Delay in seeking diagnosis and treatment among women with breast cancer

Breast cancer is the leading cancer that causes mortality among women in Malaysia. Delay in its diagnosis and treatment has major implications on the patients' prognosis and survival. The objectives of this study were to identify the magnitude of delay in consultation, diagnosis and initiation of treatment; and its associated factors among women with breast cancer. This study was a combination of quantitative and qualitative methods. The quantitative study was a retrospective cohort. Respondents were histo-pathologically diagnosed breast cancer patients who were registered at various medical centres in the year 2005-2007. Validated questionnaires were used to interview respondents. The qualitative study was using an in-depth interview. It was carried out in the East Coast and 12 volunteers were selected. A total of 328 respondents were included in the quantitative study. The mean (SD) age was 47.9 (9.4) years. The majority of respondents were Malays who had low a socio-economic status. The median time for first doctor consultation was 2 months, diagnosis 5.5 months and initiation of treatment 2.4 weeks. The rate of consultation delay more than a month was 66.8%, diagnosis delay more than three months was 73.2% and treatment delay more than a month was 27.4%. The significant factors associated with diagnosis delay were the number of children, grossly swollen breast, self-detected symptom, first doctor's inappropriate action, non-cancer interpretation, low level of fear and negative attitude to treatment. While factors associated with treatment delay were pregnancy, taking complementary alternative medicine, initially refusing mastectomy and having lumpectomy prior the definitive treatment. The reasons for delay were strengthened by the qualitative study. The identified themes were lack of knowledge, fear, beliefs in complementary alternative medicine, sanction by others, barriers, denial, attitude of wait and see and weakness of health care services system. This study found that delays in diagnosis and consultation were serious problems. Decision on health seeking behaviour was influenced by a complex interaction of socio-demographic, clinical, cognitive, practices, environmental, beliefs, cultural and psycho-social factors. A comprehensive intervention is suggested in order to detect, diagnose and treat breast cancer early before the tumour enlarges and spreads to lymph nodes and metastasis

Knowledge, attitude and practice and perception on the transmission of influenza A (HlNl) epidemic in different communities

Influenza A (H 1 N 1) was a new disease pandemic in year 2009. The aims of this study were to determine level of knowledge, attitude and practices and perception on the transmission of influenza A (H1N1) in different communities in Kelantan. Several mixed design studies were conducted. An intervention was conducted to evaluate the effectiveness of health education package on knowledge, attitude and practice towards influenza A (HlNl) infection in secondary school children. A total of 193 students in intervention group and 243 students in control group were Involved. The health educ.ation package was effective in improving knowledge and attitude scores of students towards influenza A (H 1 N 1). The second study aimed to determine level of knowledge, attitude and practices cind factors related to practice among public, teachers and nurses. Job stress among nurses was also determined. Self-administered validated questionnaire was used to collect data. Public were visitors of USM Health Campus during our study period. Teachers were randomly selected from three secondary schools in Kola Bharu. Nurses of HUSM were randomly chosen. A total 250 public, 163 secondary school teachers and 523 nurses were included. Most participants had good knowledge, attitude and practice on HlNl. The third study was a retrospective study to determine the epidemiology of influenza A (H 1 N 1) cases that had been admitted in HUSM. There were 93 cases enrolled with 44 (47.3%) patients presented with influenza-like-illness (Ill), 18 (19 .4%) patients were suspected cases and 31 (33.3%) patients were confirmed cases of H1N1. The fourth study was focus group discussion conducted among school children (n=30) and nurses (n=28). Nurses had good knowledge and perceived well on the risk of influenza A (H 1 N 1). However, the school children were lacking knowledge and had many misconception about the disease

