Background: COVID-19 pandemic has tremendously caused significant health impacts leading to high load of ICU critical patients. Multiple Intensive Care Unit (ICU) admission framework and triaging score have been adapted worldwide for admission of COVID-19 patients. The aim of this article is to review the COVID-19 ICU admission policy in five (5) countries, identify challenges and provide recommendations. Materials and Methods: Literature review was carried out through searching available literature from online databases such as EBSCO, PubMed, Research Gate, Google Scholar and Google search engine. The selected information used in this review is taken from any journal, article, report, thesis, national report, news update regarding the topic. Result: The ICU admission policy in 5 countries, namely South Africa, USA, UK, Hong Kong and Malaysia were reviewed. Different countries apply different guidelines to triage, prioritize and admit severe COVID-19 patients to ICU such as Color-coded Priority Scale in South Africa, Critical Care Triage Tool in USA, COVID-19 Critical Care Guideline in UK, COVID-19 Critical Care Triage Tool in Hong Kong and ICU Admission Prioritization Criteria in Malaysia. The ICU admission decision-making is supported with multiple ICU scorings such as Sequential Organ Failure Assessment (SOFA), Clinical Frailty score and National Early Warning score 2 (NEWS2). Conclusion: The COVID-19 ICU admission policies in these countries are well established and have been practised appropriately despite challenges faced by the ICU practitioners. All five selected national guidelines in this paper correspond to the WHO framework on the ICU admission policy. Ethical issues and legal supports on the ICU practitioners in ICU admission decision-making requires great attention form government and relevant policy stakeholders. Keywords: ICU policy, ICU admission, COVID-19, triage, Malaysia, South Africa, United States of America, United Kingdom, Hong Kong
Backgrounds: Mental health officers play a role in improving the health status of the community, both physically and mentally. Early treatment in the community carried out by mental health officers can prevent the increase of mental disorder in the community. This study aims to explore the behavior of mental health officers in their participation in Mbah Jiwo's integrated healthcare center, in dealing with and supporting the recovery of people with mental disorders. Materials and Methods: This is a descriptive research with a qualitative approach, which produces data from observational and in-depth interviews. Qualitative research describes the empirical reality behind an existing phenomenon, in this case the reality of mental health service program at Mbah Jiwo's integrated healthcare center. Sampling was conducted by purposive sampling with a sample size of 6 informants. Thematic analysis was performed using Colaizzi steps. Results: Based on Lawrence Green Behavior Causes theory, there are factors that can influence behavior, in this study factors that affect the mental health officers including, Predisposing factors, Knowledge; Reinforcing factors, social support and self-motivation; Enabling factors, availability and accessibility of health services, regulations and commitments. Conclusion: In this study, all factors affect the recovery success rate. In addition, the researcher found that, the factors of family support, the role of the community and local governments, medication adherence and routine control also affect the success rate of recovery. The result in this study are expected to be used as supporting data and references in improving the quality of mental health services, especially on community-based mental health care. Keywords: mental disorders; mental health officers; behavioral science; public health center
Background: In February 2018, the Indonesian Ministry of Health’s preventative and promotional programs called Healthy Indonesia through Family Approach reported that 73.7% of people with hypertension in Jambi province were not on regular medication to control it. In support of the government’s effort to raise the number of controlled hypertensive patients (receiving and taking treatment), the national health insurance ( Jaminan Kesehatan Nasional or JKN) with its Prolanis Clubs mandated club members to attend a monthly prevention program activity in which members got their blood pressure checked, informed about the use of the blood pressure charts, and prescribed their medication. This study appraised the prevention program and associated factors with the failure to control hypertension in the first half of 2019. Materials and Methods: This is a cross-sectional study with one hundred and eighty-five consenting JKN members aged 15-59 years, a representative sample randomly drawn from the total members of eighty-three JKN prolanis clubs in the Jambi province. JKN’s prolanis club is a popular JKN’s prevention program to control chronic diseases, including hypertension. The data were collected by means of a structured questionnaire to collect data on members’ sociodemographic characteristics. Blood pressure measurements were taken six times in six months following the World Health Organization (WHO) guidelines. Results that conform to an average systolic blood pressure of < 140 mmHg and diastolic blood pressure of < 90 mmHg in those taking anti-hypertensive medication mean controlled hypertension. Result: The prevalence of hypertension under control showed as low as 18% after six months of observation in six monthly prolanis gatherings. Controlled hypertension was associated with older age groups (45-59 years) (Adjusted Odds Ratio 27.3; 95% CI 3.63 - 205.05), taking medicine regularly (Adjusted Odds Ratio 12.9; 95% CI 5.43-30.63), and being employed (Adjusted Odds Ratio 2.4; 95% CI 1.13-5.38). Gender, educational level, poverty status, knowledge about hypertension and practices of healthy behaviour did not show significant statistical correlations with controlled hypertension. Conclusion: The findings recommend that JKN should employ more than just one intervention ( prolanis ) to control hypertension among members aged 15-59 years. Keywords: hypertension, prolanis , prevention, chronic diseases, Indonesia.
