Assessing service quality of community-based ecotourism: a case study from Kampung Kuantan Firefly Park

Community-based ecotourism (CBE) could offer business opportunities to local communities living within or adjacent to unique ecological sites. CBE focuses on impact of tourism on the community and takes environmental, social and cultural sustainability into account. To assess the extent that CBE has been practised in Malaysia, Kampung Kuantan Firefly Park (FP), a habitat of the Lampyridae species beetle, was selected as study site to evaluate the services that the park offered and to assess the ability of the service provider, with the participation from local stakeholders, to fulfil tourist requests using the criteria of CBE as guidelines. Data were collected using convenience sampling of international and domestic tourists using questionnaire. All questions had been prior tested for reliability. The method of analysis involved the critical incident technique to identify and assess the satisfaction or dissatisfaction of tourists with regard to service encounters at the park. Five service failure constructs were identified and prioritised, namely, dissatisfaction with the quality of attractions and facilities at the park, tourist expectations before the visit, inadequate knowledge of employees, unacceptable behaviours of employees and other tourists, and inadequate responses to tourist needs. The form of recovery strategies undertaken by the service provider, its employees and participating community for major service quality failures were recorded and their effectiveness assessed

Social network analysis of Kampung Kuantan Fireflies Park, Selangor and the implications upon its governance

Community-based management practices stakeholder inclusivity is claimed to be the panacea in overcoming problems and dilemmas in governing ecotourism. Kampung Kuantan Fireflies Park (KKFP) in Kuala Selangor faced several complaints from tourists which were hypothesised to be associated with governance of the park. Social network analysis was utilised to identify the key stakeholders within the governance network of managing ecotourism and in understanding the interests and roles of these stakeholders. The network metrics used were number of edges, density, geodesic distance, and degree and betweenness centralities. The network metric and map obtained suggested that the local community boatmen had the highest degree and betweenness centralities in the KKFP social network. Inclusivity, particularly in the fireflies observation boat ride and tour services, had occurred but involvement in the management decision-making held by the district office could be improved. Possible explanations are provided for the dichotomy of findings between the informal power held by the local community boatmen and the formal authority held by the district office in the context of the Malaysian culture and custom

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Inclusion of kenaf as bio-material component in sustainable manufacturing in Malaysian automotive industry

Increase in societal demand for sustainability has resulted in attention to sustainable manufacturing. Many manufacturers often focus on the economic component sustainability, neglecting the environmental and social aspects. Natural fiber reinforced polymer composites (NFC) provides a practical alternative to synthetic fiber reinforced composites largely in automotive and building product applications. At the laboratory scale, kenaf fibers reinforced polymer composites (KFC) has been proven that it is technically feasible to be developed as part of automotive bio-material components. The purpose of this study is to investigate whether such potential applications could meet the environmental and economic sustainability measurements. As illustration, the supply chain process of spare wheel cover production was used for this purpose. The first objective of the study describes the use of life cycle assessment (LCA) of utilizing kenaf fiber composites for spare wheel cover production. A cradle to gate assessment was performed based on the ISO 14040/14044 guidelines. The aims are to identify the major hotspots and most significant contributions to environmental pollution. The second objective of the study is to conduct an economic valuation of the consumer preferences from the Klang Valley area on using natural fiber composites in certain components of their car. The double bounded dichotomous- choice contingent valuation method (CVM) could be used for this purpose to solicit the interests of consumers to make extra payments towards reducing the impact to the environment. The third objective is to frame out a financial and economic feasibility assessment of using Kenaf fiber composites in the production of the spare wheel cover. The environmental cost and economic value estimates of the intangible environmental and economic impacts obtained from the previous objectives are incorporated into the cashflows to enable the computation of an economic cost-benefit analysis (CBA). Incorporating the three elements of the above study could shed light as to the environmental and economic sustainable development of Kenaf application into the automotive industry. From the objective 1, between three phases in spare wheel production, the midstream phase has a higher contribution to the environment pollution with the total environmental cost of RM14,326.30 or 63%, followed by upstream phase and downstream phase with the total contribution 19% and 18% respectively. For objective number 2, all the variables in the double-bounded approach are significant at a different level except for GENDER and LENGTHOFUSE which is insignificant in the double-bounded approach and is therefore, eliminated from the model and the mean additional WTP ranges from RM11.51 to RM16.10 has achieved. For last objective, between three phase, only downstream phase was positive where the project is both financially and economically feasible. The positive result is due to the light-weight impact where the society could benefit with fuel saving and the corresponding reduction of CO2 emissions and also the total additional WTP. To implement the project successfully, more effort is required to improve the feasibility of Kenaf fiber production. The challenge is in the low quality of local Kenaf fibers that will affect the quality of the production of automotive components. By overcoming these obstacles, the project will have huge positive impacts on both the sector and society

Factors determining stakeholders' perception of kenaf cultivation in Kelantan, Malaysia

Global warming has led to renewed interest in the more sustainable use of natural fibers in composite materials. This has led to a resurgence of interest on Kenaf fibers. The Malaysian government has selected Kenaf as a new commodity and natural fiber to be given support and priority. Even though the Government has provided incentives and support in Kenaf development, the progress in Kenaf cultivation has not met the expectation of the Government. The objectives of this study are i) to identify the important stakeholders, their stakes and roles in Kenaf cultivation in Kelantan and ii) to determine the critical factors influencing farmers' participation in Kenaf cultivation. For the first objective, social network analysis has been used to identify the stakeholders in Kenaf cultivation and for the second objective based from the result in the first objective, factor analysis is applied to map out the stakeholder' perspective in Kenaf cultivation. Data for social network analysis and factor analysis are collected through interviews using structured questionnaire. This paper provides the preliminary findings of this investigation. The result from social network analysis enables the identification of the real critical stakeholder in Kenaf cultivation which is the farmer. This key stakeholder is the target for fostering the growth of the Kenaf industry. The fmdings from factor analysis show that there are six significant factors; i) economic potentials in Kenaf cultivation, ii) strategies of tobacco cultivation, iii) grievances over Kenaf cultivation, iv) farmers' perspectives in changing crop cultivation, v) challenges on market assurances, and (vi) campaign and promotion to attract farmers involvement in Kenaf cultivation

Critical factors of farmers's participation in kenaf cultivation: Malaysian context

The Malaysian government has given support and priority to Kenaf as a new national commodity. However, the progress in Kenaf cultivation has not met the expectation of the government. The main objective of this study is to determine the critical factors influencing the limited farmer participations in Kenaf cultivation. Data were collected through interviews using a structured questionnaire that is designed to map out the farmers perspective with respect to this matter. Factor analysis indicates that there are six significant influential factors including inadequate economic potentials in Kenaf cultivation, strategicness of tobacco cultivation, grievances over Kenaf cultivation, farmers’ perspectives in changing crop cultivation, challenges in market assurances and inadequate Kenaf cultivation campaign and promotion to farmers. The government has to take note and resolve these critical factors to encourage Kenaf cultivation by farmers

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this