INTRODUCTION: Unplanned pregnancy is a major public health concern globally. Numerous studies found various factors that can predict or determine unplanned pregnancy. However, there were no studies that reported this problem in Malaysia. The objective of this study is to determine the prevalence of unplanned pregnancy in Malaysia and the associated factors. METHODS: This nationwide cross-sectional study targeted to women at postpartum period at government primary health care clinics throughout Malaysia. Structured questionnaire with face-to-face interview was used for data collection. The factors studied included mothers’ age, husband’s age, ethnicity, religion, marital status, education, occupation, household income, polygamous marriage, family support, contraception used, and disagreement of husband on contraception, smoking and alcohol consumption. History of emotional, physical and sexual intimate partner violence (IPV) were also studied. RESULTS: A total of 5727 Malaysian postpartum mothers were involved in this survey. The prevalence of unplanned pregnancy was 42.9% (95% CI: 38.6, 47.4). The multivariate logistic regression revealed that older mothers aged 45-49 years old (aOR: 8.010; 95%CI: 1.909, 33.013) and Muslim mothers (aOR: 2.465; 95%CI: 1.432-4.241) were significantly associated with unplanned pregnancy. In terms of household income, mothers with less than RM1000 per month were 1.712 (95% CI: 1.080, 2.713) times more likely to have unplanned pregnancy. The other significant associated factor was history of emotional intimate partner violence; aOR [1.720 (95% CI: 1.011, 2.925)]. CONCLUSIONS: Unplanned pregnancies were observed to be higher among older Muslim women from low income family. A possibility of unmet need for family planning should be considered and appropriate intervention strategies planned for these at-risk population.

Background: Diabetes mellitus is a highly prevalent condition in Malaysia, increasing from 11.6% in 2006 to 15.2% in 2011 among individuals 18 years and above. Co-morbid depression in diabetics is associated with hyperglycemia, diabetic complications and increased health care costs. The aims of this study are to determine the prevalence and predictors of depression, anxiety and stress symptoms in Type II diabetics attending government primary care facilities in the urban area of Klang Valley, Malaysia. Methods: The study was cross sectional in design and carried out in 12 randomly selected primary care government clinics in the Klang Valley, Malaysia. A total of 2508 eligible consenting respondents participated in the study. The Depression, Anxiety and Stress Scale (DASS) 21 questionnaire was used to measure depression, anxiety and stress symptoms. Data was analyzed using the SPSS version 16 software using both descriptive and inferential statistics. Results: The prevalence of depression, anxiety and stress symptoms among Type II diabetics were 11.5%, 30.5% and 12.5% respectively. Using multiple logistic regression, females, Asian Indians, marital status (never married, divorced/widowed/separated), a family history of psychiatric illness, less than 2 years duration of diabetes and current alcohol consumption were found to be significant predictors of depression. For anxiety, unemployment, housewives, HbA1c level of more than 8.5%, a family history of psychiatric illness, life events and lack of physical activity were independent risk factors. Stress was significantly associated with females, HbA1c level of more than 8.5%, presence of co-morbidity, a family history of psychiatric illness, life events and current alcohol consumption. For depression (adjusted OR 2.8, 95% CI 1.1; 7.0), anxiety (adjusted OR 2.4, 95% CI 1.1;5.5) and stress (adjusted OR 4.2, 95% CI 1.8; 9.8), a family history of psychiatric illness was the strongest predictor. Conclusion: We found the prevalence of depression, anxiety and stress symptoms to be high among Type II diabetics, with almost a third being classified as anxious. Screening of high risk Type II diabetics for depression, anxiety and stress symptoms in the primary care setting is recommended at regular intervals.

Acute diarrhoea is a major health problem in many parts of the world, contributing to about 1.8 million deaths globally. The objectives of the study were to assess the incidence, determinants, and severity of acute diarrhoea in the population. A nation-wide cross-sectional survey involving about 57,000 respondents was conducted via face-to-face interview among eligible respondents of all ages. An acute diarrhoeal episode was defined as having three or more episodes of loose stools in any 24-hour period within the past four weeks before the interview. The severity was measured by duration of acute diarrhoea and associated symptoms. The variables tested as determinants were age, sex, ethnicity, the highest educational level, total monthly household income, and locality. Univariate, bivariate and multivariate procedures meant for complex study design were used in the analyses. The four-week incidence of acute diarrhoea was 5% [95% confidence interval (CI) 4.8-5.2]. The incidence of acute diarrhoea among the estimated population was the highest among young adults aged 20-29 years, Other Bumiputras (the pre-dominant ethnic group in East Malaysia), those with tertiary-level of education, those earning a monthly household income of less than RM 400, and rural dwellers. Only age, ethnicity, the highest level of education attained, and locality were significantly associated with acute diarrhoea in bivariate analysis. In multivariate analysis, these four variables were found to be the determinants of acute diarrhoea. Sex and monthly household income were excluded from the model. The mean duration of acute diarrhoea was 2.0 days (standard deviation 1.3). Forty-six percent of the respondents reported stomach cramps as an associated symptom. The findings revealed that acute diarrhoea is still a major public-health concern in Malaysia and grossly under-notified. There is a need for intensification of public-health intervention efforts to reduce the incidence of acute diarrhoea while improving surveillance and notification of the disease.

