Decision-Making on Contraceptive Use among Women Living with Human Immunodeficiency Virus in Malaysia: A Qualitative Inquiry

BACKGROUND

Malaysia is the first country in the Western Pacific Region to receive the validation certificate for the elimination of mother-to-child transmission of human immunodeficiency virus (HIV). The validation report recommends making sexual and reproductive health and rights of women living with HIV a priority. This article explores and assesses the sexual and reproductive health, rights, and access to healthcare services of Malaysia's women living with HIV (WLHIV).

METHODS

A qualitative secondary analysis conducted on 73 WLHIV from all over Malaysia comprised 11 in-depth interviews and 16 focus group discussions. Data were extracted from the original interview transcripts that emerged from the following questions: (1) "What are your experiences as a woman living with HIV in relation to your sexual and reproductive health and rights?" (2) "What are your experiences in accessing contraception?" (3) "What are your day-to-day experiences as a woman living with HIV?" Data were analyzed using thematic analysis.

RESULTS

Four themes emerged from the study findings: "lack of negotiation," "idealism in pregnancy," "coping with restrictions," and "past and future fears." The four themes are grounded in religion, a patriarchal culture, meaning and expectations of motherhood, taking risks and going against medical advice to pursue fertility desires, fear of HIV transmission, and the side effects of contraceptive use.

CONCLUSION

The complexities involved in decision-making regarding contraceptive use revealed how WLHIV may have unresolved reproductive health needs inconsistent with healthcare providers' focus on HIV management and prevention. Suggestions are made for improving the sexual and reproductive health and rights of WLHIV in Malaysia, which include establishing a reproductive health counseling program.

Enabling Factors for the Successful Implementation of the CBAHI Accreditation Program

Background

Healthcare organizations worldwide tend to implement hospital accreditation programs to improve the quality of care they provide. However, the literature shows inconsistent findings on the impact of such programs on the quality of care due to improper implementation of accreditation programs.

Purpose

This study explored the enabling factors for the effective implementation of the Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) program in the Ministry of Health (MOH) hospitals in Madinah, Saudi Arabia.

Methods

This qualitative study involved 22 professionals from five CBAHI-accredited MOH hospitals in Madinah, Saudi Arabia. A purposive sampling technique was applied, and data were collected through in-depth, semi-structured interviews. A thematic analysis approach was applied to the interview transcripts.

Results

Four themes and 11 subthemes emerged. The emerging themes included the development of human capital, resolving quality management issues, ensuring the availability of resources, and strategizing CBAHI-specific solutions.

Conclusion

The current study fills this knowledge gap by identifying the factors leading to the effective implementation of the CBAHI accreditation program in the MOH hospitals. Only the effective execution of the CBAHI will increase healthcare quality and, as a result, justify the significant resources and efforts invested in these programs. Future research should replicate similar study in other governments or private hospitals.

Uptake and determinants of private health insurance enrollment in a country with heavily subsidised public healthcare: A cross-sectional survey in East Coast Malaysia

Malaysia's subsidised public healthcare system is heavily reliant on government funding. Increasing the uptake of private health insurance (PHI) would alleviate the financial burden on public healthcare facilities caused by high patient loads. The study aimed to determine the uptake of PHI and its associated factors among the East Coast Malaysian populations. A cross-sectional online survey was conducted between February and June 2021. Proportionate stratified sampling was applied to select 1138 participants, and logistic regression was performed to determine the factors associated with PHI uptake. The proportion of the study samples that purchased PHI was 54.3%. Enrolment of private health insurance was associated with working in the public sector (aOR: 6.06, 95% CI: 2.65, 13.88) and private sector (aOR: 6.27, 95% CI: 2.65, 14.85), being self-employed (aOR: 9.23, 95% CI: (3.59, 23.70), being in the middle 40% household income percentile (aOR: 2.74, 95% CI: 1.95, 3.85) and top 20% household income percentile (aOR: 4.42, 95% CI: 2.87, 6.80), and living in urban areas (aOR: 1.31, 95% CI: 1.01, 1.70). Even in the presence of subsidised public healthcare, the high proportion of PHI uptake reflects a demand for private health insurance. The study suggests that PHI should be promoted among those who are employed or self-employed, the middle- and high-income groups, and urban residents. The findings may be beneficial for the government and insurance companies to improve strategies to enhance PHI uptake among these population.

