Volume 11(Suppl 1) 2011                         Official Journal of Malaysian                         Public Health Physic...
Volume 11(Suppl 1) 2011                    Official Journal of Malaysian                    Public Health Physicians’ Asso...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
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th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                           th Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Confer...
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th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
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th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
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th                          thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011   4 Perak Health Conferen...
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MJPHM Supplement 1(2011)
MJPHM Supplement 1(2011)
MJPHM Supplement 1(2011)
MJPHM Supplement 1(2011)
MJPHM Supplement 1(2011)
MJPHM Supplement 1(2011)
MJPHM Supplement 1(2011)
MJPHM Supplement 1(2011)
MJPHM Supplement 1(2011)
MJPHM Supplement 1(2011)
MJPHM Supplement 1(2011)
MJPHM Supplement 1(2011)
MJPHM Supplement 1(2011)
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MJPHM Supplement 1(2011)

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The MOH promotes 1Care to Perak Medical Practitioners at the PERAK HEALTH CONFERENCE, 16 – 18th MAY 2011.
IMPIANA CASUARINA HOTEL IPOH,

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MJPHM Supplement 1(2011)

  1. 1. Volume 11(Suppl 1) 2011 Official Journal of Malaysian Public Health Physicians’ Association EDITORIAL BOARD Chief Editor Prof. Dato’ Dr. Syed Mohamed Aljunid (United Nations University – International Institute for Global Health) Deputy Chief Editor Assc. Prof. Dr. Sharifa Ezat Wan Puteh (Universiti Kebangsaan Malaysia)Members:Assc. Prof. Sharifah Zainiyah Syed Yahya University Putra MalaysiaDr. Lokman Hakim Sulaiman Ministry of Health MalaysiaAssc. Prof. Dr Retneswari Masilamani University MalayaAssc Prof Dr. Mohamed Rusli Abdullah University Sains MalaysiaAssc. Prof. Saperi Sulong University Kebangsaan MalaysiaDr. Maznah Dahlui University MalayaDr. Roslan Johari Ministry of Health MalaysiaDr. Othman Warijo Ministry of Health MalaysiaDr. Amrizal Muhd Nur United Nations University–International Institute for Global Health (UNU-IIGH) Chief Editor Malaysian Journal of Public Health Medicine (MJPHM) United Nations University - International Institute for Global Health (UNU-IIGH) Universiti Kebangsaan Malaysia Medical Centre (UKMMC) Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur Malaysia ISSN: 1675–0306 The Malaysian Journal of Public Health Medicine is published twice a year Copyright reserved @ 2001 Malaysian Public Health Physicians’ Association Secretariate Address: The Secretariate United Nations University - International Institute for Global Health (UNU-IIGH) Universiti Kebangsaan Malaysia Medical Centre (UKMMC) Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur Malaysia Tel: 03-91715394 Faks: 03-91715402 Email: mjphm@pppkam.org.my
  2. 2. Volume 11(Suppl 1) 2011 Official Journal of Malaysian Public Health Physicians’ Association 4TH PERAK HEALTH CONFERENCE 2011 16 – 18 th MAY 2011 IMPIANA CASUARINA HOTEL IPOH, PERAK DARUL RIDZUAN Organized by Perak State Health Department & The Malaysian Public Health Physicians’ Association (Perak) SCIENTIFIC COMMITTEE & EDITORIAL BOARDChairman: Dr. Puvaneswari Subramaniam, MOH PerakSecretar y: Mr. Paul Eruthiasamy, MOH PerakMembers: Datin Dr. Ranjit Kaur, MOH Perak Dr. Bernard Benedict, MOH Perak Dr. Wardati Malek, MOH Perak Dr. Ling He Mey, MOH Perak Mr. Gilbert Santiago, MOH Perak Mr. Ngarilah Mohd Ariff, MOH Perak
  3. 3. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011CONTENTS PAGESPLENARYPL1 ONE CARE FOR 1 MALAYSIA 1 Dr. Haji Nordin bin SalehPL2 EFFECTS OF WIRELESS COMMuNICATION ON HEALTH 2 Associate Professor Dr. Kwan Hoong NgPL3 INTEGRATED PRIMARY CARE - INTERGRATING VERTICAL 3 PROGRAMS FOR EFFECTIVENESS IN DELIVERY OF SERVICE Dr. Hjh. Safura bt Haji JaafarPL4 ENSURING CONTINUITY OF HEALTHCARE – A SHARED 4 RESPONSIBILTY Yg Bhg Dato’ Dr. Haji Ahmad Razin bin Dato’ Haji Ahmad MahirPL5 HEALTHCARE INTEGRATION – A PRIVATE PRACTITIONER’S VIEW 5 Dr. Steven Chow Kim WengSYMPOSIUM 1 COMBINED AND MuLTIDISCIPLINARY CARESYM I(1) LOOKING AT THE WHOLE CHILD 6 Dr. Aminah Bee bt. Mohd KassimSYM I(2) CONVERGING SHARED CARE IN MATERNAL AND CHILD HEALTH 7 Professor Dato’ Dr. N SivalingamSYM I(3) SUPPORT SERVICES FOR FAMILY NEEDS 8 Dr. Cheah Yee ChuangSYMPOSIUM 2 ACHIEVEMENTS OF THE MILLENNIUM DEVELOPMENT GOALSSYM II(1) IMPROVING CHILD HEALTH TOWARDS MILLENNIUM 9 DEVELOPMENT GOALS Yg Bhg Dato’ Dr. Amar Singh HSSSYM II(2) MATERNAL HEALTH – MEETING THE MILLENNIUM DEVELOPMENT 10 GOALS Dr. Safiah bt. Bahrin i
  4. 4. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011CONTENTS PAGESSYM II(3) COMBATING HIV/AIDS, TUBERCULOSIS AND MALARIA - ARE WE 11 ON TRACK? Dr. Sha’ari bin NgadimanSYMPOSIUM 3 TECHNOLOGY AND HEALTHSYM III(1) HEALTH DATA INTEGRATION 12 Dr. Md. Khadzir bin Sheikh Haji AhmadSYM III(2) ERGONOMICS IN HEALTH FACILITIES 13 Dr. Abu Hasan bin SamadSYM III(3) SACKING THE PLASTIC 14 Ms. Mageswari SangaralingamSYMPOSIuM 4 HEALTH RISK MANAGEMENTSYM IV(1) OUTBREAK RISK COMMUNICATION 15 Dr. Husnina bt. IbrahimSYM IV(2) IMPROVING PATIENT SAFETY 16 Dr. Hajah Kalsom bt. MaskonSYM IV(3) OCCUPATIONAL RISK IN HEALTHCARE 17 Professor Dr. Rusli bin NordinFREE PAPERSORAL PRESENTATIONAP 1 PREVALENCE OF PATIENTS WITH CHRONIC PAIN AND ITS 18 ASSOCIATED FACTORS IN PRIMARY CARE ATTENDEES Subashini; EM Khoo; Hanafi NSAP 2 FACTORS ASSOCIATED WITH STRESS AMONG PRIMARY 19 HEALTHCARE DOCTORS, ASSISTANT MEDICAL OFFICERS AND NURSES IN GOVERNMENT HEALTH CLINICS IN KELANTAN, 2010. Asmah; Siti Raudzah ii
  5. 5. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011CONTENTS PAGESAP 3 THE USAGE OF MATERIAL SAFETY DATA SHEET AMONG DENTAL 20 PERSONNEL IN PERAK Anna R; Bibi Saerah; Siriander D; Law C H; Rohana K et alAP 4 PREVALENCE AND PREDICTORS OF RECENT RESPIRATORY ILLNESS 21 IN THE MALAYSIAN POPULATION Paramesarvathy R; Gurpreet K; Amal NM; Tee GHAP 5 KNOWLEDGE, ATTITUDE AND PRACTICES ON DENGUE AMONG 22 RURAL COMMUNITIES IN REMBAU AND BUKIT PELANDUK, NEGERI SEMBILAN, MALAYSIA Tan KLAP 6 SCREENING FOR PATHOGENIC LEPTOSPIRA FROM WATER 23 SAMPLES AT PUSAT LATIHAN KHIDMAT NEGARA (PLKN) IN NORTHERN AND EASTERN REGION OF PENINSULAR MALAYSIA. Hasanatunnur Azmi; Norliziana MA; Roziah A; Zulhainan H; Naim AKAP 7 KEJADIAN WABAK HEPATITIS A DI PERKAMPUNGAN MASYARAKAT 24 ORANG ASLI POS JERNANG, SUNGKAI, PERAK Faizal; Azizi MZ; Azim RHAP 8 PENILAIAN KEBERKESANAN PUNJUT TEMEPHOS 500 E DALAM 25 TANGKI SEPTIK INDIVIDU Aslinda UAB; Mahani Y; Mohd NS; Noor RM; Hairul IAP 9 A STUDY ON EMERGENCY CARE SERVICES AND EQUIPMENT IN 26 HEALTHCARE FACILITIES Ch’ng ML; Benedict CTW; Amy CAL; Dang SB; Razin MahirPOSTER PRESENTATIONPP 1 EXTERNAL QUALITY ASSESSMENT FOR DIRECT SPUTUM SMEAR 27 MICROSCOPY FOR ACID FAST BACILLI IN THE STATE OF PERAK Lim JM; Tan KL; Murugan K; Akma I; Suhaila AR et alPP 2 FLUORIDE IN DRINKING WATER AND DENTAL FLUOROSIS AMONG 28 MALAY SCHOOLCHILDREN IN KAMPUNG BAHARU LANJUT, SEPANG, SELANGOR: A PRELIMINARY STUDY Shaharuddin MS; Nurul Faiza OBPP 3 FIRST DOCUMENTED CASE OF Q FEVER IN MALAYSIA IN THE 21ST 29 CENTURY – EPIDEMIOLOGY AND INVESTIGATIONS Bina Rai; Fadzilah K; Chow TS; Chee KYPP 4 OUTBREAK OF INFLUENZA LIKE ILLNESS IN SCHOOLS IN PERAK 30 TENGAH DISTRICT (FROM JANUARY - FEBRUARY 2011) Adliah MS; Ariza AR iv
  6. 6. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011CONTENTS PAGESPP 5 IS CRASH DIETING A CONCERN AMONG FEMALE STUDENTS IN A 31 MALAYSIAN PRIVATE UNIVERSITY? Sabernero I; Gurpreet KaurPP 6 HEALTH SEEKING BEHAVIOUR TOWARDS COMMUNICABLE 32 DISEASES AMONG FOREIGN WORKERS IN INDUSTIRAL AND AGRICULTURE SECTOR IN SELECTED DISTRICTS IN PERAK. Noor Asmah; Koh K; Ong KG; Wan Asmuni; Asmah ZAPP 7 PREVALENCE OF HEARING IMPAIRMENT AND CARPAL TUNNEL 33 SYNDROME IN GRASS CUTTERS OF BAKAS UNIT BATANG PADANG DISTRICT HEALTH OFFICE Azim RH; Aman SPP 8 UNHYGENIC FOOD PRACTISES - STUDENTS SUFFER 34 Hasniza A; Fauziah M N; Zulkifli H; Roziyana I; Halzeri ZPP 9 KEBERKESANAN MODuL PENDIDIKAN DIABETES TERHADAP 35 PESAKIT DIABETES DI KLINIK KESIHATAN TAIPING Bazariah Y; Amutha B; Sumathi M; Roziahwati A; Zuwariah AT et alPP 10 EVALUATION OF PRESCRIBING PATTERNS AND COST ASSOCIATED 36 WITH THE USE OF ANTIHYPERTENSIVE AGENTS AT KLINIK KESIHATAN BAGAN SERAI Nurhani MA; Toh MJPP 11 TUBERCULOSIS IN THE DISTRICT OF LARUT MATANG AND 37 SELAMA, PERAK, MALAYSIA. Syed MPPP 12 PENGGUNAAN APLIKASI ELETRONIK DALAM PENYEDIAAN KERTAS 38 SIASATAN DI UNIT INSPEKTORAT DAN PERUNDANGAN, PEJABAT KESIHATAN DAERAH KINTA Nurulhisham S; Asroyadi HA; Shahrul AD; Tajudin H; Samad M et alPP 13 GESTATIONAL DIABETES MELLITUS (GDM) 39 Sumathi M; Rosni W; Malliga SPP 14 FIELD STUDY ON THE DERMATITIS CAUSED BY A BEETLE 40 PAEDERUS FUSCIPES (ROVE BEETLE) AMONG SCHOOL CHILDREN AND TEACHERS IN TUNKU ABDUL RAHMAN (STAR) SCHOOL, IPOH. Izzati K; Ili DS; Mahani Y; Noor RMPP 15 SPECIES COMPOSITION, DENSITY AND BITING ACTIVITY OF 41 ANOPHELES SPP. FROM TWO LOCATIONS IN PERAK Mahani Y; Aslinda UAB; Nor SI; Izzati K; Noor RM et alPP 16 PENYERTAAN OPTIMuM MASYARAKAT MELALuI PENGLIBATAN 42 PANEL PENASIHAT KLINIK KESIHATAN Othman BW; Jamal NS; Mohd Fauzi AB; Roslan HPP 17 TO INCREASE PERCENTAGE OF THE DIABETIC PATIENTS WITH 43 GOOD CONTROL IN KLINIK KESIHATAN LENGGONG Sofiah ZA; Teh YS; Fauziah H; Wan TK; Azmi I et al iv