Background: Stunting in children under five years of age is still less recognized because the difference between stunted children and normal children at that age is not really seen. Many factors influence the occurrence of stunting in children under five, one of which is the child's diet. This study aims to analyze the differences in diet among stunted and non-stunting children aged 2-5 years in Langkat district. Materials and Methods: This research is a survey research using a cross-sectional design. The sample in this study amounted to 60 children, consisting of 30 stunted children and 30 non-stunting children. Dietary pattern data consisting of food intake was obtained using the 24-hour food recall Form. Data analysis used the Mann-Whitney test. Result: The results showed that there were differences in dietary patterns in stunted and non-stunting children based on the amount of nutrient intake for energy (p = 0.000), carbohydrates (p = 0.000), protein (p = 0.000), vitamin A (p = 0.014), iron (p. = 0.001), zinc (p = 0.000), magnesium (p = 0.000) and calcium (p = 0.000), except for vitamin C (p = 0.092). Conclusion: Officers are expected to further improve maternal knowledge through disseminating information about the importance of balanced nutrition for toddlers so that child feeding varies, and the socialization of exclusive breastfeeding and efforts to reduce stunting through village funds. Keywords: Stunting, Not Stunting, Dietary Pattern, Toddler, 2-5 years old.
Background: The number of cervical cancer cases related to human papillomavirus (HPV) increased in prevalence and mortality yearly despite many prevention programs introduced by the government. Knowledge and attitude towards HPV infection and vaccinations affect vaccine acceptance. Nurses play an important role in providing vaccination, health education, early treatment and screening program for its success. Materials and Methods: This cross-sectional study was conducted in March 2020 among 37 nurses working at the Obstetrics and Gynaecology Department of Hospital Universiti Sains Malaysia (HUSM), Kelantan. A validated self-administered questionnaire comprising 11 items for the knowledge domain and 8 items for the attitude domain was used. Result: The mean knowledge (SD) and mean attitude (SD) scores were 5.46 (1.71) and 27.68 (2.10). The majority of the participants (75.7%) knew that HPV is the most common sexually transmitted infection, but they (75.5%) were not aware that the Gardasil vaccine could protect against four types of HPV infection. About 97.3% of the participants believed that the vaccine is safe, but 13.5% were unsure of its efficacy. The Pearson’s chi-square and Fisher Exact tests showed no association between occupational characteristics and HPV-related characteristics with the level of knowledge towards HPV infection and vaccinations among nurses in HUSM. Conclusion: This study indicates that although nurses have favourable attitudes towards HPV infection and vaccinations, they have poor knowledge of HPV infection and vaccinations. However, none of the occupational characteristics and HPV-related characteristics tested is significantly associated with the nurses’ knowledge score. Keywords: Knowledge, attitude, occupational characteristics, HPV-related characteristics, vaccine, infection, cervical cancer
Background: Worldwide, colorectal cancer (CRC) is the third most common diagnosed cancer yet the information regarding the time points at which CRC is commonly diagnosed is sparse. This study aimed to determine the prevalence of delayed presentation of CRC patients for medical care, its associated factors and its impact on survival in northern Malaysia. Methods: Histologically confirmed and staged CRC patients between January 2007 and December 2017 in 25 hospitals, both in public and private sectors that located in northern Malaysia were included in this study. Based on the stage of CRC at the time of diagnosis, the patients were dichotomized into the “early presentation” (stage I and II) and “delayed presentation” (stage III and IV) groups. The individual data ranged from socio-demographic information, smoking status, comorbidities, symptoms at presentation, primary tumour site to survival status, was gathered from the National Cancer Patient Registry - Colorectal Cancer (NCPR-CC). The factors associated with the delayed presentation of CRC patients were identified using the multiple logistic regression analysis, and its impact on survival was demonstrated using the Cox regression analysis. Results: Of the 3,929 CRC patients included in this study, 61.9% were found to have presented to the hospitals only at stage III or IV of the disease. Delayed presentation was more common in those who were under 50 years of age (adjusted OR: 1.30; 95% CI: 1.08, 1.57), were of Malay ethnicity (adjusted OR: 1.55; 95% CI: 1.35, 1.79; as compared with Chinese), and had weight loss at the time of diagnosis (adjusted OR: 1.41; 95% CI: 1.21, 1.66). The patients who presenting late were also shown to have a higher mortality risk (adjusted OR: 2.78; 95% CI: 2.40 to 3.21). Conclusion: Most CRC patients in northern Malaysia only sought medical care when the malignancy reached advanced stages, giving rise to their poorer survival. While symptom-prompted diagnosis of CRC is still common, efforts should be made to promote the early screening not only in the elderlies but also in the young at-risk population. Keywords: Colorectal neoplasms, delayed diagnosis, survival, Malaysia.
