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Background Since the Coronavirus disease 2019 (COVID-19) pandemic began, the number of individuals recovering from COVID-19 infection have increased. Post-COVID Syndrome, or PCS, which is defined as signs and symptoms that develop during or after infection in line with COVID-19, continue beyond 12 weeks, and are not explained by an alternative diagnosis, has also gained attention. We systematically reviewed and determined the pooled prevalence estimate of PCS worldwide based on published literature. Methods Relevant articles from the Web of Science, Scopus, PubMed, Cochrane Library, and Ovid MEDLINE databases were screened using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic search process. The included studies were in English, published from January 2020 to April 2024, had overall PCS prevalence as one of the outcomes studied, involved a human population with confirmed COVID-19 diagnosis and undergone assessment at 12 weeks post-COVID infection or beyond. As the primary outcome measured, the pooled prevalence of PCS was estimated from a meta-analysis of the PCS prevalence data extracted from individual studies, which was conducted via the random-effects model. This study has been registered on PROSPERO (CRD42023435280). Results Forty eight studies met the eligibility criteria and were included in this review. 16 were accepted for meta-analysis to estimate the pooled prevalence for PCS worldwide, which was 41.79% (95% confidence interval [CI] 39.70–43.88%, I 2  = 51%, p  = 0.03). Based on different assessment or follow-up timepoints after acute COVID-19 infection, PCS prevalence estimated at ≥ 3rd, ≥ 6th, and ≥ 12th months timepoints were each 45.06% (95% CI: 41.25–48.87%), 41.30% (95% CI: 34.37–48.24%), and 41.32% (95% CI: 39.27–43.37%), respectively. Sex-stratified PCS prevalence was estimated at 47.23% (95% CI: 44.03–50.42%) in male and 52.77% (95% CI: 49.58–55.97%) in female. Based on continental regions, pooled PCS prevalence was estimated at 46.28% (95% CI: 39.53%-53.03%) in Europe, 46.29% (95% CI: 35.82%-56.77%) in America, 49.79% (95% CI: 30.05%-69.54%) in Asia, and 42.41% (95% CI: 0.00%-90.06%) in Australia. Conclusion The prevalence estimates in this meta-analysis could be used in further comprehensive studies on PCS, which might enable the development of better PCS management plans to reduce the effect of PCS on population health and the related economic burden.

This is cross-sectional research done to assess the readiness of the private Malaysian general practitioners (GPs) for the implementation of the national health financing scheme. The study focused on their levels of knowledge and attitudes towards the types of health financing scheme, gatekeeper roles in the health financing scheme, and their participation in the PeKa B40 scheme. Their acceptance and level of participation in the national health financing scheme (NHFS) were also assessed. A set of self-designed and pre-tested questionnaires focusing on the aforementioned objectives were mailed to the respondents. The selection of respondents was done by stratified random sampling of the GPs in all 14 Malaysian states at both urban and rural levels. Out of a calculated number of 362 GPs targeted, 296 responses were received which represented a response rate of 81.7%. The respondents had a mean age of 50.7 years 165 (55.75%) were males and 131 (44.3%) were females. The rural respondents totalled 158 (53.4%) as compared to those from urban 138 (46.6%) areas. The outcomes observed were that GPs with PeKa B40 provider status, positive attitude towards health financing schemes, gatekeeper roles, and PeKa B40, were strongly associated with their acceptance and level of participation in the NHFS. The GPs possessed a positive attitude and were generally ready to participate in the NHFS, but the lower scores in knowledge levels would require definite education and training plans to further enhance their readiness. More incentives should be given to GPs to enrol as PeKa B40 providers. The results of this study should be strongly considered by the government in the efforts to engage the Malaysian private GPs in the forthcoming NHFS. Most importantly, the role of GPs as gatekeepers needed to be implemented, and the PeKa B40 scheme be greatly improved.

