 10.1177/0163278717713569] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In any survey where some of the invited participants fail to respond estimates may be biased. The literature on survey nonresponse is substantial, and the intellectual focus has typically been on the nonresponse of individuals. An important yet less scrutinized area in the analysis of nonresponse is in organizational surveys, particularly surveys of health-care organizations. This study used data from the 2010 National Healthcare Establishment and Workforce Survey in Malaysia to examine the relationship between a set of measurable hospital attributes and their probability of survey response and the relationship between this probability and the differences in survey estimates. We found that readily measurable hospital characteristics such as size and geographical location are useful predictors of survey response likelihood. Larger hospitals and hospitals located in less developed geographical regions responded more favorably than their counterparts. We have also illustrated that the resulting response pattern affected some key survey estimates. These findings have the potential to extend our understanding of nonresponse to organization surveys in the health-care sector, potentially allow for the prediction of nonresponse, and help researchers to identify profiles of "reluctant responders" before a survey commences, so that additional engagement strategies may be used.
Collapse
Affiliation(s)
- Chee Yoong Foo
- 1 Healthcare Statistics Unit, National Clinical Research Centre, Kuala Lumpur, Malaysia
- 2 Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Daniel D Reidpath
- 2 Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- 3 School of Population Health, Curtin University, Perth, Australia
- 4 Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Sheamini Sivasampu
- 1 Healthcare Statistics Unit, National Clinical Research Centre, Kuala Lumpur, Malaysia
| |
Collapse
|
42
|
Lim KK, Sivasampu S, Mahmud F. Equity in access to health care in a rural population in Malaysia: A cross-sectional study. Aust J Rural Health 2016; 25:102-109. [PMID: 27377781 DOI: 10.1111/ajr.12298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To examine the extent of equity in access to health care, their determinants and reasons of unmet need of a rural population in Malaysia. DESIGN Exploratory cross-sectional survey administered by trained interviewers among participants of a health screening program. SETTING A rural plantation estate in the West Coast of Peninsular Malaysia. PARTICIPANTS One hundred and thirty out of 142 adults above 18 years old who attended the program. MAIN OUTCOME MEASURE Percentages of respondents reporting realised access and unmet need to health care, determinants of both access indicators and reasons for unmet need. Realised access associated with need but not predisposing or enabling factors and unmet need not associated with any variables were considered equitable. RESULTS A total of 88 (67.7%) respondents had visited a doctor (realised access) in the past 6 months and 24.8% (n = 31) experienced unmet need in the past 12 months. Using logistic regression, realised access was associated with presence of chronic disease (OR 6.97, P < 0.001), whereas unmet need was associated with low education level (OR 6.50, P < 0.05), 'poor' or 'fair' self-assessed health status (OR 6.03, P < 0.05) and highest income group (> RM 2000 per month) (OR 51.27, P < 0.05). Personal choice (67.7%) was more commonly expressed than barriers (54.8%) as reasons for unmet need. CONCLUSIONS The study found equity in realised access and inequity in unmet need among the rural population, the latter associated with education level, subjective health status and income. Despite not being generalisable, the findings highlight the need for a national level study on equity in access before the country reforms its health system.
Collapse
Affiliation(s)
- Ka Keat Lim
- National Clinical Research Centre, Kuala Lumpur, Malaysia
| | | | - Fatihah Mahmud
- National Clinical Research Centre, Kuala Lumpur, Malaysia
| |
Collapse
|
43
|
Ab Rahman N, Sivasampu S, Mohamad Noh K, Khoo EM. Health profiles of foreigners attending primary care clinics in Malaysia. BMC Health Serv Res 2016; 16:197. [PMID: 27301972 PMCID: PMC4908717 DOI: 10.1186/s12913-016-1444-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 06/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The world population has become more globalised with increasing number of people residing in another country for work or other reasons. Little is known about the health profiles of foreign population in Malaysia. The aim of this study was to provide a detailed description of the health problems presented by foreigners attending primary care clinics in Malaysia. METHODS Data were derived from the 2012 National Medical Care Survey (NMCS), a cross sectional survey of primary care encounters from public and private primary care clinics sampled from five regions in Malaysia. Patients with foreign nationality were identified and analysed for demographic profiles, reasons for encounter (RFEs), diagnosis, and provision of care. RESULTS Foreigners accounted for 7.7 % (10,830) of all patient encounters from NMCS. Most encounters were from private clinics (90.2 %). Median age was 28 years (IQR: 24.0, 34.8) and 69.9 % were male. Most visits to the primary care clinics were for symptom-based complaints (69.5 %), followed by procedures (23.0 %) and follow-up visit (7.4 %). The commonest diagnosis in public clinics was antenatal care (21.8 %), followed by high risk pregnancies (7.5 %) and upper respiratory tract infection (URTI) (6.8 %). Private clinics had more cases for general medical examination (13.5 %), URTI (13.1 %) and fever (3.9 %). Medications were prescribed to 76.5 % of these encounters. CONCLUSIONS More foreigners were seeking primary medical care from private clinics and the encounters were for general medical examinations and acute minor ailments. Those who sought care from public clinics were for obstetric problems and chronic diseases. Medications were prescribed to two-thirds of the encounters while other interventions: laboratory investigations, medical procedures and follow-up appointment had lower rates in private clinics. Foreigners are generally of young working group and are expected to have mandatory medical checks. The preponderance of obstetrics seen in public clinics suggests a need for improved access to maternal care and pregnancy related care. This has implication on policy and health care provision and access for foreigners and future studies are needed to look into strategies to solve these problems.
