COVID-19 clusters in Malaysia: characteristics, detection methods and modes of early transmission

Objective: Effective prevention and control measures are essential to contain outbreaks of infectious diseases, such as coronavirus disease (COVID-19). Understanding the characteristics of case clusters can contribute to determining which prevention and control measures are needed. This study describes the characteristics of COVID-19 case clusters in Malaysia, the method used to detect a cluster’s index case and the mode of early transmission, using the seven cluster categories applied in Malaysia. Methods: This cross-sectional study collected publicly available data on COVID-19 clusters occurring in Malaysia from 1 March 2020 to 31 May 2021. The characteristics of cases were described by category, and their associations with several outcomes were analysed. Descriptive analyses were performed to explore the method used to detect the index case and the mode of early transmission, according to cluster category. Results: A total of 2188 clusters were identified. The workplace cluster category had the largest proportion of clusters (51.5%, 1126/2188 clusters), while the custodial settings category had the largest median cluster size (178 cases per cluster) and longest median duration of cluster (51 days). The high-risk groups category had the highest mortality. There were significant differences in cluster size, duration and rate of detection across the categories. Targeted screening was most commonly used to detect index cases, especially in custodial settings, and in imported and workplace clusters. Household–social and social–workplace contacts were the most common modes of early transmission across most categories. Discussion: Targeted screening might effectively reduce the size and duration of COVID-19 clusters. Measures to prevent and control COVID-19 outbreaks should be continually adjusted based on ongoing assessments of the unique context of each cluster

Private Health Insurance in Malaysia: Who Is Left Behind?

Despite various efforts introduced, private health insurance coverage is still low in Malaysia. The objective of this article is to find the factors associated with not having a private health insurance in Malaysia. We analyze data involving 19 959 respondents from the 2015 National Health Morbidity Survey. In this article, we describe the prevalence of not having health insurance and conducted binary logistic regression to identify determinants of uninsured status. A total of 56.6% of the study population was uninsured. After adjusting for other variables, the likelihood of being uninsured was higher among those aged 50 years and above, females, Malay/other Bumiputra ethnicities, rural, government/semigovernment, self-employed, unpaid workers and retirees, unemployed, lower education level, without home ownership and single/widowed/divorced, daily smoker, underweight body mass index, and current drinker. The likelihood of being uninsured also increased with increasing household size while the inversed trend was seen for household income. A substantial proportion of population in Malaysia did not have private health insurance, and these subgroups have limited preferential choices for provider, facility, and care. </jats:p

Population Wellbeing Outcomes Framework

An review to provide an inventory on population wellbeing outcomes framework to guide policymakers in planning for the next Malaysia Pla

Task shifting in primary care to tackle healthcare worker shortages:An umbrella review

Background Task shifting is an approach to help address the shortage of healthcare workers through reallocating human resources but its impact on primary care is unclear. Objectives To provide an overview of reviews describing task shifts from physicians to allied healthcare workers in primary care and its impact on clinical outcomes. Methods Six electronic databases were searched up to 15 December 2020, to identify reviews describing task shifting in primary care. Two reviewers independently screened the references for relevant studies, extracted the data and assessed the methodological quality of included reviews using AMSTAR-2. Results Twenty-one reviews that described task shifting in primary care were included. Task shifted include provision of care for people with chronic conditions, medication prescribing, and health education. We found that task shifting could potentially improve several health outcomes such as blood pressure, HbA1c, and mental health while achieving cost savings. Key elements for successful implementation of task shifting include collaboration among all parties, a system for coordinated care, provider empowerment, patient preference, shared decision making, training and competency, supportive organisation system, clear process outcome, and financing. Conclusion Evidence suggests that allied healthcare workers such as pharmacists and nurses can potentially undertake substantially expanded roles to support physicians in primary care in response to the changing health service demand. Tasks include providing care to patients, independent prescribing, counselling and education, with comparable quality of care