  7. 7. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 PL 1 Plenary I - One Care For 1 MalaysiaDr. Haji Nordin bin SalehDeputy DirectorHealth Policy and Planning UnitPlanning and Development DivisionMinistry of Health MalaysiaMalaysia’s health system has been recognised internationally as a good system. However, the currentand future challenges will affect the sustainability and relevance of the present system. Therefore,readjustment of the country’s health system is critical. 1Care is the restructured national health systemconcept that would be responsive and provides choice of quality health care, ensuring universal coveragefor the health care needs of the population through the spirit of solidarity and equity. The philosophy ofthe 1Care concept is that the health system will undergo a transformation to one that is comprehensivein terms of scope, equity, affordability, effectiveness and efficiency in terms of financing, integrated interms of delivery and accountable in terms of governance (stewardship). The 1Care concept is in tandemwith the 1Malaysia philosophy to foster greater cohesiveness of the Malaysian population through thenational health system. The proposed restructured Malaysian Health System will retain the existingstrengths of the current system. The concept focuses on three components which is streamlining ofMOH’s governance and stewardship functions and restructuring of the delivery and financing system.To support the 1Care initiative and ensure effective integration of the public and private sector, it isproposed that the health system will also be financed in a more integrated manner. It is expected thatwith 1Care, the population will receive greater access to higher quality care which is affordable andsustainable through better cost containment. 1
  8. 8. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 PL II Effects Of Wireless Communication On HealthProfessor Dr. Kwan Hoong NgDepartment of Biomedical Imaging and Medical Physics Unit, University of Malaya, Kuala LumpurMobile telephony is now ubiquitous around the world. This wireless technology relies upon an extensivenetwork of antennas, or base stations, relaying information with radiofrequency (RF) waves. Wirelesslocal area networks (WLANs) are also increasingly common in homes, offices and public places.There has been a lot of concern about possible health consequences from exposure to the RF wavesproduced by wireless technologies. This talk reviews the scientific evidence on the health effects fromcontinuous low-level human exposure to base stations and other local wireless networks. To date, theonly health effect from RF radiation that has been identified is based on an increase in body temperature(greater than 1 °C) from exposure at very high field intensity found only in some industrial facilities,such as RF heaters. The levels of RF exposure from base stations and wireless networks are so low thatthe temperature increases are insignificant and do not affect human health.The public are very worried by the media or anecdotal reports of cancer clusters around base stations.Since there are a large number of base stations in the vincinity, it is expected that possible cancer clusterswill occur near base stations merely by chance. Moreover, the reported cancers in these clusters areoften a collection of different types of cancer with no common characteristics and hence unlikely to havea common cause.Over the past two decades, research studies examining a potential relationship between RF transmittersand cancer have not provided evidence that RF exposure from the transmitters increases the risk ofcancer. Similarly, long-term animal studies have not established an increased cancer risk from exposureto RF fields, even at much higher levels than that produced by base stations and wireless networks.There have been very few studies investigating health effects in individuals exposed to RF fields frombase stations. This is because of the difficulty in distinguishing possible health effects from the very lowsignals emitted by base stations from other higher strength RF fields in the environment. Most studieshave focused on the RF exposures of mobile phone users. Human and animal studies examining brainwave patterns, cardiovascular function, cognition and behaviour after exposure to RF fields have notidentified adverse effects. Though there is no convincing scientific evidence that the RF fields from basestations and wireless networks cause adverse health effects, nevertheless further research is still neededto elucidate the basic interaction mechanisms and long-term health effects. 2
  9. 9. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Integrated Primary Care - Intergrating Vertical PL III Programs For Effectiveness In Delivery of ServiceDr. Hjh. Safura bt. Haji JaafarDirector of Family Health Development DivisionMinistry of Health MalaysiaIntegrated Primary care is the provision of services around individuals and families, restructuring today’sfragmented facilities into a system of community-focused family health providers so as to consolidatehealth gains, increase efficiency without sacrificing quality, and ensure sustainability of services.The idea is not new. Thirty years ago, in 1978, the Alma-Ata Declaration pointed to the importanceof community-oriented comprehensive primary health care for all nations. In this comprehensive or‘horizontal’ healthcare concept, health care is also a basic human right that requires communityparticipation. However strategies meanders on path that is least resistance and many chooses the“selective disease-oriented approach” to address the greatest disease burden. These two positionsdiffer both philosophically and practically. The selective is short-term in outlook that solves a givenhealth problem HIV/AIDS/TB and the like through the application of specific measures. HoweverComprehensive primary health care is carried out through a long-term process that seeks to tackle theoverall health problems through the creation of an accessible permanent institutional infrastructure for‘general health services, that ensure sustainable health.Many countries have shown the failure of vertical programming to meet its main objective, ie: a bettercoverage of those with the highest needs. In addition, vertical programmes create duplication, wherebyeach disease control programme requires its own bureaucracy, leads to inefficient facility utilisation byrecipients, and may lead to gaps in care especially in patients with multiple co-morbidities. It is easier tofinance vertical programme presumably easier to account for. But such methodology of financing verticalprogrammes has ‘diverted’ skilled local health personnel away from the local (primary) healthcaresystem. As a result, the health sector became vertically organized, with staff moving from one section tothe next, jeopardising access to overall health services and raising deep concerns regarding equity. Thistype of internal ‘brain drain’ has devastating consequences and undermines critical primary healthcareservices,With scarce resources in primary care, Malaysia has introduced the REAP or Reviewed Approach inPrimary care focusing on Integration of the various vertical programs for the community to achievesustainable disease control and to build systems that is more responsive to the needs of patients andcommunities. The challenges continue; to gain in capacity development from a vertical thought processto one that is horizontal, comprehensive and wholesome. 3
  10. 10. th th Malaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Ensuring Continuity Of Healthcare – A Shared PL IV ResponsibiltyYg Bhg Dato’ Dr. Haji Ahmad Razin bin Dato’ Haji Ahmad MahirDirectorPerak State Health DepartmentWHO had defined Health as a state of complete physical, mental and social well-being and not merelythe absence of disease or infirmity? This definition should be transformed into a shared goal i.e. theindividual, family, community and society. There must be a political will and political directives to achievethis. The government had actually invested a lot of money into health care services and the health carecost continues to rise in tangent with the greater responsibility and accountability of the government toprovide equity and quality in healthcare. At the same time the expectation of the “rakyat” is also increasingin fact they became more demanding and expressing health care is a basic right of the people.However to achieve health as defined by WHO is not the sole responsibility of the Ministry Of Health andthe government. The influence on health is multi factorial. Socio-economic and cultural factors play a bigrole. However there are a lot of gaps or fragmentation between government agencies, between publicsector and private sector, between providers of health care and the “rakyat”. So much so that the sharedgoal of health is not translated as a shared mission of “shared responsibility”.“Shared Responsibility” the magical word of togetherness that has been used in the slogan, is the basicfoundation in implementing a triumphant work. Without a teamwork and devotedness spirit, it will behard to achieve the shared goal. Many government agencies had also adopted “Shared Responsibility” intheir slogan.However there are still people who are being irresponsible and negligent. This negative attitude iscontagious and has been infecting our society. It also mean that the Ministry Of Health had not achieve itmission to build partnerships to facilitate and support the people to attain fully their potential in health,to motivate them to appreciate health as a valuable asset and to take positive action to improve furtherand sustain their health status to enjoy a better quality of lifeIf this negative culture tend to continue in our society, our service sector will not continue to develop orgrow but will always be left behind.The health service will be despised by the society. Being selfish is theroot problem to an irresponsible culture in oneself. This attitude should be immediately expelled from oursociety. How can this be achieved?Can this be achieved through further reinforcement of health education, strict enforcement of laws andregulation, innovative approach to tackle health problems like the use of “explore race” approach instead of“gotong-royong”? Perhaps the long term approach is to have a cultural change in a new era of responsibility– a recognition, on the part of every Malaysian, that we have duties to ourselves, our community, ourcountry, duties that we do not grudgingly accept but rather seize gladly, firm in the knowledge that thereis nothing so satisfying to the spirit, so defining of our character, than giving our all to a difficult task. Thenature of “shared responsibility” should be cultivated in the community regardless of their backgroundsand positions. To fulfill this mission, basic components should be emphasized for the culture of “sharedresponsibility” to be practiced by all levels of society. To cultivate this culture, it must be born outfrom awareness and importance of health to our society. Starting from the beginning families and schoolsare important institutions for fertilizing an interest in the spirit of “shared responsibility”. It requires aprocess of education, upbringing and training.Whateverisdone, every program needs support from government in theformofmoney,planninganddirection. Ministry of Health should act as a catalyst for realizing the culture of “shared responsibility” inthe community with respect to health. The agencies from different departments and ministriestogether acknowledge responsibility for the realization of this dream in cultural change. Meetings anddiscussions should be made compulsory for the relevant agencies to discuss issues arising for businessesto run smoothly.Hopefully one day, our society will be culturally competent to be equally responsible for their health andin everything else e.g. clean environment and clean river. 4