Collapse
Affiliation(s)
- Norazida Ab Rahman
- Healthcare Statistics Unit, Clinical Research Centre, Ministry of Health, Kuala Lumpur, Malaysia.
| | - Sheamini Sivasampu
- Healthcare Statistics Unit, Clinical Research Centre, Ministry of Health, Kuala Lumpur, Malaysia
| | | | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
44
|
Ab Rahman N, Teng CL, Sivasampu S. Antibiotic prescribing in public and private practice: a cross-sectional study in primary care clinics in Malaysia. BMC Infect Dis 2016; 16:208. [PMID: 27188538 PMCID: PMC4869350 DOI: 10.1186/s12879-016-1530-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 04/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antibiotic overuse is driving the emergence of antibiotic resistance worldwide. Good data on prescribing behaviours of healthcare providers are needed to support antimicrobial stewardship initiatives. This study examined the differences in antibiotic prescribing rates of public and private primary care clinics in Malaysia. METHODS We used data from the National Medical Care Survey (NMCS), a nationwide cluster sample of Malaysian public and private primary care clinics in 2014. NMCS contained demographic, diagnoses and prescribing from 129 public clinics and 416 private clinics. We identified all encounters who were prescribed antibiotic and analyse the prescribing rate, types of antibiotics, and diagnoses that resulted in antibiotic. RESULTS Five thousand eight hundred ten encounters were prescribed antibiotics; antibiotic prescribing rate was 21.1 % (public clinics 6.8 %, private clinics 30.8 %). Antibiotic prescribing was higher in private clinics where they contributed almost 87 % of antibiotics prescribed in primary care. Upper respiratory tract infection (URTI) was the most frequent diagnosis in patients receiving antibiotic therapy and accounted for 49.2 % of prescriptions. Of the patients diagnosed with URTI, 46.2 % received antibiotic treatment (public 16.8 %, private 57.7 %). Penicillins, cephalosporins and macrolides were the most commonly prescribed antibiotics and accounted for 30.7, 23.6 and 16.0 % of all antibiotics, respectively. More recently available broad-spectrum antibiotics such as azithromycin and quinolones were more frequently prescribed in private clinics. CONCLUSIONS Antibiotic prescribing rates are high in both public and private primary care settings in Malaysia, especially in the latter. This study provides evidence of excessive and inappropriate antibiotic prescribing for self-limiting conditions. These data highlights the needs for more concerted interventions targeting both prescribers and public. Improvement strategies should focus on reducing inappropriate prescribing.
Collapse
Affiliation(s)
- Norazida Ab Rahman
- Healthcare Statistics Unit, Clinical Research Centre, 3rd Floor MMA Building, 124 Pahang Road, 53000, Kuala Lumpur, Malaysia.
| | - Cheong Lieng Teng
- Department of Family Medicine, International Medical University, Seremban, Malaysia
| | - Sheamini Sivasampu
- Healthcare Statistics Unit, Clinical Research Centre, 3rd Floor MMA Building, 124 Pahang Road, 53000, Kuala Lumpur, Malaysia
| |
Collapse
|
45
|
Foo CY, Lim KK, Sivasampu S, Dahian KB, Goh PP. Improving the effectiveness of service delivery in the public healthcare sector: the case of ophthalmology services in Malaysia. BMC Health Serv Res 2015; 15:349. [PMID: 26315283 PMCID: PMC4551382 DOI: 10.1186/s12913-015-1011-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background Rising demand of ophthalmology care is increasingly straining Malaysia’s public healthcare sector due to its limited human and financial resources. Improving the effectiveness of ophthalmology service delivery can promote national policy goals of population health improvement and system sustainability. This study examined the performance variation of public ophthalmology service in Malaysia, estimated the potential output gain and investigated several factors that might explain the differential performance. Methods Data for 2011 and 2012 on 36 ophthalmology centres operating in the Ministry of Health hospitals were used in this analysis. We first consulted a panel of ophthalmology service managers to understand the production of ophthalmology services and to verify the production model. We then assessed the relative performance of these centres using Data Envelopment Analysis (DEA). Efficiency scores (ES) were decomposed into technical, scale, and congestion component. Potential increase in service output was estimated. Sensitivity analysis of model changes was performed and stability of the result was assessed using bootstrap approach. Second stage Tobit regression was conducted to determine if hospital type, availability of day services and population characteristics were related to the DEA scores. Results In 2011, 33 % of the ophthalmology centres were found to have ES > 1 (mean ES = 1.10). Potential output gains were 10 % (SE ± 2.92), 7.4 % (SE ± 2.06), 6.9 % (SE ± 1.97) if the centres could overcome their technical, scale and congestion inefficiencies. More centres moved to the performance frontier in 2012 (mean ES = 1.07), with lower potential output gain. The model used has good stability. Robustness checks show that the DEA correctly identified low performing centres. Being in state hospital was significantly associated with better performance. Conclusions Using DEA to benchmarking service performance of ophthalmology care could provide insights for policy makers and service managers to intuitively visualise the overall performance of resource use in an otherwise difficult to assess scenario. The considerable potential output gain estimated indicates that effort should be invested to understand what drove the performance variation and optimise them. Similar performance assessment should be undertaken for other healthcare services in the country in order to work towards a sustainable health system. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1011-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Chee Yoong Foo
- All authors work in the National Clinical Research Centre, Ministry of Health, Kuala Lumpur, Malaysia.