Impact of the Accreditation Program of the Saudi Central Board for Accreditation of Healthcare Institutions on the Safety Dimension of the Institute of Medicine Quality

Background

Although hospital accreditation is recognized as a tool for improving healthcare, there are inconsistent results regarding its impact on healthcare quality. In Saudi Arabia, it is mandatory for all Ministry of Health (MOH) hospitals to be accredited by the Central Board for Accreditation of Healthcare Institutions (CBAHI).

Purpose

This study measured the impact of the CBAHI accreditation program on the Institute of Medicine's (IOM) safety dimension in Madinah.

Methods

A cross-sectional study was conducted using retrospective data gathered from a review of hospital records over 60 months (ie, 12 months before, 36 during, and 12 post-accreditation). The data were analyzed using piecewise (segmented) regression analysis.

Results

The three indicators (ie: incident reports, medication errors, and nosocomial infection) were continuously improved compared to the data before accreditation, as a results of implementing the CBAHI accreditation program. Therefore, the CBAHI had a significantly positively impacts on MOH hospitals' safety dimension.

Conclusion

Complying with the CBAHI standards can help reduce the rates of incident reports, medication errors, nosocomial infections, and post-admission mortality. This study provides insight for MOH hospitals and opportunities to expand the accreditation program to improve the quality of healthcare services.

Assessing progress towards Sustainable Development Goal 3.8.2 and determinants of catastrophic health expenditures in Malaysia

The Sustainable Development Goal 3.8.2 is an indicator to track a country’s progress toward universal health coverage on the financial protection against catastrophic health expenditure (CHE). The purpose of this study is to determine the proportion of households with catastrophic health expenditure, and its associated factors among Malaysian households. A secondary data analysis was performed using the Household Expenditure Survey 2015/2016. The inclusion criterion was Malaysian households with some health spending in the past 12 months before the date of the survey. Catastrophic health expenditure was defined as out-of-pocket health expenditures exceeding 10% of the total household consumption. The study included a total of 13015 households. The proportion of households with CHE in the sample was 2.8%. Female-led households (AdjOR 1.6; CI 1.25, 2.03; p-value <0.001), households in rural areas (AdjOR 1.29; 95% CI 1.04, 1.61; p-value = 0.022), small household size (AdjOR 2.4; 95% CI 1.81, 3.18; p-value <0.001) and heads of household under 60 years old (AdjOR2.34; 95% CI 1.81, 3.18; p-value <0.001) were significantly associated with CHE. Although the proportion of Malaysian households affected by CHE is small, it is increasing in comparison to previous findings. This is concerning because it may jeopardise efforts to achieve universal health coverage by 2030. To ensure financial protection and access to care, a health financing policy that includes safety net measures for households at risk of CHE is required.

