Malaysian Statistics On Medical Devices 2007

Malaysian Statistics On
MEDICAL DEVICES
2007
Ariza Zakaria
Faridah Aryani Md. Yusof
Lim T.O.
Subramani V; Mohammad Ali K; Mohd. Roslan H; Jahizah H; Zakaria Z; Ramanathan R; Katijjahbe M.A;
Muralitharan G; Suganthi C; Suarn Singh; Aizai A; Abdul Razak M; Rosemi S; Zaki Morad; Murali S; Rohna R;
Rahmat O; Mariam I.
A publication of the
Engineering Services Division, Medical Device Bureau and the Clinical Research Centre
Ministry of Health Malaysia
Malaysian Statistics On
MEDICAL DEVICES
2007
Ariza Zakaria
Faridah Aryani Md. Yusof
Lim T.O.
Subramani V; Mohammad Ali K; Mohd. Roslan H; Jahizah H; Zakaria Z; Ramanathan R; Katijjahbe M.A;
Muralitharan G; Suganthi C; Suarn Singh; Aizai A; Abdul Razak M; Rosemi S; Zaki Morad; Murali S; Rohna R;
Rahmat O; Mariam I.
Malaysian Statistics On Medical Devices 2007
August 2008
© Ministry of Health Malaysia
Published by:
The National Medical Device Survey
Level 3, MMA House
124, Jalan Pahang
53000 Kuala Lumpur
Malaysia
Tel. : (603) 4043 9300

Fax : (603) 4043 9500
e-mail : nmds@crc.gov.my
Web site: http://www.crc.gov.my/nmds

This report is copyrighted. However it may be freely reproduced without the permission of the National
Medical Device Survey. Acknowledgement would be appreciated. Suggested citation is Ariza Z, Faridah
A, Lim T.O. (Eds). Malaysian Statistics On Medical Devices 2007. Kuala Lumpur 2008
This report is also published electronically on the website of the National Medical Device Survey at:
http://www.crc.gov.my/nmds
Funding:
The National Medical Device Survey is funded by a grant from the Ministry of Health Malaysia
(MRG Grant Number MRG-CRC-2008-02)
FOREWORD
The Ministry of Health Malaysia has embarked on a landmark project, the National Medical Device
Survey (NMDS), to capture data on the availability and use of medical devices in both the government
and private sectors in Malaysia and this report is an output of the project.
This NMDS report is very relevant in the present environment of ever increasing healthcare costs in
both the government and private sectors. We are almost completely lacking in data on the availability
and use of medical devices in the country. This publication will help in some ways to rectify the
situation.
I am confident this publication will be a very useful reference to the government, the industry and the
public and I must congratulate those who are involved in the survey for successfully completing the
project. I am looking forward to see that the data are regularly updated through follow-up surveys.
Y. BHG. DATUK IR. M.S. PILLAY

Deputy Director General of Health,
Research & Technical Support,

PREFACE
Data on the availability and use of medical devices is important to better understand healthcare provision
in a country. Availability and access to medical technologies are likely to differ among countries
and almost certainly unevenly distributed within a country. These differences could be because of
several factors, such as demographic differences, differences in epidemiology of disease, differences
in medical approaches or differences in economic conditions. This type of information allows for
better decision-making in the allocation of resources and procurement of medical technologies. The
use of this information can help to ensure access to and appropriate use of medical technology for
better health outcomes.
To our knowledge, there has not been any published survey on the availability and utilization of
medical devices in Malaysia and this aptly called National Medical Device Survey (NMDS) is, we
believe, the first of its kind. However in carrying out this survey, in a country like Malaysia that does
not have single central database on the procurement or reimbursement for medical devices, the task
of compiling data on devices are fraught with problems. Data needed to be collected from multiple
sources and some of these sources were less than forthcoming in providing data due to apprehension
on the actual or possible use of the data or possibly, some sources were too busy to be able or want to
provide the data needed.
After the hurdle of data collection was surmounted, the next problem was data analysis. There was a
need for intelligent and expert analysis to distill credible information out of all these data as the data
from various sources were not always complete or clean or in the format or depth that was wanted. We
therefore regard this first report from the NMDS as a proof of concept; it demonstrates such project
is indeed feasible. These initial efforts and experiences in conducting NMDS will stand us in good
stead. NMDS is a work in progress, and as it improves its coverage and secure better cooperation
from all relevant source data providers over time, we expect to publish more comprehensive reports
in future.
We would like to thank all staff that has worked so hard in this survey. We would also like to thank
all agencies and institutions who have helped in providing data and who have helped in one way or
another.
Dr. Lim Teck Onn Mr. Zamane Abd. Rahman Mr. Chin Goo Chai
Chairperson Co-Chairperson Co-Chairperson
National Medical Device Survey,

Ministry of Health, Malaysia
iii
ACKNOWLEDGEMENTS
The National Medical Device Survey would like to thank the following :
• All the medical doctors, medical assistants and nurses who participated in NMDS survey
• Participating private hospitals for cooperating with the survey
• The Faber Mediserve Sdn. Bhd., Radicare Sdn. Bhd. and Tongkah Medivest Sdn. Bhd., for their
valuable assistance
• All who have in one way or another supported and/or contributed to the success of the NMDS
and to this report
iv
PARTICIPANTS OF THE NATIONAL MEDICAL DEVICE SURVEY
MOH Hospitals
1. Hospital Alor Gajah 67. Hospital Muadzam Shah
2. Hospital Ampang 68. Hospital Mukah
3. Hospital Bahagia 69. Hospital Papar
4. Hospital Balik Pulau 70. Hospital Parit Buntar
5. Hospital Baling 71. Hospital Pasir Mas
6. Hospital Banting 72. Hospital Pekan
7. Hospital Batu Gajah 73. Hospital Permai
8. Hospital Batu Pahat 74. Hospital Pontian
9. Hospital Bau 75. Hospital Port Dickson
10. Hospital Beaufort 76. Hospital Pulau Pinang
11. Hospital Beluran 77. Hospital Putrajaya
12. Hospital Bentong 78. Hospital Queen Elizabeth
13. Hospital Besut 79. Hospital Raja Perempuan Zainab II
14. Hospital Betong 80. Hospital Rajah Charles Brooke Memorial
15. Hospital Bintulu 81. Hospital Ranau
16. Hospital Bukit Mertajam 82. Hospital Raub
17. Hospital Changkat Melintang 83. Hospital Saratok
18. Hospital Daro 84. Hospital Umum Sarawak
19. Hospital Duchess of Kent 85. Hospital Sarikei
20. Hospital Dungun 86. Hospital Seberang Jaya
21. Hospital Gerik 87. Hospital Segamat
22. Hospital Gua Musang 88. Hospital Selama
23. Hospital Hulu Terengganu 89. Hospital Selayang
24. Institute of Respiratory Medicine 90. Hospital Semporna
25. Hospital Ipoh 91. Hospital Sentosa
26. Hospital Jasin 92. Hospital Serdang
27. Hospital Jelebu 93. Hospital Seri Manjung
28. Hospital Jeli 94. Hospital Serian
29. Hospital Jempol 95. Hospital Setiu
30. Hospital Jengka 96. Hospital Sibu
31. Hospital Jerantut 97. Hospital Sik
32. Hospital Jitra 98. Hospital Simunjan
33. Hospital Kajang 99. Hospital Sipitang
34. Hospital Kampar 100. Hospital Slim River
35. Hospital Kanowit 101. Hospital Sri Aman
36. Hospital Kapit 102. Hospital Sultan Abdul Halim
37. Hospital Kemaman 103. Hospital Sultan Haji Ahmad Shah
38. Hospital Keningau 104. Hospital Sultan Ismail
39. Hospital Kepala Batas 105. Hospital Besar Sultanah Aminah
40. Hospital Kinabatangan 106. Hospital Sultanah Bahiyah
41. Hospital Kluang 107. Hospital Pakar Sultanah Fatimah
42. Hospital Kota Belud 108. Hospital Sultanah Nur Zahirah
43. Hospital Kota Marudu 109. Hospital Sungai Bakap
44. Hospital Kota Tinggi 110. Hospital Sungai Buloh
45. Hospital Kuala Kangsar 111. Hospital Sungai Siput
46. Hospital Kuala Krai 112. Hospital Taiping
47. Hospital Kuala Kubu Bharu 113. Hospital Tambunan
48. Hospital Kuala Lipis 114. Hospital Tampin
49. Hospital Kuala Lumpur 115. Hospital Tanah Merah
50. Hospital Kuala Nerang 116. Hospital Tangkak
51. Hospital Kudat 117. Hospital Tanjong Karang
52. Hospital Kulim 118. Hospital Tapah
53. Hospital Kunak 119. Hospital Tawau
54. Hospital Labuan 120. Hospital Teluk Intan
55. Hospital Lahad Datu 121. Hospital Temenggung Seri Maharaja Tun Ibrahim
56. Hospital Langkawi 122. Hospital Tengku Ampuan Afzan
57. Hospital Daerah Lawas 123. Hospital Tengku Ampuan Jemaah
58. Hospital Likas 124. Hospital Tengku Ampuan Rahimah
59. Hospital Limbang 125. Hospital Tengku Anis
60. Hospital Daerah Lundu 126. Hospital Tenom
61. Hospital Machang 127. Hospital Tuanku Ampuan Najihah
62. Hospital Marudi 128. Hospital Tuanku Fauziah
63. Hospital Melaka 129. Hospital Tuanku Ja’afar
64. Hospital Mersing 130. Hospital Tuaran
65. Hospital Mesra Bukit Padang 131. Hospital Tumpat
66. Hospital Miri 132. Hospital Yan

University & Armed Forces Hospitals
1. Pusat Perubatan Universiti Kebangsaan Malaysia
2. Pusat Perubatan Universiti Malaya
3. Hospital Universiti Sains Malaysia
4. Hospital Angkatan Tentera Lumut
5. Hospital Angkatan Tentera Terendak
Private Hospitals
1. Amanjaya Specialist Centre 42. National Heart Institute
2. Arunamari Specialist Medical Centre 43. NCI Cancer Hospital
3. Assunta Hospital 44. Normah Medical Specialist Centre
4. Az-Zahrah Islamic Medical Centre 45. Pantai Ayer Keroh Hospital Sdn. Bhd
5. Bukit Mertajam Specialist Hospital 46. Pantai Cheras Medical Centre
6. Columbia Asia Medical Centre, Sarawak 47. Pantai Indah Hospital
7. Columbia Asia Medical Centre, Seremban 48. Pantai Mutiara Hospital
8. Columbia Asia Nursing and Rehabilitation Centre 49. Peace Medical Centre
9. Damai Medical and Heart Clinic Sdn. Bhd 50. Pelangi Medical Centre
10. Damai Service Hospital (Head Quarters) 51. Penang Adventist Hospital
11. Damai Specialist Centre Sdn. Bhd 52. Penawar Hospital
12. Damansara Specialist Hospital 53. Perak Community Specialist Hospital
13. Darul Ehsan Medical Centre 54. Perdana Specialist Hospital
14. Gleneagles Medical Centre, Penang 55. Pusat Pakar Tawakal
15. Hope Children Hospital, Farlim 56. Pusat Rawatan Islam Medical Centre
16. Hope Children Hospital, Jln Gottlieb 57. PUSRAWI Hospital Sdn. Bhd
17. Hope Children Hospital, Sg. Ara 58. PUSRAWI SMC Hospital Sdn. Bhd
18. INS Specialist Centre 59. Puteri Specialist Hospital
19. Ipoh Specialist Hospital 60. Putra Medical Centre, Alor Setar
20. Island Hospital 61. Putra Medical Centre, Sungai Buloh
21. Johor Specialist Hospital 62. Putra Specialist Hospital (Melaka) Sdn. Bhd
22. Kajang Medical Centre 63. Rafflesia Medical Centre Sdn. Bhd
23. Kajang Plaza Medical Centre 64. Rejang Medical Centre
24. Kampung Baru Medical Centre 65. Sabah Medical Centre
25. KCDC Hospital Sdn. Bhd 66. Sambhi Clinic Sdn. Bhd
26. Kedah Medical Centre 67. Sentosa Medical Centre (KPJ Kajang Specialist Hosp.)
27. Kempas Medical Centre 68. Siow Specialist Hospital
28. Kinta Medical Centre 69. Sri Kota Specialist Medical Centre
29. Kota Bharu Medical Centre 70. Sri Manjung Specialist Centre Sdn. Bhd
30. Kuantan Medical Centre 71. Srigim Specialist Women and Children’s Hospital
31. Lam Wah Ee Hospital 72. Subang Jaya Medical Centre
32. Landmark Medical Centre Sdn. Bhd 73. Sunway Medical Centre
33. Larut Medical Centre 74. Taiping Medical Centre
34. Loh Guan Lye Specialist Centre 75. Taj Hospital
35. Mahkota Medical Centre 76. Taman Desa Medical Centre
36. Medical Specialist Centre (JB) Sdn. Bhd 77. Tanjung Medical Centre
37. Metro Specialist Hospital 78. Timberland Medical Centre
38. Miri City Medical Centre 79. Tun Hussein Onn National Eye Hospital
39. Mount Miriam Hospital Cancer Centre
40. Multimedic Specialist & Maternity Centre
41. N. S. Chinese Maternity Hospital and Medical Centre
vi
About the National Medical Device Survey
The National Medical Device Survey (NMDS) is a service initiated and supported by the Ministry of
Health (MOH) to collect information on the supply, procurement and utilization of medical devices
in Malaysia. It is designed to quantify the current trends of availability and utilization of medical
devices, as well as support the implementation of the proposed regulatory system for medical devices
in Malaysia. In supporting this, the NMDS shall provide the functional capacity for the collection,
analysis, reporting and dissemination of data on medical devices in Malaysia.
Sponsors and Organization of the NMDS

The NMDS is jointly sponsored by:
• The Engineering Services Division and the Medical Device Bureau of the MOH
• The Clinical Research Centre, National Institute of Health MOH.
The Pharmaceutical Research Unit of the Clinical Research Centre MOH undertakes the daily
operation of NMDS. To ensure that the NMDS meets the needs and expectations of all interested
parties, a Governance Board has been established to oversee the operations of the NMDS. All major
groups involved in medical device issues in Malaysia such as the MOH, professional bodies, private
healthcare providers and the medical device industries are represented on this board. The board,
therefore works as a consultative forum and provide advice on issues pertaining to the NMDS and
other aspects of quality use of medical devices in Malaysia.
Premise of the NMDS

Efficient functioning of device market depends in part on buyers’ access to information on suppliers,
products and prices. Safe and effective use of device depends in part on users’ access to information
on technical performance and users’ instructions.
The objective of the NMDS is therefore to quantify the present state and time trends of medical device
procurement and utilization at various level of our health care system, whether national, regional,
local or institutional. It will provide a public information service to ensure that high quality, reliable
and timely information on medical devices are available for promoting equitable access to, and safe
and effective use of such devices in Malaysia.
Routinely compiled statistics on availability and use of medical devices have many applications, such
as to:
1. Describe the demographic patterns of device availability and utilization to better understand device
use in its natural clinical environment.
2. Estimate expenditure on medical devices, which constitutes a significant proportion of our public
and private healthcare costs.
3. Monitor and evaluate the cost-effectiveness of device-based treatments with respect to device
productivity and equity in provision, which may have significant impact on resource management
within our healthcare system.
4. Monitor users’ device-experience and evaluate the clinical effectiveness of medical devices, and
their associated health outcomes as well as factors influencing those outcomes.
5. Support reporting of adverse events or product problems by suppliers or user facilities.
6. Relate the number of adverse device effects reported to our device vigilance system to the number
of people exposed to the device in order to assess the magnitude of the problem, or to estimate the
degree of under-reporting of adverse events.
7. Stimulate and facilitate applied clinical and epidemiologic research on the economics, utilization,
safety and effective use of medical devices.
vii
NMDS Governance Board
CHAIRPERSON: Dr. Lim Teck Onn,
Director, Clinical Research Center MOH.
CO-CHAIRPERSON: Mr. Zamane Abdul Rahman,

Director, Medical Device Bureau MOH.
CO-CHAIRPERSON: Mr. Chin Goo Chai.

Director, Engineering Services Division MOH
MEMBERS
Clinical Research Centre MOH Dr. Faridah Aryani Md. Yusof
Medical Device Bureau MOH Mr. Ahmad Sharif Hambali
Engineering Services Division MOH Pn. T. Sasikala Devi
Procurement Division MOH Pn. Hamidah Bidin
Malaysian Medical Association -
Malaysian Dental Association (MDA) -
Malaysian Private Dental Practitioner’s -

Association (MPDPA)
Association of Private Hospitals Malaysia Dr. Hooshmana M Palany

(APHM)
Malaysian Medical Device Association Mr. Yong Tuan Heng
Association of Malaysian Medical Mr. Peter Ring

Industries
viii
MEMBERS OF NMDS EXPERT PANELS
Expert Panel Institution
1. Imaging and Diagnostic Facilities And Devices
Dr. Subramani A/L Venugopal (Chairperson) Hospital Tuanku Ja’afar
Dr. Nik Fatimah Salwati Hospital Sultanah Bahiyah
Dr. Hjh Salwah Hashim Hospital Pulau Pinang
Dr. Zaharah Musa Hospital Selayang.
Dr. Harikrishna A/L Sivaganabalan Hospital Tengku Ampuan Rahimah
Dr. Che Zubaidah Che Daud Institut Pediatrik, HKL.
Ir. Dr. Syed Mustafa Kamal Engineering Services Div, MOH
2. Nuclear Medicine Facilities And Devices

Dato’ Dr. Mohammad Ali Kadir (Chairperson) Hospital Pulau Pinang
Dr. Lee Boon Nang Hospital Kuala Lumpur.
3. Oncology Facilities And Devices

Dr. Mohd. Roslan Bin Haron (Chairperson) Hospital Sultan Ismail
Ass. Prof. Dr. Fuad Ismail Pusat Perubatan Universiti Kebangsaan Malaysia
Dr. Ahmad Kamal Mohamed Subang Jaya Medical Centre
Dr. Vincent Phua Hospital Kuala Lumpur
En. Mohd Farihan Jaffar Hospital Kuala Lumpur
Puan Rubiah Mohd Pakah Hospital Kuala Lumpur
Pn Mahzom Pawanchek Hospital Kuala Lumpur
4. Anaesthesiology and Intensive Care Facilities And Devices

Dato’ Dr. Jahizah Hj. Hassan (Chairperson) Hospital Pulau Pinang
Prof. Dr. Mazidar Mansor. Pusat Perubatan Universiti Malaya
Clinical Ass. Prof. Dr. Choy Yin Choy. Pusat Perubatan Universiti Kebangsaan Malaysia
Dato’ Dr. Teh Keng Hwang Hospital Sultanah Bahiyah
Dr. Irene Cheah Hospital Kuala Lumpur
Dr. Neoh Siew Hong Hospital Taiping
5. General Surgery Facilities And Devices

Dato’ Dr. Zakaria Bin Zahari (Chairperson) Hospital Kuala Lumpur
Dr. Mohammed Saffari Mohammed Haspani Hospital Kuala Lumpur
Dr. Mohd Mazri Yahya Hospital Kuala Lumpur
6. Orthopedic & Traumatology Facilities And Devices

