Assessment of knowledge, attitude and practice of food allergies among food handlers in the state of Penang, Malaysia.

OBJECTIVES: Food handler's knowledge, attitude and practice regarding food allergies are important to prevent debilitating and sometimes fatal reactions. This study aimed to assess their food allergy knowledge, attitude and practice, which could help to maintain the safety and hygiene of food consumed by the public. STUDY DESIGN: Cross-sectional survey. METHODS: A cross-sectional survey involving 121 conveniently sampled (81.76% response rate) respondents among the food handlers in the state of Penang, Malaysia, was conducted using a validated self-administered questionnaire. Their knowledge, attitude and work practice were captured using a 37-item questionnaire that elicited their responses using a mixture of closed-ended and Likert scale techniques. RESULTS: The mean knowledge score for respondents was 50.23 (SD = 14.03), attitude score was 54.26 (SD = 11.67) and practice score was 45.90 (SD = 24.78). Only 1.79% of the respondents were considered to have excellent knowledge, 21.37% had a low risk practice and 4.27% had positive attitudes towards food allergies. Most of the respondents (70%) knew about food allergies and their seriousness. There was a statistically significant correlation between the attitude and practice of respondents (r = 0.51). The type of establishment was the only characteristic significantly associated (P < 0.05) with food handler allergy knowledge, attitude and practice. CONCLUSIONS: More than half of food handlers in Penang have moderate levels of food allergy knowledge, practice and attitude. Only a small proportion of them have excellent food allergy knowledge, practice and attitude. Integration of food allergy training into compulsory food safety training programmes is needed to reduce food allergy risks and prevent fatal allergic reactions to food among their customers.

Duration of treatment in pulmonary tuberculosis: are international guidelines on the management of tuberculosis missing something?

BACKGROUND: Despite evidence of an association between tuberculosis (TB) treatment outcomes and the performance of national tuberculosis programmes (NTP), no study to date has rigorously documented the duration of treatment among TB patients. As such, this study was conducted to report the durations of the intensive and continuation phases of TB treatment and their predictors among new smear-positive pulmonary tuberculosis (PTB) patients in Malaysia. STUDY DESIGN: Descriptive, non-experimental, follow-up cohort study. METHODS: This study was conducted at the Chest Clinic of Penang General Hospital between March 2010 and February 2011. The medical records and TB notification forms of all new smear-positive PTB patients, diagnosed during the study period, were reviewed to obtain sociodemographic and clinical data. Based on standard guidelines, the normal benchmarks for the durations of the intensive and continuation phases of PTB treatment were taken as two and four months, respectively. A patient in whom the clinicians decided to extend the intensive phase of treatment by ≥2 weeks was categorized as a case with a prolonged intensive phase. The same criterion applied for the continuation phase. Multiple logistic regression analysis was performed to find independent factors associated with the duration of TB treatment. Data were analyzed using Predictive Analysis Software Version 19.0. RESULTS: Of the 336 patients included in this study, 261 completed the intensive phase of treatment, and 226 completed the continuation phase of treatment. The mean duration of TB treatment (n = 226) was 8.19 (standard deviation 1.65) months. Half (49.4%, 129/261) of the patients completed the intensive phase of treatment in two months, whereas only 37.6% (85/226) of the patients completed the continuation phase of treatment in four months. On multiple logistic regression analysis, being a smoker, being underweight and having a history of cough for ≥4 weeks at TB diagnosis were found to be predictive of a prolonged intensive phase of treatment. Diabetes mellitus and the presence of lung cavities at the start of treatment were the only predictors found for a prolonged continuation phase of treatment. CONCLUSIONS: The average durations of the intensive and continuation phases of treatment among PTB patients were longer than the targets recommended by the World Health Organization. As there are no internationally agreed criteria, it was not possible to judge how well the Malaysian NTP performed in terms of managing treatment duration among PTB patients.

Knowledge and perceptions of prescribers regarding adherence to standard treatment guidelines for malaria: a comparative cross-sectional study from Pakistan.

Despite the availability of standard treatment guidelines for malaria in Pakistan adherence to protocols by prescribers is poor. This descriptive, cross-sectional study aimed to explore the perceptions and knowledge of prescribers in Islamabad and Rawalpindi cities towards adherence to standard treatment guidelines for malaria. A questionnaire was distributed to a random sample of 360 prescribers; 64.7% were satisfied with the available antimalarial drugs and 41.3% agreed that antimalarial drugs should only be prescribed after diagnostic testing. Only half the prescribers had the guidelines available in their health facility. Almost all the prescribers (97.7%) agreed that there was a need for more educational programmes about the guidelines. Most prescribers were unaware of the correct standard treatment regimen for Plasmodium falciparum and P. vivax malaria. There were no differences in knowledge between males and females, but prescribers having more experience, practising as general practitioners and working in private health-care facilities possessed significantly better knowledge than their counterparts.

