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Maznah Dahlui

University of Malaya, Malaysia, Social and Preventive Medicine, Faculty Member

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Dr. Maznah Dahlui is a Public Health Specialist, an Associate Professor and the Head of Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya.She lectures on health economics, supervises and conducts economic evaluation projectsand is the Head for the Post-graduate Unit of the department.Her experiences working in the Ministry of Health, Malaysia provides good linkages withthe ministry resulting in consultancy works on evaluating and monitoring the NationalStrategic Planning of HIV/AIDs and as UNAIDs consultant for the National AIDs Spending Assessment in Malaysia. She is in the research team for the Study of Disease and InjuryBurden, Cost-effectiveness of vaccination for the pilgrimage and the study on the Return of Investment of NSEP, Malaysia. Her works with the Ministry of Health was acknowledgedby World Health Organization who conferred her to do the study to evaluate the practice of female circumcision in Malaysia.Dr. Maznah has great interest on breast cancer and has been involved in several studieson breast cancer especially on the economic evaluation of the various screening andtreatment of breast cancer, and the relationships between lifestyles and the quality of life inbreast cancer patients. She had conducted several intervention studies to enhance theknowledge and uptake of breast cancer, joint venture with NGOs and recently had beenappointed to lead the Quality of Life and Costing components in the Malaysian BreastCancer Cohort study which is one of the many collaborative efforts by the Centre of Population Health, University of Malaya. Internationally, Dr. Maznah is collaborating withUni. of Leeds, United Kingdom, Uni. of Singapore and Uni. Al Aen, UAE looking intofactors causing delay in diagnosis and treatment for Breast Cancer.
Address: Faculty of Medicine
University of Malaya
Kuala Lumpur

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Papers by Maznah Dahlui

Assessing the Performance of Non-specialised Private Hospitals in Malaysia Using the Pabón‐lasso Model

Research Square (Research Square), Nov 13, 2023

Attendance management system (AMS): Comparison of two different approaches

Two different approaches of implementing Fast track analysis for attendance management system has... more Two different approaches of implementing Fast track analysis for attendance management system has been designed and analyzed. The first design is applying data access through card reader and the data is being saved in the memory card. All the data which are representing Student ID are processed by attendance management system for monitoring the attendance student performance. This is done via off-line approach. While the second approach is applying same data access through RFID via a control unit for validating the Student ID. Once the ID is recognized, the control unit will send the ID through Bluetooth to Smart-Phone. An App such as MagnetCode is installed to receive the student ID and save it in Excel format. The two approaches have pro and con in-term of costing and processing speed. However after thorough comparison study have been conducted the 2nd approach has more advantages compared to 1st approach. Therefore the main aim to verily which of the two approaches would be more practical for the lecturer to use in the class is finally revealed and summarized.

From Evidence to Policy: Economic Evaluations of Healthcare in Malaysia: A Systematic Review

Value in health regional issues, May 1, 2020

Hepatitis C elimination by 2030 in Malaysia: an achievable goal?

Journal of virus eradication, Oct 1, 2019

Attendance Management System (AMS) with fast track analysis

Fast track analysis for Attendance Management System (AMS) is designed to facilitate the lecturer... more Fast track analysis for Attendance Management System (AMS) is designed to facilitate the lecturer in monitoring student attendance during lecture session. Monitoring attendance is crucial especially for large group of students. Lecturers have difficulties to verify student's attendance during class and would take up some time. Error in key in the attendance into the system is also likely when transferring the attendance into the main system, with no way to trace the mistakes once the class is over. Late comers would be overlooked due to recording on the time they join the classes. Hence, a new system was innovated applying simple mechanism which consists of RFID data logger and data analysis using ASP.net. The system is portable and quick to verify attendances within 5 minutes regardless, of the size of the class.