Background: The percentage of people suffering from depression and/or anxiety globally has doubled from 416 million in 1990 to 615 million in 2013. Amongst associated factors identified were job demand, poor social support, organizational issues, financial problems, wages and workload. Thus, the objective of this study was to determine the prevalence and what are the associated factors that influencing depression, anxiety and stress level among healthcare workers in Pejabat Kesihatan Daerah Melaka Tengah.. Materials and Methods: The study design of this research was a cross sectional method. We recruited all 1203 healthcare workers, but the final number was 702 responses screened for analysis in which provide complete data on the variables of interest of the study. This study was conducted from August till December 2018. The validated Malay version of DASS 21 was used as a research tool in this study.. Result: The highest prevalence among healthcare workers in Pejabat Kesihatan Daerah Melaka Tengah was anxiety (14.0%), followed by depression (7.0%) and stress (4.3%).The prevalence of depression was significant among PPKP (OR: 10.27, 95%CI: 4.19-25.17) and those respondents working at PKD administrative office (5.40, 95%CI: 2.60-11.21); anxiety prevalence was statistically associated with age (OR: 2.26, 95%CI: 1.10-4.65), work place (OR: 3.75, 95%CI: 1.99-7.06), and occupation (OR: 5.17, 95%CI: 2.20-12.14). Lastly, stress prevalence was found to be significant among PPKP (OR: 5.29, 95%CI: 1.68, 16.65). Conclusion: Age, working at PKD administrative office and occupation as PPKP were significantly associated with DAS score among healthcare workers in Pejabat Kesihatan Daerah Melaka Tengah.. Keywords: anxiety, depression, Stress, healthcare workers
Background: The objective of this study was to explore the factor structure of the Children’s Eating Behavior Questionnaire (CEBQ) among Malay children and to determine the association between “food approach” scales and excess weight among urban primary school children in Malaysia. Materials and Methods: The exploratory factor analysis involved assessment of the factor structure of CEBQ using Principal Component Analysis with varimax rotation and reliability tests (Cronbach’s alpha and test-retest reliability). This study utilized data from the baseline information collected for a randomized control field trial of an educational intervention to reduce adiposity in children. Parents completed the CEBQ and children’s weight and height were measured to calculate the body mass index z-score. The association between “food approach” scale and obesity was assessed using multiple linear regression, adjusted for sex and family income. Result: Exploratory factor analysis on the 35 items revealed seven-factor solution, two factors (enjoyment of food and food fussiness) loaded on the same factor. Internal consistency reliability for the subscales ranged between 0.56 and 0.85. Food responsiveness, one of the “food approach” subscales, was found to be positively and significantly associated with excess weight (β = 0.094, p = 0.014, 95% CI; 0.02-0.17). Conclusion: Although CEBQ is a valuable psychometric tool, adjustments may be required for certain subscales in the context of our local setting in Malaysia. The food responsiveness subscale was positively associated with excess weight. This subscale of food responsiveness need to be taken into consideration in health campaigns targeted at the reduction of childhood obesity. Keywords: Body mass index, Paediatric obesity, Factor analysis, Adiposity, Feeding behaviour, Schools.