HOUSEHOLDS’ HEALTH EXPENDITURES ON ACUTE GASTROENTERITIS IN MALAYSIA

Acute gastroenteritis (AGE) causes significant health and economic burden on society. The aim of this study is to estimate households’ direct and indirect expenditures on AGE and its predicted factors. This cross-sectional study was conducted between December 2019 and March 2020 using a bilingual proforma distributed using Survey Monkey among individuals with self-reported AGE in all 14 states of Malaysia. The finding revealed the average expenditure for a single episode of AGE was RM395.58 (± SD 798.02). The mean indirect expenditure was higher at RM259.14 (± SD 379.92) vs. direct expenditure of RM136.44 (± SD 596.47). The highest expenditure was seen among those who obtained inpatient care. The multiple linear regression analysis showed that household income (RM0.13; 95% CI: 0.01, 0.27; p=0.043) and type of healthcare facility (private vs government) (RM1842.05; 95% CI: 395.13, 3288.98; p=0.014) had a significant association with households’ total health expenditure on AGE. Acute gastroenteritis incurred substantial costs on all affected households regardless of care-seeking modalities. Interestingly, the main economic burden of AGE was the indirect cost of productivity loss; interpreted in terms of days away from work. In conclusion, AGE instigated an economic burden on both households and employers. The household income and type of facility were found to be significant factors associated with the households’ health expenditures due to AGE. This study recommends food safety awareness among the public and enforcement of safe food handling practices among food vendors and industries.

Validity and reliability of a questionnaire on knowledge, attitude, practice and perception (KAP2) towards food poisoning and its prevention during dining out among consumers in Terengganu

Having adequate knowledge, attitude, practice, and realistic perception (KAP2) of food poisoning prevention will minimize the risk of food poisoning while dining out. However, there is no validated KAP2 questionnaire on the prevention of food poisoning during dining out, notably among consumers. Throughout the current research, a validated KAP2 questionnaire on food poisoning and prevention during dining was developed. A crosssectional pilot survey was conducted among 30 selected consumers in Kuala Nerus, Terengganu. Convenience sampling was applied to the recruitment of consumers based on inclusion and exclusion criteria. The KAP2 questionnaire comprised the knowledge section (42 questions), attitude (15 questions), practice (13 questions) and the perception (15 questions). Knowledge questions were analysed using difficulty and discrimination index, while attitude, practice, and perception were analysed by construct validity and reliability analysis. The difficulty index with less than 0.3 is considered as difficult, between 0.30-0.70 as an acceptable value, and more than 0.70 as easy. The discrimination index below than 0.2 is considered poor, between 0.2-0.24 as good, more than 0.35 as excellent items. The construct validity was conducted by referring to the value of Cronbach's alpha, inter-item correlation (˃ 0.30), item-total correlation (˃ 0.30), and Cronbach's alpha if item deleted. The results were found from 42 knowledge items, 29 easy items, ten acceptable items and three difficult questions. The discrimination index revealed that 25 items were poor, 11 items were excellent, three items had a good discrimination index and three items needed to be revised. Based on construct validity, five attitude’s items, three practice’s items and ten perception’s items were removed due to inter-item correlation and item-total correlation value < 0.30. The reliability analysis of the attitude portion was 0.848 which is a good reliability, 0.780 practice, and 0.611 perceptions to be found an acceptable value of reliability. Overall, the developed KAP2 questionnaire is a valid and reliable questionnaire that can serve as an evaluation tool for measuring knowledge, attitudes, practice and perception in the prevention of food poisoning during dining out among consumers.

EFFECTIVENESS OF COMMUNITY-BASED HEALTH EDUCATION ON PREPAREDNESS FOR FLOOD-RELATED COMMUNICABLE DISEASES IN KELANTAN

The flood disaster in Kelantan in 2014 had resulted in substantial health implications including increased cases of communicable diseases. There was a lack of community preparedness including customized health educations in the prevention and control of flood-related communicable diseases in the affected areas. The research was aimed to evaluate the effectiveness of community-based health education modules on flood-related communicable diseases among communities in Kelantan. Health education modules focusing on major food-related diseases were developed.  A non-randomized community-controlled trial using the modules were conducted. Outcomes were assessed on knowledge, attitude and preventive practice scores to flood-related communicable diseases using a pre-validated questionnaire. Independent t test was used to compare mean scores between the intervention community (Tumpat) and the control community (Bachok) at 1-month post intervention. One-way independent ANOVA test was done to compare score differences at baseline (pre), post 1-month and post 2-month from repeated surveys among random samples within the intervention community. There were significant improvements in all knowledge components from 9.4% to 52.6% with 10% increment in attitude scores toward preventing behaviours on flood-related communicable diseases.  When compared against the control community at one-month post-intervention, there were significantly higher knowledge on types of diseases, symptoms and risk factors as well as practice scores of drinking safe water and protective habits. This research demonstrated that community-based health education is effective in improving relevant knowledge, attitude and preventive practices among affected communities as part of their preparedness toward communicable diseases related to flood.

