Introduction The epidemiology of hepatitis, which is apparently endemic in Asia, is still poorly documented in Malaysia. Available statistics are modelled estimates based on expert input or estimated from small studies on special populations. We therefore determined the prevalence of chronic hepatitis B and C in Malaysia based on a large sample data from a screening campaign. Methods A total of 10,914 subjects participated in the hepatitis screening campaign in 2018 and 2019. A low-cost Point-of-care test, which has previously been validated, was used to screen for HBsAg and anti-HCV. All screen positive subjects were recalled to undergo confirmatory serology tests and nucleic acid tests. Results We estimated 1.17% or 238,971 Malaysian adults aged 20 or older had chronic HBV, while only 0.74% or 151,144 adults had chronic HCV. Young adults below age 30 years had very low prevalence of HBV (0.09%). Women had lower prevalence of HBV and HCV, Chinese had the highest prevalence of HBV while Malay had the highest prevalence of HCV. Conclusion Young adults seems to be protected from HBV perhaps owing to the introduction of universal HBV vaccination since 1989. Chronic HBV however remains prevalent in older adults especially among the Chinese. Chronic HCV is uncommon in Malaysia.
Introduction In 2016 the World Health Organization (WHO) had adopted a global strategy to eliminate Hepatitis B (HBV) by 2030 through five core interventions, the first four were preventive while the fifth is the cascade of care, the continuum of services that persons with chronic HBV should receive as they progress from screening to diagnosis to treatment to chronic care. We determined the prevalence of the awareness and treatment of chronic HBV in Malaysia based on a large sample data from a screening campaign. Methods A total of 10,436 subjects participated in the HBV screening campaign organized by the Hepatitis Free Pahang Malaysia (HFPM) in 2018 and 2019. All screen-positive subjects were recalled to undergo laboratory-based HBsAg and HBV DNA tests. Patients with confirmed chronic HBV were referred to local health services, while continued being monitored by HFPM. Results We estimated 13.1% of Malaysian adults aged 20 or older with chronic HBV were aware of their HBV status, and of those only 0.7% had received prior anti-viral treatment, but among those with baseline HBV DNA level>20,000 IU/ml, 15.6% were subsequently treated. Tenofovir disoproxil fumarate was the only medicine used on all treated patients. The linkage to care post-screening was broken in substantial number of patients, only 108 (54%) subjects had returned to have their HBV DNA measured and only 115 (58%) patients had subsequently sought care and were on still follow-up. Conclusion Few Malaysian adults with HBV were aware of their infection and even less received anti-viral therapy. Concerted public health efforts are urgently needed to improve HBV screening and care cascade in order to meet WHO targets for HBV elimination. Keywords Cascade of care, Awareness, Treatment, Hepatitis B, Malaysia
Background In 2015, The Lancet Commission on Global surgery (LCoGS) published a report highlighting the growing burden of surgical disease worldwide. The need for Global surgery research was emphasised in developing high-quality surgical care, especially in lower and middle-income countries (LMICs). We aim to assess the current state of global surgery research, illuminate trends within and discuss the impact of the report. Methods A literature search identified all clinical research in the global surgery field published between 2015 and 2019. Three databases - MEDLINE, Web of Science and the Cochrane Library were used to identify articles screened by a minimum of two independent authors against eligibility criteria, using a method adapted from the PRISMA guidelines. These articles were categorised to describe trends including number of articles published, surgical conditions, study types, and geographical author distribution. All methods utilised have adhered to an a-priori protocol. Results 1,495 from 5,272 eligible articles were analysed. The number of global surgery research articles increased from 288 in 2015 to 314 articles in 2019. 65% focused on surgical conditions treatable with basic interventions. 49% of Global surgery research articles involved authors from high income countries. Conclusion We have summarised the current state of global surgery research since publication of the LCoGS 2015 report. Though research output is still minimal from countries with greatest clinical need, the overall trend highlights progression in research made by LMICs, notably through establishing global research collaborations. Our findings demonstrate additional efforts are necessary to further improve research output in LMICs. Take-home message Research output is still minimal from countries with greatest clinical need, the overall trend highlights progression in research made by LMICs, notably through establishing global research collaborations.
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