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Abstract: Objective: Hepatitis C is a chronic infectious liver disease that can lead to cirrhosis, liver cancer and liver failure. This study aimed to estimate the healthcare cost of treating chronic hepatitis C virus (HCV) from the perspective of Ministry of Health hospitals in Malaysia. Methods: The cost analysis study was conducted from the healthcare provider's perspective. Healthcare sector resource utilisations for managing patients with chronic hepatitis C were obtained from a retrospective cohort study of patients with hepatitis C at Sultanah Bahiyah Hospital, Malaysia, between December 2008 and 2014. These utilisations were organised by disease stage. When no patients were available for a specific stage, resource utilisations were estimated using expert opinions collected through iterative structured interviews with two gastroenterologists. Key findings: There were 112 patients included in the final analysis. Ninety‐one per cent of these were male, and patients had a mean age of 45.8 (SE 1.1) years. The mean (SE) annual total cost for ‘mild and moderate chronic HCV’ was GBP 338.08 (58.95), that for ‘compensated cirrhosis chronic HCV’ was GBP 493.39 (162.57), that for ‘recovered, no HCV, history of mild fibrosis’ was GBP 259.73 (30.79), that for ‘recovered, no HCV, history of moderate fibrosis’ was GBP 257.09 (31.10), that for ‘recovered, no HCV, history of severe fibrosis’ was GBP 359.92, that for ‘decompensated cirrhosis’ was GBP 512.89 (214.12), and that for ‘hepatocellular carcinoma’ was GBP 426.08. Conclusions: Chronic HCV infection is generally a progressively expensive condition. [ABSTRACT FROM AUTHOR]

Background: One major challenge in prioritizing health care using cost-effectiveness (CE) information is when alternatives are more expensive but more effective than existing technology. In such a situation, an external criterion in the form of a CE threshold that reflects the willingness to pay (WTP) per quality-adjusted life-year is necessary.Objectives: To determine a CE threshold for health care interventions in Malaysia.Methods: A cross-sectional, contingent valuation study was conducted using a stratified multistage cluster random sampling technique in four states in Malaysia. One thousand thirteen respondents were interviewed in person for their socioeconomic background, quality of life, and WTP for a hypothetical scenario.Results: The CE thresholds established using the nonparametric Turnbull method ranged from MYR12,810 to MYR22,840 (~US $4,000-US $7,000), whereas those estimated with the parametric interval regression model were between MYR19,929 and MYR28,470 (~US $6,200-US $8,900). Key factors that affected the CE thresholds were education level, estimated monthly household income, and the description of health state scenarios.Conclusions: These findings suggest that there is no single WTP value for a quality-adjusted life-year. The CE threshold estimated for Malaysia was found to be lower than the threshold value recommended by the World Health Organization. [ABSTRACT FROM AUTHOR]

Objective This study aimed to investigate the effect of calendar packaging (CP) on medication adherence among hypertensive patients in Malaysia. Setting Outpatient Pharmacy Department, Kulim Hospital. Methods This was a parallel randomized controlled trial of CP (intervention group) versus normal pack (control group) for patients who were on daily dose antihypertensive drug (amlodipine).The primary outcome was medication adherence to amlodipine, assessed by medication possession ratio (MPR), percentage of on-time refills and Malay Version Morisky medication adherence scales. Key findings Eighty-three patients participated. The mean age (standard deviation) was 55.85 (10.25) and 56.55 (10.42) for intervention and control group respectively. This study found that intervention group has better medication adherence score than the control group measured by MPR, Morisky medication adherence score ( P < 0.05) and percentage of on-time refills ( P < 0.01). Intervention group showed a significantly lower systolic and diastolic blood pressure ( P < 0.05) compared to control group. Intervention group was significantly associated with higher medication adherence measured by MPR (β = 0.006, P < 0.05), Morisky scale (β = 0.365, P < 0.05) and percentage of on-time refill (β = 0.063, P < 0.01); in addition lower systolic blood pressure (β = −4.4, P < 0.05) after controlling for the study period and patient age. Conclusions This study found that CP could improve adherence to medication among hypertensive patients. The results also suggest possible improvement in blood pressure with the use of CP. [ABSTRACT FROM AUTHOR]

