Tin Tin Su

Abstract: OBJECTIVE: The objective of the study is to assess the socioeconomic status of the households affected by the tsunami of 2004 & to determine the factors associated with the recovery of household economic status. METHODS: The study was conducted in tsunami-affected areas in Malaysia in 2010-2011. A total of 193 households were included in the survey. Multivariate logistic regression was performed to determine the factors related to the recovery of households' economic status. FINDINGS: Among 193 households, 37% were in a better condition, 40% were unchanged and 22% had not recovered. It took 2.2years to get back to pre-disaster economic status. Factors leading to successful household economic recovery were "household resided in Sungai Petani", "belong to highest income quartile" and "age of household head". In contrast, "extended family type" and "unemployed household head" reduced the odds of recovery. Households which lost their fishing boats during the tsunami had less chance to recover their previous status. CONCLUSION: The findings of our study would be useful for policy consideration and planning of post disaster management in order to enhance the recovery of household economic status in the short period.

Abstract: OBJECTIVE: The objective of this study was to evaluate the effect of a call-recall approach in enhancing Pap smear practice by changes of motivation stage among non-compliant women. METHODS: A cluster randomized controlled trial with parallel and un-blinded design was conducted between January and November 2010 in 40 public secondary schools in Malaysia among 403 female teachers who never or infrequently attended for a Pap test. A cluster randomization was applied in assigning schools to both groups. An intervention group received an invitation and reminder (call-recall program) for a Pap test (20 schools with 201 participants), while the control group received usual care from the existing cervical screening program (20 schools with 202 participants). Multivariate logistic regression was performed to determine the effect of the intervention program on the action stage (Pap smear uptake) at 24weeks. RESULTS: In both groups, pre-contemplation stage was found as the highest proportion of changes in stages. At 24weeks, an intervention group showed two times more in the action stage than control group (adjusted odds ratio 2.44, 95% CI 1.29-4.62). CONCLUSION: The positive effect of a call-recall approach in motivating women to change the behavior of screening practice should be appreciated by policy makers and health care providers in developing countries as an intervention to enhance Pap smear uptake.

Abstract: The objective of the study is to identify the determinants of household direct and indirect costs in the Nouna District, Burkina Faso. The data used were from a household survey conducted during 2000-2001. The multinominal logit models were applied to investigate the determinants of direct and indirect costs. The respondents who were sick in the rainy season and severity of illness significantly increased the probability of having high direct and indirect household costs. Acute illness occured in an adult was positively associated with magnitude of household indirect costs. Household economic status and utilization of western medical care played an important role in magnitude of direct cost. The information on determinants of household direct and indirect costs is necessary in order to get a complete picture of household costs for seeking health care and identification of vulnerable social groups and households.

Abstract: The objective of the study is to investigate the success rate of quit attempts and identify factors associated with success or failure of quit attempts in a quit smoking clinic. A cohort study was conducted with 495 smokers who enrolled in a quit smoking clinic from 2005 to 2008. The factors leading to quit smoking successfully were "being Malay", "having high blood pressure" "type of Nicotine Replacement Therapy" and "duration of follow up". In contrast, clerical staff had negative association to quit smoking. People who started smoking in their teenage years had a high risk of relapse. Integration of active follow up and tailor-made support programmes for quitters appear necessary in order to maintain their non-smoking status and encourage them to be permanent quitters. Integration of quit smoking clinics and primary care clinics could be another potential step for the success of quit smoking programmes.

Abstract: Introduction: Return-to-work (RTW) can be a problematic occupational issue with detrimental impact on the quality of life of previously-employed breast cancer survivors. This study explored barriers and facilitators encountered during the RTW process in the area of cancer survivorship. Materials and Methods: Six focus groups were conducted using a semi-structured interview guide on 40 informants (employed multiethnic survivors). Survivors were stratified into three groups for successfully RTW, and another three groups of survivors who were unable to return to work. Each of the three groups was ethnically homogeneou