  11. 11. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Malaysian Healthcare Scenario –Private Practitioners’ PLV PerspectiveDr. Steven Chow Kim WengPresidentFederation of Private Medical Practitioners’ Associations, MalaysiaIncreasingly year by year we see the progressive commercialization of all aspects of healthcare startingfrom the medical education and all the way to delivery of tertiary and primary care. In tandem with thisis the alarming rise in the cost of private medical care. Some private hospitals in Kuala Lumpur nowquote patients from RM5000 to RM9000 for an open appendectomy and RM12000 to RM15000 for alaparoscopic appendectomy. On the other hand, the surgeon’s fee for both is capped at RM1370.There is some fundamental issue regarding the way our healthcare system is been regulated. It is animportant that this issue needs to be addressed urgently. Nowadays, private hospital bills reachingRM100K is not a rarity anymore. FPMPAM find this trend extremely alarming. The public is of theperception that a high hospital bill is due to hefty doctors’ fees. This is not true. It should be noted thatthe average doctor’s professional fees accounts for about 10-15% of the overall private hospital bill.The provisions of the Private Healthcare Facilities and Services Act 1998 and Regulations 2006, has NOprovisions to regulate hospital bills. As there is NO prescribed schedule for private hospital fees, privatehospitals are free to charge as they see fit. Ultimately, they answer only to their shareholders.The FPMPAM have made regular representation to the Ministry of Health on this matter. The usualresponse is that it is not possible to control hospital fees, as there were different classes of hospitalsproviding different class of services i.e. 3-star to 6-star hospitals. The situation in some hospitals hasreached to a point where our members, the doctors themselves find it hard to advise patient on thecost of hospitalization. Often, the hospital bills end up way above what was originally estimated and thedoctor is accused of over-charging.Now that most of the major private hospital chains are owned and operated by GLCs, the boundarybetween the regulators and the operators of healthcare will clearly be blurred. GLCs are government –corporate owned and answerable to government. It is thus clear that not only are the hands of the doctortied in this matter, even the MOH itself is in a quandary as to how it can act effectively in this matter.Doctors in the private sector can urge the patients and the public to speak out against this disturbingtrend. We can call upon our elected leaders and members of public office on both sides of the House totake heed and institute appropriate measures to protect the patients and the public. The commercializedcorporate model private hospital will not benefit the majority of our population who are only able toafford basic healthcare needs.The Federation is of the view that the healthcare must not be treated as a commercial commodity.The future healthcare system must prioritize and preserve the social obligation of providing qualityaffordable and compassionate patient care for the people of Malaysian over and the commercialagenda. 5
  12. 12. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 SYM I (1) Looking At The Whole ChildDr. Aminah Bee bt. Mohd KassimSenior Principal Assistant DirectorFamily Health Development DivisionMinistry of Health MalaysiaMultidisciplinary approach draws appropriately from multiple disciplines to redefine problems andreach solutions based on a new understanding of complex situations. Multidisciplinary approach isholistic care. What are pro and cons of multidisciplinary care? Can be it carried out effectively? Can it beimplemented at the primary care level? How can it be applied in the holistic care of the child? 6
  13. 13. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Converging Shared Care In Maternal And Child SYM I (2) HealthProfessor Dato Dr Sivalingam Nalliah FRCOG, FAMM, MCGP, FICS, MedClinical School, International Medical University, Kuala LumpurConventional wisdom indicates the motive of any health delivery system is to sustain a healthy population.Indices for healthcare have been traditionally employed to indicate the achievement of health throughstrategies developed benchmarking against both national and international standards. The MilleneumDevelopment Goals has been incorporated into the KPIs of the Perak Health Department. Three primaryaims of the MDG are to reduce child mortality, improve maternal mortality and ensure environmentalsustainability. All three are relevant to the discussion when one considers maternal and child health inPerak.The objective of this paper is to review the maternal mortality and child health indices conventionallyemployed and induce a discussion on how the current healthcare delivery system has worked inattempting to achieve the three indices of the MDGs.Data on mortality below 5 years of age in Perak is higher than the MDG target of 5.5 per 1000 LB. ThePerinatal Mortality Rate in 2010 was much higher in Perak largely contributed by normally formedmacerated stillbirths and prematurity. Both these factors contribute to fetal wastage and affect maternalhealth adversely. The stillbirth rate for Perak compared to national levels again reigns higher contributedlargely by prematurity.The MDGs aims to improve maternal health and reduce maternal deaths by three quarters. Here againPerak is lagging with MMR being 30.1/100,000 LB, much higher than the proposed 11.0/100,000 forthe country.To address the problems squarely there is a need to restructure the healthcare delivery system using thevital statistics available to ensure the current strategies remain relevant as the delivery rate in Perak hasdeclined over the years while the health facilities have improved at an exponential rate. What needs tobe re-looked is the quality of shared care in both maternal and child healthcare, Although it may not bepossible to relate the causes of mortality to specific conditions one needs to review the quality of careby health care givers and how social factors and the environment contributes to some of the remediablefactors like prematurity and childhood illness especially in the perinatal period.Concerns have been expressed by the rapid introduction of technology with a shifted emphasis onspecialized care by experts in both obstetrics and neonatalogy. Subspecialists in OBGYN have beenfocusing and utilizing available consultation time in detailed ultrasound care with less emphasis on caseselection. The neonatologist has established standard of care on sustaining the low birth weight babybecause of the possibility of maintaining life utilizing intensive care support systems. Both these expertshave benchmarked their standard of care to international standards. But one now sees that maternalmedicine, the cause of many of the mortalities, being shifted to other personnel. It is now evident thatthe divide between primary care and specialist care has blurred with high risk cases being managed inprimary care because of the changed philosophy of care. It is time to re-look at the training of the primarycare physician and the midwife to ensure their competency in caring for risk cases within their set up.Data need to be generated on competency in use of technology like the ultrasound and its applicabilityto manage risk cases in the primary care setting.The vital statistics clearly indicates that maternal mortality is not declining in spite of introductionof technology and increasing numbers of health care givers. The need to converge primary care andhospitalist care is urgent as the MDGs set out will not achieved if the current health care strategiescontinues to prevail. Transformation is not more a catchword but need to be realized through healthcareengineering. 7
  14. 14. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 SYM I (3) Support Services For Family NeedsDr. Cheah Yee ChuangConsultant PsychiatristHospital Bahagia Ulu Kinta, PerakCare for persons with serious mental illness (SMI) has moved from custodial to community settings.Individuals with SMI require treatment, rehabilitation and support to function in the community. Thereare two types of burden on family members, i.e objective burden and subjective burden. Family requireappropriate and sufficient education, training and emotional support for their care-giving role. 8