Diagnosis delay of breast cancer and its associated factors in Malaysian women

<p>Abstract</p> <p>Background</p> <p>Breast cancer is the leading cause of cancer mortality among women in Malaysia. Delayed diagnosis is preventable and has major effects on patients' prognosis and survival. The objectives of our study were to identify the magnitude of delayed diagnosis and its associated factors in women with breast cancer in Malaysia.</p> <p>Methods</p> <p>This study had a cross-sectional design. Respondents had histologically confirmed breast cancer and were registered at five medical centres between 2005 and 2007. All breast cancer patients who attended hospital clinics at the East Coast were included. Patients at Kuala Lumpur hospitals were selected by systematic sampling. A standardised questionnaire was developed to interview respondents. We measured the time from the first recognition of symptoms to the first general practitioners' consultation and to the histological diagnosis of breast cancer. Diagnosis delay was defined when there was more than 6 months from the recognition of symptoms to the histological diagnosis. Multiple logistic regression was used for analysis.</p> <p>Results</p> <p>In total, 328 respondents were included. The mean (standard deviation) age was 47.9 (9.4) years. Most respondents were of Malay ethnicity, were married housewives with a median family income of RM1500 a month. Most respondents had ductal carcinoma (89.3%) and the stage distribution was as follows: 5.2% stage I, 38.7% stage II, 44.8% stage III and 11.3% stage IV. The median time to consultation was 2 months and the median time to diagnosis was 5.5 months. The frequency of diagnosis delay of more than 3 months was 72.6% and delay of more than 6 months occurred in 45.5% of the cases. The factors associated with diagnosis delay included the use of alternative therapy (odds ratio (OR) 1.77; 95% confidence interval (CI): 1.06, 2.94), breast ulcer (OR 5.71; 95% CI: 1.59, 20.47), palpable axillary lymph nodes (OR 2.19; 95% CI: 1.23, 3.90), false-negative diagnostic test (OR 5.32; 95% CI: 2.32, 12.21), non-cancer interpretation (OR 1.68; 95% CI: 1.01, 2.78) and negative attitude toward treatment (OR 2.09; 95% CI: 1.15, 3.82).</p> <p>Conclusions</p> <p>Delays in consultation and diagnosis are serious problems in Malaysia. Diagnosis delay was influenced by complex interactions between many factors. Breast awareness and education are required to promote early detection, diagnosis and treatment before the tumours enlarge and metastasis.</p

Improving malaria preventive practices and pregnancy outcomes through a health education intervention: A randomized controlled trial.

BACKGROUND: The prevalence of malaria in pregnancy and its complications, remain very high in Nigeria. This study aimed to determine the effects of a malaria health educational intervention based on the information-motivation-behavioural skills (IMB) model on malaria preventive practices and pregnancy outcomes. METHODS: The study was a randomized controlled parallel-group study, where 372 randomly selected antenatal care attendees were randomly assigned to one of either two groups after collecting baseline data. The intervention group then received a four-hour health education intervention in Hausa language, which was developed based on the IMB model, while the control group received a similarly designed health education on breastfeeding. Follow up data were then collected from the participants at a first (2 months post-intervention) and second (4 months post-intervention) follow up, and at the end of their pregnancies. RESULTS: For both groups, reported ITN use had increased from baseline (Intervention: Often-14.0%, Almost always-9.1; Control: Often-12.4%; Almost always 16.1%) to the time of second follow up (Intervention: Often -28.10%, Almost always-24.5; Control: Often-17.2%; Almost always 19.5%). Reported IPTp uptake at second follow up was also higher for the intervention group (Intervention: Two doses-59.0%, Three doses 22.3%; Control group: Two doses-48.4%, Three doses-7.0%). The drop in the haematocrit levels was greater for the control group (32.42% to 30.63%) compared to the intervention group (33.09% to 31.93%). The Generalized Linear Mixed Models (GLMM) analysis revealed that the intervention had significantly improved reported ITN use, reported IPTp uptake, and haematocrit levels, but had no significant effect on the incidence of reported malaria diagnosis or babies' birth weights. CONCLUSIONS: The intervention was effective in improving ITN use, IPTp uptake, and haematocrit levels. It is, therefore, recommended for the modules to be adopted and incorporated into the routine antenatal care programmes in health centres with predominantly Hausa speaking clients. TRIAL REGISTRATION: Pan African Clinical Trial Registry, PACTR201610001823405. Registered 26 October 2016, www.pactr.org

Validity and reliability of a Hausa language questionnaire assessing information, motivation and Behavioural skills for malaria prevention during pregnancy.

