Knowledge, attitudes, practices and health beliefs toward Leptospirosis among urban and rural communities in Northeastern Malaysia

Background: Leptospirosis is a zoonotic disease with a worldwide distribution, especially in developing countries such as Malaysia. This study was designed to explore the knowledge, attitudes, beliefs and practices (KABP) toward leptospirosis among the communities in northeastern Malaysia and to determine the sociodemographic factors associated with the KABP toward leptospirosis. A cross-sectional study using a stratified sampling method was conducted among 214 individuals in four locales in northeastern Malaysia. Methods: A cross-sectional study was conducted among 214 respondents in northeastern Malaysia using a multi-stage stratified random sampling method. The study population was divided into two groups based on geographical locations: urban and rural. All data were entered and analyzed using the IBM Statistics for Social Sciences (SPSS) version 22.0 software for Windows (IBM, Armonk, NY, USA). The continuous variables were presented using mean and standard deviation (SD), whereas the categorical variables were described using frequency and percentage. Multiple logistic regression was performed to determine the associated factors for good KABP toward leptospirosis among the respondents. Results: It was found that 52.8% of respondents had good knowledge, 84.6% had positive attitudes, 59.8% had positive beliefs, and 53.7% had satisfactory practices. There were no significant sociodemographic factors associated with knowledge and practice, except for educational status, which was significant in the attitude and belief domains. Those with higher education exhibited better attitudes (Odds Ratio (OR) 3.329; 95% Coefficient Interval (CI): 1.140, 9.723; p = 0.028) and beliefs (OR 3.748; 95% CI: 1.485, 9.459; p = 0.005). The communities in northeastern Malaysia generally have good knowledge and a high level of positive attitude; however, this attitude cannot be transformed into practice as the number of people with satisfactory practice habits is much lower compared to those with positive attitudes. As for the belief domain, the communities must have positive beliefs to perceive the threat of the disease. Conclusions: Our current health program on preventing leptospirosis is good in creating awareness and a positive attitude among the communities, but is not sufficient in promoting satisfactory practice habits. In conclusion, more attention needs to be paid to promoting satisfactory practice habits among the communities, as they already possess good knowledge and positive attitudes and beliefs

Households’ Health Expenditures on Acute Gastroenteritis in Malaysia

Acute gastroenteritis (AGE) causes significant health and economic burden on society. The aim of this study is to estimate households’ direct and indirect expenditures on AGE and its predicted factors. This cross-sectional study was conducted between December 2019 and March 2020 using a bilingual proforma distributed using Survey Monkey among individuals with self-reported AGE in all 14 states of Malaysia. The finding revealed the average expenditure for a single episode of AGE was RM395.58 (± SD 798.02). The mean indirect expenditure was higher at RM259.14 (± SD 379.92) vs. direct expenditure of RM136.44 (± SD 596.47). The highest expenditure was seen among those who obtained inpatient care. The multiple linear regression analysis showed that household income (RM0.13; 95% CI: 0.01, 0.27; p=0.043) and type of healthcare facility (private vs government) (RM1842.05; 95% CI: 395.13, 3288.98; p=0.014) had significant association with households’ total health expenditure on AGE. Acute gastroenteritis incurred substantial cost on all affected households regardless of care-seeking modalities. Interestingly, the main economic burden of AGE was the indirect cost of productivity loss; interpreted in terms of days away from work. In conclusion, AGE instigated economic burden on both households and employers. The household income and type of facility were found to be significant factors associated with the households’ health expenditures due to AGE. This study recommends food safety awareness among the public and enforcement of safe food handling practices among food vendors and industries

Perceived severity and susceptibility towards leptospirosis infection in Malaysia