Effectiveness of Mass and Small Media Campaigns to Improve Cancer Awareness and Screening Rates in Asia: A Systematic Review

Journal of Global Oncology, Dec 1, 2019

PURPOSE The main objective of this systematic review was to identify whether mass and small media... more PURPOSE The main objective of this systematic review was to identify whether mass and small media interventions improve knowledge and attitudes about cancer, cancer screening rates, and early detection of cancer in Asia. METHODS The review was conducted according to a predefined protocol. Medline, EMBASE, CINAHL, Web of Science, Cochrane Library, and Google Scholar were searched in September 2017, and data extraction and rating of methodologic study quality (according to Joanna Briggs Institute rating procedures) were performed independently by reviewers. RESULTS Twenty-two studies (reported across 24 papers) met the inclusion criteria. Most studies (n = 21) were conducted in high or upper-middle income countries; targeted breast (n = 11), cervical (n = 7), colorectal (n = 3), or oral (n = 2) cancer; and used small media either alone (n = 15) or in combination with mass media and other components (n = 5). Studies regarding cancer screening uptake were of medium to high quality and mainly reported positive outcomes for cervical cancer and mixed results for breast and colorectal cancer. The methodologic strength of research that investigated change in cancer-related knowledge and the cost effectiveness of interventions, respectively, were weak and inconclusive. CONCLUSION Evidence indicated that small media campaigns seemed to be effective in terms of increasing screening uptake in Asia, in particular cervical cancer screening. Because of the limited number of studies in Asia, it was not possible to be certain about the effectiveness of mass media in improving screening uptake and the effectiveness of campaigns in improving cancer-related knowledge.

Budget impact analysis of two treatment approaches for hepatitis C in Malaysia through the use of voluntary and compulsory licensing options

Frontiers in Public Health, Feb 22, 2023

Results: The stratified treatment cascade with in Scenario B was found to be cost-saving compared... more Results: The stratified treatment cascade with in Scenario B was found to be cost-saving compared to Scenario A. The cumulative savings for the stratified treatment cascade was USD. million over 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.

Is universal <i>HLA-B*15:02</i> screening a cost-effective option in an ethnically diverse population? A case study of Malaysia

British Journal of Dermatology, Sep 21, 2017

Strong association was documented between human leukocyte antigen (HLA)-B*15:02 and carbamazepine... more Strong association was documented between human leukocyte antigen (HLA)-B*15:02 and carbamazepine-induced severe cutaneous adverse reactions (SCARs) in Asians. Beyond Asia, the HLA testing is potentially valuable in many countries with increasingly diverse communities of Asian ancestry, to facilitate an early recognition of patient susceptibility to SCARs. To determine the cost-effectiveness of universal HLA-B*15:02 screening in preventing carbamazepine-induced Stevens-Johnson syndrome/ toxic epidermal necrolysis in an ethnically-diverse Malaysian population. A hybrid model of a decision tree and Markov model was developed to evaluate three strategies for treating newly-diagnosed epilepsy among adults - (i) carbamazepine initiation without HLA-B*15:02 screening (current practice); (ii) universal HLA-B*15:02 screening prior to carbamazepine initiation; and (iii) alternative treatment [sodium valproate (VPA)] prescribing without HLA-B*15:02 screening. From a societal perspective, base-case analysis and sensitivity analyses were performed over lifetime time horizon. Incremental cost-effectiveness ratios were calculated. In the base-case analysis, both universal HLA-B*15:02 screening and VPA prescribing were dominated by current practice. Compared to current practice, universal HLA-B*15:02 screening resulted in 0.0255 quality-adjusted life years (QALYs) loss at an additional cost of USD707, while VPA prescribing resulted in 0.2622 QALYs loss at an additional cost of USD4,127, due to estimated differences in antiepileptic treatment efficacy. This study suggests that universal HLA-B*15:02 screening is unlikely to be a cost-effective intervention in Malaysia compared to current practice. However, with the emergence of an ethnically-diverse population in many other countries, this may render HLA-B*15:02 screening a potentially viable intervention when an increasing proportion of the population is at risk and an equally effective yet safer antiepileptic drug is available. This article is protected by copyright. All rights reserved.

The association of urinary sodium excretion with dietary sodium intake among selected low-income urban households

Singapore Medical Journal, 2023

An Economic Evaluation of Everolimus As Second Line Treatment of Metastatic Renal Cell Carcinoma: A Malaysian Perspective

Journal of Global Oncology, Oct 1, 2018

The resulting incremental cost-effectiveness ratio was € 56,667 per QALY. ConClusions: These econ... more The resulting incremental cost-effectiveness ratio was € 56,667 per QALY. ConClusions: These economic analysis results demonstrate that although treatment with nivolumab is associated with higher costs of treatment, nivolumab provides significant survival benefits, improved quality-of-life, and a favorable toxicity profile versus everolimus. The ICER results above might be subject to change during negotiations with local authorities. This analysis aims to inform coverage and reimbursement decisions in Portugal.

