dijangkiti. Untuk rawatan elektif seperti tampalan gigi, penskaleran, rawatan
ortodontik, rawatan gigi palsu dan lain lain rawatan yang bukan kecemasan perlu
ditangguhkan kecuali terdapat keperluan yang mendesak. Oleh itu, jadual
perkhidmatan rawatan perlu bergantung kepada penilaian risiko yang dijalankan
tanpa menjejaskan keutamaan pesakit. Sekiranya prosedur kecemasan ini tidak
dapat ditangguhkan, ia perlu dilakukan dengan meminimumkan penggunaan alatan
pergigian yang mengeluarkan aerosol yang tinggi.
Kedua, pihak klinik perlu memperluaskan perkhidmatan tele-kesihatan semasa
pandemik ini. Sebagai contoh, pesakit adalah digalakkan untuk membuat temujanji
melalui telefon atau sistem janjitemu atas talian terlebih dahulu sebelum hadir ke
klinik. Sistem janjitemu atas talian tersebut telah dibangunkan dengan kerjasama
Unit Sistem Maklumat, Jabatan Kesihatan Negeri Kedah. Ianya mula digunakan oleh
semua Klinik Pergigian Primer di Kedah pada bulan Ogos 2020. Melalui sistem
tersebut Klinik Pergigian Primer boleh membuka slot temujanji untuk pesakit hadir
ke klinik mengikut kemampuan untuk menerima pesakit.
Ketiga, bagi memastikan keselamatan petugas kesihatan, pihak klinik perlu
mempertingkatkan amalan norma baru seperti pemakaian PPE yang bersesuaian
dan penjarakan sosial sepanjang Klinik Pergigian Primer beroperasi. Klinik
Pergigian Primer juga perlu mengambil kira masa dari 20 hingga 30 minit (fallow
time) bagi rawatan pergigian yang melibatkan prosedur AGP yang dijalankan ke atas
pesakit berisiko. Semasa Fallow time bilik rawatan akan dibiarkan tertutup setelah
selesai rawatan untuk proses penyingkiran aerosol secara semulajadi sebelum
dapat menerima pesakit seterusnya. Akhir sekali dicadangkan untuk menyediakan
lebih banyak bilik Aerosol Generating Procedure (AGP) yang lengkap dengan Extra-
oral Vacuum Suction (EOVS) dan Air Decontamination Unit (ADU) bagi memastikan
perkhidmatan pergigian dapat diteruskan dan pada masa yang sama masih
mematuhi prosedur operasi piawai bagi mengekang penularan COVID-19.
KESIMPULAN
Kesimpulannya kajian menunjukkan terdapat penurunan penggunaan perkhidmatan
Klinik Pergigian Primer di JKN Kedah dari segi kehadiran pesakit luar ke klinik dan
pemberian rawatan kecemasan dan bukan kecemasan semasa pandemik COVID-
19. Hal ini mungkin disebabkan arahan pentadbiran untuk risiko penularan yang
tinggi menyebabkan hanya kes-kes kecemasan yang diterima. Selain itu ini
disebabkan oleh penutupan premis gunasama UTC sepanjang tempoh PKP yang
menempatkan klinik-klinik pergigian menyebabkan operasi klinik terpaksa
ditangguhkan. Pesakit juga mungkin merawat sendiri atau mendapatkan rawatan di
swasta bagi rawatan cabutan gigi dan tampalan bagi mengurangkan risiko
150
pendedahan disamping kos yang mampu milik. Bagi menjamin pemberian
perkhidmatan pergigian yang berterusan, dicadangkan pihak klinik membuat
perancangan awal untuk rawatan kes, mempertingkatkan amalan norma baharu
semasa di tempat kerja, penggunaan tele-health dan kawalan kejuruteraan seperti
bilik khas prosedur AGP.
PENGHARGAAN
Penulis ingin mengucapkan setinggi-tinggi penghargaan kepada Ketua Pengarah
Kesihatan kerana kebenaran untuk menerbitkan artikel ini
RUJUKAN
General Dental Council. (2020). COVID-19 and dentistry - Survey of the UK public
for the General Dental Council. Retrieved from https://www.gdc-uk.org/docs/default-
source/research/covid-19-and-dentistry-survey-of-the-uk-public-report0e677a96-
bdc1-4447-a20e-1d402b7dbb4b.pdf?sfvrsn=8f04c781_12
Izani, I., Jaafar, H., & Mohd Nor M. (2022). The Impact of COVID-19 to Healthcare
Service Utilization in Malaysia: A Scoping Review. Malaysian Journal of
Public Health Medicine, 22(1).
MOH. (2020). Garis Panduan Perkhidmatan Kesihatan Pergigian Pasca Perintah
Kawalan Pergerakan Pandemik Covid-19 N0.1/2020.
151
PUBLIC AWARENESS & PERCEPTION ON PHARMACY VALUE ADDED
SERVICES (PVAS) BEFORE & DURING COVID-19 PANDEMIC IN KEDAH,
MALAYSIA
Norazila Abdul Ghani 1,Nurliana Abdul Latif 1, Hani Sahara Jamil1, Siti Sarah Fahmy
Hazim2, Siti Sarah Fahmy Hazim2, Sareh Safwan Abu Seman3, Intan Shafiza Romli4,
Noor Farahin Haniza5, Nurasyikin Muhamad6, Nurul Akmal Saad7, Nor Zahidah Mohd.
Nasir8, Mohamad Sadiq Abdul Rashid9, Tuan Noor Khaizura Tuan Rahim10, Tan Chia
Ying11, Noor Amaelia Zulkiflee 12, Nur Liyana Mansor 13, Humaira Haron 14, Farah Aina
Nasruddin15, Nik Wafieza Nik Rahimi16, Nurzila Ab. Rahman17, Irham Bokhari18, Izwan
Abd Lateh19, Ang Qi Hui20, Chee Sze Hui21, Ooi Kiat Lay22
1Hospital Jitra , 2Klinik Kesihatan Bandar Alor Setar, 3Jabatan Kesihatan Negeri Kedah, Kedah,
4Hospital Sultanah Bahiyah 5Hospital Sultan Abdul Halim, 6Hospital Kulim, 7Hospital Kuala Nerang,
8Hospital Yan, 9Hospital Sik, 10Hospital Baling, 11Hospital Sultanah Maliha, 12Kota Setar District
Health Office, 13Kuala Muda District Health Office14KulimDistrict Health Office, 15Kubang Pasu District
Health Office, 16Baling District Health Office, 17Yan District Health Office, 18Sik District Health Office,
19Padang Terap District Health Office, 20Pendang District Health Office, 21Bandar Baharu District
Health Office, 22Langkawi District Health Office
*Corresponding author: Norazila Abdul Ghani, Pharmacy Unit, Hospital Jitra, [email protected]
ABSTRACT
Background:COVID-19 has become a pandemic in Malaysia and this urged the
government during the time to enforce a movement control order(MCO). Pharmacies in
governmentfacilitiesare actively involved to assist patients to get the subsequent supply
ofmedication through the use of Pharmacy Value Added Services(PVAS). This study aims
to evaluate the trend of PVAS in Kedah before and during pandemic Covid-19 and explore
the awareness and perception of the public towards PVAS services in Kedah during
pandemic Covid-19
Methodology:This cross-sectional study was conducted by reviewing PVAS records before
and during the Covid-19 pandemic in the outpatient pharmacies in Kedah public healthcare
facilities. Phone call interviews were conducted using a validated questionnaire among 381
patients using PVAS in all pharmacy public hospitals in Kedah, in order to explore the
awareness and perception towards PVAS services. Descriptive and inferential statistics
were used to analyze the data.
Results: Twelve out of 20 facilities show incremental trends of PVAS as compared before
the Covid-19 pandemic with PKD Kuala Muda recorded the highest rise in PVAS (22,438).
A total of 381 respondents with a mean age of 52.13 years (±15.3 SD) were interviewed
through a telephone call. Slightly more than half of the respondents (n=203, 53%) were
unaware of the existence of PVAS before Covid-19. 55.2% choose PVAS to avoid contact
with someone who unknowingly has positive Covid-19. Besides, PVAS is much easier and
faster compared to traditional dispensing systems. About 97% of the respondents agree to
use PVAS to collect their next medication supply.
Conclusion:
Slightly more than half of the respondents were unaware of the existence of PVAS before
the Covid-19 pandemic. More than half of the facilities show increasing trends in PVAS
during the Covid-19 pandemic. Pharmacists play major roles in introducing new and current
PVAS to patients.
Keyword:Covid-19, PVAS, pandemic, Kedah
152
INTRODUCTION
Coronavirus disease 2019 (COVID-19) is a highly contagious illness that affects the
respiratory system. It is caused by a newly discovered coronavirus called severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-
nCoV). Avoidance of the public is one of the principal methods of deterrence. This
new strain was unknown until December 31, 2019, when an outbreak of pneumonia
of unidentified cause emerged in Wuhan City, Hubei Province, China. World Health
Organization (WHO) declared Covid-19 as a pandemic on March 11, 2020 (1). Until
June 14, 2020, more than 7 million people were infected with the virus and 427 630
deaths were reported around the world (2).
In Malaysia, the first case of COVID-19 was detected on 24 January 2020 (3). Since
then, the case become a pandemic in Malaysia, and this urges the government
during the time to enforce a movement control order (MCO) or well known as
Perintah Kawalan Pergerakan (PKP) to constrain the virus from
spreadingunmanageably around the country. March 18, 2020, became an
unforgettable history for Malaysians when it became the first day for MCO to be
implemented (4). Most of the activities were constrained. Borders are closed.
Schools, universities and industries are ordered to close except for essential
services such as health services, postal services, banking and finance, and
supermarkets. Masks, hand sanitizers and social distancing turn out to be crucial for
everyone. Malaysians need to adapt to the new norm.
Based on the study done by the National Survey on the Use of Medicines (NSUM)
2015 among 3,081 consumers in Malaysia found that 30.3% of them are on chronic
medication. Among them, 88.4% obtained their medications from District Health
Offices, 80.3% from hospitals and 76.1% from community pharmacies (5). In Ministry
of Health Malaysia (MOHM) facilities; chronic illness patients are receiving only one-
month worth of medication supply. The purpose is to ensure the quality of the
medications preserved, ease monitoring of any undesired side effects, enhance
compliance, reduce waste and lessen the risk of medication error due to massive
medications stockpiled at home (6).
To facilitate the subsequent supply of medication, MOHM has launched a full
government-funded (except for Medicines by Post), Pharmacy Value Added
Services (PVAS) in its facility. These services aim to reduce the waiting time at
conventional pharmacy counters and provide convenience in collecting partial
medication supplies. The service offers various types of Pharmacy Appointment
systems namely `Integrated Drug Dispensing System (IDDS), Pharmacy Drive
Through (PDT), Telephone and Collect (T&C), WhatsApp and Collect (W&C),
153
Appointment Card Dispensing System (ACDS), Medicines by Post (MBP) and so on
(7).
Previous study found an increasing trend in the overall refilling prescription rate, with
the introduction of PVAS. The middle-aged population group (40–65 years of age)
was found to utilize the PVAS more than other age groups (13). In Malaysia, The
PVAS are generally well accepted and showed to have reduced the pharmacy
waiting time (14). The implementation of MCO limits the movement of Malaysians.
The government urged the public to stay at home in order to break the chain. They
are only allowed to go out to buy necessities and do essential work. Police and
armies were stationed to restrict the movement of the public. Some of them were
incapable of going back home due to the MCO being implemented during the school
holidays. Thus, for chronic illness patients that depend on monthly medication
supply, choosing PVAS during the pandemic is more convenient for them because
it is effortless, time-saving and more convenient.
This study becomes a medium to promote add on services provided in pharmacy
settings. It will benefit the respondents in terms of identifying various types of PVAS
available in pharmacy settings. This provides convenience and time-saving in
collecting partial medication supply.This study aims to evaluate the trend of PVAS in
Kedah before and during pandemic Covid-19 and explore the awareness and
perception of the public towards PVAS services in Kedah during pandemic Covid-19
METHODOLOGY
Study Design
This study reviewed 6 months of PVAS records before (September 1, 2019 -
February 29, 2020) and 6 months during the Covid-19 pandemic (March 1, 2020,to
August 31, 2020) in the outpatient pharmacies in Kedah public healthcare facilities.
Both records were analyzed and compared to determine whether there is any
significant impact of the pandemic Covid-19 on public behaviour towards monthly
medication supply.Standardized and validated questionnaires were used to
investigate the perception and behaviour toward PVAS during the pandemic
Interviews were conducted through phone calls among patients who registered for
PVAS during the pandemic.
The interview session was conducted in November 2020-January 2021; generally
took between 3 and 5 minutes.All data collectors were briefed by principal
investigators prior to data collection. The detail of the study and the Gantt chart was
presented and the questionnaire and data collection form were distributed to all data
collectors during the session.