Background: There is increasing concerns globally over the mental health of youths especially those in tertiary institutions of learning. University education is associated with stress and conflicts arising from the rigours of learning as well as the transition from dependent to independent life. It is therefore important to identify strategies useful for the improvement of the mental and social wellbeing of this unique stratum of the society. Materials and methods: This study will be the first phase of a proposed three phase research. It will be a cross-sectional study that would utilize a multistage systematic randomization. It will assess mental health literacy, prevalence and risk factors for psychiatric morbidity, and preference for internet-based mental health intervention and its determinants. Data collection would involve the use of a semi-structured self–administered questionnaire on sociodemographic factors, a mental health literacy questionnaire (MHLq) and the General Health Questionnaire (GHQ-12). Descriptive and inferential statistics will be presented while regression model analysis will predict factors associated with mental morbidity and literacy. Results from this data will influence other phases which are aimed at designing appropriate mental health interventions for university students. Expected outcome: This study is aimed at bridging the gap in literature concerning mental disorders among students in University of Ilorin. It would also provide baseline data for the development and implementation of suitable and sustainable interventions to reduce the burden mental ill heath among the students in the university of Ilorin in particular, and by extension students in other Universities across Nigeria. Keywords: Research protocol, mental health literacy, psychiatric morbidity, university students/ tertiary institutions
Diabetes Mellitus is a chronic metabolic disorder associated with an increased rate of glucose which can be reduced by diets, drugs, lifestyle changes and physical activity. The present study aimed to investigate the comparison of the effectiveness of drug medication and combination of drug medication with exercise on biochemical parameters of type 2 Diabetes mellitus. A follow up study of 150 diabetes patient’s biochemical test >30 years of age were conducted in two phages before and after three months from Diabetes Hospital, Barishal. The investigator categorized two groups of diabetes patients where intervention of drugs along with physical exercise was given to 76 respondents and on the other hand 74 respondents by drugs to find out which intervention was more effective. This study found the incidence of reduced blood glucose from 49.3% to 12% ([mean± SD] from 10.04±2.98 to 7.38±2.72) by drugs and from 50.7% to 18.7% ([mean± SD] from 10.82±3.08 to 7.08±2.99) by drugs with physical activity during fasting after three months of intervention. After 2 hours eating, blood glucose reduced to 19.3% (14.10±4.62 to 12.90±3.92) and 22% (13.51±4.31 to 11.01±4.15) respectively. Analyst explored drugs with physical exercise was associated with fasting glucose, after 2 hours eating glucose and serum glutamic pyruvic transaminase after three months of intervention which was statistically significant (P<.05). Combination of drugs and physical activity targeting this factor has proven to be superior to conventional drug use for reducing blood glucose of diabetic patients. Keywords: Effect, Drugs, Physical Exercise, Biochemical Parameters and Type 2 Diabetes Mellitus Patients.
Background: Prediabetes is a global health problem among the non-communicable diseases and much effort has been exerted in the past in response to the increased prevalence of prediabetes. The objective of this scoping review is to describe evidences on the types of prediabetes diet and intervention studies available for prediabetes and its effects on glycaemic control. Materials and Methods: The scoping review was conducted based on the framework by Arksey and O’Malley. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) diagram was used as a guide to record the review process. Articles from years 1995 until 2020 on prediabetes diet among adults aged 18 years and above were retrieved based on the keywords using electronic databases (Ovid, PubMed, Cochrane Library and Google Scholar). Virtual library databases were also included in the searches. Result: A total of 652 articles were identified through database searches and 20 records were identified through manual search. A total of 205 duplicate records were removed and subsequently, the titles and abstracts of 467 records were screened for inclusion. The full texts of 223 articles were reviewed for eligibility, and finally, 78 studies were included in the review. Conclusion: The prediabetes state is reversible and provides an opportunity for treatment. Therefore, the focus on nutrition must be included in diabetes prevention strategies. Currently, a diet low in fat intake, rich in fiber, whole grains, and fruits and vegetables, as well as a Mediterranean-type diet, may be recommended for the prevention of diabetes in prediabetes. Keywords: prediabetes diet, impaired glucose tolerance, impaired fasting glucose, diabetes prevention, dietary intervention