Abstract: Introduction: The Pap smear test has been regarded as a promising cervical screening tool since 1940s. Yet its importance has been overlooked by beneficiaries in Malaysia. This underlines the need to identify the prevalence of Pap smear practice and influencing factors towards the practice among educated working women. Methods: A survey was conducted with 403 female teachers from 40 public secondary schools in Malaysia selected by cluster random sampling. Data were collected from January to March 2010 using a self-administered questionnaire. Multivariate logistic regression was performed to identify the factors related to the Pap smear practice. Results: The rate for participants who ever had Pap test was only 38% and poor practice of was significantly higher among: those with aged less than 35 years; those practicing hormonal contraceptive method; and individuals perceiving barriers to the Pap smear screening test. In contrast, the findings were significantly lower in women with longer duration of teaching service; higher income groups; ever pregnant; having chronic diseases; health insurance coverage; and who had perceived benefit of Pap smear screening. Conclusion: Barriers towards practicing Pap smear exist even among educated career women. Tailor-made health promotion and education on cervical cancer and the benefit of Pap smear screening are essential to change the behavior of the study population.

Abstract: Although mindfulness meditation practice appears to confer positive effects on various clinical conditions, physiological responses to this practice in healthy individuals are largely unknown. This study is aimed at evaluating the physiological effects of short-term mindfulness meditation in university students intending to take a written term examination. Young healthy university students (n=18) recruited as participants were divided equally into a meditation group without examination stress, a non-meditating group with examination stress, and a meditation group with examination stress. The meditation intervention groups were offered mindfulness practice twice daily of 1 h each time for a period of 5 weekdays, except for weekends, for 3 consecutive weeks. The parameters measured included heart rate, blood pressure and serum cortisol. Depression Anxiety Stress Scales (DASS) were also obtained to monitor any negative psychological symptoms. All parameters were measured before intervention, just after intervention, which also coincided with the eve of the academic examination and at 3 weeks after. The DASS-Stress scale was significantly (p<0.05) reduced after intervention in the meditation group with no examination challenge. However, no significant changes were found in the cardiovascular and cortisol outcomes amongst all groups for all time lines. Even though these findings did not show any significant physiological responses to the short-term mindfulness practice in stressful conditions, nonetheless, the results demonstrate the potential benefits of this practice in alleviating stress in the neutral environment of university students. Future studies should address the effects of mindfulness practice in larger groups exposed in stressful situations.

Abstract: The use of tobacco by adolescents is a major public health concern worldwide. There are 1.2 billion smokers globally, of which more than 50% are young people. The Southeast Asian countries have about 600 million tobacco smokers within the global burden of tobacco users. Most smokers begin at early stage of life and persist through adulthood. Malaysia alone has about 5 million smokers, 20% of whom are younger than 18 years old. Many factors are implicated in the continuous rising trend of tobacco use among adolescents in Southeast Asia. A triad of family, environmental, and individual factors synergistically acts to motivate adolescents toward smoking. This article discusses the current trends of tobacco use and implications of increasing rise in adolescent smoking in the Southeast Asia region.

Abstract: Introduction: Cervical cancer has long been known as a preventable disease. Yet it still is a prime women's health issue globally. In Malaysia, the current cervical cancer screening program, introduced in the 1960s, has been found to be unsuccessful in terms of Pap smear coverage. The aim of this study is to determine providers perceptives on the program and the feasibility of practicing an organized cervical screening program in Malaysia. Methods: 11 key informant interviews were conducted with policy makers and health care providers from the Ministry of Health in Malaysia from October 2009 to May 2010. Interviewees' perceptions were explored on current and organized cervical screening program based on their expertise and experience. Results: The results highlighted that the existing cervical screening program in Malaysia faced flaws at all levels that failed to reduce cervical cancer morbidity and mortality. The identified weaknesses were poor acceptance by women, lack of commitment by health care providers, nature of the program, an improper follow-up system, limited resources and other competing needs. Complementarily, all interviewees perceived an organized cervical screening program as an alternative approach both feasible and acceptable by women and government to practice in Malaysia. Conclusion: Better screening coverage depends on an effective screening program that incorporates a behaviour-based strategy. A new program should be focused in the policy-making context to improve screening coverage and to effectively combat cervical cancer.