Perspectives of healthcare providers on barriers to and unmet needs of stroke rehabilitation in Kelantan, Malaysia

Singapore Medical Journal, 2023

Exploration of Malaysian Stakeholders View on Barriers to and Facilitators of Colorectal Cancer Screening Among Older Population

Asia-Pacific Journal of Public Health, 2023

According to the Malaysian National Cancer Registry (MNCR), more than 70% of colorectal cancer (C... more According to the Malaysian National Cancer Registry (MNCR), more than 70% of colorectal cancer (CRC) cases in Malaysia are presented in the advanced stages of the disease, leading to poor survival rates while taxing the health care system. This study aims to explore the barriers to and facilitators of CRC screening uptake in the perspectives of the general population, health care providers, and policymakers. In-depth, semi-structured interviews were conducted with 25 purposively sampled respondents comprising general population above the age of 40, health care providers, and policymakers. Commonly reported barriers to CRC screening included psychological, poor knowledge and awareness, lack of physicians’ recommendation, and inadequate implementation of CRC-related campaigns at systemic level. Facilitating factors for CRC screening included family support and family history of CRC. A comprehensive understanding of barriers and facilitators is relevant for designing an effective intervention and policy to increase CRC screening rates in Malaysia.

Effectiveness of progressive muscle relaxation therapy as a worksite health promotion program in the automobile assembly line

Industrial Health, 2016

Change in public awareness of colorectal cancer symptoms following the Be Cancer Alert Campaign in the multi-ethnic population of Malaysia

BMC Cancer, Mar 25, 2020

Background: Colorectal cancer (CRC) cases are detected late in Malaysia similar to most Asian cou... more Background: Colorectal cancer (CRC) cases are detected late in Malaysia similar to most Asian countries. The Be Cancer Alert Campaign (BCAC) was a culturally adapted mass media campaign designed to improve CRC awareness and reduce late detection in Malaysia. The evaluation of the BCAC-CRC aimed to assess campaign reach, campaign impact and health service use. Methods: Participants aged ≥40 years (n = 730) from randomly selected households in Selangor State Malaysia, completed interview-based assessments. Campaign reach was assessed in terms of responses to an adapted questionnaire that was used in evaluations in other countries. The impact of the campaign was assessed in terms of awareness, confidence to detect symptoms and self-efficacy to discuss symptoms with a doctor as captured by the Cancer Awareness Measure (CAM). CAM was administered before-and-after campaign implementation and responses by BCAC recognisers (i.e. participants who recognised one or more of the BCAC television, radio or print advertisements when prompted) and non-recognisers (i.e. participants who did not recognise any of the BCAC advertisements) were compared analytically. Logistic regression analysed comparative differences in cancer awareness by socio-demographic characteristics and recognition of the BCAC materials. Results: Over 65% of participants (n = 484) recognised the BCAC-CRC. Campaign-recognisers were significantly more likely to be aware of each CRC symptom at follow-up and were more confident about noticing symptoms (46.9% vs 34.9%, p = 0.018) compared to non-recognisers. There was no difference between groups in terms of selfefficacy to see a doctor about symptoms. Improved symptoms awareness at follow-up was lower for Indians compared to Malays (adjusted odds ratio (OR) 0.53, 95% Confidence Interval (CI): 0.34, 0.83, p = 0.005). Health service use data did not indicate an increase in screening activity during or immediately after the campaign months.

Women's health beliefs and uptake of breast cancer screening in Malaysia

European Journal of Cancer Care, Aug 10, 2022

A Treatment of Metastatic Renal Cell Carcinoma: The Cost Effectiveness of Axitinib From a Malaysian Perspective

Journal of Global Oncology, Oct 1, 2018

Background: Axitinib has been suggested to be effective as a second line treatment of metastatic ... more Background: Axitinib has been suggested to be effective as a second line treatment of metastatic renal cell carcinoma. However, its adoption may be limited by its financial consequences. Therefore, a cost-utility analysis was conducted to estimate the economic value of axitinib as a second line treatment of metastatic renal cell carcinoma. Aim: This analysis will informed the decision makers on the potential use of axitinib in this population within the Ministry of Health facilities. Methods: A state transition model was developed using Microsoft Excel 2010 to simulate a hypothetical cohort of patient receiving axitinib or best supportive care over 5 years of time horizon. A monthly cycle was chosen without a half cycle correction. Three health states were included in the model as progression free, disease progression and dead. A 3% discount rate was applied as recommended in the Pharmacoeconomic Guidelines for Malaysia. Total costs were estimated using unit costs from local sources and published data. The clinical and utility parameters were derived from the published literatures. Results: The mean probabilistic incremental discounted cost and QALY for axitinib were RM 113,576.29 and 0.35413 respectively, yielded a probabilistic incremental cost-effectiveness ratio (ICER) of RM 320,719. Unavailability of the local price for axinitib may play a part in the higher estimation of ICER. Conclusion: Axitinib may not be considered as a cost-effective second line treatment of metastatic renal cell carcinoma as the ICER is beyond the value of 3 GDP per capita.