Dato’ Dr. Ramanathan Ramiah (Chairperson) Hospital Ipoh
Dr. Mohammad Anwar Hau Abdullah Hospital Raja Perempuan Zainab II
Dr. Kamariah Nor Mohd Daud Hospital Kuala Lumpur
Dr. Ng Yue Onn Hospital Ampang
Dr. Lee Joon Kiong Pantai Medical Centre Bangsar
Dr. Mahathar Abd Wahab Hospital Kuala Lumpur
ix
7. Physiotherapy and Occupational Therapy Facilities And Devices
Cik Katijjahbe Mohd Ali (Chairperson) Pusat Perubatan Universiti Kebangsaan Malaysia
Datin Hjh Asiah Bt Hashim Hospital Kuala Lumpur
Pn. Misnah Roslam Hospital Serdang
Pn. Tan Wai Choo Hospital Sungai Buloh
Pn. Wong Swee Fong Hospital Tengku Ampuan Rahimah
Pn. Lim Khee Li Hospital Kuala Lumpur
Pn. Hjh. Hamidah Hj. Ariffin Hospital Selayang
Pn. Khuzaimah Abd. Aziz Hospital Kuala Lumpur
Pn. Jamaliah Musa, Hospital Kuala Lumpur
Pn. Zalila Kashim Hospital Kuala Lumpur
Pn Aqilah Leela T. Narayanan Hospital Sultanah Aminah
Pn. Zunaidah Abu Samah Hospital Kuala Lumpur
Pn. Tan Foo Lan Hospital Kuala Lumpur
Pn Anil Kalsom Bte Musa Hospital Tengku Ampuan Rahimah
Pn. Rohana Mukahar Pusat Perubatan Universiti Kebangsaan Malaysia
Dr. Julia Patrick Engkasan Pusat Perubatan Universiti Kebangsaan Malaysia
Pn. Noormah Mohd Darus Health Technology Assesment Div., MOH
8. Obstetrics & Gynecology Facilities And Devices

Dr. Muralitharan Ganesalingam (Chairperson) Hospital Kuala Lumpur
Dr. Zaridah Shaffie Hospital Tuanku Fauziah
Dr. Krishnakumar A/L Harikrishnan Hospital Tuanku Ja’afar
Dr. R.P Japaraj Hospital Ipoh
9. Neurology Facilities And Devices

Dr. Suganthi Chinnasami Hospital Kuala Lumpur
Y. Bhg. Dato’ Dr. Md. Hanip Bin Rafia Hospital Kuala Lumpur
Dr. Santhi Datuk Puvanarajah Hospital Kuala Lumpur
Dr. Mooi Chin Leong Hospital Kuala Lumpur
10 Psychiatry Facilities And Devices

Dato’ Dr. Suarn Singh Hospital Bahagia Ulu Kinta
Dr. Hj. Mohd Daud Dalip Hospital Mesra Bukit Padang
Dr. Siti Nor Aizah Ahmad Hospital Kuala Lumpur.
Prof Dr. Mohd Fadzillah Bin Abdul Razak Universiti Malaysia Sarawak
En Rosdi Bin Zainol Hospital Kuala Lumpur
Dr. Hj. Mohd Rasidi M. Saring Hospital Sultanah Bahiyah

11. Cardiology And Cardiothoracic Surgery Facilities And Devices
Dr. Aizai Azan (Chairperson) Institut Jantung Negara
Dr. Surinder Kaur Institut Jantung Negara
Dr. Alan Yean Yip Fong Hospital Umum Sarawak
Dr. Chong Wei Peng Pusat Perubatan Universiti Malaya
Dr. Faisal Bin Ismail Hospital Serdang
Dr. Ernest Ng Hospital Serdang
Prof Dr. Sim Kui Hian Hospital Umum Sarawak
Dr. Ong Tiong Kiam Hospital Umum Sarawak
12. Respiratory Medicine Facilities And Devices

Dato’ Dr. Abdul Razak Abdul Mutalif Hospital Pulau Pinang
Assoc. Prof. Dr. Roslina Abdul Manap Pusat Perubatan Universiti Kebangsaan Malaysia
Dr. Tengku Saifudin Tengku Ismail Hospital Selayang
Dr. Noor Aliza Md Tarekh Hospital Sultanah Aminah
Dr. George Kutty Simon Hospital Sultanah Bahiyah
Dr. Ashari Yunus Institut Perubatan Respiratori
Dr. Jamalul Azizi Abdul Rahman Hospital Queen Elizabeth
Dr. Norhaya Mohd Razali Hospital Sultanah Nur Zahirah
Assoc. Prof. Dr. Pang Yong Kek Pusat Perubatan Universiti Malaya
Assoc. Prof. Dr. How Soon Hin Universiti Islam Antarabangsa Malaysia /
Hospital Tengku Ampuan Afzan
Professor Dr. Liam Chong-Kin Pusat Perubatan Universiti Malaya
Dr. Mat Zuki Bin Mat Jaeb Hospital Raja Perempuan Zainab II
Dr. Zalwani Bt Zainuddin Hospital Tuanku Fauziah
Bgd Gen Dr. Mohd Ello Mohd Sued Hospital Angkatan Tentera Lumut
13. Gastroenterology Facilities And Devices

Dr. Hj. Rosemi Salleh (Chairperson) Hospital Raja Perempuan Zainab II
Dato’ Dr. Muhammad Radzi Abu Hassan Hospital Sultanah Bahiyah
Dr. Hjh Rosaida Hj Md Saudi Hospital Kuala Lumpur
Dr. Sheikh Anwar Abdullah Pusat Perubatan Universiti Kebangsaan Malaysia
14. Nephrology Facility And Devices

Prof. Dato’ Dr. Zaki Morad (Chairperson) Ampang Puteri Specialist Hospital
Dr. Ong Loke Meng Hospital Pulau Pinang
Dato’ Dr. Rozina Ghazalli Hospital Pulau Pinang
Dr. Hooi Lai Seong Hospital Sultanah Aminah
Dr. Goh Bak Leong Hospital Serdang
Dr. Lim Yan Ngo Hospital Kuala Lumpur
Tn. Hj. Mohd Sulaiman Bin Dalimi Hospital Serdang
En. A. Suhaili Bin Shahri Hospital Kuala Lumpur
Sr Lee Day Guat National Renal Registry
xi
15. Urology Facilities And Devices
Dr. Murali Sundram Abdullah (Chairperson) Hospital Kuala Lumpur
Dr. Clarence Lei Chang Moh Normah Medical Centre
16. Dermatology Facilities And Devices

Dr. Rohna Ridzwan (Chairperson) Hospital Selayang
Puan Sri Datin Dr. Suraiya Hani Tun Hussein. Hospital Kuala Lumpur
Dr. Asmah Johar Hospital Kuala Lumpur
Dr. Choon Siew Eng Hospital Sultanah Aminah, Johor Bahru
Dr. Najeeb Bin Mohd. Safdar Hospital Tuanku Jaafar
17. Otorhinolaryngology And Audiology Facilities And Devices

Prof. Madya Dr. Rahmat Omar (Chairperson) Pusat Perubatan Universiti Malaya
Dato’ Dr. Abd. Majid Md. Nasir Hospital Kuala Lumpur
Dr. Junainah Sabirin Health Technology Assesment Div., MOH
En. Mahamad Almyzan Awang Pusat Perubatan Universiti Kebangsaan Malaysia
Cik Nor Shahrina Mohd Zawawi Pusat Perubatan Universiti Kebangsaan Malaysia
18. Ophthalmology And Optometry Facilities And Devices

Datin Dr. Mariam Ismail (Chairperson) Hospital Selayang
Dr. Goh Pik Pin Hospital Selayang
Dato’ Dr. Balaravi Pillai Hospital Ipoh
Dato’ Dr. Vasantha Kumar S. Thangasamy Hospital Tengku Ampuan Rahimah
Dr. Hj. Abdul Mutalib Bin Othman Hospital Queen Elizabeth
Dr. Jamalia Rahmat Hospital Kuala Lumpur
xii
NMDS Project Staff
Project Leader Dr. Faridah Aryani Md. Yusof
Clinical Research Manager Dr. Ariza Zakaria.
Clinical Research Coordinator -
Research Assistants -
Economist Mr. Adrian Goh
Statistician Dr. Hoo Ling Ping
IT Manager Ms. Celine Tsai Pao Chien
Database Developer/ Administrator Ms Tang Roh Yu

Mr. Patrick Lum See Kai
Network Administrator Mr. Kevin Ng Hong Heng

Mr. Adlan Abd. Rahman
Desktop Publisher & Webmaster Ms. Azizah Alimat
xiii
CONTENTS
FOREWORD i
Preface iii
Acknowledgements iv
Participants Of The National Medical Device Survey v
About The National Medical Device Survey vii
NMDS GOVERNANCE BOARD viii
Members Of NMDS Expert Panels ix
NMDS Project Staff xiii
Contents xv
ABBREVIATIONS xvi
METHODS xvii
Chapter 1: Imaging And Diagnostic Facilities And Devices 1
Chapter 2: Nuclear Medicine Facilities And Devices 5
Chapter 3: Oncology Facilities And Devices 9
Chapter 4: Anaesthesiology And Intensive Care Facilities And Devices 11
Chapter 5: General Surgery Facilities And Devices 15
Chapter 6: Orthopaedic And Traumatology Facilities And Devices 21
Chapter 7: Physiotherapy And Occupational Therapy Facilities And Devices 23
Chapter 8: Obstetrics & Gynaecology Facilities And Devices 27
Chapter 9: Neurology Facilities And Devices 31
Chapter 10: Psychiatry Facilities And Devices 35
Chapter 11: Cardiology And Cardiothoracic Surgery Facilities And Devices 39
Chapter 12: Respiratory Facilities And Devices 43
Chapter 13: Gastroenterology Facilities And Devices 47
Chapter 14: Nephrology Facilities And Devices 53
Chapter 15: Urology Facilities And Devices 57
Chapter 16: Dermatology Facilities And Devices 63
Chapter 17: Otorhinolaryngology And Audiology Facilities And Devices 69
Chapter 18: Ophthalmology And Optometry Facilities And Devices 73
Chapter 19: Gaps In Medical Technology In Malaysia 79
xv
ABBREVIATIONS
ABBI Advanced Breast Biopsy Instrumentation NCV Nerve Conduction Velocity
APC Argon Plasma Coagulation NCS Nerve Conduction Study
BAER Brainstem Auditory Evoked Response ND No Data
BER Beyond Economic Repair Nd:YAG Neodymium-Doped Yttrium Aluminium Garnet
BiPAP Bilevel Positive Airway Pressure NMDS National Medical Device Survey
Cathlab Cardiac Catheterization Laboratory OAE Otoacoustic Emission
CCU Coronary Care Unit ORL Otorhinolaryngology
COPD Chronic Obstructive Pulmonary Disease PCA Patient Controlled Analgesia
CPAP Continuous Positive Airway Pressure PD Peritoneal Dialysis
CPM Continuous Passive Motion PET Positron Emission Tomography
CRC Clinical Research Centre PICU Paediatric Intensive Care Unit
CRRT Continuous Renal Replacement Therapy PSG Polysomnography
CT Computed Tomography PUVA Psoralen combined with exposure to ultraviolet
CTG Cardiotocography light A (UVA)
CUSA Cavitron Ultrasonic Surgical Aspirator SDP Source Data Providers
DBE Double Balloon Enteroscope SSEP SomatoSensory Evoked Potential
DG Director General of Health, Ministry of Health, SWD Short Wave Diathermy
Malaysia TCD Transcranial Doppler
ECG Electrocardiography TEE Trans-Oesophageal Echocardiography
ECMO Extra-Corporeal Membrane Oxygenator TENS Transcutaneous Electrical Nerve Stimulation
ECT Electroconvulsive Therapy UVA Ultraviolet light A
EEG Electroencephalography UVB Ultraviolet light B
EMG Electromyography VACS Vacuum Assisted Closure System
EOG Electrooculography VEP Visual Evoked Potential
EP Evoked Potential VT Video-Telemetry
ESWL Extracorporeal Shockwave Lithotripter WHO World Health Organization
EUS Endoscopic Ultrasound
FESS Functional Endoscopic Sinus Surgery
GB Governance Board
HAL Haemorrhoid Artery Ligation
HD Haemodialysis
HDU Haemodialysis Unit
HFOV High Frequency Oscillatory Ventilator
HKL Kuala Lumpur Hospital
HDR High Dose-Rate
IABP Intra-Aortic Balloon Pump
ICU Intensive Care Unit
IMRT Intensity Modulated Radiotherapy
IVUS Intra Vascular Ultrasound
KKM Kementerian Kesihatan Malaysia
LINAC Linear Accelerator
LDR Low Dose-Rate
LVAD Left Ventricular Assist Device
MDB Medical Device Bureau
MMHD Malaysian Medical Health Directory
MOH Ministry of Health
MRI Magnetic Resonance Imaging
NC Not Classified (cannot be classified between
public and private sectors)
xvi
METHODS
Introduction
The NMDS is designed, broadly speaking, to estimate the quantity and pattern of use of medical
devices in Malaysia, as well as to estimate our expenditure on devices. This is an ambitious project,
which requires multiple surveys targeting the various levels of the medical device supply chain and
utilization in healthcare facilities in the country in order to capture all the required data to meet its
purpose. For this first effort, we had therefore realistically targeted data sources that are absolutely
critical and accessible.
Hence, the statistics on the availability of medical device in this report are estimated based on data
from only a limited number of surveys. In particular, the scope of the survey was limited to:
• Hospitals only, though for certain therapy areas (Nephrology, Cardiology), we were able to
supplement the data from more specialized surveys conducted by the National Renal Registry
(NRR) and National Cardiovascular Disease Database (NCVD)
• Asset device only. Data on disposable devices will have to await future survey.
Survey Population, Sampling And Response (Coverage) Rate

The survey conducted by NMDS and supplemented by those by NRR and NCVD, its survey population,
its sampling unit and sample size, and the survey response or coverage rates are summarized in the
table below.
# Site Classification Survey population MaximumResponse Minimum Response

Rate (%) Rate (%)
1. Public sector 137 71 43
2 Private sector 79 55 37
* Note:
1. Public sector consists of 132 MOH, 3 University and 2 Armed Forces hospitals.
2. Response rates vary between specialties.
The survey conducted by NMDS and supplemental surveys by NRR and NCVD were entirely by
primary data collection. For MOH data, available database on device asset was also used to cross-
check the data.
Data Management
The collected data, whether in databases, on paper or electronic data collection form, is compiled into
a single database, appropriately processed and coded prior to statistical analysis.
The database server is running on a Windows 2000 Server. The server environment is Intel Xeon
2.4 Mhz, with a total of 2GB RAM memory and 67.8GP Raid5 Hard disk. The NMDS database was
created in Ms SQL Server 2000. The application has 3 modules: Contact Management, Data Entry
and Data Processing.
xvii
The data processing steps for this initial version of NMDS data are presented as follows, in 2
phases:
Phase 1 Survey/Database Development and Data Collection
1. On the basis of the NMDS project’s Terms of Reference (ToR), some initial discussions were
held within CRC, supplemented with research on literature to develop the first drafts of NMDS
survey forms.
2. Various existing databases were obtained and studied to extract learnings for application on the
NMDS. Where relevant, these learnings were used to enhance/edit the structure and content of
survey forms.
3. On the basis of the said information in 1 & 2, the first draft of the survey forms were produced
and presented for challenge of adequacy in the required data fields/ variables for each specialty.
4. Draft survey forms were shared with internal and external referees and the feedback was collated
for the finalization of the survey forms.
In most cases, the project team had to consult with the experts in various disciplines to get a
better understanding of the variables of significance.
5. The survey forms were then finalized for approval, with the final versions being made up of 28
medical specialties and 5 supportive specialties.
The variables required were divided into 3 sections:

Section 1: Establishment Details.
Section 2: Diagnostic and Therapeutic Facility.
Section 3: Associated Equipment of Interest.
6. Approval of the NMDS survey was granted by the Chairperson of the NMDS, allowing the team
to proceed with actualizing the survey activities.
7. The approved survey forms were shared with the IT department for them to use as the basis for
creating the NMDS Database. The intention was for the Database to be ready for populating by
the time the completed survey forms had been returned by the SDPs.
8. Upon approval, survey forms were sent out to the Directors of relevant identified SDPs to seek
voluntary participation into the survey. SDPs were identified from the Malaysian Medical Health
Directory (MMHD) and counter-checked by staff making the calls.
9. The project team was dependent on the SDP sites to ensure the survey forms were appropriately
distributed within their institutions. The project team then followed up with each individual
specialty. The follow up was dependent on the availability of the specialty at the site with the
MMHD used as reference. Where there are uncertainties, the NMDS project team contacts the
SDP directly to ascertain the availability of specialties.
A “service provider” of a particular specialty was defined as any participating site that provides
specialists services respective to the discipline and includes sites that only provide visiting
specialist services. It does not require a resident specialist to be available at the site.
10. SDPs are meant to respond within a set deadline. Feedback is received either by fax or post prior
to Data processing. The NMDS project team also takes the initiative to pursue timely feedback
from the respondents.
xviii
Data Processing of Survey Data
1. Survey data was entered into the NMDS Database that had been created by the IT department based
on the finalized survey forms (refer to Phase 1: 7 above). Drop down options similar to that in the
survey form of each specialty was part of the database design to minimize data entry errors.
Prior to data entry, personnel were fully briefed on how to use the database and enter the data via a
training event which included a demonstration.
Personnel were supervised whilst doing the first few entries to make sure sufficient competency had
been developed to minimize if not eliminate errors.
A standard document on steps and precautions on Data entry was mailed to each personnel. Those
who were unable to decipher the feedback were advised to enquire from senior staff.
Each entry is recorded for quality assurance purposes.
2. Visual review and manual assessment of entries are performed to capture erroneous, inconsistent or
inaccurate entries in the survey forms. These typically occur when information is entered under the
“Others” or “Shared Equipment” section. Follow-up with the SDP is performed where required.
Where data was provided using brand names, online searches or follow-up with the SDP was
conducted to guide any required editing of the survey form data.
3. The populated Database then underwent Edit Checks, with the database entries being meticulously
crosschecked against the original survey forms.
4. It was then decided to exclude further data processing of a subset of devices reported by the SDPs
due to limitations in resources. The criteria for selection of devices to be reported per specialty were
outlined by priority for treatment and quality of survey data available. Selection was done by the
NMDS project team with support from the Chairperson.
Only data on functioning medical devices were processed and reported. Functioning medical devices
were defined as medical equipment that were used in daily procedures at the participating site and
excludes:
• equipment deemed as in Beyond Economic Repair as well as
• equipment which, although were still in working condition, were non-operational (not used)
at the site.
5. Data is then exported to Datamed Bio-Statistics for further data processing.
This included a specific focus on estimation of missing data from poorly populated survey forms or
non-responsiveness.
Datamed personnel were tasked with grouping and collating the NMDS data into forms and reports
that would allow further study by the project team. These forms and reports were used by the team to
assess the quality of the NMDS data internally as well as with assistance from the expert panel.
xix
Statistical Methods
In this report, the quantity of the availability of a device is expressed as in absolute count as well as
in number per million inhabitants. The latter statistics are calculated as follows:
T
Number of device/million population =
P
Where T is an estimate of the total quantity of the device available in the country in the year under
consideration
P is the mid-year population of Malaysia or the relevant geographic region where the survey was
conducted
T the total is estimated from the sample of relevant health care facilities as follows:
The total is estimated by T = Σ Wi Ti
Where;
Ti is the value of the quantity of device available in the ith facility in the year
Wi is the sampling weight of the ith facility
Wi = (B/b) * (bi/ Ь)
Where B is total number of beds in the population, b is number of beds of the responding hospitals
(sample), bi is number of beds in the ith facility, and Ь the mean number of beds in the population.
The sampling weight for each sampling unit or unit of analysis therefore has the following
components:
1. Probability of selection.
The basic weight is obtained by multiplying the reciprocals of the probability of selection at each step
of sampling design.
2. Adjustment for non-response.