A Reliability Study of the Malay Version of the Malaysian Ministry of Health's Adolescent Client Satisfaction Questionnaire among Adolescents Attending Health Clinics in Northeastern Malaysia

Background

The need for client feedback in assessing healthcare services is widely recognized. However, little is known about the satisfaction of adolescent clients utilizing healthcare services in Malaysia. To the best of our knowledge, there is no validated instrument to measure the satisfaction of adolescent clients attending health clinics in Malaysia. This cross-sectional study aimed to determine the reliability of the Malay version of the Malaysian Ministry of Health’s Adolescent Client Satisfaction Questionnaire among adolescents attending health clinics in northeastern Malaysia.

Methods

A cross-sectional study was conducted in January 2019 among adolescents aged 10–19 years attending four designated health clinics in the northeastern state of Peninsular Malaysia. The test for Cronbach’s α was performed to determine the internal consistency reliability.

Results

There were a total of 85 adolescent clients involved in this study. The mean age of respondents was 15.6 years. The majority of respondents were female, Malay, students, and had attained a secondary level of education. The mean total satisfaction score was 78.35. The internal consistency reliability according to the Cronbach’s α of the domain was 0.854, which is considered highly reliable. The corrected item-total correlation for the domain was acceptable as it was ≥0.4.

Conclusion

The Malay version of the Malaysian Ministry of Health’s Adolescent Client Satisfaction Questionnaire has excellent internal consistency reliability. Therefore, it may be recommended as a tool to measure the satisfaction level among adolescents attending health clinics in Malaysia.

Making Health Services Adolescent-Friendly in Northeastern Peninsular Malaysia: A Mixed-Methods Study

A mixed-methods study was conducted in a Malaysian state beginning with a cross-sectional quantitative study to determine the relationship between clinic characteristics and clinic score of adolescent-friendliness. Subsequently, perceptions of healthcare providers on the facilitating factors for the provision of adolescent-friendly health services were explored qualitatively to support the quantitative findings. Availability of trained healthcare providers, adequate privacy, dedicated adolescent health services team, and adolescent health promotional activities were the clinic characteristics that significantly (p < 0.05) related with clinics' scores of adolescent-friendliness. The facilitating factors required for adolescent-friendly health services were (1) healthcare providers' commitment and prioritization towards adolescent-friendly health services; (2) organizational supports; (3) appropriate clinic settings; and (4) external supports for adolescent health promotional activities. The qualitative findings reaffirmed those of the quantitative study on the significant clinic characteristics required for adolescent-friendly health services. This study provides valuable insight for the Ministry of Health to elicit the required facilitating factors to further improve the quality of adolescent health services in Malaysia.

A 10-Year Journey of the USM Master and Doctoral Degrees in Public Health

The article introduces readers to the Master of Public Health and Doctor of Public Health programmes, offered by the Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia. The programme vision, structure and accomplishments over the decade are presented to provide an understanding of the programme. It is hoped that this professional programme will continue to flourish and produce new generations of public health medicine specialist equipped with the necessary knowledge and skills to make significant contribution towards improving the health of the population.

Leptospirosis and its prevention: knowledge, attitude and practice of urban community in Selangor, Malaysia

BACKGROUND

Leptospirosis is still endemic in Malaysia and has been prevalent in Selangor where cases have been underreported. Primarily, this was due to lack of awareness in the urban community in this region. This study determined the knowledge, attitude and preventive practice (KAP) of leptospirosis, and identified the significant predictors influencing KAP among urban community in Hulu Langat, Selangor.

