Arts and Sciences
Malaysia - Preventing childhood injuries in Malaysia: Piloting a home environment risk assessment and mitigation program
The Johns Hopkins International Injury Research Unit (JH-IIRU) is currently working with the Faculty of Medicine and Health Sciences (FMHS), Universiti Putra Malaysia (UPM) to address the knowledge gap regarding childhood injuries at home in order to address the growing burden of child injuries. THe project has the following specific objectives: 1) develop and pilot-test an injury hazard assessment module appropriate for an urban developing country setting; 2) develop and pilot test an educational pamphlet regarding the importance and methodologies to reduce injury hazards in the home; and 3) develop and pilot test a home-based tutorial program for its feasibility and acceptability as a means of disseminating home safety information.
I spent the time period from June 25, 2013 until August 25, 2013 in Malaysia working on the Johns Hopkins University collaboration, “Preventing Childhood Injuries in Malaysia: Piloting a home environment injury risk assessment and mitigation program.” Many supplemental experiences shaped my time here as well. In this report, I will summarize my experience.
The day after I arrived, I immediately took the train to Serdang Station where I met Dina, a PhD student at UPM and colleague on the childhood injury project. Soon after I was acquainted with my three suitemates from Thailand. All three of them were here for an environmental and occupational health exchange program. Living with them was an illuminating experience for their commend of the English language is limited and I do not speak Thai. However, that did not prevent us from getting along well and throughout the past two months we have shared many good laughs, meals, films, and conversations. In August, we got two new roommates both females from Kelantan studying speech therapy. They exposed me more to what Northern Malaysia is like and how it is to grow up and live in Malaysia for their entire lives. Julia, my roommate and fellow researcher, a PhD student from Hopkins, has been amazing to work with. In addition to Dina, she was my main collaborator for the duration of the summer.
I had a very fulfilling research experience at UPM. As a Global Health Established Field Placement Fellow, my assignment is to come to Malaysia to work on the ground so I was very excited to start working right away but of course there were several tasks that needed to be accomplished in preparation before data collection. One notable thing we accomplished is writing an entire Statement of Procedure Manual for the study. This means we wrote operating guides for (1) how to make clusters (2) how to assign clusters to each arm of the experiment (3) how to collect data (4) how to submit the surveys (5) how to pay the enumerators (6) how to store the data (7) how to perform quality assurance. The next step was to pack 60 binders full of materials that included address forms, consent forms, surveys, home assessments, and either pamphlets, tutorials, or nothing else for the control group.
We performed a pilot test in Putrajaya and Equine Park, two locations that are not included in our study but we suspect are similar to the study locations. Putrajaya has a mix of residences ranging from flats to large houses. Interestingly, all the residents are government employees. During the pilot test, it became evident that our response rate would be very low, on the order of close to 30% of less. Because of this we calculated different theoretical response rates to develop different sampling schemes.
One major obstacle we overcame was when we incorrectly grouped neighborhoods to form clusters to be assigned interventions because our method was not as random as possible. We reclustered the original clusters into 20 per arm by combining clusters with the same assigned intervention in nearby geographical areas. We placed the 60 new clusters on a large map. We had to redo this and those new clusters with buffer zones between the intervention arm clusters what were we conducted the study on.
I started working on a literature review concerning different aspects of the study. I researched the burden of childhood injuries in low/middle income countries verses high-income countries. I also gathered information about the effectiveness of pamphlets verses home visits in terms of health behavior change. I found out that home tutorials are better at encouraging health behavior change which prompted the question, notwithstanding cost, why are pamphlets one of the most predominate health communication tools.
In addition to research, I engaged in other activities at UPM. I attended two talks. The first one was an occupational health lecture given by a professor. That was my second time being educated about hazards, injuries, interventions at different levels and laws that protect workers. This information turned out to be useful for the purposes of the childhood injury project as it shares a lot of similar themes. The second talk I attended was the Department of Community Health’s CME Talk on UPM female staff’s attitude toward and usage of modern contraceptive methods. I enjoyed the talk; it was interesting because it had a study design similar to that of our study.
During my stay in Malaysia, I had to get accustomed to certain aspects of Malaysian culture such as the food, language, and culture.
This Ramadan was an interesting experience for me because it was only the second time I’ve spent Ramadan in a majority Muslim country; last year when I was in Sudan, was the first time. Even more special is that it was my roommate’s very first time hearing of such a tradition and it was amusing to introduce it to her. The cafeteria was closed everyday until 4:30 PM but my roommate Julia stuck it out with me everyday until it was time to break fast at approximately 7:30 PM. We often joked about how she was practically fasting with the rest of us in the office. For one iftar, Dina took Julia and I to Ramadan Bazaar where we got to experience a huge variety of traditional Malay foods. That was quite a delicious experience.
I had a pleasant experience working under Dr. Bachani and Dr. Kulan and I hope to return to Malaysia in the future. I learned a lot of lessons in study design and what it takes to run a randomized control trial with 3 arms (2 interventions and one control) and 60 clusters.