Objectives The current study aims to compare the retail prices of the 10 most prescribed drugs in Northern Malaysia and Australia. Methods A cross-sectional study was conducted to compare the retail prices of the 10 most used prescription medications in Penang, Malaysia, with the retail prices of the same drugs in Australia. Data collection was done using a standard form. Percentage difference was calculated using simple mathematical formulae in Microsoft Excel. Key findings Findings demonstrate that the mean retail drug prices in Penang, Malaysia, were 30.30-148.28% higher than the mean retail prices in Australia. In addition, variation between retail prices was also noticed between pharmacies in Penang, with a difference between highest and lowest of 80%. Conclusion Malaysia has average higher retail prescription drug prices compared to Australia due to the lack of pharmaceutical market regulation, which could impose limits on prices, profits and total spending on pharmaceuticals. [ABSTRACT FROM AUTHOR]

Generic medicines play a key role in the affordability of pharmaceuticals. This study aims to compare price and to document the actual savings that can be achieved if generics are used by consumers in the state of Penang, Malaysia. This is a cross-sectional pilot study on the price of innovator and generic medicines for the 20 most-used medications in Malaysia. Upon consent, 20 retail pharmacies were conveniently selected. A pre-validated data collection form was used to collect their selling price from the community pharmacist. The analysis was limited to medicines in the same dosage form and dose. Those still under patent protection or combined with other active ingredients were excluded from the study. This study found that most innovator drugs are 27–90 per cent more expensive than generics. Some generic drugs are, however, more expensive than their innovator counterparts (40 per cent higher). Some locally produced generics are also more expensive than foreign products. The current findings suggest that consumers can save up to 90 per cent of the cost of their medication by using generic products. Further investigation is needed to explore the causality of the observed differences in price of products in order to increase their accessibility to the general population.Journal of Generic Medicines (2008) 6, 35–42. doi:10.1057/jgm.2008.25; published online 21 October 2008 [ABSTRACT FROM AUTHOR]

Background Around the globe, community pharmacy has always been a health care hub made accessible to the public. Aim This study was conducted to evaluate consumers' perceptions towards the role of the pharmacist as health educator ( HE) and hence to identify the barriers toward consumers' acceptance of the role. Method This qualitative study was conducted in four states of Malaysia where participants (>18 years old) were recruited using a convenience sampling method until saturation of themes. A semi-structured interview guide was used and face-to-face interviews with consenting participants were conducted for approximately 20 min by trained interviewers. All interviews were audio-recorded, transcribed verbatim and evaluated using a thematic content analysis approach. Results In all, 21 consumers were interviewed. Analysis of interview transcripts identified four major themes: understanding of the term ' HE', facilitators and barriers for consumers accepting pharmacists as HE, and strategies to overcome the barriers. Most respondents acknowledged and recognised the roles of community pharmacists in terms of giving clear advice and explanations about healthcare issues and medications, and the ability to educate the public. The major barriers included the experience of the pharmacist, consumers' preferences for general practitioners as their HEs, the unavailability of pharmacists on the premises and personal encounters with pharmacists with bad attitudes. Conclusion Consumers generally accept pharmacists as HEs. However, some barriers do exist. The pharmacy stakeholders in the country need to address these barriers in order to improve future utilisation of community pharmacists as HEs in the existing healthcare system. [ABSTRACT FROM AUTHOR]