The response rate was less than 100% for hospital surveys; an adjustment to the sampling weight is
required. The non-response adjustment weight is a ratio with the number of units in the population
as the numerator and the number of responding sampling units as the denominator. The adjustment
reduces the bias in an estimate to the extent that non-responding units have same characteristics as
responding units. Where this is unlikely, some adjustments took into account differences in some
relevant characteristics between responding and non-responding units that may influence drug
utilization, such as bed strength, staff strength, scope of services for hospitals etc.
Finally, adjustments are also made to the statistical estimates to approximate known values from
existing device asset database and from key informants, where these are available.
xx
CHAPTER 1
IMAGING AND DIAGNOSTIC FACILITIES AND DEVICES
Edited by :
Dr. Subramani a/l Venugopal1
With contributions from :

Dr. Che Zubaidah Che Daud2, Dr. Harikrishna a/l Sivaganabalan3, Dr. Hjh. Salwah Hashim4, Dr. Nik
Fatimah Salwati5, Dr. Zaharah Musa6
1 Hospital Tuanku Ja’afar, 2 Hospital Kuala Lumpur, 3 Hospital Tengku Ampuan Rahimah, 4 Hospital Pulau
Pinang, 5 Hospital Sultanah Bahiyah, 6 Hospital Selayang
REPORT
The National Medical Devices Survey (NMDS), a service initiated and supported by the Ministry of
Health, and coordinated by the CRC, gives complete information on the availability of devices and
services in all states in Malaysia. This information is crucial for future planning and financing of
equipment and manpower.
The current survey can be considered a good starting point, but some minor changes will be made for
future data collection, in order to better reflect the Imaging and Diagnostic facilities, equipment and
services that are available. Accurate compilation of data in this NMDS survey will greatly facilitate
the planners to buy the right thing for the right place at the right time.
With capital expenditure for Imaging and Diagnostic being very high, coupled with rapid advances in
technology, it is imperative that we have accurate records of the devices available, so that they can be
optimally utilized, with minimal or no duplication of services, for a given population.
Almost all larger hospitals (both public and private) in the country are now fairly well equipped
with general radiography, fluoroscopy, ultrasound, mammography, computed tomography (CT) and
magnetic resonance scanners. Angiography services are available in most tertiary centers. Basic and
vascular interventional radiology is fast developing into a necessity. Smaller or primary hospitals
and health facilities are also fairly well equipped with radiological services commensurate with the
clinical services provided.
However, the rapid explosion of technology has thrown so many new machines and techniques,
which need careful evaluation, before being adopted in Malaysia.
This report is done with the data provided by the contributors from all states. Some of the states
cannot obtain accurate data from all hospitals, especially in the private hospitals.

Table 1: Available Therapeutic and Diagnostic Facilities in Imaging and Diagnostic Medicine
Population Radiology Centre
No in million No % pmp
Malaysia 26.64 108 100 4
Sector
Public - 66 61
Private - 42 39
State
Johor 3.17 9 8 3
Kedah & Perlis 2.11 7 6 3
Kelantan 1.53 7 6 5
Melaka 0.73 5 5 7
Negeri Sembilan 0.96 2 2 2
Pahang 1.45 7 6 5
Perak 2.28 11 10 5
Terengganu 1.04 3 3 3
Pulau Pinang 1.49 11 10 7
Sabah 3 13 12 4
Sarawak 2.36 12 11 5
Selangor & W.P. Kuala Lumpur 6.43 21 19 3
Table 2: Available Medical Devices in Imaging and Diagnostic Medicine

Magnetic
Computed
Resonance Angiographic Mobile C-Arm
Population Tomography (CT)
Imaging (MRI) Unit Unit
Scanner
Unit
No in million No % pmp No % pmp No % pmp No % pmp
Malaysia 26.64 100 100 4 63 100 2 42 100 2 250 100 9
Sector
Public - 51 51 31 49 17 40 152 61
Private - 49 49 32 51 25 60 98 39
State
Johor 3.17 7 7 2 5 8 2 3 7 1 16 6 5
Kedah &
2.11 7 7 3 6 9 3 3 7 1 18 8 9
Perlis
Kelantan 1.53 3 3 2 2 3 1 2 5 1 11 4 7
Melaka 0.73 5 5 7 4 6 5 3 7 4 9 4 12
Negeri
0.96 3 3 3 2 3 2 2 5 2 8 3 8
Sembilan
Pahang 1.45 4 4 3 2 3 1 1 2 1 11 4 8
Perak 2.28 6 6 3 4 6 2 2 5 1 22 9 10
Terengganu 1.04 1 1 1 1 2 1 0 0 0 8 3 8
Pulau Pinang 1.49 14 14 9 8 13 5 7 16 5 28 12 19
Sabah 3 7 7 2 3 5 1 2 5 1 11 4 4
Sarawak 2.36 11 11 5 5 8 2 3 7 1 21 8 9
Selangor & W.P
6.43 32 32 5 21 33 3 14 33 2 87 35 14
Kuala Lumpur

Mammography
Total Conventional Digital
Population with Stereotactic
Mammography Mammography Mammography
Biopsy System

Malaysia 26.64 95 100 4 37 100 1 9 100 0 37 100 1
Sector
Public - 48 51 10 27 2 22 27 73
Private - 47 49 27 73 7 78 10 27
State
Johor 3.17 9 9 3 3 8 1 0 0 0 5 13 2
Kedah & Perlis 2.11 7 7 3 1 3 0 1 11 0 4 11 2
Kelantan 1.53 2 2 1 1 3 1 0 0 0 1 3 1
Melaka 0.73 4 4 5 4 11 5 0 0 0 0 0 0
Negeri Sembilan 0.96 4 4 4 2 5 2 0 0 0 1 3 1
Pahang 1.45 4 4 3 2 5 1 0 0 0 1 3 1
Perak 2.28 8 8 4 3 8 1 0 0 0 4 11 2
Terengganu 1.04 1 1 1 0 0 0 0 0 0 1 3 1
Pulau Pinang 1.49 12 13 8 5 14 3 1 11 1 5 13 3
Sabah 3 6 6 2 2 5 1 1 11 0 3 8 1
Sarawak 2.36 8 8 3 5 14 2 1 11 0 2 5 1
Selangor & W.P
6.43 30 32 5 9 24 1 5 56 1 10 27 2
Kuala Lumpur
Population Ultrasound with Doppler

Malaysia 26.64 387 100 15
Sector
Public - 203 52
Private - 184 48
State
Johor 3.17 31 8 10
Kelantan 1.53 21 5 14
Melaka 0.73 12 3 16
Pahang 1.45 13 4 9
Perak 2.28 25 6 11
Sabah 3 31 8 10
Sarawak 2.36 29 7 12
Selangor & W.P Kuala Lumpur 6.43 140 36 22
*Note:
1. Counts for “Ultrasound with Doppler” units mentioned above exclude Echocardiocardiography units, which are mentioned under
Chapter 11: Cardiology and Cardiothoracic Surgery Facilities and Devices.

CHAPTER 2
NUCLEAR MEDICINE FACILITIES AND DEVICES
EXPERT PANEL MEMBERS
Chairperson: Dato’ Dr. Mohamed Ali Abdul Khader1
Members : D
r. Lee Boon Nang2, Dr. Ng Chen Siew 3, Dr. Felix Sundram4, Assoc. Prof Sazilah A. Sarji 5
1 Hospital Pulau Pinang, 2 Hospital Kuala Lumpur, 3 Hospital Sultanah Aminah, 4 Subang Jaya Medical
Centre, 5 University Malaya Medical Centre
INTRODUCTION
Since the early 1960’s, when nuclear medicine services first started in Malaysia, its scope has
expanded from just providing diagnostic services to the present therapeutic and also interventional
nuclear medicine. With the introduction of Positron Emission Tomography (PET), the setting up of
cyclotron facility and the use of targeted delivery agents for imaging and therapy, the possibility of
achieving earlier, more accurate and more specific diagnosis, it promises significant improvements
in clinical outcomes. This increasing insight into the molecular origins of disease, the visualization
of pathological changes at the cellular and biochemical level, before their anatomical changes occur
shall without doubt reshape the whole pattern of healthcare.
Worldwide, the field of nuclear medicine has developed tremendously and has become an established
medical specialty and has expanded to various fields of subspecialisations and also integration with
other medical specialties to provide more comprehensive patient management.
Nuclear Medicine involves the use of radioactive isotopes (radioisotopes) to prevent, diagnose, and
treat disease.
Scope of Nuclear Medicine

Nuclear Medicine Service has 3 major sections:
a) Clinical Nuclear Medicine
b) Nuclear Pharmacy
c) Nuclear Medicine Physics
a) Clinical Nuclear Medicine

The Clinical Nuclear Medicine section is the mainstay of the department providing the diagnostic and
therapeutic aspect of nuclear medicine. This section incorporates the nuclear medicine physicians,
medical officers, nurses and the technologists.
b) Section of Nuclear Pharmacy

The nuclear pharmacy section is managed by a pharmacist trained in nuclear medicine and handles
the quality control, and the preparation of radiopharmaceuticals for nuclear medicine procedure.
c) Nuclear Medicine Physics Section

The Nuclear Medicine Physics section is managed by the nuclear medicine physicist who is also a key
member of the nuclear medicine team. The responsibilities revolve around the safety issues in relation
to patients, staff and the public, quality assurance relating to both the performance of key equipment
as well as procedural factors contributing to the quality of service.

REPORT
The nuclear medicine service in the Ministry of Health is to be setup as nuclear medicine department
on a regional basis. These centres will play a bigger role as training centres and also develop a chosen
subspecialty area to focus on at a tertiary level later on.
In Malaysia, the nuclear medicine services began its operation as a unit in the department of Radiotherapy
in Kuala Lumpur Hospital and between in the next 30 years only 3 additional centres began its operation
all within the Klang valley. It is only in the 1990’s that more centres were setup due to the advancement
of nuclear medicine technologies both in the hardware and computerization. In the year 2007 there
are a total of 12 nuclear medicine centers providing various degrees of services ranging from purely
diagnostic to therapy and the more recent sophisticated Positron Emission Tomography.
However the provision of nuclear medicine services are provided by nuclear medicine setup under
various jurisdictions like in the department of Radiology, Department of Internal Medicine, Department
of Oncology and in one center under the department of Biomedical Imaging. Until 2005 there was no
independent nuclear medicine department in the Ministry of Health.
To facilitate planned expansion, a National Nuclear Medicine Meeting was held on 2nd to 5th May 2002
in Johor Bahru, officiated by the Director General of Health, Malaysia. During this meeting, the major
stakeholders involving nuclear medicine attended where various issues, problems, weaknesses were
identified and extensively discussed. Recommendations and target for achievement were prioritized.
All regional nuclear medicine centres would be equipped in phases with:
• Hot lab providing dispensing of radioisotopes
• Diagnostic nuclear medicine services
• Therapeutic nuclear medicine services
• Therapeutic nuclear medicine wards
• Positron Emission Tomography (PET) services
The nuclear medicine facilities and devices data collated are as below :
Table 1: Available Therapeutic and Diagnostic Facilities in Nuclear Medicine
Hospital with Radionuclide

Population Nuclear Medicine Centre
Isolation Ward
No in million No % pmp No % pmp

Malaysia 26.64 5 100 0 12 100 0
Sector
Public - 3 60 8 66
Private - 2 40 4 34
State
Johor 3.17 0 0 0 1 8 0
Kedah & Perlis 2.11 0 0 0 0 0 0
Kelantan 1.53 1 20 1 1 8 1
Melaka 0.73 0 0 0 0 0 0
Negeri Sembilan 0.96 1 20 1 0 0 0
Pahang 1.45 0 0 0 0 0 0
Perak 2.28 0 0 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0
Pulau Pinang 1.49 0 0 0 1 8 1
Sabah 3 0 0 0 0 0 0
Sarawak 2.36 0 0 0 1 8 0
Selangor & W.P. Kuala Lumpur 6.43 3 60 0 8 67 1

Table 2: Available Medical Devices in Nuclear Medicine
Total Gamma Single head 2-head Gamma 3-head Gamma
Population
Camera Units Gamma Camera Camera Camera
Malaysia 26.64 12 100 0 2 100 0 9 100 0 1 100 0
Sector
Public - 10 83 2 100 7 78 1 100
Private - 2 17 0 0 2 22 0 0
State
Johor 3.17 1 8 0 0 0 0 1 11 0 0 0 0
Kedah & Perlis 2.11 0 0 0 0 0 0 0 0 0 0 0 0
Kelantan 1.53 2 17 1 1 50 1 1 11 1 0 0 0
Melaka 0.73 0 0 0 0 0 0 0 0 0 0 0 0
N. Sembilan 0.96 0 0 0 0 0 0 0 0 0 0 0 0
Pahang 1.45 0 0 0 0 0 0 0 0 0 0 0 0
Perak 2.28 0 0 0 0 0 0 0 0 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 3 25 2 1 50 1 2 22 1 0 0 0
Sabah 3 0 0 0 0 0 0 0 0 0 0 0 0
Sarawak 2.36 2 17 1 0 0 0 2 22 1 0 0 0
Selangor & W.P
6.43 4 33 1 0 0 0 3 33 0 1 100 0
Kuala Lumpur
References :
1. Nuclear Medicine in the 21st Century: Contributing To Better Health Care, MOH DG Technical Report
2. 2006 Annual Report, Ministry of Health, Malaysia
3. Malaysian Statistics on Medicine, 2005

CHAPTER 3
Oncology FACILITIES AND DEVICES
Edited by:
Ass. Prof. Dr. Fuad Ismail1
With contributions from:

Dr. Ahmad Kamal Mohamed2, Dr. Mohd Roslan B. Haron3, Dr. Vincent Phua4, En. Mohd Farihan
Jaffar4, Puan Rubiah Pakah4, Pn. Mahzom Pawanchek4
1 Pusat Perubatan Universiti Kebangsaan Malaysia, 2 Pusat Perubatan Subang Jaya, 3 Hospital Sultan Ismail,
4 Hospital Kuala Lumpur.
REPORT
Radiotherapy is one of the cornerstones of cancer therapy, both for cure and palliation. Radiotherapy
services are equipment based with 2 distinct modalities, teletherapy and brachytherapy.
Teletherapy is currently based on Linear Accelerators (LINAC) with older cobalt units available in a
few hospitals. There are 5 cobalt units in the country. These are technically still working but are not
used as they are being phased out to be replaced by linacs. The only working unit is in a private centre
in Selangor.
Linacs form the backbone of radiotherapy with the capability to deliver 2-D & 3-D treatment as
standard. There are a total of 30 linacs in Malaysia with a ratio of 1.17 per million population (pmp).
This is far lower than the recommended ratio in UK of 4 PMP. Apart from the lack of equipment,
there is also a great imbalance in the distribution of linacs in Malaysia with almost half concentrated
in the Klang Valley (Selangor & Wilayah Persekutuan). Large states such as Kedah, Perak, Pahang
and Terengganu still lack radiotherapy centres hence have no available equipment. As radiotherapy is
given over several weeks, the lack of facilities results in patients having to move to another state for
a protracted period of time for treatment. The other states have between 1-4 linacs each.
Improvements in technology have resulted in improved treatment delivery by improved radiation

dosimetry. Five (5) radiotherapy centres are able to offer more sophisticated radiotherapy using
Intensity Modulated Radiotherapy (IMRT). Other specialized equipment includes one (1) cyberknife
device and linac based stereotactic devices (4), all in Klang Valley except one.
Brachytherapy is an important modality in radiotherapy especially in gynaecological malignancies.

Both High Dose-Rate (HDR) and Low Dose-Rate (LDR) are equally effective. The overall capacity
in the country is adequate for gynaecological treatment but due to unequal distribution, there is no
services in some states namely Kedah, Pahang & Terengganu. Klang Valley has overcapacity with
about half the available brachytherapy devices.
Radiotherapy may be given for palliation or for cure. Treatment time may be between 1 – 7 weeks.
The current recommendation states that 50% of patient with cancer require radiotherapy treatment
at some point. The incidence rate of cancer in Australia is over 4000 PMP compared to 1400 PMP in
Malaysia. The required number of machines in Australia is estimated to be 6.5 per million population.
Given that our incidence is about 3 times lower, the number of linacs required in our country should
be about 60 machines in total. Equitable distribution of equipment is equally important.

Table 1: Available Therapeutic and Diagnostic Facilities in Oncology
No Data to Date
Table 2: Available Medical Devices in Oncology

High dose Low dose
Population Linear Accelerator IMRT
Brachytherapy Brachytherapy
Malaysia 26.64 28 100 1 8 100 0 10 100 0 7 100 0
Sector
Public - 14 50 6 75 5 50 3 43
Private - 14 50 2 25 5 50 4 57
State
Johor 3.17 3 11 1 1 13 0 1 10 0 1 14 0
Kedah &
2.11 0 0 0 0 0 0 0 0 0 0 0 0
Perlis
Kelantan 1.53 2 7 1 1 13 1 0 0 0 1 14 1
Melaka 0.73 2 7 3 0 0 0 2 20 3 0 0 0
Negeri
0.96 2 7 2 0 0 0 1 10 1 1 14 1
Sembilan
Pahang 1.45 0 0 0 0 0 0 0 0 0 0 0 0
Perak 2.28 0 0 0 0 0 0 1 10 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 4 14 3 1 13 1 0 0 0 1 14 1
Sabah 3 1 4 0 0 0 0 1 10 0 0 0 0
Sarawak 2.36 3 11 1 1 13 0 0 0 0 1 14 0
Selangor &
W.P Kuala 6.43 11 39 2 4 50 1 4 40 1 2 29 0
Lumpur
Co 60
Population CyberKnife
* Equipment on phase out
Malaysia 26.64 1 100 0 1 100 0
Sector
Public - 0 0 0 0
Private - 1 100 1 100
State
Johor 3.17 0 0 0 0 0 0
Kedah & Perlis 2.11 0 0 0 0 0 0
Kelantan 1.53 0 0 0 0 0 0
Melaka 0.73 0 0 0 0 0 0
Pahang 1.45 0 0 0 0 0 0
Perak 2.28 0 0 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0
Pulau Pinang 1.49 0 0 0 0 0 0
Sabah 3 0 0 0 0 0 0
Sarawak 2.36 0 0 0 0 0 0
Selangor &
6.43 1 100 0 1 100 0
W.P Kuala Lumpur
10
CHAPTER 4
ANAESTHESIOLOGY AND INTENSIVE CARE
FACILITIES AND DEVICES
Edited by:
Dato’ Dr. Jahizah Hassan1, Professor Marzida Mansor2, Associate Professor Choy Yin Choy3, Dr.
Mary Suma Cardosa4, Dr. Irene Cheah5, Dr. Neoh Siew Hong6, Dato’ Dr. KH Teh 7.
1 Hospital Pulau Pinang, 2 Pusat Perubatan Universiti Malaya, 3 Pusat Perubatan Universiti Kebangsaan Malaysia,
4 Hospital Selayang, 5 Hospital Kuala Lumpur, 6 Hospital Ipoh, 7 Hospital Sultanah Bahiyah.
INTRODUCTION
The data on medical devices for Anaesthesiology and Intensive Care was collected over duration
of one-year using survey forms that were sent to both public and private hospitals in Malaysia. The
availability of the therapeutic and diagnostic facilities in anaesthesia was based on the number of
Intensive Care Units (ICU), High Dependency Units, Anaesthetic Clinics and Acute Pain Services in
Malaysia.
Table 1: Available Therapeutic and Diagnostic Facilities in Anaesthesiology
Paediatric Adults Burns Paediatric Burns

Adult Intensive
Population Intensive Care Intensive Care Intensive Care
Care Unit (ICU)
Unit (PICU) Unit Unit
Malaysia 26.64 103 100 4 32 100 1 12 100 0 3 100 0