METHODS

This cross-sectional study was conducted from 2015 to 2017 using validated questionnaire. Sampling methods included multistage cluster sampling, followed by simple random sampling to obtain 315 respondents. Descriptive analysis was performed to determine the KAP while χ2 and the subsequent logistic regression analysis were carried out to identify associations and predictors between variables.

RESULTS

Respondents were mainly Malaysian Bumiputra with a mean (Standard Deviation (SD)) age of 32.5 (13.0) years. Of 315 respondents, 80.3% (n = 253) had poor knowledge, 87.0% (n = 274) had good attitude, and 81.3% (n = 256) showed unacceptable practice towards leptospirosis and its prevention. Regression analysis identified age as the sole predictor influencing good knowledge (AOR 2.388; 95% CI = 1.298, 4.396; p = 0.005). Education level (AOR 2.197; 95% CI = 1.109, 4.352; p = 0.024) was also noted as the significant predictor influencing the overall practice.

CONCLUSIONS

The urban community in Selangor showed a positive attitude in waste management despite having little knowledge regarding the disease itself. The study also discovered inadequacy in preventive practice, hence marking the importance of the proper integration of knowledge and attitude into forming an acceptable practice to reduce transmission of Leptospira among urban population in Malaysia.

Seroprevalence of leptospiral antibodies among market workers and food handlers in the central state of Malaysia

OBJECTIVE

The high prevalence of leptospirosis in humans is of great public health concern, particularly in tropical and subtropical regions. This study aimed to determine the seroprevalence of leptospiral antibodies and distribution of serovars, and to assess the usefulness of enzyme-linked immunosorbent assay (ELISA) as a screening method for leptospiral antibodies in a high-risk healthy community.

METHODS

Cross-sectional study of 231 market workers and food handlers in wet markets and food premises from two localities in central Malaysia. Respondents' background information was obtained using a questionnaire. Serum samples were tested for leptospiral antibodies using ELISA and microscopic agglutination test (MAT).

RESULTS

Seroprevalence of leptospirosis among healthy workers was 46.3%. Detection of seropositivity was higher by MAT (46%) than ELISA (15%). We observed high seropositivity among local workers (49%), food handlers (49.5%), females (60.8%) and those aged 34 years and older (46.3%). Local strain LEP175 was the predominant serovar, followed by WHO strain Patoc.

CONCLUSION

Overall seroprevalence among healthy food handlers and market workers was high in this study. The workplace places susceptible individuals at risk of leptospirosis.

Seroprevalence and distribution of leptospirosis serovars among wet market workers in northeastern, Malaysia: a cross sectional study

BACKGROUND

Leptospirosis is a zoonotic disease associated with occupations which exposed workers to environments contaminated with urine of infected animals. The objective of this study was to determine the seroprevalence of leptospirosis among wet market workers in Kelantan.

METHODS

A cross sectional study was conducted in two main wet markets in Kelantan and 232 wet market workers were randomly selected. Blood samples were analysed for microscopic agglutination test (MAT) against 20 live leptospirosis reference serovars. MAT titres of 1:100 or more were considered as seropositive.

RESULTS

It was found that the overall seroprevalence for leptospirosis among the respondents was 33.6% (95% CI = 27.5, 39.7). The samples were tested positive against serovars Melaka (IMR LEP 1), Terengganu (IMR LEP 115), Sarawak (IMR LEP 175), Copenhageni (IMR LEP 803/11), Hardjobovis (IMR LEP 27), Australis, Autumnalis, Bataviae, Canicola, Grippotyphosa, Hardjoprajitno, Icterohaemorrhagiae, Javanica, Pyrogenes, Terrasovi, Djasiman, Patoc and Pomona. The predominant serovars was Autumnalis (18.2%).

CONCLUSION

Wet markets workers were at risk for leptospirosis infection evidenced by high seroprevalence of leptospirosis in this study. Further research need to be conducted to determine factors that favours infection in this groups.

