- Faculty of Medicine
University of Malaya
Kuala Lumpur
- Dr. Maznah Dahlui is a Public Health Specialist, an Associate Professor and the Head of Department of Social and Prev... moreDr. 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.edit
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AimsDespite the availability of newer antiseizure medications, carbamazepine (CBZ) remains the gold standard. However, patients of Asian ancestry are susceptible to CBZ‐related severe cutaneous adverse reactions. Universal HLA‐B*15:02... more
AimsDespite the availability of newer antiseizure medications, carbamazepine (CBZ) remains the gold standard. However, patients of Asian ancestry are susceptible to CBZ‐related severe cutaneous adverse reactions. Universal HLA‐B*15:02 screening is a promising intervention to address this. With the increasing recognition of integrating real‐world evidence in economic evaluations, the cost‐effectiveness of universal HLA‐B*15:02 screening was assessed using available real‐world data in Malaysia.MethodsA hybrid model of a decision tree and Markov model was developed to evaluate 3 strategies for treating newly diagnosed epilepsy among adults: (i) CBZ initiation without HLA‐B*15:02 screening (current practice); (ii) universal HLA‐B*15:02 screening prior to CBZ initiation; and (iii) alternative prescribing without HLA‐B*15:02 screening. The model was populated with real‐world inputs derived from the Malaysian population. From a societal perspective, base‐case analysis and sensitivity analy...
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espanolEl uso de auditorias operativas explica la diferencia en los costos incurridos al proporcionar servicios a los pacientes hospitalizados que usan BPJS. Este estudio tiene como objetivo identificar la diferencia de costo entre los... more
espanolEl uso de auditorias operativas explica la diferencia en los costos incurridos al proporcionar servicios a los pacientes hospitalizados que usan BPJS. Este estudio tiene como objetivo identificar la diferencia de costo entre los costos reales y las tasas establecidas para la hospitalizacion de los tratamientos cardiaco isquemicos cronicos, infarto cerebral, enfermedad renal en etapa terminal y diabetes tipo 2. Se puede obtener la contencion de costos a traves del monitoreo y la administracion de costos. El costo de la variacion para manejar varias enfermedades no se puede evitar debido a las caracteristicas y al metodo de diferencia de costos. Se toman medidas para garantizar que las operaciones se lleven a cabo de manera efectiva y eficiente. EnglishThe operational audit uses to explain cost variances that occurred in the delivery of healthcare services to inpatients utilizing the BPJS. This study aimed to identify cost variance between actual cost and set tariff for inpatie...
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Haze imposes a substantial disease burden on the human population especially in the Southeast Asia region due to the high frequency of haze episodes. The reduction of air quality levels by haze has resulted in a substantial disease burden... more
Haze imposes a substantial disease burden on the human population especially in the Southeast Asia region due to the high frequency of haze episodes. The reduction of air quality levels by haze has resulted in a substantial disease burden and an increase in healthcare utilization (HU). This study aims to determine the association between haze and HU of haze-related respiratory illnesses with a focus given on the acute exacerbation of bronchial asthma (AEBA) and chronic obstructive pulmonary disease (AECOPD). A cross-sectional study was conducted through secondary data collection of haze/non-haze episodes as the study exposures and HU related to the exacerbation of bronchial asthma and COPD as the study outcomes. Data on haze/non-haze episodes and HU for four consecutive years (2012–2015) were retrieved from the Department of Environment and Ministry of Health Malaysia, respectively. In the four consecutive years, the percentage of haze episodes recorded in all stations was higher (6...