154
Study Population
Patients using PVAS in public hospitals and health clinics in Kedah, Malaysia
Sample Size
The sample size estimation was performed using the Raosoft sample size calculator.
In 2019, about 293,368 patients were using PVAS in Kedah. Based on the Raosoft,
a total of 384 respondents (Confidence interval: 95%, Margin of Error: 5%) was
needed.
Inclusion Criteria
i. PVAS registration from September 1, 2019, until August 31, 2021
ii. Patients or family are able to understand and speak Malay or English
Exclusion Criteria
i. Refused to be interviewed
ii. Insufficient or illegible patient record
Statistical Analysis
The data were analysed using Statistical Package for Social Science (SPSS) version
20. Descriptive statistics were used to determine the frequency, mean and
percentage of the data. Descriptive statistics were used to present the demographic
information. Fisher’s exact test was employed to test the association among the
demographic profiles, perceptions and behaviour towards PVAS during the
pandemic. A P-value of less than 0.05 was considered to be statistically significant.
RESULTS
A total of 1,364,251 partial prescriptions (Partial filling of a prescription) were
received in Kedah Public Hospitals and District Health Offices from1st September
2019 to 31st March 2020 (before Covid-19). There was a 19.5% dropout recorded
(1,098,027 partial prescriptions) from 1stApril 2020 until 31stAugust 2020 (during
Covid-19) which might be due to the enforcement of the first MCO in Malaysia that
required the public to stay home and limit their movement.
The trend of PVAS in Kedah before and during pandemic Covid-19
According to data received, all facilities recorded decreasing trends in partial
prescriptions received before and during the Covid-19 pandemic (Table1). Langkawi
District Health Offices recorded huge differences for a partial prescription before and
during Covid-19 (-77.1%), followed by Hospital Sultanah Bahiyah (-29.4%) and
Public District Health Offices in Yan (-27.4%). This is because the prescriptions with
2-3 months duration were fully supplied to the patient during the pandemic in order
to reduce overcrowding of patients to collect the medication at the pharmacy counter.
155
Despite this reduction in the number of partial prescriptions, 12 out of 20 facilities
(60%) show increment trends of PVAS, as compared to before the Covid-19
pandemic with Kuala Muda District Health Offices recorded the highest rise in PVAS
(202.3%) followed by Sik District Health Offices (65.1%).80% of facilities showed
increments in the percentage of prescription supply using PVAS; with an overall
increment of 40.1% and the Langkawi District Health Office recorded huge
differences in the percentage (27.61%). Some facilities started to introduce new
PVAS such as WhatsApp & Collect (W&C) during the pandemic, which contribute to
a further raise in total PVAS in Kedah (Table 2).
The awareness and perception of the public towards PVAS services in Kedah
during pandemic Covid-19
Approximately 384 respondents were conveniently approached, of whom 381
participants (52.13 ± 15.3 years old) consented through phone calls and completed
the questionnaires during the interview session, which were used for the final data
analysis (final response rate 99.22%). Fifty percent of the participants were females
(n=193), with Malay being the dominant ethnic group (n=317, 83.2%) (Table 3).
Slightly more than half of the respondents (n=203, 53.3%) were unaware of the
existence of PVAS before Covid-19. About 55.2% choose PVAS to avoid contact
with someone who unknowingly hasa positive Covid-19. Besides, PVAS is much
easier and faster compared to the traditional dispensing system. About 94.4% of the
respondents agree to use PVAS to collect their next medication supply (Table 4).
A non-parametric test was run on all demographic data and showed abnormal
distribution when compared with PVAS existence knowledge. All demographic
demonstrates non-significant value (P-value<0.05) except for one group. A Fisher’s
exact test indicates a significant association between PVAS knowledge and
occupational group (p=0.036)(Table 5)
156
Table 1: Prescription supply using PVAS & Partial Prescriptions Rec
During Pandemic Covid-19
Kedah public hospital & District Health No. of prescription supply Differenc
Office using PVAS es in total
BEFORE DURING PVAS
COVID19 COVID19 received
(%)
Hospital Sultanah Bahiyah (HSB) 41,000 31,548 -23.1
Hospital Sultan Abdul Halim (HSAH) 34,090 31,291 -8.2
Hospital Kulim (HK) 11,246 11,228 -0.2
Hospital Sultanah Maliha (HSM) 2,031 1,928 -5.1
Hospital Jitra (HJ) 2,484 2,797 12.6
Hospital Kuala Nerang (HKN) 1,929 3,081 59.7
Hospital Yan (HY) 1,919 2,093 9.1
Hospital Baling (HB) 2,797 3,705 32.5
Hospital Sik (HS) 2,208 1,615 -26.9
Kota Setar District Health Office (KSDHO) 5,255 8,077 53.7
Kuala Muda District Health Office (KMDHO) 11,090 33,528 202.3
Kulim District Health Office (KDHO) 4,473 4,112 -8.1
Langkawi District Health Office (LDHO) 1,810 1,461 -19.3
Kubang Pasu District Health Office (KPDHO) 4,450 7,150 60.7
Padang Terap District Health Office (PTDHO) 550 555 0.9
Yan District Health Office (YDHO) 295 415 40.7
Baling District Health Office (BDHO) 615 513 -16.6
Sik District Health Office (SDHO) 252 416 65.1
Bandar Baharu District Health Office (BBDHO) 2,044 2,169 6.1
Pendang District Health Office (PDHO) 651 244 62.5
Total 131,189 147,926 12.8
Mean 6559 7396 P=0.989*
*Mann-Whitney U test
ceived in Kedah Public Hospitals & District Health Office Before and
Number of partial Difference in % Prescription supply Difference %
l prescriptions received Partial using PVAS Prescription
supply using
BEFORE DURING Prescriptions BEFORE DURING
PVAS
COVID19 COVID19 Received (%) COVID19 COVID19
1.67
220,854 155,879 -29.4 18.56 20.24 -2.77
60,630 58,535 -3.5 56.23 53.46 1.86
22,237 21,412 -3.7 50.57 52.44 2.37
7,539 6,577 -12.8 26.94 29.31 2.24
25,204 23,127 -8.2 9.86 12.09 5.41
24,035 22,929 -4.6 8.03 13.44 1.76
36,605 29,900 -18.3 5.24 7.00 3.58
50,746 40,738 -19.7 5.51 9.09 -0.65
32,927 26,670 -19 6.71 6.06 2.96
140,255 120,431 -14 3.75 6.71 10.72
264,403 224,767 -15 4.19 14.92 1.79
59,802 44,339 -25.9 7.48 9.27 27.61
16,583 3,792 -77.1 10.91 38.53 3.14
158,454 120,216 -24.1 2.81 5.95 0.97
15,752 12,433 -21.1 3.49 4.46 1.73
15,965 11,588 -27.4 1.85 3.58 -0.02
104,663 90,077 -13.9 0.59 0.57 0.54
48,259 39,016 -19.2 0.52 1.07 2.16
40,524 30,094 -25.7 5.04 7.21 -1.89
18,814 15,507 -17.6 3.46 1.57 40.10
1,364,251 1,098,027 -19.5 9.62 13.47 P=0.239*
68213 54901 P=0.449* 11.59 14.85
157
Table 2: Total Number of Partial Prescription in Kedah Public Kedah Pu
PVAS.
Integrated Medicines by Telephone & WhatsApp Appoin
Drug Post (MBP) Collect (T&C) & Collect Card
Hospitals Dispensing (W&C)
System (IDDS)
Before
During
Before
During
Before
During
Before
During
Before
HSB 29015 18129 1485 2530 1132 3985 0 0 2883
HSAH 3340 2822 1234 1810 4894 2224 0 0 1906
HK 3491 3675 0 0 305 309 0 0 7338
HSM
HJ 590 569 0 0 300 331 0 0 1141
HKN 526 302
HY 126 111 123 202 1077 1324 0 194 758
HB
HS 0 0 1383 1256 0 1037 0
KSDHO
KMDHO 206 138 0 0 1639 1852 0 54 0
KDHO 238 224 0 0 669 804 0 1329 782
LDHO
KPDHO 102 97 0 0 1000 700 0 0 1106
PTDHO
YDHO 221 428 0 0 1361 1287 0 254 3630
BDHO 135 123 135 187 7189 7359 0 516 570
SDHO
BBDHO 157 165 000 0 0 46 4066
PDHO 61 21
78 78 000 2 0 0 1749
TOTAL
0 0 505 1781 0 2076 3867
% DIFF
MEDIAN 230 277 000 0 0 0 320
P VALUE 33 12
0 0 159 216 0 0 0
29 18 000 2 0 0 230
22 16 0 0 0 206 0 0 230
1046 1178
000 0 0 0 998
24 32 000 0 0 0 627
3967
2977 4729 21613 23638 0 5506 32201
0 28415 37.05 8.57 100.00 -15
0.00 275.3
-39.61 0.00 0.00 405 515.5 890
181.5 151.5 0.002
0.877 0.494 0.5
0.756
*Mann-Whitney U test
ublic Hospitals & District Health Office that Registered Under Difference
ntment Pharmacy Locker4u Put & Collect Pusat PHARMEDS
(AC) Drive (L4U) (P&C) PemberianUbat
Through Setempat
(PDT) (PPUS)
During
Before
During
Before
During
Before
During
Before
During
Before
During
2101 6318 4594 167 209 0 0 0 0 00
1043 14742
1504 324 369 10381 6953 1040 867 537 427
4 124
7120 112 115 116 0 0 0 0 00
1028 0 0 00
775 00 00 0 0 0 0 00
00 0 0 00
0 00 00 0 0 0 0 00
0 0 0 00
655 0 0 420 677 0 0 00
538 0 0 00
3860 00 00 74 49 0 0 00
432 00 0 0 00
3332 0 0 1108 693 0 0 00
1438 0 0 00
3215 00 00 0 280 0 0 00
278 0 0 00
0 43 2248 000 0 0 0 00
156 00 0 0 00
194 0 0 3061 24911 0 0 00
991 0 0 00
212 00 115 116 135 453
00 537 427
27829 00 000 0 37.05
5.71
000 0 0.00 0.00
715
00 000 0 0.971
542 00
0 0 103 187
00 0 0 356 337
00 000 0
00
000 0
00 0 0 0 3764
1690
721 810 15638 38304 1040 867
7 21708 10.99 59.17 -39.61
22.12 0.00 0.00 0.00 24.5 0.00 0.00
0.00 0.00
0.908 0.441 0.971
0.938
158
Table 3: Demographic characteristics of the study participants N=381
Characteristic Frequency, n Percentage(%)
Age (52.13 ± 15.3 years old)
<18 years 2 0.5
18 – 30 years 35 9.2
31 – 40 years 53 13.9
41 – 50 years 77 20.2
51 – 60 years 92 24.1
61 – 70 years 79 20.1
> 71 years 42 11.0
Unknown (Missing) 1 0.3
Gender Male 186 48.8
Female 193 50.7
Unknown (Missing) 2 0.5
Ethnicity Malay 317 83.2
Chinese 42 11.0
India 16 4.2
Others 3 0.8
Unknown (Missing) 1 0.3
Highest No formal education 15 3.9
Education Level Primary school 56 14.7
Secondary school 187 49.1
College/university 119 31.2
Unknown 2 0.5
Employment Government servant 69 18.1
Private sector 47 12.3
Business owner 98 25.7
Housewife 92 24.1
Student 11 2.9
Pensioner 62 16.3
Unemployed 1 0.3
Unknown (Missing) 1 0.3
First month Mar 2020 69 18.1
started PVAS April 2020 70 18.4
May 2020 38 10.0
June 2020 71 18.6
July 2020 53 13.9
Aug 2020 76 19.9
(Missing) 4 1.0
159
Table 4: Awareness and attitude of the public towards PVAS services in Kedah
during Covid-19
Item in questionnaire Answer Frequency Percentage
(N=381) (%)
Have you heard about Yes 177 46.5
PVAS before the Covid- No 203 53.3
19pandemic?