Economic benefit of leptospirosis prevention in Kelantan, Malaysia: Willingness-to-contribute approach

Leptospirosis is an endemic disease in Malaysia. Despite the increasing incidence rate, knowledge on the economic assessment of preventing leptospirosis is still limited. This paper introduces the willingness-to-contribute (WTC) method for estimating the economic benefit of preventing leptospirosis. A cross-sectional study using the WTC method was applied to measure how much time respondents in Kelantan were willing to contribute toward preventing leptospirosis. Study respondents were wet market traders aged 18 years old and above who were fluent in the Malay language. The average WTC value was multiplied by the population of Kelantan to derive the monetary value of preventing leptospirosis. Two hundred and fifty respondents participated in the study. The mean time contribution was 6.68 hours (SD9.01) per month. The average WTC corresponded to a monthly cost savings of US$4.94 per person. Approximately between US$106.7 million to US$315 million per annum can be saved through the prevention of leptospirosis in Kelantan. Preventing leptospirosis is beneficial to Kelantan and would bring major economic savings. The findings are intended to help policy makers in the planning and management of leptospirosis policies and interventions.

A qualitative exploration of the misconceptions, knowledge gaps and constructs of leptospirosis among rural and urban communities in Malaysia

This qualitative study aimed to explore the misconceptions, knowledge gaps and constructs of leptospirosis among 72 respondents from rural and urban districts in two states of Malaysia. We conducted focus group discussions and data were examined using thematic analyses. The layman term of 'rat urine disease' contributed the most to the misconceptions regarding leptospirosis. There were gaps in the knowledge among urban and rural respondents in the two states, with the majority of subjects demonstrating a poor understanding of the disease. Construction of knowledge about leptospirosis relied mostly on the information provided by mass and social media; reading materials; word-of-mouth publicity; observations; experiences; and knowledge sharing among families, friends, and communities. The study findings may provide the foundation for the development of educational materials that may reduce the gaps in knowledge, and thereby improve health literacy and enhance preventive health behaviours for avoiding leptospirosis.

Leptospirosis Health Intervention Module Effect on Knowledge, Attitude, Belief, and Practice among Wet Market Workers in Northeastern Malaysia: An Intervention Study

Leptospirosis is an infectious disease which can be prevented by increasing awareness and promoting preventive health behaviours among high risk groups including wet market workers. Thus, the aim of this study was to determine the effectiveness of Leptospirosis Health Intervention Program (LHIP) in improving knowledge, attitude, belief and practice towards leptospirosis among wet market workers in Kelantan. This intervention study was conducted in two main wet markets in Kelantan involving 116 participants in each control and intervention groups. The health education intervention was based on Leptospirosis Health Intervention Module. The knowledge, attitude, belief and practice scores were measured before and six weeks after the intervention to examine the effect of the program. The results showed that knowledge (p < 0.001), attitude (p = 0.001), belief (p < 0.001) and practice (p < 0.001) scores changes were significantly higher in the intervention group compared to the control group. The adjusted mean differences were 12.93 (95% CI: 8.47, 17.39) for knowledge, 5.55 (95% CI: 2.28, 8.81) for attitude, 7.21 (95% CI: 3.43, 10.99) for belief and 7.35 (95% CI: 3.64, 11.05) for practice scores. Leptospirosis Health Intervention Program was an effective health educational tools to improve awareness and preventive behaviours among risk groups such as wet market workers.