Sector
Public - 65 55 12 38 10 83 2 67
Private - 38 45 20 62 2 17 1 33

State
Johor 3.17 13 13 4 3 10 1 0 0 0 0 0 0
Kedah & Perlis 2.11 9 9 4 1 3 0 2 17 1 1 33 0
Kelantan 1.53 4 4 3 3 9 2 1 8 1 0 0 0
Melaka 0.73 5 5 7 1 3 1 1 8 1 0 0 0
N. Sembilan 0.96 5 5 5 1 3 1 0 0 0 0 0 0
Pahang 1.45 4 4 3 1 3 1 1 8 1 0 0 0
Perak 2.28 10 10 4 3 9 1 0 0 0 0 0 0
Terengganu 1.04 2 2 2 1 3 0 0 0 0 0 0 0
Pulau Pinang 1.49 13 13 9 4 12 3 0 0 0 1 33 1
Sabah 3 5 5 2 3 9 1 0 0 0 0 0 0
Sarawak 2.36 7 7 3 2 6 1 1 8 0 0 0 0
Selangor & W.P
6.43 26 25 4 9 28 1 6 50 1 1 33 0
Kuala Lumpur
11
Population High Dependency Unit Anaesthetic Clinic Acute Pain Service
No in million No % pmp No % pmp No % pmp
Malaysia 26.64 55 100 2 30 100 1 38 100 1
Sector
Public - 21 38 15 50 38 100
Private - 34 62 15 50 0 0
State
Johor 3.17 8 15 3 4 13 1 5 13 2
Kedah & Perlis 2.11 4 7 2 2 7 1 4 11 2
Kelantan 1.53 2 4 1 1 3 1 2 5 1
Melaka 0.73 3 5 4 2 7 3 2 5 3
Negeri Sembilan 0.96 3 5 3 1 3 1 2 5 2
Pahang 1.45 3 5 2 2 7 1 2 5 1
Perak 2.28 5 9 2 2 7 1 3 8 1
Terengganu 1.04 2 4 2 0 0 0 1 3 1
Pulau Pinang 1.49 4 7 3 5 17 3 2 5 1
Sabah 3 2 4 1 3 10 1 1 3 0
Sarawak 2.36 6 11 3 3 10 1 4 11 2
Selangor & W.P.
6.43 13 24 2 5 17 1 10 26 2
Kuala Lumpur
The data showed that Malaysia has 4 adult, 1 paediatric and 0 adult and paediatric burns ICU per
million population (pmp) as shown in Table 1. The distribution of the adult intensive care is almost
equal between the private and public hospitals; however there are more paediatric intensive care
units available in the private sector. In the case of adult and paediatric ICUs, majorities are in the
public sectors. With regards to distribution of ICU throughout Malaysia it is not surprising to find
that majority of the intensive care services are located in places where there are major public or
private hospitals. The availability of adult ICU for instance varies from 26% in Selangor and W.P
Kuala Lumpur to 2% in Terengganu. This is probably due to maldistribution of human resources and
availability of private hospitals, which is probably influenced by population’s income, geographical
demarcation and urbanization. The paediatric ICU availability follows the similar trend as the adult
ICU and in fact, their services are even more deficient as compared to adult ICU. We have 1 paediatric
ICU pmp. Their availability ranges from as low as 0% in Terengganu to 20% in Selangor& WP Kuala
Lumpur. Adult and paediatric burns ICU are the most deficient of all the intensive care facilities.
More of these services should be made available in the near future.
High dependency unit is available in most of the states as a step down unit. It is encouraging to note
that the anaesthetic clinic services have taken off in Malaysia, both in the public and private sectors.
This reflects that a proportion of patients schedule for elective surgery were seen prior to surgery
for optimization. This anaesthetic clinic services will certainly reduce cancellation rate of elective
surgery and improves patient care and safety. In terms of medical devices, there are not many devices
are needed in the anaesthetic clinic. Perhaps in future when more anaesthetists are trained to do
specific echocardiography to assess the cardiovascular status of patients preoperatively, then, this
statistic on anaesthetic clinic may be more relevant.
The data showed that Acute Pain Services are well establish in most major public hospitals but not
available in private hospitals. We are fully aware that such services are available in majority of the
private hospitals using similar devices. The data is not being captured probably due to the fact that
acute pain services are being provided by individual practitioner / anaesthetist rather than by the acute
pain team.
12
Table 2: Available Medical Devices in Anaesthesiology
High Frequency
Anaesthesia Adult Portable Intensive Care
Population Adult Intensive
Ventilator Ventilator Ventilator
Care Ventilator
No in
No % pmp No % pmp No % pmp No % pmp
million
Malaysia 26.64 655 100 25 236 100 9 793 100 30 26 100 1
Sector
Public - 451 69 184 78 555 70 21 81
Private - 204 31 w 52 22 238 30 5 19
State
Johor 3.17 66 10 21 22 9 7 84 11 26 1 4 0
Kedah &
2.11 30 5 14 13 6 6 31 4 15 0 0 0
Perlis
Kelantan 1.53 19 3 12 15 6 10 50 6 33 0 0 0
Melaka 0.73 21 3 29 12 5 16 41 5 56 0 0 0
N. Sembilan 0.96 11 2 11 4 2 4 14 2 15 0 0 0
Pahang 1.45 18 3 12 10 4 7 32 4 22 1 4 1
Perak 2.28 49 7 21 18 8 8 46 6 20 0 0 0
Terengganu 1.04 21 3 20 4 2 4 25 3 24 0 0 0
P. Pinang 1.49 79 12 53 31 13 21 134 17 90 0 0 0
Sabah 3 48 7 16 21 9 7 29 4 10 1 4 0
Sarawak 2.36 65 10 28 18 8 8 64 8 27 0 0 0
Selangor & W.P
6.43 228 35 35 68 29 11 243 31 38 23 88 4
Kuala Lumpur
Paediatric High
Neonatal / Patient
Frequency Flexible Fiber
Paediatric Controlled
Population Oscillatory Optic Intubation
Intensive Care Analgesia (PCA)
Ventilator Scope
Ventilator Infusion Pump
(HFOV)
Malaysia 26.64 379 100 14 41 100 2 121 100 5 387 100 15
Sector
Public - 303 80 38 93 86 71 279 72
Private - 76 20 3 7 35 29 108 28
State
Johor 3.17 36 9 11 5 12 2 8 7 3 15 4 4
Kedah & Perlis 2.11 32 8 15 7 17 3 6 5 3 15 4 7
Kelantan 1.53 20 5 13 6 15 4 7 6 5 16 4 10
Melaka 0.73 9 2 12 1 2 1 2 2 3 11 3 15
N. Sembilan 0.96 20 5 21 1 2 1 7 6 7 6 2 6
Pahang 1.45 18 5 12 1 2 1 4 3 3 24 6 17
Perak 2.28 27 7 12 2 5 1 8 7 4 36 9 16
Terengganu 1.04 15 4 14 1 2 1 5 4 5 7 2 7
P. Pinang 1.49 35 9 23 2 5 1 10 8 7 43 11 29
Sabah 3 44 12 15 6 15 2 7 6 2 12 3 4
Sarawak 2.36 18 5 8 2 5 1 8 7 3 30 8 13
Selangor & W.P
6.43 105 28 16 7 17 1 49 40 8 173 45 27
Kuala Lumpur
13
Population Level 1 Infusion Pump With or Without Hotline
Malaysia 26.64 491 100 18
Sector
Public - 293 60
Private - 198 40
State
Johor 3.17 46 9 15
Kelantan 1.53 29 6 19
Melaka 0.73 12 2 16
Pahang 1.45 19 4 13
Perak 2.28 77 16 34
Sabah 3 23 5 8
Sarawak 2.36 7 1 3
The data in Table 2 concentrate on ventilators, which comprise of anaesthesia ventilator, adult
portable ventilator, ICU ventilator, high frequency adult ICU ventilator and paediatric and neonatal
high frequency oscillatory. These equipment are the common items available in the facilities in Table
1 but the figures may not be a true reflection of the services rendered to the population as some of
these equipment may not being used due to shortage of anaesthetists and nurses. Similarly, the same
reasoning applies to the data on anaesthesia ventilators (anaesthetic machines) and flexible fibre optic
intubation scopes. In future, it may be more useful to have a statistics on the number of operation
theatres in each hospitals surveyed as these two devices are mostly available in the operating theatre
(OT) rather than in the intensive care. With regards to the anaesthesia ventilators, we are assuming
that these ventilators are the ones that are attached to the anaesthetic machines.
The main data collection on the device used for acute pain service is patient controlled analgesia (PCA)
infusion pump. The pumps are widely available in both private and public hospitals in a reasonable
numbers, indicating that the services are being provided in both sectors. The last equipment in Table
2 is level 1 infusion pump with or without hotline. The figures combined the generic and specific for
rapid infusion. The hotline is widely available in most hospital. However Level 1infusion pumps are
not widely available.
This is our first effort in trying to compile our own data on medical devices for our fraternity; therefore
the data may not reflect the actual numbers, as many of the private hospitals are not included. The
range of equipment covered is also inadequate and more detailed definitions and information should
be made available in the future.
14
CHAPTER 5
GENERAL SURGERY FACILITIES AND DEVICES
EXPERT PANEL MEMBERS
Chairperson : Dato’ Dr. Dato’ Dr. Zakaria Bin Zahari 1
Members : Dr. Mohammed Saffari Mohammed Haspani1, Dr. Mohd Mazri Yahya1
1 Hospital Kuala Lumpur
Table 1: Available Therapeutic and Diagnostic Facilities in General Surgery
Day Case Surgery Surgical Neonatal Anorectal

High Dependency
Population Unit Intensive Care Physiology
(Surgical) Unit
Unit (SNICU) Laboratory
No in
million
Malaysia 26.64 63 100 2 41 100 2 9 100 0 1 100 0
Sector
Public - 27 43 17 41 7 78 1 100
Private - 36 57 24 59 2 22 0 0
State
Johor 3.17 4 6 1 2 5 1 1 11 0 0 0 0
Kedah &
2.11 6 10 3 5 12 2 1 11 0 0 0 0
Perlis
Kelantan 1.53 3 5 2 3 7 2 1 11 1 0 0 0
Melaka 0.73 2 3 3 3 7 4 1 11 1 0 0 0
N. Sembilan 0.96 1 2 1 2 5 2 1 11 1 0 0 0
Pahang 1.45 4 6 3 3 7 2 0 0 0 0 0 0
Perak 2.28 7 11 3 4 10 2 0 0 0 0 0 0
Terengganu 1.04 0 0 0 1 3 1 0 0 0 0 0 0
P. Pinang 1.49 5 8 3 5 12 3 1 11 1 0 0 0
Sabah 3 5 8 2 2 5 1 1 11 0 0 0 0
Sarawak 2.36 7 11 3 3 7 1 0 0 0 0 0 0
Selangor & W.P.

6.43 19 30 3 8 20 1 2 22 0 1 100 0
Kuala Lumpur
15
Population Liver Transplant Unit Robotic Surgical Suite
Malaysia 26.64 1 100 0 0 0 0
Sector
Public - 1 100 0 0
Private - 0 0 0 0
State
Johor 3.17 0 0 0 0 0 0
Kedah & Perlis 2.11 0 0 0 0 0 0
Kelantan 1.53 0 0 0 0 0 0
Melaka 0.73 0 0 0 0 0 0
Pahang 1.45 0 0 0 0 0 0
Perak 2.28 0 0 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0
Pulau Pinang 1.49 0 0 0 0 0 0
Sabah 3 0 0 0 0 0 0
Sarawak 2.36 0 0 0 0 0 0
Table 2: Available Medical Devices in General Surgery

Gamma Probe
Automated Vacuum Assisted
For Sentinel Node
Population Breast Tissue Breast Biopsy ABBI System
And Parathyroid
Core Biopsy Gun Gun
Surgery
No in
million
Malaysia 26.64 31 100 1 4 100 0 0 0 0 1 100 0
Sector
Public - 24 80 2 50 0 0 0 0
Private - 7 23 2 50 0 0 1 100
State
Johor 3.17 1 3 0 0 0 0 0 0 0 0 0 0
Kedah & Perlis 2.11 3 10 1 1 25 0 0 0 0 0 0 0
Kelantan 1.53 4 13 3 0 0 0 0 0 0 0 0 0
Melaka 0.73 2 6 3 0 0 0 0 0 0 0 0 0
N. Sembilan 0.96 0 0 0 0 0 0 0 0 0 0 0 0
Pahang 1.45 2 6 1 1 25 1 0 0 0 0 0 0
Perak 2.28 3 10 1 0 0 0 0 0 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 3 10 2 1 25 1 0 0 0 1 100 1
Sabah 3 1 3 0 0 0 0 0 0 0 0 0 0
Sarawak 2.36 2 6 1 0 0 0 0 0 0 0 0 0
Selangor & W.P.
6.43 10 33 2 1 25 0 0 0 0 0 0 0
Kuala Lumpur
16
Operating Table
Ultrasonic
With Yellow-Fin Argon Plasma
Harmonic Dissector and
Population Boots And Jacknife Coagulation
Scalpel Aspirator
Positioning System
(CUSA)
Capability
Malaysia 26.64 123 100 5 45 100 2 40 100 2 33 100 1
Sector
Public - 51 41 23 51 24 60 11 33
Private - 72 59 22 49 16 40 22 67
State
Johor 3.17 18 15 6 2 4 1 2 5 1 2 6 1
Kedah & Perlis 2.11 5 4 2 5 11 2 5 12 2 0 0 0
Kelantan 1.53 4 3 3 3 7 2 3 8 2 0 0 0
Melaka 0.73 6 5 8 1 2 1 0 0 0 6 18 8
Negeri Sembilan 0.96 7 6 7 1 2 1 0 0 0 0 0 0
Pahang 1.45 3 2 2 2 4 1 6 15 4 4 12 3
Perak 2.28 18 15 8 5 11 2 3 8 1 3 9 1
Terengganu 1.04 1 1 1 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 20 16 13 10 22 7 5 12 3 3 9 2
Sabah 3 12 10 4 1 2 0 1 3 0 1 3 0
Sarawak 2.36 11 9 5 3 7 1 2 5 1 4 12 2
Selangor & W.P.
6.43 18 15 3 12 27 2 13 32 2 10 31 2
Kuala Lumpur
Haemorrhoid
Transrectal Anorectal Pudendal Nerve
Artery Ligation
Population Ultrasound Manometer Latency Test
(HAL) Doppler
Equipment
Equipment
No in
million
Malaysia 26.64 4 100 0 0 0 0 1 100 0 3 100 0
Sector
Public - 2 50 0 0 0 0 2 67
Private - 2 50 0 0 1 100 1 33
State
Johor 3.17 0 0 0 0 0 0 0 0 0 0 0 0
Kedah & Perlis 2.11 1 25 0 0 0 0 0 0 0 1 33 0
Kelantan 1.53 1 25 1 0 0 0 0 0 0 0 0 0
Melaka 0.73 0 0 0 0 0 0 0 0 0 0 0 0
N. Sembilan 0.96 0 0 0 0 0 0 0 0 0 0 0 0
Pahang 1.45 0 0 0 0 0 0 0 0 0 0 0 0
Perak 2.28 0 0 0 0 0 0 0 0 0 1 33 0
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 1 25 1 0 0 0 0 0 0 0 0 0
Sabah 3 0 0 0 0 0 0 0 0 0 0 0 0
Sarawak 2.36 1 25 0 0 0 0 1 100 0 0 0 0
Selangor & W.P.
6.43 0 0 0 0 0 0 0 0 0 1 33 0
Kuala Lumpur
17
Radiofrequency Liver Dialysis Endovenous Laser
Population Craniotome
Ablation Unit Unit (MARS) Unit
Malaysia 26.64 3 100 0 0 0 0 4 100 0 74 100 3
Sector
Public - 0 0 0 0 0 0 50 68
Private - 3 100 0 0 4 100 24 32
State
Johor 3.17 0 0 0 0 0 0 0 0 0 10 14 3
Kedah & Perlis 2.11 0 0 0 0 0 0 0 0 0 6 8 3
Kelantan 1.53 0 0 0 0 0 0 0 0 0 1 1 1
Melaka 0.73 0 0 0 0 0 0 0 0 0 3 4 4
N. Sembilan 0.96 0 0 0 0 0 0 0 0 0 2 3 2
Pahang 1.45 0 0 0 0 0 0 0 0 0 4 5 3
Perak 2.28 0 0 0 0 0 0 0 0 0 7 10 3
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 3 100 2 0 0 0 1 25 1 6 8 4
Sabah 3 0 0 0 0 0 0 0 0 0 4 5 1
Sarawak 2.36 0 0 0 0 0 0 0 0 0 12 16 5
Selangor & W.P.
6.43 0 0 0 0 0 0 3 75 0 19 26 3
Kuala Lumpur
Paediatric
Paediatric Thoracoscopy
Paediatric Upper Cystoscopy Set
Lower And Abdominal
Gastrointestinal For Urology
Gastrointestinal Laparoscopy Set
Population Diagnostic And And Complex
Diagnostic And For Minimally
Therapeutic Intersex Surgery
Therapeutic Invasive
Endoscope Set
Endoscope Set Laparoscopic
Surgery
Malaysia 26.64 14 100 1 12 100 0 15 100 1 13 100 0
Sector
Public - 10 71 8 67 8 53 3 21
Private - 4 29 4 33 7 47 10 86
State
Johor 3.17 2 14 1 2 17 1 1 7 0 0 0 0
Kedah & Perlis 2.11 2 14 1 1 8 0 1 7 0 1 7 0
Kelantan 1.53 2 14 1 2 17 1 2 13 1 0 0 0
Melaka 0.73 1 7 1 1 8 1 1 7 1 1 7 1
N. Sembilan 0.96 1 7 1 1 8 1 2 13 2 0 0 0
Pahang 1.45 0 0 0 0 0 0 0 0 0 0 0 0
Perak 2.28 0 0 0 0 0 0 2 13 1 0 0 0
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 1 7 1 1 8 1 2 13 1 10 78 7
Sabah 3 0 0 0 0 0 0 0 0 0 0 0 0
Sarawak 2.36 0 0 0 0 0 0 1 7 0 0 0 0
Selangor & W.P.
6.43 5 36 1 4 34 1 3 20 0 1 7 0
Kuala Lumpur
18
Vacuum Assisted
Robotic Surgery
Population Closure System Dermatome
System
(VACS)
Malaysia 26.64 22 100 1 51 100 2 2 100 0
Sector
Public - 11 50 34 67 2 100
Private - 11 50 17 33 0 0
State
Johor 3.17 1 5 0 3 6 1 0 0 0
Kedah & Perlis 2.11 0 0 0 8 15 4 0 0 0
Kelantan 1.53 4 18 3 4 8 3 0 0 0
Melaka 0.73 1 5 1 1 2 1 0 0 0
Negeri Sembilan 0.96 0 0 0 1 2 1 0 0 0
Pahang 1.45 0 0 0 2 4 1 0 0 0
Perak 2.28 1 5 0 5 10 2 0 0 0
Terengganu 1.04 0 0 0 2 4 2 0 0 0
Pulau Pinang 1.49 1 5 1 6 12 4 0 0 0
Sabah 3 1 5 0 2 4 1 0 0 0
Sarawak 2.36 10 45 4 4 8 2 1 50 0
Selangor & W.P.
6.43 3 14 0 13 25 2 1 50 0
Kuala Lumpur
19
CHAPTER 6
ORTHOPAEDIC AND TRAUMATOLOGY
Edited by:
Dr. Kamariah Nor MD1., Dr. Mohammad Anuar H.A2., Dr. Ng YO3, Dato’ Dr. Ramanathan R4, Dr.
Lee JK 5 and Dr. Mahathar AW.1.
1 Hospital Kuala Lumpur, 2 Hospital Raja Perempuan Zainab II, 3 Hospital Ampang, 4 Hospital Ipoh,
5 Pusat Perubatan Pantai Bangsar.
REPORT
External fixation is the commonest mode of treatment for open fractures. Generally all hospitals with
orthopedic services will have at least one external fixator set. So, generally in Malaysia there are 333
sets of external fixators, which equate roughly to 13 sets per million population. However, in Sabah,
there are only 15 sets of external fixators that are generally inadequate for the 3 million population.
The distribution of external fixators is balanced between the public and private sector. However in
the public sector, the distributions were high in urban areas and Wilayah Persekutuan.
Overall, there is some mal-distribution of external fixators, with higher concentration in Penang (22
PMP) but low concentration in Sabah. As for Ilizarov set, there are higher numbers in Sarawak
(5PMP) as compared to other states (1-2 PMP). The panel recommends that each hospital which
provides orthopaedic and trauma services should have at least one set of external fixators (each for
upper limb, lower limb and mini set).
Currently there are only 116 sets of upper limb external fixators (4 set PMP), which is not enough to
deal with the increasing number of upper limb injuries.
The Panel also suggests a more proper definition and clarification of external fixator sets. The
specification can be varies from different companies with different capacities. In addition, data on
trained personnel available to operate the devices in that particular hospital may be useful. This will
indicate whether the devices are being used optimally or if they can be mobilized to other hospitals if
trained personnel are not available or have been transferred.
Table 1: Available Therapeutic and Diagnostic Facilities in Orthopedic & Traumatology