  15. 15. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Improving Child Health Towards Millennium SYM II (1) Development Goals (MDG)Dato’ Dr. Amar Singh HSSCert Theology (Aust, Hons), MBBS (Mal), MRCP (UK), FRCP (Glasg), MSc Community Paediatrics(Ldn, dist.)Senior Consultant Paediatrician (Community) and Head of Paediatric Department, Hospital RPB IpohHead Clinical Research Centre PerakAbstractThere has been a dramatic decline in child mortality in past few decades with under 5 mortality (U5M)declining from 25.7 per 1000 life births in 1980 to 7.9 in 2007. Historically, tends in childhood mortalityhave largely focused on the absolute rate and its reduction. It is important to look at sub-analysis of themortality to derive strategies for the prevention of childhood deaths. An evaluation of the childhoodmortality trends shows 4 key issues.Firstly the decline in childhood mortality has levelled off in the past 8-10 years and it is unlikely thatMalaysia will achieve the MDG4 goal. Secondly the vast number of under 5 deaths occur in the first yearof life and in particular the first month of life (neonatal deaths account for 60% of under 5 deaths).Thirdly segments of the population and sub-groups still have very high child mortality. In particularthe remote rural communities (Orang Asli, Interior Sarawak and Sabah). We are an emerging anddeveloping economy but have pockets of extreme third world. Fourthly some regions in the country arestill underreporting childhood deaths and accurate detection and documentation will significant riseour mortality rate.To significantly impact child health towards achieving the millennium development goals we will have torecognise that health needs and challenges have dramatically changed in the past three decades. And thathealth care professionals and health care systems have changed much slower to meet these challenges.It is important to note that the Malaysian performance is comparable with neighbouring and developedcountries but is not uniform. It is important that managers and those in political power appreciate thatfurther reduction in mortality will require enormous effort/resources. Our current expenditure onhealth is very low compared to developed and some developing countries.5 immediate and key strategies we can use to impact child health include the following. Firstly puttingin place a mortality system that evaluates, monitors U5M to identify areas for intervention. Secondlytarget currently known vulnerable populations/pockets where care is suboptimal. Thirdly improveskills training to identify ill children and effectively resuscitate them. Fourthly continue with existingservices but consolidate key areas especially intensive care (NICU/PICU) and Retrieval services. Fifthlyconsiderably strengthen MCH services including health education to parents.In recent decades there has been an “explosion” of tertiary level specialised services as means to meetthe health needs of the community. The forces that drive the provision of health care are often other thantrue health needs - whether those perceived by the public, professionals or governments. Often “marketforces” determine how such services develop. It is vital that the heath care service move to acceleratethe development of “wellness” services and focus on the communities and not the hospitals or the healthprofessionals. To move forward, we must “Make the Right Real”, which means address the reality thatwe see before us and act accordingly. If we continue to deviate our focus from the true health needs ofchildren and communities we will fail to make further significant impact on child health. Strong advocacyis required and this will require not just a transformation of our work but more importantly our hearts. 9
  16. 16. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Maternal Health – Meeting The Millennium SYM II (2) Development GoalsDr. Safiah bt. BahrinSenior Principal Assistant DirectorFamily Health Development DivisionMinistry of Health MalaysiaImproving maternal health is a vital economic and social investment and is one of the Eight MillenniumDevelopment Goals (MDG). The original target consist of two indicators for monitoring progress whichis reducing maternal mortality ratio by three quarters between 1990 and 2015, and increasing theproportion of births attended by skilled health personnel to more than ninety per cent. However, in year2005, due to the slow reduction in maternal mortality ratio (MMR) globally, world leaders recognizedthat sexual reproductive health is a prerequisite for achieving MDG 5, it also contributes significantlyto reducing poverty and hunger (MDG 1), promoting gender equality and empowerment of women(MDG 3) and combating HIV and other diseases (MDG 6). In order to achieve MDG 5, programs andinitiatives will need to expand beyond maternal health. An accelerated action towards universal accessto reproductive health (an additional target in MDG 5) enhances the progress towards achieving theMillennium Development Goal by 2015. 10
  17. 17. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Combating HIV/AIDS, Tuberculosis and Malaria- SYM II (3) Are We On Track?Dr. Sha’ari bin NgadimanDeputy Director of Disease Control (Infectious Disease)Ministry of Health MalaysiaHIV/AIDS, Tuberculosis and Malaria are among communicable diseases that taken millions of lives.HIV/AIDS has taken more than 20 million lives and may take millions more if trends continue. Malariakills a child in the world every 45 seconds and close to 90% of malaria deaths occur in Africa, whereit accounts for a fifth of childhood mortality. About 1.8 million people died from tuberculosis in 2008,about 500,000 of whom were HIV-positive. United Nation put target to reduce these diseases in theMillennium Development Goals.The global response to AIDS has demonstrated tangible progress. The new HIV infections fell steadilyfrom a peak of 3.5 million in 1996 to 2.7 million in 2008. Deaths from AIDS-related illnesses also droppedfrom 2.2 million in 2004 to two million in 2008. Tuberculosis prevalence is falling in most regions exceptAsia and estimated that 11 million people suffered from tuberculosis in 2008. Half the world’s populationis at risk of malaria and estimated 243 million cases of malaria in 2008, causing 863,000 deaths, inwhich 89% of them in Africa. With the assistance of Global fund, it helped to control malaria and hopeto achieve the MDG target.Malaysia has achieved considerable success in controlling many infectious diseases over time. A shift indisease pattern from communicable to non-communicable diseases tends to occur as a nation progressesfrom a developing to developed status. This changing disease pattern has occurred in Malaysia. Since1970, infectious diseases, such as tuberculosis (TB) and malaria, have declined sharply.In Malaysia, the main driver of the HIV epidemic was among injecting drug users. From 1990 to 1996,the number of annual newly detected HIV cases attributed to injecting drug use rose from 60 per cent(in 1990) to 83 per cent (in 1996). Since 2002, new cases detected have continually declined, despite asubstantial increase in the number of screenings. Tuberculosis remains a significant health issue. Thenumber of notified cases (all forms) increased from 10,873 in 1990 to 18,102 in 2009. The notificationrate has fluctuated slightly since 1990, although the trend from the past six years is showing a slowincrease. The number of reported tuberculosis-related deaths in 2009 was 1,582, up from 942 in 2000.For malaria, the country is currently progressing towards the MDG-Plus complete elimination by 2020.Since the implementation of the Malaria Eradication Programme in 1967 (later to become the MalariaControl Programme in 1982) the number of malaria cases has declined significantly.In managing the HIV/AIDS, tuberculosis and malaria situation, the new national strategic plans weredrafted. These strategic plans will be use in implementation activities, direction for the country toachieve MDG target for HIV/AIDS and tuberculosis and MDG-plus for malaria. 11
  18. 18. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 SYM III (1) Health Data IntegrationDr. Md. Khadzir bin Sheikh Haji AhmadDeputy Director, Planning and Development DivisionMinistry of Health MalaysiaIntroductionThe evolution of Health Information Management System in Malaysia started from a basic paper-basedstatistical reporting system to an ICT enabled Health Information Management system. Since colonialtimes, health information was collected and collated for statistical reports, which in general is notadequate and not timely for effective and efficient management. The Health Information ManagementSystem (HIMS) was developed with the intention to gather information required for programmeplanning, monitoring and evaluation. The deployment of Hospital Information Systems was intendedto enable healthcare providers to produce efficient and timely report. However these gave rise to issuesof interoperability of disparate systems, which resulted in the production of reports of variable qualityand timeliness. A seamless integration, where information can be exchanged and readily used, betweenHealth Information Systems and the HIMS is therefore crucial.MethodologyThe use of Health Informatics Standards is the building blocks to facilitate the implementation of aninteroperable system. Steps were taken to ensure that these standards were chosen, developed andadopted in current Health Information Systems. A web-based Business Intelligence (BI) application suchas Sistem Maklumat Rawatan Perubatan (SMRP) was developed based on the existing manual reportswith a focus at a granular level to enable effective data mining and analysis. Integration between SMRPand HIS was tested. A benchmarking criteria for Interoperability and Health Information Systems wasalso developed through a consensus between relevant stakeholders to ensure proper implementationof Health Information Systems.ResultsPromising results were demonstrated during the implementation of the recent HIS project. Currently,one hospital has achieved interoperability between HIS and SMRP.Analysis The adherence to data definitions in the development of Health Information Systems with theinvolvement of the correct stakeholders have contributed to enabling interoperability.DiscussionHealth informatics standards in particular the National Health Data Dictionary and proper adherencein data definitions is essential towards achieving interoperability. Data collected should be at a granularlevel to enable effective data mining and analysis. 12