BACKGROUND: Many studies on malaria knowledge, attitude and practice among pregnant women have been conducted in Hausa speaking communities in Nigeria. Despite this, no standard and uniform instrument for assessing this important public health problem has been developed in the Hausa language, even though it is widely spoken. The aim of this study was to develop and validate a questionnaire in Hausa language assessing information, motivation, and behavioural skills for malaria prevention during pregnancy. METHODS: The questionnaire was first developed in English language, and then assessed for its contents by a team of experts. It was then forwardly translated to Hausa, and backwardly translated again to English by independent language experts. These two English versions were then compared by a Public Health expert, following which the questionnaire was administered to 190 Hausa speaking antenatal care attendees. Exploratory factor analysis was performed on the data collected. Sixty three out of the 190 respondents were invited after 2 weeks to answer the same questionnaire, following which reliability tests were performed. RESULTS: The questionnaire showed good internal consistency, with Cronbach's alpha values of 0.859, 0.890 and 0.773 for information, motivation and behavioural skills constructs respectively. The motivation and behavioural skills constructs were able to delineate their items into three and two sub-sections respectively. The factor loadings for the two constructs ranged from 0.610 to 0.965. As for test retest reliability, the Krippendorff's alpha values for the items of the motivation section ranged from 0.941 to 0.996; that for behavioural skills ranged from 0.810 to 0.953, while for frequency of ITN use, it was 0.988. The Cohen's kappa values for the information section ranged from 0.689-0.974, except the item for 'fever' (zazzabi) which was 0.382, and was as such reworded to a simpler terminology 'hotness of the body' (zafin jiki). CONCLUSIONS: The Hausa language IMB questionnaire on malaria in pregnancy demonstrated good validity, and a high level of reliability. It is as such recommended for use among Hausa speaking communities to ensure uniformity and objectivity

Effects of a health educational intervention on malaria knowledge, motivation, and behavioural skills: a randomized controlled trial

Background: The levels of insecticide-treated net use among pregnant women and uptake of intermittent preventive treatment in pregnancy, have been sub-optimal in Nigeria. Previous studies have reported positive correlations between knowledge, attitude and practice of malaria preventive measures. It has also been reported that information and motivation, act through a mediator (behavioural skills), to cause a health behaviour change. The aim of this study was as such to develop, implement, and assess the effects of a health educational intervention based on the information–motivation–behavioural skills (IMB) model on the levels of knowledge, motivation, and behavioural skills for ITN use and IPTp uptake among pregnant women in a hospital in north-eastern Nigeria. Methods: This was a randomized controlled parallel-group trial in which 372 antenatal care attendees were randomly assigned to either an intervention or control group after collecting baseline data using a structured questionnaire. The intervention group received a 4-h health education on malaria, guided by a module developed based on the IMB theory, while the control group received health education on breastfeeding for a similar duration and by the same facilitator. Follow-up data were subsequently collected at 2 months and at 4 months post-intervention using the same questionnaire. The generalized linear mixed models analysis was used to determine the between-group and within-group effects of the intervention. The intention-to-treat analysis was used after missing data had been replaced. This was followed by a sensitivity analysis, where the analyses were repeated without replacing the missing values. Results: The intervention was significant in achieving a 12.75% (p < 0.001), 8.55% (p < 0.001), and 6.350% (p < 0.001) higher total knowledge, motivation, and behavioural skills scores respectively, for the intervention group over the control group. The sensitivity analysis revealed no great differences in the effect sizes, even when missing data were not replaced. Conclusion: The intervention module was effective in improving knowledge, motivation and behavioural skills. It is as such recommended to be adopted and incorporated into the routine antenatal health education schedules. It is also recommended that booster doses of the module be given say 2 months after the first dose to sustain levels of motivation and behavioural skills

Survival analysis and prognostic factor of non-Hodgkin lymphoma treated in Hospital Universiti Sains Malaysia (HUSM)

INTRODUCTION: Non-Hodgkin’s lymphoma (NHL) is included in the ten leading cancers worldwide, accounting for an estimated more than 63 thousand new cases and over 19 thousands deaths per year. The study on survival rate and prognostic factors may be useful in building a better intervention program as well as improving survival rate. OBJECTIVES: The aims of this study were to determine the survival and to identify the prognostic factors that influence the risk of death of non-Hodgkin’s lymphoma (NHL) in Hospital Universiti Sains Malaysia (HUSM). METHODOLOGY: A retrospective record review was conducted involving 154 patients diagnosed as NHL from 1st January 1997 till 31st December 2006. Additional three years follow-up after the recruitment of the subjects was done to verify patients’ status. All patients who fulfilled the inclusion criteria were included in the study. The required information at time of diagnosis as well as patients’ survival status until 31st December 2009 was retrieved from medical records. For some patients who were still alive upon discharge from hospital but defaulted appointment or were loss to follow-up were traced by telephone calls and home visit to obtain information on patients’ survival status. Data entry and analysis was done using SPSS version 12 and STATA version 9. Kaplan-Meier procedure was used to calculate survival estimates while Cox Proportional Hazards Model was used to determine prognostic factors. RESULTS: The overall 5 and 10-years survival rates for NHL in HUSM was 33.2% (95%CI: 25.2, 41.4) and 26.9% (95%CI: 18.7, 35.8) respectively. Adjusted for other variables, the significant prognostic factors identified by Cox Proportional Hazards Model are age at diagnosis (HR=1.02; 95%CI: 1.0, 1.2; p=0.009), number of extranodal involvement (HR= 3.2; 95%CI: 1.4, 7.0; p=0.005), thrombocytopenia (HR= 2.0; 95%CI: 1.2, 3.6; p= 0.001) and lymphocytopenia (HR= 2.3; 95%CI: 1.3, 4.2; p= 0.006). CONCLUSION: The 5 and 10-year survival of NHL patients treated in HUSM was lower compared to other studies. The significant prognostic factors identified in this study were age at diagnosis, number of extranodal involvement, thrombocytopenia and lymphocytopenia. However, other important significant prognostic factors such as stage, treatment modalities and grade were not identified as prognostic factors in this study after adjusting other variables. Key word: Non-Hodgkin’s lymphoma, survival, prognostic factors