No Data To Date
21
Table 2: Available Medical Devices in Orthopedics & Traumatology
Total External External Fixator External Fixator External Fixator

Population
Fixator Unit Lower Limb Unit Upper Limb Unit Mini Unit
No in
million
Malaysia 26.64 333 100 13 151 100 6 116 100 4 67 100 3
Sector
Public - 213 64 98 65 73 63 44 66
Private - 120 36 53 35 43 37 23 34
State
Johor 3.17 26 8 8 10 7 3 8 7 3 8 12 3
Kedah &
2.11 35 11 17 16 10 8 12 10 6 7 10 3
Perlis
Kelantan 1.53 20 6 13 10 7 7 6 5 4 4 6 3
Melaka 0.73 8 2 11 3 2 4 3 3 4 2 3 3
N. Sembilan 0.96 10 3 10 4 3 4 5 4 5 1 1 1
Pahang 1.45 15 4 10 6 4 4 5 4 3 4 6 3
Perak 2.28 34 10 15 15 10 7 12 10 5 7 10 3
Terengganu 1.04 8 2 8 3 2 3 3 3 3 2 3 2
P. Pinang 1.49 33 10 22 18 12 12 11 10 7 4 6 3
Sabah 3 15 4 5 6 4 2 5 4 2 4 6 1
Sarawak 2.36 33 10 14 15 10 6 10 9 4 8 12 3
Selangor & W.P
6.43 96 30 15 45 29 7 36 31 6 16 24 2
Kuala Lumpur
Population Illizarov Unit

Malaysia 26.64 47 100 2
Sector
Public - 34 72
Private - 13 28
State
Johor 3.17 4 9 1
Kelantan 1.53 2 4 1
Melaka 0.73 2 4 3
Pahang 1.45 1 2 1
Perak 2.28 4 9 2
Sabah 3 3 6 1
Sarawak 2.36 11 23 5
22
CHAPTER 7
pHYSIOTHERAPY And occupational therapy
Contributors:
Datin Hjh Asiah Bt Hashim1, Cik Katijjah Be Mohd Ali2, Pn. Misnah Roslam3, Pn. Tan Wai Choo4,
Pn. Wong Swee Fong5, Pn. Lim Khee Li1, Pn. Hjh. Hamidah Hj. Ariffin6, Pn. Khuzaimah Abd. Aziz1,
Pn. Jamaliah Musa1, Pn. Zalila Kashim1
1 Hospital Kuala Lumpur, 2 Pusat Perubatan Universiti Kebangsaan Malaysia, 3 Hospital Serdang, 4 Hospital Sungai
Buloh, 5 Hospital Tengku Ampuan Rahimah, 6 Hospital Selayang
REPORT
The data portrayed in this report are data from the NMDS (2007) as well as data collated by the
expert panel of this discipline (2008 data). Whilst the data collected in 2007 includes input from the
private sector institutions, those of 2008 below are all from the public hospitals and health clinics in
Malaysia. Figures from the private sectors, University Hospitals and Arm Forces Hospitals in 2008
were not obtained.
The findings are as follows:-

There is an increase of number of device per million population (PMP) from year 2007 to 2008.
MEDICAL DEVICE PMP
Transcutaneous Electrical Nerve Stimulation (TENS) From 13 to 14
Short wave Diathermy (SWD) From 6-9
Pressure Feedback* From 2-3
*Note :
The pressure feedback survey done in 2008 refers to a simple device that is commonly used to measure the core muscle work of cervical
and lumbar region.
There is decrease of number of device per million population (PMP) from year 2007 to 2008 :
MEDICAL DEVICE PMP
Ultrasound* From 11-7
Laser From 3-2
Continuous Passive Motion Exerciser From 2-0
*Note:
There is a doubt whether the Neuromuscular Ultrasound Therapy stimulation system is referred to just an ultrasound machine which is
commonly used in the physiotherapy department and Klinik Kesihatan in Malaysia.
The number of devices shown is not proportionate to the population of the respective states. It is most
likely based on the demand of the cases seen and the services provided by the hospitals. The Klang
valley is the most populated but does not have the most number of devices such as SWD, TENS,
Ultrasound, laser, pressure feedback and CPM.
Conclusion:
The figures obtained for devices compared with the population (PMP) are very far from desirable
stage. Even though with addition of devices from the private sectors, it still makes no difference in
number of devices in per million population as demonstrated in 2007.
23
Table 1: Available Therapeutic and Diagnostic Facilities in Physiotherapy and Occupational
Therapy
No Data To Date
Table 2: Available Medical Devices in Physiotherapy and Occupational Therapy
Transcutaneous Electrical Nerve Short wave Diathermy

Population
Stimulation (TENS) (SWD)
Year ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08
Malaysia 26.64 333 - 100 - 13 - 163 - 100 - 6 -
Sector -
Public - 268 374 80 - 123 173 75 -
Private 65 ND 20 - 40 ND 25 -
State
Johor 3.17 31 22 9 6 10 7 8 13 5 7 3 4
Kedah & Perlis 2.11 11 39 3 10 5 18 7 15 4 8 3 7
Kelantan 1.53 11 17 3 5 7 11 10 9 6 5 7 6
Melaka 0.73 17 8 5 2 23 11 6 3 4 2 8 4
N. Sembilan 0.96 8 16 2 5 8 17 6 9 4 5 6 9
Pahang 1.45 16 39 5 10 11 27 12 17 7 10 8 12
Perak 2.28 17 35 5 9 7 15 14 16 9 10 6 7
Terengganu 1.04 12 12 4 3 12 12 11 16 7 10 11 15
Pulau Pinang 1.49 35 20 11 5 23 13 14 9 9 5 9 6
Sarawak 2.36 31 34 9 9 13 14 18 17 11 10 8 7
Sabah 3 18 28 6 8 6 9 9 19 6 11 3 6
Selangor & W.P
6.43 126 104 38 28 20 16 48 30 29 17 7 5
Kuala Lumpur
24
Continuous Passive Motion
Population Ultrasound Therapy
Exerciser (CPM)
Year ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08
Malaysia 26.64 287 - 100 - 11 - 48 - 100 - 2 -
Sector -
Public - 223 192 78 - 29 11 60 -
Private 64 ND 22 - 19 ND 40 -
State
Johor 3.17 14 15 5 8 4 5 3 1 6 9 1 0
Kedah & Perlis 2.11 10 18 3 9 5 9 0 3 0 27 0 1
Kelantan 1.53 7 10 2 5 5 7 0 0 0 0 0 0
Melaka 0.73 12 5 4 3 16 7 0 0 0 0 0 0
Negeri Sembilan 0.96 5 7 2 4 5 7 1 0 2 0 1 0
Pahang 1.45 12 17 4 9 8 12 2 0 4 0 1 0
Perak 2.28 10 21 3 11 4 9 9 0 19 0 4 0
Terengganu 1.04 4 13 1 7 4 13 0 0 0 0 0 0
Pulau Pinang 1.49 22 11 8 6 15 7 6 4 13 2 4 3
Sarawak 2.36 17 22 8 11 7 9 2 1 4 9 1 0
Sabah 3 16 24 8 123 5 8 2 1 4 9 1 0
Selangor & W.P
6.43 158 29 56 15 25 5 23 1 48 9 3 0
Kuala Lumpur
Population Laser Therapy Pressure Biofeedback System
Year ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08 ‘07 ‘08
Malaysia 26.64 74 - 100 - 3 - 44 - 100 - 2 -
Sector -
Public - 56 58 76 - 41 84 93 -
Private 18 ND 24 - 3 ND 7 -
State
Johor 3.17 3 2 4 3 1 1 6 1 14 1 2 0
Kedah & Perlis 2.11 2 3 3 5 1 1 1 14 2 17 0 7
Kelantan 1.53 3 4 4 7 2 5 2 7 5 8 1 5
Melaka 0.73 2 0 3 3 1 7 2 8 1 10
Negeri Sembilan 0.96 3 3 4 5 3 3 2 4 5 5 2 4
Pahang 1.45 6 7 8 12 4 5 2 8 5 10 1 6
Perak 2.28 13 8 18 14 6 4 5 15 11 17 2 7
Terengganu 1.04 1 2 1 3 1 2 1 4 2 5 1 4
Pulau Pinang 1.49 8 3 11 5 5 2 2 5 5 6 1 3
Sarawak 2.36 3 3 4 5 1 2 7 8 15 10 3 3
Sabah 3 3 7 4 12 1 2 6 4 14 5 2 1
Selangor & W.P
6.43 27 16 36 29 4 2 9 7 20 8 1 1
Kuala Lumpur
25
CHAPTER 8
Obstetrics & Gynaecology FACILITIES AND DEVICES
Edited by :
Dr. Murali Ganesalingam1

Dr. Krishnakumar a/l Harikrishnan2, Dr. R.P Japaraj3, Dr. Zaridah Shaffie4
1 Hospital Kuala Lumpur, 2 Hospital Tuanku Ja’afar, 3 Hospital Ipoh, 4 Hospital Tuanku Fauziah
INTRODUCTION
There are various types of equipment being used within the obstetrics and gynaecology discipline.
What would improve our ability to determine the best equipment to purchase would be a pre-survey
questionnaire on the equipment and their make and the benefits and disadvantages of a particular
brand that is currently in use.
Equipment such as suction pumps are equipment that are currently part of any operating theatre set
up and there is no need to purchase such equipment specifically for suction curettage as we used to
previously when suction pumps were not part of standard operating theatre equipment. Such items
must be identified and deleted from future surveys.
Hospitals are currently built as turnkey projects and come fully equipped. There must be a system
to capture the equipment that is in place and a system to ensure that future projects need to secure
appropriate approvals before furnishing equipment to hospitals.
We are now using more disposable equipment. Vacuum extractors for delivering babies for example
are now available in disposable form. A study should be done on these to assess the quality of the
products and their effectiveness in clinical use.
Postal studies do not work, as the response rate and response time are not under the control of the
agency carrying out the study. Small groups of investigators should be formed to represent the various
disciplines and perhaps work out a method whereby these groups can visit hospitals in a staggered
manner and obtain information first hand.
Other equipment that needs to be assessed from obstetrics and gynaecology would be:
1. Equipment for urodynamic studies
2. Equipment used in assisted reproduction
3. Laparoscopic equipment
4. Hysteroscopic equipment
5. Colposcopic equipment
6. The various stirrups used during gynaecological surgery
7. Gynaecological examination couches for office examination
27
Table 1: Available Therapeutic and Diagnostic Facilities in Obstetrics & Gynaecology
Labour Suite Gynaecology Assisted Reproductive
Population
Oncology Unit Centre (Fertility Center)
Malaysia 26.64 198 100 5 10 100 0 16 100 1
Sector
Public - NC - 5 50 NC -
Private - NC - 5 50 NC -
State
Johor 3.17 32 16 10 1 10 0 3 19 1
Kedah & Perlis 2.11 23 12 11 0 0 0 0 0 0
Kelantan 1.53 12 6 8 0 0 0 0 0 0
Melaka 0.73 8 4 11 3 30 4 1 6 1
Negeri
0.96 15 8 15 1 10 1 0 0 0
Sembilan
Pahang 1.45 8 4 6 0 0 0 0 0 0
Perak 2.28 12 6 5 0 0 0 1 6 0
Terengganu 1.04 6 3 6 0 0 0 0 0 0
Pulau Pinang 1.49 15 8 10 1 10 1 3 19 2
Sabah 3 20 10 7 1 10 0 2 12 0
Sarawak 2.36 20 10 8 0 0 0 1 6 0
Selangor & W.P
6.43 27 14 4 3 30 0 5 31 1
Kuala Lumpur
Table 2: Available Medical Devices in Obstetrics & Gynaecology

Total
Cardiotocograph
External Internal Combined
(assume each CTG
Population Cardiotocograph Cardiotocograph Internal and
has internal and
External CTG
external CTG
functions)
Malaysia 26.64 789 100 30 581 100 22 196 100 7 76 - -
Sector
Public - NC - 419 72 166 85 NC -
Private - NC - 163 28 30 15 NC -
State
Johor 3.17 100 13 31 38 7 12 7 4 2 ND - -
Kedah & Perlis 2.11 44 5 21 43 7 20 16 8 8 6 - 3
Kelantan 1.53 38 5 25 29 5 19 21 11 14 5 - 3
Melaka 0.73 40 5 55 13 2 18 3 2 4 15 - 21
N. Sembilan 0.96 40 5 42 31 5 32 6 3 6 5 - 5
Pahang 1.45 25 3 17 20 3 14 8 4 6 7 - 5
Perak 2.28 54 7 24 45 8 20 19 10 8 32 - 14
Terengganu 1.04 23 3 22 23 4 22 4 2 4 2 - 2
P. Pinang 1.49 55 7 37 48 8 32 14 7 9 4 - 3
Sabah 3 69 9 23 58 10 19 25 13 8 ND - -
Sarawak 2.36 107 14 45 47 8 20 14 7 6 ND - -
Selangor & W.P
6.43 194 25 30 187 33 29 59 29 9 ND - -
Kuala Lumpur
28
Hysteroscope Transabdominal Transvaginal
Colposcope
Population system Transducer Transducer
system
Ultrasound Ultrasound
Malaysia 26.64 91 100 3 87 100 3 279 100 10 195 100 8
Sector
Public - NC - NC - NC - NC -
Private - NC - NC - NC - NC -
State
Johor 3.17 18 20 5 17 20 5 60 21 19 55 27 17
Kedah & Perlis 2.11 7 8 3 2 2 1 21 8 10 14 7 7
Kelantan 1.53 4 4 3 4 5 3 10 4 7 8 4 5
Melaka 0.73 4 4 5 3 3 4 20 7 27 15 7 21
N. Sembilan 0.96 6 7 6 5 6 5 25 9 26 15 7 16
Pahang 1.45 2 2 1 3 3 2 6 2 4 3 1 2
Perak 2.28 4 4 2 12 14 5 15 5 7 12 6 5
Terengganu 1.04 1 1 1 3 3 3 3 1 3 3 1 3
P. Pinang 1.49 8 9 5 5 6 3 14 5 9 13 6 9
Sabah 3 8 9 3 3 3 1 22 8 7 12 6 4
Sarawak 2.36 7 8 3 6 7 3 14 5 6 6 3 3
Selangor & W.P
6.43 22 24 3 24 28 4 69 25 11 47 23 7
Kuala Lumpur
Blood gas
Suction and Amnioscope Laparoscope
Population machine for fetal
Curettage System system system
sampling
Malaysia 26.64 314 100 12 160 100 6 107 100 4 78 100 3
Sector
State
Johor 3.17 37 12 12 20 13 6 15 14 5 18 23 6
Kedah & Perlis 2.11 17 5 8 0 0 0 0 0 0 2 3 1
Kelantan 1.53 12 4 8 0 0 0 1 1 1 2 3 1
Melaka 0.73 8 3 11 4 3 5 3 3 4 4 5 5
N. Sembilan 0.96 30 10 31 7 4 7 5 5 5 5 6 5
Pahang 1.45 7 2 5 6 3 4 3 3 2 2 3 1
Perak 2.28 32 10 14 15 9 7 12 11 5 4 5 2
Terengganu 1.04 2 1 2 3 2 3 3 3 3 1 1 1
P. Pinang 1.49 20 6 13 0 0 0 0 0 0 3 4 2
Sabah 3 28 9 9 22 14 7 12 11 4 8 10 3
Sarawak 2.36 22 7 9 14 9 6 6 6 3 7 9 3
Selangor & W.P
6.43 99 32 15 69 43 11 47 43 7 22 28 3
Kuala Lumpur
29
CHAPTER 9
NEUROLOGY FACILITIES AND DEVICES
Edited by :
Dr.Suganthi Chinnasami1 , Dr. Mooi Chin Leong1, Dr. Santhi Datuk Puvanarajah1, Dato’ Dr. Hj. Md.
Hanip Rafia1.

