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Health System Research in Perak 2006 – 2009

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Health System Research in Perak 2006 – 2009 㻾㼑㼟㼑㼍㼞㼏㼔㻌 㼀㼛㻌㼙㼍㼗㼑㻌㼍 Health System Research Difference Perak 2006 - 2009 Research To make a Health System Research Difference Perak 2006 - 2009 July 2013 Health System Research (HSR) in Perak 2006-2009 Using Research to Make a Difference © July 2013, Clinical Research Centre Perak, Level 4, Ambulatory Care Centre, Raja Permaisuri Bainun Hospital, Jalan Hospital, 30990 Ipoh, Perak, Malaysia. Editorial Committee Amar-Singh HSS Ooi Qing Xi Lionel Chia Dick Hua Lim Wei Yin Lina Hashim Arvinder Singh Harbaksh Singh Advisors Datin Dr Ranjit Kaur Praim Singh Deputy Director of Perak State Health Department (Public Health) Sondi Sararaks Head Health Outcomes Research Division, Institute for Health Systems Research (IHSR) Dr Asmah Zainal Abidin Head of Assistant Director of Public Health Division (Non-Communicable Disease Centre, NCDC) Perak State Health Department Disclaimer The views, interpretations, implications, conclusions, and recommendations expressed in this book are those of the authors of individual reports and do not necessarily represent the opinions, the views or policy of the Ministry of Health Malaysia. Acknowledgement The authors wish to thank the Director-General of Health Malaysia for giving permission to publish these reports. Contents Home Safety Practices for Prevention of Poisoning in 1 Young Children Effective Implementation of a Structured 41 Psychoeducation Programme Among Caregivers of Schizophrenia Patients in the Community Improving Asthma Care in Ministry of Health Primary 89 Care Clinics The Involvement of Lay Educators in Diabetic Control 123 of Type 2 Diabetic Patients Improving Knowledge of Type 2 Diabetes Mellitus 163 Patients on Oral Hypoglycaemic Agents Health Seeking Behaviour Towards Communicable 205 Diseases Among Foreign Workers in Industrial & Agriculture Sectors of Selected Districts in Perak, Malaysia Improving Blood Pressure Controls in Primary Care 249 Settings An Intervention Programme Among Overweight 281 Primary School Children Effectiveness of the Diabetic Foot Care Programme in 321 a Primary Care Setting Home Safety Practices for Prevention of Poisoning in Young Children Health Systems Research 2008/2009 Authors Shoba Pathmanathan Paediatric Department, Hospital Raja Permaisuri Bainun Ipoh, Perak Lina Hashim Clinical Research Centre Perak Affendi Yusuf Manjung District Health Office Vishanthri Kulasingam Greentown Health Clinic Hooi-Meng Puah Kinta District Health Office Amar-Singh HSS Clinical Research Centre Perak, Department of Paediatrics, Hospital Raja Permaisuri Bainun Ipoh, Perak Sondi Sararaks Institute for Health Systems Research Ranjit Kaur Praim Singh Perak State Health Department Asmah Zainal Abidin Perak State Health Department Clinical Research Centre (CRC) Perak recommends using the following statement to cite this report in our publication entitled “Health System Research (HSR) in Perak 2006-2009: Using Research to Make a Difference”: Shoba Pathmanathan, Lina Hashim, Affendi Yusuf, Vishanthri Kulasingam, Hooi-Meng Puah, Amar-Singh HSS, Sondi Sararaks, Ranjit Kaur Praim Singh, Asmah Zainal Abidin. ”Home Safety Practices for Prevention of Poisoning in Young Children” in Health System Research (HSR) in Perak 2006-2009: Using Research to Make a Difference. Clinical Research Centre (CRC) Perak, 2013, pp 1. (ISBN: 9789671063422) ISBN 1 9789671063422 Contents of Report page Abstract 3 1. 0 Introduction 5 1.1 Problem statement 1.2 Problem analysis 2.0 Objective 9 2.1 General objective 2.2 Specific objectives 3.0 Methodology 9 3.1 Overview of research design 3.2 Intervention package 3.3 Study type 3.4 Ethical considerations 3.5 Variables 3.6 Sampling 3.7 Techniques for data collection & pre-testing 3.8 Plan for Data Analysis and Interpretation (Include Dummy Tables) 4.0 Results 17 4.1 Results of Evaluation of Safety Device 4.2 Socio-demographic data 5.0 Discussion 24 5.1 Statement of principal findings 5.2 Strengths and weaknesses of the study 5.3 Strengths and weaknesses in relation to other studies 5.4 Meaning of the Study (Possible Mechanism and Implication for Clinicians/Policymakers) 5.5 Unanswered questions and future research 6.0 Conclusion & Recommendations 27 References 28 Appendices 31 2 Home Safety Practices for Prevention of Poisoning in Young Children ABSTRACT Home Safety Practices for Prevention of Poisoning in Young Children Shoba Pathmanathan¹, Lina Hashim², Affendi Yusuf³, Vishanthri Kulasingam4, Hooi-Meng Puah5, Amar-Singh HSS¹,², Sondi Sararaks6, Ranjit Kaur Praim Singh7, Asmah Zainal Abidin7 1 Paediatric Department, Hospital Raja Permaisuri Bainun Ipoh 2 Clinical Research Centre Perak 3 Manjung District Health Office 4 Greentown Health Clinic 5 Kinta District Health Office 6 Institute for Health Systems Research 7 Perak State Health Department Introduction and Objectives Poisoning in young children is defined as unintentional ingestion of medication(s) and common household products or chemicals. Poisoning in young children is a preventable cause of mortality and