  19. 19. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 SYM III (2) Ergonomics In Health FacilitiesDr. Abu Hasan bin SamadMedical Advisor & Country Occupational Health ManagerExxonMobil Subsidiaries in MalaysiaHealth care facilities in both public and private sectors are no different from the other traditionalworkplaces. More than a quarter million workers in Malaysia are directly or indirectly involvedin the health care services delivery. Various occupational hazards are present in the health caresectors including the traditional physical, chemical, biological, psychosocial and ergonomics hazards.Ergonomics hazard in particular is gradually becoming more important as we continue to use ICT(Information and Communication Technology) as the backbone of health care delivery at variouslevels throughout the country ranging from the small primary clinic in the rural area to the big tertiaryhospital in the city. The long working hours and demanding duties around the clock are additionalconcerns. Furthermore there are still a number of manual activities being done by the health carepersonnel at the various levels of services in the different disciplines.This paper will cover various aspects of ergonomics hazards including the office ergonomics andfield ergonomics at the various health care settings. It will focus more on the importance of creatingawareness among the health care personnel, prevention and early detection and treatment ofergonomics-related illnesses or injuries. The roles of individual employee, supervisor or manager in theimplementation of ergonomics program will be emphasized. Various tools used in the implementationof a good ergonomics program and learnings from other successful program will also be shared. 13
  20. 20. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 SYM III (3) Sacking The PlasticMageswari SangaralingamResearch OfficerConsumers’ Association of PenangPlastics have become a bane in our society, causing environmental pollution and adverse health effects.We must reject this toxic substance that is problematic throughout its lifecycle, from production, use todisposal. This presentation will encompass an introduction to plastics, some common plastics and whywe need to sack the plastic. All types of plastics are harmful in some way but this presentation will focuson sacking polystyrene, plastic bags and Polyvinyl Chloride (PVC) from healthcare. Several tips are givento avoid exposure to the toxins and sack plastics. 14
  21. 21. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 SYM IV (1) Outbreak / Risk CommunicationDr. Husnina bt. IbrahimPublic Health Specialist (Epidemiology)Senior Principal Assistant DirectorDisease Control DivisionMinistry of Health MalaysiaIn the current response to pandemic (H1N1) 2009 influenza, Malaysia was able to build upon thecommunication strategy and activities which was conducted for avian influenza outbreak and pandemicpreparedness. It is important to find a balance between working rapidly to implement the communicationnecessary for the response while also respecting the fundamentals of effective social and behaviorchange communication. In order to find this balance, it is useful to rely on existing resources as much aspossible.Communication objectivesFor communication to be effective, especially at time of pandemic when there is uncertainty about howit will affect a country, key partners and stakeholders should reach consensus at the national level on theobjectives of communication. This should happen before an outbreak occurs in the country. On genericlevel, these objectives include the following: • Help to reduce transmission of disease • Mitigate health impact • Minimize panic and social disruption • Help Government provide credible information during responseRisk / outbreak Communication:As there are many ideas and concepts on this issue, the term used basically for the communicationbetween health and Government authorities and the population of a country in a pandemic situationbefore and in response to an outbreak in that country.It is well documented that when Government and other stakeholders are transparent by providing timelyand correct information to the population, their effort to reduce transmission and mitigate the impact ofthe pandemic are more successful.Effective risk communication, however takes planning and capacity building which includes: • Identifying and training of spokesperson from Government and other relevant stakeholders in view of providing coordinated and consistent messaging. • Media training and continued orientation in order to have an informed and balanced reporting • During response, regular updates to the public from relevant stakeholders via mass media, maintenance of quality websites and other information sources as well as monitoring for rumors and surveys. 15
  22. 22. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 SYM IV (2) Improving Patient SafetyDr. Hajah Kalsom bt. MaskonSenior Deputy DirectorMedical Development DivisionMinistry of Health MalaysiaPatient safety is a public health issue. Patient safety is a fundamental principle of health care. “FIRSTDO NO HARM”. In every point of care-giving contains a certain degree of inherent potential of adverseevents which may result from problems in practice, products, procedures or systems. Patient safetyimprovements demand a complex system-wide effort, involving a wide range of actions in performanceimprovement, environmental safety and risk management, including infection control, safe use ofmedicines, equipment safety, safe clinical practice and safe environment of care.Recognizing this, Malaysia health care, through the Patient Safety Council Malaysia has initiated anumber of patient safety actions which aims to coordinate, disseminate and accelerate improvementsin patient safety nationwide. Some of the initiatives are strengthening of clinical governance and theimplementation the WHO World Alliance for Patient Safety Programmes, which include Clean Care IsSafer Care, Safer Surgery Through Better Communication, Reducing Antimicrobial Resistance, Researchin Patient Safety and Reporting and Learning. There is a need of a concerted effort from all healthcaregivers, patients as well as the community so as to ensure improvements in patient safety. 16
  23. 23. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 SYM IV (3) Occupational Risk In HealthcareProf. Dr. Rusli bin NordinMBBS; MPH; PhD; FFOMI; FAOEMM; AMProfessor of Public Health & HeadClinical School Johor BahruJeffrey Cheah School of Medicine and Health SciencesMonash University Sunway CampusThe healthcare environment, like any other workplaces, has its own sets of hazards and risks to thehealth of healthcare workers and patients. Managing occupational risk in healthcare depends on thecollective responsibility of management (employer) and healthcare workers (employees) as well as thecooperation of patients.Safety and Health Committee has the responsibility to ensure that OSH activitiesare diligently observed and in compliance with the prevailing OSH laws, regulations, guidelines andapproved industry codes of practices. Health risk assessment activities must be carried out when thereare changes to the work processes or when new technologies and procedures are adopted. Health riskmanagement is aimed at ensuring that the workplace is safe and that each healthcare worker is fit forwork. Employee assistance program is an important component of the OSH program. 17
  24. 24. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Prevalence Of Patients With Chronic Pain And Its AP 1 Associated Factors In Primary Care AttendeesSubashini; EM Khoo; Hanafi NSIntroductionChronic pain is a major healthcare problem worldwide and a common reason for seeking health servicesin primary care.ObjectiveTo determine the prevalence of chronic pain and factors associated with it.MethodsA cross-sectional quantitative study on randomly sampled patients aged 21 years and above attendingprimary care clinic at the University Malaya Medical Center was conducted. Patients with diagnosedacute psychosis, dementia and mental retardation were excluded. Face to face interviews were done.Case screening questionnaires (self-administered) were used to identify patients with chronic pain, anddemographic data and causes of chronic pain were collected.Results490 patients were approached and 465 consented (95% response rate). The prevalence of chronic painwas 54.8%. The prevalence was higher among Indians (63.6%), followed by Malays (54.0%) and Chinese(47.2%). Common causes of chronic pain include arthritis (22.4%), followed by limb pain (19.6%),back pain (16.9%) and headache (16.9%). There was significant association between chronic pain andethnicity (x2=8.450, p=0.038), marital status (x2=6.974, p=0.031), education levels (x2=7.359, p=0.025)and co-morbidities such as stroke (x2=4.693, p=0.030), ischaemic heart disease (x2=6.279, p=0.012) andarthritis (x2=34.909, p<0.001). Multivariate analysis showed Indian ethnicity (OR=1.737, 95%CI: 1.141,2.644) and patients with arthritis (OR=4.413, 95%CI: 2.635, 7.390) were predictive of chronic pain.ConclusionChronic pain is common in primary care attendees. Early identification of these patients can help inbetter chronic pain management.Keywords: chronic pain, University Medical Center, age 18
  25. 25. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Factors Associated With Stress Among Primary AP 2 Healthcare doctors, assistant medical officers and nurses In government Health Clinics In Kelantan, 2010Asmah; Siti RaudzahDepartment of Community Medicine and Health Sciences, University Malaysia Sarawak, KuchingIntroductionStress is experienced by everyone in their daily life including the healthcare providers.ObjectiveThe main objective of this study was to determine the prevalence and its associated factors of stressamong primary healthcare doctors, assistant medical officers and staff nurses at government healthclinics in Kelantan.MethodThis was a cross sectional study conducted from 1st June until 31st August 2010. Total of 248 respondents(responds rate 84.9%) were selected through stratified random sampling. The Malay version of thevalidated Depression, Anxiety and Stress Scale and Karasek’s Job Content Questionnaire were used asresearch instruments.ResultsThe prevalence of stress was 7.3% (95% CI 4.06, 10.54). The study among doctors showed thatsupervisor support (adj b = -0.74, 95% CI -0.98, -0.50, P <0.001) and hazardous condition (adj b = 0.86,95% CI 0.58, 1.15, P <0.001) were significant associated factors for stress. For assistant medical officers,study revealed that co-worker support (adj b = -1.45, 95% CI -1.77, -1.12 P = 0.002), job insecurity (adjb= 0.89, 95% CI 0.61, 1.16, P <0.001) and supervisor support (adj b= 0.44, 95% CI 0.17, 0.71, P = 0.002)were the significant associated factors for stress. Whilst among nurses, study showed that duration ofemployment (adj b = 0.30, 95% CI 0.24, 0.36, P <0.001), number of children (adj b= -0.95, 95% CI -1.25,-0.65 P<0.001), decision authority (adj b= -0.19, 95% CI -0.33, -0.06, P =0.005), psychological job demand(adj b= -0.33, 95% CI -0.44, -0.22, P <0.001), physical exertion (adj b= 2.81, 95% CI 1.78, 3.84, P <0.001)and job insecurity (adj b= 0.45, 95% CI 0.04, 0.87, P =0.033) were the significant associated factors forstress.ConclusionFinding of this study may be useful for health promotion program of preventing stress among healthcareproviders in the country.Keywords: stress, primary healthcare workers, job content questionnaire, Kelantan 19