Neurophysiology Unit HKL
1 Hospital Kuala Lumpur.
NEUROPHYSIOLOGY SERVICES IN PUBLIC SECTOR IN MALAYSIA

The first Neurophysiology unit in Malaysia was set up in 1964 at Kuala Lumpur Hospital with only
one staff in charge of the unit. Over the years there has been a gradual increase in the total number of
neurophysiology units in various states in Malaysia. Currently, there are about 19 units with 67 trained
Medical Assistants. The Clinical Neurophysiology Unit provides standard electroencephalography
(EEG) and video-telemetry (VT); nerve conduction studies (NCS) and electromyography (EMG);
evoked potentials (EP) which include visual, somatosensory and brainstem auditory evoked response;
Transcranial Doppler (TCD); and sleep studies. The unit in HKL also runs a 6 months training programme
every year for technologists working in the various neurophysiology units in other major hospitals
nationwide since.
Epilepsy is one of the most common neurological conditions affecting at any given time between
0.5% and 1% of the general population in developed country. Most studies of the prevalence of active
epilepsy have estimated the figure to be 4 and 10 per 1000. The diagnosis of epilepsy is clinical and
rests on the description of the seizure provided by the patient and eyewitnesses. Electroencephalogram
(EEG) is the study used to record the electrical activity of the brain and should only be carried out in
those patients in whom the symptoms suspicious of epilepsy. In such patients the findings of epileptic
abnormalities in the EEG lends weight to the diagnosis and the seizure type may also be clarified.
EEGs are often insensitive as more than 50% of patients with epilepsy will have a normal tracing.
Portable EEG recording is done in cases where better detection of the interictal and ictal events may
be achieved with prolonged recording using portable equipment and this allows recording to take
place in the patient’s usual environment.
Behavioral correlation can be achieved in inpatients by video monitoring during EEG and this is called
as Video-EEG telemetry. This investigation is mandatory in the evaluation for Epilepsy Surgery and
may be the only way to distinguish epileptic seizures from the nonepileptic events.
Electrodiagnostic (EDX) studies play a key role in the evaluation of patients with neuromuscular
disorders. Nerve conduction study and needle electromyography form the core of the EDX study and
are often used to diagnose disorders of the nerve and muscles. Performed and interpreted correctly,
EDX studies yield critical information about the underlying neuromuscular disorder and allow use of
other laboratory tests in an appropriate and efficient manner. The principal goals of every EDX study
are to localize the disorder and assess its severity. If the disorder localizes the peripheral nerves (i.e.
neuropathic), EDX studies often yield further key information, including the fiber types involving the
underlying pathophysiology and the temporal course of the disorder.
Polysomnography (PSG) is a diagnostic test during which a number of physiological variables are
measured and recorded during sleep. Information is gathered from all leads and fed into a computer
and results in a series of waveform tracings, which enable the technician to visualize the various
waveforms, assign a score for the test, and assist in the diagnostic process. The PSG monitors many
body functions including brain(EEG), eye movements (EOG), muscle activity or skeletal activation
(EMG) heart rhythm (ECG), and breathing function or respiratory effort during sleep. PSG is useful
in identifying the abnormality in sleep disorders such as dyssomnias and parasomnias.
31
Transcranial Doppler ultrasound (TCD) is used in the management of ischemic stroke and subarachnoid
haemorrhage. In ischemic stroke, TCD can detect any stenosis in the intracranial arteries (anterior
and posterior circulation) and also the degree of stenosis. It can indirectly detect internal carotid
artery stenosis too. Microemboli in the cerebral arteries can also be detected and this may help in
the medical management of the patients. In subarachnoid haemorrhage, TCD is used to evaluate the
degree of vasospasm, and this will help the neurosurgeons in determining the subsequent management
either medically or surgically. TCD can be used to look for cerebral vasoreactivity and can be used as
a supplementary investigation in brain death. It is also used as a screening tool for PFO looking for
emboli during bubble contrast injection in the peripheral vein. A possible new indication for TCD is
sonothrombolysis, increasing the recanalisation rate of thrombosed arteries in acute stroke when used
together with rtPA. This is still being researched.
The data collected from the previous MOH and private survey regarding the neuromedical devices are
not complete and under reported. This is most likely secondary to poor response from the concerned
units. The data for the Selangor state should be separated from the Federal Territory as there are 3
federal states currently which are Kuala Lumpur, Labuan and Putrajaya. This will show a better
picture of the current statistics. The Nerve Conduction Velocity measurement system and EMG
machine should be tabulated as a single medical device in the statistics instead of reporting it as two
separate devices because both tests are done in the same machine. Till today there are no Ambulatory
EEG services in Malaysia, which will enable patient to continue with their daily living activities.
There should be data survey for DBS (deep brain stimulation) for Parkinson’s disease management,
PET/SPECT imaging services in Malaysia, Depth Electrode monitoring for epilepsy, availability of
Genetic studies for hereditary Neurological diseases as well as HLA B 1502 allele testing for all
patients started on Carbamazepine as well as Aquaporine a-4 testing for NMO patients.
The public sector data is corrected up to date. However the private sector data is dependant on
voluntary and accurate submission of the statistics reported and therefore its difficult to verify and
comment. In summary this chapter shows the importance of the neurophysiology units in providing
diagnostic studies for the increasing work-up demand in the discipline of Neurology.
The tables below show the number of neurophysiology units and the diagnostic equipments available
in Malaysia in year 2007.
Table 1: Available Therapeutic and Diagnostic Facilities in Neurology

Neurophysiology Unit
Malaysia 26.64 24 100 1
Sector
Public - 21 87
Private - 3 13
State
Johor 3.17 1 4 0
Kelantan 1.53 1 4 1
Melaka 0.73 1 4 1
N. Sembilan 0.96 1 4 1
Pahang 1.45 2 8 1
Perak 2.28 1 4 0
Sabah 3 3 13 1
Sarawak 2.36 3 13 1
32
Table 2: Available Medical Devices in Neurology.
Electro- Ambulatory Electro- Evoked Video Telemetry
Population encephalography encephalography Potential (EP) Recording
(EEG) machine (EEG) machine system System
Malaysia 26.64 51 100 2 21 100 1 29 100 1 11 100 0
Sector
Public - 28 55 14 67 18 62 8 73
Private - 23 45 7 33 11 38 3 27
State
Johor 3.17 2 4 1 1 5 0 1 3 0 0 0 0
Kedah & Perlis 2.11 3 6 1 1 5 0 1 3 0 1 9 0
Kelantan 1.53 1 2 1 1 5 1 7 24 5 2 18 1
Melaka 0.73 3 6 4 2 10 3 0 0 0 0 0 0
N. Sembilan 0.96 1 2 1 1 5 1 1 3 1 0 0 0
Pahang 1.45 2 4 1 0 0 0 1 3 1 1 9 1
Perak 2.28 5 10 2 1 5 0 2 7 1 0 0 0
Terengganu 1.04 1 2 1 1 5 1 1 3 1 0 0 0
P. Pinang 1.49 9 18 6 3 14 2 5 17 4 1 9 1
Sabah 3 4 8 1 1 5 0 1 3 0 1 9 0
Sarawak 2.36 3 6 1 1 5 0 0 0 0 1 9 0
Selangor & W.P
6.43 17 33 3 8 38 1 9 31 1 4 36 1
Kuala Lumpur
Electromyography
Population Nerve Conduction Velocity (NCV) Measurement System
(EMG) machine
EMG/NCS EP/EMG/NCS
NMDS Data (Sourced from (Sourced from
Expert Panel) Expert Panel)
Malaysia 26.64 36 100 1 27 100 1 4 - - 17 - -
Sector
Public - 20 56 18 67 - 4 - 17 -
Private - 16 44 9 33 - ND - ND -
State
Johor 3.17 2 6 1 1 4 0 0 0 0 1 6 0
Kedah &
2.11 0 0 0 0 0 0 1 25 0 0 0 0
Perlis
Kelantan 1.53 7 19 5 7 26 5 0 0 0 1 6 1
Melaka 0.73 2 6 3 0 0 0 0 0 0 1 6 1
N. Sembilan 0.96 1 3 1 1 4 1 0 0 0 1 6 1
Pahang 1.45 1 3 1 1 4 1 0 0 0 2 12 1
Perak 2.28 2 6 1 2 7 1 0 0 0 1 6 0
Terengganu 1.04 1 3 1 1 4 1 0 0 0 1 6 1
P. Pinang 1.49 5 14 3 4 15 3 0 0 0 1 6 1
Sabah 3 2 6 1 1 4 0 1 25 0 3 18 1
Sarawak 2.36 1 3 0 0 0 0 0 0 0 0 0 0
Selangor & W.P
6.43 12 33 2 9 33 1 2 50 0 5 29 1
Kuala Lumpur
33
Population Transcranial Doppler
NMDS Data
Malaysia 26.64 7 100 0
Sector
Public - 4 57
Private - 3 43
State
Johor 3.17 0 0 0
Kelantan 1.53 0 0 0
Melaka 0.73 0 0 0
Pahang 1.45 0 0 0
Perak 2.28 0 0 0
Sabah 3 1 14 1
Sarawak 2.36 0 0 0
34
CHAPTER 10
PSYCHIATRY FACILITIES AND DEVICES
Expert Panel Members
Chairperson : Dato’ Dr. Suarn Singh1
Members:
Dr. Siti Nor Aizah Ahmad2 (Author), Dr. Hj. Mohd Rasidi M. Saring3, Dr. Hj. Mohd Daud Dalip4,
Prof. Dr. Mohd Fadzillah Abdul Razak5
1 Hospital Bahagia Ulu Kinta, 2 Hospital Kuala Lumpur, 3 Hospital Sultanah Bahiyah, 4 Hospital Mesra, 5 Universiti
Malaysia Sarawak
REPORT
Mental health disorders are diverse spectrum of diseases encompassing alterations in thinking, mood
and behaviour. The prevalence of mental health disorders among Malaysians is 10.7% [1]; and ranked
fourth as the leading cause of burden of disease-by-disease categories [2]. The novel discoveries and
rapid advances in understanding psychiatric disorders in the last few decades catalyzed the changing
structures in the treatment modalities, management and delivery of mental health services. The
challenging issue is to ensure the services and facilities are equally available and accessible to all
citizens.
Since the era of deinstitutionalization, the psychiatric-related rehabilitation services gradually

developed into broad categorization of hospital-based and community-based services. The day
care centers and training shelter workshop constitute the hospital-based rehabilitation services;
whereas psychosocial rehabilitation centers and psychiatric nursing homes are facilities based in the
community.
The number of facilities seems fairly equally distributed in hospital and community. This concurs with
the direction in mental health service to deliver and develop more community mental health facilities.
However, the distributions of these facilities are not uniform throughout the country. This could
reflect that specialized psychiatric rehabilitation expertise and service are currently only available in
certain states. In comparison, the percentage of service contact in community mental health service in
Australia was at least 50%; and it reached 98% in certain states [3].
The hospital-based facilities form 53.5% of the total available facilities. However, 94% of the hospital-
based facilities are manned by the public sector. All states in Malaysia have at least 1 day care center
except Melaka, Pahang and Perlis. The training and shelter workshops are only available in 6 states.
The psychosocial rehabilitation centers and psychiatric nursing homes are entirely run by public
sector.
It must be noted that once the Mental Health Act 2001 is enforced, the available therapeutic and
diagnostic facilities will have to be recategorized into the 3 facilities as provided for in the said Act.
The facilities are as follows:
“Psychiatric Hospital” (means a government psychiatric hospital or a private psychiatric hospital
including a gazetted private psychiatric hospital)
“Psychiatric Nursing Home” (means a government psychiatric nursing home or a private psychiatric
nursing home, and includes a gazetted private psychiatric nursing home)
“Community Mental Health Centre” (means a government community mental health centre or a
private community mental health centre, and includes a gazetted private community mental health
centre)
35
Although its exact mechanism of action is still unknown, electroconvulsive therapy is an effective
treatment modality to achieve rapid and short-term improvement in especially severe depression,
severe mania and catatonia [4]. This device is widely available nationwide, mainly in hospitals,
but also available in private practice (13%). Its use in England is less, probably attributed to better
antidepressants and psychotherapeutic interventions [5]. It is a safe treatment but its adverse effect
resulting in cognitive impairment and retrograde amnesia which may happen to some patients, is a
significant concern.
Table 1: Available Diagnostic and Therapeutic Facilities in Psychiatry

Hospital-based rehabilitation Community-based rehabilitation
facilities facilities
Population Training
Psychosocial Psychiatric
Day Care Centre and Shelter
Rehab. Centre Nursing Home
Workshop
Malaysia 26.64 16 100 1 7 100 0 6 100 0 5 100 0
Sector
Public - 15 94 7 100 6 100 5 100
Private - 1 6 0 0 0 0 0 0
State
Johor 3.17 3 19 1 1 14 0 1 17 0 2 40 1
Kedah & Perlis 2.11 1 6 0 0 0 0 0 0 0 0 0 0
Kelantan 1.53 1 6 1 0 0 0 1 17 1 0 0 0
Melaka 0.73 0 0 0 0 0 0 0 0 0 0 0 0
N. Sembilan 0.96 2 13 2 0 0 0 1 17 1 0 0 0
Pahang 1.45 0 0 0 1 14 1 0 0 0 0 0 0
Perak 2.28 1 6 0 1 14 0 1 17 0 0 0 0
Terengganu 1.04 1 6 1 0 0 0 1 17 1 0 0 0
P. Pinang 1.49 1 6 1 0 0 0 0 0 0 0 0 0
Sabah 3 0 0 0 1 14 0 0 0 0 0 0 0
Sarawak 2.36 2 13 1 1 14 0 0 0 0 3 60 1
Selangor & W.P
6.43 4 25 1 2 29 0 1 17 0 0 0 0
Kuala Lumpur
36
Table 2 Available Medical Devices in Psychiatry
Population Electroconvulsive Therapy (ECT) machine
Malaysia 26.64 45 100 2
Sector
Public - 39 87 -
Private - 6 13 -
State
Johor 3.17 3 7 1
Kelantan 1.53 4 9 3
Melaka 0.73 1 2 1
Pahang 1.45 2 4 1
Perak 2.28 6 13 3
Sabah 3 2 4 1
Sarawak 2.36 6 13 3
Selangor & W.P. Kuala Lumpur 6.43 9 20 1
References:
1. The National Health Morbidity Survey, 1996.
2. Division of Burden of Disease, Institute for Public Health, Malaysian Bureau of Disease and
Injury Study in Health Prioritisation: Burden of Disease Approach.2004, Ministry of Health
Malaysia
3. Australian Institute of Health and Welfare (AIHW) 2008. Mental health services in Australia
2005–06. Mental health series no. 10. Cat no. HSE 56. Canberra: AIHW.
4. National Institute for Clinical Excellence, United Kingdom (2003)
5. Royal College of Psychiatrists, United Kingdom (2008)
37
CHAPTER 11
CARDIOLOGY AND CARDIOTHORACIC SURGERY
Edited by:
Dr. Aizai Azan1
With contributions from:

Dr. Alan Yean Yip Fong2, Dr. Chong Wei Peng3, Dr. Ernest Ng4, Dr. Faisal B. Ismail1,
Co-contributors:
Prof. Dr. Sim Kui Hian2, Dr. Ong Tiong Kiam2
1 Institut Jantung Negara, 2 Hospital Umum Sarawak, 3 Pusat Perubatan Universiti Malaya, 4 Hospital Serdang
REPORT
In 2007, there were 73 dedicated coronary care units (CCU) reported in Malaysia. There were 36
cardiac catheterization laboratories, 47 echocardiography laboratories and 3 invasive electrophysiology
laboratories. There was a single heart transplant unit located in the Klang Valley, which is complemented
by all the acquired left ventricular assist devices (LVADs) in the country. They were 16 cardio-
pulmonary rehabilitation programmes, which were not well represented nationwide.
Table 1: Available Therapeutic and Diagnostic Facilities in Cardiology and Cardiothoracic Surgery
Echocardiography Cardio-
Coronary Care Electrophysiology
(Non-Invasive Pulmonary
Population Unit (CCU) Laboratory
Cardiology) Rehabilitation
Laboratory Programme
Malaysia 26.64 73 100 3 3 100 0 47 100 2 16 100 1
Sector
Public - 41 56 - 1 33 22 47 12 75
Private - 32 44 - 2 67 25 53 4 25
State
Johor 3.17 5 7 2 0 0 0 4 9 1 1 6 0
Kedah &
2.11 5 7 2 0 0 0 3 6 1 2 13 1
Perlis
Kelantan 1.53 3 4 2 0 0 0 3 6 2 1 6 1
Melaka 0.73 4 5 5 0 0 0 5 11 7 1 6 1
N. Sembilan 0.96 4 5 4 0 0 0 3 6 3 0 0 0
Pahang 1.45 4 5 3 0 0 0 1 2 1 1 6 1
Perak 2.28 7 10 3 0 0 0 4 9 2 2 13 1
Terengganu 1.04 1 1 1 0 0 0 1 2 1 1 6 1
Pulau Pinang 1.49 9 12 6 1 33 1 5 11 3 0 0 0
Sabah 3 4 5 1 0 0 0 5 11 2 2 13 1
Sarawak 2.36 5 7 2 0 0 0 3 6 1 1 6 0
Selangor & W.P.
6.43 22 30 3 2 67 0 10 21 2 4 25 1
Kuala Lumpur
39
Cardiac
Invasive Cardiac Transplant
Population Catheterization
Cardiovascular Lab Unit
Laboratory (Cathlab)
Malaysia 26.64 36 100 1 9 100 0 1 100 0
Sector
Public - 28 78 - 4 44 0 0
Private - 8 22 - 5 56 1 100
State
Johor 3.17 2 6 1 1 11 0 0 0 0
Kedah & Perlis 2.11 1 3 0 0 0 0 0 0 0
Kelantan 1.53 2 6 1 1 11 1 0 0 0
Melaka 0.73 3 8 4 2 22 3 0 0 0
Negeri Sembilan 0.96 1 3 1 0 0 0 0 0 0
Pahang 1.45 1 3 1 0 0 0 0 0 0
Perak 2.28 1 3 0 0 0 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 6 17 4 2 22 1 0 0 0
Sabah 3 1 3 0 1 11 0 0 0 0
Sarawak 2.36 3 8 1 1 11 0 0 0 0
Selangor & W.P.
6.43 15 42 2 1 11 0 1 100 0
Kuala Lumpur
Regarding the actual medical devices recorded, data was obtained for numbers of ambulatory blood
monitoring system, ECG telemetry system, Holter system and Electrophysiology monitoring system.
These devices were well represented nationwide. For invasive support systems, intra-aortic balloon
pumps and heart-lung bypass units were located at facilities, which offered interventional cardiology
and cardiac surgery procedures. Other non-invasive diagnostic devices data were obtained for Doppler
(vascular) machines, echocardiography systems and transoesophageal echocardiography systems.
In the main, these non-invasive devices were more commonly available compared to the invasive
systems.
40
Table 2: Available Medical Devices in Cardiology and Cardiothoracic Surgery.
Ambulatory
Electrophysiology
Blood Pressure ECG Telemetry
Population Holter system monitoring
Monitoring System
system
System
Malaysia 26.64 217 100 8 97 100 4 87 100 3 42 100 2
Sector
Public - 38 18 67 67 29 33 21 50
Private - 179 82 32 33 58 67 21 50
State
Johor 3.17 17 8 5 6 6 2 4 5 1 10 23 3
Kedah & Perlis 2.11 2 1 1 3 3 1 3 3 1 0 0 0
Kelantan 1.53 1 0 1 0 0 0 4 5 3 0 0 0
Melaka 0.73 3 1 4 0 0 0 6 7 8 0 0 0
N. Sembilan 0.96 15 7 16 0 0 0 3 3 3 2 5 2
Pahang 1.45 9 4 6 2 2 1 3 3 2 5 12 3
Perak 2.28 5 2 2 1 1 0 5 6 2 1 2 0
Terengganu 1.04 2 1 2 4 4 4 0 0 0 0 0 0
Pulau Pinang 1.49 17 8 11 19 19 13 15 17 10 9 21 6
Sabah 3 8 4 3 0 0 0 6 7 2 3 7 1
Sarawak 2.36 2 1 1 4 4 2 6 7 3 0 0 0
Selangor & W.P
6.43 136 62 21 58 59 9 32 36 5 12 28 2
Kuala Lumpur
Extra-Corporeal
Intra-aortic Left Ventricular
Membrane Heart-Lung
Population Balloon Pump Assist Device
Oxygenator Bypass Unit
(IABP) Machine (LVAD)
(ECMO) Machine
Malaysia 26.64 1 100 0 62 100 2 32 100 1 1 100 0
Sector
Public - 0 0 19 31 10 30 0 0
Private - 1 100 43 69 22 70 1 100
State
Johor 3.17 0 0 0 7 11 2 3 9 1 0 0 0
Kedah & Perlis 2.11 0 0 0 2 3 1 1 3 0 0 0 0
Kelantan 1.53 0 0 0 5 8 3 1 3 1 0 0 0
Melaka 0.73 0 0 0 4 6 5 2 6 3 0 0 0
N. Sembilan 0.96 0 0 0 0 0 0 0 0 0 0 0 0
Pahang 1.45 0 0 0 2 3 1 0 0 0 0 0 0
Perak 2.28 1 100 0 1 2 0 1 3 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 0 0 0 12 19 8 8 25 5 0 0 0
Sabah 3 0 0 0 2 3 1 1 3 0 0 0 0
Sarawak 2.36 0 0 0 3 5 1 4 13 2 0 0 0
Selangor & W.P
6.43 0 0 0 24 39 4 11 34 2 1 100 0
Kuala Lumpur
41
Trans-
Intravascular
Doppler Echocardiography Oesophageal
Population Ultrasound
machine system Echocardiogr.
(IVUS) machine
(TEE) system
Malaysia 26.64 30 100 1 153 100 8 45 100 2 7 100 0
Sector
Public - 21 70 66 43 21 47 3 43
Private - 9 30 87 57 24 53 4 57
State
Johor 3.17 1 3 0 7 5 2 3 7 1 1 14 0
Kedah & Perlis 2.11 0 0 0 10 7 5 3 7 1 0 0 0
Kelantan 1.53 1 3 1 10 7 7 1 2 1 0 0 0
Melaka 0.73 2 7 3 7 5 10 2 4 3 1 14 1
N. Sembilan 0.96 0 0 0 6 4 6 0 0 0 0 0 0
Pahang 1.45 1 3 1 5 3 3 1 2 1 0 0 0
Perak 2.28 1 3 0 10 7 4 2 4 1 0 0 0
Terengganu 1.04 0 0 0 2 1 2 0 0 0 0 0 0
Pulau Pinang 1.49 5 17 3 17 10 11 9 20 6 0 0 0
Sabah 3 1 3 0 11 7 4 1 2 0 0 0 0
Sarawak 2.36 0 0 0 12 8 5 9 20 4 1 14 0
Selangor & W.P
6.43 18 60 3 56 36 9 14 31 2 4 57 1
Kuala Lumpur
Commentary
• Concentration of services and devices in the Klang Valley.
• Despite the wide availability of coronary care units, there is a relative lack of cardio-pulmonary
rehabilitation programmes.
• Interventional electrophysiology laboratories are a very specialized area of Cardiology and
resources are limited to a few centres.
• We note that there are more heart-lung bypass units in the private sector.
• Current data not available for implantable cardiac devices eg pacemakers, defibrillators and
cardiac heart valves.
• More detailed information on the cardiac surgery devices and facilities will be available in the
future.
• More detailed information on non-invasive devices used in cardiology diagnostics to be
available in the future eg treadmill machines and tilt table devices.
• National registries, concentrated at tertiary, and hospital-based, will provide targeted
information at their respective levels eg Acute Coronary Syndrome, cardiac bypass surgery
and percutaneous coronary intervention.
42
CHAPTER 12
RESPIRATORY FACILITIES AND DEVICES
Edited by :
Dato’ Dr. Abdul Razak Abdul Mutalif1

