Catastrophic health expenditure: a community-based study in Sarawak, Malaysia

Background: Accessing health services can lead to individuals having to pay catastrophic proportions of their available income and push many households into poverty. The aim of the study was to estimate the catastrophic health expenditure in respect of household expenditure and to determine the factors affecting it in Sarawak, Malaysia. Methods: We collected household expenses based on a recall period of one month through a face-to-face interview. We calculated the catastrophic health expenditure in terms of 10% of household expenditure and 40% of the capacity to pay. A binary logistic regression analysis was done to determine the factors associated with catastrophic health expenditure. Data analysis was done by IBM SPSS version 27.0. Results: The analysis revealed that one-quarter (25.7%) of the household expenditure was on food, equivalent to MYR 373.562, and 18.83% of the total household expenditure was on health (MYR 292.83). About two-fifths (37.4%) of the households had incurred catastrophic health expenditure on 10% of household consumption and 15.6% catastrophic health expenditure on 40% of household expenditure. Multivariate analysis with forward and backward linear regression methods revealed that age, gender, family size, socioeconomic status, and chronic illness appeared to be potential predictors of 10% catastrophic health expenditure (p<0.05). In contrast, socioeconomic status and level of education appeared to be potential predictors for 40% catastrophic health expenditure (p<0.05). Conclusions: Subsidised health care may not protect against the occurrence of catastrophic health expenditure among the household in the lower socioeconomic status. Family size and age also could affect household catastrophic health expenditure

Factor associated with tobacco use among the adult population in Sarawak, Malaysia: a cross sectional study

Introduction: Consumption of tobacco in any form is one of the leading causes of preventable mortality. The World Health Organization recommends that it should be monitored regularly. &nbsp;This study was designed to estimate the prevalence of tobacco use among the rural adult population in Sarawak and factors associated with it. Methods: This was a cross-sectional study conducted among the adult population in Sarawak. Data were collected from ten villages in Kota Samarahan and Kuching Division by face to face interview using modified Global Adult Tobacco Survey questionnaire. Non-probability sampling method was adopted to select the villages. All the households of the villages were visited and an adult member was selected randomly from each house irrespective of the sex. After missing value imputation, 1000 data were analysed using statistical software SPSS 19.0 version. Results: Analysis showed that 30.9% of the respondents were current tobacco users and 11% were past tobacco users. The mean age (SD) at starting tobacco was 18.1 (6.48) years. The frequency of tobacco use was 14 times per day.&nbsp; Hierarchical Logistic regression analysis revealed that age with male sex (OR=1. 064, 95% CI: 1.052, 1.076), secondary education (OR=-2.712; 95% CI: 1.122, 6.555), higher secondary and above (OR=3. 571; 95% CI: 1.641,7.774), occupation as business (OR=3. 152; 95% CI: 1.732, 5.735) and environmental exposure such as smoking at working place (OR=2. 754;95% CI: 1.895,4.002), coffee house (OR=2. 274;95% CI: 1.32,3.919) and at home (OR=1. 827;95% CI: 1.242,2.687) appeared to be&nbsp; important predictors of tobacco use (p&lt;0.05). Conclusion: A large proportion of males use tobacco products. Though tobacco use was negligible among females, but they would be potential users. Environmental exposure to tobacco appeared to be important predictors. Tobacco control campaigns should target banning of tobacco use in closed and open areas and also to intensify the monitoring of all forms of tobacco used by the population

Factor associated with tobacco use among the adult population in Sarawak, Malaysia: a cross sectional study

Introduction: Consumption of tobacco in any form is one of the leading causes of preventable mortality. The World Health Organization recommends that it should be monitored regularly. This study was designed to estimate the prevalence of tobacco use among the rural adult population in Sarawak and factors associated with it. Methods: This was a cross-sectional study conducted among the adult population in Sarawak. Data were collected from ten villages in Kota Samarahan and Kuching Division by face to face interview using modified Global Adult Tobacco Survey questionnaire. Non-probability sampling method was adopted to select the villages. All the households of the villages were visited and an adult member was selected randomly from each house irrespective of the sex. After missing value imputation, 1000 data were analysed using statistical software SPSS 19.0 version. Results: Analysis showed that 30.9% of the respondents were current tobacco users and 11% were past tobacco users. The mean age (SD) at starting tobacco was 18.1 (6.48) years. The frequency of tobacco use was 14 times per day. Hierarchical Logistic regression analysis revealed that age with male sex (OR=1. 064, 95% CI: 1.052, 1.076), secondary education (OR=-2.712; 95% CI: 1.122, 6.555), higher secondary and above (OR=3. 571; 95% CI: 1.641,7.774), occupation as business (OR=3. 152; 95% CI: 1.732, 5.735) and environmental exposure such as smoking at working place (OR=2. 754;95% CI: 1.895,4.002), coffee house (OR=2. 274;95% CI: 1.32,3.919) and at home (OR=1. 827;95% CI: 1.242,2.687) appeared to be important predictors of tobacco use (p<0.05). Conclusion: A large proportion of males use tobacco products. Though tobacco use was negligible among females, but they would be potential users. Environmental exposure to tobacco appeared to be important predictors. Tobacco control campaigns should target banning of tobacco use in closed and open areas and also to intensify the monitoring of all forms of tobacco used by the population

Factors Affecting Smoking Menthol Brand Cigarette Among The Adult Population In Sarawak, Malaysia