Why are you not I can come anytime during 77 43.8
interested to join PVAS office hours to collect my
before Covid-19? medicine
I live/work near the hospital
/District Health Office 46 26.1
I have family members and 39 22.2
friends who can help me to 24 13.6
collect my medicine
Others (Did not aware of the
Why do you choose PVAS service) 77 21.0
after the Covid- I’m afraid of going to the 125 34.2
19pandemic?
hospital during the pandemic
I’m afraid there will be an
interaction between me and 24 6.6
someone who was positive for
Covid-19
So many roadblocks around
my area 19 5.2
Unable to go home during 121 33.1
MCO
Others (convenience, faster,
no need to wait)
Which PVAS are you Integrated Drug Dispensing 42 10.3
46 11.3
currently using now System (IDDS)
Medicines by Post (MBP)
Telephone & Collect (T&C) 108 26.6
Appointment Card (AC) 66 16.3
Pharmacy Drive Through 53 13.1
(PDT)
WhatsApp & Collect (WC) 48 11.8
Besides PVAS you are Put & Collect (P&C) 26 6.4
currently using now, Others (FB Messenger) 17 4.2
Integrated Drug Dispensing 149 19.5
System (IDDS)
which other PVAS that Medicines by Post (MBP) 80 10.5
189 24.8
you know? Telephone & Collect (T&C) 131 17.2
120 15.7
Appointment Card (AC)
Pharmacy Drive Through
(PDT)
WhatsApp & Collect (WC) 26 3.4
Put & Collect (P&C) 50 6.6
Others 18 2.4
Pharmacy 296 73.6
160
Who inform you regarding Doctor / Nurse 28 7.0
PVAS? Internet 13 3.2
Family members / Friends 50 12.4
I would like to use PVAS Newspaper 1 0.2
to collect my medicines in Television 3 0.7
the next 3 months Others (Brochure, Banner, 11 2.7
Would you like to MOH website)
recommend PVAS to Yes 370 94.4
others? No 11 2.8
Unsure 11 2.8
Yes 379 99.5
No 1 0.3
Unsure 1 0.3
Table 5: Association Demographic characteristics and knowledge on PVAS
n Knowledge on PVAS before p-
value
Covid-19
0.609
Mean (SD)
a
Yes, n (%) No. n (%) Unknow
0.382
n, n (%)
a
Age group <18 years 2 2(100) 0 (0)
18 – 30 years 0.788
35 15(42.9) 20 (57.1)
a
31 – 40 years 53 22(41.5) 31(58.5)
0.195
41 – 50 years 77 33(42.9) 44 (57.1)
a
51 – 60 years 92 49(53.3) 42 (45.7)
0.036
61 – 70 years 79 37(46.8) 42 (53.2)
a
> 71 years 42 18(42.9) 24 (57.1)
Gender Male 186 91(48.9) 85 (44.0) 0 (0)
Female 193 95(51.1) 107 (55.4) 1 (0)
Ethnic Malay 317 149 (47.0) 167(52.7)
Chinese 42 18 (42.9) 24 (57.1)
India 16 8 (50.0) 8 (50.0)
Others 3 2(66.7) 1 (33.3)
Unknown 3 0 (0.0) 2 (66.7)
Education No formal 15 7 (46.7) 8 (53.3)
level education
Primary school 56 18 (42.9) 24 (57.1)
Secondary 187 8 (50.0) 8 (50.0)
school
University/ 119 2 (66.7) 1 (33.3)
college
Unknown 2 0 (0.0) 2 (66.7)
Occupation Government 69 43 (62.3) 26 (37.7) 0(0.0)
servant
Private sector 47 20 (42.6) 27 (57.4) 0 (0.0)
Self-employed 98 44 (44.9) 53 (54.1) 1 (1.0)
Housewife 92 34 (37.0) 58 (63.0) 0 (0.0)
Students 11 3 (27.3) 8 (72.7) 0 (0.0)
Pensioner 62 32 (51.6) 30 (48.4) 0 (0.0)
Unemployed 1 0 (0.0) 1 (100.0) 0 (0.0)
aFisher’s exact test
161
DISCUSSIONS
All facilities recorded decreasing trends in partial prescriptions (partial filling of a
prescription) received before and during the Covid-19 pandemic. This finding is in
line with what has been reported earlier (10). The reduction trend can be partially
explained by patients’ responding to intensive communication; outreach efforts and
avoiding the risks of contracting COVID-19, Malaysian movement control (MCO),
and the stay at home directive in Malaysia (11).
District Health Offices in Langkawi showed major differences in total partial
prescriptions received between March-August 2020 as compared to previous
months because all chronic patients have their appointment rescheduled by
pharmacy units. Medications for chronic illness were supplied for two months, a
surplus from the normal one-month supply, resulting in lengthening the pharmacy
appointment. Consequently, a significant drop was seen in their total partial
prescriptions. Eleven out of twenty facilities show incremental trends of PVAS as
compared before the Covid-19 pandemic with PKD Kuala Muda recorded the highest
rise in PVAS which is 22,438. Some facilities started to introduce new PVAS such
as WhatsApp & Collect (W&C) after a pandemic which contribute to a further rise in
total PVAS in Kedah.
Meanwhile, the Integrated Drug Dispensing System (IDDS) or known as Sistem
Pendispensan Ubat Bersepadu (SPUB) showed the most popular PVAS that was
extensively used by all facilities throughout the study. This service is a nationwide
standard referral system allowing patients to get their refills from other preferred
MOH health facilities. This is to ensure the continuous supply of medicine to the
patients even though they stay far from their current treatment health facilities (12).
This might be due to IDDS being among the earliest PVAS introduced by the Ministry
of Health (MOH) to aid people in collecting their remaining medication supply. Thus,
it is well known among patients who have been using pharmacy services for quite
some time.
Slightly more than half of the respondents (n=203, 53%) were unaware of the
existence of PVAS before Covid-19. A non-parametric test was run on all
demographic data and showed abnormal distribution when compared with PVAS
existence knowledge. All demographic characteristics demonstrate non-significant
value between PVAS knowledge except for the occupational group.
In this study, we found that about 34.2% choose PVAS to avoid contact with
someone who is unknowingly positive for Covid-19. Besides, PVAS is much easier
and faster compared to the traditional dispensing system. Respondents also claimed
162
they started using PVAS after being recommended by the Pharmacists at the
counter. This was proved when more than half of the facilities displayed an
increasing trend of PVAS despite decreasing trends of partial prescriptions received.
In addition, about 97% of the respondents agreed to use PVAS to collect their next
medication supply because it benefited them in various ways. This finding
corroborated the findings of a previous study (13). They conducted the study in
Perak, Malaysia and found the majority of the respondents felt that PVAS had made
their life easier (290, 95.7%) and planned to recommend the pharmacy VAS to
others (292, 96.4%) (13).
Those participants from this study who refused to use PVAS on the next collection
preferred eye-to-eye interaction and claimed that the distance from home to the
hospital / District Health Office was quite close, thus it was easier for them to collect
the next medication supply. Ministry of Health (MOH) through Pharmacy Services
need to expand PVAS service since it benefits in many ways, especially during a
disaster such as a flood whereby a lot of people are unable to collect their medication
supply as usual. Pusat Pemberian Ubat Setempat (PPUS), part of PVAS enforced
by HSAH needs to be expanded to all facilities as a contingency plan in case of an
emergency situation such pandemic or disaster happens so that patients can have
continuous medication supply without fail.
CONCLUSION
Overall, more than half of the facilities show increasing trends in PVAS during Covid-
19. Some facilities started to introduce new PVAS such as WhatsApp & Collect
(W&C) after the pandemic, which contribute to a further raise in total PVAS in Kedah.
Slightly more than half of the respondents were unaware of the existence of PVAS
before the Covid-19 pandemic. More than half of the facilities show increasing trends
in PVAS during the Covid-19 pandemic. Pharmacists play major roles in introducing
new and current PVAS to patients so that patients are able to receive continuous
medication supply smoothly.
RECOMENDATION
These findings are useful for health managers to identify the next PVAS services
that can be offered and to facilitate the improvement in the current system so that
the PVAS system is not only useful during the Covid-19 period, it may as well be
used in other challenging situations such as during flood season where medications
supply are limited.
ACKNOWLEDGEMENT
The authors wish to extend their gratitude to the Pharmaceutical Services Division,
Kedah State Health Department and Head of Pharmacy Unit of Healthcare Facilities
163
in Kedah for giving full support and assistance in this research, and to all
respondents who participated in this study. The authors would like to thank the
Director General of Health Malaysia for his permission to publish this paper. and all
the individuals who had contributed to make this study a success.
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164
PUSAT PEMBERIAN VAKSIN (PPV) MEGA SPORTS ARENA
AMANJAYA TONGGAK IMMUNITI KELOMPOK KUALA MUDA
Suziana R.1, Norliza M.S.1*, Hafsah K.1*, Mahfuzah M.N.1, Azlina K1,
Shahed Pervez M.A.1, Ashiekin M.1, Sangkari R.1
1Pejabat Kesihatan Daerah Kuala Muda, 08000, Sungai Petani, Kedah.
*Corresponding author: Norliza M.S, Pejabat Kesihatan Daerah Kuala Muda, [email protected]
________________________________________________________________________________
ABSTRAK
Perlaksanaan Program Imunisasi Covid 19 Kebangsaan (PICK) telah dimulakan
pada Februari 2021 bagi mencegah penyakit Covid 19. Suntikan peringkat pertama
dimulakan kepada Petugas Barisan Hadapan bagi menghindari mereka mendapat
jangkitan penyakit tersebut dan memastikan system kesihatan dan keselamatan
berada pada tahap optima. PICK juga menlindungi populasi Malaysia yang berisiko
tinggi dari mortality dan morbidity akibat jangkitan Covid 19. Oleh itu PPV Mega
Sports Arena Amanjaya telah ditubuhkan supaya Program imunisasi Covid-19
Kebangsaan (PICK) ini perlu diselesaikan seawal mungkin bagi mencapai imuniti
kelompok bagi Daerah Kuala Muda khususnya dan Negeri Kedah amnya. Pada
peringkat perlaksaan suntikan kepada masyarakat hanya 3 PPV Awam sahaja yang
mampu beroperasi bermula April 2021 dengan kapasiti maksimum suntikan sehari
sebanyak 3000 dos. Keadaan ini akan melambatkan peratusan rakyat Kedah untuk
disuntik. Oleh tu, dicadangan bagi mewujudkan PPV Mega dengan kapasiti suntikan
sebanyak 5000 sehari yang diterajui oleh pihak swasta iaitu Protect Health
Corperation (PH Corp). Selaras dengan itu apabila kelulusan Amanjaya Sports
Arena sebagai PPV Mega telah diperolehi maka CITF daerah dengan kerjasama
padu dan jitu daripada Pejabat Daerah, Pejabat Kesihatan Daerah, Polis Diraja
Malaysia, Majlis Perbandaran Daerah Sungai Petani (MPSPK), Angkatan Tentera
Malaysia (ATM), Angkatan Pertahanan Awam Malaysia (APM), RELA, Jabatan Belia
dan Jabatan Bomba dan Penyelamat serta pihak ASASP telah bertungkus lumus
melaksanakan proses transformasi gelanggang futsal kepada PPV bagi
pengoperasian satu-satunya PPV Mega di Negeri Kedah. Terdapat halangan dalam
menjayakan transformasi ini tetapi berjaya diharungi dengan kerjasama pelbagai
pihak maka telah dirasmikan pada 6 Ogos 2021. Secara keseluruhannya, PPV Mega
Amanjaya Sports Arena telah beroperasi selama 55 hari bermula 6.8.2021 sehingga
29.9.2021 dan ditutup secara rasminya pada 30.09.2021. Sejumlah 172,246 vaksin
Pfizer dan 16,568 vaksin Sinovac telah diberikan. Keseluruhan pemberian vaksin
adalah sejumlah 188,814 (dos 1 dan dos 2) iaitu 170,714 kategori dewasa dan
18,640 kategori remaja.
Katakunci: Covid 19, Vaksin, PPV, PICK
165
PENGENALAN
Pelaksanaan Program Immunisasi Covid 19 Kebangsaan (PICK) telah bermula
pada Februari 2021 bermatlamat bagi melindungi petugas barisan hadapan
daripada jangkitan Covid 19 untuk memastikan sistem kesihatan dan keselamatan
pada tahap optima. Selain itu, objektif PICK juga adalah untuk melindungi populasi
Malaysia yang berisiko tinggi daripada mortaliti dan morbiditi akibat jangkitan Covid
19 serta mengawal penularan wabak dalam kawasan berisiko tinggi bagi
menghentikan penularan Covid 19 di kawasan wabak.
YAB Tan Sri Dato’ Hj. Muhyiddin Yassin melalui perutusan khas penjelasan
berkaitan pelaksanaan darurat pada 04.02.2021 telah menyatakan bahawa PICK
adalah program vaksinasi terbesar yang pernah di laksanakan di negara kita. Vaksin
Covid 19 adalah antara sinar harapan kita yang paling utama untuk kita menang
dalam perang melawan Covid 19. Justeru itu, seluruh rakyat Malaysia perlu
bersama-sama mengembeleng tenaga dan segala sumber yang ada untuk
menjayakannya.
KENYATAAN MASALAH
Bagi Daerah Kuala Muda, dengan populasi yang padat di mana penduduk Kuala
Muda merangkumi 20% populasi di negeri Kedah, ianya satu program yang sangat
mencabar untuk dilaksanakan kerana sasaran penduduk kategori 18 tahun dan ke
atas yang layak di suntik Vaksin Covid 19 adalah sebanyak 362,900 orang.