| | - Ka Keat Lim
- All authors work in the National Clinical Research Centre, Ministry of Health, Kuala Lumpur, Malaysia.
| | - Sheamini Sivasampu
- All authors work in the National Clinical Research Centre, Ministry of Health, Kuala Lumpur, Malaysia.
| | - Kamilah Binti Dahian
- All authors work in the National Clinical Research Centre, Ministry of Health, Kuala Lumpur, Malaysia.
| | - Pik Pin Goh
- All authors work in the National Clinical Research Centre, Ministry of Health, Kuala Lumpur, Malaysia.
| |
Collapse
|
46
|
Abstract
INTRODUCTION As the population ages, the prevalence of hypertension also increases. Although primary care is usually the patient's first point of contact for healthcare, little is known about the management of hypertension among elderly patients at the primary care level. This study aimed to determine the antihypertensive prescription trend for elderly patients, the predictors of antihypertensive use and any inappropriate prescribing practices in both public and private primary care settings. METHODS Data on patient demographics, diagnosis, prescription pattern, payment mode and follow-up was extracted from a cross-sectional study involving 122 public primary care clinics and 652 private primary care clinics in Malaysia. Encounters with hypertensive patients aged ≥ 60 years were included. RESULTS A total of 1,017 antihypertensive medications were prescribed - calcium channel blockers (27.1%), beta blockers (25.5%), diuretics (23.3%), angiotensin-converting enzyme inhibitors (14.9%) and angiotensin receptor blockers (6.3%). Out of the 614 patient encounters, 53.1% of the patients were prescribed monotherapy, 31.6% were prescribed dual therapy, 12.2% triple therapy, 2.8% quadruple therapy and 0.3% quintuple therapy. Type of primary care clinic and payment mode were significant predictors for the prescription of combination therapy and fixed-dose combination therapy, respectively. Four types of inappropriate prescriptions were identified. CONCLUSION Calcium channel blockers were the most common antihypertensive drug prescribed and more than half of the elderly patients were on monotherapy. Antihypertensive drug prescription was found to be associated with the type of primary care clinic and the payment mode, suggesting that prescription is influenced by the cost of the drug.
Collapse
Affiliation(s)
- Ka Keat Lim
- Healthcare Statistics Unit, Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Sheamini Sivasampu
- Healthcare Statistics Unit, Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
47
|
Norazida AR, Sivasampu S, Teng CL. Cough and cold medication in children: a public health concern. Med J Malaysia 2014; 69:219-223. [PMID: 25638235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The indiscriminate use of cough and cold medicines (CCMs) in children has become a public health concern. The study evaluates the prescription pattern of CCMs in primary care setting. METHODS Analysis of CCMs prescription data among children aged 12 years and below who had participated in the National Medical Care Survey (NMCS) 2010. Data was extracted from NMCS 2010, a cross-sectional survey on the primary healthcare service which was carried out from December 2009 to April 2010 in public and private primary care clinics in Malaysia. RESULT Of 21,868 encounters for NMCS 2010, 3574 (16.3%) were children 12 years old and below; 597 (17%) were from public clinics and 2977 (83%) were from private clinics. Of these 3574 encounters, 1748 (49%) children were prescribed with CCM with total of 2402 CCMs. On average, CCMs were prescribed at a rate of 1.3 CCMs per encounter in public clinics and 1.4 CCMs per encounter in private clinics. CCMs containing single ingredient constituted 77% of the prescriptions while 23% were of multiple ingredient preparations. There were 556 (23%) CCMs prescribed to children younger than 2 years. Majority (65%) were prescribed with one CCM per visit, 32% received two CCMs and 3% of the children received three or more CCMs per visit. CONCLUSION Prescription of CCMs to children is common. Prevalence of CCM prescriptions among young children is of concern, in view of concerns about the safety and adverse effects related to the use of CCMs in this age group. Firmer policies and greater effort is needed to monitor the prescriptions of CCMs to children.
Collapse
Affiliation(s)
- A R Norazida
- Ministry of Health Malaysia, Clinical Research Centre, Healthcare Statistics Unit, Malaysia.
| | - S Sivasampu
- Ministry of Health Malaysia, Clinical Research Centre, Healthcare Statistics Unit, Malaysia
| | - C L Teng
- International Medical University, Department of Family Medicine, Malaysia
| |
Collapse
|