Breast and colorectal cancer awareness in Malaysians and barriers towards screening: A systematic review

medRxiv (Cold Spring Harbor Laboratory), Feb 23, 2022

Background: Breast cancer (BC) and colorectal cancer (CRC) are considered primary cancers that af... more Background: Breast cancer (BC) and colorectal cancer (CRC) are considered primary cancers that affect both male and females globally. In Malaysia, BC is the most commonly diagnosed cancer among women of all ethnic groups and CRC is the second most common cancer in males and the second most common cancer in females. This systematic review was carried out to assess cancer symptom awareness and barriers to undergoing cancer screening for BC and CRC. Methods: A pre-defined search was conducted between January 2008 and December 2018 using the following databases: MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus and Cochrane Library for relevant articles. The search was updated in June 2020. Reviewers independently performed the data extraction and quality assessment of the included study according to the Joanna Briggs Institute assessment tools. Result: 22 studies met the inclusion criteria (BC n=11; CRC n=11). Nine studies assessed symptom knowledge for BC and eight for CRC. Two studies described barriers towards cancer screening for BC and one for CRC. Four CRC studies assessed symptoms knowledge and cancer screening barriers. The most commonly reported BC symptoms were 'painless breast lump'(27.6%-90.8%), 'nipple discharge' (1.6%-74.5%) and 'pain in breast/ breast region' (11.5%-82.8%) meanwhile CRC symptoms were 'change in bowel habits (new-onset diarrhoea or constipation)' (28.4%-86.6%), 'bleeding and/or bleeding from the back passage' (11.5%-71.9%) and 'weight loss' (9.3%-83.4%). 'Financial issue' (10%-17.5%) was the most frequent blockade identified towards BC screening meanwhile 'fear of result' (27.6%-32.1%) for CRC screening by Malaysians. Overall the studies carried out in Malaysia, six studies on BC symptom knowledge and one study on BC screening barrier were scored as medium study quality while four studies on CRC symptom knowledge and three studies on CRC screening barriers were scored as medium study quality. Conclusion: Studies described varied and overall, limited, symptom awareness and barriers towards BC and CRC screening which likely contributes to the delayed presentation of cancers in Malaysia. There is a need for improving the awareness of BC and CRC symptoms as well as the importance of screening to encourage the early presentation of symptomatic cancer patients and down-staging of cancer.

Prevalence and Economic Impact of Rotavirus Hospitalizations Among Libyan Children: A Pre-Vaccine Impact Evaluation

Health care, Aug 10, 2016

Guest Editorial: Coronavirus (COVID-19) is Here to Stay!

Journal of Health and Translational Medicine, 2020

The beginning of this year, 2020, has been a very challenging one as all over the world, we were ... more The beginning of this year, 2020, has been a very challenging one as all over the world, we were caught right in the midst of the Coronavirus (COVID-19) pandemic. This pandemic is a serious global health threat, and its devastating effects are felt in all aspects of life. The World Health Organization (WHO) reported that as of 17th May 2020, we have 4,534,731 confirmed cases of COVID-19, and 307,537 deaths in total, throughout the world. In the WHO Western Pacific region, there were 167,546 confirmed cases, and 6,730 deaths while in the WHO Southeast Region, the COVID-19 accounted for a total of 136,314 confirmed cases, and 4,425 deaths (1). In Malaysia, the figure stood, thus far, at 6,872 confirmed cases, and 114 deaths while in Indonesia, there were 17,514 confirmed cases, and 1,148 deaths (2). Different countries are at different phases of this pandemic. While the curve may have flattened in some countries, there might still be spikes here and there. The COVID-19 pandemic has ...