OBJEKTIF
Program imunisasi Covid-19 Kebangsaan (PICK) ini perlu diselesaikan seawal
mungkin bagi mencapai imuniti kelompok bagi Daerah Kuala Muda khususnya dan
Negeri Kedah amnya.
Program Imunisasi Covid-19 Kebangsaan (PICK) dilaksanakan secara berfasa iaitu
i) Fasa 1 - melibatkan petugas barisan hadapan
ii) Fasa 2 - golongan berisiko tinggi dan warga emas 60 tahun ke atas
iii) Fasa 3 - golongan dewasa 18 tahun ke atas
iv) PICK R - remaja berusia 17 hingga 12 tahun
v) PICK C - kanak-kanak berusia 11 hingga 5 tahun
166
PENUBUHAN JAWATANKUASA BERTINDAK
Rajah 1: Mekanisma Covid Imunisasi Task Force
Badan bertindak Jawatankuasa Covid 19 Immunisation Task Force (CITF) telah
diwujudkan di peringkat negeri dan seterusnya di peringkat daerah bagi memainkan
peranan untuk pelaksanaan PICK. Penubuhan Jawatankuasa PICK Pejabat
Kesihatan Daerah Kuala Muda (PKDKM) pada 04.02.2021 yang diterajui oleh Dr
Suziana binti Redzuan, Pegawai Kesihatan Daerah Kuala Muda merupakan PICK
terawal yang ditubuhkan sebagai pasukan bertindak untuk pelaksanaan vaksinasi di
daerah Kuala Muda. Taklimat kepada semua Ketua Jabatan di daerah Kuala Muda
telah dilaksanakan pada 16.02.2021.
PENUBUHAN PPV AWAM
Pada peringkat awal pelaksanaan, JK PICK PKDKM telah mengenal pasti sekurang-
kurangnya 20 lokasi sebagai Pusat Pemberian Vaksin (PPV) bagi daerah Kuala
Muda. Namun, berikutan kekangan beberapa faktor penubuhan PPV yang tidak
dapat dielakkan seperti ketiadaan kelulusan peruntukan untuk penyediaan peralatan
167
perubatan dan peruntukan yang terhad untuk peralatan bukan perubatan, hanya 3
PPV Awam sahaja yang mampu beroperasi bermula April 2021 dengan kapasiti
maksimum suntikan sehari sebanyak 3000 dos. Pengoperasian 3 PPV Awam ini
dapat dilaksanakan hasil daripada kerjasama pihak Pejabat Daerah Kuala Muda
(PKDKM), Jabatan Kebajikan Masyarakat (JKM), Angkatan Tentera Malaysia
(APM), Polis DiRaja Malaysia (PDRM), BOMBA, Angkatan Pertahanan Malaysia
(APM), Majlis Perbandaran Sungai Petani Kedah (MPSPK), Hospital Swasta dan
juga sumbangan daripada wakil-wakil rakyat, syarikat-syarikat persendirian serta
individu. Walau bagaimanapun, pemerhatian dan penilaian situasi oleh JK PICK
PKDKM telah mendapati liputan suntikan bagi daerah Kuala Muda berjalan dengan
sangat perlahan. Ini kerana pemberian vaksinasi dos 1 kepada populasi yang layak
dijangka selesai pada November 2021 berikutan kapasiti suntikan yang sedikit dan
bekalan vaksin yang tidak stabil pada ketika itu. JK PICK PKDKM telah
membangkitkan kebimbangan berkaitan isu ini kepada CITF daerah dan perkara ini
telah dipanjangkan kepada Pejabat Setiausaha Kerajaan (PSUK) Negeri Kedah dan
CITF Federal.
CADANGAN PENGLIBATAN SWASTA DAN PENGWUJUDAN PPV MEGA
Justeru itu, bermula Mei 2021, CITF daerah telah memohon penglibatan swasta bagi
melaksanakan pemberian vaksinasi dengan skala yang lebih besar sekaligus
mempercepatkan PICK daerah Kuala Muda. Pada ketika itu, cadangan bagi
mewujudkan PPV Mega dengan kapasiti suntikan sebanyak 5000 sehari yang
diterajui oleh Protect Health Corperation (PH Corp) telah diutarakan oleh CITF
daerah kepada CITF Federal. Sebagai langkah persediaan ke arah pembukaan PPV
Mega di Kuala Muda, satu sesi lawatan ke PPV Integrasi di Langkawi International
Convention Centre (LICC), Langkawi telah dibuat oleh Jawatankuasa CITF Daerah
bersama JK PICK PKDKM bagi mendapatkan gambaran sebenar dan maklumat
terperinci berkaitan proses vaksinasi berskala besar. Selepas beberapa siri
perbincangan pihak JK PICK PKDKM bersama CITF Daerah dan seterusnya
perjumpaan bersemuka bersama Menteri Besar Kedah, cadangan tersebut akhirnya
telah dipersetujui oleh pihak Kerajaan Negeri Kedah. Rentetan itu, melalui
kerjasama daripada Jabatan Kesihatan Negeri Kedah (JKNK), Majlis Keselamatan
Negara (MKN) dan CITF daerah, pihak JK PICK PKDKM telah membuat sesi
lawatan bagi mencari tapak yang sesuai sebagai pusat pemberian vaksin berskala
besar. Setelah menilai beberapa faktor yang melibatkan keluasan kawasan,
kemudahan dan keselamatan, akhirnya Amanjaya Sports Arena, Sungai Petani
(ASASP) telah dikenalpasti sebagai lokasi PPV Mega tersebut. Kelulusan untuk
menjadikan ASASP telah diperolehi seminggu sebelum tarikh cadangan
pembukaan. Iaitu pada 06.08.2021.
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TRANSFORMASI GELANGGANG FUTSAL AMANJAYA SPORTS ARENA,
SUNGAI PETANI KEPADA PPV MEGA
Selaras dengan kelulusan Amanjaya Sports Arena sebagai PPV Mega, CITF daerah
dengan kerjasama padu dan jitu daripada Pejabat Daerah, Pejabat Kesihatan
Daerah, Polis Diraja Malaysia, Majlis Perbandaran Daerah Sungai Petani (MPSPK),
Angkatan Tentera Malaysia (ATM), Angkatan Pertahanan Awam Malaysia (APM),
RELA, Jabatan Belia dan Jabatan Bomba dan Penyelamat serta pihak ASASP telah
bertungkus lumus melaksanakan proses transformasi bagi pengoperasian satu-
satunya PPV Mega di Negeri Kedah. Bermula dengan beberapa sesi perbincangan
dan mesyuarat oleh JK PICK PKDKM bagi penyediaan pelan lantai untuk
mengubahsuai gelanggang futsal berjaring kepada PPV Mega berkapasiti 5000
suntikan sehari, merupakan tugasan sukar untuk dilaksanakan. Pada peringkat ini,
JK PICK PKDKM berkampung beberapa hari di PKDKM bagi menilai, merangka
pelan susun atur setiap stesen, menyenaraikan semua keperluan peralatan
perubatan dan bukan perubatan, keperluan petugas kesihatan dan bukan kesihatan,
susun atur laluan keluar dan masuk (hanya ada satu laluan keluar masuk yang sedia
ada) dan keperluan kemudahan asas untuk petugas dan orang awam termasuk
kemudahan untuk OKU bagi melancarkan pengoperasian PPV Mega dengan
mematuhi SOP yang berkuatkuasa.
Selain itu, ASASP hanya mempunyai dua ruangan berhawa dingin yang boleh
dijadikan ruangan suntikan iaitu bilik khas senamrobik dan bilik mesyuarat ASASP
namun keluasan ruang adalah sangat terhad kerana bagi PPV Mega memerlukan
sekurang-kurangnya 15 bilik suntikan untuk menampung 5000 penerima vaksin
sehari. JK PICK PKDKM perlu merangka pengubahsuaian bilik tersebut sebagai bilik
suntikan. Cabaran berganda apabila pada peringkat awalnya, pihak ASASP tidak
bersetuju untuk jaring gelanggang futsal ditanggalkan kerana ianya melibatkan kos
yang tinggi dengan keadaan masa yang terlalu suntuk. Akan tetapi, JK PICK
bertegas untuk menanggalkan jaring gelanggang futsal untuk memaksimumkan
penggunaan setiap ruang kerana mengambil kira isu keselamatan, pengudaraan
dan keselesaan awam. Akhirnya dengan sokongan daripada CITF daerah, pihak
ASASP terpaksa akur dengan cadangan tersebut dan kerja menanggalkan jaring-
jaring telah diselesaikan dalam tempoh 24jam. Namun cabaran berterusan apabila
didapati skru jaring-jaring tersebut timbul di lantai dan dibimbangi boleh
mencederakan petugas dan orang ramai. Justeru kerja-kerja menampal skru
tersebut telah dilaksanakan serta merta.
169
Rajah 2: Gelanggang Futsal ditransformasikan Kepada PPV
SEBELUM SELEPAS
Rajah 3: Bilik Senamrobik Sebagai Bilik Suntikan
Setelah proses transformasi berjaya dilaksanakan, cabaran baru pula timbul kerana
persekitaran dalaman yang sangat panas di gelanggang tersebut berikutan
kekurangan kipas dan ketiadaan penghawa dingin. Ini sekaligus menyebabkan
keperluan peralatan semakin bertambah iaitu keperluan tambahan untuk kipas dan
air cooler. Pada ketika itu, cabaran semakin berat kerana tempoh masa persediaan
hanya tinggal 2 hari sebelum tarikh pembukaan di mana semua keperluan ini perlu
diadakan serta merta dan ianya semakin sukar kerana sumber kewangan yang
terhad.
Di samping itu, balai polis bergerak telah disediakan oleh PDRM Kuala Muda bagi
memastikan kawalan keselamatan dan kelancaran lalu lintas semasa vaksinasi
dilaksanakan. Pihak ASASP juga telah menyediakan 2 pengawal keselamatan yang
170
bertugas 24 jam sehari untuk bersama-sama membantu dari segi kawalan
keselamatan di PPV Mega.
Seterusnya proses menyusun atur peralatan berdasarkan stesen vaksinasi
mengikut keperluan PPV mega dengan kapasiti suntikan 5000 suntikan sehari
mengambil kira kesesuaian struktur dalaman gelanggang futsal dilaksanakan dalam
masa 24 jam sebelum pembukaan. Namun, hasil komitmen 100% dan usaha tanpa
kenal erti penat daripada semua pihak yang terlibat telah menjayakan
pengoperasian PPV Mega pada 06.08.2021 yang dirasmikan oleh YAB Menteri
Besar Kedah.
PENGOPERASIAN PPV MEGA
Rajah 4: Tadbir Urus PPV Mega Sports Arena Amanjaya
171
Dengan rasminya PPV Mega Amanjaya Sports Arena telah mula beroperasi pada
06.08.2021 seperti yang dirancang. Perlaksanaan pemberian vaksin di PPV Mega
adalah mengikut garis panduan Program Imunisasi Covid-19 Kebangsaan (PICK).
PH Corp telah melantik Poliklinik Hairuddin dan UNIklinik sebagai ‘health care
organizer’ (HCO) untuk melaksanakan pemberian vaksinasi Covid 19. Secara
keseluruhannya PPV Mega beroperasi secara dua shif dari pukul 8 pagi hingga 10
malam. Kapasiti suntikan adalah 5000 suntikan sehari. Selain HCO, JK PICK
PKDKM juga telah melantik dua pegawai perubatan daripada PKDKM sebagai
Pengurus PPV bagi menyediakan laporan harian dan sebagai coordinator kepada
kedua-dua HCO tersebut. Pengurus PPV ini juga bertanggungjawab untuk
memastikan kelancaran pelaksanaan vaksinasi.
CABARAN DALAM PENGOPERASIAN PPV MEGA
Walaupun PPV Mega telah bersedia untuk memberikan suntikan vaksinasi Covid 19
dengan kapasiti 5000 suntikan sehari namun pada peringkat awal operasi, daerah
Kuala Muda menghadapi isu bekalan vaksin yang tidak stabil menyebabkan
pemberian vaksin di PPV Mega Sports Arena Amanjaya hanya sebanyak 1500
sehingga 4000 dos vaksin pada 12 hari pertama pengoperasian. Justeru itu, CITF
daerah telah mengutarakan isu ini ke peringkat negeri kerana kegagalan
memaksimumkan kapasiti suntikan amatlah merugikan dan tidak berbaloi dengan
segala persediaan yang telah dilaksanakan merangkumi bayaran sewa premis,
bayaran petugas dan sewaan peralatan yang digunakan. Hasil desakan berterusan
daripada CITF daerah, akhirnya bekalan vaksin kembali stabil dan kapasiti
maksimum 5000 suntikan sehari telah berjaya dicapai.