Introduction: The paper explores turnover intention and job satisfaction among healthcare employees of Ministry of Health (MOH) Malaysia. Methods: A nationwide study was carried out in order to identify dimensions of job satisfaction and turnover intention among public healthcare employees. Data was collected by means of self-administered questionnaire and distributed based on quota sampling. Results: The study shows that public healthcare workforce is generally satisfied with their work (mean 3.45). In addition, medical specialists and assistant medical officers were found to be significantly more satisfied than other job designations. However, intention to resign was high among medical specialists, pharmacists and dentists. A high proportion of medical specialists also had received job offers from the private sector. Conclusion: The findings showed that employee turnover may not necessarily be due to job dissatisfaction, but rather due to demand from the private sector. Findings from the study would assist policy-makers with respect to talent management in public healthcare service.

Introduction: Health care transformation is crucial for developing nation like Malaysia to ensure a commensurate health system of higher quality and safety. Family Doctor Concept (FDC) was piloted to achieve Universal Health Coverage (UHC) in Malaysia. This concept is a way to strengthen primary healthcare service and a commitment of achieving „One Family One Doctor‟ that provides comprehensive service throughout the life-course. FDC offers proactive approach to register members of the population with the purpose of capturing all members of the population within the operational service areas and providing personalized care. This article aims to describe the implementation of FDC, a model for delivery of Primary Health Care (PHC), and the initial results and experiences of this pilot implementation.Methods: Phase of implementation from two health clinics showed pre and post health performance indicators of FDC. The process of implementation involved motivating the staff, creating staff registry, mapping and rearranging, infrastructure reorganization, zoning, registration, engaging, profiling and provision of longitudinal and holistic care to the clients and population.Results: There were promising improvements in coverage and clinical performance of the doctor-team through the provision of a more holistic longitudinal care with greater ownership and ultimate mission of working towards universal health coverage. Conclusion: The FDC may be seen as a simplified approach towards achieving UHC but is certainly a definitive effort to ensure every member of the population within the operational area will be signed up to a doctor team.

Introduction: The immunochemical fecal occult blood test (iFOBT) has been widely used for opportunistic colorectal cancer (CRC) screening in average-risk individuals seeking care from public health clinics in Malaysia. This study provides a 5-year outcome evaluation of such a practice. Methods: The findings for a few outcome indicators, ranging from the iFOBT uptake to the CRC and polyp detection rates, were generated from the data contributed by 583 public health clinics between 2014 and 2018. The trends in their changes were also evaluated. Results: The iFOBT uptake constantly increased over the years (p < 0.001), totaling 2.29 % (n = 127,957) as at 2018. Nearly 10 % (n = 11,872) of the individuals screened had a positive test result. Of those who underwent colonoscopy (n = 6,491), 4.04 % (n = 262) and 13.93 % (n = 904) were found to have CRC and polyps, respectively. Conclusion: An uptrend in the CRC screening uptake was witnessed following the introduction of the iFOBT in public health clinics.

Reliable information on causes of death is essential for an evidence-based health policy. There is a challenge in ascertaining the cause for deaths occurring without medical attention. This has been a persistent problem for Malaysia, where 50% of deaths are registered as “nonmedically certified” deaths mostly with ill-defined causes. During 2014–2016, a research study was conducted in a nationally representative sample of 15,000 deaths in Malaysia, to verify their registered causes and develop cause-specific mortality estimates. Standard Verbal Autopsy (VA) methods were used to ascertain causes for the nonmedically certified deaths in the sample. VA methods were successful in assigning specific causes for most cases with ill-defined causes of death, resulting in plausible mortality patterns. The Malaysian government issued official instructions for routine implementation of VA methods for nonmedically certified deaths. Nationwide capacity development was implemented to improve data quality. These activities provide several lessons for strengthening the national mortality statistics programs.