Background: Studies from both developed and developing countries have demonstrated a considerable fluctuation in the average cost of TB treatment. The objective of this study was to analyze the medical resource utilization among new smear positive pulmonary tuberculosis patients. We also estimated the cost of tuberculosis treatment from the provider and patient perspectives, and identified the significant cost driving factors. Methods: All new smear positive pulmonary tuberculosis patients who were registered at the chest clinic of the Penang General Hospital, between March 2010 and February 2011, were invited to participate in the study. Provider sector costs were estimated using bottom-up, micro-costing technique. For the calculation of costs from the patients' perspective, all eligible patients who agreed to participate in the study were interviewed after the intensive phase and subsequently at the end of the treatment by a trained nurse. PASW was used to analyze the data (Predictive Analysis SoftWare, version 19.0, Armonk, NY: IBM Corp.). Results: During the study period, 226 patients completed the treatment. However, complete costing data were available for 212 patients. The most highly utilized resources were chest X-ray followed by sputum smear examination. Only a smaller proportion of the patients were hospitalized. The average provider sector cost was MYR 992.34 (i.e., USD 325.35 per patient) whereby the average patient sector cost was MYR 1225.80 (i.e., USD 401.90 per patient). The average patient sector cost of our study population accounted for 5.7% of their annual family income. In multiple linear regression analysis, prolonged treatment duration (i.e., > 6 months) was the only predictor of higher provider sector costs whereby higher patient sector costs were determined by greater household income and persistent cough at the end of the intensive phase of the treatment. Conclusion: In relation to average provider sector cost, our estimates are substantially higher than the budget allocated by the Ministry of Health for the treatment of a tuberculosis case in Malaysia. The expenses borne by the patients and their families on the treatment of the current episode of tuberculosis were not catastrophic for them. [ABSTRACT FROM AUTHOR]

Background: Chronic pain has a major impact on a patient's quality of life, affecting physical and psychological functioning. It has debilitating consequences on social and economic aspects too. This study aimed to explore the status of health-related quality of life (HRQoL) of Malaysian patients suffering from chronic non-malignant pain.Methods: Four hospitals offering pain clinic services were involved in this multicentre cross-sectional study conducted between June and September 2020. Adult patients who had been diagnosed with non-malignant chronic pain lasting for at least three months and able to communicate in English or Malay language were recruited in this study. Participants were informed about the study and were made aware that their participation was entirely voluntary. A battery of questionnaires consists of the EuroQol-5 dimensions-5 levels questionnaire (EQ-5D-5L) and the EuroQol visual analogue scale (EQ VAS), the Pain Self-Efficacy questionnaire (PSEQ) and the Pain Catastrophizing Scale (PCS) were self-administered by the patients. Besides, a structured questionnaire was used to collect their socio-demographic information, pain condition, sleep quality and working status. Participants' usage of pain medications was quantified using the Quantitative Analgesic Questionnaire (QAQ).Results: A total of 255 patients participated in this study. A median EQ-5D index value of 0.669 (IQR: 0.475, 0.799) and a median EQ VAS score of 60.0 (IQR: 50.0, 80.0) were recorded. Malay ethnicity (Adj. B: 0.77; 95% CI: 0.029, 0.126; p = 0.002) and a higher level of self-efficacy (Adj. B: 0.008; 95% CI: 0.006, 0.011; p < 0.001) were predictors of a better HRQoL, while suffering from pain in the back and lower limb region (Adj. B: -0.089; 95% CI: - 0.142, - 0.036; p = 0.001), the use of a larger amount of pain medications (Adj. B: -0.013; 95% CI: - 0.019, - 0.006; p < 0.001), and a higher degree of pain magnification (Adj. B: -0.015; 95% CI: - 0.023, - 0.008; p < 0.001) were associated with a poorer HRQoL.Conclusions: These findings suggested that Malay ethnicity and a higher level of self-efficacy were predictors of a better HRQoL in patients with chronic pain, whereas pain-related factors such as higher usage of medication, specific pain site and pain magnification style were predictors of poorer HRQoL. [ABSTRACT FROM AUTHOR]