  26. 26. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 The usage Of Material Safety Data Sheet Among Dental AP 3 Personnel In PerakAnna R ; Bibi Saerah; Siriander D; Law C H; Rohana K et alPerak Oral Health Division IntroductionThe MSDS is an important source of information for all health care workers while handling theconcerned materials within their working environment. The aim of this study is to review and assesthe present status of the usage and level of knowledge of MSDS among the dental personnel in the OralHealth Division of Perak.ObjectiveThe objectives were to determine the present status of MSDS usage among Dental Personnel in the OralHealth Division of Perak, secondly to assess and compare the level of knowledge on MSDS usage andthirdly to determine the barriers for usage of MSDS.MethodThis cross-sectional study involved a total of 244 Dental personnel randomly selected from the OralHealth Division of Perak. Self-administered questionnaire was used. Data were analyzed using SPSSversion 15.0.ResultsThe mean (sd) knowledge score was 77.9% (9.15%). There were significant differences in the meanknowledge score between DO and DSA as well as between DN/DT and DSA. Highest proportion of DT(56.5%) reported that understanding of language was a barrier followed by DN (50.7%), DSA (44.4%)and DO (15.2%). This study also revealed that there is still poor usage of MSDS among more than half ofall the categories of dental personnel.ConclusionThis study revealed that there is poor usage of MSDS among more than half of all the categories of dentalpersonnel. Awareness training, filing and labeling system for easier retrieval of MSDS as well as thetranslation of important information into simple Malay language were recommended to make MSDSmore user-friendly.Keywords: Dental personnel, MSDS, usage 20
  27. 27. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Prevalence and Predictors Of Recent Respiratory AP 4 Illness In The Malaysian PopulationParamesarvathy R; Gurpreet K; Amal NM; Tee GHKuala Lumpur City Council, Institute for PH, Institute for Medical ResearchIntroductionRecent illness related to the respiratory system has been the leading cause of outpatient attendancein many countries. Recent respiratory illness in this study was defined by symptoms such as cough,cold, fever and difficulty in breathing reported in the last 14 days from the date of interview. Recentrespiratory illness (RRI) imposes a big load on the burden of disease in Malaysia.ObjectiveThe aim of the study was to determine the prevalence and predictors of recent respiratory illness in theMalaysian population.MethodsA cross-sectional population-based household survey, as part of the Third National Health andMorbidity Survey was conducted between April and August 2006 to obtain community-based data andinformation on the prevalence of RRI. Face to face interview was carried out to collect data on self-reported RRI over a two-week recall period.ResultsA total of 55,660 respondents were interviewed with a response rate of 98.2%. The overall prevalenceof recent respiratory illness was 42.0%. The highest reported RRI was significant among the 10–19years age group (19.5%), females (52.6%), Malays (62.5%), those with secondary educational level(40.29%), those earning less than RM2000 per month (25.90%), among Malaysians (96.9%), thosemarried (61.8%), housewives ( 21.8%) and urban dwellers (60.0%). Age, sex, ethnicity, maritalstatus, citizenship, occupation, education and residence were significantly associated with RRI. In themultivariate analysis, only ethnicity and citizenship were significantly associated with RRI.ConclusionThe information obtained from this survey is useful to policy makers in the Ministry of Health to reviewand strengthen existing health programmes towards achieving the goal of Health for All by 2020.Keywords: Recent respiratory illiness, outpatient, survey 21
  28. 28. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Knowledge, Attitude And Practices On Dengue AP 5 Among Rural Communities In Rembau And Bukit Pelanduk, Negeri Sembilan, MalaysiaTan KLCommunity Medicine Division, International Medical UniversityObjectiveWorld Health Organization declares dengue to be endemic in South East Asia. The aim of the study wasto assess the level of knowledge, attitude and practice concerning dengue among rural communities inNegeri Sembilan.MethodologyA cross-sectional study involving 400 respondents from Rembau and Bukit Pelanduk, which representsa rural community, was conducted in August 2010. Data was collected by face-to-face interview using astructured questionnaire on knowledge, attitude and practice of dengue. All respondents aged 18 yearsand over were interviewed. Each question was analyzed individually. Knowledge, attitude and practicewere assessed using a scoring system and grouped as ‘good’ or ‘poor’ based on an arbitrary cut-offpoint.ResultsMajority of the respondents were females (58.0%), Malays (68.0%) and had secondary level education(59.5%). It was found that 58% of the community had good knowledge. Out of the 400 respondents,88.5% cited that their main source of information on dengue was from television or radio. Over 80%of the community had good attitude and most of them were supportive of Aedes control measures. Inthe community, 76% had good practice with 84.3% of respondents practicing some form of preventivemeasures against mosquito bite.ConclusionTelevision and radio are important means of conveying health messages to the public among ruralpopulation. More research and development of educational strategies designed to improve behaviourand practice of effective control measures among the rural community are recommended.Keywords: dengue, knowledge, practice, rural population 22
  29. 29. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Screening For Pathogenic Leptospira From Water AP 6 Samples At Pusat Latihan Khidmat Negara (Plkn) In Northern And Eastern Region Of Peninsular MalaysiaHasanatunnur A; Norliziana MA; Roziah A; Zulhainan H; Naim AKIpoh Public Health Laboratory (IPHL)IntroductionRecent local outbreaks of leptospirosis among athletes, military personnel and civilians have highlightedthe importance of screening for pathogenic leptospira from water samples related to water recreationalactivities.ObjectiveMethods for detection of pathogenic leptospira in water samples specifically related to waterrecreational activities at all Pusat Latihan Khidmat Negara (PLKN) were established as one of theMinistry of Health (MOH) strategy based on the guidelines for diagnosis, management, prevention andcontrol of leptospirosis in Malaysia.MethodsTwo series of screening programmes were carried out in 2010, February-March 2010 (1st series) andJune-August 2010 (2nd series). All water samples were collected accordingly, filtered and cultured intoboth EMJH and Fletcher media. Incubation of both media was carried out at 30°C in shaking incubatorfor 2 weeks. In the presence of any motile spirochete leptospira-like organism, cultured samples weresubjected to DNA extraction followed by Polymerase chain reaction (PCR) to determine the presence ofpathogenic leptospira.ResultsIn the first screening program, a total of 115 water samples were collected from 29 PLKNs. 21 samples(18%) from 13 PLKNs were found positive for pathogenic leptospira (10 PLKNs from northern regionand 3 PLKNs from eastern region). Out of the 123 water samples collected from 30 PLKNs in the secondscreening program, 16 samples (13%) from 9 PLKNs were found positive for pathogenic leptospira (8PLKNs from northern region and 1 PLKN from eastern region).ConclusionThe presence of pathogenic leptospira in facilities related to water activities at PLKNs may indicate andhighlight the importance of maintaining all water related facilities in order to minimize any chances ofleptospira infection. The authority must also strictly ensure that no activities are conducted if pathogenicleptospira are detected. This is to prevent any possibility of human infection by pathogenic leptospira.Keywords: leptospira, water samples, PLKN 23
  30. 30. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Kejadian Wabak Hepatitis A Di Perkampungan AP 7 Masyarakat orang Asli Pos Jernang, Sungkai, PerakFaizal; Azizi MZ; Azim RHPejabat Kesihatan Daerah Batang Padang, PerakPengenalanHepatitis A merupakan salah satu penyakit bawaan air dan makanan yang disebabkan oleh VirusHepatitis A (HAV). Pada umumnya penyakit ini adalah berlaku di negara-negara yang sedangmembangun di mana tahap kebersihan dan sanitasi adalah rendah. Wabak ini telah berlaku di PosJernang, Sungkai, Perak pada 24 Ogos hingga 26 Disember 2010.ObjektifUntuk mengenalpasti punca jangkitan HAV dan cadangan langkah kawalan dan pencegahan yang perludilakukan dalam membendung wabak.MetodologiKajian wabak secara retrospektif telah dijalankan dengan mengenalpasti punca jangkitan danmenilai aspek-aspek persekitaran dan tingkahlaku yang mendorong berlakunya wabak ini. Analisamenggunakan program Microsoft Office Excel 2007 secara diskriptif statistik melalui format line listingKementerian Kesihatan Malaysia.KeputusanSejumlah 6 kanak-kanak masyarakat asli telah dijangkiti HAV iaitu 3 lelaki dan 3 perempuan denganbilangan orang terdedah seramai 950 menjadikan kadar serangan 0.6%. Bilangan kes mengikutkumpulan umur adalah 4 (66.7%) bagi 1 hingga 7 tahun, manakala 2 (33.3%) bagi 7 hingga 13 tahun.Bilangan kes mengikut gejala adalah cirit birit 6 (100%), demam 6 (100%), Jaundis 6 (100%) dan ‘Darkurine’ 6(100 %). Keluk Epidemik menunjukkan ’Propagated source’. Punca jangkitan adalah daripadapersekitaran yang tidak bersih di mana tabiat membuang air besar (najis) di merata tempat, tempatpermainan kanak-kanak juga didapati berdekatan dengan air limbah yang tidak terurus dengan baikdan dicemari dengan najis.KesimpulanPunca penyakit ini di sebabkan oleh pencemaran daripada tanah/tempat permainan (persekitaran)secara fecal-oral. Kawalan telah dibuat dan berjaya membendung jangkitan daripada terus merebak.Pencegahan dan kawalan seperti menjaga kebersihan diri, teknik membasuh tangan yang betul danmakan makanan yang bersih (tidak tercemar) adalah kunci kepada kesihatan.Katakunci: Hepatitis A, Punca Jangkitan, Pencegahan dan Kawalan 24