Models for Integrative Medicine/Healthcare

Rapid review on the approaches for integrative medicin

Public-Private Partnerships for Cancer Care in Malaysia: A Rapid Review

This study aims to identify and describe public-private partnership (PPP) initiatives implemented across the cancer care continuum, spanning screening, diagnosis, treatment, survivorship, and palliative care in Malaysia. Specifically, the review will: - Characterise the governance and formalisation features of PPP initiatives, including how roles and responsibilities are distributed across public and private entities - Map the scope of services and care domains addressed by these partnerships; and - Document reported outputs or contributions to service access, continuity, or system reach A rapid review approach will be used. The focus is on publicly accessible sources, including (a) peer-reviewed databases (PubMed, EMBASE, CINAHL, PsycINFO, EconLit) and (b) grey literature (Google Scholar, Google Advanced Search, policy documents, organisational websites, and institutional news/social media). PPP is defined as an umbrella term for any formalised arrangement between public and private entities to deliver, finance, or support health services. These arrangements involve defined roles, shared responsibilities, and agreed deliverables, underpinned by legal, administrative, or policy instruments. While often involving resource- or risk-sharing, accountability, and mutual value creation, the defining feature is formalised collaboration that contributes directly to service provision or system support. The inclusion criteria for sources include being set in Malaysia, written in English or Malay language, and describing PPP initiative or arrangement according to the definition of PPP used in this study, operating along the cancer care continuum or supporting cancer-related health service delivery. Sources will be excluded if they describe initiatives without formal agreements, defined obligations, or structured roles, involve procurement-only arrangements or focus on non-service-oriented partnerships. The search terms will include key concepts such as public-private sector partnerships, cancer, and Malaysia. Screening will be performed by a single reviewer, with piloting and verification. A single reviewer will extract data from included records using a structured data extraction form, with verification by a second reviewer. Discrepancies or uncertainties will be discussed and resolved by consensus, or referred to a third reviewer at each stage if necessary. Data extraction will use a structured form (Excel/Google Sheets) covering PPP characteristics, governance arrangements, cancer care domain, and reported outcomes. Given potential limitations in available documentation, the review will prioritise descriptive analysis and map PPP initiatives against the WHO health system building blocks and the cancer care continuum. The review will provide (1) a structured mapping of PPP initiatives across the cancer care continuum in Malaysia, (2) descriptive profiles of public and private entities involved in PPPs, formalisation features, and service arrangements, (3) identification of service domains where PPPs are concentrated or underutilise, and (4) synthesised lessons and reflections to inform MOH policy planning, stewardship, and alignment of PPPs with national cancer care strategies

Pertussis clinical case definition: Time for change in developing countries?

BackgroundDeveloping countries still struggle with late detection and mortality from pertussis. A review of clinical case definitions is necessary for early disease detection. This paper aimed to study possible clinical characteristics for earlier pertussis detection in a sporadic setting.MethodsWe conducted a retrospective review of medical and laboratory records in a general paediatric ward of a district hospital in a developing country. Inclusion criteria were all children hospitalised with nasopharyngeal swab taken for Bordetella pertussis. We compared sensitivity and specificity of World Health Organization diagnostic criteria with other clinical characteristics. Polymerase chain reaction Bordetella pertussis was the gold standard used.ResultsOut of 207 eligible admissions, the study retrieved 128 complete records. Approximately half of the children were less than 3 months old. The World Health Organization diagnostic criteria had a low sensitivity (15%), but high specificity (92%). In comparison, combinations that included paroxysmal cough, ill contact and facial congestion had higher sensitivity. Increasing cough duration improved specificity while compromising sensitivity.ConclusionSeveral clinical characteristics such as paroxysmal cough, facial congestion and a history of ill contact have potential for early clinical detection. Conventional emphasis on cough duration may hamper early detection

Effect of supplementary private health insurance on inpatient utilisation: Evidence from Malaysia

Supplementary private health insurance (PHI) provides better access to healthcare, improves health outcomes, potentially lowers the costs for health systems and supports the social security system. Improperly regulated PHI, however, may aggravate inequity of access towards preferential care and encourage moral hazard among PHI purchasers, altering the health-seeking behaviour, which is often observed through the pattern of health care utilisation. We investigated the effect of PHI ownership on private inpatient care utilisation, its frequency of admission and length of stay by conducting secondary data analysis of the Malaysian National Health Morbidity Survey (NHMS) 2015 data, a nationally representative community health survey. Malaysian adults 18 years of age and above who utilised inpatient healthcare facilities were included. In this cross-sectional study, we addressed the endogeneity effect of health insurance by employing instrumental variable estimation and a two-stage residual inclusion analysis. We found a significant increase in private inpatient utilisation among those who owned PHI compared to those who did not (β = 4.39, p < 0.001). There was no significant difference in the frequency of admission and length of stay. The increase in private inpatient utilisation among PHI owners may reflect the demand for timely care and hospitality provided by the private sector, potentially exacerbating the moral hazard behaviour among PHI owners. Further exploration of this issue could impact future healthcare systems financing designs and PHI regulation