Ass. Prof. Dr. Roslina Abdul Manap2, Dr. Ashari Yunus3, Dr. Norhaya Mohd. Razali4,
Ass. Prof. Dr. How Soon Hin5
1 Hospital Pulau Pinang, 2 Pusat Perubatan Universiti Kebangsaan Malaysia, 3 Institut Perubatan Respiratori,
4 Hospital Sultanah Zahirah, 5 Universiti Islam Antarabangsa Malaysia, Kuantan
REPORT
The National Medical Devices Survey (NMDS), a service initiated and supported by the Ministry of
Health, gives complete information on the availability of devices and services in all states in Malaysia.
This information is very important for future planning and financing of equipment and manpower. As
can be seen later, some states have more manpower and equipment when compared to others. These
discrepancies can be due to availability of trained doctors and facilities in some states and none in the
others. The data available in this survey can also aid in clinical and epidemiological research.
Data on the availability of therapeutic and diagnostic facilities shows some variations in the public
and private sector. With the public hospitals having problems in space and patient load, there is
no specific High Dependency Wards for respiratory cases. Almost all public hospitals use general
intensive care units (ICU) to treat respiratory cases. The public hospitals however are well equipped
with pulmonary physiology laboratories and sleep laboratories (Table 1).
Lung transplantation is a very new service provided by the Malaysian hospital. Only one hospital,
National Heart Center with the collaboration of the Institute of Respiratory Medicine, screens cases
and performs surgery. On the other hand, smoking cessation is a very well established activity in
many health clinics and some public hospitals. A total of one hundred centers carry out this service.
This is not enthusiasm of providing service is not noticed in the field of Pulmonary Rehabilitation, as
only four public hospital provide it. This is probably due to lack of manpower in the physiotherapy
units (Table 1).
Medical devices in the respiratory medicine are well equipped in the public hospitals all over Malaysia.
The commitment of the Health Ministry in early diagnosis of COPD is noted in the availability of
spirometers, thrice higher then in the private hospitals. This is due to its cheap costs now and easier
to use devices. Almost all states have at least one polysomnograph system in their hospitals and
some also have portable somnograph machines (Table 2). Body box is a very specialized device
and very costly. It is available in most regional public hospitals. Broncho-videoscope systems are
freely available in both public and private hospitals. This device is the most important equipment for
diagnosis of several lung diseases, like cancers, infections and parenchymal lung disorders. Medical
pleuroscope is also a new technology, done by physicians in the wards; this is in all public hospitals.
In the private hospitals, rigid scopes were used by surgeons both for thoracoscopy and bronchoscopy
for diagnostic and therapeutic procedures, done sometimes by surgeons. This is only done in some
public hospitals and not yet available in private hospitals. BiPAP and CPAP systems are used in many
public and private hospitals in the treatment of COPD and obstructive apneas.
This report is done with the data provided by the contributors from all states. Some of the states
cannot obtain accurate data from all hospitals, especially in the private hospitals. The future survey
should look into other ways and methods of obtaining better information on the devices and services
in the field of Respiratory Medicine.
43
Table 1: Available Therapeutic and Diagnostic Facilities in Respiratory Medicine
High Dependency
Bronchoscopy Respiratory Sleep
Population (Respiratory)
Suite Laboratory Laboratory
Ward
Malaysia 26.64 24 100 1 34 100 1 15 100 1 16 100 1
Sector
Public - 9 38 24 71 13 87 9 56
Private - 15 62 10 29 2 13 7 44
State
Johor 3.17 3 12 1 2 6 1 1 7 0 1 6 0
Kedah & Perlis 2.11 1 4 0 2 6 1 1 7 0 1 6 0
Kelantan 1.53 0 0 0 1 3 1 0 0 0 0 0 0
Melaka 0.73 1 4 1 1 3 1 0 0 0 1 6 1
N. Sembilan 0.96 2 8 2 2 6 2 1 7 1 0 0 0
Pahang 1.45 0 0 0 2 6 1 2 13 1 1 6 1
Perak 2.28 3 12 1 4 12 2 3 20 1 1 6 0
Terengganu 1.04 0 0 0 1 3 1 1 7 1 1 6 1
Pulau Pinang 1.49 4 17 3 5 15 3 3 20 2 2 13 1
Sabah 3 1 5 0 5 15 1 1 7 0 1 6 0
Sarawak 2.36 1 5 0 2 6 1 0 0 0 1 6 0
Selangor & W.P.
6.43 8 33 1 7 21 1 2 13 0 6 38 1
Kuala Lumpur
Smoking Cessation Pulmonary

Population Lung Transplant Unit
Centre Rehabilitation Unit
Malaysia 26.64 1 100 0 12 100 9 6 100 0
Sector
Public - 1 100 12 100 6 100
Private - 0 0 0 0 0 0
State
Johor 3.17 0 0 0 2 17 1 0 0 0
Kedah & Perlis 2.11 0 0 0 1 8 0 0 0 0
Kelantan 1.53 0 0 0 1 8 1 0 0 0
Melaka 0.73 0 0 0 1 8 1 0 0 0
Negeri Sembilan 0.96 0 0 0 0 0 0 0 0 0
Pahang 1.45 0 0 0 1 8 1 1 17 1
Perak 2.28 0 0 0 1 8 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 0 0 0 0 0 0 1 17 1
Sabah 3 0 0 0 1 8 0 1 17 0
Sarawak 2.36 0 0 0 1 8 0 0 0 0
Selangor & W.P.
6.43 1 100 0 3 25 0 3 50 0
Kuala Lumpur
44
Table 2: Available Medical Devices in Respiratory Medicine
Pneumo- Total Portable
Population Spirometer tacography Polysomnograph Polysomnograph
Machine System Machine
Malaysia 26.64 94 100 3 5 100 0 19 100 1 5 100 0
Sector
Public - 71 76 5 100 14 74 5 100
Private - 23 24 0 0 5 26 0 0
State
Johor 3.17 5 5 2 0 0 0 0 0 0 0 0 0
Kedah & Perlis 2.11 23 25 11 1 20 0 1 5 0 1 20 0
Kelantan 1.53 6 6 4 0 0 0 2 11 1 0 0 0
Melaka 0.73 2 2 3 0 0 0 2 11 3 0 0 0
N. Sembilan 0.96 3 3 3 0 0 0 1 5 1 1 20 1
Pahang 1.45 5 5 3 0 0 0 1 5 1 2 40 1
Perak 2.28 7 7 3 0 0 0 0 0 0 0 0 0
Terengganu 1.04 1 1 1 1 20 1 0 0 0 0 0 0
Pulau Pinang 1.49 6 6 4 2 40 1 1 5 1 0 0 0
Sabah 3 4 4 1 0 0 0 1 5 0 1 20 0
Sarawak 2.36 7 7 3 0 0 0 1 5 0 0 0 0
Selangor & W.P
6.43 25 27 4 1 20 0 9 47 1 0 0 0
Kuala Lumpur
Body Adult Broncho-

Adult BIPAP Adult CPAP
Population pletysmograph videoscope
system system
(“body box”) System
Malaysia 26.64 7 100 0 107 100 4 55 100 2 147 100 6
Sector
Public - 7 100 82 77 21 38 72 49
Private - 0 0 25 23 34 62 75 51
State
Johor 3.17 0 0 0 4 4 1 5 9 2 9 6 3
Kedah & Perlis 2.11 0 0 0 1 1 0 2 4 1 3 2 1
Kelantan 1.53 0 0 0 5 5 3 1 2 1 11 7 7
Melaka 0.73 0 0 0 8 7 11 10 18 14 9 6 12
N. Sembilan 0.96 0 0 0 4 4 4 2 4 2 7 5 7
Pahang 1.45 1 14 1 12 11 8 2 4 1 9 6 6
Perak 2.28 0 0 0 9 8 4 2 4 1 8 5 4
Terengganu 1.04 1 14 1 5 5 5 0 0 0 2 1 2
Pulau Pinang 1.49 1 14 1 6 6 4 10 18 7 25 17 17
Sabah 3 1 14 0 4 4 1 4 7 1 6 4 2
Sarawak 2.36 0 0 0 5 5 2 2 4 1 13 9 6
Selangor & W.P
6.43 3 43 0 44 41 7 15 27 2 45 31 7
Kuala Lumpur
45
Paediatric BiPAP
Paediatric
Medical Paediatric CPAP system with
Population bronchoscopy
Pleurascope Flow Driver Appropriate
(rigid) Set
Mask
Malaysia 26.64 7 100 0 41 100 1 10 100 0 18 100 1
Sector
Public - 6 86 29 71 7 70 6 33
Private - 1 14 12 29 3 30 12 67
State
Johor 3.17 0 0 0 3 7 1 0 0 0 1 6 0
Kedah & Perlis 2.11 1 14 0 5 12 2 1 10 0 0 0 0
Kelantan 1.53 0 0 0 2 5 1 0 0 0 1 6 1
Melaka 0.73 0 0 0 3 7 4 1 10 1 1 6 1
Negeri
0.96 0 0 0 3 7 3 0 0 0 0 0 0
Sembilan
Pahang 1.45 1 14 1 2 5 1 3 30 2 0 0 0
Perak 2.28 0 0 0 8 20 4 0 0 0 2 11 1
Terengganu 1.04 1 14 1 1 2 1 0 0 0 0 0 0
Pulau Pinang 1.49 1 14 1 1 2 1 1 10 1 4 22 3
Sabah 3 1 14 0 0 0 0 0 0 0 1 6 0
Sarawak 2.36 0 0 0 0 0 0 0 0 0 2 11 1
Selangor & W.P
6.43 2 29 0 13 32 2 4 40 1 6 33 1
Kuala Lumpur
46
CHAPTER 13
GASTROENTEROLOGY FACILITIES AND DEVICES
Chairperson: Dr. Hj. Rosemi Salleh1
Secretary: Dr. Hjh. Rosaida Hj. Md. Said2
Representative: Y. Bhg. Dato’ Dr. Hj. Muhammad Radzi bin Abu Hassan3, Dr. Sheikh Anwar
Abdullah4
Contributors: Dr. Jeyaram Menon 5, Dr. S. Ganesananthan2
1 Hospital Raja Perempuan Zainab II, 2 Hospital Kuala Lumpur, 3 Hospital Sultanah Bahiyah, 4 Pusat Perubatan
Universiti Kebangsaan Malaysia, 5 Hospital Queen Elizabeth.
REPORT
For the first time in Malaysia, we are able to report national estimates on the devices pertaining to
Gastroenterology Units.
Gastroenterology is one of the medical subspecialties which involve a substantial amount of medical
devices. These devices cover use for therapeutic as well as diagnostic purposes. The provision
of therapeutic and diagnostic facilities in Gastroenterology can be divided into 1) Non-Invasive
Gastroenterology Laboratory; and 2) Endoscopy Day Care Unit/Suite. Non-invasive gastroenterology
laboratory refers to provision of devices that do not involve endoscopes, for example capsule
endoscopic system, manometry and breath test system.
In Malaysia, more services are provided in endoscopy day care units or suites (55). This is in comparison
to only 9 non-invasive gastroenterology laboratories available around the country, in Pahang, Sabah,
Sarawak and Selangor & Kuala Lumpur. This may be because the expertise/ technologies were not
readily available in the past. Now, there are more and more centres providing these non-invasive
services, but they are incorporated into the endoscopy day care units or suites. Those with separate
non-invasive laboratories were mostly from the private sector. As there are more private health services
available in the Klang Valley, this may explain why the most number of non-invasive gastroenterology
laboratories were recorded for Selangor & W.P. Kuala Lumpur.
The endoscopy day care units/suites are available in all states except Terengganu. The highest number
was recorded by Selangor & W.P. Kuala Lumpur (17) followed by Pulau Pinang (6), with Sarawak,
Johor and Kedah & Perlis having the 3rd highest number (5).
The case of Terengganu having no available therapeutic and diagnostic facilities in gastroenterology
may not be fully accurate, as the data is based on the feedback provided only. If there is a lack of
cooperation or communication between the departments or in the feedback process, there will be
under-reported data.
The devices that related to gastroenterology specialty can be divided into:

1. Endoscopes / Gastroenterology devices
2. Invasive
3. Non-invasive
47
1. Endoscopes / Gastroenterology devices
Base on the survey done last year (2007), the gastroduodenoscope and colonoscope devices are the
most available in Malaysia with the average of 6 and 5 per million population respectively.
Gastroduodenoscope systems have the largest number in the country, which is about 167, followed
by 137 colonoscopes.
Other endoscopic devices are 84 duodenoscopes followed by 47 sigmoidoscopes, 16 Endoscopic

ultrasound (EUS), 12 enteroscopy and 4 Double Balloon Enteroscopic (DBE) systems.
Majority of these devices are located in Selangor and Wilayah Persekutuan.
Based on the survey, the number of availability is still not enough for screening purposes, for example
screening for colorectal cancer.
Other devices such as DBE and EUS are still low in numbers due to the need of special trainings and
their usage are still low.
2. Invasive
3. Non-Invasive
There are five non-invasive procedures in which four of them are considered relatively new in
Malaysia. The newer non-invasive procedures involve the total water perfused low compliance
software pneumohydraulic pump with transducers for anorectal and oesophageal manometry, total
24-hour digitrap per recording device, wireless 48 hour bravo pH recording system, GI breath test
system and capsule endoscopic system.
The newer non-invasive procedures are technically simpler and easier to do, and may replace some of
the invasive procedures. However, the limitations of these tests are costly and need expertise. Thus,
the non-invasive tests will not be available in every centre but to the targeted main centre chosen.
Presently, the individual non-invasive procedures that available in Malaysia are as stated below:-
48
Table 1: Available Therapeutic and Diagnostic Facilities in Gastroenterology.
Non-Invasive
Endoscopy Day Care Unit/
Population Gastroenterology
Suite
Laboratory
Malaysia 26.64 100 0 55 100 2

Sector
Public - 4 44 22 40
Private - 5 56 33 60

State
Johor 3.17 0 0 0 5 9 2
Kedah & Perlis 2.11 0 0 0 5 9 2
Kelantan 1.53 0 0 0 3 5 2
Melaka 0.73 0 0 0 2 4 3
Pahang 1.45 2 22 1 3 5 2
Perak 2.28 0 0 0 4 7 2
Terengganu 1.04 0 0 0 0 0 0
Pulau Pinang 1.49 0 0 0 6 11 4
Sabah 3 1 11 0 1 2 0
Sarawak 2.36 1 11 0 5 9 2
Table 2: Available Medical Devices in Gastroenterology

Electro- Laser Biliary
Total Biliary Mechanical Biliary
Population hydraulic Biliary Lithotripter
Lithotripter Unit Lithotripter Unit
Lithotripter Unit Unit
Malaysia 26.64 31 100 1 26 100 1 3 100 0 2 100 0
Sector
Public - 19 62 15 58 2 67 1 50
Private - 12 38 11 42 1 33 1 50
State
Johor 3.17 2 6 1 2 8 1 0 0 0 0 0 0
Kedah & Perlis 2.11 4 13 2 4 15 2 0 0 0 0 0 0
Kelantan 1.53 5 17 3 4 15 3 1 33 1 0 0 0
Melaka 0.73 1 3 1 1 4 1 0 0 0 0 0 0
N. Sembilan 0.96 0 0 0 0 0 0 0 0 0 0 0 0
Pahang 1.45 3 9 2 1 4 1 1 33 1 1 50 1
Perak 2.28 0 0 0 0 0 0 0 0 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 5 16 3 5 19 3 0 0 0 0 0 0
Sabah 3 1 3 0 1 4 0 0 0 0 0 0 0
Sarawak 2.36 4 13 2 3 12 1 1 34 0 0 0 0
Selangor & WP
6.43 6 20 1 5 19 1 0 0 0 1 50 0
Kuala Lumpur
49
Low compliance
software
pneumohydraulic Wireless 48
External short 24-hr digitrap
pump with hour Bravo
Population wave biliary per recording
transducers for pH recording
lithotripter unit device
anorectal and system
oesophageal
manometry
Malaysia 26.64 1 100 0 7 100 0 8 100 0 2 100 0
Sector
Public - 0 0 4 57 6 75 1 50
Private - 1 100 3 43 2 25 1 50
State
Johor 3.17 0 0 0 0 0 0 0 0 0 0 0 0
Kedah & Perlis 2.11 0 0 0 1 14 0 1 13 0 0 0 0
Kelantan 1.53 0 0 0 0 0 0 1 13 1 0 0 0
Melaka 0.73 0 0 0 0 0 0 0 0 0 0 0 0
N. Sembilan 0.96 0 0 0 0 0 0 0 0 0 0 0 0
Pahang 1.45 0 0 0 0 0 0 1 13 1 1 50 1
Perak 2.28 0 0 0 0 0 0 0 0 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 1 100 1 3 43 2 2 24 1 1 50 1
Sabah 3 0 0 0 1 14 0 0 0 0 0 0 0
Sarawak 2.36 0 0 0 0 0 0 0 0 0 0 0 0
Selangor & W.P
6.43 0 0 0 2 29 0 3 37 0 0 0 0
Kuala Lumpur
Intestinal Intestinal
GI Breath Test Capsule Tract Stenting Tract Stenting
Population
System Endoscopic System Bouginage: TTS Bouginage: Savary-
dilator Guillard dilator
Malaysia 26.64 8 100 0 6 100 0 46 100 2 32 100 1
Sector
Public - 1 13 5 83 34 74 19 59
Private - 7 88 1 17 12 26 13 41
State
Johor 3.17 0 0 0 0 0 0 6 13 2 2 6 1
Kedah & Perlis 2.11 0 0 0 1 17 0 6 13 3 3 9 1
Kelantan 1.53 0 0 0 0 0 0 1 2 1 5 16 3
Melaka 0.73 1 13 1 0 0 0 2 4 3 3 9 4
N. Sembilan 0.96 0 0 0 0 0 0 1 2 1 2 6 1
Pahang 1.45 1 13 1 0 0 0 3 7 2 3 9 2
Perak 2.28 2 24 1 0 0 0 1 2 0 3 9 1
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 2 24 1 1 17 1 4 9 3 3 9 2
Sabah 3 1 13 0 0 0 0 2 4 1 1 4 0
Sarawak 2.36 0 0 0 0 0 0 9 20 4 1 4 0
Selangor & W.P
6.43 1 13 0 4 66 1 11 24 2 6 19 1
Kuala Lumpur
50
Video-endoscopic
Video-endoscopic Video-endoscopic Video-endoscopic
workstation
workstation workstation with: workstation
with: endoscopic
Population with: gastroscope duodenoscope with: enteroscope
ultrasound and
and appropriate and appropriate and appropriate
appropriate
accessories accessories accessories
accessories
Malaysia 26.64 167 100 6 84 100 3 12 100 0 16 100 1
Sector
Public - 84 50 41 49 4 33 9 56
Private - 83 50 43 51 8 67 7 44
State
Johor 3.17 19 11 6 8 10 3 1 8 0 0 0 0
Kedah & Perlis 2.11 12 7 6 9 11 4 0 0 0 1 6 0
Kelantan 1.53 6 4 4 7 8 5 0 0 0 1 6 1
Melaka 0.73 9 5 12 4 5 5 0 0 0 0 0 0
N. Sembilan 0.96 6 4 6 3 4 3 0 0 0 0 0 0
Pahang 1.45 4 2 3 4 5 3 2 17 1 2 13 1
Perak 2.28 14 8 6 6 7 3 1 8 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 20 12 13 9 11 6 0 0 0 1 6 1
Sabah 3 5 3 2 2 2 1 0 0 0 0 0 0
Sarawak 2.36 15 9 6 10 12 4 2 17 1 2 13 1
Selangor & W.P
6.43 57 35 9 22 25 3 6 50 1 9 56 1
Kuala Lumpur
Video-endoscopic
workstation with: Video-endoscopic Video-endoscopic Heater probe for
double balloon workstation with: workstation (contact dermal
Population enteroscopic sigmoidoscope with: colonoscope device) for
system and and appropriate and appropriate gastrointestinal
appropriate accessories accessories bleed
accessories
Malaysia 26.64 4 100 0 47 100 2 137 100 5 27 100 1
Sector
Public - 2 50 19 40 66 48 17 63
Private - 2 50 28 60 71 52 10 37
State
Johor 3.17 0 0 0 5 11 2 12 9 4 3 11 1
Kedah & Perlis 2.11 0 0 0 4 9 2 9 7 4 2 7 1
Kelantan 1.53 0 0 0 3 6 2 11 8 7 2 7 1
Melaka 0.73 0 0 0 2 4 3 6 4 8 0 0 0
N. Sembilan 0.96 0 0 0 3 6 3 4 3 4 0 0 0
Pahang 1.45 1 25 1 3 6 2 4 3 3 3 11 2
Perak 2.28 0 0 0 5 11 2 11 8 5 4 15 2
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 0 0 0 1 2 1 16 12 11 1 4 1
Sabah 3 0 0 0 1 2 0 5 4 2 1 4 0
Sarawak 2.36 0 0 0 6 13 3 13 9 6 3 11 1
Selangor & W.P
6.43 3 75 0 14 30 2 46 33 7 8 30 1
Kuala Lumpur
51
CHAPTER 14
NEPHROLOGY FACILITIES AND DEVICES
Edited by :
Dato’ Dr. Zaki Morad1 , Dr. Ong Loke Meng2