  31. 31. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Penilaian Keberkesanan Punjut Temephos 500 E Dalam AP 8 Tangki Septik IndividuAslinda UAB; Mahani Y; Mohd NS; Noor RM; Hairul IKinta HD, Perak Health DepartmentPengenalanTangki septik individu didapati kondusif bagi pembiakan vektor denggi dan merupakan penyebabutama kejadian wabak di negeri Perak. Bagi mengawal pembiakan Aedes dalam tangki septik,punjut Temephos 500 E telah mula digunakan secara meluas di negeri Perak mulai tahun 2008,walaubagaimanapun beberapa aduan penduduk mengatakan masih terdapat banyak nyamuk dipersekitaran rumah mereka.ObjektifMenilai keberkesanan punjut Temephos 500E dalam tangki septik yang dirawat dalam tempoh 6 bulan.KaedahSebanyak 80 tangki septik diperiksa, 46 didapati sesuai untuk pembiakan nyamuk di Kg. baru Batu 10,Chemor. Semua tangki septik yang berpotensi dibahagikan kepada empat kumpulan iaitu 13 tangkidirawat dengan 4 punjut, 13 dirawat dengan 3 punjut, 10 dirawat dengan 2 punjut, 10 tangki septiktidak dirawat dan bertindak sebagai kawalan. Pensampelan larva di lapangan, kajian biosai di makmal,sukatan pH air telah dijalankan pada setiap minggu selama 3 bulan.KeputusanKajian awal sebelum rawatan punjut Temephos 500E dimulakan, mendapati spesies nyamuk dalamtangki septik didominasi oleh Amigeres spp. (70-80%), Culex spp. (15-20%) dan Aedes albopictus(5-10%). Hasil kajian mendapati dalam tempoh 3 bulan, tiada larva nyamuk dikesan dalam tangki septikyang diletakkan 4 punjut temephos 500E , sebanyak 25% tangki septik yang dirawat dengan 3 punjutpositif pembiakan Amigeres spp. dan Culex spp. bermula pada minggu keduabelas. Manakala 63% tangkiseptik yang dirawat dengan 2 punjut, positif pembiakan Amigeres spp. dan Culex spp. bermula padaminggu kelima. Tangki septic yang tidak rawat, 100% didapati positif sejak minggu pertama.RumusanTiada pembiakan Aedes untuk keseluruhan tangki septik yang dirawat sehingga 3 bulan. Kajian bioasaijuga mendapati kadar mortaliti larva Aedes albopictus adalah 100% dalam tempoh 24 jam bagi semuatangki septik yang dirawat.Katakunci: Aedes, Culex, Armigeres, tangki septik, denggi, temephos 500E 25
  32. 32. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 A Study On Emergency Care Services And Equipment In AP 9 Healthcare FacilitiesCh’ng ML; Benedict CTW; Amy CAL; Dang SB; Razin MahirHospital Raja Permaisuri Bainun, Ipoh; Perak State Health Department; Ministry of Health, Putrajaya,MalaysiaIntroductionThe importance of emergency care services and availability of equipment in healthcare facilities cannever be understated. Their availability is crucial to reduce morbidity and save lives.ObjectivesTo study the availability of basic emergency care services and equipment in private healthcare facilitiesand the types of basic emergency care equipment made available.Materials And MethodsThis is a cross-sectional study carried out involving 485 private healthcare facilities at various locationsin the 9 districts in the State of Perak.ResultsThe results show that out of the 485 private healthcare facilities studied, 78.4% of the total numberof private healthcare facilities had a low score. The remaining 21.6% of the total number of privatehealthcare facilities studied had a high score. The results also show a statistically significant difference(p< 0.05) between various types of private healthcare facilities with regards to the availability of basicemergency care services and equipment.ConclusionsDifferent types of private healthcare facilities have been found to fare significantly different when itcomes to their providing of basic emergency care services and equipment. Only about a quarter of privatehealthcare facilities scored high. The majority i.e. about three-quarters of private healthcare facilitiesscored poorly.RecommendationsIt is strongly recommended that equipment should be made available in healthcare facilities as they areessential to reduce morbidity and save lives. Not only should these equipment be made available butthey should also be properly maintained and at optimal working conditions.Keywords: emergency care services, equipment, private healthcare facilities 26
  33. 33. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 External Quality assessment For Direct Sputum Smear PP 1 Microscopy For Acid Fast Bacilli In The State Of PerakLim JM; Tan KL; Murugan K; Akma I; Suhaila AR et alIpoh Public Health Laboratory (IPHL); TB / Leprosy Control Unit, PerakIntroductionEQA identifies inappropriate procedures, out-of-date reagents, uncontrolled instrumentation, and /ortraining needs of incompetent or untrained staff.ObjectiveConsidering the importance of EQA, we evaluated the performance of AFB sputum smear microscopycarried out in 2010 for State of Perak, Malaysia.MethodsA total of 9,587 AFB slides were collected based on statistically valid sampling procedure - Lot QualityAssurance Sampling (LQAS) from 81,744 AFB sputum smears prepared in 86 microscopic centres inthe year 2010. EQA was carried out as described in the External Quality Assessment for AFB SmearMicroscopy Manual (EQA-IUATLD/WHO).ResultsOverall, a total of 9,574 or 99.87% of AFB slides analyzed were in good agreement and only 13 slides(0.13%) were considered as false reading, of which 2 slides (0.02%) were considered as false positivereading, while another 11 slides (0.11%) were false negative. Assessment on general quality, cleanlinessand proper staining of AFB slides showed an average of > 75% of the slides were prepared accordingly.In addition, the quality of smear size, evenness and thickness of AFB sputum smear prepared, showedan average of < 55% in quality.ConclusionThe overall performance of direct smear sputum microscopic examinations in the peripherallaboratories of the State of Perak was satisfactory. However, the low percentage of quality for smearsize, evenness and thickness of AFB smear prepared must be overcome in great efforts. A proper andregular on-the-job training of staffs at the peripheral laboratory coupled with supportive supervisionby Ipoh Public Health Laboratory would greatly help to improve the DSSM performance.Keywords: EQA, agreement, false reading, AFB smear 27
  34. 34. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Fluoride In Drinking Water And Dental Fluorosis Among PP 2 Malay Schoolchildren In Kampung baharu Lanjut, Sepang, Selangor: A Preliminary StudyShaharuddin MS; Nurul Faiza OBDepartment of Community Health, Universiti Putra MalaysiaObjectiveA study was conducted in November, 2010 to assess dental fluorosis occurrence and its relationshipwith fluoride in both drinking water and urine among 69 Malay schoolchildren aged 12-years-old,studying in a primary school at Kampung Baharu Lanjut in Sepang, Selangor.MethodologyBoth drinking water and urine samples were collected and analysed using a direct readingspectrophotometer based on the SPADNS method. Samples were collected for two consecutive daysand then cooled to 4oC before being transported to the laboratory for analysis. EDTA was used topreserve urine samples.ResultsFrom the 69 respondents, 40 (58%) were males and 29 (42%) were females. Fluoride levels in drinkingwater ranged from 0.27 to 0.70 mg/L with a mean of 0.521 + SD 0.1004 mg/L, while urinary fluoridelevels ranged from 0.36 to 2.70 mg/L, with a mean of 1.818 + SD 0.466 mg/L. Prevalence of dentalfluorosis was 53.6% (37 respondents), with a minimum score of 1 to a maximum score of 4. Mean scorewas 0.824. Most (42%) respondents with dental fluorosis had a score of 1. Dental fluorosis occurredmore in females (51.4%) than in males (48.6%). There was no significant difference in score of fluorosisbetween males and females (p>0.05). There was no relationship between score of fluorosis with fluoridein both drinking water and urine (p>0.05).ConclusionFluoride levels in drinking water and urine were within the standard set by the relevant authorities,while dental fluorosis in the study population was very mild.Keywords: fluoride, dental fluorosis, Malay schoolchildren, drinking water, urine 28
  35. 35. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 PP 3 First documented Case of Q Fever In malaysia InThe 21st Century – Epidemiology And InvestigationsBina Rai; Fadzilah K; Chow TS; Chee KYPenang State Health DepartmentIntroductionQ fever, caused by Coxiella Burnetti has never been routinely screened among livestock in Malaysia. InApril 2007, a private doctor managing a goat farm in Penang developed fever of 2 weeks duration. Hepresented with history of handling the abortus of goats and was admitted for investigation of fever ofunknown origin. He was notified as suspected brucellosis but was later confirmed as Q feverObjectiveAn investigation was initiated to find more cases, early treatment and prevent the chain oftransmission.Methods This is a descriptive study. Epidemiological investigations included a site visit to the farm. An interviewof patients, farm workers, family members and veterinary staff was done. Laboratory investigationswere carried out. The State veterinary department investigated the animals. The veterinary workers inthe State and farm workers were screened for Q fever.ResultsThe goat farm had about 100 goats including imported goats. All the people interviewed wereasymptomatic. Patients interviewed were tested positive for IgM and IgG for Q fever. 25.4% of goatstested had antibody positive for Q fever and were treated. Out of 54 people screened, 19 were IgMpositive (7 both IgG and IgM positive) and 2 IgG positive only. All are under regular follow-up. Thedoctor recovered completely.ConclusionIt is now compulsory for livestock from endemic countries to be screened for Q fever. Veterinary staff arealso advised to use adequate protective gear while handling livestock. This is a first documented case ofQ fever in Malaysia. The source is likely to be from imported goats.Keywords: Q fever, goat farm, livestock 29