Background: According to the World Health Organization’s recent report, in Malaysia, tuberculosis (TB) treatment success rate for new smear positive pulmonary tuberculosis (PTB) patients is still below the global success target of 85%. In this study, we evaluated TB treatment outcome among new smear positive PTB patients, and identified the predictors of unsuccessful treatment outcome and longer duration of treatment (i.e., > 6 months). Methods: The population in this study consisted of all new smear positive PTB patients who were diagnosed at the chest clinic of Penang General Hospital between March 2010 and February 2011. During the study period, a standardized data collection form was used to obtain socio-demographic, clinical and treatment related data of the patients from their medical charts and TB notification forms (Tuberculosis Information System; TBIS). These data sources were reviewed at the time of the diagnosis of the patients and then at the subsequent follow-up visits until their final treatment outcomes were available. The treatment outcomes of the patients were reported in line with six outcome categories recommended by World Health Organization. Multiple logistic regression analysis was used to find the independent risk factors for unsuccessful treatment outcome and longer treatment duration. Data were analyzed using the PASW (Predictive Analysis SoftWare, version 19.0. Armonk, NY: IBM Corp). Results: Among the 336 PTB patients (236 male and 100 female) notified during the study period, the treatment success rate was 67.26% (n = 226). Out of 110 patients in unsuccessful outcome category, 30 defaulted from the treatment, 59 died and 21 were transferred to other health care facilities. The mean duration of TB treatment was 8.19 (SD 1.65) months. In multiple logistic regression analysis, risk factors for unsuccessful treatment outcome were foreign nationality, male gender and being illiterate. Similarly, risk factors for mortality due to TB included high-grade sputum and presence of lung cavities at the start of treatment, being alcoholic and elderly. Likewise, concurrent diabetes, presence of lung cavities at the start of the treatment and being a smoker were the significant predictors of longer treatment duration. Conclusion: Our findings indicated that the treatment success rate among the new smear positive PTB patients was less than the success target set by World Health Organization. The proportion of patients in the successful outcome category may be increased by closely monitoring the treatment progress of the patients with aforementioned high risk characteristics. Similarly, more aggressive follow-up of the treatment defaulters and transferred out patients could also improve the TB treatment success rate. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to obtain norms of the SF-36v2 health survey and the association of summary component scores with socio-demographic variables in healthy households of tuberculosis (TB) patients. Design: All household members (18 years and above; healthy; literate) of registered tuberculosis patients who came for contact tracing during March 2010 to February 2011 at the respiratory clinic of Penang General Hospital were invited to complete the SF-36v2 health survey using the official translation of the questionnaire in Malay, Mandarin, Tamil and English. Scoring of the questionnaire was done using Quality Metric’s QM Certified Scoring Software version 4. Multivariate analysis was conducted to uncover the predictors of physical and mental health. Results: A total of 649 eligible respondents were approached, while 525 agreed to participate in the study (response rate = 80.1 %). Out of consenting respondents, 46.5 % were male and only 5.3 % were over 75 years. Internal consistencies met the minimum criteria ( α > 0.7). Reliability coefficients of the scales were always less than their own reliability coefficients. Mean physical component summary scale scores were equivalent to United States general population norms. However, there was a difference of more than three norm-based scoring points for mean mental component summary scores indicating poor mental health. A notable proportion of the respondents was at the risk of depression. Respondents aged 75 years and above ( p = 0.001; OR 32.847), widow ( p = 0.013; OR 2.599) and postgraduates ( p < 0.001; OR 7.865) were predictors of poor physical health while unemployment ( p = 0.033; OR 1.721) was the only predictor of poor mental health. Conclusion: The SF-36v2 is a valid instrument to assess HRQoL among the households of TB patients. Study findings indicate the existence of poor mental health and risk of depression among family caregivers of TB patients. We therefore recommend that caregivers of TB patients to be offered intensive support and special attention to cope with these emotional problems. [ABSTRACT FROM AUTHOR]

