Papers by Norita binti Hussein
PLoS ONE, 2020
Introduction Pregnancy planning varies among women with diabetes. Observing that the literature e... more Introduction Pregnancy planning varies among women with diabetes. Observing that the literature examining the factors affecting diabetic women’s pregnancy intentions in multi-ethnic Asian populations is limited, we sought to explore these factors to give a better perspective on these women’s pregnancy planning. Methods This qualitative study used individual in-depth interviews to capture the views and experiences of non-pregnant diabetic women of reproductive age in four public health clinics in a southwestern state of peninsular Malaysia from May 2016 to February 2017. The participants were purposively sampled according to ethnicity and were interviewed using a semi-structured topic guide. Interviews were audio-recorded, and transcripts were analysed using thematic analysis. Results From the 33 interviews that were analysed, four important factors influencing participants’ decisions regarding pregnancy planning were identified. Participants’ perception of poor pregnancy outcomes du...
The Cochrane library, Oct 11, 2021
Preconception risk assessment for thalassaemia, sickle cell disease, cystic fibrosis and Tay-Sach... more Preconception risk assessment for thalassaemia, sickle cell disease, cystic fibrosis and Tay-Sachs disease.
Health science reports, May 1, 2023
PubMed, Jun 1, 2017
Background: Hyperlipidaemia is a significant risk factor for cardiovascular disease. However, adh... more Background: Hyperlipidaemia is a significant risk factor for cardiovascular disease. However, adherence to lipidlowering therapy is often unsatisfactory due to a combination of patient factors, therapy, socio-economic and health system-related factors. Aims: to identify the prevalence of adherence to lipidlowering therapy, the factors contributing to non-adherence and knowledge regarding hyperlipidaemia and its' treatment among Malaysian patients with hyperlipidemia. Methods: A quantitative study using a cross-sectional survey was carried out in an urban primary care clinic in August 2015. Patients on lipid-lowering therapy for ≥ 1 year aged ≥ 18 years were selected using simple random sampling. consenting patients answered a selfadministered questionnaire (in Malay/English) which included socio-demographic profile, hyperlipidaemia profile, adherence to lipid-lowering therapy (using the Morisky Medication Adherence scale-8; score ≥ 6 taken as adherent), reasons leading to non-adherence, knowledge regarding hyperlipidaemia and its' treatment, and use of non-allopathic medicine. Results: the response rate was 90.7%. the prevalence of adherence to lipid-lowering therapy was 82.4%. "the most common reasons for non-adherence was being worried about side effect of lipid-lowering agent (71.4%), followed by the need to take too many drugs in a day (61.4%) and negative influences by friends, relative and mass media (60%)". Factors associated with non-adherence include male gender, on longer duration of therapy, less frequency of follow-up, less number of follow-up clinics, taking medication at night/random timing and having lower knowledge scores. Conclusion: Overall the prevalence of adherence was high in patients with hyperlipidaemia. Interventions to boost adherence should target those who were identified as nonadherent.
Family Medicine and Community Health, Dec 1, 2017
Creutzfeldt-Jakob Disease (CJD) is a fatal neurodegenerative brain disease. The author describes ... more Creutzfeldt-Jakob Disease (CJD) is a fatal neurodegenerative brain disease. The author describes a case presented to primary care clinic whereby neuropsychiatric symptoms were the patient's initial presentation which later manifested with declining cognitive impairment, myoclonus and extrapyramidal symptoms. A typical abnormal magnetic resonance imaging (MRI) features were observed. The patient succumbed within six months of presentation.
Optimizing maternal health and improving reproductive outcomes are widely acknowledged as major c... more Optimizing maternal health and improving reproductive outcomes are widely acknowledged as major challenges in the health care system. Care during the antenatal period has been the focus of improving maternal health and reproductive outcomes. Yet, evidences have shown that antenatal care alone is not enough. Initiating care before conception or preconception care could be potentially effective to further improve maternal health and reproductive outcomes. viii Glossary For reasons of consistency within this thesis, some terms have been standardised throughout the text. Primary Care Provider Primary care provider refers to general practitioners (GPs), practice nurses, midwives and in some centres, health visitors, nurse specialists or physician assistants who deliver health care in primary care setting. Health Care Provider Health care provider refers to any providers of medical and health services. This includes providers from primary, secondary and tertiary care. Primary Care A clinical speciality of health care that emphasizes the point at which the patient first seeks assistance from the medical care system. Primary care is comprehensive which includes health promotion, illness prevention, treatment and care of the sick, community development and rehabilitation.
The Cochrane library, Aug 12, 2015
Preconception risk assessment for thalassaemia, sickle cell disease, cystic fibrosis and Tay-Sach... more Preconception risk assessment for thalassaemia, sickle cell disease, cystic fibrosis and Tay-Sachs disease.
