Early resumption of sexual intercourse and its determinants among postpartum Iban mothers

Introduction: Recurrent pregnancy with close child spacing can result from early resumption of sexual intercourse during the postpartum period. This would expose mothers to complications such as unsafe abortion, postpartum depression and premature birth. The aim of this study is to identify the factors associated with early resumption of sexual intercourse among postpartum Iban mothers.Methods: This is a cross sectional study conducted in Sri Aman Division, Sarawak between 1st July and 31st August 2006. A total of 265 Iban mothers agreed to participate in this study. They were interviewed face-to-face using structured questionnaire. Any postpartum sexual intercourse at 6 weeks or less is considered an early resumption of sexual intercourse.Results: Univariable analyses showed significant association between early sexual intercourse and use of contraceptive; mothers’ and husbands’ income; mothers who believed their husbands were sexually abstinent during their confinement period; mothers who stayed with their spouse after delivery; and those with high libido. Multivariable analysis showed only mothers’ and husbands’ income, use of contraceptive and those who believed their husbands practiced sexual abstinence during their confinement period were significantly associated with early resumption of sexual intercourse. Conclusions: Counselling on postpartum resumption of sexual intercourse among Iban mothers should focus on these determinants to ensure a more effective counselling outcome among Iban mothers

Corporate culture and health care organization

Each organization has a particular culture, due to personal interactions, with certain values shared by its members. Corporate culture is defined as ‘the set of shared, taken-for-granted implicit assumptions that a group holds and that determines how it perceives, thinks about, and reacts to its various environments’. Positive corporate culture is linked to increased staff alignment, advanced level of employee commitment, increased employee productivity, enhanced organizational effectiveness and increased profitability. Researchers claimed that most studies suggesting the associations between culture and performance are methodologically weak. Cultural transformation has been a big part of NHS reforms and health system redesign in United States to deliver improvements in quality and performance. Environment, market competition, technology advancement, information age and government policies will influence the cultural change within the organization. Undesirable culture might emerge if the organization does not act appropriately to manage its corporate culture. There are six critical success factors for the implementation of corporate culture changes: committed and effective leadership, clear definition of the desired goals, rigorous implementation of a change management model, effective mitigation of change resistance, active governance structure and a design model, and effective communication. Among the issues in implementing corporate culture within healthcare organizations are middle managers dilemma, cultural diversity and subcultures within the organization, size of healthcare organization and critical mass

The COMBI (Communication for Behavioural Impact)program in the prevention and control of dengue - the Hulu Langat experience

Background: The COMBI concept is a novel approach by the WHO to control communicable diseases which are influenced by community behaviour. The Ministry of Health is currently evaluating its use against dengue in selected areas throughout Malaysia. COMBI doctrine differs from previous dengue campaigns. It acknowledges that the factors contributing to dengue proliferation may differ between areas. Factors for a given area are analysed, then a single precise behavioural goal to overcome those problems is formulated. To inculcate this behavioural change, the target community is subjected to an intensive campaign using Integrated Marketing Communication techniques adapted from the advertising industry, particularly involving volunteers from the community itself. Methodology: In Selangor the pilot project was implemented in Section 3 and Section 4 of Bandar Baru Bangi, in the district of Hulu Langat. Here, Aedes breeding was found to occur mainly in water containers of semi permanent nature (eg. ‘kolah’, aquatic plant jars, flower pot bases etc). A total of 172 volunteers were recruited to disperse the message of “Suluh – Suluh, Basuh - Basuh” whilst distributing leaflets and flashlights to 2666 homes. Residents were instructed to illuminate such water containers twice weekly and scrub any containers found to contain larvae. The program commenced on 23/5/2004 and lasted 16 weeks. Results : During this period, the initial Aedes Index of 5 was reduced to 0.96 while combined cases of Dengue Fever / Dengue Haemorraghic Fever in Sections 3 and 4 reported to the Hulu Langat District Health Office also dropped to 1 (unconfirmed). Conclusion : The COMBI approach in Hulu Langat successfully demonstrated that correct problem identification synergized with community engagement can potentially reduce Aedes proliferation and dengue morbidity