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Walau bagaimanapun, ketika bekalan vaksin mencukupi bagi kapasiti 5000 suntikan
sehari, namun bermula 26.08.2021 kadar respon kehadiran penerima vaksin dari
senarai panggilan mysejahtera menurun dengan mendadak. JK PICK PKDKM telah
mengarahkan untuk satu pasukan task force dibentuk bagi mengenalpasti punca
situasi ini. Hasil kaji selidik yang dijalankan mendapati perkara ini disebabkan oleh;
Temujanji untuk penerima vaksin lewat diberi oleh mysejahtera
Kebanyakan senarai nama yang diberi temujanji oleh mysejahtera telah
disuntik di PPV lain, tetapi tidak mendapat sijil digital dan nama tidak
dikemaskini dalam senarai mysejahtera
Senarai nama yang sudah meninggal tidak dikemaskini dalam mysejahtera
Penerima vaksin tidak menyemak mysejahtera masing – masing
Penerima vaksin tidak setuju untuk menerima vaksin
Beberapa strategi telah dilaksanakan bagi memperbaiki keadaan antaranya :
‘Add vaccine’ untuk senarai menunggu bagi mereka yang belum mendapat
notifikasi my sejahtera
Mendapatkan Kerjasama pasukan data entry PICK PKDKM, Pejabat Daerah,
penghulu-penghulu Mukim dan wakil-wakil rakyat untuk mencari dan
mendapatkan senarai nama yang belum menerima temujanji atau belum
disuntik dari segenap pelusuk daerah.
Bekerjasama dengan PH Corp dengan cara ‘blast SMS’ melalui senarai nama
yang diterima daripada my sejahtera
Mendaftar penerima vaksin bukan warganegara melalui sistem HEROKUAPP
Membuka walk in secara berperingkat bermula pada 31 Ogos 2021, dimulakan
dari umur 40 tahun ke atas dan kemudian 18 tahun dan ke atas
Mewujudkan ‘helpdesk task force’ bagi menyelesaikan masalah sijil digital dan
menghubungi sebanyak yang mungkin penerima vaksin yang tidak hadir
temujanji
Walau bagaimanapun, akhirnya isu kemerosotan kehadiran penerima vaksin ke
PPV Mega telah dapat diatasi apabila pemberian vaksin kepada kanak-kanak dan
kumpulan remaja berusia 12 hingga 17 tahun (PICK-R) perlu dilaksanakan di daerah
Kuala Muda. JK PICK PKDKM telah mengesyorkan untuk pelaksanaan pemberian
dos 1 PICK-R dilaksanakan di PPV Mega serta PPV awam yang lain sekaligus
mempercepatkan aktiviti vaksinasi remaja di Kuala Muda.
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PELAKSANAAN PICK-REMAJA
PICK-Remaja telah bermula pada 16.9.2021 dengan menyasarkan pemberian
vaksin kepada kanak-kanak dan kumpulan remaja berusia 12 hingga 17 tahun
daerah Kuala Muda yang berjumlah 47,100 orang. Sehubungan dengan itu, PPV
Mega melaksanakan program PICK-R selama 7 hari dan berjaya memberikan
vaksinasi dos 1 kepada 18,640 remaja.
PENUTUP
Secara keseluruhannya, PPV Mega Amanjaya Sports Arena telah beroperasi
selama 55 hari bermula 6.8.2021 sehingga 29.9.2021 dan ditutup secara rasminya
pada 30.09.2021. Sejumlah 172,246 vaksin Pfizer dan 16,568 vaksin Sinovac telah
diberikan. Keseluruhan pemberian vaksin adalah sejumlah 188,814 (dos 1 dan dos
2) iaitu 170,714 kategori dewasa dan 18,640 kategori remaja.
RUMUSAN
Dengan kejayaan PPV Mega Amanjaya Sports Arena memberikan vaksinasi
sebanyak 188,814 (dos 1 dan dos 2) dalam tempoh 55 hari beroperasi, Daerah
Kuala Muda telah mencapai herd immunity lebih awal di mana pencapaian
keseluruhan liputan imunisasi adalah 291,758 (lengkap 2 dos) bersamaan 80.4%
pada 30.09.2021, berbanding hanya 68,958 (lengkap 2 dos) iaitu 19% pada
01.08.2021. Kesimpulannya, pengoperasian PPV Mega Amanjaya Sports Arena
yang merupakan satu-satunya PPV Mega di negeri Kedah adalah tonggak imuniti
daerah Kuala Muda khususnya dan negeri Kedah secara amnya. Kerjasama padu
dan jitu daripada semua pihak kerajaan dan swasta adalah faktor utama yang
menyumbang kepada kejayaan pengoperasian PPV Mega Amanjaya Sports Arena
seterusnya meningkatkan liputan imunisasi sekaligus membantu memerangi wabak
Covid-19.
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PSV IN KUALA MUDA: A SUCCESS STORY
Natrah N1, Siti Khadijah C.A1, Hidayati T.R1, Aizamin A1, Fatimah Azzahra
M.F1
1Pejabat Kesihatan Daerah Kuala Muda, 08000, Sungai Petani, Kedah.
Corresponding author: Natrah Nordin, Pejabat Kesihatan Daerah Kuala Muda, 08000, Sungai
Petani, Kedah, [email protected]
_______________________________________________________________________________
ABSTRACT
Pusat Simpanan Vaksin (PSV) Kuala Muda is one of three PSVs in Kedah assigned
by Ministry of Health to be responsible on receiving and distributing a safe and
effective Covid 19 vaccines throughout Kedah state. With the total number of
1,155,272 doses of several types of vaccines received, there have many challenges
and experience to get through. Starting from a training personnel on implementation
of National COVID-19 Immunization Programme to a distribution of vaccines and
their related consumables for vaccination centre, PSV had improved their skill and
knowledge as well. The challenges during implementation of the vaccination
programme are identified and strategized solutions were taken successfully. These
include challenges to improvise the facilities and capabilities, insufficient vaccine
stock, difficulties in supplying more frequent and small quantity of vaccines due to
stability of the product, increasing in types of vaccine caused insufficient storage in
PSV and opening of more PPV with high daily injection capacity. Alongside these
challenges, staff mobilization and multitasking, high stock holding and nearly expiry
vaccines are also addressed.
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INTRODUCTION
In response to Covid-19 pandemic, a few vaccines were allowed for emergency
used. This situation had highlighted the challenges by National Pharmaceutical
Regulatory Agency (NPRA) in getting safe and effective vaccines distributed in
Malaysia. A proper storage and distribution of the vaccines also need to be ensured
and equipped. Pejabat Kesihatan Daerah Kuala Muda has given a mandate to be
one of the three main PSVs in Kedah State besides PSV PKD Kota Star and PSV
Langkawi. PSV plays an important role not only as a centre for vaccine distribution,
but also needs to ensure that the vaccines and their related consumables are
handled in compliance with the standard of procedures and guidelines during
receiving, storing, distributing, recording, reporting, and documenting. Pharmacy
programme is the main unit to accomplishing the roles of PSV in PKD Kuala Muda.
Though pharmacy has known their capabilities in procuring hundreds of stocks
including cold chains items such as vaccines and insulins, handling Covid-19
vaccines during the National COVID-19 Immunization Program (PICK) possessed
many hurdles and challenges. Thus, we would like to share our success stories as
one of the PSVs in Kedah State.
CHALLENGES AND ACTIONS TAKEN IN PSV KUALA MUDA
Improvised The Facilities and Capabilities
With the conditional approval of Pfizer BioNTech Vaccine by the NPRA on the 8th Of
January 2021, the first vaccine received at PSV Kuala Muda was on 24th February
2021 with the quantity of 4,680 doses. This vaccine needs to be stored in special
equipment Ultra Low-Temperature Fridge (ULTF) with the storage temperature is
within -75⁰ C to -90⁰ C. Previously, PSV Kuala Muda has not equipped with this
ULTF as well as enough top loading refrigerators to store undiluted, thawed vaccine
at 2⁰ C to 8⁰ C.
Before the first supply of the vaccines, the first step was to ensure our PSV had a
proper and sufficient storage equipment in PKD Kuala Muda. With collaboration
among Pharmacy Programme in Jabatan Kesihatan Negeri Kedah (JKNK) and
Ministry of Health (MOH), we received one ULTF which has been placed at Stor
Vaksin on the 8th of Feb 2021. Since the number of vaccines received was limited
and this high value item was stored, the security of this PSV needs to be improved.
Thus, Stor Vaksin has been installed with 3 channel CCTVs with an extra monitoring
and guarded by police and army. To ensure a smooth process of vaccine receiving
and distributing, we ensured enough barcode scanners and smartphones to be used
with Vaccine Management System (VMS) are provided by MOH.
Handling Covid-19 vaccines involved the use of a new tracking system which was
VMS. This system was very new to us. Previously, only two systems were used such
as Pharmacy Inventory System (PhIS) and e-Perolehan. In order to received
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vaccines direct from manufacturers mainly from Belgium, VMS was used to get lot
release approval from NPRA within one hour of receiving the stock. Any issue
encountered, the stock needs to be quarantined and resolved before the lot can be
distributed. Thus, the staff needs to be trained using this new system with proper
receiving process. For PSV Kuala Muda, we only have two pharmacists who have
undergone online training organized by the MOH. Since the training was done
virtually and the ULTF is a new equipment, we did the hands-on training and a
session of simulation training before we received the first shipment of the vaccine.
PSV Kuala Muda was responsible to cater the distribution of vaccines to four districts
in Kedah including Baling, Sik, Kulim dan Bandar Baharu. At the early phase and
with limited experience, we need to supply 24 PPVs under our PSV. However, this
does not hinder us from trying our best and learning by experience to ensure all the
processes of receiving the shipment from the manufacturer, storing, and distributing
the vaccines were well organized and followed the correct standard operating
procedures stated by the authority.
In addition, receiving Pfizer vaccines in a special thermal shipping container and
maintaining ultra-cold temperatures gave another challenge to us. The manufacturer
shipped the Pfizer vaccine in a special thermal shipping container and used the dry
ice to maintain the storage condition at an ultra-low temperature between -90C and
-60C. This shipping container was quite heavy, bulky, and required to follow the
necessary steps to unpack the box to keep it in good condition before returning the
box to the supplier. Furthermore, we must limit the number of ULTF door open as
the temperature will increase abruptly and be time-consuming to get it back to its
temperature target range.
We found it difficult to load a large quantity of stock with the current number of four
pharmacists from Unit Farmasi Logistik (UFL), thus we decided to mobilise three
pharmacists from KK Bandar Sungai Petani (KKBSP) to the UFL team. With
additional staff, the process of receiving and documenting stock would be faster
particularly during large quantity shipment days. For example, on 19 August 2021,
we received 81,900 doses of Pfizer vaccine, so we managed to complete all the
processes of unpacking the thermal shipping containers. The processes include
checking the temperature of the thermal shipping container by using controlant
temperature monitoring device provided, tagging each of the vaccine tray with VMS
barcode and placing all the vaccine trays into the ULTF freezer within five minutes
as stated in the requirement.
As the number of shipments increased and more vaccines were included in the PICK
program, we need a bigger storage capacity. PSV Kuala Muda did receive several
177
top-loading refrigerators to store the vaccines, however, these refrigerators are
unable to be kept in one place due to limited space and power supply. Thus, these
refrigerators have been placed at different health clinics. The number of PSVs in
PKD Kuala Muda was increased from one to six PSVs to improve the receiving and
distribution of vaccines throughout the Kuala Muda District. PSV for Pfizer BioNTech
vaccine was assigned at Stor Vaksin(PKD Kuala Muda), Sinovac (KK Bandar Sg.
Petani, KK Taman Intan, KK Bedong, KK Kota Kuala Muda, KK Merbok), Astra
Zeneca (KK Taman Intan) and CansinoBio (KK Bandar Sg. Petani, KK Bedong).
Insufficient Stock
Another challenge that we faced during the initial implementation of PICK was the
limited supply of the Pfizer vaccine. The quantity of vaccine allocated for Kedah was
divided by the state level committee, then further divided to 24 PPVs under PSV
Kuala Muda to ensure enough vaccine to inoculate the frontliners. There were times
when the details on the quantity of vaccine received were kept changing, which
changes the amount of vaccine to be distributed to the other PPV. Besides, we also
need to deal with the police to ensure the security of vaccines during transportation.
This is where the good communication between the pharmacists in all PSVs and
PPVs played an important role to overcome this issue. Our communication and
discussion regarding vaccines management were beyond normal office hours. The
continuous and full commitment showed by our team helped to reduce the
information gaps and we managed to receive 3,510 vials, equivalent to 21,060 doses
to vaccinate our frontliners in Phase 1. And as the number of vaccines received
increased steadily, the quantities for all PPVs were enough to cater to the demands.
More Frequent and Small Quantity Supply
Before the U.S. Food and Drug Administration has revised and authorized the new
storage and stability of undiluted and thawed Pfizer vaccine for up to one month, the
earlier recommendation was only five days stored in the refrigerator at 2C to 8C.
