Introduction: A scaled-up treatment cascade with direct-acting antiviral (DAA therapy is necessary to achieve global WHO targets for hepatitis C virus (HCV) elimination in Malaysia. Recently, limited access to sofosbuvir/daclatasvir (SOF/DAC) is available through compulsory licensing, with access to sofosbuvir/velpatasvir (SOF/VEL) expected through voluntary licensing due to recent agreements. SOF/VEL has superior clinical outcomes but has higher drug acquisition costs compared to SOF/DAC. A stratified treatment cascade might be the most cost-e cient approach for Malaysia whereby all HCV patients are treated with SOF/DAC except for patients with cirrhosis who are treated with SOF/VEL. Methods: This study aimed to conduct a 5-year budget impact analysis of the proposed stratified treatment cascade for HCV treatment in Malaysia. A disease progression model that was developed based on model-predicted HCV epidemiology data was used for the analysis, where all HCV patients in scenario A were treated with SOF/DAC for all disease stages while in scenario B, SOF/DAC was used only for non-cirrhotic patients and SOF/VEL was used for the cirrhotic patients. Healthcare costs associated with DAA therapy and disease stage monitoring were included to estimate the downstream cost implications. Results: The stratified treatment cascade with 109 in Scenario B was found to be cost-saving compared to Scenario A. The cumulative savings for the stratified treatment cascade was USD 1.4 million over 5 years. Discussion: A stratified treatment cascade with SOF/VEL was expected to be cost-saving and can result in a budget impact reduction in overall healthcare expenditure in Malaysia.

Background: Family Planning (FP) is one of the pillars of Safe Motherhood Program in reducing maternal mortality and morbidity. Despite positive evidence on the benefit of family planning, its utilisation among Malaysian population is still lower than expected. This study aimed to determine the prevalence of family planning utilisation and its associated factors among adults in Malaysia. Methods: An online survey was conducted involving 402 respondents of Malaysian adults. Convenience sampling was used in recruiting the respondents. Pretested questionnaire was distributed using online google form through various social media platform. Family planning utilisation was defined as the usage of any contraceptive methods (modern or traditional) within the past one year. The independent variables studied were sociodemographic characteristics, knowledge and attitude towards family planning, presence of spousal communication for family planning and accessibility to the service. Results: Prevalence of FP utilisation was 49.0% with higher percentages noted among female, Malay, age between 24-35 years, married, completed tertiary education, middle income group (M40) and having one to five children. Mean (SD) scores of knowledge (9.01 (2.271) and attitude (42.20 (4.948) towards FP were higher among respondents who utilised FP. The accessibility rate for FP services was 69.9%. Multiple logistic regression analysis showed that predictors for FP utilisation were, high scores of knowledge (P=0.001) and attitude (P=0.026) towards FP, age group of 25-34 (P=0.001) together with 35-50 years old (P=0.001) and having 1 to 5 children in the family (P=0.011). Conclusion: Family planning utilisation remains low despite easily accessible services. Increasing knowledge, instils positive attitude and targeting towards suitable population are among the crucial elements to be focused in any intervention plans by the relevant authorities

Introduction: Acne is a common skin disease with a high psychosocial burden, affecting mostly adolescents and youth worldwide. Management of acne is often challenged by cutaneous side effects that leads to therapeutic intolerance, poor compliance and impaired efficacy. Materials and Methods: This was a single-centre, evaluatorblinded, split-face, randomised study investigating the effects of thermal spring water (TSW) in improving efficacy and tolerability of standard acne therapy. Total of 31 participants with mild-to-moderate acne were recruited and subjected to TSW spray one side of the face 4 times daily for 6 weeks in addition to standard therapy. The other side received standard therapy only. Results: Six (19.4%) males and 25 (80.6%) female with mean age 25.1±6.13 participated, 15 (48.4%) had mild acne while 16 (51.6%) had moderate acne. Seven (22.6%) were on oral antibiotics, 25 (80.6%) used adapalene, 6 (19.4%) tretinoin and 21 (67.7%) benzoyl peroxide. Skin hydration improved and better on spring water treated side with mean difference12.41±30.31, p = 0.04 at the forehead, 39.52±65.14, p < 0.01 at the cheek and 42.172±71.71, p < 0.01 at the jaw at week 6. Participants also report significant reduction in dryness at the treated side at week 6, mean difference 0.93±0.10, p < 0.001. TEWL, sebum and pH were comparable on both sides with no significant differences. Tolerability towards standard therapy improved as early week 2 with reduction of stinging following application of topical therapy (mean difference 0.62±1.43, p = 0.03), increase in skin feeling good (-1.79±1.70, p < 0.001) and skin suppleness (0.62±1.43, p < 0.001). These improvements were significantly maintained till week 6. Cardiff acne disability index significantly improved at week 6 (p<0.001) despite no significant changes in Comprehensive Acne Severity Scale score before and after treatment.