morbidity. Poisoning accounts for 2% of the accidental deaths in developed countries and for 5% in developing countries. Most poisoning accidents occur in children aged between 1 to 4 years old. The objective of the study was to evaluate and improve home poison safety practices to prevent poisoning in homes with children aged 1-4 years in the Kinta and the Manjung Districts. Methodology The study was a non-controlled community trial conducted at urban and semi-urban areas in Perak state to assess home safety practices and effectiveness of an intervention programme in home setting. Initial validation of a safety device involved 100 children and 100 adults (parents/caregivers accompanying the child) who attended Ministry of Health (MOH) health clinics and were recruited to test two home safety devices. In both urban and semi-urban areas, 300 households with children aged 1-4 years were randomly selected. They were audited at baseline. Two post-intervention audits were conducted at 3 and 6 months post-baseline audit using the same tools as in the first audit. The households were divided into two intervention arms. Caregivers in the first arm received Intervention Package 1 which consists of an immediate post-audit feedback, an educational pamphlet and a home safety device while caregivers in the second arm received Intervention Package 2 which consists of an immediate post-audit feedback and an educational pamphlet. Results At baseline, 60-71% of urban and semi-urban households in Perak had unsafe home safety practices to prevent poisoning in young children. Only 30 (20.4%) households in the Kinta District compared to 79 (52.7%) households in the Manjung District had good Home Safety Practices for Prevention of Poisoning in Young Children 3 knowledge. Good knowledge does not ensure a safe household. At the end of the study there was a statistically significant increase in the percentage of safe households in both districts with Kinta District doing better. Kinta District had an incarese from 48.6% (CI 40.4-56.8) to 93.9% (CI 89.7-98.0) while in the Manjung District, the increase was from 21.3% (CI 14.7-28.0) to 67.7% (CI 59.7-75.6). Conclusion The intervention package notably the Home Safety Practices Audit checklist, which was developed by the researchers for the study, significantly improved home poisoning safety practices. 75.7-85.3% of urban and semi-urban households in Perak had a safe home to prevent poisoning in children at the end of the study. Addition of the safety device to the home safety practices audit further improves home poisoning safety practices. Knowledge and perception does not ensure a safe household in prevention of poisoning in young children. Keywords poisoning in children, home poisoning safety practices, safe households, home safety practices audit checklist, safety device 4 Home Safety Practices for Prevention of Poisoning in Young Children 1.0 INTRODUCTION Poisoning in young children is defined as unintentional ingestion of medication and common household products (J. Nixon et al. 2004). Poisoning in young children is a preventable cause of mortality and morbidity (Laffoy M., 1997). Poisonings account for 2% of the accidental deaths in developed countries and for 5% in developing countries (Nadarajah P., 2004). Most poisoning accidents occur in children aged between 1 to 4 years (48.5% in the study by Sibel E. and Sukran S. (2006) and 60.3% according to FDA’s Poisoning Surveillance and Epidemiology Branch 1981. Around 80-85% poisoning accidents occur in the home (B. Jacobson et al. 1989). Children under the age of 5 are in a stage of development where they constantly explore their home environment. This is a normal characteristic and should not be restricted. Unfortunately they usually put whatever they see or reach in their mouth (A. W. Craft, 1990). Most of the poisoning accidents (49.5%) stemmed from storing of drugs within the reach of children. Out of these accidents, 49.5% were due to drugs, 17.5% due to cleaning agents and 16.5% due to insecticides/pesticides (Sibel E. et al. 2006). In a study on home safety in the United States, although most families reported locked storage of medications, 77% had unlocked storage of medication documented during home observation (Kimberly E. et al. 2007). Medications involved in suspected poisoning were most frequently packed in containers without Child Resistant Containers (CRC) (63%) or transparent blisters (20%). However safe packaging cannot compensate for unsafe storage. Bathroom and kitchen cabinets and drawers are the safest place to store medication (H. M. Wiseman et al. 1987). The concept of CRC is widely supported by parents as an important mechanism for protecting children from toxic products. However the support for CRCs was often based on the notion that they were childproof rather than child resistant. As a result some parents were more likely to store products unsafely if they were in CRCs (L. Gibbs et al. 2005). CRC is defined by the Poison prevention Packaging Act to be packaging that is “difficult for children under age of 5 years to open” but “not difficult for normal adults to use properly”.
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