Determinants of uptake of first dose of intermittent preventive treatment among pregnant women in a secondary health Centre in Maiduguri, Nigeria

Background: Studies on uptake of first dose of intermittent preventive treatment in pregnancy (IPTp) are lacking, despite it being a predictor of subsequent doses. This study aimed at assessing the determinants of uptake of first dose of IPTp among pregnant women at the State Specialist Hospital, Maiduguri. Methods: A cross-sectional study was conducted, in which respondents were selected using a systematic random sampling method, and structured questionnaires were used to obtain information from them. Chi-squared test was used to determine factors associated with uptake of first IPTp dose, while a further multivariate logistic regression was performed to determine its predictors. Results: Three hundred and eighty respondents answered the survey, whose ages ranged from 15 to 45 years, and 86.8% were multigravid. Sixty five percent of them were aware of IPTp, and 34.7% believed that IPTp could be harmful to their pregnancies. Over a half of the respondents (52.9%) believed that taking all their IPTp medicines was very good for their pregnancies, while 45.0% felt that taking their IPTp medicines was very pleasant. Only two respondents (0.5%) stated that it was very untrue that their significant others thought that they should take all their IPTp medicines. Half of the respondents said it was very easy for them to take all their IPTp medicines even if they were experiencing mild discomforts while taking them. Less than a half (42.37%) had received their first dose of IPTp. In bivariate as well as multivariate analysis, only higher level of knowledge was significantly associated with uptake of first IPTp dose. Those with better knowledge of IPTp were about twice more likely to have taken their first dose of IPTp, compared to those with lower knowledge of IPTp (AOR = 1.85; 95% CI: 1.17–2.92). Conclusions: Knowledge of IPTp as well as its uptake, were sub-optimal in this study. Since knowledge of IPTp significantly predicts uptake of the first dose of IPTp, there is the need to implement health education campaigns to raise the awareness of pregnant women and their families on the need to receive and comply with it

Renal Survival of Chronic Kidney Disease Patients in a Tertiary Referral Hospital in Malaysia

Chronic kidney disease (CKD) represents a major public health issue, which then progresses to end-stage renal disease (ESRD) sooner or later. This retrospective cohort study aimed to determine the renal survival time of CKD patients. In total, 247 CKD patients in one of the tertiary referral hospitals in Malaysia between January 2005 and December 2015 were enrolled. All CKD patients were included if they were dependent on dialysis. Patients who were transferred out and those with incomplete records were excluded from the study. The renal survival time was calculated from the time of the first diagnosis of CKD to a confirmed ESRD diagnosis or the use of dialysis. In total, 193 (78.1%) CKD patients progressed to ESRD. The mean age of the ESRD patients was 53 years old. The majority of ESRD patients were male (57.0%) and of Malay ethnicity (89.6%). The most common comorbidities among ESRD patients were hypertension (92.2%) and diabetes mellitus (85.5%). The majority of patients were in Stage IV and V (97.9%). The overall renal survival time of CKD patients who develop ESRD was 26 months (95% confidence interval: 20.41, 31.59). Patients who smoked (P = 0.001), had hyperlipidemia (P <0.001) and consumed lipid-lowering agents (P = 0.004) had a significant P-value in the log-rank test. The progression of CKD from diagnosis to ESRD was within 2 years. Therefore, early recognition of CKD is important to improve patients' outcomes and prolong their renal survival time