Search

Background: This study was aimed at determining the factors and predictors of knowledge, attitude and practice on lifestyle preventive measures against hypertension among residents in selected villages in Negeri Sembilan. Method: A self-administered questionnaire was used to collect respondents’ sociodemographic characteristics and their scores on knowledge, attitude and practice of lifestyle preventive measure against hypertension, in this cross sectional study. Body mass index (BM) was measured using calibrated measuring scales. Results: Among 787 respondents recruited, majority were of Malay ethnicity (60.2%), predominantly male (62.6%), aged between 31 to 55 years (44.2%), with normal BMI (63.4%). Significant associations were found between level of knowledge and age, (χ2 = 6.3, p= 0.043), ethnicity (χ2< = 12.1, p= 0.007), hypertensive status (χ2 = 11.25, p= 0.001), and BMI (χ2 = 17.578, p= 0.001). Factors found to be significantly associated with level of attitude were age (χ2= 17.498, p= 0.001), hypertensive status (χ2 = 20.529, p= 0.001), and BMI (χ2 = 8.633, p= 0.035) while for level of practice, only age (χ2 = 25.09, p= 0.001). Significant predictors for good level of knowledge were older age group (p=0.021), ethnicity other than Malay, Chinese, or Indian (p=0.007), higher income (p=0.022), not being hypertensive (p <0.001) and lower BMI status (p<0.001), while for good level of attitude were older age group (p<0.001), and not being hypertensive (p<0.001). Significant predictors for good level of practice were older age group (p<0.001), ethnicity other than Malay, Chinese, or Indian (p=0.006), and not being hypertensive (p<0.001). Conclusion: Knowledge, attitude and practice among respondents were unsatisfactory and predicts by several factors studied. [ABSTRACT FROM AUTHOR]

Introduction: Health education and awareness program have shown to be the factor that promote adherence behaviour and successful outcome of tuberculosis (TB). Mobile health (mHealth) initiative that utilize WhatsApp may help in achieving health objectives. Aims: This study aimed to determine the effectiveness of Health Education Module named TB@Clicks delivered through WhatsApp to enhance treatment adherence and successful outcome among pulmonary tuberculosis (PTB) patients. Methodology: A randomized controlled trial was done among all newly diagnosed TB cases registered in Seremban District between 1st of July 2017 until 9th of April 2018. The patients who fulfils the eligibility criteria were systematically selected and randomly assigned to receive TB@Clicks module through WhatsApp or continue with the existing conventional health education. The respondents were followed-up until treatment was completed. The estimated total sample size was 110. Adherence rate and treatment outcome were gathered from the record book in Health Clinics. Multivariate statistical analysis was conducted to determine the effectiveness of intervention on both outcomes. Result: A total of 110 PTB patients were recruited and 93 patients retained in the study (84.5%). Among them, 50 (90.9%) was from intervention group and 43 (78.2%) was from control group. There were 81.8% of respondents who received intervention adhered to TB treatment and 85.5% has the successful treatment outcome as compared to only 69.1% adherence and 70.9% with treatment success in control group but both were not statistically significant (p=0.121 & p=0.065). In multivariate analyses performed using generalized linear mixed models, PTB patients who had received intervention was 4.1 (95% CI = 1.16-14.87) times as likely to had successful treatment outcome as patients who had not received intervention. Conclusion: The TB@Clicks intervention module delivered through WhatsApp was effectively enhanced the treatment success rate but no significant effects on the adherence rate among PTB patients. [ABSTRACT FROM AUTHOR]

