Health-seeking behaviour among patients with faecal incontinence in a Malaysian academic setting

Background: Faecal incontinence (FI) is not a commonpresenting complaint in Malaysia, and little has beenpublished on this topic. Since it is a treatable condition, agreater understanding of factors contributing to healthseekingbehaviour is needed in order to plan effectiveprovision of services.Methods: A survey of 1000 patients and accompanyingrelatives, visiting general surgical and obstetrics andgynaecology clinics for matters unrelated to FI, wasconducted at University Malaya Medical Centre betweenJanuary 2009 and February 2010. A follow-up regressionanalysis of the 83 patients who had FI, to identify factorsassociated with health-seeking behaviour, was performed.Variables identified through univariate analysis weresubjected to multivariate analysis to determineindependence. Reasons for not seeking treatment were alsoanalysed.Results: Only eight patients (9.6%) had sought medicaltreatment. On univariate analysis, the likelihood of seekingtreatment was significantly higher among patients who hadmore severe symptoms (OR 30.0, p=0.002), had incontinenceto liquid stool (OR 3.83, p=0.002) or when there was analteration to lifestyle (OR: 17.34; p<0.001). Nevertheless, theonly independently-associated variable was alteration inlifestyle. Common reasons given for not seeking treatmentwas that the condition did not affect patients’ daily activities(88.0%), “social taboo” (5.3%) and “other” reasons (6.7%).Conclusions: Lifestyle alteration is the main driver of healthseekingbehaviour in FI. However, the majority do not seektreatment. Greater public and physician-awareness on FIand available treatment options is needed.

What are the direct medical costs of managing Type 2 Diabetes Mellitus in Malaysia?

Introduction: An economic analysis was performed to estimate the annual cost of diabetes mellitus to Malaysia. Methods: We combined published data and clinical pathways to estimate cost of follow-up and complications, then calculated the overall national cost. Costs consisted of diabetes follow-up and complications costs. Results: Patient follow-up was estimated at RM459 per year. Complications cost were RM42,362 per patient per year for nephropathy, RM4,817 for myocardial infarction, RM5,345 for stroke, RM3,880 for heart failure, RM5,519 for foot amputation, RM479 for retinopathy and RM4,812 for cataract extraction. Conclusion: Overall, we estimated the total cost of diabetes as RM2.04 billion per year for year 2011 (both public and private sector). Of this, RM1.40 billion per year was incurred by the government. Despite some limitations, we believe our study provides insight to the actual cost of diabetes to the country. The high cost to the nation highlights the importance of primary and secondary prevention.