Development of Early Marriage Attitude Scale: A Multi-Dimensional Scale for Measuring the Attitudes Toward Child Marriage

SAGE Open, 2021

Child marriage can cause lifetime disadvantage and deprivation for female adolescents; however, i... more Child marriage can cause lifetime disadvantage and deprivation for female adolescents; however, it is still widespread in developing countries. Evaluation of female adolescents’ attitudes toward child marriage is vital to design adequate prevention programs. The aim of the study was to develop a self-administered scale to measure female adolescents’ attitudes toward child marriage in Malaysia. The scale items were created and refined through four stages: item pool generation, expert review, translations, and pretesting. A pretest was conducted with 30 female adolescents in Kuala Lumpur, Malaysia, to check for understandability of the language, and responses were analyzed. The scale was tested for face and content validities during the expert review process. Forty items were obtained in seven constructs as follows: (a) intuitive decision making, (b) believing in fate, (c) parental economic hardship during adolescence, (d) spiritual belief, (e) social norms, (f) opinion about premarit...

Assessing the Performance of Non-specialised Private Hospitals in Malaysia Using the Pabón‐lasso Model

Research Square (Research Square), Nov 13, 2023

Attendance management system (AMS): Comparison of two different approaches

Two different approaches of implementing Fast track analysis for attendance management system has... more Two different approaches of implementing Fast track analysis for attendance management system has been designed and analyzed. The first design is applying data access through card reader and the data is being saved in the memory card. All the data which are representing Student ID are processed by attendance management system for monitoring the attendance student performance. This is done via off-line approach. While the second approach is applying same data access through RFID via a control unit for validating the Student ID. Once the ID is recognized, the control unit will send the ID through Bluetooth to Smart-Phone. An App such as MagnetCode is installed to receive the student ID and save it in Excel format. The two approaches have pro and con in-term of costing and processing speed. However after thorough comparison study have been conducted the 2nd approach has more advantages compared to 1st approach. Therefore the main aim to verily which of the two approaches would be more practical for the lecturer to use in the class is finally revealed and summarized.

From Evidence to Policy: Economic Evaluations of Healthcare in Malaysia: A Systematic Review

Value in health regional issues, May 1, 2020

Hepatitis C elimination by 2030 in Malaysia: an achievable goal?

Journal of virus eradication, Oct 1, 2019

Attendance Management System (AMS) with fast track analysis

Fast track analysis for Attendance Management System (AMS) is designed to facilitate the lecturer... more Fast track analysis for Attendance Management System (AMS) is designed to facilitate the lecturer in monitoring student attendance during lecture session. Monitoring attendance is crucial especially for large group of students. Lecturers have difficulties to verify student's attendance during class and would take up some time. Error in key in the attendance into the system is also likely when transferring the attendance into the main system, with no way to trace the mistakes once the class is over. Late comers would be overlooked due to recording on the time they join the classes. Hence, a new system was innovated applying simple mechanism which consists of RFID data logger and data analysis using ASP.net. The system is portable and quick to verify attendances within 5 minutes regardless, of the size of the class.

Effectiveness of Mass and Small Media Campaigns to Improve Cancer Awareness and Screening Rates in Asia: A Systematic Review

Journal of Global Oncology, Dec 1, 2019

PURPOSE The main objective of this systematic review was to identify whether mass and small media... more PURPOSE The main objective of this systematic review was to identify whether mass and small media interventions improve knowledge and attitudes about cancer, cancer screening rates, and early detection of cancer in Asia. METHODS The review was conducted according to a predefined protocol. Medline, EMBASE, CINAHL, Web of Science, Cochrane Library, and Google Scholar were searched in September 2017, and data extraction and rating of methodologic study quality (according to Joanna Briggs Institute rating procedures) were performed independently by reviewers. RESULTS Twenty-two studies (reported across 24 papers) met the inclusion criteria. Most studies (n = 21) were conducted in high or upper-middle income countries; targeted breast (n = 11), cervical (n = 7), colorectal (n = 3), or oral (n = 2) cancer; and used small media either alone (n = 15) or in combination with mass media and other components (n = 5). Studies regarding cancer screening uptake were of medium to high quality and mainly reported positive outcomes for cervical cancer and mixed results for breast and colorectal cancer. The methodologic strength of research that investigated change in cancer-related knowledge and the cost effectiveness of interventions, respectively, were weak and inconclusive. CONCLUSION Evidence indicated that small media campaigns seemed to be effective in terms of increasing screening uptake in Asia, in particular cervical cancer screening. Because of the limited number of studies in Asia, it was not possible to be certain about the effectiveness of mass media in improving screening uptake and the effectiveness of campaigns in improving cancer-related knowledge.

