Identifying factors in the provision of intravenous stroke thrombolysis in Malaysia: a multiple case study from the healthcare providers’ perspective

Background: Translation into clinical practice for use of intravenous thrombolysis (IVT) for the management of ischemic stroke remains a challenge especially across low- and middle-income countries, with regional inconsistencies in its rate. This study aimed at identifying factors that influenced the provision of IVT and the variation in its rates in Malaysia. Methods: A multiple case study underpinning the Tailored Implementation for Chronic Diseases framework was carried out in three public hospitals with differing rates of IVT using a multiple method design. Twenty-five in-depth interviews and 12 focus groups discussions were conducted among 89 healthcare providers, along with a survey on hospital resources and a medical records review to identify reasons for not receiving IVT. Qualitative data were analysed using reflective thematic method, before triangulated with quantitative findings. Results: Of five factors identified, three factors that distinctively influenced the variation of IVT across the hospitals were: 1) leadership through quality stroke champions, 2) team cohesiveness which entailed team dynamics and its degree of alignment and, 3) facilitative work process which included workflow simplification and familiarity with IVT. Two other factors that were consistently identified as barriers in these hospitals included patient factors which largely encompassed delayed presentation, and resource constraints. About 50.0 – 67.6% of ischemic stroke patients missed the opportunity to receive IVT due to delayed presentation. Conclusions: In addition to the global effort to explore sustainable measures to improve patients’ emergency response for stroke, attempts to improve the provision of IVT for stroke care should also consider the inclusion of interventions targeting on health systems perspectives such as promoting quality leadership, team cohesiveness and workflow optimisation

A cross-sectional study on knowledge, attitude and practice of malaria among the heads/spouses of household in Kampung Engkeroh from 14th June 2004 to 20th August 2004

Malaria is a major public health problem in many regions in the world including Malaysia. Over one hundred million cases of Malaria occur worldwide with one million deaths recorded yearly. In Malaysia, about 12,000 cases occur yearly, in which Serian district alone records more than 300 cases yearly. Thus, reducing the incidence of Malaria is one of the top priorities of the public health programme in Malaysia. This research mainly aimed at studying the knowledge, attitude and practice towards Malaria among the heads/spouseso f household in Kampung Engkeroh. A sample population of 100 were interviewed using structured questionnaire. The practice was also assessed using a checklist to examine if proper prevention methods were used. Data collected were entered into SPSS version 11.0 and analyzed appropriately. Out of 100 respondents, only 86% were aware of Malaria with the main sources of information being the local health clinic, the mass media and family or friends. 92% had poor knowledge while 8% had good knowledge on Malaria. There was significant association between levels of knowledge and levels of attitude. As for the attitude, 68% showed positive attitude while the remaining 32% showed negative attitude towards Malaria. However, only 7% showed good practice while the other 93% had poor practice on prevention of Malaria. There were significant association between levels of attitude and levels of education but it was found that attitude did not influence the level of knowledge. This study also found that there was no relationship between levels of knowledge and practice as well as the levels of income and practice. However, there was association found between levels of attitude and practice. This goes to show that although many are aware of the presence of this disease in their area and majority of respondents have a positive attitude, the knowledge and practice among respondents in Kg. Engkeroh is exceptionally poor. There are many factors that can be associated with this finding such as the location of the village, which is far from town and the local health clinic, the levels of education and the levels of income. It was notable that many respondents are concerned about the disease as cases occur in this village yearly. The conclusion that can be drawn from here is that efforts should be made to improve the knowledge, attitude and practice on Malaria with emphasis on the element of knowledge and practice by holding a health intervention programme. This study can be useful as a reference for future researches in the local setting. The need of more research and publications which apply to the local people and culture should be emphasized