Background: Reliable national data on disability which is internationally comparable is needed in Malaysia. This study aims to examine the prevalence of disability among adults in Malaysia and its determinants, particularly the socioeconomic factors and comorbidities. Methods: This study was based on the disability module, which is part of the National Health and Morbidity Survey 2015. This survey was implemented using a multi-stage stratified sampling design. A locally validated Washington Group questionnaire was used to collect data on disability. Results: Based on the definition of having at least one domain scored "a lot of difficulty or unable to do at all" or at least “some difficulty” scored in two domains, the prevalence of disability among adults in Malaysia was 11.8% (95% CI: 11.15, 12.53). Logistic regression analysis performed showed that population at risk of having disability in Malaysia were those of older people, ethnic minority, low level of education, single, obese, physically inactive and having mental health problems. Among older people, disability was significantly higher among those with no formal education, having mental health problems and physically inactive. Conclusions: The prevalence of disability among adults in Malaysia is comparable to WHO estimates and most developing countries. Planning for healthcare services should consider at-risk population, particularly older people and those from disadvantaged background to ensure equity healthcare.

Background: Cancer represents a signifcant global public health challenge, with escalating incidence rates straining healthcare systems. Malaysia, like many nations, has witnessed a rise in cancer cases, particularly among the younger population. This study aligns with Malaysia’s National Strategic Plan for Cancer Control Programme 2021–2025, emphasizing primary prevention and early detection to address cancer’s impact. Therefore, we aim to describe the timeliness of cancer care for symptom presentation, socio-demographic, patient, as well as organizational-related factors among patients in Malaysia diagnosed with breast, colorectal, nasopharyngeal, and cervical cancer. Methods: This cross-sectional study enrolled adult cancer patients diagnosed with breast, cervical, colorectal, or nasopharyngeal cancer from 2015 to 2020 in seven public hospitals/oncology centres across Malaysia. Data were collected through patient-administered surveys and medical records. Presentation delay, defned as the duration between symptom onset and the patient’s frst visit to a healthcare professional exceeding 30 days, was the primary outcome. Statistical analysis included descriptive statistics and chi-square tests. Results: The study included 476 cancer patients, with breast cancer (41.6%), colorectal cancer (26.9%), nasopharyn geal cancer (22.1%), and cervical cancer (9.5%). Over half (54.2%) experienced presentation delays with a median interval of 60 days. Higher proportions of presentation delay were observed among nasopharyngeal cancer patients, employed patients with lower socioeconomic statuses, and those without family history of cancer. Most patients self-discovered their frst cancer symptoms (80%), while only one-third took immediate action for medical check-ups. Emotional and organizational factors, such as long waiting times during doctor’s visits (47%), were potential barriers to seeking cancer care. Conclusion: This study highlights the signifcant problem of presentation delay among cancer patients in Malaysia. The delay is infuenced by various factors encompassing sociodemographic characteristics, health-seeking behav iours, and healthcare system-related issues. A comprehensive approach addressing both individual barriers and insti tutional obstacles is imperative to mitigate this presentation delay and improve cancer outcomes.

Institute for Public Health Crisis Preparedness and Response Centre (CPRC-IPH) was established and given the task of logistic management during the major flood disaster in Malaysia on the eve of 2015 new year. The objective of this paper is to share the experience and challenges faced in the process. Upon establishment, CPRC-IPH recruited its members, set up a designated flood operation room, created an inventory of stand-by vehicles, deployed them to flooded areas for aids, monitored their activities thoughout, devised the idea of vehicle-day to quantify the intensity of involvement of the stand-by vehicles provided by different parties, and submitted feedback daily to Ministry of Health Malaysia Crisis Preparedness and Response Centre (CPRC-KKM) in Putrajaya. The result wasa 22-member team running CPRC-IPH for 20 days, different tasks outlined in the terms of reference. Eighty-seven (87) vehicles were on stand-by, of which 55 were from various agencies under Ministry of Health (MOH) Malaysia, 15 from concessionaries, and 17 from a private rental company. In total, 281 vehicle-days were completed throughout the period; out of which 39 vehicle-days were contributed by MOH vehicles, 124 by concessionaries, and 118 were rented. On average, around 14 cars were deployed each day with two from MOH. This greatly reduced the impact to the exisiting core business of the participating MOH agencies. Three challenges faced by CPRC-IPH in the process were shortage of vehicle supply, communication breakdown, and difficulties in monitoring. Government private partnership, establishment of standard operation procedure for disaster management, prior structured training for CPRC members, utilisation of diverse information systems, and creative simplification of quantifying measurement were the keys in solving the problems faced. In conclusion, CPRC-IPH fulfilled the logistic management successfully. It is hoped that its experience may help to improve the logistic management for flood disaster in the future.