Background: Perceived severity and susceptibility refers to one's belief of the seriousness and the risk of contracting a specific disease. It is an essential study in public health as it assists in the understanding of the motivating factors towards disease prevention. This qualitative study aimed to explore perceived severity and susceptibility towards leptospirosis infection among respondents in two states of Malaysia. Methods: Focus group discussions using the phenomenology approach was conducted involving 72 respondents in Selangor and Kelantan. Data were examined using content analysis. Results: Respondents perceived leptospirosis infection as severe due to its poor disease prognosis and complications. However, some rated it less severe when compared with other chronic diseases such as cancer and AIDS. Their perceptions were influenced by their knowledge about the disease, media portrayal and frequency of health campaigns by the government. All respondents believed they were not susceptible to the disease. Conclusion: The low perceived susceptibility of leptospirosis infection is a matter of concern as it may contribute to respondents' lack of motivation towards preventing the disease. The study findings may provide the basis for health promotional activities designed to heighten public perceived threat towards leptospirosis infection and thereby improving preventive health behaviors for avoiding leptospirosis

Economic benefit of leptospirosis prevention in Kelantan, Malaysia: willingness-to-contribute approach

Leptospirosis is an endemic disease in Malaysia. Despite the increasing incidence rate, knowledge on the economic assessment of preventing leptospirosis is still limited. This paper introduces the willingness-to-contribute (WTC) method for estimating the economic benefit of preventing leptospirosis. A cross-sectional study using the WTC method was applied to measure how much time respondents in Kelantan were willing to contribute toward preventing leptospirosis. Study respondents were wet market traders aged 18 years old and above who were fluent in the Malay language. The average WTC value was multiplied by the population of Kelantan to derive the monetary value of preventing leptospirosis. Two hundred and fifty respondents participated in the study. The mean time contribution was 6.68 hours (SD9.01) per month. The average WTC corresponded to a monthly cost savings of US$4.94 per person. Approximately between US$106.7 million to US$315 million per annum can be saved through the prevention of leptospirosis in Kelantan. Preventing leptospirosis is beneficial to Kelantan and would bring major economic savings. The findings are intended to help policy makers in the planning and management of leptospirosis policies and interventions

Leptospirosis and its prevention: knowledge, attitude and practice of urban community in Selangor, Malaysia

Background: Leptospirosis is still endemic in Malaysia and has been prevalent in Selangor where cases have been underreported. Primarily, this was due to lack of awareness in the urban community in this region. This study determined the knowledge, attitude and preventive practice (KAP) of leptospirosis, and identified the significant predictors influencing KAP among urban community in Hulu Langat, Selangor. Methods: This cross-sectional study was conducted from 2015 to 2017 using validated questionnaire. Sampling methods included multistage cluster sampling, followed by simple random sampling to obtain 315 respondents. Descriptive analysis was performed to determine the KAP while χ 2 and the subsequent logistic regression analysis were carried out to identify associations and predictors between variables. Results: Respondents were mainly Malaysian Bumiputra with a mean (Standard Deviation (SD)) age of 32.5 (13.0) years. Of 315 respondents, 80.3% (n = 253) had poor knowledge, 87.0% (n = 274) had good attitude, and 81.3% (n =256) showed unacceptable practice towards leptospirosis and its prevention. Regression analysis identified age as the sole predictor influencing good knowledge (AOR 2.388; 95% CI = 1.298, 4.396; p = 0.005). Education level (AOR 2. 197; 95% CI = 1.109, 4.352; p = 0.024) was also noted as the significant predictor influencing the overall practice. Conclusions: The urban community in Selangor showed a positive attitude in waste management despite having little knowledge regarding the disease itself. The study also discovered inadequacy in preventive practice, hence marking the importance of the proper integration of knowledge and attitude into forming an acceptable practice to reduce transmission of Leptospira among urban population in Malaysia

Uptake and determinants of private health insurance enrollment in a country with heavily subsidised public healthcare: A cross-sectional survey in East Coast Malaysia.