Introduction: Primary care is the first level of contact with the health system to promote health, prevent illness, care for common illnesses, and manage on-going health problems. Maternal health services were one of the important components of primary care delivered through health clinics and community clinics. It is crucial to ensure scarce resources in health clinic were utilized efficiently. Data envelop analysis is a technique which had advantage in assessment of efficiency of primary care because the technique can handle multiple inputs and outputs in efficiency score calculation. Objectives: To assess technical efficiency of maternal health services and it determinants in primary care setting of health clinics in Negeri Sembilan using data envelopment analysis (DEA). Methodology: This evaluation research employing cross-sectional study design using primary data from health district offices and health clinics in Negeri Sembilan. Sources of data includes administrative records and expenditure records from district health offices, and maternal health services utilization obtained from clinic records. The study randomly selected 16 maternal health services of health clinics as DMUs. Data for 2016 and 2017 were used in the analysis. Analysis of DEA used two-stage DEA. In the first stage DEA to efficiency score, namely: overall technical efficiency (OTE), pure technical efficiency (PTE) and scale efficiency (SE) scores. In the second stage, four environmental variables namely location of health clinic, distance of health clinic to the nearest health facility, years of service of nurses and comorbidity of patient regressed against PTE score using Tobit regression analysis. Results: In 2016, average pure technical efficiency (PTE) for maternal health services were 60.50% (SD 35.50). An increased in mean PTE in 2017 for maternal health services with the score of 67.30% (SD 34.30). Maternal health services in type 2 health clinic were efficient as compared with other types of health clinic in 2016. In 2017, maternal health services in health clinic type 6 were efficient. One determinant was found to significantly affect TE (comorbidity of patient). Conclusion: The findings from this study found that technical efficient maternal health services in Negeri Sembilan were in Health Clinic Type 5 (31.25%) and Health Clinic Type 6 (37.50%) in 2016 and 2017 respectively. Patients with more comorbidity significantly decrease technical efficiency of maternal health services. [ABSTRACT FROM AUTHOR]

Background: Out-of-pocket (OOP) payments is a principal means of financing health care throughout both developed and developing countries. Over-reliance on OOP payments may pose an undesirable effect from an equity perspective, where equity in financing is an important policy objective of the health care system. Objectives: To assess the progressivity of OOP payments for health care among Malaysian households. Methods: This paper used cross-sectional nationally representative data derived from the Malaysian Household Expenditure Survey (HES) 2014/15, which comprised of 14,473 households. Progressivity measures deviation from proportionality in the relation between OOP payments and ability to pay (ATP). This paper combined evidence from proportion approach, graphical measures (concentration curve) and summary indices (Gini coefficient, concentration index and Kakwani index) to demonstrate the progressivity of OOP health payments among Malaysian households. Result: More than two-third (77%) of Malaysian households surveyed reported to have made OOP health payments. The average shares of OOP payments from household consumption was 1.65% and was increasing across the household consumption quintiles. The OOP payments distribution was progressive demonstrated by all three approaches. The household consumption and burden of OOP payments was concentrated among the richer populations, with positive Gini coefficient and concentration index. The Kakwani index of OOP payments was 0.0910, indicates mildly progressive OOP payments in Malaysia. Conclusion: The OOP health payments in Malaysia has a progressive distribution. However, reducing progressivity trend should be monitored by the policymakers, and to decide further strategies on policy improvements pertaining to the country's health financing. [ABSTRACT FROM AUTHOR]