Low Levels of Knowledge, Attitudes and Preventive Practices on Leptospirosis among a Rural Community in Hulu Langat District, Selangor, Malaysia

Little is known on the knowledge, attitudes and preventive practices (KAP) of leptospirosis worldwide. This study embarked on assessing the KAP of leptospirosis among rural communities in Malaysia. A total of 444 participants (223 male; 221 female) aged between 18 and 81 years old were surveyed by using a self-administered questionnaire. A majority of participants had poor knowledge level (57.0%), unacceptable attitudes (90.3%) and unacceptable preventive practices (69.1%) on leptospirosis, and only 29.7% knew “rat-urine disease” as leptospirosis. Only 34.2% of the participants knew the bacteria could enter via wound lesions. Ethnicity and income were strongly associated with knowledge level and preventive practices, respectively (p-values < 0.05). As for attitudes, ethnicity, income and education type were significantly associated (p-values < 0.05). Only 36.5% of the participants were willing to see a doctor and did not mind if their house or surrounding area is dirty (59.7%). Surprisingly, only 32.9% had used rubber boots during floods. By logistic regression analysis, ethnicity was the only significant predictor for both knowledge level (an odds ratio (AOR) = 0.39, 95% confidence interval (CI) = 0.222–0.680) and preventive practices (AOR = 1.81, 95% CI = 1.204–2.734). Ethnicity (AOR = 0.40, 95% CI = 0.239–0.665), income (AOR = 1.58, 95% CI = 1.041–2.385) and education type (AOR = 3.69, 95% CI = 1.237–10.986) were strong predictors for attitudes. Among the KAP variables, attitude (AOR = 4.357, 95% CI = 2.613–7.264) was the only predictor for the preventive practices by logistic regression analysis. The KAP elements on leptospirosis are still lacking and poor health seeking behavior and attitudes are of our utmost concern. Thus, effective strategies should be planned to impart knowledge, and develop proactive approaches and good preventive modules on leptospirosis to this leptospirosis-prone community.

Development and validation of a new knowledge, attitude, belief and practice questionnaire on leptospirosis in Malaysia

Background

In Malaysia, leptospirosis is considered an endemic disease, with sporadic outbreaks following rainy or flood seasons. The objective of this study was to develop and validate a new knowledge, attitude, belief and practice (KABP) questionnaire on leptospirosis for use in urban and rural populations in Malaysia.

Methods

The questionnaire comprised development and validation stages. The development phase encompassed a literature review, expert panel review, focus-group testing, and evaluation. The validation phase consisted of exploratory and confirmatory parts to verify the psychometric properties of the questionnaire. A total of 214 and 759 participants were recruited from two Malaysian states, Kelantan and Selangor respectively, for the validation phase. The participants comprised urban and rural communities with a high reported incidence of leptospirosis. The knowledge section of the validation phase utilized item response theory (IRT) analysis. The attitude and belief sections utilized exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

Results

The development phase resulted in a questionnaire that included four main sections: knowledge, attitude, belief, and practice. In the exploratory phase, as shown by the IRT analysis of knowledge about leptospirosis, the difficulty and discrimination values of the items were acceptable, with the exception of two items. Based on the EFA, the psychometric properties of the attitude, belief, and practice sections were poor. Thus, these sections were revised, and no further factor analysis of the practice section was conducted. In the confirmatory stage, the difficulty and discrimination values of the items in the knowledge section remained within the acceptable range. The CFA of the attitude section resulted in a good-fitting two-factor model. The CFA of the belief section retained low number of items, although the analysis resulted in a good fit in the final three-factor model.

Conclusions

Based on the IRT analysis and factor analytic evidence, the knowledge and attitude sections of the KABP questionnaire on leptospirosis were psychometrically valid. However, the psychometric properties of the belief section were unsatisfactory, despite being revised after the initial validation study. Further development of this section is warranted in future studies.

Escaping domestic violence: A qualitative study of women who left their abusive husbands

Objectives

This qualitative study aims to discover the factors that influenced the decisions of women who successfully escaped domestic violence by attaining a divorce.

Methods

In-depth interviews were conducted with 17 women, ages 21-56 who were either divorced or currently in the process of getting divorced in Kelantan, Malaysia.