Journal of Community Genetics
Asia Pacific Journal of Public Health
Asthma exacerbations are among the commonest reasons for hospitalizations in Malaysian pilgrims d... more Asthma exacerbations are among the commonest reasons for hospitalizations in Malaysian pilgrims during the Hajj. We interviewed 21 stakeholders involved in the pre-Hajj health examination at 14 primary care clinics, to explore their perceptions on barriers to and facilitators of asthma care for Hajj pilgrims. The disadvantages of the short time frame and centralized organization of the pre-Hajj health examinations were viewed as compromising clinicians’ level of competencies in asthma care, which could potentially be enhanced through more training, audit, and supervision by specialists. Longer time frame to permit sufficient disease control, provision of care by a dedicated asthma team, asthma registry to support continuous care, more resources of long-acting β-agonist/inhaled corticosteroid, and provision of influenza and pneumococcal vaccines at no cost were the perceived facilitators. Delivery of asthma education, especially the asthma action plan, should be tailored to the level...
Introduction Pulmonary rehabilitation (PR) could improve health outcomes for the increasing numbe... more Introduction Pulmonary rehabilitation (PR) could improve health outcomes for the increasing number of people with chronic respiratory diseases (CRDs), but programmes need to be adapted to low-resource settings and, in the context of a pandemic, to home-based delivery. Aim To assess the feasibility of delivering a home-PR programme for patients with CRDs in Malaysia. Methods We recruited patients with CRDs from two hospitals in Klang Valley, Malaysia to a Home-PR programme. Following Centre-based assessment, patients performed the exercises at home (five sessions/week for 8 weeks (total 40 sessions)). We monitored the patients via weekly telephone calls and asked about adherence to the programme. We measured functional exercise capacity (6-Minutes walking test (6MWT)) and Health-Related Quality-of-Life (HRQOL: COPD Assessment Test (CAT)) at baseline and post- PR at 9 weeks. We conducted semi-structured interviews with 12 purposively sampled participants to explore views and feedback ...
General practice and primary care, 2021
Asthma exacerbations are among the commonest reasons for hospitalisations in Malaysian pilgrims d... more Asthma exacerbations are among the commonest reasons for hospitalisations in Malaysian pilgrims during the Hajj. We interviewed twenty-one stakeholders involved in the pre-Hajj health examination at 14 primary care clinics, to explore their perceptions on barriers to and facilitators of asthma care for Hajj pilgrims. The disadvantages of the short timeframe and centralised organisation of the pre-Hajj health examinations were viewed as compromising clinicians' level of competencies in asthma care, which could potentially be enhanced through more training, audit and supervision by specialists. Longer time frame to permit sufficient disease control, provision of care by a dedicated asthma team, asthma registry to support continuous care, more resources of long-acting β-agonist/inhaled corticosteroid and provision of influenza and pneumococcal vaccines at no cost were the perceived facilitators. Delivery of asthma education especially the asthma action plan should be tailored to the level of the pilgrim's health literacy and facilitated by educational resources, family engagement and regular health briefing.
European Respiratory Journal, 2020
Journal of Community Genetics, 2020
Family history has long been recognised as a non-invasive and inexpensive tool to identify indivi... more Family history has long been recognised as a non-invasive and inexpensive tool to identify individuals at risk of genetic conditions. Even in the era of evolving genetic and genomic technology, the role of family history in predicting individual risk for genetic testing and guiding in preventive interventions is still relevant, especially in low-resource countries. The aim of this study was to explore primary care doctors' views and experiences in family history taking and how they utilised family history in day-today clinical consultations in Malaysia. Four focus group discussions and six in-depth interviews involving 25 primary care doctors were conducted. Three themes emerged from the analysis: (1) primary care doctors considered family history as an important part of clinical assessment, (2) proactive versus reactive approach in collecting family history and (3) family history collection was variable and challenging. Family history was documented in either free text or pedigree depending on the perception of its appropriateness during the consultation. This study highlighted the need to improve the approach, documentation and the implementation of family history in the Malaysian primary care settings. Integrating family filing concept with built-in clinical decision support into electronic medical records is a potential solution in ensuring effective family history taking in primary care.
Diabetes Research and Clinical Practice, 2012
Please cite this article in press as: Wong SSL, et al. Effectiveness of a colour coded HbA1c grap... more Please cite this article in press as: Wong SSL, et al. Effectiveness of a colour coded HbA1c graphical record in improving diabetes control in people with type 2 diabetes: A randomized control trial. Diab Res Clin Pract (2011),
South African Family Practice, 2009
Randomised controlled trials form the foundation for 'evidence-based-medicine', but the results o... more Randomised controlled trials form the foundation for 'evidence-based-medicine', but the results of such research can be relied upon only if it was conducted according to principles and standards collectively referred to as 'Good Clinical Practice' (GCP). The GCP was established as a basis both for the scientific and ethical integrity of research involving human subjects and for generating valid observations and sound documentation of research findings. It provides a framework for clinical investigators and pharmaceutical companies to conduct clinical trials according to similar rules and regulations, to ensure clinical research is consistently performed to high ethical and scientific standards and an assurance that the data and reported results are credible and accurate, and that the rights, integrity, and confidentiality of trial subjects are protected. Thus the GCP protects the rights, safety and well-being of subjects and ensures that investigations are scientifically sound and advance public health goals. This article has been peer reviewed.