This complicated the allocation and distribution process since the PSV need to
ensure the correct amount of stock was taken out from the ULTF. Overestimation
quantity of vials taken out leads to the risk of an expired items after 5 days and
underestimating the quantity will affect the vaccination process because the frozen
vaccine requires a minimum of four hours to thaw before it can be administered.
Providentially, we managed to handle this problem with frequent and small quantity
supply of stock. Even though this process increased the workload of both parties,
but we reduced the risk of wasting expired stocks in our PSV. We also applied this
frequent and small quantity supply at the time we have nearly expired items.
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Increase in Types of Vaccine Caused Insufficient Storage
From June to August 2021, Kuala Muda became one of the districts with the highest
number of new Covid-19 cases daily. As the number of positive cases increases
rapidly along with a high number of deaths, the authority accelerated the vaccination
program by increasing the number of PPVs and increased the amount and different
types of vaccines. As we all know the vaccine is extremely temperature sensitive. A
proper storage and handling method must be complied with to ensure the right
quality of vaccine is well preserved. Increased in the number and type of vaccines
have caused insufficient storage in top-loading. Storage remains a critical challenge
at the national and state levels.
There was an increase in stock for Coronavac Vaccine and the arrival of a new
vaccine which was Covid-19 Vaccine (ChAdox-S recombinant) solution for injection
by Astra Zeneca on 28th May 2021. The first shipment received was 20 vials which
equal to 240 doses. We started to receive the Astra Zeneca vaccine in large amounts
on 5th August 2021. We received 2000 vials of vaccine equivalent to 24,000 doses.
Assigning one PSV for one type of vaccine seems not suitable anymore because we
need larger storage capacity, some PSVs required more than one brand and
different quantity of each vaccine received.
Furthermore, a certain type of vaccine requires more space than others. For
instance, the pre-filled syringe for Coronavac was a single-dose vial and bulky. This
requires more space for their storage. To overcome this situation, more PSVs was
established to store the Coronavac vaccine. We optimized the storage capacity of
all PSVs, and we made it as follow:
Unit Farmasi Logistik - Pfizer
Klinik Kesihatan Bandar Sungai Petani - Pfizer, Sinovac, Cansino
Klinik Kesihatan Taman Intan - Sinovac, Astra Zeneca
Klinik Kesihatan Bedong - Astra Zeneca, Sinovac
Klinik Kesihatan Kota Kuala Muda - Sinovac
There was once, we received extra 200 trays of Comirnaty vaccine, and our storage
capacity had reached full capacity. We overcome this issue by temporarily storing at
Hospital UiTM Puncak Alam facility as they have an extra ultra-temperature fridge.
Upon handling different brands of vaccine and their nature, we keep updating our
information to our PPV provider, ensuring everyone aware of the type of vaccine that
they are receiving (i.e brand, storage temperature, multiple dose). Apart from that,
we guided them on good practice in handling cold chain products, dilution protocol,
the maximum duration for the diluted vaccine, and missing dose.
We stored different brands of vaccines and different multiple doses at different top-
loading fridges to avoid confusion. We tagged each box of the different batch of
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vaccines with a different colour stickers to allow the identification process to run
smoothly.
Opening of Public PPV with High Daily Injection Capacity
Beside an increasing the number of vaccines, the Covid-19 Immunization Task
Force (CITF) committee had increased the number of PPV in Kuala Muda. Dewan
Kenangan was the first public PPV embarked in Kuala Muda. The PPV started on
11th April 2021 with capacity of 600 doses daily as initially to 1,200 doses per day.
This was followed by PPV Pusat Latihan Anti Dadah Kebangsaan (PLAK) that
started on 1st June (600 to 800 doses per day) and PPV Gurun Jaya on 4th July 2021
(1,000 doses per day). The rest of PPVs established were Klinik Kesihatan Merbok,
Klinik Kesihatan Kota Kuala Muda, Klinik Kesihatan Bukit Selambau and Klinik
Kesihatan Sungai Lalang. Each PPV having their own PSV where PPV Dewan
Kenangan was cater by PSV KK Bandar Sg. Petani, PPV PLAK by PSV KK Taman
Intan and PPV Gurun Jaya by PSV KK Bedong.
Four new PPVs were set up in addition to available PPV public and their PSVs were
assigned, namely:
PPV Outreach – This type of PPV covers elderly at Home Care, bed-ridden
individuals, and people in the rural area who are having transport problems. The
supply of vaccines and related consumables was catered by PSV KK Bedong
Private PPV – PPV General Practitioner (GP) and PPV Private Hospital – This
type of PPV was listed under Protect Health, where there 33 GP clinics and 3
private hospitals around PKD Kuala Muda were involved. Daily injection capacity
of the total these PPVs was 1,200 doses daily (PSV KK Bandar Sg. Petani).
Public-Private PPV - i) PPV Mega – This type of PPV acts as the main vaccination
that provides 5,000 vaccines doses on daily basis (PSV Stor Vaksin) and ii) PPV
Integrasi 2,000 doses daily (PSV KK Bandar Sg. Petani)
PPV Industry (PIKAS) - This type of PPV covers individuals at the factory and
industrial areas cater 1,800 doses daily (PSV KK Kota Kuala Muda)
With the increased in the number of PPVs, the supply of vaccines by PSVs also
increased. This greatly increases the workload of pharmacists at PSV. Pharmacists
as one of the frontline healthcare workers not only busy with routine works providing
service to the patient but also entrusted with the responsibility to provide an
uninterrupted supply of vaccines to PPVs.
As PSV KKBSP having more PPVs to handle which were 37 centres, we formed a
group of five pharmacists to perform every task dealing with the vaccine – receiving
the vaccine, storing the vaccine, allocating vaccine, and distributing vaccine for the
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vaccination center. Initially, we were having difficulty in ensuring a smooth process
during handling vaccines. As time passed, we were able to cultivate standard
operating procedures (SOP) for every step mentioned earlier. With a proper
workflow, we were able to shorten the time in process of receiving the vaccine and
the process of preparing the vaccine for distribution.
Staff Mobilization and Multitasking
Pharmacy experienced a shortage in the workforce due to staff mobilization during
the period of increased in Covid-19 cases in Kuala Muda. Several pharmacists have
been deployed and mobilized to Bilik Gerakan as investigation officer to investigate
the positive cases of Covid 19. Some pharmacists were assigned to assist the work
in Covid-19 Assessment Centre (CAC) as well as to assist data entry in Sistem
Informasi Makmal Kesihatan Awam (SIMKA). The remains needed to operate the
daily clinics with doubled workloads. Majority of staff involved in this mobilization was
from KK Bandar Sg. Petani.
Ideally, we need to allocate a minimum of 14 staff to run the pharmacy counter and
a minimum of 2 staff for vaccine every day to run smoothly. Every pharmacist has
multiple roles and portfolios. All the portfolios need to be performed on a routine
basis despite understaffing conditions. This required our staff to juggle multiple
responsibilities while at the same time entertaining a newly added portfolio related
to COVID-19.
During the critical moment of understaffing, we established a value-added service,
name Leave and Collect for refill prescription. All the refill prescriptions had a
separate number and the patients needed to leave their prescription and collect their
medication in the evening. This reduced the crowd at the waiting area and allowed
physical distancing between the patients. Only new prescriptions were proceeded
immediately and dispensed at the time. This in a way helped us to optimize the
remaining staff, allowing us to multi-tasking and performed the vaccine-related task
without affecting services at the counter.
In UFL, pharmacists who were involved in the vaccine-related task are also in charge
of the procurement process for drug and non-drug supply for PKD Kuala Muda. They
also involved in management of Personal Protective Equipment (PPE) procurement
and had been mobilized to CAC when needed. Furthermore, the vaccines supplied
were also included with Low Dead Volume syringes, needles, diluents, and
vaccination cards. All these items need to be processed, handled, and distributed as
well during this entire new challenge. Although time was constrained and the
workload was high, with time and experience being built repetitively, we managed to
handle the situation gradually.
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High Stock Holding and Nearly Expiry Vaccines
The vaccines management during PICK was different compared to the National
Immunisation Program to prevent 13 types of vaccine-preventable diseases such as
Hepatitis B, Diphtheria, etc. This is because it involves a large number of populations
in a short time. During the early stage of Phase 3, we faced a problem of inadequate
vaccines to supply to PPVs. The vaccination rate at that particular time was slow.
Therefore, our capacity of storage was underutilized.
However, as the population has reached beyond 80% completed vaccination, there
was an issue with overstocking and nearly expiring vaccines. Top management had
encouraged all PPVs to allow walk-in, offer vaccination for foreigner and refugees
population, executed more outreach programs to reach the unreachable community
(e.g bed-ridden individuals, disabled person, nursing homes, rural areas), and
exchanged the nearly expired vaccines with other PSV.
When PICK becoming laggard, the response rate in PPVs were decreased. PSV
cannot rely on the full capacity of PPVs needs. Thus, the total of doses received and
to be issued to the PPVs has been re-estimated and need to be prepared the stocks
accordingly. Besides that, majority of PPVs reported having problems in finishing
their vaccines stocks. At this stage, we cut down the number of vaccines supply to
the PPVs while maintaining the total number of PPVs.
In early of November 2021, nearly three months of stock was kept in our PSV without
any vaccination plan after PICK-Adolescent ended. There are vaccines kept with
expiry date within one to two months. Preventive action needed to be done. PSV
played a major role in offering and suppling nearly expired vaccine to other PSVs
throughout Kedah and other states including Selangor, Penang, Negeri Sembilan
and Pahang after an announcement by MOH regarding PICK-Booster
implementation. Stock holding in PSV Kuala Muda was managed to cut down from
2.45 months to 0.97 month with a total of 95,940 doses of Pfizer expiring from
27.11.2021 to 11.12.2021 was completely distributed by the end of November. Not
long after that, MOH had announced to extend the expiry date of Comirnaty and
Sinovac, which helps in reducing the number of wastages.
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Table 1: Stock Balance, Stock Usage Per Month And Stock Holding Of Comirnaty
Within Immunization Phase And After Preventive Action Taken
Immunisation Phase year 2021 After
preventive
Pfizer stock status action taken
(Comirnaty) Phase 1 Phase 2 Phase PICK-A PICK-A End of Nov.
Feb - Mar Apr-June 3 Jul- Oct Nov 2021
Sept
Stock balance (vials) 783 2,145 36,043 35,882 30,484 17,972
Stock usage per month (vials) 1,345 6,371 41,945 27,536 12,455 18,482
Stock holding (month) 0.58 0.34 0.86 1.30 2.45 0.97
CONCLUSION
The journey from vaccines distributions to achievement of Kuala Muda herd
immunity against Covid-19 presents significant challenges that require collaborative
responses. Despite the great success in assuring safety and efficacy of vaccines
distribution, there are many challenges ahead for achieving targeted group for
vaccination in future. This vaccination programme was a great success as all the
difficulties were overcome with cooperation from many sectors. As a result, the
majority of the targeted groups in Kuala Muda have received vaccination against
Covid-19. We will continue to work hard in the fight against Covid-19 to ensure that
everyone is safe during this pandemic.
ACKNOWLEDGEMENT
The authors would like to thank the Director General of Health Malaysia for his
permission to publish this paper.
REFERENCES
The Secretariat of the Special Committee for Ensuring Access to Covid-19 Vaccine Supply
(JKJAV). National COVID-19 Immunisation Programme,. 2021.
Program Perkhidmatan Farmasi KKM. Garis Panduan Pengurusan Produk Vaksin
Covid-19 di Fasiliti Kesihatan. 2021.
Website: https://www.npra.gov.my/easyarticles/images/users/1047/FAQ-
Comirnaty-English_29102021.pdf
Surat Pekeliling Ketua Pengarah Kesihatan bil 4/2021: Pelaksanaan Program
Imunisasi Covid-19 Kebangsaan, 3 Mac 2021.
Code Blue Phase Two Covid-19 Vaccine Registrations Hit 32% Of Target (2021)
Available At: Https://Codeblue.Galencentre.Org/2021/05/06/Phase-Two-
Covid-19-Vaccine-Registrations-Hit-32-Of-Target/ (6 May 2021)
Subramanian, L. and Nayler, J. (2021). Africa’s Covid-19 Vaccine Supply Chain and
Logistics Readiness. Pamela Steele Associates Ltd.
National Covid-19 Immunisation Programme, JKJAV. (18 february 2021)
183
FACTORS ASSOCIATED WITH MATERNAL COVID-19 IN KULIM
DISTRICT, KEDAH.