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Research Interests: Microbiology, Medical Microbiology, Medicine, Diarrhea, Biological Sciences, and 15 moreLibya, Decision Trees, Humans, Cost Effectiveness Analysis, Female, Male, Gastroenteritis, Infant, Clinical Sciences, Newborn Infant, Economic Models, Cost Benefit Analysis, Immunization Programs, Child preschool, and Medical and Health Sciences
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Malaysia has recorded a cumulative total of over 98,000 persons infected with HIV by the end of 2012. The number of recorded cases of HIV infection in Malaysia is highest among people who inject drugs(PWID) which constitutes 67 per cent... more
Malaysia has recorded a cumulative total of over 98,000 persons infected with HIV by the end of 2012. The number of recorded cases of HIV infection in Malaysia is highest among people who inject drugs(PWID) which constitutes 67 per cent of the total cumulative cases. In the effort to mitigate the HIV transmission among PWID, the government of Malaysia initiated harm reduction programmecomprising the Needle Syringe Programme (NSP) and Methadone Maintenance Therapy (MMT) in 2006. Since its inception as a National Pilot Project in 2006, the funding for the programmes hasgradually been increased to increase the coverage of these programmes. During the phase of the harmreduction programme, the NSP was carried out by non-governmental organizations affiliated with theMalaysian AIDS Council whilst the MMT was provided by medical practitioners in the public andprivate health sectors. Since then the MMT programme has been expanded into the non-health sectorand is being implemented by the prisons and the National Anti-Drug Agencies (NADA). By the end of2011, the Malaysian government has invested a total of RM69.3 million for harm reduction programme.Despite the official recognition that the harm reduction programme may have been successful inreducing HIV transmission, concerns have been raised that public funding for these activities may not be sustainable in the long run and sources of alternative funding is desired. Thus, an assessment of the economic impact and cost-effectiveness of this programme is very much needed. This project aimed to assess whether the harm reduction programme in Malaysia, which consists of NSP and MMT programmes amongst PWID, have been cost-effective from the perspective of the government by estimating savings in direct health care cost to the government resulting from infections that were averted because of the NSP and MMT programmes. The cost-effectiveness and ROI of these programmes were evaluated over 3-time periods, from 2006 to current year 2013, a short 10-year future projection from 2013 to 2023, as well as projections from 2006 to 2050 to capture the long-term costs and benefits of the programmes. The main objectives of this study are to evaluate whether the harm reduction programme in Malaysia is cost-effective and whether they provide return on investments to the government. The cost-effective evaluation is aimed at examining whether the harm reduction programme represent value for money from the viewpoint of society, i.e. the benefits obtained justify the money spent by the government. On the other hand, the ROI analysis examines whether these programmes provide cost savings to the government, who is the main programme funder. As such, this economic evaluation has been conducted from the government perspective only. Cost of provision of MMT from private practitioners have not been included in the analysis.
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This paper presents the investigation results of UV measurement at different level of altitudes and the development of a new portable instrument for measuring UV. The rapid growth of industrial sectors in developing countries including... more
This paper presents the investigation results of UV measurement at different level of altitudes and the development of a new portable instrument for measuring UV. The rapid growth of industrial sectors in developing countries including Malaysia, brings not only income to the nation, but also causes pollution in various forms. Air pollution is one of the significant contributors to global warming by depleting the Ozone layer, which would reduce the filtration of UV rays. Long duration of exposure to high to UV rays has many devastating health effects to mankind directly or indirectly through destruction of the natural resources. This study aimed to show correlation between UV and altitudes which indirectly can help predict Ozone depletion. An instrument had been designed to measure and monitors the level of UV. The instrument comprises of two main blocks namely data logger and Graphic User Interface (GUI). Three sensors were used in the data logger to detect changes in the temperatur...
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The sudden surge in the number of healthcare utilizations compels the hospital to plan for its future needs. Several time-series projections of Covid-19 were conducted to forecast the disease burden and resources utilization through... more
The sudden surge in the number of healthcare utilizations compels the hospital to plan for its future needs. Several time-series projections of Covid-19 were conducted to forecast the disease burden and resources utilization through simple predictive analytics. The projections revealed a rapid increase in the number of cases and patient in care at the hospital. It was estimated that the number of patients in care to range from 62 to 81 and 89 to 121 patients daily in the second and third phase of movement control order respectively. It was estimated that more than 100,000 plastic aprons, 80,000 sterile and non-sterile isolation gowns, 40,000 masks N95 and face shields, 30,000 gloves and nearly 17,000 bottles of hand sanitizers are needed until late May. Hence, a simple mathematical algorithm is a helpful tool to manage hospital resources during the pandemic.
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Background: Cataract is the second priority eye disease in the world and this case in Indonesia occupies the third-highest position in Southeast Asia. There are two methods for cataract treatment that can be expensive, small incision... more
Background: Cataract is the second priority eye disease in the world and this case in Indonesia occupies the third-highest position in Southeast Asia. There are two methods for cataract treatment that can be expensive, small incision method (SICS) and Phacoemulsification method, and it is important to know the cost-effective comparison of those two methods. Objective: This study aims to conduct Cost-Effectiveness Analysis (CEA) between cataract surgery; Small Incision Cataract Surgery (SICS) and Phacoemulsification, at Undaan Eye Hospital Surabaya. Materials and Method: A prospective study following up patients from before surgery up to 21 days’ post surgery. A total of 155 cataract patients had undergone surgery; 25 patients and 130 patients had SICS and Phacoemulsification, respectively. Quality-Adjusted Life Years (QALYs) was used as the outcome measure. The assessment of utility using ‘Visual Function 25’ (VF-25) was the quality of life regarding visual function before surgery...