BMC Primary Care
Background Primary healthcare workers (PHCWs) are at the frontline of dealing with viral pandemic... more Background Primary healthcare workers (PHCWs) are at the frontline of dealing with viral pandemics. They may experience significant psychological stresses, which have hitherto not been examined in depth. We aimed to explore the impact of the COVID-19 pandemic on the psychological health and wellbeing of frontline PHCWs in Malaysia. Method We purposively recruited PHCWs with diverse backgrounds in Klang Valley, Malaysia. Using longitudinal qualitative methods, we conducted two sequential semi-structured telephone interviews, 3 to 4 weeks apart, to capture different stages of the pandemic. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Result Twenty-one PHCWs participated yielding a total of forty-two interviews. Themes clustered around stressors associated with work, home, and leisure activities, emotional changes, and modifying factors. In the first interviews, COVID-19 had just started in Malaysia. Participants expressed fear about the actual and p...
npj Primary Care Respiratory Medicine
Asthma, a common chronic respiratory illness is mostly managed in primary care. We aimed to deter... more Asthma, a common chronic respiratory illness is mostly managed in primary care. We aimed to determine healthcare resources, organisational support, and doctors’ practice in managing asthma in a Malaysian primary care setting. A total of six public health clinics participated. We found four clinics had dedicated asthma services. There was only one clinic which had a tracing defaulter system. Long-term controller medications were available in all clinics, but not adequately provided. Resources, educational materials, and equipment for asthma management were present, though restricted in number and not placed in main locations of the clinic. To diagnose asthma, most doctors used clinical judgement and peak flow metre measurements with reversibility test. Although spirometry is recommended to diagnose asthma, it was less practiced, being inaccessible and unskilled in using as the main reasons. Most doctors reported providing asthma self-management; asthma action plan, but for only half ...
npj Primary Care Respiratory Medicine
Implementing asthma guideline recommendations is challenging in low- and middle-income countries.... more Implementing asthma guideline recommendations is challenging in low- and middle-income countries. We aimed to explore healthcare provider (HCP) perspectives on the provision of recommended care. Twenty-six HCPs from six public primary care clinics in a semi-urban district of Malaysia were purposively sampled based on roles and experience. Focus group discussions were guided by a semi-structured interview guide and analysed thematically. HCPs had access to guidelines and training but highlighted multiple infrastructure-related challenges to implementing recommended care. Diagnosis and review of asthma control were hampered by limited access to spirometry and limited asthma control test (ACT) use, respectively. Treatment decisions were limited by poor availability of inhaled combination therapy (ICS/LABA) and free spacer devices. Imposed Ministry of Health programmes involving other non-communicable diseases were prioritised over asthma. Ministerial policies need practical resources a...
npj Primary Care Respiratory Medicine
Supported self-management reduces asthma-related morbidity and mortality. This paper is on a feas... more Supported self-management reduces asthma-related morbidity and mortality. This paper is on a feasibility study, and observing the change in clinical and cost outcomes of pictorial action plan use is part of assessing feasibility as it will help us decide on outcome measures for a fully powered RCT. We conducted a pre–post feasibility study among adults with physician-diagnosed asthma on inhaled corticosteroids at a public primary-care clinic in Malaysia. We adapted an existing pictorial asthma action plan. The primary outcome was asthma control, assessed at 1, 3 and 6 months. Secondary outcomes included reliever use, controller medication adherence, asthma exacerbations, emergency visits, hospitalisations, days lost from work/daily activities and action plan use. We estimated potential cost savings on asthma-related care following plan use. About 84% (n = 59/70) completed the 6-months follow-up. The proportion achieving good asthma control increased from 18 (30.4%) at baseline to 38...
Asthma, a common chronic respiratory illness is mostly managed in primary care. We aimed to deter... more Asthma, a common chronic respiratory illness is mostly managed in primary care. We aimed to determine healthcare resources, organisational support, and doctors’ practice in managing asthma in public primary health clinics in Malaysia. A total of six clinics participated. Here, we found only four had dedicated asthma clinics. There was only one clinic which had a tracing defaulter system. Long-term controller medications were available in all clinics, however not adequately provided. Resources, educational materials, and equipment for asthma management were present, though restricted in number and not placed in important areas of the clinic. To diagnose asthma, most doctors used clinical judgement, peak flow meter measurements with reversibility test. Although spirometry is the recommended method to diagnose asthma, it was less practiced, being inaccessibility and unskilled in using as the main reasons. Most doctors reported providing asthma self-management; asthma action plan, but f...
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Papers by Norita binti Hussein