Research indicates that university and college students, especially international students, are at higher risk of experiencing mental health problems than other populations during the (COVID 1-9) pandemic. This study examines the relationship between four independent variables (loneliness, stress, anxiety, and depression) with the mental health of international students enrolled at Universiti Utara Malaysia during the COVID-19 pandemic. A survey was conducted involving 326 international students from the university and the data was analyzed using the SPSS version 24 for its involving descriptive statistics, ANOVA, and t-test. The result reveals that there is a significant relationship between loneliness, stress, and depression with mental health with the exception of anxiety. Finally, the implication, limitation, recommendation, and conclusion were also discussed. Keywords: Covid-19, Mental health, loneliness, Anxiety, depression, International students, Malaysia
Background: Worldwide, cervical cancer is the fourth most frequent cancer among women after breast, lung and colon cancer. In the developing countries, cervical cancer ranks as high as the second most frequently diagnosed cancer and is the third cause of cancer death among women. Cervical cancer can be detected early using Papanicolaou (Pap) smear test and thus may early treatment can be instituted and saves lives. However, screening uptake for Pap smear was low. The aim of this review was to systematically assess the factors associated with Pap smear uptake among women in developing countries in the recent years. Materials and Methods: This study searched for relevant articles published in English over the period between January 2015 and 1 st of April 2019 using Ovid MEDLINE, EMBASE, CINAHL, PubMed and SCOPUS. All observational studies using validated questionnaire and probability sampling were included in this review. Studies related to validating instruments and using healthcare providers as participants were excluded from this review. Result: Seven studies involving a total of 8628 women fulfilled the eligibility criteria to be included in this review. Factors associated with Pap smear uptake identified include older women, higher educational level, higher income, married women, multi-parity, good knowledge, awareness and perception on cervical cancer, its screening and decision making, as well as healthy lifestyle. Conflicting results were found for risky sexual behaviours. Conclusion: Target groups for improving Pap smear uptake should include younger women, low parity, low socioeconomic group and women with high-risk sexual behaviours. Keywords: Papanicolaou test, vaginal smears, early detection of cancer, female, uterine cervical neoplasms, developing countries, heathy lifestyle, mass screening.
Background: Mobile devices have become a necessity in the daily lives and a preferred choice among everyone, including children. These devices can be used to perform internet-based transactions. This study aimed to describe the usage and determine the predictors of high usage of mobile devices among pre-schoolers. Materials and Methods: This study applied a cross-sectional study design and multistage random sampling. This study was conducted on parents or guardians of selected public pre-school children (KEMAS) using self-verified content questionnaires. The questionnaires consisted of questions on parental and child socio-demographic information, family background, child mobile device usage, and child emotional behaviour. Result: The study obtained a response rate of 71.9% (463 parents or guardians). About 71.0% of the pre-school children used mobile devices, and the majority used smartphones (71.6%). In total, 24.0% of the pre-schoolers used mobile devices regularly (average 60 minutes and more per day). Mobile devices usage was higher among pre-schoolers whose parents spent less than 60 minutes a day with their children (AOR 4.00, 95% CI: 2.21, 7.02) and parents with low levels of education (AOR 2.90, 95% CI: 1.46, 5.74). Having a more educated parent (AOR 0.37, 95% CI: 0.19, 0.73) reduced the usage of mobile devices among the pre-school children in the study. Conclusion: Parental and family factors are the leading factors affecting the high usage of mobile devices among pre-school children. Therefore, there is a need to increase the awareness of parents and families on this matter. Keywords: mobile devices, pre-school, regular users, children, mobile device usage
Background: Evidence suggests that the COVID-19 pandemic has generally increased levels of depression among the public. However, the impact on undergraduate students in Malaysia has not been well-documented. This study aims to determine the depression level of undergraduate students of Universiti Kebangsaan Malaysia during pandemic COVID-19 and its contributing factors. Materials and Methods: This is a cross-sectional, online survey involving a total of 163 samples of undergraduate students recruited through convenience sampling from Universiti Kebangsaan Malaysia. An online survey was conducted via google form to determine socio-demographic characteristics and level of depression using Socio-demographic Questionnaire and Patient Health Questionnaire (PHQ-9). Result: This study showed that the overall mean score was below the depression level that is 9.71. Findings showed that the Chinese 82% (aOR: 0.18) and Indian ethnicity 95% (aOR: 0.05), were significantly less likely to get depression compared to Malay ethnicity among undergraduate students during the COVID-19 pandemic. Conclusion: Findings also showed that other socio-demographic factors are not significantly associated with participant’s depression levels. In conclusion, there is a need for future study across ethnicity to explore the relationship between ethics and depression during COVID-19. Keywords: Covid-19 pandemic; depression; undergraduate students; Universiti Kebangsaan Malaysia
