Introduction: Despite accessibility and ability to provide comprehensive support for family violence victims, little is known of the barriers to effective family violence intervention at the primary ...care setting. Using part of the data from the Improving Opportunities for primary care and Advocacy for Family Violence (IMOCAFV), this paper aims to discuss these barriers. Methods: Qualitative data were obtained from key persons who are involved in family violence intervention in Malaysia. Thirty service providers from various disciplines participated. The data set was analyzed using thematic analysis. Results: Barriers at the service provider level include a high workload, the lack of training and poor attitude on family violence management. Absence of an optimal environment within the health facilities and accessibility to social services are barriers at the organizational level. Inability to recognize the primary health care services, and service compartmentalization are strong barriers to seamless support to victims. A lack of community awareness of primary health care services as a resource for help coupled with no clear policy and ineffective policy implementation become barriers at the societal level. Conclusion: Effective family violence intervention in primary care setting is hampered at multiple levels. Efforts are required to improve the awareness of the primary health care potentials, to increase its capacity, processes, and infrastructure. A clearly written family violence policy and its implementation process that include primary health care are likely to allow synergistic multidisciplinary effort to combat family violence in Malaysia.
A prospective study was carried out to determine the incidence, clinical presentation, early outcome, and risk factors associated with periventricular haemorrhage (PVH) in 88 (84 per cent) of the 105 ...consecutive very low birth weight (VLBW) (< 1500 g) Malaysian neonates born in the Maternity Hospital, Kuala Lumpur. Based on the cranial ultrasound findings, PVH was detected in 86 of the 88 neonates (98 per cent, 95 per cent confidence intervals: 95 to 101). Seventeen (20 per cent) of them had grade I, 52 (61 per cent) had grade II, 7 (8 per cent) had grade III and 10 (12 per cent) had grade IV PVH. PVH was detected in all the affected neonates by the fifth day of life. Sixty-four neonates (74 per cent) were symptomatic when PVH was first detected. Shock (P < 0.01), pallor (P = 0.028), low haematocrit of less than 40 per cent (P < 0.01), convulsion (P < 0.001), and bulging of anterior fontanelle (P = 0.019) were significantly more common in the neonates with severe PVH (grades III or IV). Death occurred in 43/86 (50 per cent, 95 per cent confidence interval: 39-61 per cent) of the neonates with PVH before their first discharge from the hospital. Ventriculomegaly developed in 29/43 (67 per cent, 95 per cent confidence intervals: 54.4-81.4) of the survivors with PVH. Our study suggests that PVH is a common problem in the Malaysian VLBW neonates. To reduce the incidence and severity of this condition, prevention of preterm delivery and improvement in the basic facilities for neonatal care would help.
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