The Malaysian health reform in primary health care services

Introduction : Family Health Development Division is one of the earliest divisions in Public Health Department, Ministry of Health Malaysia. The division has progressed each year with the extension and expansion of the scopes of services since the establishment of Maternal and Child Health Unit in 1956. The services currently include school children, adolescent, adult and elderly health and also known as life-course perspective: from womb to tomb. Objectives : The objective is to elaborate and explain the reformation of primary health care services implemented in the past and present. Methods : The methodology applied is compilation, data review and comparison from annual report, action plan report, articles, speeches, specialists and stake holder view. Results : The focus of Primary Health Care Service is covering health promotion, disease prevention, early detection and treatment, acute disease care, disease limitation and rehabilitation, clinical support services and teleprimary care. The reformation is caused by factors such as globalization, modernization, growth of health market, emergence and re-emergence of diseases, and development of medical technology. Three health fields that have underwent and under going reformation are concept and wellness practise in primary healthcare, primary healthcare clinical support services development and primary healthcare informatics development. The outcome of these reformations is the increment of service quality and outstanding services for patients and health staffs. Conclusion : Health reformation in primary healthcare is greatly needed to give excellent services for primary health care for today and future

Prevalence of back pain among nurses working in Government Health Clinics and Hospital in Port Dickson, Malaysia

Introduction : Nursing is an occupation associated with high risk of developing back pain due to their nature of work practices. The aim of this study was to determine the prevalence of back pain among nurses working in government health clinics and hospitals in Port Dickson and the factors associated with it. Methods : A cross sectional study was conducted involving 126 nurses working in government health clinics and district hospital in Port Dickson. They were universally sampled. A self-administered questionnaire, assessing personal and socio-demographic characteristics, back pain, work factors and psychosocial factors. Results : The prevalence of back pain among nurses was 79.4% and factors that showed significant association were workplace (p=0.026) and carried heavy load (p=0.043). Conclusion : Where one work and nature of work one does has been shown in this study to be important issues to be considered in helping to manage back pain related to work. It is also recommended that staff need to be encouraged to do exercise to strengthen the back muscles, increase spinal flexibility and blood circulation to the spine as well as need to be reminded regarding ergonomic adjustment at work

Factors affecting social misconduct amongst adolescents in Melaka Tengah district

Background : Social misconduct amongst adolescents is a worrying and ever growing problem in Malaysia, despite efforts taken to overcome it. Methods : A cross sectional study was conducted among secondary school students in Melaka Tengah District to measure the prevalence and determine the factors associated with social misconduct amongst adolescents. A total of 414 form four students were recruited by systematic random sampling fulfilling the study criteria between Jun to September 2008, from eight randomly selected secondary schools in the district. Data were collected using a structured self-administered questionnaire and analyzed using SPSS software version 12.0. Socio-demographic, housing and family factors in relation with social misconduct were studied. Results : The prevalence of the social misconduct in this study was 70.5%. The most prevalent misconduct includes loitering (37.4%), truancy (30.0%), watching pornographic films (28.7%), and involved in pre-sexual activities (23.7%). The factors that showed significant association with social misconduct were sex and race. Conclusion : The prevalence of social misconduct is high among adolescent and males as well as Malays are at higher risk. Activities planned for adolescents should be stressed on the danger and effects of social misconduct and be more focused towards male and Malay adolescents

Participation and empowerment : determining the healthcare organization's success

Introduction : An organization performs well with proper management methods. Participation is a process involving cooperation and collaboration within all levels of individuals, groups or community for the purpose of organization improvement. Empowerment brings the organization further by delegation of power and responsibilities to others for better result. Methodology : This is a systematic review on various publications, articles and studies based on the findings and researches conducted by experts and scholars involved with participation and empowerment of organisations Results : Participation and empowerment are crucial in every organization including healthcare. Its success depends on factors such as proper planning, mutual understanding, regular training and continuous education. They contribute towards better outcome in goal setting, decision making, problem solving and organizational development. There are also various levels of empowerment and participation depending on the type of activities, organisation’s performance and level of authority. Conclusion : The prerequisite for an organisation’s success is dependent upon holistic participation and appropriate empowerment. The benefits gained from these measures are indeed invaluable. It creates sense of ownership, increases motivation and satisfaction, optimizing resources, promote innovations, enhancing quality and improving efficiency