Summary: Treatment with antiepileptic drugs is commonly guided by serum level monitoring. Such monitoring requires expensive laboratory equipment and products. However, well-conducted studies on the cost-effectiveness of therapeutic drug monitoring for antiepileptic drugs are lacking particularly in patients with structural-metabolic epilepsy. The study aims to assess the cost-effectiveness of serum level monitoring services in the management of children with structural-metabolic epilepsy during the first year of diagnosis. A retrospective cost-effectiveness analysis was conducted from the provider perspective. It included patients attended a paediatric neurology clinic. The effectiveness measures used in this analysis were the number of patients that achieved ≥50% reduction in seizure frequency, and the number of patients with 3-month seizure free. Medical records of the patients were reviewed for the required information. Medical chart/billing data obtained from the hospital were collected to estimate the resources used (One Malaysian Ringgit MYR is equivalent to 0.31 USD). The recruited children were followed for one year following their first visit. The average cost effectiveness ratio for the monitored patients (MYR 2735 per patient that achieved a ≥50% reduction in seizure frequency) was lower than that for non-monitored patients (MYR 2921 per patients that achieved a ≥50% reduction in seizure frequency), with incremental cost-effectiveness ratio of MYR 2357 per one additional patient that achieved a ≥50% reduction in seizure frequency. The average cost effectiveness ratios for monitored and non-monitored group were MYR 8279 and MYR 6433 per patient with a 3-month seizure-free period, respectively, with incremental cost-effectiveness ratio of MYR 29,666 per one additional patient with a 3-month seizure-free period. In terms of the effectiveness measures used, serum level monitoring of antiepileptic drugs was found to be cost-effective. However, the incremental cost-effectiveness ratio was found to be sensitive to the cost of management. [Copyright &y& Elsevier]

Objective: The objective of this study was to assess and compare the knowledge and perception of breast cancer among women of various ethnic groups in the state of Penang. Subjects and Methods: A cross-sectional survey was conducted from February 5 to March 15, 2008. 384 participants were conveniently selected and interviewed face to face by a trained researcher (M.A.H.) using a validated questionnaire. Participants were required to answer 22 questions concerning knowledge of breast cancer and 5 questions on the perception of breast cancer management and treatment outcomes. Results: The mean total score of knowledge was 59.1%, with Indian women having significantly less knowledge than the Chinese and Malay women (p < 0.001). Only 117 (32.3%) and 120 (33.0%) women were aware of the recommended breast self-examination (BSE) and clinical breast examination (CBE) guidelines, respectively. Multiple regression analysis showed that ethnicity, age, level of education and employment status were major determinants of breast cancer knowledge. Conclusion: The current study has demonstrated that women in the state of Penang have serious knowledge deficits about breast cancer and poor awareness of BSE and CBE guidelines. This study has highlighted the need of an intensive breast cancer awareness campaign which should also stress the importance of early detection and reporting of breast cancer. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Antibiotic resistance is a major public health concern, accelerated by antibiotic overuse. Inadequate knowledge among the public has been associated with inappropriate use of antibiotics. This study determined the impact of a self-developed educational leaflet for addressing specific knowledge gaps in antibiotic use among the public. Methods: This was an experimental study conducted at five hospitals and 20 primary health care clinics in the state of Perak. Adults over 18 years of age were recruited using sequential sampling. The first phase of data collection consisted of a pre-intervention assessment, an educational session, and an immediate post-intervention assessment. Each educational session was conducted by trained pharmacists and lasted approximately 15 min for each participant. A two-week post-intervention assessment was then conducted via a phone call to re-assess the participants using the same questionnaire. Results: Out of 300 questionnaires distributed, 234 were completed for our study. The mean age of participants was 40.7 ± 14.6 years old. Most of the respondents were female (143, 61.1%), Malay (162, 69.2%), and had tertiary education (162, 69.2%). A mean score was generated for each domain, with knowledge towards antibiotic resistance: 2.83 ± 1.28 pre-intervention, 3.76 ± 0.62 immediate post-intervention, and 3.67 ± 0.78 two-weeks post-intervention (total score: 4.00); knowledge towards antibiotic use: 2.03 ± 1.56 pre-intervention, 4.56 ± 1.46 immediate post-intervention, and 4.32 ± 1.48 two-weeks post-intervention (total score: 6.00); perception towards antibiotic use: 2.83 ± 1.38 pre-intervention, 4.25 ± 1.06 immediate post-intervention, and 4.22 ± 1.02 two-weeks post-intervention (total score: 5.00). Significant improvement in the mean scores were found before and after intervention in all domains (p < 0.001). Conclusion: The educational leaflet was able to address salient knowledge gaps in the participants and remained sustainable over a two-week follow-up. Thus, its inclusion into future antibiotic awareness campaigns should be encouraged. [ABSTRACT FROM AUTHOR]