In Malaysia, smoking is the third risk factor with the most disease burden and it was hugely associated with diseases of the heart and lungs. In response to the tobacco epidemic, WHO had adopted the Framework Convention on Tobacco Control (FCTC) on 21st May 2003 but despite ratifying to FCTC in 2005 and enforcing various types of policies in the country, consumption of cigarette remains widespread in Malaysia. Hence the objective of this study which is to determine the role of cigarette policies in reducing cigarette consumption and the occurrences of chronic obstructive pulmonary disease (COPD) and lung cancer in Malaysia. This is a time series study with cigarette consumption and COPD and lung cancer occurrences as the dependent variables while the independent variable was all policies related to cigarette smoking in Malaysia between the years 1995 until 2017. Data analyses were done using Microsoft Excel Version 16.12, and IBM SPSS Statistics Version 23. Descriptive statistics were conducted to describe the variables using mean and standard deviation or as median and interquartile range. Time series scatter plot was utilized to plot the data on a monthly basis. The mean for cigarette consumption was 1,268.34 million cigarettes (standard deviation (SD) 669.31 million). The median for minimum cigarette price was RM0.35 per cigarette (interquartile range (IQR) RM0.10 per cigarette). Import duty showed a median of RM0.20 (IQR RM0.06) while excise duty's median and IQR was RM0.12 and RM0.19 respectively. The median for COPD was 962 cases (IQR 381), while the mean for lung cancer cases was 231 cases (SD 55). Cigarette consumption showed a fluctuating pattern followed by a down going trend from year 2012 until 2017. This coincides with the introduction of more cigarette related policies and the introduction of minimum cigarette price policy with increasing excise tax rates. However, COPD and lung cancer cases showed an increasing trend despite the decreasing cigarette consumption, more policies implementation and increasing tax rates. In conclusion, cigarette policies have played a major role in reducing cigarette consumption but not the number of COPD and lung cancer occurrences in Malaysia from year 1995 until 2017. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes mellitus (DM) is steadily increasing worldwide, with a significant DM population in Asian countries. Adherence to medications is important to achieve good glycaemic control among patients with DM. Thus, patients' adherence to their medication regimen should be determined to optimise DM management. Aims: To determine medication adherence and the relationship between patient profile and medication adherence among patients with type 2 DM (T2DM). Design: Cross-sectional survey. Methods: This study was conducted in a public hospital in Selangor, Malaysia, from December 2016 to June 2017. Data was obtained through administration of the Medication Compliance Questionnaire and an electronic medical records database. Multivariate logistic regression analysis was used to determine the predictors of medication adherence. Results: A total of 232 (95.9% response rate) patients participated in this study. The overall percentage of medication adherence among patients with DM was 55.2%. The majority of participants were female (53.4%), Malay (47.0%), aged 41–64 years (55.2%; mean age, 56.69 years), married (84.5%), unemployed (60.8%) and attended secondary school (53.9%). The factors independently associated with adherence were ethnicity (odds ratio [OR], 1.43; 95% confidence interval [CI]: 1.03–1.99) and haemoglobin A1c (HbA1c) level (OR, 2.71; 95% CI: 1.56–4.72). Conclusions: The medication adherence among patients with DM in a public hospital in Selangor, Malaysia was low. A health intervention emphasising patient-centred care is warranted to improve DM patients' adherence to prescribed medication. Considering that Malaysia has a multi-ethnic population, the patients' ethnicity and their HbA1c levels need to be considered in the implementation of any intervention to improve medication adherence. Impact statement: Medication adherence is influenced by individual patients' characteristics. To improve adherence to the medication regimen, nurses should consider patients' profiles. [ABSTRACT FROM AUTHOR]

Background: Coronary artery bypass grafting (CABG) is the best treatment option for coronary heart disease. It improves survival and quality of life (QOL) for patients with multivessel coronary artery disease and those with more advanced coronary artery disease, left ventricular dysfunction, or diabetes. The purpose of this study is to measure the QOL among patients after CABG surgery and its associated factors. Materials and Methods: A cross-sectional study was conducted in a cardiothoracic centre in Malaysia involving 184 respondents. A pretested, self-administered questionnaire which included the validated SF-36 Health Survey was filled by respondents who met the inclusion and exclusion criteria. Non parametric test was used to identify factors associated with QOL among the respondents. Significance level was set at 0.05. Result: The total number of respondents was 184 with response rate of 100%. From the analysis, the mean(SD) score of the eight domains of SF-36 ranges between 58.8(25.4) and 82.7(23.5), where the lowest score was physical functioning domain while the highest score was bodily pain and social functioning domain. The mean(SD) age of respondents was 59.86(8.17). Majority of respondents were male (82.6%), Malay (43.5%), Muslims (45.1%), married (85.9%), received minimal primary education (96.7%) and retired/unemployed (48.9%). Age, gender, religion, educational level and employment status, showed to have significant association with at least one domain of QOL including physical component score (PCS) and mental component score (MCS) with statistical significant set at P<0.05. Conclusion: Quality of life scores showed to be higher compared to coronary artery disease patients. Several sociodemographic characteristics (employed, married, high education level) were associated with good quality of life domains among the respondents. [ABSTRACT FROM AUTHOR]

Background: Handwashing is a cornerstone of public health and the practice of handwashing with soap tops the international hygiene agenda. Handwashing with soap is among the most effective and inexpensive ways to prevent infections. This study aims to determine the level of hand washing practices and the factors associated with hand washing practices among adolescent Yemeni students in Malaysia. Materials and Methods: A cross-sectional study was conducted among Yemeni adolescent in Malaysia using stratified random sampling. Data was collected using validated and self-administrated questionnaire which comprises eight sections. Data collected was analysed using IBM Statistical Package for Social Science (SPSS) version 23. Descriptive, chi square and binary logistic regressions was used for analysis. All the association and predictors were considered significant at P< 0.05. Result: In this study out of 221 respondents, most of them (65.6 %) were more than the age of 14 and 57.9% of them were males. Most of the students’ parents had a university level of education: 39.8% of mothers and 70.1% of the fathers. Majority of the respondents (64.7%) stayed for more than 36 months in Malaysia. The predictors of poor hand washing practice were only older age (P = 0.002), poor knowledge (P= 0.001), no influence of sociocultural and family factors (P= 0.023) and absence of clean running tap water (P= 0.001). Conclusion: The students had good handwashing practice. However, there should be ongoing health education about hand washing practice to students and the parents as well. [ABSTRACT FROM AUTHOR]