Knowledge and perceptions of prescribers regarding adherence to standard treatment guidelines for malaria: a comparative cross-sectional study from Pakistan

Despite the availability of standard treatment guidelines for malaria in Pakistan adherence to protocols by prescribers is poor.This descriptive, cross-sectional study aimed to explore the perceptions and knowledge of prescribers in Islamabad and Rawalpindi cities towards adherence to standard treatment guidelines for malaria.A questionnaire was distributed to a random sample of 360 prescribers; 64.7% were satisfied with the available antimalarial drugs and 41.3% agreed that antimalarial drugs should only be prescribed after diagnostic testing.Only half the prescribers had the guidelines available in their health facility.Almost all the prescribers [97.7%]agreed that there was a need for more educational programmes about the guidelines.Most prescribers were unaware of the correct standard treatment regimen for Plasmodium falciparum and P.vivax malaria.There were no differences in knowledge between males and females, but prescribers having more experience, practising as general practitioners and working in private health-care facilities possessed significantly better knowledge than their counterparts

على الرغم من توافر الدلائل الإرشادية العلاجية المعيارية للملاريا في باكستان فإن التزام محرري الوصفات بها سيء. وتستهدف هذه الدراسة الوصفية المستعرضة استقصاء مدركات ومعارف محرري الوصفات الطبية في مدينتي إسلام آباد وراولبندي حول الالتزام بالدلائل العلاجية المعيارية للملاريا. وقد وزع الباحثون استبيانا على عينة عشوائية تضم 360 من محرري الوصفات الطبية، واتضح أن 64.7 % منهم كانوا راضين بالأدوية المتوافرة المضادة للملاريا، وأن 41.3 % موافقون على أن الأدوية المضادة للملاريا ينبغي أن لا توصف إلا بعد إجراء اختبار تشخيصي. ولم تكن الدلائل الإرشادية متوافرة إلا عند نصف المرافق الصحية التي يعمل بها محررو الوصفات الطبية. وكان جميع محرري الوصفات الطبية تقريبا [97.7 %]موافقين على الحاجة لمزيد من البرامج التعليمية حول الدلائل الإرشادية، وكان معظم محرري الوصفات الطبية غير مطلعين على النظام العلاجي المعياري الصحيح للمتصورة المنجلية والمتصورة النشيطة. ولم يكن هناك اختلاف في المعارف بين الذكور والإناث، إلا أن محرري الوصفات ذوي الخبرة الأكثر، والذين يمارسون باعتبارهم أطباء عامين ويعملون في مرافق الرعاية الصحية الخاصة يمتلكون معارف أفضل من غيرهم من الزملاء

Malgré la disponibilité de guides thérapeutiques normalisés pour le paludisme au Pakistan, le respect des protocoles de soins par les prescripteurs est médiocre.La présente étude descriptive et transversale visait à explorer les connaissances des prescripteurs dans les villes d'Islamabad et de Rawalpindi concernant les guides thérapeutiques normalisés pour le paludisme et leurs perceptions du respect de ces guides.Un questionnaire a été distribué à un échantillon aléatoire de 360 prescripteurs; 64, 7 % étaient satisfaits des médicaments antipaludiques disponibles et 41, 3 % convenaient que les antipaludéens devaient être prescrits uniquement après un test diagnostique.Seule la moitié des prescripteurs possédaient les guides thérapeutiques sur leur lieu de travail.Presque tous les prescripteurs [97, 7 %]convenaient que davantage de programmes d'éducation sur ces guides étaient nécessaires.La plupart des prescripteurs ignoraient les bons schémas thérapeutiques types pour le paludisme à Plasmodium falciparum et P.vivax.Aucune différence n'a été observée entre les connaissances des hommes et des femmes.Toutefois, les prescripteurs chevronnés, ceux exerçant comme médecins généralistes et travaillant dans des établissements de soins de santé privés avaient de bien meilleures connaissances que leurs confrères

Willingness to pay for voluntary community-based health insurance: findings from an exploratory study in the state of Penang, Malaysia.