Background: The general problem is lack of inter-professional collaboration and the way private primary care responds to manage chronic diseases in Malaysia. Absence of prescription review, inadequate patient education, the highest percentage of prescribing errors and half of the chronic disease patients are nonadherent. Medicines are the most common and life long used interventions in chronic diseases. Hence, the need to manage medicine in chronic diseases becomes obligatory. As both general practitioner and community pharmacist can dispense medications, this has resulted in a business rivalry. There is a need to build consensus among various healthcare stakeholders for a collaborative medication therapy management model (CMTM) where community pharmacist has an active role in chronic care. Method: This study utilized modified e-Delphi method to build consensus. A validated e-Delphi survey was administered to a purposive sample of 29 experts. Consensus was pre-defined to be the point where >85% of the experts fall in either agree or strongly agree category for each statement. The inter-expert agreement was computed in both rounds using Intra-class correlation coefficient and Kendall's W. Delphi operates in an iterative fashion till there comes stability in responses. At the end of each round, experts were provided aggregate response, their own response and choice to change their response in the light of aggregate response. Results: Response rate was 70.73% and 100% in 1st and 2nd round, respectively. Consensus was achieved on 119/132 statements which mainly referred to the need, structural and regulatory aspects of CMTM model in Malaysia. However, there were some flashpoints on dispensing separation and means to finance this model. Stability in response of experts was achieved after 2nd round; hence, no next round was executed. Conclusion: Overall, the study findings witnessed the expert panel’s support for the CMTM model. Study helped to sketch CMTM model and facilitated development of some recommendations to the authorities which may help to formulate a policy to bring CPs under a working relationship with GPs. Hence, this study should be taken as a call for redefining of the roles of CPs and GPs in Malaysia. [ABSTRACT FROM AUTHOR]

Objective: To improve pharmaceutical care delivery in Malaysia, the Ministry of Health (MOH) had introduced the concept of value added services (VAS). Despite its reported convenience and advantages, VAS utilization rate is low in the country. The study aims to explore patients’ understanding, beliefs and expectations towards VAS in Malaysia using the theory of planned behaviour (TPB) as the theoretical model. Methods: A qualitative methodology was used whereby face‐to‐face interviews were conducted with 12 patients who collected partial medicine supplies from government pharmacies. Participants were recruited using purposive and snowball sampling method in the state of Negeri Sembilan, Malaysia. Interviews were audio‐recorded. Verbatim transcription and thematic content analysis were performed on the data. Results: Thematic content analysis yielded five major themes: (i) attitudes towards using VAS, (ii) subjective norms, (iii) perceived behavioural control, (iv) lack of knowledge and understanding of VAS and (v) expectations towards VAS. Conclusion: The interviews explored and informed new information about salient beliefs towards pharmacy VAS. The findings suggest that VAS is still in its infancy and a more robust and effective advertising and marketing campaign is needed to boost the adoption rate. Behavioural attitudes, subjective norms and perceived control elements were discussed and serve as important variables of interest in future study. Expectations towards VAS serve as an important guideline to further improve patient‐oriented services. [ABSTRACT FROM AUTHOR]