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Background: The role of breast cancer treatments in reducing recurrence and death has been established. However, the treatments side effects greatly impact on quality of life and little is known about the non-adherence rates. The purpose... more
Background: The role of breast cancer treatments in reducing recurrence and death has been established. However, the treatments side effects greatly impact on quality of life and little is known about the non-adherence rates. The purpose of this study was to determine the non-adherence rates to surgery, chemotherapy, radiotherapy and hormonal therapy, and factors that affect it in public hospitals in Malaysia. Methods: A multicentre cross-sectional study was conducted in six public hospitals involving all newly diagnosed breast cancer patients in 2012. Data were collected through medical record reviews and interview by using structured questionnaire. Non-adherence was categorized as any breast cancer patients refusing or discontinuing any treatment due to non-medical reasons. Univariable logistic regression and multiple logistic regressions were used for analysis. Results: A total of 340 breast cancer patients were included in the study. The proportion for non-adherence to surg...
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Dexamethasone can reduce mortality in hospitalised COVID-19 patients needing oxygen and ventilation by 18% and 36%, respectively. Here, we estimate the potential number of lives saved and life years gained if this treatment were to be... more
Dexamethasone can reduce mortality in hospitalised COVID-19 patients needing oxygen and ventilation by 18% and 36%, respectively. Here, we estimate the potential number of lives saved and life years gained if this treatment were to be rolled out in the UK and globally, as well as the cost-effectiveness of implementing this intervention. Assuming SARS-CoV-2 exposure levels of 5% to 15%, we estimate that, for the UK, approximately 12,000 (4,250 - 27,000) lives could be saved between July and December 2020. Assuming that dexamethasone has a similar effect size in settings where access to oxygen therapies is limited, this would translate into approximately 650,000 (240,000 - 1,400,000) lives saved globally over the same time period. If dexamethasone acts differently in these settings, the impact could be less than half of this value. To estimate the full potential of dexamethasone in the global fight against COVID-19, it is essential to perform clinical research in settings with limited...
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A Correction to this paper has been published: https://doi.org/10.1038/s41467-021-22038-x.
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We used a cultural adaptation framework and local partnership working in Malaysia to translate and implement an established cancer awareness-raising mass media campaign.
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Background/Aims: Economic evaluation is integral to informed public health decision-making in the rapidly growing field of precision and personalized medicine (PM); however, this research requires specialized expertise and significant... more
Background/Aims: Economic evaluation is integral to informed public health decision-making in the rapidly growing field of precision and personalized medicine (PM); however, this research requires specialized expertise and significant resources. Generic models are a novel innovation to efficiently address a critical PM evidence shortage and implementation barrier by enabling use of population-specific input values. This is a generic PM economic evaluation model proof-of-concept study for a pharmacogenomic use case. Methods: An 8-step generic economic model development process was applied to the use case of human leukocyte antigen (HLA)-B*15:02genotyping for prediction of carbamazepine-induced cutaneous reactions, with a user-friendly decision-making tool relying on user-provided input values. This generic model was transparently documented and validated, including cross-validation comparing cost-effectiveness results with 3 country-specific models. Results: A generic pharmacogenomic...
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Simple and fast are the two terms that could describe the process of configuring a readymade SmartGLCD into a unique data-logger. The Universal data-logger uses sound and PIR sensors to monitor sound and movement of human or any subjects... more
Simple and fast are the two terms that could describe the process of configuring a readymade SmartGLCD into a unique data-logger. The Universal data-logger uses sound and PIR sensors to monitor sound and movement of human or any subjects that trigger the two signals. The devices has been configured through MicroC development tools and Visual GLCD. Initially Visual GLCD is used for creating the graphic for control object, logo and text. While MicroC is a C compiler for building the coding for all the functions of the objects. The process of configuration requires good understanding of C programming and good knowledge in microcontroller structure. The experimental results of the data logging are displayed on the large graphic display 240 × 128 pixel and also saved in SD card. An experimental work has been carried out to justify the manifestation of data against the characters of subject. The results is very promising with regards to fast review of data interpretation through large graphic display. Two proposals of applications also have been highlighted for data measurement and subject monitoring using the device. The first proposal is to monitor baby's condition in an incubator and the second proposal is to monitor mental patient in a rehab room.