Nurul Afzan Aminuddin1* , Siti Noor Khamariah Ramli1, Dyana Nabila Mohd
Nasir1, Shakirah Ismail1, Alias Abdul Aziz1
1Kulim District Health Office
*Corresponding author: Nurul Afzan Aminuddin, Kulim District Health Office, [email protected]
ABSTRACT
Background: The ongoing pandemic of coronavirus disease 2019 (COVID-19) has
caused serious concerns about its potential adverse effects on pregnancy. There
are limited data on factor associated with maternal COVID-19. The goal of the
current study was to determine the factor associated with COVID-19 among antennal
and postnatal mothers in Kulim District Kedah.
Methodology: This is an un-matched case-control study involving seven 7 maternal
and child health clinics in Kulim District, Kedah between Jun 2021 and Dec 2021. A
total of 140(70 mothers with COVID-19 and 70 mothers without COVID-19) were
included in the study sample. The primary outcome measured was COVID-19
occurrence among mothers attending maternal health care services.
Results: Mothers who are infected with COVID-19 had a higher mean age [30.29
(SD±5.229) years] compared to mothers without COVID-19 [28.06(SD±4.329)
years]. The odds of having COVID-19 are higher among non-Malay mothers
(adjusted OR 5.148; 95% CI: 1.020–25.991; p–value 0.027) and mothers who were
not received COVID-19 vaccination (adjusted OR 8.274; 95% CI: 0.928–73.738; p–
value 0.022).
Conclusion: Mothers who were not received COVID-19 vaccination are significantly
associated with COVID-19 infection. Therefore, mothers benefit greatly from
COVID-19 vaccination and should be encourage to do so .Identifying targeted
groups will be useful for designing prevention strategies for COVID-19 pandemic.
Keyword: COVID-19, maternal, antenatal, outcome, vaccine.
184
INTRODUCTION
Coronavirus disease 2019 (COVID-19), which is a highly infectious viral infection
triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
has had a disastrous effect on the world's demographics, resulting in millions of
deaths worldwide, and found itself as the most serious global public health crisis.
COVID-19 is a newly emerged respiratory illness that spread in 210 countries of the
world and declared as pandemic by the World Health Organization (WHO). As of 26
December 2021, over 278 million cases and just under 5.4 million deaths have been
reported globally(World Health Organization, 2021).
From March 2020 to June 2021, 3,396 COVID-19 cases were reported among
pregnant women in Malaysia. It is estimated that almost 1% of pregnant women in
Malaysia are infected with COVID-19 (Ministry of Health Malaysia, 2021). Non-
pharmaceutical interventions such as social distancing, hand hygiene, and mask use
together with effective vaccination are critical in slowing the spread of COVID-19 is
ultimately necessary to control this global pandemic(Lerner, Folkers, & Fauci, 2020).
Malaysia has increased its vaccination rate in response to the ongoing COVID-19
pandemic, where 78.6% of the population has been fully vaccinated as of 18 January
2022 (MInistry of Health Malaysia, 2022).
Pregnant women are more susceptible to COVID-19 complications due to the
gestation related physiological and immunity changes (Ellington et al., 2020; Mertz,
Lo, Lytvyn, Ortiz, & Loeb, 2019). The Centre for Disease Control and Prevention
(CDC) reported that pregnant women with COVID-19 infection were more likely to
be hospitalized, admitted to intensive care units, and require ventilator support
(Ellington et al., 2020). Pregnant women are also at risk for preterm birth, which can
have significant long-term adverse impacts on the lifelong health of the maternal and
child.
In a recent report that included 400,000 women of reproductive age, pregnant
women with COVID-19 were found to be more likely than non-pregnant women to
be admitted to the intensive care unit, receive extracorporeal membrane
oxygenation, and die (Zambrano et al., 2020). A study in United State found that,
ethnicity contributed toward significant risk toward COVID-19 infection and severe
disease(Ellington et al., 2020; Zambrano et al., 2020). There are no significant
differences between the age groups of pregnant mothers, but they are at a very high
risk of contracting COVID-19 with existing comorbidities(Ellington et al., 2020).
However, to the best of our knowledge, there is limited study published on maternal
factors associated with COVID-19 in Malaysia. Therefore, the aim of this study is to
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compare the maternal characteristic among antenatal and postnatal mothers with
COVID-19 and without COVID-19.
METHODOLOGY
This observational unmatched case-control study was conducted among mothers
who attended antenatal and postnatal care at seven health centers in Kulim district
from Jun 2021 until December 2021. Seventy mothers who contracted COVID-19
and 70 without COVID-19 were enrolled in the study. All mothers were Malaysian
citizens attending services at Maternal and Child Health (MCH) Clinics in Kulim
District. The individual from both groups were randomly selected from the name list
of mothers at MCH clinics; with positive COVID-19 for the case, and negative
COVID-19 for the control in this study. The diagnosis of COVID-19 was based on
laboratory-confirmed cases.
Study population information including demographics(race, religion, occupation,
husband occupation, education), undelying medical and obstetrics
history(comorbidity,parity), COVID-19 vaccination, COVID-19 infection status and
pregnancy outcome was gathered through medical records and administrative data.
The data was then compiled into Excel files. The minimum sample size was
calculated based on the formula for case-control studies by Fleiss (Jung et al.,
2020)], with a power of 80% and a confidence interval (CI) of 95%. A minimum of
140 samples were obtained.
Primary Outcome
The primary outcome measured in this study was the Covid-19 occurrence among
mothers from Jun 2021 until December 2021 in Kulim District.
Secondary Outcomes
The characteristics of COVID-19 occurrence among cases such as the pregnancy
phase categorized were antenatal and post natal. The severity of COVID-19 was
categorized into five; no symptoms, mild symptoms, with pneumonia, with
pneumonia and requiring oxygen therapy, and critical and requiring assisted
ventilation. The level of care was categorized into four; low-risk quarantine &
treatment centre, in ward hospital admission, ICU admission and Covid Assessment
Centre with home quarantine. Maternal was categorized into dead and alive. The
fetal outcome was categorized into dead, alive and miscarriage.
Independent Variables
The independent variables in this study include sociodemographic characteristics
(age, race, religion, occupation, husband occupation, education level), parity,
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COVID-19 vaccination status, type of vaccine and maternal comorbid status. At the
time of recruitment, age was defined (in years) based on the date of birth and
categorized into 19 years old and less, 20-34 years and 35 years old and more.
Ethnicity was categorized and recoded into Malay, Chinese, Indian and others
according to major ethnicities in Malaysia. Religion was categorized into Muslim and
non-Muslim. Occupation was categorized and recoded into employed and
unemployed. Education level was categorized into primary/secondary and tertiary.
COVID-19 vaccination status was categorized into completed and not completed.
Type of vaccine was categorized into Pfizer and AstraZeneca/Sinovac. Comorbid
status was categorized into Diabetes Mellitus(DM)/Gestational DM, anaemia,
obesity, others and no underlying comorbidity.
Data Analysis
Data were managed and recorded in Excel spreadsheets. The data was then
transferred and analyzed using IBM Statistical Package for Social Sciences (SPSS)
version 22 software. Univariate descriptive analysis was performed by using
frequency (n) and percentage (%) for categorical data, mean and standard deviation
(SD) for normally distributed continuous data, and median and interquartile range
(IQR) for not normally distributed continuous data. Data exploration was performed
to assess the pettern of quantitative data distribution by using Kolmogorov–Smirnov
test, mean, median, mode, skewness and kurtosis values. Simple logistic regression
was used for bivariate analysis.The variable(s) from the simple logistic regression
analysis with p < 0.25 was further analysed using multiple logistic regression to
control for potential confounders. Two-sided p < 0.05 were considered statistically
significant.
RESULTS
Characteristics of study population
Maternal characteristics of the 70 cases with COVID-19 and 70 un-matched controls
without COVID-19 who met the eligibility criteria for the study are shown in Table 1.
Mothers who are infected with COVID-19 had a higher mean age [30.29 (SD±5.229)
years] compared to mothers without COVID-19 [28.06(SD±4.329) years]. The
majority of the study population are aged between 20 to 34 years old (81.4%), Malay
(89.3%) and Muslim (89.3%), employed (50.7%), attained a minimum of
primary/secondary education (60.0%), vaccinated against COVID-19 (91.4%) and
with no underlying comorbid (60.0%).
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Table 1: Characteristics of the study population
Characteristic COVID-19 Non-COVID-19 N(%) P-
value
Age n (%) n (%)
Mean 30.29 Mean 28.06 0.011
Parity (Min 16; Max 41, (Min 19; Max 41,
SD±5.229) SD± 4.329) 0.183
Age groups
≤19 years 1.47 1.15
20-34 years (Min 0; Max 4, (Min 0; Max 6,
≥35 years
Race S.D 1.191) S.D 1.366)
Malay
Non-malay 2 2.9 2 2.9 4(2.9) 0.373
Religion 54 77.1 60 85.7 114(81.4)
Muslim 14 20.0 8 11.4 22(15.7)
Non-muslim
Occupation 58 82.9 67 95.7 125(89.3) 0.014
Employed 12 17.1 3 4.3 15(10.7)
Unempoyed
Husband 58 82.9 67 95.7 125(89.3) 0.014
occupation 12 17.1 3 4.3 15(10.7)
Employed
Unempoyed 31 44.3 0.128
Single mother 39 55.7 40 57.1 71(50.7)
Education level 30 42.9 69(49.3)
Primary/secondary 69 98.6
Tertiary 0 0.0 70 100.0 139(99.3) 0.238
COVID-19 1 1.4 0 0.0 0(0.0)
vaccination status 0 0.0 1(0.7)
completed 41 58.6
Not completed 29 41.4 43 61.4 84(60.0) 0.730
Type of COVID-19 27 38.6 56(40.0)
vaccine 59 84.3
Pfizer 11 15.7 69 98.6 128(91.4) 0.003
AstraZeneca/Sinovac 1 1.4 12(8.6)
Comorbid 53 89.8
DM/GDM 6 10.2 53 76.8 106(75.7) 0.052
Anemia 16 23.2 22(15.7)
Obesiti 21 30.0
Others 3 4.3 15 21.4 36(25.7) 0.007
No comorbid 5 7.1 3 4.3 6(4.3)
7 10.0 0 0.0 5(3.6)
34 48.6 2 2.9 9(6.4)
50 71.4 84(60.0)
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Factors associated with maternal COVID-19 in Kulim District, Kedah.
Table 2 shows the factors associated with maternal COVID-19 in Kulim District,
Kedah. Simple logistic regression analysis indicated eight variables with p < 0.25,
which were included in the multiple logistic regression analysis. Adjusted analysis
showed that mother who are non-Malay and did not received COVID-19 vaccine had
higher odds for Coronavirus Disease 2019 (COVID-19) compared to Malay ethnicity
and mother who had received COVID-19 vaccine.
Table 2: Factors associated with maternal COVID-19 in Kulim District, Kedah
Factors (n=140) Crude 95% CI p- Adj. 95% CI p-
ORa value ORb value
Age (years) 1.090 (1.018;1.166) 0.010 (0.992;1.155) 0.075
Parity 1.216 (0.911-;1.624) 0.179 1.071 NS
Race NS
Non-Malay 4.621
Malay 1.000 (1.243;17.178) 0.011 5.148 (1.020;25.991) 0.027
1.000
Religion 4.621 (1.243;17.178) 0.011 NS NS
Non-muslim 1.000 (0.860;3.272) 0.128 NS NS
Muslim
Occupation 1.677
Unempoyed 1.000
Employed
COVID-19 12.864 (1.613;102.603) 0.001 8.274 (0.928;73.738) 0.022
vaccination 1.000 1.000 NS NS
No (0.969;7.340) 0.047
Yes 2.667 NS NS
1.000 (0.932;4.550) 0.010
Type of COVID-19 (1.466;13.279)
vaccine 2.059
Pfizer 4.412
AstraZeneca/Sinovac 1.000
Comorbid
DM/GDM
Others
No comorbid
aCrude odd ratio using simple logistic regression; bAdjusted odd ratio (multiple logistic regression
using Backward likelihood method, Hosmer and Lemenshow test p-value 0.334 , Nagelkerke R2=
17.4%); 1= reference, NS=not significant
Covid 19 infection characteristic and pregnancy outcome
The majority of COVID-19 among the sample population occurred during the
antenatal phase (90.0%) with a median period of gestation: 25.50, category 2
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(58.6%) and received care at Covid Assessment Centre and home quarantine
(57.1%). There was 7.1% maternal mortality,10% fetal death and 1.4% miscarriage
among the case group.