Determining factors on level of knowledge regarding pap smear among married women in Hulu Langat district, Selangor

Introduction : Cervical cancer can be prevented through pap smear screening and its proper management of high risk cases. High level of knowledge regarding pap smear screening will encourage women to do pap smear as recommended. Methadology : A cross sectional study was carried out in Jun 2007 to find out the level of knowledge regarding pap smear among married women in Kg. Sesapa Kelubi, Hulu Langat Selangor. Universal sampling was conducted using guided questionnaire and data was analysed using SPSS version 12. Result : A total of 154 women participated in this study. Only 3.9% of respondents practiced pap smear as recommended and only 51.3% of them have high level of knowledge with 27.9% has no knowledge regarding pap smear. Women between the ages of 20-35 years old have higher level of knowledge (77.9%). The only factor that showed significant association with level of knowledge in this study is level of education. Age, income, gravida and occupation did not show any significant association. Conclusion : The effectiveness of pap smear screening program should be regularly evaluated to determine the problem of its low coverage. Proper strategy should be planned to increase knowledge among women and their participation in pap smear program

Stres dalam kalangan penduduk dewasa luar bandar,daerah Hulu Langat,Selangor.

Background : Study of stress among adults in rural community is seldom been conducted and this study aims to see the prevelence of the stress among this group of population. Methodology : A cross sectional study was conducted to measure the prevalence of stress among the rural people in Hulu Langat District, Selangor using O`Donnell Personal Stress Inventory and coping mechanism practiced by them. Result : A total of 265 respondents through universal sampling participated in this study. The stress prevalence identified was 16.2%. The factors which have significant association with stress were age, education level, marital status, working women, duration of working per day and body mass index. Diseases such as diabetis mellitus and hypertension showed no association with stress. Preferred coping mechanism used by respondents included emotional support, instrumental support, behaviour modification and denial. Conclusion : Stress among the rural population is high in Malaysia. Measures has to be taken to reduce the stress as it can effect the general health of the people

Persepsi pakar perubatan kesihatan awam, Kementerian Kesihatan Malaysia mengenai Sistem Saraan Malaysia (SSM)

Skim Sistem Saraan Malaysia (SSM) telah diperkenalkan pada tahun 2002 menggantikan skim Sistem Saraan Baru (SSB) kepada kakitangan sektor awam. Satu kajian keratan rentas telah dijalankan ke atas Pakar Perubatan Kesihatan Awam (PPKA) pada 2004 yang bertujuan untuk mendapatkan persepsi mereka mengenai skim SSM. Semua PPKA yang berdaftar dengan Persatuan Pakar Perubatan Kesihatan Awam (PPPKA) yang berkhidmat dengan Kementerian Kesihatan Malaysia (KKM) dipilih sebagai responden. Kajian ini menggunakan borang soalselidik yang diisi sendiri oleh responden. Kadar respon kajian ini ialah 70.0% iaitu 217 responden. Kajian ini mendapati sebanyak 80.6% PPKA tidak bersetuju dengan pelaksanaan SSM, hanya 7.4% bersetuju dan sebanyak 12.0% berkecuali. Kelemahan-kelemahan utama SSM yang dikenalpasti oleh responden yang tidak bersetuju dengan SSM ialah prosedur atau skim perkhidmatan yang kabur (83.9%), peperiksaan Tahap Kecekapan yang tidak releven (54.1%) dan kenaikan pangkat terjejas (40.5%). Hasil kajian ini dapat membantu pihak-pihak yang terlibat memperbaiki kelemahan-kelemahan SSM supaya pelaksanaannya menjadi lebih mantap dan dapat menangani kelemahan yang wujud di dalam skim tersebut