Health care in Malaysia is funded primarily through taxation and is no longer sustainable. One funding option is voluntary community-based health insurance (VCHI), which provides insurance coverage for those who are unable to benefit immediately from either a social or private health insurance plan. This study is performed to assess the willingness of Malaysians to participate in a VCHI plan. A cross-sectional study was performed in the state of Penang between August and mid-September 2009 with 472 randomly selected respondents. The respondents were first asked to select their preferred health financing plan from three plans (out-of-pocket payment, compulsory social health insurance and VCHI). The extent of the household's willingness to pay for the described VCHI plan was later assessed using the contingent valuation method in an ex-ante bidding game approach until the maximum amount they would be willing to pay to obtain such a service was agreed upon. Fifty-four per cent of the participants were female, with a mean age of 34 years (SD = 11.9), the majority of whom had a monthly income of Int$1157-2312. The results indicated that more than 63.1% of the respondents were willing to join and contribute an average of Int$114.38 per month per household towards VCHI. This amount was influenced by ethnicity, educational level, household monthly income, the presence of chronic disease and the presence of private insurance coverage (p < 0.05). In conclusion, our study findings suggest that most Malaysians are willing to join the proposed VCHI and to pay an average of Int$114.38 per month per household for the plan.

Cost-Effectiveness of Clinical Pharmacy Education on Infection Management among Patients with Chronic Kidney Disease in an Indonesian Hospital.

OBJECTIVES: This study evaluated the clinical and economic impacts of clinical pharmacy education (CPE) on infection management among patients with chronic kidney disease (CKD) stages 4 and 5 in Haji Adam Malik Hospital, Indonesia. METHODS: A quasi-experimental economic evaluation comparing CPE impact on 6-month CKD mortality was conducted on the basis of payer perspective. The experimental group (n = 63) received care by health care providers who were given CPE on drug-related problems and dose adjustment. The control group (n = 80) was based on the historical cohort of patients who received care before the CPE. Measure of clinical outcome applied in this study was number of lives saved/100 patients treated. Cost-effectiveness ratios for CKD stages 4 and 5 patients without CPE and with CPE and incremental cost-effectiveness ratios (ICERs) for CKD stages 4 and 5 patients were analyzed. RESULTS: Lives saved (%) in the treatment of CKD without CPE: CKD stage 4, 78.57; CKD stage 5, 57.58. Lives saved (%) in the treatment of CKD with CPE: CKD stage 4, 88.89; CKD stage 5, 65.45. Cost-effectiveness ratios for stage 4 with and without CPEs were Rp3,348,733.27 and Rp3,519,931.009, respectively. Cost-effectiveness ratios for stage 5 with and without CPEs were Rp7,137,874.93 and Rp7,871,822.27, respectively. ICERs were Rp2,045,341.22 for CKD stage 4 and Rp1,767,585.60 for CKD stage 5. CONCLUSIONS: Treatment of CKD stages 4 and 5 with CPE was more effective and cost-effective compared with treatment of CKD stages 4 and 5 without CPE. The ICERs indicated that extra costs were required to increase life saved in both stages.

A literature review of the cardiovascular risk-assessment tools: applicability among Asian population.

BACKGROUND: Cardiovascular diseases, the main causes of hospitalisations and death globally, have put an enormous economic burden on the healthcare system. Several risk factors are associated with the occurrence of cardiovascular events. At the heart of efficient prevention of cardiovascular disease is the concept of risk assessment. This paper aims to review the available cardiovascular risk-assessment tools and its applicability in predicting cardiovascular risk among Asian populations. METHODS: A systematic search was performed using keywords as MeSH and Boolean terms. RESULTS: A total of 25 risk-assessment tools were identified. Of these, only two risk-assessment tools (8%) were derived from an Asian population. These risk-assessment tools differ in various ways, including characteristics of the derivation sample, type of study, time frame of follow-up, end points, statistical analysis and risk factors included. CONCLUSIONS: Very few cardiovascular risk-assessment tools were developed in Asian populations. In order to accurately predict the cardiovascular risk of our population, there is a need to develop a risk-assessment tool based on local epidemiological data.

Vascular intersection detection in retina fundus images using a new hybrid approach.

The use of vascular intersection aberration as one of the signs when monitoring and diagnosing diabetic retinopathy from retina fundus images (FIs) has been widely reported in the literature. In this paper, a new hybrid approach called the combined cross-point number (CCN) method able to detect the vascular bifurcation and intersection points in FIs is proposed. The CCN method makes use of two vascular intersection detection techniques, namely the modified cross-point number (MCN) method and the simple cross-point number (SCN) method. Our proposed approach was tested on images obtained from two different and publicly available fundus image databases. The results show a very high precision, accuracy, sensitivity and low false rate in detecting both bifurcation and crossover points compared with both the MCN and the SCN methods.