Table 3: COVID-19 infection characteristic and pregnancy outcome
Characteristic COVID-19 (n=70)
n (%)
POG covid infection occurence Median: 25.50
(Min 9; Max 39, IQR; 15)
Pregnancy phase
Antenatal 63 90.0
Postnatal 7 10.0
Severity of COVID-19
Category 1 15 21.4
Category 2 41 58.6
Category 3 2 2.9
Category 4 5 7.1
Category 5 7 10.0
Level of care
Low risk quarantine & treatment centre 6 8.6
In ward hospital admission 18 25.7
ICU admission 6 8.6
Covid Assessment Centre with home quarantine 40 57.1
Maternal outcome
Died 5 7.1
Alive 65 92.9
Fetal outcome
Died 7 10.0
Alive 62 88.6
Miscarriage 1 1.4
DISCUSSIONS
This study discovered notable findings regarding maternal characteristics who
contracted COVID-19 in Kulim District, Kedah. Mothers who are infected with
COVID-19 had a higher mean age [30.29 (SD±5.229) years] compared to mothers
without COVID-19 [28.06(SD±4.329) years]. This result is in line with previous
studies which reported that pregnant mothers with COVID-19 had a mean age
[30.97(SD ±4.13)] that was higher than non-COVID mean age [29.97(SD±3.43)]
(Sun, Zhang, Liao, & Cheng, 2020).
We found a is high percentage of diabetes among COVID-19 mothers, compared to
non-COVID-19 groups. An earlier study confirmed diabetes among the most
common comorbid associated with COVID-19 in pregnancy(Sun et al., 2020; Z.
Wang, Wang, & Xiong, 2020). Other than that, the percentage of obesity is higher in
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the case group compared to the control group. Previous meta-analysis analysis
prove individuals with obesity were higher risk for COVID-19 positive, >46.0% higher
(OR = 1.46; 95% CI, 1.30–1.65; p < 0.0001) (Popkin et al., 2020).
The COVID-19 pandemic has happened when the prevalence of people with
overweight/obesity is increasing in almost all countries worldwide. In reality, nearly
all nations nowadays have a high prevalence of people overweight/obesity, more
than 20% including Malaysia (Malik, Willet, & Hu, 2020); "Rising rural body-mass
index is the main driver of the global obesity epidemic in adults" 2019). To date, no
country has experienced a decline in the prevalence of people overweight/obesity
that will contribute more impact on the COVID-19 pandemic.
This study reported a significant finding of an association between races with
maternal COVID-19 infection. We found that being of non-Malay ethnicity was
associated with a 5-fold increased odds of testing positive for COVID-19. These
findings are consistent with other studies that found that being of Black or Hispanic
ethnicity was associated with a 2.7- to 3.6-fold increased odds of testing positive for
COVID-19 infection (Gershengorn et al., 2021). However, race and ethnicity may be
risk markers rather than risk factors for disease (Kaplan & Bennett, 2003). When
race is used as a variable in a study, there is a tendency to assume that the results
manifest the biology of racial differences or true risk factors rather than risk markers
such as class, lifestyle or socioeconomic status (Osborne & Feit, 1992). This is
verified by Gershengorn et al. (2021), that found intermediating factors between race
and COVID-19 association are population density in living area, median income and
household size.
We also found that mothers who did not received COVID-19 vaccination had an 8-
fold increased odds of COVID-19 infection (Blaszczyk, 2022). This finding is in line
with a study by Stock et al. (2022) that a higher percentage [77.4% (3,833 out of
4,950; 95% CI 76.2−78.6)] of COVID-19 infections happened in pregnant women
who were unvaccinated at the time of COVID-19 diagnosis.
Research on the structure and replication cycle of the virus allowed for the
development of effective and safe vaccines (J. Wang, Peng, Xu, Cui, & Williams,
2020). However, the involvement of pregnant women in clinical trials of therapeutics
and vaccines has been excluded (Mullard, 2020). Thus, after the first COVID-19
vaccines were permitted for use, the eligibility of pregnant women for vaccination
was unclear. The limited finding regarding the safety and efficacy of the COVID-19
vaccine among pregnant women exaggerated their concerns about vaccine safety
which led to poor vaccine acceptance(Mohan, Reagu, Lindow, & Alabdulla, 2021).
191
Gray et al. (2021) found that vaccine-induced antibody concentrations were
comparable in all groups in a prospective cohort study involving 84 pregnant women,
16 non-pregnant women, and 31 lactating women that quantified immunoglobulin
concentrations, two to six weeks after the second dose, and during delivery.
Compared with pregnant women 1–3 months after natural SARS-CoV-2 infection,
immunoglobulin levels after vaccination were significantly higher than levels after
COVID-19 infection during pregnancy(Gray et al., 2021).
We found that among COVID-19 groups, there is 7.1% maternal mortality, 10% fetal
death and 1.4% miscarriage. Another study in Brazil also noted that maternal
mortality rate of 7.5 (95% CI 7.1–7.8) per 1000 patients-days among pregnant and
postpartum women hospitalised with COVID-19(Siqueira et al., 2022). A study in
Scotland found a perinatal mortality rate of 8.0 per 1,000 births and preterm birth
rate was 10.2%; 95% CI 9.1−11.6) following SARS-CoV-2 infection(Stock et al.,
2022).
This finding was novel as there is limited research on maternal factors on COVID-19
especially in the Malaysian population. However, our study has several limitations.
The sample size is relatively small and implementing a case-control study design
imposes possible biases, including selection bias and information bias. Other than
that, it is difficult to establish a temporal relationship between exposure and disease
due to limited data on date of vaccine received and date of mothers contracting the
COVID-19 infection. This study was just able to establish a correlation between
exposures and outcomes, but cannot establish causation.
CONCLUSION
Antenatal and postnatal mothers who have not received COVID-19 vaccination are
significantly associated with COVID-19 infection. Therefore, pregnant mothers have
many advantages from immunization against COVID-19 and should be encouraged
to take the vaccine. Identifying targeted groups will help design prevention strategies
for the COVID-19 pandemic.
ACKNOWLEDGEMENT
The authors would like to thank the Director General of Health Malaysia for his
permission to publish this paper. The authors would also like to acknowledge the
contribution of all health staf and clinicians who were involved in the collecting the
data especially to Norpishah Abdul Razak, Norita Mohd noor, Siti Zuraini Muhamad
Razee, Siti Hamidah Dali, Norhayati Mohammad, Zaharuna Ibrahim and Noorsyukila
Samsudin.
192
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COVID-19 VACCINE HESITANCY AMONG ANTENATAL MOTHERS
IN KEDAH: A DESCRIPTIVE STUDY
Nurul Afzan Aminuddin1 , Norizan Ahmad 2*, Aniza Ahmad2, Khalijah Abdul
Rashid2.
1Kulim District Health Office
2Family Health Unit, Kedah State Health Department
*Corresponding author: Norizan Ahmad, Kedah State Health Department,
[email protected]
ABSTRACT
Background: Pregnant mothers are deemed vulnerable and are susceptible to
severe COVID19 diseases. The aim of the current study was to determine the
incidence of COVID-19 vaccination hesitancy among antenatal mothers in Kedah,
Malaysia in addition to the demographic characteristics and underlying reasons.
Methodology: This a secondary data descriptive analysis of COVID-19 vaccine
hesitancy among antenatal mothers collected by 67 public health centers in Kedah
between Jan 2021 and Nov 2021. The primary outcome measured was incidence of
COVID-19 vaccine refusal.
Results: A total of 165 antenatal mother were included in the study. Incidence Rates
of COVID-19 Vaccination hesitancy among antenatal mothers in Kedah are 4.24 per
1000 antenatal mothers. Baling (11.9) and Kulim (8.1) district contributed the highest
incidence rate of vaccine refusal. Majority of mothers who refused COVID-19
vaccine were age 25-34 years-old (57.8%), Malay ethnicity (90.9%), muslim (97.6%),
housewives (80.6%) with mother received primary and secondary education level
(62.8%). The main reason of hesitancy are doubtful regarding unsafe content of
vaccine (27.3%), doubtful about the halal status of vaccine contents (24.2%),
influence from family/friends (21.8%) and fear of side effects/bad experience
(21.2%).
Conclusion: There is significant incidence of COVID-19 vaccination hesitancy
among pregnant women in Kedah. Majority of them are malay ethnicity, muslim,
younger age, housewives with low education level. Concern about vaccine safety,
vaccine halal status and influences from closed person are the major reason for
refusal. Identifying targeted groups and reason will be useful for designing
vaccination strategies that increase vaccine uptake during the current COVID-19
pandemic.
Keyword: COVID-19, vaccine, refusal, reason, pregnant, antenatal
195
INTRODUCTION
More than 2 year has exceeded since the coronavirus disease 2019 (COVID-19)
pandemic hit the world, no specific treatment against the disease is available. More
than 5 millions of life tolls have been recorded worldwide to date (Worldometer,
2021). Huge loss of human life has generated public health challenges, abused
health systems, interrupted supply chains and the economy, while prompting a
mental health calamity(Diseases, 2020; Januszek et al., 2021).
Therefore, it is imperative to escape infection. In the lack of an effective treatment
for COVID-19, public health interventions are the only offered approaches of disease
control. Social distancing, face masks, and personal hygiene are the most effective
precautions, but maintaining these actions is not feasible in the long run. As a
consequence, herd immunity by vaccination becomes the most effective eradication
method, as in other historical viral epidemic diseases(Hinman, 2017).
Immunization is one of the greatest public health achievements, protecting human
from dangerous illness and saving millions of lives every year(Domek et al., 2018).
The success of a vaccine is determined not exclusively on its efficacy, but also its
acceptance. Decreased acceptance of vaccination programs has become an
emerging problem in high-income as well as low-and middle-income (LMIC)
countries, even before the COVID-19 pandemic happen(Butler & MacDonald, 2015;
Cooper, Larson, & Katz, 2008; Larson, Cooper, Eskola, Katz, & Ratzan, 2011;
Salmon, Dudley, Glanz, & Omer, 2015). Vaccine hesitancy has become an important
threat to global health especially among vulnerable group such as pregnant
women(Ceulemans et al., 2021; World Health Organization, 2021). Vaccine
hesitancy is the unwillingness or hesitancy to vaccinate despite the availability of
vaccines(World Health Organization, 2021). The reasons for this are multifaceted,
culture-specific, and frequently not fully explicit(Domek et al., 2018). The emergence
of the highly transmissible B.1.617.2 (Delta) variant among primarily unvaccinated
people has exposed the cost of vaccine hesitancy.
Pregnant mothers are deemed vulnerable and are susceptible to severe COVID19
diseases(Karimi, Makvandi, Vahedian-Azimi, Sathyapalan, & Sahebkar, 2021; La
Verde et al., 2021; Lokken et al., 2021). Pregnant patients are at risk of
severe/critical disease and mortality compared to non-pregnant adults, and also at
risk for preterm birth, which can have significant long-term adverse impacts on the
lifelong health of the maternal and child (Lokken et al., 2021; Raju et al., 2017).
Despite evolving evidence of safety and efficacy of COVID-19 vaccines toward
pregnancy (Machingaidze & Wiysonge, 2021; Team, 2021). Concerns about the
safety of vaccines against COVID-19, including the rapid pace of vaccine
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development, as one of the primary reasons for hesitancy with majority of study
carried out in high-income countries, but limited data from low- and middle-income
countries (LMICs)(Machingaidze & Wiysonge, 2021). Other various key aspects
behind vaccine hesitancy include fear or distrust of the vaccine, underestimation of
the worth of the vaccine, and poor vaccine accesscibility(World Health Organization,
2021). The objective of current study described pregnant mothers who refused
vaccine in year 2021(January-November) in Kedah, Malaysia.
METHODOLOGY
The present study used secondary data of COVID-19 vaccine hesistancy and new
antenatal case collected by 67 government health clinics across 11 districts were
obtained from the State Health Department of Kedah. Pregnant mothers who refused
COVID-19 vaccine were identified by the doctors or nurses stationed at the
government health clinics. Their information, including name, age, citizenship,
ethnicity, religion, home address, occupation, and the reason for refusal, was then
compiled in the proforma in the excel format and reported to the State Health
Department monthly. Data had been validated by person in charge in eleven District
Health Office respectively and by person in charge at state level in Kedah State
Health Department.
The secondary data covered a total of 165 samples in excel files, comprising the
subjects’ sociodemographic profiles, reason for refusal, action been taken such as
referral to medical officer/specialist for counselling and outcome of vaccine hesitancy
status. All 165 samples were included in this secondary data analysis. The total
number of new antenatal cases in year 2021 at Kedah are 27 884.
Primary Outcome
The incidence of vaccine hesitancy among pregnant mothers is the primary outcome
measure in this secondary data descriptive analysis. The incidence were calculated
based on number of pregnant mother refused vaccine divided by number of new
antenatal cases by district and at state level.
Independent Variables
The independent variables in this study comprise sociodemographic characteristics
(age, ethnicity, citizenship, religion, occupation, education level), district, reasons for
hesitancy and intervention given to the antenatal mothers.
Age was defined in years at recruitment based on date of birth and categorized into
19 years old and less, 20-24 years, 25-29 yeasr, 30-34 years, 35-39 years and 40
years and above. Ethnicitiy was categorized and recoded into Malay, Chinese,
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Laporan Teknikal Jabatan Kesihatan Negeri Kedah 2022
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