Results

Several themes emerged, indicating the following five reasons for divorce: 1) reaching the point of ultimatum, 2) having adequate support pre- and post-divorce, 3) concern for children's welfare, 4) seeking financial independence, and 5) fear of harm.

Conclusion

The identification of the driving factors for divorce may spark a change in our society's mindset to empower female divorcees and allow them to lead happy, abuse-free lives.

Barriers to unmet needs among mothers of children with disabilities in Kelantan, Malaysia: A qualitative study

Objectives

The present study aimed to determine the barriers that deter mothers of children with disabilities from attaining their unmet needs.

Methods

In-depth interviews of 12 mothers of children with disabilities were conducted from November 2014 to January 2015 in Kelantan, Malaysia. The mothers were recruited by purposive sampling. Thematic analysis was used for identifying, analysing and reporting the data.

Results

Barriers to the unmet needs among mothers of children with disabilities were found to stem from the mothers' expectation and further propagated by lack of support, the role of healthcare professionals in providing care, inappropriate policies and shortage of resources required for survival and maintaining care.

Conclusions

Identification of the barriers to the attainment of unmet needs among mothers of disabled children is crucial for resolving the issue of unmet needs. Deeper understanding of these barriers may facilitate positive actions toward addressing the needs of these mothers and to alleviate the stress on mothers of disabled children. A concerted effort to coordinate services across all disciplines is required to dismantle these barriers by improving the provision of health care delivery and evaluation of welfare policies and services.

Multiplex amplification refractory mutation system (MARMS) for the detection of β-globin gene mutations among the transfusion-dependent β-thalassemia Malay patients in Kelantan, Northeast of Peninsular Malaysia

The aim of this study was to adapt MARMS with some modifications to detect beta mutation in our cohort of thalassemia patients. We focused only on transfusion-dependent thalassemia Malay patients, the predominant ethnic group (95%) in the Kelantanese population. Eight mutations were identified in 46 out of 48 (95.83%) beta thalassemia alleles. Most of the patients (54.2%) were compound heterozygous with co-inheritance Cd 26 (G>A). The frequencies of spectrum beta chain mutation among these patients are presented in Table 2. Among the transfusion dependent beta thalassemia Malay patients studied, 26 patients were found to be compound heterozygous and the main alleles were Cd 26 (G>A). Compound heterozygous mutation of Cd 26 (G>A) and IVS 1-5 (G>C) were 12 (46.2%), Cd 26 (G>A) and Cd 41/42 (TTCT) were 9 (34.6%), Cd 26 (G>A) and IVS 1-1 (G>C) were 2 (7.7%) respectively. Meanwhile the minority were made of a single compound heterozygous of Cd 26 (G>A) and Cd 71/72, Cd 26 (>A) and Cd 17 (A>T), Cd 26 (G>A) and -28 (G>A) respectively. Twenty out of forty six patients were shown to have homozygous of IVS 1-5 (G>C) were 2 (10.0%), Cd 26 (G>A) were 15 (75.0%), Cd 19 (A>G) were 1 (5.0%), and IVS 1-1 (G>T) were 2 (10.0%). The beta chain mutations among the Kelantanese Malays followed closely the distribution of beta chain mutations among the Thais and the Malays of the Southern Thailand. The G-C transition at position 5 of the IVS 1-5 mutation was predominant among the Malay patients. In conclusion, this method has successfully identified the mutation spectrum in our cohort of transfusion-dependent beta thalassemia patients, and this method is equally effective in screening for mutation among thalassemia patients.

The bandicoot rat, a new host record for Angiostrongylus cantonensis in Indonesia

A survey for Angiostrongylus cantonensis in possible definitive and intermediate hosts was conducted in Ancol, Jakarta. Adult worms were found in 43% of bandicoot rats, Bandicota indica setifera, in 14% of Rattus rattus diardii and 36% of the Achatina fulica were infected with larval forms of the parasite. The finding of the parasite in the bandicoot rat constitutes a new host record for Indonesia.