Introduction: Early diagnosis of tuberculosis and prompt treatment are essentials components in controlling tuberculosis effectively. Delay in diagnosis will lead to delay in treatment and this may increase the infectivity in the community, worsen the disease state and increase the risk of mortality. Objectives: The aim of this study is to determine the proportion of treatment delay and its predictors among PTB patients in Melaka. Methodology: A cross-sectional study was conducted among PTB patients in Melaka from April until May 2018. A total of 184 eligible respondents were included in this study. They were interviewed by using a pre-tested and validated questionnaire adopted from World Health Organization (WHO). Data were analyzed by using SPSS version 23. Descriptive statistics and bivariate analysis was used to assess the significant contributing factors, and a multivariate logistic regression analysis to assess the relative impact of predictors of treatment delay. P-values of <0.05 were considered statistically significant. Results: Total of 122 (66.3%) out of 184 PTB patients had treatment delay. The median duration of treatment delay was 30 days. In multivariable analysis, co-morbidities (AOR 3.66, 95% CI: 1.702, 7.872), more than two health visits (AOR 5.938, 95% CI: 2.602, 13.552) and time to reach health facility of more than 15 minutes (AOR 3.352, 95% CI: 1.491, 7.537) were significant predictors of treatment delay. Conclusion: Based on the results, the proportion of treatment delay among PTB patients in Melaka was higher than found in other studies in Malaysia. The predictors were comorbidities, more health visits, and longer time taken to reach health facility. [ABSTRACT FROM AUTHOR]

Background: Dengue vaccine can assist in controlling the rise of dengue. Highly effective cost of dengue vaccine in Malaysia is estimated to be between RM50 to RM200 per dose. It is important to know the willingness to pay (WTP) for the vaccine to assist in policy-making decisions for future dengue vaccine programme. The aim of study was to determine willingness to pay for dengue vaccine among healthcare workers (HCW) in Petaling Health District. Materials and Methods: A cross-sectional study was conducted among HCWs of Petaling Health District, Selangor from September to July 2018 via simple random sampling according to proportion of HCWs in specific facilities. A self-administered questionnaire using the contingent valuation method was used to estimate WTP. Factors associated with WTP for dengue vaccine were assessed and associations measured using Chi-square test with significance level at 0.05. Results and Discussion: Response rate was 92.2%. Majority of the respondents were female (72.3%), presently married (73.4%) with 93.6% aged 40 years or less, having at least college or matriculation education (54.3%). For monthly household income, 51.1% was between RM 3001 to RM 9000. Only 17.0% had history of dengue with 43.1% having family history of dengue. The median WTP for dengue vaccine was RM 20 per dose ranging between RM1 to RM500. Among the HCWs, 51.1% had a high WTP for dengue vaccine defined as at or above the median WTP. Factors significantly associated with WTP for dengue vaccine were monthly household income (χ2=11.974, p=0.003), dengue preventive practice (χ2=4.715, p=0.03), knowledge of dengue vaccine (χ2=3.062, p=0.05) and perception towards vaccination (χ2=5.593, p=0.02). Conclusion: The study revealed that the range of WTP for dengue vaccine among healthcare workers was RM 1 to RM 500; with 51.1% of HCWs of Petaling Health District having high WTP for dengue vaccine. The predictors for WTP for dengue vaccine were monthly household income, knowledge regarding dengue vaccine, dengue preventive practice and perception towards vaccination. [ABSTRACT FROM AUTHOR]