  36. 36. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Outbreak Of Influenza Like Illness In Schools In Perak PP 4 Tengah District (From January - February 2011)Adliah MS; Ariza ARPerak Tengah Health Office, Bandar Seri Iskandar, PerakIntroductionInfluenza A (H1N1) infection had become a major public health problem in Malaysia after World HealthOrganization announced pandemic Influenza A (H1N1) which started in Mexico April 2009.ObjectiveThe aim of the study is to describe the situation of Influenza like Illness (ILI) infection in the districtfrom 1 January 2011 until 28 February 2011.MethodsThis study is a cross sectional study from secondary data that was obtained from all cases registeredwith the Perak Tengah Health District. Secondary data collection was obtained from a registry ofcases fulfilling criteria of Influenza-Like Illness (ILI) that was compiled from Crisis and PreparednessResponse Centre (CPRC) Perak Tengah District Health Office from 1 January 2011 until 28 February2011. A total of 163 cases were selected and SPSS version 11.5 software was used for data entry andanalysis.ResultsResults showed that median age of the participants is 14 years (IQR: 13-15), and the highest percentagewas in the age group of 14-18 years. Most of the participants are Malays (98.2%). Prevalence of symptomsof ILI was 23.9% and from 24 throat swab sample sent and analyzed for laboratory confirmation, 14(58.3%) were positive. Bivariet analysis showed that there were no association between age, genderand staying in the hostel with ILI incident.ConclusionOur findings support the previous study that influenza A (H1N1) virus predominantly affects youngerpopulation age group. Prevalence of infection is high in school going group (14 – 18 years). This groupof youths are highly exposed in the population and may pose as the source of transmission to thecommunity. There is a need for the Ministry of Health to consider giving vaccination for school childrento control the spread of the disease.Keywords: Outbreak in schools, Influenza like illness, cross-sectional study 30
  37. 37. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Is Crash Dieting A Concern Among Female Students In PP 5 A Malaysian Private University?Sabernero I; Gurpreet KFaculty of Health & Life Science, Management & Science University, Institute for Pulic HealthIntroductionCrash dieting is a diet practice that cuts back on the amount of calories and fats that a person consumesdaily. It is recognized by health care professionals as a dangerous way to lose weight.ObjectiveThe main objective of the study was to determine dietary practices among female students in a localprivate university in relation to weight lost desire.MethodologyThe study was cross sectional in design. A hundred questionnaires were distributed randomly amongfemale students in the university. Those who were pregnant or suffering from diabetes, hypertensionor other metabolic disorders were excluded. Verbal consent was obtained from potential respondentsbefore answering a self-administered questionnaire in English. Data was collected from July-August2010 and analyzed using SPSS version 17.ResultsThe response rate was 99%. Majority of respondents were Malay (72.7%), non-smokers (86.9%) andhad a Body Mass Index (BMI) between 18.5-22.9 kg/m2 (59.6%). The mean age and BMI were 22.5years and 22.2 kg/m2 respectively. Majority reported to practicing crash diets (41.6%), skipping mealsoccasionally (61.4%) and exercising 3 times or less per week (82.2%). At every BMI category, majorityadmitted to wanting to lose 5-10 kgs in weight in the next few months.ConclusionCrash dieting was found to be a common practice among majority of the females in this institution.This raises concern, as regular practice can have detrimental physical and mental consequences. Theimplications are significant especially when the respondents are highly educated women who willbecome future leaders, career women and mothers.Keywords: Crash dieting; female students 31
  38. 38. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Health Seeking Behaviour Towards Communicable PP 6 Diseases Among Foreign Workers In Industiral And Agriculture Sector In Selected Districts In PerakNoor Asmah; Koh K; Ong KG; Wan Asmuni; Asmah ZAObjectiveThe objective of the study is to determine the health seeking behavior towards communicable diseasesamong foreign workers in the industrial and agriculture sectors in Perak.MethodologyA cross sectional community survey was done to look at health seeking behaviour towardscommunicable diseases among foreign workers in the agriculture and industrial sectors from Perak,Malaysia. Two staged random stratified sampling method was conducted to ensure that all relevantsectors and ethnic groups were included. The study gathered information through interviews and selfadministrated using a standardized, pre-tested questionnaire.Results710 foreign workers were interviewed. A total of 338 (47.9%) workers were from agricultural sectorand 372 (52.4%) were from industrial sector. Most respondents were legal workers (90.3%), and only9.7 % (69) were illegal. Seventy respondents (9.85%) had experienced serious illnesses and another209 respondents (29.4%) had experienced mild illnesses. For those who had experienced seriousillnesses, 68 out of 70 (97.14%) respondents sought medical treatment as compared to only 172 outof 209 (82.3%) for respondents with mild illnesses. In response to 4 clinical scenarios (PTB, Malaria,Cholera and Typhoid symptoms), they would seek appropriate healthcare.ConclusionThis study shows that foreign workers do not seem to have problems in seeking health care. Accessto health care is a problem in the plantation sector in term of geographical location. Both legal andillegal foreign workers appear to understand serious illness and take appropriate action accordingly.Therefore, there is a need to improve access to health care for plantation workers.Keywords: Health seeking behavior, foreign workers, illness 32
  39. 39. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 Prevalence Of Hearing Impairment And Carpal Tunnel PP 7 Syndrome In Grass Cutters Of Bakas Unit Batang Padang District Health OfficeAzim RH; Aman SBatang Padang District Health Office, Occupational Health Clinic Tanjong MalimIntroductionGrass-cutting activity by using shoulder-mounted grass-cutting machine exposes an individual tophysical hazards i.e. noise and vibration. Noise is unwanted sound. Vibration is mechanical oscillationsabout an equilibrium point. Hearing impairment (HI) is when the capability of hearing threshold isabove 25dB at any frequency. Carpal tunnel syndrome (CTS) is the situation when the median nerve iscompressed within the carpal tunnel and causes the signs and symptoms.ObjectiveThe aim of this study was to determine the prevalence of HI and CTS in grass cutters of the BAKAS Unitin Batang Padang District Health Office.MethodologyA cross sectional study was carried out at Batang Padang District Health Office, from November tillDecember 2010. Prevalence of HI and CTS secondary to vibration was identified in grass cutters.Hearing was assessed by audiometric test, done by trained operators. Exposure to CTS was assessed byworker’s responses on self-administered questionnaire. CTS status was confirmed by history, that wassuggestive of the syndrome and provocative test was performed by an occupational health physician.Data was analyzed by using Microsoft Office Excel 2007 in descriptive statistics.ResultsA total of 19 male grass cutters from BAKAS Unit participated in the study. The mean age was 41.2years old, weight was 71.5 kg and height was 163.3 cm. The percentage of smokers was 47.4% and thosehaving medical problems were 15.8%. Workers with hearing impairment were 12 (63.2%), out of which4 (33.3%) were having noise-induced hearing loss, where else CTS was present in 1 (5.3%).ConclusionThe prevalence of HI in grass cutters was high, indicating high morbidity due to noise where else CTSwas low, indicating low morbidity due to vibration in this occupation. The need for use of ear-protectingdevice is mandatory and periodical medical surveillance is advised. Health programmes especiallyhealth education and promotion should be delivered to the workers in view of their risk in developinghearing problems and the importance of wearing personal protective equipment.Keywords: Grass cutters, Hearing impairment, Carpal tunnel syndrome, Prevalence 33
  40. 40. th thMalaysian Journal of Public Health Medicine, Vol. 11(Suppl 1) 2011 4 Perak Health Conference 16-18 May 2011 PP 8 Unhygenic Food Practises - Students SufferHasniza A; Fauziah M N; Zulkifli H; Roziyana I; Halzeri Z et alBachok District Health Office, KelantanIntroductionOccurrence of food poisoning is notifiable under schedule 6 of the Communicable Disease Control Act1988. Bachok District Health Office received a notification of suspected food poisoning on the 11thJanuary involving a group of students after eating at a hostel at SK Kandis, Bachok, Kelantan.ObjectiveAn investigation was undertaken to determine source of outbreak, identify the causative agents andrecommend control measures.MethodolgyCases were those who ate at the hostel between 9 to 11, January 2011 and developed an acute onset ofabdominal pain and diarrhea. Activities were carried out to determine more cases. HACCP inspectionwas carried out which included testing the water supply for coliform.ResultsIt was a common source outbreak with an attack rate of 10.9% involving all the female students aged12 years who stayed at the hostel. There was no reported similar cases from the other students. Theincubation period ranged from 45 minutes to 3 hours and the implicated food was “kuih buah melaka”.Cohort study revealed RR for “kuih buah melaka” was 1.77 (1.24 < RR < 2.53). HACCP inspectionshowed several violations; contamination of raw materials, holding time of more than 4 hours, cross-contamination of water supply, improper food storage, unsanitary premise and unhygienic food handlers.Raw food such raw coconut and coconut milk were contaminated with coagulase positive staphylococci.Food handlers were positive for coagulase positive Stapylococci. Rating of food premise under Food Act,1983 was 83.5%. The hostel kitchen was closed under the CDC act 1988.ConclusionUnhygienic food practices observed at the hostel kitchen had lead to the outbreak of food poisoningamong the students.Keywords: food poisoning, coagulase positive Staphyloocci, Bachok District health Office, SK Kandis 34

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