Background Most family caregivers of stroke patients in Malaysia do not receive adequate prior preparation or training. This study aimed to determine levels of patient positioning knowledge and caregiving self-efficacy among caregivers of stroke patients. Methods This cross-sectional study was conducted at an urban teaching hospital involving 128 caregivers of stroke patients. The caregivers were conveniently sampled and completed the data collection forms, which comprised their socio-demographic data, patients' functional status, the Caregiving Knowledge For Stroke Questionnaire: Patient Positioning (CKQ-My© Patient Positioning) to measure caregiver's knowledge on patient positioning, and the Family Caregiver Activation Tool (FCAT©) to measure caregivers' self-efficacy in managing the patient. Descriptive and multivariate inferential statistics were used for data analysis. Results Among the caregivers sampled, 87.3% had poor knowledge of positioning (mean score 14.9 ± 4.32). The mean score for FCAT was 49.7 ± 6.0 from a scale of 10 to 60. There was no significant association between knowledge on positioning and self-efficacy. Multiple linear regression showed that caregivers' age (B = 0.146, p = 0.003) and caregiver training (B = 3.302, p = 0.007) were independently associated with caregivers' self-efficacy. Conclusion Caregivers' knowledge on the positioning of stroke patients was poor, despite a fairly good level of self-efficacy. Older caregivers and receiving caregiver training were independently associated with better caregiver self-efficacy. This supports the provision of caregiver training to improve caregiver self-efficacy.

Influenza is a contagious respiratory illness that can cause life-threatening complications among high-risk groups. Estimating the economic burden of influenza is essential to guide policy-making on influenza vaccination programmes, especially in resource-limited settings. This study aimed to estimate the economic burden of influenza on older adults (those aged [greater than or equal to]60 years) in Malaysia from the provider's perspective. The main data source in this study was the MY-DRG Casemix database of a teaching hospital in Malaysia. Cases with principal and secondary diagnoses coded in the International Classification of Diseases version 10 (ICD-10) as J09, J10.0, J10.1, J10.8, J11.0, J11.1, J11.8, J12.8, and J12.9, which represent influenza and its complications, were included in the study. The direct cost of influenza at all severity levels was calculated from the casemix data and guided by a clinical pathway developed by experts. The effect of the variations in costs and incidence rate of influenza for both the casemix and clinical pathway costing approaches was assessed with sensitivity analysis. A total of 1,599 inpatient and 407 outpatient influenza cases were identified from the MY-DRG Casemix database. Most hospitalised cases were aged <18 years (90.6%), while 77 cases (4.8%) involved older people. Mild, moderate, and severe cases comprised 56.5%, 35.1%, and 8.4% of cases, respectively. The estimated average annual direct costs for managing mild, moderate, and severe influenza were RM2,435 (USD579), RM6,504 (USD1,549), and RM13,282 (USD3,163), respectively. The estimated total annual economic burden of influenza on older adults in Malaysia was RM3.28 billion (USD782 million), which was equivalent to 10.7% of the Ministry of Health Malaysia budget for 2020. The sensitivity analysis indicated that the influenza incidence rate and cost of managing severe influenza were the most important factors influencing the total economic burden. Overall, our results demonstrated that influenza imposes a substantial economic burden on the older Malaysian population. The high cost of influenza suggested that further efforts are required to implement a preventive programme, such as immunisation for older people, to reduce the disease and economic burdens.

The economic burden of influenza is a significant issue within healthcare system, related to higher medical costs particularly among the elderly. Yet, influenza vaccination rates in the elderly in Malaysia were considerably low as it is not part of Malaysia’s national immunization program, with substantial mortality and morbidity consequences. Therefore, we conducted a cost-effectiveness analysis of quadrivalent influenza vaccine (QIV) for the elderly in Malaysia compared with the current no-vaccination policy. A static cost-utility model, with a lifetime horizon based on age, was used for the analysis to assess the cost-effectiveness and health outcomes associated with QIV. Univariate and probabilistic sensitivity analyses were performed to test the effects of variations in the parameters. The use of QIV in Malaysia’s elderly population would prevent 66,326 potential influenza cases and 888 potential deaths among the elderly, leading to 10,048 potential quality-adjusted life years (QALYs) gained. The QIV would also save over USD 4.4 million currently spent on influenza-related hospitalizations and reduce productivity losses by approximately USD 21.6 million. The ICER per QALY gained from a third-party payer’s perspective would be USD 2216, which is lower than the country’s gross domestic product per capita. A QIV-based vaccination program in the elderly was found to be highly cost-effective, therefore would reduce the financial burden of managing influenza and reduce pre-mature death related to this disease.