Haze imposes a substantial disease burden on the human population especially in the Southeast Asia region due to the high frequency of haze episodes. The reduction of air quality levels by haze has resulted in a substantial disease burden and an increase in healthcare utilization (HU). This study aims to determine the association between haze and HU of haze-related respiratory illnesses with a focus given on the acute exacerbation of bronchial asthma (AEBA) and chronic obstructive pulmonary disease (AECOPD). A cross-sectional study was conducted through secondary data collection of haze/non-haze episodes as the study exposures and HU related to the exacerbation of bronchial asthma and COPD as the study outcomes. Data on haze/non-haze episodes and HU for four consecutive years (2012–2015) were retrieved from the Department of Environment and Ministry of Health Malaysia, respectively. In the four consecutive years, the percentage of haze episodes recorded in all stations was higher (67%) as compared to non-haze (33%) episodes. Means (SD) of patients diagnosed with AEBA and AECOPD were also significantly higher (p < 0.05) for inpatient 74 (62.1) and outpatient 320 (650.1) cases during haze episodes as compared to inpatient 34 (16.5) and outpatient 146 (170.5) cases during non-haze episodes. Findings from this study indicated that haze episodes incurred a significant healthcare burden due to an increase in HU. The evidence from this study will help the policymakers to prepare and allocate resources to control future implications of haze-related illnesses.

Period poverty is a global community health dilemma that has long been overlooked. This condition is described as having insufficient access to menstrual products, education, and sanitation facilities. Briefly, period poverty means that millions of women are subjected to injustice and inequity due to menstruation. This review aimed to explore the definition, challenges, and effects of period poverty on the community, especially among women at their productive ages. In addition, suggestions to minimize the impact of period poverty are discussed. A search strategy was applied using the keywords “period poverty,” “period equity,” “period poverty,” and “menstrual hygiene” in Google Scholar, ScienceDirect, SpringerLink, MEDLINE, and PubMed electronic databases, journals, and articles on relevant topics. Trained researchers conducted a keyword search from January 2021 to June 2022. Based on the reviewed studies, it has been proven that many countries are still affected by the period stigma and taboo, inadequate exposure to menstrual health and its management, lack of education about menstruation, and shortage of access to menstrual products and facilities. The next step is to reduce and slowly eliminate the period poverty issue by conducting more research to increase clinical evidence and future references. This narrative review could inform policymakers of the magnitude of the burden related to this issue and guide them to develop effective strategies to minimize the impact of poverty, especially during the challenging years of the post-coronavirus disease 2019 era.

The internet has become an important medium for learning and communication during the COVID-19 pandemic, particularly for university students. Nevertheless, an increase in internet usage could predispose people to internet addiction (IA) and internet gaming (IG). Equally, there is concern that anxiety levels have increased during the pandemic. The aim of this study is to determine the prevalence of IA and IG, and their associations with anxiety among medical students during the pandemic. Data were collected during the second wave of the “Conditional Movement Control Order” (CMCO) in Malaysia between 12 November and 10 December 2020. A total of 237 students participated through proportionate stratified random sampling in this cross-sectional study. They completed a set of online questionnaires which consisted of a sociodemographic profile, the Malay version of the internet addiction test (MVIAT), the Malay version of the internet gaming disorder short form (IGDS9-SF) and the Malay version of the depression, anxiety and stress scale (DASS-21). The prevalence of IA and internet gaming disorder (IGD) were 83.5% and 2.5%, respectively. A multiple logistic regression showed that those in pre-clinical years had a greater risk of anxiety than those in clinical years [(AOR) = 2.49, p-value 0.01, 95% CI = 1.22–5.07]. In contrast, those who scored high on IA were protected against anxiety [AOR = 0.100, p-value 0.03, 95% CI = 0.01–0.76)]. In conclusion, IA was highly prevalent during the COVID-19 pandemic and its high usage might serve as a protective factor against anxiety among the medical students in this study sample.

Introduction: Increasing prevalence of dementia and the associated caregiving burden are expected due to longer life expectancy. This review aimed to critically assess dementia-driven caregiving burden and the associated factors in Malaysia. Methods: A systematic search using several combinations of keywords was conducted in Ovid Medline, PubMed, Science Direct, ProQuest, and Ebscohost databases. The primary outcome was the score or level of caregiver burden, while the secondary outcome was the factors associated with such burden. The quality of the individual articles was assessed using the Newcastle–Ottawa Scale and the Joanna Briggs Institute checklist. Results: The systematic search resulted in seven studies being reviewed, consisting of six cross-sectional studies and one quasi-experimental study. Using the Zarit Burden Interview, two studies reported moderate caregiver burden with mean scores of 35.4 (15.08) and 46.0 (17.0). High levels of burden or strain were reported using the Caregiver Strain Index in other studies. The three main associated factors with burden identified in these studies were the presence of behavioural and psychological symptoms of dementia (BPSD), higher education level, and lack of social support. Conclusion: Moderate to severe caregiving burden level were found to be experienced by dementia caregivers in this country. High education, lack of support, as well as taking care of patient with BPSD being the most prominent factors associated with burden. Therefore, burden should be regularly assessed among the dementia caregivers especially among those with lack of social support and manage family members with BPSD, as to prevent adverse outcome from dementia caregiving.