Malaysia's subsidised public healthcare system is heavily reliant on government funding. Increasing the uptake of private health insurance (PHI) would alleviate the financial burden on public healthcare facilities caused by high patient loads. The study aimed to determine the uptake of PHI and its associated factors among the East Coast Malaysian populations. A cross-sectional online survey was conducted between February and June 2021. Proportionate stratified sampling was applied to select 1138 participants, and logistic regression was performed to determine the factors associated with PHI uptake. The proportion of the study samples that purchased PHI was 54.3%. Enrolment of private health insurance was associated with working in the public sector (aOR: 6.06, 95% CI: 2.65, 13.88) and private sector (aOR: 6.27, 95% CI: 2.65, 14.85), being self-employed (aOR: 9.23, 95% CI: (3.59, 23.70), being in the middle 40% household income percentile (aOR: 2.74, 95% CI: 1.95, 3.85) and top 20% household income percentile (aOR: 4.42, 95% CI: 2.87, 6.80), and living in urban areas (aOR: 1.31, 95% CI: 1.01, 1.70). Even in the presence of subsidised public healthcare, the high proportion of PHI uptake reflects a demand for private health insurance. The study suggests that PHI should be promoted among those who are employed or self-employed, the middle- and high-income groups, and urban residents. The findings may be beneficial for the government and insurance companies to improve strategies to enhance PHI uptake among these population

Logistic regression analysis of determinants of private health insurance uptake.

Logistic regression analysis of determinants of private health insurance uptake.</p

Escaping domestic violence: A qualitative study of women who left their abusive husbands

Objectives: This qualitative study aims to discover the factors that influenced the decisions of women who successfully escaped domestic violence by attaining a divorce. Methods: In-depth interviews were conducted with 17 women, ages 21-56 who were either divorced or currently in the process of getting divorced in Kelantan, Malaysia. Results: Several themes emerged, indicating the following five reasons for divorce: 1) reaching the point of ultimatum, 2) having adequate support pre- and post-divorce, 3) concern for children's welfare, 4) seeking financial independence, and 5) fear of harm. Conclusion: The identification of the driving factors for divorce may spark a change in our society's mindset to empower female divorcees and allow them to lead happy, abuse-free lives. Keywords: Divorce, Domestic violence, In-depth interview, Malaysi

Metasynthesis: Experiences of Women with Severe Maternal Morbidity and Their Perception of the Quality of Health Care.

To explore the experiences of women with severe maternal morbidity and their perception of the quality of health care.The exploration of factors associated with severe maternal morbidity has emerged as an alternative strategy in reducing maternal mortality. This approach is useful for the evaluation and improvement of maternal health services.Included a comprehensive search, appraisal of reports of qualitative studies, the classification of studies and the synthesis of findings.A literature search was conducted through nine databases for articles published between January 1980 and August 2013.The quality of included studies was assessed with a modified Critical Appraisal Skills Program tool. The synthesis applied a meta-ethnographic approach. It involved (1) identifying and comparing the findings; (2) creating a parsimonious thematic structure and (3) searching for disconfirming data.Nine studies published between 2005 and 2012, involving 292 women with severe maternal morbidity, were included. Three key themes were identified: 'provision of care', 'severe maternal morbidity' and 'health care seeking behavior'. Barriers to the access and utilization of heath care services were identified.The findings appear to suggest that mental and physical health outcomes of women who experienced severe maternal morbidity were poor. There is a need to identify the persistence and severity of these outcomes over a longer period of time. More realistic and less biased information may be obtained in community-based interviews. The impact of potential negative fetal outcomes would be a strong influencing factor for the women. These findings may help to increase awareness of the non-physical components of severe maternal morbidity and provide guidance for professionals regarding preventive measures

Barriers to unmet needs among mothers of children with disabilities in Kelantan, Malaysia: A qualitative study

Objectives: The present study aimed to determine the barriers that deter mothers of children with disabilities from attaining their unmet needs. Methods: In-depth interviews of 12 mothers of children with disabilities were conducted from November 2014 to January 2015 in Kelantan, Malaysia. The mothers were recruited by purposive sampling. Thematic analysis was used for identifying, analysing and reporting the data. Results: Barriers to the unmet needs among mothers of children with disabilities were found to stem from the mothers’ expectation and further propagated by lack of support, the role of healthcare professionals in providing care, inappropriate policies and shortage of resources required for survival and maintaining care. Conclusions: Identification of the barriers to the attainment of unmet needs among mothers of disabled children is crucial for resolving the issue of unmet needs. Deeper understanding of these barriers may facilitate positive actions toward addressing the needs of these mothers and to alleviate the stress on mothers of disabled children. A concerted effort to coordinate services across all disciplines is required to dismantle these barriers by improving the provision of health care delivery and evaluation of welfare policies and services