Abstract: To evaluate patients' satisfaction and loyalty to private hospitals and to identify factors influencing patient loyalty. A cross-sectional, population-based study was conducted between May and September of 2005. Sana'a, the capital city of the Republic of Yemen. Eight hundred and nineteen respondents who were admitted for at least 1 day in a private hospital within last 6 months from the date of interview. The scores on the modified SERVQUAL market research instrument including six domains (tangibility, reliability, responsiveness, assurance, empathy and cost) that identify perceptions of service quality. In addition, the respondents were asked whether or not they would return to the same facility when they need future medical care (loyalty). Loyalty was higher among females [odds ratio (OR) = 1.44; P < 0.05], among those reporting higher reliability scores (OR = 1.24; P < 0.01), higher assurance scores (OR = 1.2; P < 0.01) and higher empathy scores (OR = 1.13; P < 0.05) and also among those reporting higher cost (OR = 1.15; P < 0.05). No significant association was found between patient loyalty and, tangibility and responsiveness score. Improvements are required to achieve high-quality healthcare services in the private hospitals in Yemen and increase loyalty among patients. Findings from this study could inform private sector healthcare development in low- and middle-income countries.

Abstract: The objective of the study is to identify user's perception of key quality aspects of the hospital and its influence on willingness to pay. The study was conducted in 2001 in Dhading District Hospital, Nepal. This was a descriptive, cross-sectional study design using quantitative and qualitative methods: questionnaire exit interview and focus group discussions with inpatients and outpatients, focus group discussion with service providers, and key informant interviews. The research identified attitude, technical and interpersonal skills of health personnel, availability of drugs and services as important quality aspects to be improved. Users were motivated to use this hospital and were ready to pay if they received proper treatment from skilled and communicative staff. This study highlights the importance of identifying the quality factors important to service users as a first step in improving quality. For the users within this study, this meant improving attitude, interpersonal skills, and technical skills of service personnel.

Abstract: Indirect costs or productive labour time lost are the largest share of household economic burden of illness. However, the estimate of household indirect cost can vary depending on the valuation methods used. We therefore estimated household indirect cost in a subsistence farming society in Burkina Faso based on daily production value. These results were validated by using willingness-to-pay method and current wage rate. Among the three methods, the value of a day lost for adults assessed by willingness-to-pay method was considerably higher than other methods. There were no significant differences in indirect costs estimated by daily production value and wage rate. There were significantly higher indirect costs for households which were of higher economic status when daily production value was used. It might raise a question of equity. The willingness-to-pay method can capture the various aspects of indirect cost such as differences among age groups and gender, important individual characteristics and seasons. Thus, it is an appropriate approach for rural subsistence farmer communities. Estimation of indirect cost by wage rate can also be used as a rapid estimation of indirect cost in a rural area in developing countries as an alternative for daily production value.

Abstract: We try to identify determinants of illness reporting, provider choice and resulting expenditure with different econometric models using data from a representative household panel survey of 800 households in Nouna health district, Burkina Faso, during 2000�2001. The factors �being an adult�, �married�, �illness occurred in rainy season� and �severe illness� significantly increased the magnitude of health expenditure. Compared to malaria, individuals spent more on other infectious diseases, injury and the other disease category. In contrast, people were less likely to spend on chronic illness. An individual who belonged to a household headed by a female, a literate household head and with a higher household expenditure had a significantly positive association with the magnitude of expenditure. Findings from this study can be used for policy implication to improve health system performance in Burkina Faso through enhancing health care utilization.

Abstract: Objective To quantify the extent of catastrophic household health care expenditure and determine the factors responsible for it in Nouna District, Burkina Faso. Methods We used the Nouna Health District Household Survey to collect data on 800 households during 2000-01 for our analysis. The determinants of household catastrophic expenditure were identified by multivariate logistic regression method. Findings Even at very low levels of health care utilization and modest amount of health expenditure, 6-15% of total households in Nouna District incurred catastrophic health expenditure. The key determinants of catastrophic health expenditure were economic status, household health care utilization especially for modern medical care, illness episodes in an adult household member and presence of a member with chronic illness. Conclusion We conclude that the poorest members of the community incurred catastrophic health expenses. Setting only one threshold/cut-off value to determine catastrophic health expenses may result in inaccurate estimation leading to misinterpretation of important factors. Our findings have important policy implications and can be used to ensure better access to health services and a higher degree of financial protection for low-income groups against the economic impact of illness.