Budget impact analysis of two treatment approaches for hepatitis C in Malaysia through the use of voluntary and compulsory licensing options

Frontiers in Public Health, Feb 22, 2023

Results: The stratified treatment cascade with in Scenario B was found to be cost-saving compared... more Results: The stratified treatment cascade with in Scenario B was found to be cost-saving compared to Scenario A. The cumulative savings for the stratified treatment cascade was USD. million over 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.

Is universal <i>HLA-B*15:02</i> screening a cost-effective option in an ethnically diverse population? A case study of Malaysia

British Journal of Dermatology, Sep 21, 2017

Strong association was documented between human leukocyte antigen (HLA)-B*15:02 and carbamazepine... more Strong association was documented between human leukocyte antigen (HLA)-B*15:02 and carbamazepine-induced severe cutaneous adverse reactions (SCARs) in Asians. Beyond Asia, the HLA testing is potentially valuable in many countries with increasingly diverse communities of Asian ancestry, to facilitate an early recognition of patient susceptibility to SCARs. To determine the cost-effectiveness of universal HLA-B*15:02 screening in preventing carbamazepine-induced Stevens-Johnson syndrome/ toxic epidermal necrolysis in an ethnically-diverse Malaysian population. A hybrid model of a decision tree and Markov model was developed to evaluate three strategies for treating newly-diagnosed epilepsy among adults - (i) carbamazepine initiation without HLA-B*15:02 screening (current practice); (ii) universal HLA-B*15:02 screening prior to carbamazepine initiation; and (iii) alternative treatment [sodium valproate (VPA)] prescribing without HLA-B*15:02 screening. From a societal perspective, base-case analysis and sensitivity analyses were performed over lifetime time horizon. Incremental cost-effectiveness ratios were calculated. In the base-case analysis, both universal HLA-B*15:02 screening and VPA prescribing were dominated by current practice. Compared to current practice, universal HLA-B*15:02 screening resulted in 0.0255 quality-adjusted life years (QALYs) loss at an additional cost of USD707, while VPA prescribing resulted in 0.2622 QALYs loss at an additional cost of USD4,127, due to estimated differences in antiepileptic treatment efficacy. This study suggests that universal HLA-B*15:02 screening is unlikely to be a cost-effective intervention in Malaysia compared to current practice. However, with the emergence of an ethnically-diverse population in many other countries, this may render HLA-B*15:02 screening a potentially viable intervention when an increasing proportion of the population is at risk and an equally effective yet safer antiepileptic drug is available. This article is protected by copyright. All rights reserved.

The association of urinary sodium excretion with dietary sodium intake among selected low-income urban households

Singapore Medical Journal, 2023

An Economic Evaluation of Everolimus As Second Line Treatment of Metastatic Renal Cell Carcinoma: A Malaysian Perspective

Journal of Global Oncology, Oct 1, 2018

The resulting incremental cost-effectiveness ratio was € 56,667 per QALY. ConClusions: These econ... more The resulting incremental cost-effectiveness ratio was € 56,667 per QALY. ConClusions: These economic analysis results demonstrate that although treatment with nivolumab is associated with higher costs of treatment, nivolumab provides significant survival benefits, improved quality-of-life, and a favorable toxicity profile versus everolimus. The ICER results above might be subject to change during negotiations with local authorities. This analysis aims to inform coverage and reimbursement decisions in Portugal.

Perspectives of healthcare providers on barriers to and unmet needs of stroke rehabilitation in Kelantan, Malaysia

Singapore Medical Journal, 2023

Exploration of Malaysian Stakeholders View on Barriers to and Facilitators of Colorectal Cancer Screening Among Older Population

Asia-Pacific Journal of Public Health, 2023

According to the Malaysian National Cancer Registry (MNCR), more than 70% of colorectal cancer (C... more According to the Malaysian National Cancer Registry (MNCR), more than 70% of colorectal cancer (CRC) cases in Malaysia are presented in the advanced stages of the disease, leading to poor survival rates while taxing the health care system. This study aims to explore the barriers to and facilitators of CRC screening uptake in the perspectives of the general population, health care providers, and policymakers. In-depth, semi-structured interviews were conducted with 25 purposively sampled respondents comprising general population above the age of 40, health care providers, and policymakers. Commonly reported barriers to CRC screening included psychological, poor knowledge and awareness, lack of physicians’ recommendation, and inadequate implementation of CRC-related campaigns at systemic level. Facilitating factors for CRC screening included family support and family history of CRC. A comprehensive understanding of barriers and facilitators is relevant for designing an effective intervention and policy to increase CRC screening rates in Malaysia.

