Ariffin, et al.: Antimalarial Drugs in MalaysiaThis work aims to identify the pattern of antimalarial use in Malaysia as a baseline data on common drugs used in the local setting. Data on malaria prevalence and drug use pattern over the past 10 years was collected retrospectively from Vector Borne Disease Sector and Pharmaceutical Services Division, Ministry of Health. The defined daily dose/inhabitant/years are used to describe the antimalarial utilization pattern. We observed a decline of 42% malaria cases within a span of 10 years despite a steady increase in the number of Plasmodium knowlesi cases noted in Malaysia. Infections caused by the P. falciparum and P. vivax species demonstrated a reduction in cases within the span of 10 years. Between 2005 and 2013 both chloroquine and primaquine were noted to be the most common antimalarial drugs used, followed by pyrimethamine-combination and quinine. Artemisinin in particularly artesunate and mefloquine use were found to be limited during the study period. Despite being one of the oldest drugs, the quinolines were found to be the most common antimalarials used. The use of primaquine is highlighted due to the gradual increase in the use of the drug in recent years. Indeed, the general decrease in antimalarial use is attributed to the distinct reduction in malaria cases in the country.
The global community has struggled with COVID-19 for a year. However, the ability to comply with strict preventive measures for many more months to come should be strictly monitored. The study aimed to assess COVID-19 preventive practices and knowledge among the Malaysian public after a year of the COVID-19 pandemic. This was a questionnaire-based study performed on adults in Malaysia, assessing both practices and knowledge of COVID-19 preventive measures. A total of 2558 respondents were included. The average practice score was 7.9±0.99 (maximum possible score=9). Overall, when leaving the house, the most common type of mask used were medical masks (n=1792, 70.1%). A majority admitted that they always wore masks (n=2284, 89.3%), approximately half (n=1325, 51.8%) only sometimes sanitized their hands, whilst 1456 (56.9%) always complied with the one-meter social distancing rule. The average mask knowledge score was 11.1±1.9 (maximum possible score=15). The average score for other preventive measures was 5.7±0.7 (maximum possible score=6). There was a significant positive association between practice and overall total knowledge of prevention measures (ρ=0.1, 95% CI=0.02-0.01, p=0.03), in which an increase in prevention practices was observed with an increase in overall knowledge score. This study demonstrates that even after a year of struggling with the new norms of COVID-19, there is still a need to continuously educate the public on COVID-19 preventive measures among Malaysians. In addition, further steps must be taken to improve the current practice of preventive measures, which includes targeting behavioral changes.
BackgroundRecurrence rates of Plasmodium vivax infections differ across various geographic regions. Interestingly, South-East Asia and the Asia-Pacific region are documented to exhibit the most frequent recurrence incidences. Identifying patients at a higher risk for recurrences gives valuable information in strengthening the efforts to control P. vivax infections. The aim of the study was to develop a tool to identify P. vivax- infected patients that are at a higher risk of recurrence in Malaysia.MethodsPatient data was obtained retrospectively through the Ministry of Health, Malaysia, from 2011 to 2016. Patients with incomplete data were excluded. A total of 2044 clinical P. vivax malaria cases treated with primaquine were included. Data collected were patient, disease, and treatment characteristics. Two-thirds of the cases (n = 1362) were used to develop a clinical risk score, while the remaining third (n = 682) was used for validation.ResultsUsing multivariate analysis, age (p = 0.03), gametocyte sexual count (p = 0.04), indigenous transmission (p = 0.04), type of treatment (p = 0.12), and incomplete primaquine treatment (p = 0.14) were found to be predictors of recurrence after controlling for other confounding factors; these predictors were then used in developing the final model. The beta-coefficient values were used to develop a clinical scoring tool to predict possible recurrence. The total scores ranged between 0 and 8. A higher score indicated a higher risk for recurrence (odds ratio [OR]: 1.971; 95% confidence interval [CI]: 1.562–2.487; p ≤ 0.001). The area under the receiver operating characteristic (ROC) curve of the developed (n = 1362) and validated model (n = 682) was of good accuracy (ROC: 0.728, 95% CI: 0.670–0.785, p value < 0.001, and ROC: 0.766, 95% CI: 0.700–0.833, p-value < 0.001, respectively). In both the developed and validated models, area under the ROC curves showed no significant difference in predicting recurrence based on the constructed scoring mechanism (p = 0.399; Z-value: −0.8441; standard error: 0.045).ConclusionsThe developed model to predict recurrence was found to be of good accuracy and could be a useful tool in targeting patients at a higher risk for recurrence for closer monitoring during follow-up, after treatment with primaquine.
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