Technology based health intervention has seen an increase in use in multiple health programs. Improving non-adherence days ensures that children achieve maximum benefits of the immunization program. Determining the cost-effectiveness of the intervention to improve non-adherence days to the under-five childhood immunization schedule will be beneficial to policy and decision makers. A quasi-experimental study was conducted in nurseries in Putrajaya and Cyberjaya from January 2016 to January 2018. The sample size were 196 respondents with Putrajaya as the intervention group and Cyberjaya as the wait-listed control group. The intervention was a technology based health education module. Intervention groups received the intervention through the messaging service of Whatsapp at pre-determined intervals. Respondents answered a validated, self-administered questionnaire at baseline, immediately post-intervention and 3 months post-intervention. The costs of this program was then calculated to determine its cost-effectiveness. Data was analysed using Statistical Package for Social Science (SPSS) Version 23. The mean non-adherence days were 10 at baseline with no significant difference between both groups. The cost-effectiveness analysis showed that the intervention was cost effective with the cost-effectiveness ratio being less than 1. The technology based health intervention module was cost-effective in improving non-adherence days. The ability to improve non-adherence will greatly benefit children who receive the under-five childhood immunizations and the costs reduction may help policy makers to determine future plans of action. [ABSTRACT FROM AUTHOR]

Background: Health Planning is the process of determining national health problems, identifying needs and resources, planning goals and setting administrative actions needed to achieve the goal. Health planning is essential in ensuring the health program runs well either for the short or long-term duration. Health planning has a variety of theories, the main planning strategy theories are used in the public sector is rational, incremental, and mixed- scanning. Materials and Methods: The objective of the study is to describe and discuss the health planning theories using health planning cycle. The practice development of national health planning in five ASEAN countries has been selected as a case study based on the National Health Planning documents. The literature review carried out through online databases and national health planning document and this case study have followed health planning cycle component such as situation analysis, formulation, implementation of the programme and evaluation. The lessons were based on literature review and national health planning documents. Result: In developing of the national health planning (NHP), various health planning theory are used by the ASEAN countries. To classify the NHP according to the type planning theory used, some characteristics of the NHP development must be identify. Most of the developing ASEAN countries like Myanmar and Philippines that have a high political influence in their national decision making, the incremental theory is used in developing their NHP. As for Malaysia, their NHP based on analysis of problem in achieving previous NHP and cause-effect theory in formulating new plan with clear objectives therefore, the health planning theory used by Malaysia is the rational theory. In Indonesia and Thailand, the country developed the NHP based on comprehensive methods of decision making in view of tackling both the current national health problem and global health problem where there is a mixture of rational and incremental theory, therefore the theory applied by Indonesia and Thailand are mixed scanning theory. Conclusion: Five ASEAN countries was selected to be discussed whereby all of them were applied by any one of these three health planning theories. Myanmar and Philippines adapted incremental theory, while Indonesia and Thailand applied mixed-scanning theory. Lastly Malaysia applied rational theory in forming its national health plan. [ABSTRACT FROM AUTHOR]

Background: Acculturative stress are contributed by acculturative stressors and related to the aptitude of the individual whether he has enough coping capacity to overcome the situation or not. International students would be more likely to encounter higher stress upon arrival to foreign country as compared to host groups of students, as they have to adjust to new social, cultural and academic environment, and uncertain surrounding. The aim of this study is to determine the predictors of acculturative stressors among international postgraduate students studying in a Malaysia public university. Materials and Methods: A cross sectional study was conducted among 404 international postgraduate students in a public university in Malaysia. Acculturative stressors were assessed by a self-administered questionnaire with six main subsection, including homesickness, perceived discrimination, living condition, academic pressure, financial concern and social support. It consists of 38 items in likert-5 point response format. Data was analysed using IBM SPSS. Independent t-test and one-way ANOVA were used to determine the association between acculturative stressors and demographic factors, and predictors were explored using hierarchical regressions analysis. Result: The response rate for the study was 82.1%. The mean age of the respondents was 32 years, whereas the majority of respondents (75.7%) were male students. Respondents were mainly from Middle East (42.3%) and Africa (37.1%). Hierarchical regression analysis found that the gender (p<0.05), religion (p<0.05), continent of origin (p<0.05), duration of stay (p<0.001), academic pressure (p<0.001), financial concern (p<0.001), and social support (p<0.05) were significant predictors. Academic pressure had a significant moderate positive relationship (r=0.433, p<0.001) with acculturative stress. Conclusion: Three significant predictors of acculturative stress among international postgraduate students were academic pressure, financial concern and social support. In addition, female, being Christian, and those who came from Middle East experienced more stressors. [ABSTRACT FROM AUTHOR]