Menthol brand cigarette has been found to be linked with early initiation of smoking and addiction of nicotine. This study was designed to find out the factors associated with smoking menthol brand cigarettes among adult population in Sarawak. This was a cross-sectional study conducted among the adult population in Sarawak. Data were collected from ten villages in Kota Samarahan and Kuching Division by face to face interview using modified Global Adult Tobacco Survey questionnaire. Non-probability purposive sampling method was adopted to select the villages. All the households of the villages were visited, and an adult member was selected randomly from each household irrespective of sex. After missing value imputation, 1000 data sets were analysed using statistical software SPSS 19.0 version. Analysis showed that 28.8% of the respondents were current smokers, and 7.8% were past smokers. Among the smokers, 56.3% were habituated with menthol brand cigarette. Logistic regression analysis revealed that age at initiation of smoking before 15 years of age (OR=11. 68, 95% CI: 4.25, 32.10), smoking within five minutes of wake up from sleep (OR=3. 20, 95% CI: 1.35, 7.54), nature of job as business (OR=4. 81, 95% CI: 2.13, 10.86) and service holders (OR= 3.85, 95% CI: 2.07, 7.16) and family size 5 and above (OR=2. 22, 95% CI: 1.25, 3.94) appeared to be important determinants of smoking any menthol brand cigarette (p<0.05). Menthol is a prominent design feature to attract and retain younger smokers. It does not necessarily make the transition from experimenting with cigarettes, but to encourage early smokers to become a confirmed smoker. So, anti-tobacco public health programme should focus on age-specific community approach

A Holistic Ecosystem for Rural mHealth Applications and Lesson Learnt

Delivering mHealth applications requires a mHealth ecosystem and this paper will present the development of an ecosystem of mHealth applications to be deployed at remote and rural villages that do not enjoy the same health benefits as in urban areas. Some evidence was found to indicate advantages of mHealth applications in supporting healthy living and wellness behavioural change among the people. The fundamental principle of an ecosystem is to enhance the participation of all the stakeholders and to understand the big picture of the work process holistically. The stakeholders include developers, telecommunication providers, patients, caregivers, healthcare providers, the Ministry of Health and other government sectors. It is important to balance the commercial interests and the peoples’ needs. For the last decade, commercialised mHealth applications are increasingly available to target heterogeneous audiences and address specific health needs. With that, research interest in mHealth is also increasing together with the complexity of the ecosystems that impact all the stakeholders. We will present the development of protocols and privacy from lessons learnt to increase the effectiveness of mHealth in practice and to allow better understanding for future development and employment. We have also conducted a pilot participatory study at four telecentres at rural areas in Malaysia using commercialised mHealth systems

Effectiveness of pictorial health warning on cigarette packages: A cross-sectional study in Sarawak, Malaysia

Specific health warning placed on the tobacco product packages is considered as an effective and low-cost method for increasing the knowledge and awareness among the community. Thus, a study was conducted to assess the perception of pictorial health warnings (PHWs) against smoking among the adult rural population of Sarawak

Factors associated with tobacco use among the adult population in sarawak, malaysia:a cross sectional study

Background: Consumption of tobacco in any form is one of the leading causes of preventable mortality. The World Health Organization recommends that it should be monitored regularly. A study was conducted to estimate the prevalence of tobacco use and factors associated with it among rural adult population in Sarawak. Methods: This was a cross-sectional study conducted among the adult population. Data were collected from ten Kampungs (villages) in Kota Samarahan and Kuching Division by face-to-face interview using modified Global Adult Tobacco Survey (GA TS) questionnaire. Non-probability sampling method was adopted to select the villages. All the households of the selected villages were visited and an adult member, irrespective of sex, was selected randomly from each household. The study was conducted for a period of one year from July 2012 to June 2013. After missing value imputation, 1000 data were analysed using statistical software SPSS 19.0 version. Results: Analysis showed that 30.9% of the respondents were current tobacco users and 11% were past tobacco users. The mean age (SD) of starting tobacco use was 18.1 (6.48) years. The mean frequency of tobacco use was 14 times per day. Hierarchical Logistic regression analysis revealed that age with male sex (OR=1.064, 95% CI: 1.052, 1.076), secondary education (OR=-2.712; 95% CI: 1.122, 6.555), higher secondary and above (OR=3. 571; 95% CI: 1.641,7.774), business as occupation (OR =3.152; 95% CI: 1.732, 5.735) environmental exposure such as smoking at working place (OR=2.754;95% CI: 1.895,4.002), coffee house (OR=2. 274;95% CI: 1.32,3.919) and at home (OR=1. 827;95% CI: 1.242,2.687) appeared to be important predictors of tobacco use (p<0.05). ConclusionS: A large proportion of males used tobacco products. Though tobacco use was negligible among females, nonetheless they would be potential users. Environmental exposure to tobacco appeared to be important predictors. Tobacco control campaigns should target banning of tobacco use in more closed and open areas and also to intensify the monitoring of all forms of tobacco used by the populatio

Burden of Stroke Caregivers : Evidence from a Qualitative Study in Sarawak, Malaysia

Background: Stroke survivors experience long-term physical, psychosocial and cognitive impairment that are formidable challenges to caregivers because caring for stroke survivors needs explicit knowledge and caregivers have to endure the stressfulness as a result of caring. In addition, little is known about perceived benefits of the stroke care giving experience. Objectives: This study was aimed to determine the caregivers’ burden and challenges as reported by caregivers of stroke survivors. Materials and Methods: This was a cross-sectional study involving 18 stroke caregivers. The data were collected from November 2015 to June 2016 at a conveniently selected community rehabilitation centre in Kuching, Sarawak. Results: The qualitative data analysis revealed that the burden was aggravated by financial problems, multiple responsibilities hold by the caregivers, behavioural changes of the stroke survivors and lack of social support during care giving. Conclusion: This study highlighted the experiences by the caregivers in caring for the stroke survivors that focused on the different needs of the caregivers. Understanding these experiences may help the service providers to provide better support and resources for caregivers in caring for stroke survivors