A COMPARISON OF MORBIDITY PATTERNS IN PUBLIC AND PRIVATE PRIMARY CARE CLINICS IN MALAYSIA

Objectives: To compare the morbidity patterns in public and private primary care clinics; determine patients’ reasons forencounter (RFE) and diagnoses using the ICPC-2, and compare ten commonest diagnoses and RFEs.Methods: A cross-sectional study on randomly selected clinics was conducted nationwide. Doctors completed the PatientEncounter Record (PER) for systematically selected encounters for a week.Results: Response rate was 82.0% (public clinic) and 33% (private clinic) with 4262 encounters and 7280 RFE. Overall, thethree commonest disease categories encountered were respiratory (37.2%), general and unspecified (29.5%), and cardiovasculardiseases (22.2%). Public and private clinics handled 27% versus 50% acute cases and 20.0% versus 3.1% chronic cases i.e.33.7 and 5.6 chronic diseases per 100 RFE respectively.Conclusion: Doctors in public clinics saw more chronic and complex diseases as well as pregnancy related complaints andfollow-up cases while in private clinics more acute and minor illnesses were seen. Health services should be integrated andsupport given to co-manage chronic diseases in both sectors

A comparison of morbidity patterns in public and private primary care clinics in Malaysia

Objectives: To compare the morbidity patterns in public and private primary care clinics; determine patients' reasons for encounter (RFE) and diagnoses using the ICPC-2, and compare ten commonest diagnoses and RFEs. Methods: A cross-sectional study on randomly selected clinics was conducted nationwide. Doctors completed the Patient Encounter Record (PER) for systematically selected encounters for a week. Results: Response rate was 82.0 (public clinic) and 33 (private clinic) with 4262 encounters and 7280 RFE. Overall, the three commonest disease categories encountered were respiratory (37.2), general and unspecified (29.5), and cardiovascular diseases (22.2). Public and private clinics handled 27 versus 50 acute cases and 20.0 versus 3.1 chronic cases i.e. 33.7 and 5.6 chronic diseases/100 RFE respectively. Conclusion: Doctors in public clinics saw more chronic and complex diseases as well as pregnancy related complaints and follow-up cases while in private clinics more acute and minor illnesses were seen. Health services should be integrated and support given to co-manage chronic diseases in both sectors. © Academy of Family Physicians of Malaysia

Entomological Investigation and Control of a Chikungunya Cluster in Singapore

In August 2008, a team from the National Environmental Agency conducted an entomological investigation of a chikungunya cluster in Singapore, with the primary aim of identifying the vector responsible for the outbreak and to assess the vector control operation. A total of 173 adult mosquitoes were caught using both the sweep-net method and the BG Sentinel Traps in and around the affected workers' quarters. Of these, 120 (69.4%) were Aedes albopictus and the rest were Culex quinquefasciatus. More than 2700 Ae. albopictus larvae were also collected from 33 breeding habitats detected. No Aedes aegypti was found. During the preintervention period, 6 (8.4%) out of 71 adult female Ae. albopictus were found positive for the chikungunya virus (CHIKV). Vector control measures resulted in a 90% reduction of adult Ae. albopictus caught by BG Sentinel Traps. Postintervention surveillance revealed the presence of CHIKV-positive mosquitoes. These findings led to continued intensive vector control operation in the affected area that further reduced vector population and interrupted the transmission of the disease. The E1 gene sequence of the CHIKV was identical to those of CHIKV isolated from human chikungunya cases working in the affected area, and contained the A226V mutation. The incrimination of Ae. albopictus as a major vector involved in the transmission of A226V CHIKV had led to the revision of chikungunya control strategy in Singapore. This study suggests the benefit of a vector control program that includes the evaluation of control measures in conjunction to virological surveillance in vector population