Background: This paper reviews the past studies on mental disorders in Malaysia since it becomes a threat in developed and developing countries. Past studies in other countries have investigated the relationship between mental disorders with at-work productivity loss. However, the issues between mental disorders and at-work productivity loss in Malaysia have remained unclear and vague. Hence, this paper aims to identify the effect of mental disorders on work productivity in Malaysia and sheds light on future research based on previously published evidence. Materials and Methods: This paper summarizes and synthesizes the findings from previous studies on mental disorders in Malaysia and relates to productivity loss. The studies were identified by using electronic databases and the papers were selected according to the inclusion criteria to find relevant journal articles related to issues, prevalence, associated risk factors, and productivity. Result: Mental disorders such as depression and anxiety are considered a common mental disorders in Malaysia. Most of the studies on mental disorders only determined the prevalence and associated risk factors but overlook the impact of productivity loss among workers. Besides, schizophrenia also costs a huge economic burden despite the low prevalence. Hence, this study enlightens future research to address the issue of productivity loss among workers due to mental disorders as it gives a substantial impact on the economic burden. Conclusion: This study thus illuminates future research in Malaysia to resolve the issue of productivity loss among employees due to mental problems, as it has a direct economic burden. Keywords: Mental disorders, depression, anxiety, productivity, risk factor
Background: Smoking cessation programs have been widely implemented especially at the Malaysian Ministry of Health's facilities to help smokers reduce their smoking habits and slowly stop smoking. This unhealthy practice is the cause of many diseases as there are more than 6000 poisons in cigarette smoke that can give implication to environmental and health impact to those around smokers. This paper aims to explore the effectiveness of peer support intervention in improving the knowledge, attitudes and motivation (KAM) of allied health male trainee smokers in Malaysian training institutes. Materials and Methods: A cluster randomisation control trial was conducted among male smoker trainees at six training institutes involving 324 respondents. Data on knowledge, attitude, motivation, socio-demographic characteristics factors were collected using the self-administers questionnaire. Evaluation was performed three times during baseline, three and six months to see the differences between intervention and control groups. Repeated measure Anova and Chi-square test were used in data analysis. This study utilised Generalised Estimating Equations (GEE) to handle the clustering effects. Result: The mean value of the knowledge intervention group at baseline was 10.87 (2.39), 12.38 (2.24) on the second evaluation and 13.88 (2.24) on the third evaluation, whereas the mean for the control group was 10.44 (2.27), 10.36 (1.88) on the second evaluation and 10.47 (2.16) on the third evaluation. For the attitude variable, the mean value for the intervention group at baseline was 9.12 (1.25), followed by 10.19 (0.94) on the second evaluation and 10.59 (0.85) on the third evaluation. Meanwhile, the control group recorded a mean value at baseline of 7.71 (1.39), followed by 8.25 (1.52) on the second evaluation and 8.74 (1.83) on the third evaluation. The mean value of knowledge and attitudes was always higher than the control group throughout the baseline to the third evaluation. There was a significant difference in the mean value for knowledge and attitude between groups based on time with a p-value 0.05. Conclusion: This study found that good knowledge, favourable attitudes and good motivation are the key drivers of a smoker's success in quitting smoking. The approach used to help smokers is very important in determining the success of a program. Therefore, those who conducted smoking cessation programs can take the opportunity to apply this method in helping smokers to improve their knowledge, attitudes and motivation for changing their behaviour. Keywords: smoking cessation, peer motivation, Allied Health Trainee, knowledge, attitudes, motivation
