Dengue virus (DENV) infection is a major public health concern, posing huge economic and disease burdens globally. In Malaysia, the incidence of DENV infections has increased significantly over the years. Nevertheless, the passive surveillance mechanism applied may not capture the actual magnitude of DENV infection. There was also a paucity of community-based studies exploring DENV seroprevalence. This study aimed to determine the DENV seroprevalence and the associated factors among the urban population in Petaling district, Malaysia. A population-based cross-sectional study was conducted from 18 August to 26 October 2018 with 533 participants recruited. Blood samples were collected and analysed for DENV seropositivity using a composite reference standard comprised of three dengue serological tests. Associated factors were identified by fitting Generalised Linear Mixed Models with binomial error structure and logit link function. DENV seroprevalence obtained was 79.0% (95% CI: 75.2–82.4%). The age-specific DENV seroprevalence showed an increasing trend with advancing age, from 22.7% (95% CI: 9.6–45.0%) for those aged below five years old to 94.9% (95% CI: 81.3–98.7%) for those aged ≥60 years old. Only age group and house level were found to be significant factors associated with DENV seropositivity. The odds of being DENV seropositive generally increased with age, from 13.43 (95% CI: 2.77–65.22) for the 5–9 years old age group to 384.77 (95% CI: 39.27–3769.97) for the ≥60 years old age group, as compared to those aged below 5 years old. For house level, those who lived on the first and second floor (OR: 8.98, 95% CI: 3.16–25.12) and the third floor and above (OR: 4.82, 95% CI: 1.89–12.32) had greater odds of being DENV seropositive compared to those living on the ground floor. This study demonstrated the persistently high DENV seroprevalence among the urban population in Petaling district, which could be useful to evaluate dengue control measures taken and estimate more accurate disease incidence. The associated factors with DENV seropositivity identified could also contribute to undertaking more targeted preventive and control measures.

Cluster Hospital Initiative (CHI) in Malaysia is a hospital merger exercise to establish an integrated network of specialist and non-specialist hospitals. The resource sharing, services realignment, and better care coordination from this integration have been shown to improve operational efficiency and quality of care from the providers’ perspective. However, there are very limited studies which focus on the effects of hospital merger on patients. Therefore, this study aims to explore patients’ and caregivers’ experiences of CHI. A qualitative study using purposive sampling was conducted from July to August 2017 at the three pilot sites. Semi-structured in-depth interviews were conducted with 85 patients and caregivers who received healthcare services before and after CHI. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic text analysis. Three main themes transpired from the analysis were changes in healthcare service delivery, time spent on healthcare-related activities, and financial implications. Firstly, participants were generally satisfied with the increased access to specialist services, better quality of care, and upgraded equipment and facilities. Secondly, many participants experienced a shorter waiting time and reduced travelling time after CHI. Thirdly, CHI led to financial savings for the participants in terms of reduced out-of-pocket expenditure and productivity loss. This study demonstrated that the implementation of CHI appeared to be well-received by the patients. The expected benefits brought on by hospital mergers were also acknowledged by the study participants. A follow-up study is recommended due to the short duration of CHI implementation and low awareness about the initiative among patients.

This single-center study aimed to explore the factors associated with coronavirus disease (COVID-19) transmission in a hospital. All laboratory-confirmed COVID-19 cases among health care workers (HCWs) in a tertiary hospital in Malaysia were analyzed cross-sectionally from January 25, 2020, to September 10, 2021. A total of 897 HCWs in the hospital had laboratory-confirmed COVID-19 infection during the study period. Around 37.4% of HCWs were suspected to acquire COVID-19 infection from the hospital workplace. Factors associated with lower odds of workplace COVID-19 transmission were being females, ≥30 years old, fully vaccinated, and working as clinical support staff. Involvement in COVID-19 patient care was significantly associated with higher odds (adjusted odds ratio = 3.53, 95% confidence interval: [2.42, 5.12]) of workplace COVID-19 transmission as compared with non-workplace transmission. Most HCWs in the tertiary hospital acquired COVID-19 infection from non-workplace settings. During a pandemic, it is important to communicate with HCWs about the risk of both workplace and non-workplace COVID-19 transmission and to implement measures to reduce both workplace and non-workplace COVID-19 transmission.