A feasibility study of a school-based asthma programme in Malaysia conducted during COVID-19 pandemic

Background: Asthma is a common non-communicable disease among children that may require urgent treatment during school hours. We developed a school-based programme to improve children's asthma control. Aim(s): To assess the feasibility of the programme. Method(s): The mixed-methods study was conducted in October 2020 in a Malaysian primary school. Despite COVID19 restrictions we delivered sessions to children with asthma and their parents, and school staff and, measured participation rate and explored views on the programme. Result(s): We identified 34 children with asthma (3.7% of school population). The session for school staff received good participation 55/62 (88.7%) and feedback (>80% scored good/excellent). In mid-October, COVID-19 forced national school closure so sessions for children with asthma and their parents were conducted remotely, and sessions for the whole school were abandoned. Only 14/34 (41.2%) children with asthma attended the remote sessions as 9/34 parents were uncontactable;11/34 of parents declined children's participation because they lacked internet facilities or timing was inconvenient. Children enjoyed the interactive methods (e.g. videos, games) used to deliver messages. Parental participation was minimal (4/14;28.5%). Conclusion(s): The school-based intervention was feasible, though restricted by the pandemic. Although remote health programmes gained popularity during the pandemic, widespread use could disadvantage children from lower socio-economic backgrounds who had limited access to the electronic devices/ and the internet.

Home-based pulmonary rehabilitation for patients with chronic respiratory diseases in Malaysia: A feasibility study

Introduction: Chronic respiratory diseases (CRDs) are growing problems worldwide. Pulmonary rehabilitation (PR) has proven benefits for patients with CRDs, but programmes need to be adapted to low resource settings, in the context of the recent COVID-19, to home-based delivery. Aim(s): To evaluate the feasibility of delivering home-based PR for patients with CRDs in Malaysia. Method(s): We recruited people with CRD from two hospitals in Klang Valley, Malaysia to home-based PR programme. Patients were provided education sessions, and assessments [functional exercise capacity {6-Minutes walking test (6MWT)}] and [Health-Related Quality of Life (HRQOL) {COPD Assessment Test (CAT)}] were made at centres prior to the start of programme. They performed exercise at least 5 sessions per week for 8 weeks at home and were supervised weekly via phone calls. Post PR, we assessed the attendance and retention rate and measured 6MWT and CAT at centre. Result(s): We recruited 30 patients. The retention rate was 93.3%;2 dropped out due to hospitalization. However, only 11(36.7%) attended post PR assessment at centres, of these 9 (81.8%) had performed all 40 sessions of home exercises. The attendance for post- PR assessment was limited due to COVD-19 restrictions that forbade travel in Malaysia at that time. Data from the 11 patients showed significant change in CAT scores, 5.09;pre: 22.45, post: 17.36(95% confidence interval (CI) 1.48, 8.70, p=0.01) but no significant change in 6MWT distance -24.36;pre: 276.36, post: 300.72(95% CI -80.52,-31.79, p=0.356). Conclusion(s): Home-based PR is feasible and can be a valuable method to deliver PR remotely.

Differences in Physical and Mental Health of Older Adults over the Covid-19 Pandemic from Face-to-Face versus Hybrid Methods

Background/Purpose: As a result of the COVID-19 pandemic, changes in data collection methods have been introduced in research to ensure continuity despite physical distancing and lockdown restrictions. Our objective was to compare differences in physical and mental health of older adults participating in falls research using data collection methods pre-covid-19 pandemic (face-to-face) and during the pandemic (hybrid). Method(s): Individuals aged 60 years and over with at least one fall in the past 12 months, and controls with no history of falls in the past 12 months were recruited. Pre-pandemic, individuals were interviewed face-to-face exclusively, those interviews after the start of the pandemic were conducted virtually with physical assessments conducted face-to-face to minimize physical contact. Cognitive status, physical performance, psychological status, quality of life, physical activity, and social participation were measured. Result(s): Of the 145 participants of similar socio-demographic backgrounds, 69 were interviewed face-to-face, while 76 were assessed using a hybrid method. Differences were observed in presence of fall characteristics, with fewer fallers seeing a doctor and more fallers attending the emergency department after the start of the pandemic. After adjustment for baseline differences, participants interviewed using hybrid status had lower depression scores (OR (95%CI)=0.29(0.14-0.61)) and stress scores (OR(95%CI)=0.33(0.15-0.72)), but greater fear of falling (OR(95%CI)=2.16(1.04-4.48)) and reduced social participation (OR(95%CI)=2.64(1.20-5.79)). Conclusion(s): Alterations in data collection methods to overcome pandemic restrictions should take into consideration potential differences in individuals who agree to participate as well as the influence of major life events on the psychological status of participants. Copyright © 2022, Full Universe Integrated Marketing Limited. All rights reserved.

COVID-19: four paediatric cases in Malaysia. (Coronavirus (COVID-19) collection.)

Objective: This is a brief report of 4 paediatric cases of COVID-19 infection in Malaysia Background: COVID-19, a coronavirus, first detected in Wuhan, China has now spread rapidly to over 60 countries and territories around the world, infecting more than 85000 individuals. As the case count amongst children is low, there is need to report COVID-19 in children to better understand the virus and the disease. Cases: In Malaysia, until end of February 2020, there were four COVID-19 paediatric cases with ages ranging from 20 months to 11 years. All four cases were likely to have contracted the virus in China. The children had no symptoms or mild flu-like illness. The cases were managed symptomatically. None required antiviral therapy. Discussion: There were 2 major issues regarding the care of infected children. Firstly, the quarantine of an infected child with a parent who tested negative was an ethical dilemma. Secondly, oropharyngeal and nasal swabs in children were at risk of false negative results. These issues have implications for infection control. Consequently, there is a need for clearer guidelines for child quarantine and testing methods in the management of COVID-19 in children.

COVID-19: Four Paediatric Cases in Malaysia.

OBJECTIVE: This is a brief report of 4 paediatric cases of COVID-19 infection in Malaysia BACKGROUND: COVID-19, a coronavirus, first detected in Wuhan, China has now spread rapidly to over 60 countries and territories around the world, infecting more than 85000 individuals. As the case count amongst children is low, there is need to report COVID-19 in children to better understand the virus and the disease. CASES: In Malaysia, until end of February 2020, there were four COVID-19 paediatric cases with ages ranging from 20 months to 11 years. All four cases were likely to have contracted the virus in China. The children had no symptoms or mild flu-like illness. The cases were managed symptomatically. None required antiviral therapy. DISCUSSION: There were 2 major issues regarding the care of infected children. Firstly, the quarantine of an infected child with a parent who tested negative was an ethical dilemma. Secondly, oropharyngeal and nasal swabs in children were at risk of false negative results. These issues have implications for infection control. Consequently, there is a need for clearer guidelines for child quarantine and testing methods in the management of COVID-19 in children.

How should front-line general practitioners use personal protective equipment (PPE)?

The COVID-19 outbreak continues to evolve with the number of cases increasing in Malaysia, placing a significant burden on general practitioners (GPs) to assess and manage suspected cases. GPs must be well equipped with knowledge to set up their clinics, use Personal Protective Equipment (PPE) appropriately, adopt standard protocols on triaging and referrals, as well as educate patients about PPE. The correct use of PPE will help GPs balance between personal safety and appropriate levels of public concern.