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Research Interests: Breast Cancer, Medicine, Comorbidity, Logistic Regression, Military, and 15 moreHumans, Female, Government Agencies, Registries, Mastectomy, Clinical Sciences, Middle Aged, Time Factors, Odds ratio, Military Personnel, Logistic Models, Confidence Interval, Breast Conserving Surgery, Breast Neoplasms, and Neoplasm staging
This study was a randomised controlled trial designed to assess the effectiveness of progressive muscle relaxation training (PMRT) in the clinical management of chemotherapy-related nausea and vomiting as an adjuvant intervention to... more
This study was a randomised controlled trial designed to assess the effectiveness of progressive muscle relaxation training (PMRT) in the clinical management of chemotherapy-related nausea and vomiting as an adjuvant intervention to accompany pharmacological antiemetic treatment (metoclopramide and dexamethasone i.v.). Seventy-one chemotherapy-naive breast cancer patients of an outpatient oncology unit of a university hospital in Hong Kong participated, with 38 subjects randomised to the experimental group and 33 to the control group. The intervention included the use of PMRT 1 h before chemotherapy was administered and daily thereafter for another 5 days (for a total of six PMRT sessions). Each session lasted for 25 min and was followed by 5 min of imagery techniques. The instruments used for data collection included the Chinese versions of the Profile of Mood States and the State-Trait Anxiety Inventory (measured before chemotherapy and then at day 7 and day 14 after chemotherapy), and the Morrow Assessment of Nausea and Vomiting Scale, which was used daily for the first 7 post-chemotherapy days. The use of PMRT considerably decreased the duration of nausea and vomiting in the experimental group compared with the control group ( P<0.05), whereas there were trends toward a lower frequency of nausea and vomiting ( P=0.07 and P=0.08 respectively). Neither nausea nor vomiting differed in intensity between the two groups. The significant effects were mainly evident on the first 4 post-chemotherapy days, when differences were statistically significant. Although there was a significantly less severe overall mood disturbance in the experimental group over time ( P<0.05), this did not apply in the case of anxiety. Such findings suggest that PMRT is a useful adjuvant technique to complement antiemetics for chemotherapy-induced nausea and vomiting and that incorporation of such interventions in the care plan can enhance the standards of care of cancer patients who experience side effects of chemotherapy.
Research Interests: Breast Cancer, Chemotherapy, Medicine, Imaging Techniques, Dexamethasone, and 15 moreHumans, Chinese, Female, Data Collection, Nausea, Adult, Antineoplastic Agents, Antiemetic, Emesis, Antiemetics, Control Group, Chemotherapy Induced Nausea and Vomiting, Experimental Group, Breast Neoplasms, and Medical and Health Sciences
Research Interests: Depression, Bangladesh, Adolescent, Anxiety, Gender based violence, and 15 moreHumans, Affective Disorders, Female, Cohort Study, Depressive Disorder, Clinical Sciences, Functional Illiteracy, Adult, Cross Section, Educational Status, ANXIETY, Antenatal Care, Cross sectional Study, Cross Sectional Studies, and Antepartum
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PURPOSE The aim of this study is to determine the pathway that women follow for Breast Cancer Care (BCC) and the time intervals from symptom discovery to treatment initiation and to develop a quality matrix framework. METHODS A... more
PURPOSE The aim of this study is to determine the pathway that women follow for Breast Cancer Care (BCC) and the time intervals from symptom discovery to treatment initiation and to develop a quality matrix framework. METHODS A retrospective cohort study was conducted at six tertiary centers in Malaysia. All women with newly diagnosed breast cancer were interviewed, and a medical records review was conducted using a structured questionnaire. The BCC timeliness framework showed that the total time between a woman discovering their first breast changes and the date of initial treatment was divided into three distinct intervals: presentation interval, diagnostic interval, and treatment interval. Four diagnosis subintervals, referral, biopsy, report, and diagnosis resolution intervals, were also looked into. RESULTS The BCC timeliness framework was used to capture important time points. The median total time, presentation interval, diagnostic interval, and treatment interval were 4.9 mo...
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The effectiveness of a life style modification and peer support home blood pressure monitoring in control of hypertension: protocol for a cluster randomized controlled trial
Background: The breast cancer survival rate is the highest among all types of cancers, and survivors returning to work after completing treatment is extremely important in regards to economy and rehabilitation. The aim of this systematic... more
Background: The breast cancer survival rate is the highest among all types of cancers, and survivors returning to work after completing treatment is extremely important in regards to economy and rehabilitation. The aim of this systematic review study is to identify the prevalence of breast cancer survivors who return to work (RTW) and the factors associated to RTW. Methods: A computer based literature search was carried out. “PubMed, Cochrane Library, Embase, Web of Science, and Science Direct ” databases were searched systematically. Our search strategy identified a total of 12,116 papers of which 26 studies met the inclusion criteria and quality assessment. These were original papers published
In Malaysia, majority anti‐HCV positive haemodialysis patients do not undergo hepatitis C confirmation due to the high cost of HCV RNA. HCV Core Antigen might be a cost‐effective diagnostic test to identify HD patients who have active HCV... more
In Malaysia, majority anti‐HCV positive haemodialysis patients do not undergo hepatitis C confirmation due to the high cost of HCV RNA. HCV Core Antigen might be a cost‐effective diagnostic test to identify HD patients who have active HCV infection eligible for Direct Acting Anti‐viral therapy.