This paper describes a study to evaluate the readability scores of Malaysian newspaper articles meant to create awareness of diabetes among the public. In contrast to patient-specific sources of information, mass media may potentially reach healthy people, thus preventing them from becoming part of the diabetes statistics. Articles published within a selected corpus from the years 2013 to 2018 and related to awareness regarding diabetes were sampled, and their readability was scored using Flesch Kinkaid Reading Ease (FKRE). Features of three articles ranked as the best and worst for readability were qualitatively analyzed. The average readability for the materials is low at 49.6 FKRE, which may impede the uptake of information contained in the articles. Feature analysis of articles with the best and worst readability indicates that medical practitioners may not be the best spokesperson to reach the public. It also indicates that simple sentence structures could help improve readability. There is still much room for improvement in attaining good public health literacy through mass media communication. Public health and media practitioners should be vigilant of the language aspects of their writing when reaching out to the public.

Risk of readmissions is an important quality indicator for stroke care. Such information is limited among low- and middle-income countries. We assessed the trends for 28-day readmissions after a stroke in Malaysia from 2008 to 2015 and evaluated the causes and factors associated with readmissions in 2015. Using the national hospital admission records database, we included all stroke patients who were discharged alive between 2008 and 2015 for this secondary data analysis. The risk of readmissions was described in proportion and trends. Reasons were coded according to the International Classification of Diseases, 10th Edition. Multivariable logistic regression was performed to identify factors associated with readmissions. Among 151729 patients, 11 to 13% were readmitted within 28 days post-discharge from their stroke events each year. The trend was constant for ischemic stroke but decreasing for hemorrhagic stroke. The leading causes for readmissions were recurrent stroke (32.1%), pneumonia (13.0%) and sepsis (4.8%). The risk of 28-day readmission was higher among those with stroke of hemorrhagic (adjusted odds ratio (AOR): 1.52) and subarachnoid hemorrhage (AOR: 2.56) subtypes, and length of index admission >3 days (AOR: 1.48), but lower among younger age groups of 35-64 (AORs: 0.61-0.75), p values <0.001. The risk of 28-day readmission remained constant from 2008 to 2015, where one in eight stroke patients required readmission, mainly attributable to preventable causes. Age, ethnicity, stroke subtypes and duration of the index admission influenced the risk of readmission. Efforts should focus on minimizing potentially preventable admissions, especially among those at higher risk.

Background The elderly population in Malaysia are projected to reach almost one third of the total population by 2040. The absence of a National Dementia Strategy (NDS) in preparing the healthcare services for the ageing population is compounded by the lack of assessment of preparedness of future healthcare workers to manage complications related to ageing i.e., dementia. Studies in countries with NDS demonstrated lack of dementia knowledge among medical undergraduates. Hence, this study aimed to assess the knowledge on dementia among final year medical undergraduates in Malaysia and its associated factors, using the Dementia Knowledge Assessment Scale (DKAS). Methods This cross-sectional study, employed multistage sampling method to recruit final year medical undergraduates from eleven selected public and private medical institutions across Malaysia. Online self-administered measures were delivered to final year medical undergraduates through representatives of medical students’ society after approval from Deanery and institutional ethics board of participating universities. The measure collected demographic information, previous dementia exposure (i.e., formal or informal) and the 25-item Likert scale DKAS. Bivariate analysis and linear regression were conducted to confirm factors influencing dementia knowledge components. Results A total of 464 respondents from 7 universities participated in this study. Overall dementia knowledge among respondents with and without exposure, was low, with average score of 29.60 ± 6.97 and 28.22 ± 6.98, respectively. DKAS subscales analysis revealed respondents scored highest in care consideration subscale (9.49 ± 2.37) and lowest in communication and behaviour subscale (4.38 ± 2.39). However, only causes and characteristic subscale recorded significantly higher knowledge score among respondents with previous exposure (7.88 ± 2.58) ( p  =0.015). Higher knowledge of dementia was associated with previous formal dementia education ( p =0.037) and informal occupational/working experience in caring for dementia patients ( p  = 0.001). Informal occupational/working experience (B = 4.141, 95% CI 1.748–6.535, p  = 0.001) had greater effect than formal education (i.e. lectures/workshops) (B = 1.393, 95% CI 0.086–2.700, p  = 0.037) to influence respondents’ knowledge on dementia. Conclusion Dementia knowledge among final year medical undergraduates is low. To improve dementia knowledge, Malaysian medical curriculum should be reviewed to incorporate formal education and informal occupational/working experience, as early as in undergraduate training to help prepare future healthcare providers to recognise dementia among ageing Malaysians.