Background: Leadership reform was one of the primary health care (PHC) reforms proposed by the World Health Organization (WHO) in response to the failures of the 'health for all' goals by the Declaration of Alma Ata. WHO had recommended a leadership approach that was interpreted as the persuasive democratic leadership style. The aim of this manuscript was to analyse leadership styles and functions of different countries, as well as to study the strategies by other countries in achieving leadership reform. Materials and Methods: Roemer's model was used to analyse leadership styles and functions between countries. Articles, reports and related publications from online databases such as PubMed, CINAHL and Google Scholar were used for the review. Result and Discussion: Malaysia, Indonesia, Nigeria and Australia are practising the persuasive democratic leadership style in the PHC system. This is shown by the prominent government role in PHC policy making, management and the financing mechanism to ensure universal health coverage. Element of democracy can be seen by the participation of various stakeholders from different levels of the countries' PHC system in the negotiation of the PHC services and resources allocation in order to meet the local needs in these four countries. However, government domination became one of the challenges identified as it leads to lack of decentralisation. Several countries had found the solutions towards PHC reform, much of it by the reform in leadership through implementing policy level interventions, aligning bottomup and top-down interventions, and distributed leadership concept among others. Conclusion: Different countries have different styles of leadership in its PHC reform, facing different types of challenges with its own set of solutions, approaches that many countries could learn from in enhancing their PHC services. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common cancer and the second principal cause of cancer deaths in women worldwide as well as in Malaysia. Breast self-examination (BSE) has a role in raising breast cancer awareness among women and educational programs play an important role in breast cancer preventive behavior. The aim of this study is to develop, implement and evaluate the effectiveness of Breast Health Awareness program based on health belief model on knowledge of breast cancer and breast-selfexamination and BSE practice among female students in Malaysia.Methods: A single-blind randomized controlled trial was carried out among 370 female undergraduate students from January 2011 to April 2012 in two selected public universities in Malaysia. Participants were randomized to either the intervention group or the control group. The educational program was delivered to the intervention group. The outcome measures were assessed at baseline, 6, and 12 months after implementing the health educational program. Chi-square, independent samples t-test and two-way repeated measures ANOVA (GLM) were conducted in the course of the data analyses.Results: Mean scores of knowledge on breast cancer (p<0.003), knowledge on breast self examination (p<0.001), benefits of BSE (p<0.00), barrier of BSE (0.01) and confidence of BSE practice (p<0.00) in the intervention group had significant differences in comparison with those of the control group 6 and 12 months after the intervention. Also, among those who never practiced BSE at baseline, frequency of BSE practice increased 6 and 12 months after the intervention (p<0.05).Conclusion: The Breast Health Awareness program based on health the belief model had a positive effect on knowledge of breast cancer and breast self-examination and practice of BSE among females in Malaysia.Trial Registration: The ANZCTR clinical trial registry ( ACTRN12616000831482 ), retrospectively registered on Jun 23, 2016 in ANZCTR.org.au. [ABSTRACT FROM AUTHOR]

Aim: Breast cancer is the most common cancer among women worldwide, including Malaysia. In developing countries, predictors affecting breast self-examination (BSE) practice are different. This cross-sectional study was conducted to determine the prevalence of BSE practice and the predictors affecting BSE practice among undergraduate female students in Klang Valley, Malaysia. Material and Methods: A cross-sectional study was conducted among 820 female undergraduate students to assess the BSE performance and related determinants of BSE practice in Klang Valley, Malaysia. Data were collected via a self-administered structured questionnaire that was developed for this study. Results: The mean age of the respondents was 21.7±1.2 years old. Most of them were single (96.8%), Malay (91.9%) and 19.6%of the participants performed BSE regularly. Multivariate logistic regression modeling revealed that BSE performance was more likely among women who have checked their breast with a doctor (odds ratio=2.04, P=0.00), and women who have personal history of breast disease (odds ratio=4.43, P=0.03). Conclusion: The findings showed a low BSE practice rate among young Malaysian women. Hence, the community's breast health awareness is needed to improve breast cancer prevention among young Malaysian women. [ABSTRACT FROM AUTHOR]

Focuses on the access and equity of public health care provisions in Malaysia. Adoption of health care system reforms; Attempts to provide universal health care services; Achievement of minimum cost in equitable health care.