Background : Sexually Transmitted Infections (STIs) are frequently associated with significant morbidity, crippling sequelae and adverse maternal and child health conditions. Despite widespread availability of Primary Health Care (PHC) centres in Kaduna State, the capacity of those facilities to provide STIs services remains unknown. This study aims to assess the capacity of PHC centres to provide STIs services in Kaduna State, North-western Nigeria. Materials and Methods : This cross-sectional study employed cluster sampling method to select 44 upgraded PHCs in four randomly selected Local Government Areas of Kaduna North senatorial district. In each facility, the STIs section of the WHO Service Availability and Readiness Assessment (SARA) tool was administered to the facility in-charges to assess the capacity of each PHC to provide STIs-related services. Data was analysed using SPSS version 23 and presented graphically using Microsoft Excel. Result : Majority of the PHCs (95%) provide STIs services including diagnosis and treatment based on clinical assessment. Most of the facilities (70%) also had the national STIs treatment guidelines on the day of visit. Of the 44 PHCs visited, only 9 (20%) had a staff who received STIs training in the two years preceding the study. Conclusion : STIs services were widely available in Kaduna State PHCs with most facilities able to provide diagnosis and treatment of common STIs based on clinical assessment. Lack of STIs treatment guidelines and poor staff training were also common and these two may greatly diminish the quality of STIs services rendered. More efforts are therefore needed to address these gaps and improve the quality of STIs services. Keywords : Primary Health Care, Sexually Transmitted Infections, STIs, Kaduna, Nigeria
Background: Pharmacy held a significant role in forming patient’s perceived quality of hospital services as a whole due to 80% of patient visits were related to medication procurement. The time of the National Health Insurance (JKN) outpatient non-compounded medication service of Menur Mental Hospital still has not reached the targeted 30 minutes, which according to Lean Thinking, could have been caused by interruption of waste hence further identification was necessary. This study aims to identify 8 types of waste on the JKN outpatient non-compounded medication service. Materials and Methods: Observational descriptive study with a cross-sectional design using primary data sources, consisted of the process of the service and interviewees; and secondary data sources, consisted of relevant published research results and literature. Data were analysed using current-state mapping, identification of value-added, identification of types of waste, identification of causes of waste, and future-state mapping. Result: The average waiting time was 76.59 minutes, with a total of 48 activities, 43.75% value-added, 25.9% necessary non-value-added, 74.1% unnecessary non-value-added or waste. Waste including 1 defect, 2 transportation, 9 waiting, 3 motion, 3 overprocessing, and 1 human potential. Causes of waste including 1 machine factor, 1 technology factor, and 3 environmental factors. Designed process post waste minimisation showed a decrease by 69.1% in waiting time, with a total of 20 activities. Conclusion: There were 6 out of 8 types of waste found on the process which could be minimised through improvements on their factors, namely an upgrade of computer specifications, integration between hospital management information system with INA-CBG’s system, placement of printer according to forward grip reach, placement of connector window or preparation tables according to forward grip reach, and addition of scheduling feature on printer system. Keywords: Waste, waiting time, pharmacy, drug, medicine, dispensing
Background: This study aims to describe barriers in diagnosing brain death by categorizing the data analysed from the National Transplant Procurement Management Unit (NTPMU) Registry. Materials and Methods: Data records of the NTPMU registry from 2018-2019 were extracted. These data were analysed to describe the following: (i) Brain death proportion; (ii) Demographic characteristics; (iii) Admission and brain death test characteristics; (iv) Reason for brain death test not done and; (v) Correlations. Result: A total of 772 referrals were made, of which 322 were suspected for brain death. Out of this, 126 cases were confirmed for brain death, whereas 27 consented for organ donation. The proportion of confirmed brain deaths from the reported total deaths from 2018-2019 is 15.8%. Neurosurgical (57.5%) and intensive care (78.1%) units reported for the most referrals made. Severe traumatic brain injury (39.2%) and spontaneous intracranial haemorrhage (41.8%) are the two most frequent causes of admission with suspected brain death. Unable to correct parameters (34.7%), cardiac death before test was done (31.2%) and no clearance from family (21.2%) are the most frequently reported causes for brain death test not done. Selected variables showed no correlation with duration between first and second brain death tests. Conclusion: A sound understanding in clinical knowledge and awareness among healthcare workers, a well-structured brain death consensus statement, properly executed training to improve attitudes and a well-managed awareness campaigns directing to the public are critical in overcoming the barriers in brain death diagnosis. Keywords: Barriers, brain death diagnosis, organ donation, Malaysia, organ transplant