Background: Despite the existence of different screening methods, the response to cancer screening is poor among Malaysians. The current study aims to examine cancer patients' perceptions of cancer screening and early diagnosis. Methods: A qualitative methodology was used to collect in-depth information from cancer patients. After obtaining institutional ethical approval, patients with different types and stages of cancer from the three major ethnic groups (Malay, Chinese and Indian) were approached. Twenty semi-structured interviews were conducted. All interviews were audiotaped, transcribed verbatim, and translated into English for thematic content analysis. Results: Thematic content analysis yielded four major themes: awareness of cancer screening, perceived benefits of cancer screening, perceived barriers to cancer screening, and cues to action. The majority of respondents had never heard of cancer screening before their diagnosis. Some participants reported hearing about mammogram and Pap smear tests but did not undergo screening due to a lack of belief in personal susceptibility. Those who had negative results from screening prior to diagnosis perceived such tests as untrustworthy. Lack of knowledge and financial constraints were reported as barriers to cancer screening. Finally, numerous suggestions were given to improve screening behaviour among healthy individuals, including the role of mass media in disseminating the message 'prevention is better than cure'. Conclusions: Patients' narratives revealed some significant issues that were in line with the Health Belief Model which could explain negative health behaviour. The description of the personal experiences of people with cancer could provide many cues to action for those who have never encountered this potentially deadly disease, if incorporated into health promotion activities. [ABSTRACT FROM AUTHOR]

Introduction: Public knowledge and attitudes towards antibiotics play a vital role in the success of the treatment process. This study aimed to assess public knowledge and attitudes toward antibiotic usage which could serve as baseline data for future studies within a government hospital setting in Malaysia. Methodology: A self-administered cross-sectional survey involving 408 respondents was conducted using a validated questionnaire at an outpatient pharmacy department in Penang Hospital, Malaysia, from February to March 2009. Results: Nearly 55% of the respondents had a moderate level of knowledge. Three quarters of the respondents (76.7%) could correctly identify that antibiotics are indicated for the treatment of bacterial infections. However, 67.2% incorrectly thought that antibiotics are also used to treat viral infections. About 59.1% of the respondents were aware of antibiotic resistance phenomena in relation to overuse of antibiotics. With regard to attitudes, 38% believed that taking antibiotics when having cold symptoms could help them to recover faster, while 47.3% expected antibiotics to be prescribed for common cold symptoms. Age, race and educational level were among the demographic characteristics significantly associated with knowledge and attitudes toward antibiotic use. Poor level of knowledge was found in less than one-third of the respondents whereas more than one-third of the respondents wrongly self-medicate themselves with antibiotics once they have a cold. Conclusion: Educational interventions are needed to promote prudent use of antibiotics among the public. [ABSTRACT FROM AUTHOR]

Background: Self-efficacy has been shown to be positively correlated with self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus. However, such evidence is lacking in the Malaysian primary care setting. The objectives of this study were to i) determine the levels of self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting ii) determine the relationship between self-efficacy, self-care behaviour and glycaemic control iii) determine the factors associated with glycaemic control. Methods: This was a cross-sectional study involving patients with type 2 diabetes mellitus from two public primary care clinics in Malaysia. Self-efficacy and self-care behaviour levels were measured using previously translated and validated DMSES and SDSCA questionnaires in Malay versions, respectively. Glycaemic control was measured using HbA1c. Results: A total of 340 patients with type 2 diabetes mellitus were recruited. The total mean (±SD) of self-efficacy and self-care behaviour scores were 7.33 (±2.25) and 3.76 (±1.87), respectively. A positive relationship was found between self-efficacy and self-care behaviour (r 0.538, P < 0.001). Higher self-efficacy score was shown to be correlated with lower HbA1c (r − 0.41, P < 0.001). Multiple linear regression analysis demonstrated that higher self-efficacy scores (b − 0.398; 95% CI: -0.024, − 0.014; P < 0.001), shorter duration of diabetes (b 0.177; 95% CI: 0.002, 0.007; P < 0.001) and smaller waist circumference (b 0.135; 95% CI: 0.006, 0.035; P = 0.006), were significantly associated with good glycaemic control. Conclusion: This study demonstrated that higher self-efficacy was correlated with improved self-care behaviour and better glycaemic control. Findings of this study suggest the importance of including routine use of self-efficacy measures in the management of type 2 diabetes mellitus in primary care. [ABSTRACT FROM AUTHOR]