Effectiveness of progressive muscle relaxation therapy as a worksite health promotion program in the automobile assembly line

Industrial Health, 2016

Change in public awareness of colorectal cancer symptoms following the Be Cancer Alert Campaign in the multi-ethnic population of Malaysia

BMC Cancer, Mar 25, 2020

Background: Colorectal cancer (CRC) cases are detected late in Malaysia similar to most Asian cou... more Background: Colorectal cancer (CRC) cases are detected late in Malaysia similar to most Asian countries. The Be Cancer Alert Campaign (BCAC) was a culturally adapted mass media campaign designed to improve CRC awareness and reduce late detection in Malaysia. The evaluation of the BCAC-CRC aimed to assess campaign reach, campaign impact and health service use. Methods: Participants aged ≥40 years (n = 730) from randomly selected households in Selangor State Malaysia, completed interview-based assessments. Campaign reach was assessed in terms of responses to an adapted questionnaire that was used in evaluations in other countries. The impact of the campaign was assessed in terms of awareness, confidence to detect symptoms and self-efficacy to discuss symptoms with a doctor as captured by the Cancer Awareness Measure (CAM). CAM was administered before-and-after campaign implementation and responses by BCAC recognisers (i.e. participants who recognised one or more of the BCAC television, radio or print advertisements when prompted) and non-recognisers (i.e. participants who did not recognise any of the BCAC advertisements) were compared analytically. Logistic regression analysed comparative differences in cancer awareness by socio-demographic characteristics and recognition of the BCAC materials. Results: Over 65% of participants (n = 484) recognised the BCAC-CRC. Campaign-recognisers were significantly more likely to be aware of each CRC symptom at follow-up and were more confident about noticing symptoms (46.9% vs 34.9%, p = 0.018) compared to non-recognisers. There was no difference between groups in terms of selfefficacy to see a doctor about symptoms. Improved symptoms awareness at follow-up was lower for Indians compared to Malays (adjusted odds ratio (OR) 0.53, 95% Confidence Interval (CI): 0.34, 0.83, p = 0.005). Health service use data did not indicate an increase in screening activity during or immediately after the campaign months.

Women's health beliefs and uptake of breast cancer screening in Malaysia

European Journal of Cancer Care, Aug 10, 2022

A Treatment of Metastatic Renal Cell Carcinoma: The Cost Effectiveness of Axitinib From a Malaysian Perspective

Journal of Global Oncology, Oct 1, 2018

Background: Axitinib has been suggested to be effective as a second line treatment of metastatic ... more Background: Axitinib has been suggested to be effective as a second line treatment of metastatic renal cell carcinoma. However, its adoption may be limited by its financial consequences. Therefore, a cost-utility analysis was conducted to estimate the economic value of axitinib as a second line treatment of metastatic renal cell carcinoma. Aim: This analysis will informed the decision makers on the potential use of axitinib in this population within the Ministry of Health facilities. Methods: A state transition model was developed using Microsoft Excel 2010 to simulate a hypothetical cohort of patient receiving axitinib or best supportive care over 5 years of time horizon. A monthly cycle was chosen without a half cycle correction. Three health states were included in the model as progression free, disease progression and dead. A 3% discount rate was applied as recommended in the Pharmacoeconomic Guidelines for Malaysia. Total costs were estimated using unit costs from local sources and published data. The clinical and utility parameters were derived from the published literatures. Results: The mean probabilistic incremental discounted cost and QALY for axitinib were RM 113,576.29 and 0.35413 respectively, yielded a probabilistic incremental cost-effectiveness ratio (ICER) of RM 320,719. Unavailability of the local price for axinitib may play a part in the higher estimation of ICER. Conclusion: Axitinib may not be considered as a cost-effective second line treatment of metastatic renal cell carcinoma as the ICER is beyond the value of 3 GDP per capita.