Introduction: Autism spectrum disorder (ASD) is a public health concern globally, characterized by impairments in cognitive process, social functioning, communication skills, behaviours and interests. These problems require multidisciplinary approach through an early intervention programme (EIP) which is remarkably expensive. To date, the knowledge of EIP costs for ASD children in Malaysia remains unknown. The objective of this study was to determine the annual average EIP costs for ASD children from the societal perspective (total average costs, education costs, treatment costs, and living costs), and its contributing factors. Methods: A cross-sectional cost analysis study using simple random sampling according to proportion was conducted among 280 parents of ASD children receiving EIP services in Klang Valley. The data was collected using interview-based questionnaire and proforma. The Activity- based Costing Technique and Microsoft Excel 2016 were used to estimate the total annual average EIP costs, education costs, treatment costs, and living costs per ASD child. The association between the total annual average EIP costs and its contributing factors were carried out using Statistical Package for Social Sciences version 25. Results: The total annual average EIP costs, education costs, treatment costs, and living costs per ASD child were estimated at RM15,158; RM3,896; RM1,948; and RM4,409 respectively. There was a significant association (p<0.05) between the total annual average EIP costs and its contributing factors; family income, ASD level, programme characteristics, and family support. Conclusion: The study determined the total annual average EIP costs and its contributing factors. This information is beneficial as evidence to assist the decision on future resource allocation by the policy maker. [ABSTRACT FROM AUTHOR]

Introduction: With the increasing number of international students joining various universities worldwide, including Malaysia, acculturative stress resulting from their attempts to adjust to the cultures of host countries is one of the most challenging issues affecting their life in general and academic life in particular. The purpose of this study is to determine the level of acculturative stress and intention to dropout among new postgraduate international students in public universities, Malaysia. Methods: a cross-sectional study was conducted among 522 new international postgraduate students joining Malaysian public universities on their first semester. A multistage sampling method was adapted, and data were collected via self-administered questionnaire by using a validated questionnaire. Results: Out of the overall number of 522 respondents, (68.60%) of them were males while (31.40%) were females, the mean age of respondents was 28.95 ±5.91 years. The majority of the participants 60.54% (326) were single, whereas those who are married students represented 205 (39.3%). This study showed that 410 (78.5%) of the new postgraduate international students experienced a moderate level of acculturative stress with a median value of 107.00, while 63 (12.1%) high level of stress and 49 (4.9%) experience low level of acculturative stress. Consequently224 ,42.1% of the participants students they have intention to dropout from the university for any reason, while 298 (57.1%) they don't have any intention to dropout from the university Conclusions: This study showed the importance of educational intervention program among new international postgraduate students towards adapting to the Malaysian culture, in relation with increasing their cultural knowledge and interaction with host nationals and to reduce their acculturative stress and their intention to dropout from the university. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer is the most common cancer and the second principal cause of cancer deaths in women worldwide as well as in Malaysia. The present study aimed to assess the impact of a health educational intervention to improve knowledge and practice breast self-examination (BSE) among female undergraduate students in Klang Valley, Malaysia. Methods: Randomized Community Trial study was carried out in three phases; pre intervention phase, intervention phase, and post intervention phase. A total number of 396 female undergraduate students from two public universities in Klang Valley, Malaysia participated in this study. The students were randomly divided into intervention (n = 198) and control (n=198) groups. Interventional health education in the form of a lecture, which supported by an educational model, presentations were administered. Data were collected within January 2011- March 2012. Results: The mean age of participation was 21.7 years, majority of them were Malay 380 (96%), Muslim 376 (94.95) and single 381 (96.2). The results showed that there was a significant improvement in knowledge regarding all aspects of breast cancer and breast self-examination of the intervention group from pre- to post-tests. After intervention, about 33.3% practiced breast self-examination (BSE) in post-test compared to 22.2% who practiced it in pre-test. Also, there were statistically significant differences between those who practice and did not practice BSE in term of knowledge score of BSE (p-value <0.05). There was no association between breast self-examination and (age, race, family history of breast cancer) (p value <0.05). Conclusion: The knowledge and practices of women toward breast selfexamination for early detection were observed to be inadequate in respondents but there was a significant improvement after the intervention. [ABSTRACT FROM AUTHOR]