Data on post stroke outcomes in developing countries are scarce due to uncoordinated healthcare delivery systems. In Malaysia, the national stroke clinical practice guideline does not address transfer of care and longer term post stroke care beyond tertiary care. Hence, post stroke care delivery may be delivered at either tertiary or primary care facilities. This study aimed at describing patients’ characteristics and outcomes of post stroke care delivered by the primary care teams at public primary care healthcentres across Peninsular Malaysia. Multi staged sampling was done to select public primary care health centres to recruit post stroke patients. At each health centre, convenience sampling was done to recruit adult patients (≥18 years) who received post stroke care between July-December 2012. Baseline measurements were recorded at recruitment and retrospective medical record review was done simultaneously, for details on medical and / or rehabilitation treatment at health centre. Changes in the measurements for post stroke care were compared using paired t-tests and Wilcoxon Rank test where appropriate. Total of 151 patients were recruited from ten public primary care healthcentres. The mean age at stroke presentation was 55.8 ± 9.8 years. Median duration of follow up was 2.3 (IQR 5.1) years. Majority co-resided with a relative (80.8%), and a family member was primary caregiver (75.%). Eleven percent were current smokers. Almost 71.0% of patients achieved BP ≤ 140/90 mmHg. Only 68.9% of the patients had been referred for neurorehabilitation. Percentage of recorded data was highest for blood pressure (88.1%) while lowest was HbA1c (43.0%). For clinical outcomes, systolic and diastolic blood pressure, triglyceride level and calculated GFR (eGFR) showed statistically significant changes during follow up (p < 0.05). Post stroke care at public primary care healthcentres showed benefits in stroke risk factors control (i.e. hypertension and dyslipidaemia) but deterioration in renal function. A more structured coordination is needed to optimise post stroke care beyond acute phase management for patients who reside at home in the community.

Background Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking. Methods Expert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted. In Phase One, experts chartered current care processes in public healthcare facilities, from acute stroke till discharge and also patients who presented late with stroke symptoms to public primary care health centres. In Phase Two, modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices. Care algorithms were designed around existing work schedules at public health centres. Results Indication for patients eligible for monitoring by primary care at public health centres were identified. Gaps in transfer of care occurred either at post discharge from acute care or primary care patients diagnosed at or beyond subacute phase at health centres. Essential information required during transfer of care from tertiary care to primary care providers was identified. Care algorithms including appropriate tools were summarised to guide primary care teams to identify patients requiring further multidisciplinary interventions. Shared care approaches with Specialist Stroke care team were outlined. Components of the iCaPPS were developed simultaneously: (i) iCaPPS-Rehab© for rehabilitation of stroke patients at community level (ii) iCaPPS-Swallow© guided the primary care team to screen and manage stroke related swallowing problems. Conclusion Coordinated post stroke care monitoring service for patients at community level is achievable using the iCaPPS and its components as a guide. The iCaPPS may be used for post stroke care monitoring of patients in similar fragmented healthcare delivery systems or areas with limited access to specialist stroke care services. Trial registration No.: ACTRN12616001322426 (Registration Date: 21st September 2016).