Breast and colorectal cancer awareness in Malaysians and barriers towards screening: A systematic review

medRxiv (Cold Spring Harbor Laboratory), Feb 23, 2022

Background: Breast cancer (BC) and colorectal cancer (CRC) are considered primary cancers that af... more Background: Breast cancer (BC) and colorectal cancer (CRC) are considered primary cancers that affect both male and females globally. In Malaysia, BC is the most commonly diagnosed cancer among women of all ethnic groups and CRC is the second most common cancer in males and the second most common cancer in females. This systematic review was carried out to assess cancer symptom awareness and barriers to undergoing cancer screening for BC and CRC. Methods: A pre-defined search was conducted between January 2008 and December 2018 using the following databases: MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus and Cochrane Library for relevant articles. The search was updated in June 2020. Reviewers independently performed the data extraction and quality assessment of the included study according to the Joanna Briggs Institute assessment tools. Result: 22 studies met the inclusion criteria (BC n=11; CRC n=11). Nine studies assessed symptom knowledge for BC and eight for CRC. Two studies described barriers towards cancer screening for BC and one for CRC. Four CRC studies assessed symptoms knowledge and cancer screening barriers. The most commonly reported BC symptoms were 'painless breast lump'(27.6%-90.8%), 'nipple discharge' (1.6%-74.5%) and 'pain in breast/ breast region' (11.5%-82.8%) meanwhile CRC symptoms were 'change in bowel habits (new-onset diarrhoea or constipation)' (28.4%-86.6%), 'bleeding and/or bleeding from the back passage' (11.5%-71.9%) and 'weight loss' (9.3%-83.4%). 'Financial issue' (10%-17.5%) was the most frequent blockade identified towards BC screening meanwhile 'fear of result' (27.6%-32.1%) for CRC screening by Malaysians. Overall the studies carried out in Malaysia, six studies on BC symptom knowledge and one study on BC screening barrier were scored as medium study quality while four studies on CRC symptom knowledge and three studies on CRC screening barriers were scored as medium study quality. Conclusion: Studies described varied and overall, limited, symptom awareness and barriers towards BC and CRC screening which likely contributes to the delayed presentation of cancers in Malaysia. There is a need for improving the awareness of BC and CRC symptoms as well as the importance of screening to encourage the early presentation of symptomatic cancer patients and down-staging of cancer.

Prevalence and Economic Impact of Rotavirus Hospitalizations Among Libyan Children: A Pre-Vaccine Impact Evaluation

Health care, Aug 10, 2016

Guest Editorial: Coronavirus (COVID-19) is Here to Stay!

Journal of Health and Translational Medicine, 2020

The beginning of this year, 2020, has been a very challenging one as all over the world, we were ... more The beginning of this year, 2020, has been a very challenging one as all over the world, we were caught right in the midst of the Coronavirus (COVID-19) pandemic. This pandemic is a serious global health threat, and its devastating effects are felt in all aspects of life. The World Health Organization (WHO) reported that as of 17th May 2020, we have 4,534,731 confirmed cases of COVID-19, and 307,537 deaths in total, throughout the world. In the WHO Western Pacific region, there were 167,546 confirmed cases, and 6,730 deaths while in the WHO Southeast Region, the COVID-19 accounted for a total of 136,314 confirmed cases, and 4,425 deaths (1). In Malaysia, the figure stood, thus far, at 6,872 confirmed cases, and 114 deaths while in Indonesia, there were 17,514 confirmed cases, and 1,148 deaths (2). Different countries are at different phases of this pandemic. While the curve may have flattened in some countries, there might still be spikes here and there. The COVID-19 pandemic has ...

Development of Early Marriage Attitude Scale: A Multi-Dimensional Scale for Measuring the Attitudes Toward Child Marriage

SAGE Open, 2021

Child marriage can cause lifetime disadvantage and deprivation for female adolescents; however, i... more Child marriage can cause lifetime disadvantage and deprivation for female adolescents; however, it is still widespread in developing countries. Evaluation of female adolescents’ attitudes toward child marriage is vital to design adequate prevention programs. The aim of the study was to develop a self-administered scale to measure female adolescents’ attitudes toward child marriage in Malaysia. The scale items were created and refined through four stages: item pool generation, expert review, translations, and pretesting. A pretest was conducted with 30 female adolescents in Kuala Lumpur, Malaysia, to check for understandability of the language, and responses were analyzed. The scale was tested for face and content validities during the expert review process. Forty items were obtained in seven constructs as follows: (a) intuitive decision making, (b) believing in fate, (c) parental economic hardship during adolescence, (d) spiritual belief, (e) social norms, (f) opinion about premarit...