Dr. Goh Bak Leong3, Dr. Hooi Lai Seong4, Dr. Lim Yan Ngo5, Dato’ Dr. Rozina Ghazalli2, En. A.
Suhaili b. Shahri5, Sr. Lee Day Guat6, Tn. Hj. Mohd Sulaiman B. Dalimi3, Tn Haji Wazir Hussin7,
En. Chua Kee Long
1 Ampang Puteri Specialist Hospital,2 Hospital Pulau Pinang, 3 Hospital Serdang, 4 Hospital Sultanah Aminah,
5 Hospital Kuala Lumpur, 6 Pusat Penyelidikan Klinikal HKL, 7 Hospital Tengku Ampuan Rahimah.
INTRODUCTION
Nephrology as a distinct specialty developed in this country in the 1970s. From the very beginning, the
public image of nephrology was haemodialysis (HD) treatment and the machines associated with it.
Both haemodialysis and peritoneal dialysis treatment maintain their pre-eminent place in Nephrology
practice because they consume a disproportionate share of the budget. A significant proportion of the
cost of care in Nephrology goes to purchasing and maintaining the dialysis machines. The National
Renal Registry has captured data on dialysis practice in the country for the last fifteen years. They
have data not only on the numbers but also the utility of these machines. Such information is useful
in planning for services and as a guide for purchases in the future.
Apart from the HD machines there are other machines that are used in dialysis practice but have not
been captured in this first attempt. They include water treatment machines (or more popularly called
the Reverse Osmosis machine), dialyzer reprocessor machine, dialyzer rinsing machines and other
related equipment. It is hoped that subsequent endeavours will include these machines to give a
comprehensive picture of the dialysis program in the country.
Doctors in general do not have deep interest in the workings of these machines. Yet they place their
patients regularly under these machines. It is hoped that the Medical Device Directory will spur
greater interest amongst doctors and other healthcare providers who regularly use these machines on
how these machines work, their cost, their efficient usage and more importantly their impact on the
patients’ health.
53
RESULTS
Table 1: Available Therapeutic and Diagnostic Facilities in Nephrology
Chronic Haemodialysis Unit

Population Peritoneal Dialysis Unit

Malaysia 26.64 31 100 1 455 100 17

Sector
Public - 25 81 146 32
Private - 6 19 309 68

State
Johor 3.17 4 10 1 63 14 20
Kedah & Perlis 2.11 1 3 0 32 7 15
Kelantan 1.53 2 7 1 18 4 12
Melaka 0.73 2 7 3 20 4 27
Pahang 1.45 2 7 1 17 4 12
Perak 2.28 3 10 1 50 11 22
Terengganu 1.04 1 3 1 10 2 10
Pulau Pinang 1.49 2 7 1 42 9 28
Sabah 3 2 7 1 26 6 9
Sarawak 2.36 1 3 1 29 6 12
Table 1 shows the distribution of peritoneal dialysis (PD) and haemodialysis (HD) centres in the
country. The information was obtained from the National Medical Device survey and the National
Renal Registry (NRR) (1). In the survey the overall response rate was 57% with 66% response from
the public sector and 46% from the private sector. The response rate in the NRR was 100%.
The public sector is the major providers of PD while the private sectors the major provider of
HD. Twenty-five (80.6%) of the 31 PD units are located in public sector. PD units with both adult
and paediatric nephrologists are regarded as separate units. On the other hand, two-thirds of the
haemodialysis centres are private (comprising non-governmental organization and HD units in private
sector) while 32% (146) are in the public sector.
There is a wide variation in distribution of PD and HD centres in Malaysia. The number of HD

centres in each state ranged from 9 to 28 centres per million population (pmp). The states with the
lowest population least served were Sabah, Terengganu and Kelantan. Most (71%) of the PD centres
are located in west coast states of West Malaysia. Only 3 (9.7%) centres are located in East Malaysia.
The dominance of HD over PD can largely explained by the increase in HD centres runned by non-
governmental organizations following the introduction of government subsidy for haemodialysis.
54
Table 2: Available Medical Devices in Nephrology
Continuous Renal
Haemodialysis Peritoneal Dialysis
Population Replacement Therapy
machine Cycler
(CRRT) machine
Malaysia 26.64 5008 100 188 112 100 4 61 100 2
Sector
Public - 1388 28 107 96 44 72
Private - 3620 72 5 4 17 27
State
Johor 3.17 730 15 230 6 5 2 4 7 1
Kedah & Perlis 2.11 337 7 160 7 6 3 4 5 1
Kelantan 1.53 143 3 93 1 1 1 3 3 1
Melaka 0.73 219 4 300 3 3 4 4 3 3
Negeri Sembilan 0.96 216 4 225 5 4 5 2 3 2
Pahang 1.45 182 4 126 3 3 2 3 3 1
Perak 2.28 553 11 243 8 7 4 3 5 1
Terengganu 1.04 115 2 111 0 0 0 1 2 1
Pulau Pinang 1.49 472 9 317 8 7 5 8 12 5
Sabah 3 202 4 67 4 4 1 2 3 1
Sarawak 2.36 307 6 130 4 4 2 5 8 2
Selangor & W.P
6.43 1532 31 238 63 56 10 28 47 4
Kuala Lumpur
Table 2 shows the distribution of HD, PD cycler and continuous renal replacement therapy (CRRT)
machines.
There were more HD machines (188 pmp) compared with PD cyclers (4 pmp). However the survey
included only PD cyclers in health facilities and home based machines for patients on automated PD
were not included. There were 5008 (188 pmp) HD machines (range 67 - 317 machines pmp), 112
PD cyclers (range 0 - 10 pmp) and 61 CRRT machines (range 1-5 pmp) in Malaysia. 72.3% of the
haemodialysis, 27.9% of CRRT machines but only 4.5% of PD cyclers were located in the private
sector.
There was a wide variation of distribution of HD machines among the states in Malaysia. The west
coast states of West Malaysia had the highest number of machines. Selangor and Federal Territory
had the highest absolute number of HD machines (1532) while Penang was the highest population
served (317 pmp). The least served states were Sabah (67 pmp), Kelantan (93 pmp) and Terengganu
(111 pmp).
A vast majority (95.5%) of the PD cyclers are located in the public sector. Selangor and the Federal
Territory of Kuala Lumpur (FTKL) had the highest number of PD cyclers: 63 (10 pmp). The
surveyhowever included only the cyclers located in health facilities and did not include cyclers used
at home by patients. Furthermore the number of PD cyclers under estimates the use of peritoneal
dialysis as continuous ambulatory peritoneal dialysis does not require the use of PD cycler.
72.1% of CRRT machines are in the public sector with the best served states in west coast of Peninsular
Malaysia (Selangor & FTKL, Penang and Melaka). This is not unexpected as CRRT is an expensive
modality in the treatment of acute renal failure.
55
Summary
This is the first report on the nephrology and urology services available in the country. There may be
gaps in the data collected and this be filled with subsequent reports.
HD penetration is better compared with PD in Malaysia. The private sector is the major provider of
HD facilities while the public sector is the major provider of PD. There is an inequity in distribution
of nephrology facilities in the country with the highest population served in the West Coast of states
of West Malaysia (Penang, Selangor & FT and Perak) and the lowest in Sabah, Terengganu and
Kelantan. Future planning should include increasing the number of PD centres as the demand for
human resource, cost and office space is less.
References
1. 15th report of the Malaysian Dialysis and Transplant Registry 2007.
56
CHAPTER 15
UROLOGY FACILITIES AND DEVICES
Authors :
Dr. Murali Sundram Abdullah1, Dr. Clarence Lei Chang Moh2
1 Hospital Kuala Lumpur, 2 Normah Medical Centre.
REPORT
Response Rates
Of the 92 hospitals purported to provide urology services, 73% responded to the survey. To our
knowledge, of these 92 hospitals, only 50 have full time resident urologists offering the full range of
general urology services. Of these 52 hospitals, roughly 2/3 (37) are private institutions.
Table 1: Available Diagnostic and Therapeutic Facilities in Urology
Renal Transplant Urodynamic

Population Stone Center Robotic Centre
Center Laboratory
Malaysia 26.64 47 100 2 7 100 0 3 100 0 7 100 0
Sector
Public - 12 25 4 57 - 2 67 - 3 43 -
Private - 35 75 3 43 - 1 33 - 4 57 -
State
Johor 3.17 4 9 1 0 0 0 0 0 0 1 14 0
Kedah & Perlis 2.11 3 6 1 0 0 0 0 0 0 1 14 0
Kelantan 1.53 1 2 1 0 0 0 0 0 0 0 0 0
Melaka 0.73 3 6 4 0 0 0 0 0 0 1 14 1
Negeri Sembilan 0.96 2 4 2 0 0 0 0 0 0 0 0 0
Pahang 1.45 2 4 1 0 0 0 0 0 0 0 0 0
Perak 2.28 3 6 1 0 0 0 0 0 0 0 0 0
Terengganu 1.04 1 2 1 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 6 13 4 0 0 0 0 0 0 0 0 0
Sabah 3 2 4 1 0 0 0 0 0 0 0 0 0
Sarawak 2.36 3 6 1 0 0 0 1 33 0 1 14 0
Selangor & W.P.
6.43 17 36 3 7 100 1 2 67 0 3 43 0
Kuala Lumpur
57
Population Andrology Laboratory
Malaysia 26.64 2 100 0

Sector
Public - 0 0
Private - 2 100

State
Johor 3.17 1 50 0
Kelantan 1.53 0 0 0
Melaka 0.73 0 0 0
Pahang 1.45 0 0 0
Perak 2.28 0 0 0
Sabah 3 0 0 0
Sarawak 2.36 0 0 0
Selangor & W. P. Kuala Lumpur 6.43 1 50 0
Some of the facilities listed under urology suffer from a lack of strict definition and hence the
possibility of false reporting.
A stone centre is a stand-alone centre with dedicated facilities for the treatment of all types of urinary
stones. The centre should have the full range of endoscopic and percutaneous methods of stone
clearance; either possesses or has access to an ESWL machine and should have a resident urologist.
This definition may not be applied strictly because some centers have general surgeons who practice
urology and some centers have visiting urologists who offer some but not the entire range of urological
services.
A renal transplant centre is a stand-alone center that provides a continuum of comprehensive care
to patients undergoing kidney transplantations both living related and cadaveric. The service may
include monitoring of patients awaiting transplantation, medical and surgical therapies, and follow-
up care inclusive of management of immunosuppressive therapy. There are 4 public centers, which do
the majority of the transplants, and 3 private centers all of which are in the Klang valley.
A robotic centre is a stand-alone center equipped with capabilities to perform robotic assisted
laparoscopic surgical procedures. Possession of a robotic machine must be a perquisite. There are 2
in the public and 1 in the private.
An urodynamic laboratory is a stand-alone center dedicated to performing urodynamic assessments

for the diagnosis and management of incontinence, lower urinary tract dysfunctions and prolapses.
Possession of a urodynamic machine (with or without fluoroscopy) is a prerequisite. The total
of 7 recorded is too small as the public sector alone has 10. Urodynamic machines under the
urogynaecologists are not shown here.
An andrology laboratory is a stand-alone center that specifically provides male infertility testing
services. It may or may not provide cryopreservation or sperm banking services. Although many
hospitals offer hormonal assays and semen analysis and have urologists on staff, it is not clear if this
constitutes an andrology laboratory.
58
Table 2: Available Medical Devices in Urology
Extracorporeal
Total Extracorporeal Extracorporeal
Shockwave
Extracorporeal Shockwave Shockwave
Lithotripter
Population Shockwave Lithotripter Lithotripter
(ESWL) with Vital
Lithotripter (ESWL) with (ESWL) with
Data Monitoring
(ESWL) unit Fluoroscopy unit Ultrasound unit
Capability
Malaysia 26.64 70 100 3 22 100 1 27 100 1 20 100 1
Sector
Public - 22 31 6 27 10 37 5 25
Private - 48 69 16 73 17 63 15 75
State
Johor 3.17 7 10 2 3 14 1 2 7 1 3 15 1
Kedah & Perlis 2.11 6 9 3 1 5 0 2 7 1 2 10 1
Kelantan 1.53 4 6 3 1 5 1 2 7 1 1 5 1
Melaka 0.73 10 14 14 3 14 4 4 15 5 3 15 4
N. Sembilan 0.96 0 0 0 0 0 0 0 0 0 0 0 0
Pahang 1.45 1 1 1 0 0 0 0 0 0 0 0 0
Perak 2.28 2 3 1 0 0 0 2 7 1 0 0 0
Terengganu 1.04 1 1 1 0 0 0 1 4 1 0 0 0
Pulau Pinang 1.49 9 13 6 3 14 2 3 11 2 3 15 2
Sabah 3 4 6 1 1 5 0 2 7 1 1 5 0
Sarawak 2.36 10 14 4 3 14 1 3 11 1 3 15 1
Selangor & W.P
6.43 16 23 2 7 29 1 6 22 1 4 20 1
Kuala Lumpur
Total Intracorporeal Intracorporeal Intracorporeal

Population Intracorporeal Lithotripter Unit Lithotripter Unit Lithotripter Unit
Lithotripter Unit with Lithoclast with Ultrasound with Laser
Malaysia 26.64 73 100 3 42 100 2 24 100 1 5 100 0
Sector
Public - 25 34 12 29 12 50 2 40
Private - 48 66 30 71 12 50 3 60
State
Johor 3.17 8 11 3 4 10 1 3 13 1 0 0 0
Kedah & Perlis 2.11 7 10 3 4 10 2 2 8 1 0 0 0
Kelantan 1.53 6 8 4 3 7 2 3 13 2 0 0 0
Melaka 0.73 5 7 7 3 7 4 2 8 3 0 0 0
N. Sembilan 0.96 2 3 2 1 2 1 1 4 1 0 0 0
Pahang 1.45 4 5 3 1 2 1 1 4 1 1 20 1
Perak 2.28 2 3 1 2 5 1 0 0 0 0 0 0
Terengganu 1.04 2 3 2 1 2 1 1 4 1 0 0 0
Pulau Pinang 1.49 7 10 5 5 12 3 2 8 1 0 0 0
Sabah 3 3 4 1 2 5 1 1 4 0 0 0 0
Sarawak 2.36 7 10 3 3 7 1 2 8 1 1 20 0
Selangor & W.P
6.43 20 27 3 13 31 2 6 25 1 3 60 0
Kuala Lumpur
59
ESWL machine numbers are grossly overestimated probably because of over reporting in the last
column (ESWL with vital data monitoring) and this should be left out in future surveys. To our
knowledge there are a total of 45 ESWL machines in Malaysia of which only 14 are in the public
sector. 40% are located in Selangor & WP area and the rest quite evenly distributed among the other
states capitals.
The most common intracorporeal lithotripsy device is the lithoclast followed by the ultrasonic
lithotripter. Laser lithotripsy, which is delivered via a flexible fiber, is the latest lithotripsy device.
Uroflowmetry Bladder scan to

Total Urodynamic Uroflowmeter in a
Population with urodynamic measure residual
machine separate toilet
machine bladder volume
Malaysia 26.64 21 100 1 16 100 1 31 100 1 16 100 1
Sector
Public - 7 33 4 25 14 45 6 38
Private - 14 67 12 75 17 35 10 62
State
Johor 3.17 2 10 1 2 13 1 3 10 1 1 6 0
Kedah & Perlis 2.11 2 10 1 2 13 1 2 6 1 2 13 1
Kelantan 1.53 1 5 1 1 6 1 2 6 1 0 0 0
Melaka 0.73 0 0 0 2 13 3 3 10 4 1 6 1
N. Sembilan 0.96 1 5 1 0 0 0 0 0 0 0 0 0
Pahang 1.45 1 5 1 1 6 1 1 3 1 1 6 1
Perak 2.28 0 0 0 0 0 0 1 3 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 4 19 3 3 19 2 4 13 3 3 19 2
Sabah 3 0 0 0 0 0 0 1 3 0 1 6 0
Sarawak 2.36 3 14 1 2 13 1 2 6 1 2 13 1
Selangor & W.P
6.43 7 33 1 3 19 0 12 39 2 5 31 1
Kuala Lumpur
The table on urodynamic equipment is flawed. There should be only 3 categories – Bladder scan,
Uroflowmetry and Urodynamic machine. The first two are basic urodynamic devices available in
most urological centers and the numbers given appear too small whereas the numbers for urodynamic
machines (which are mainly found in high volume public centers) are too high.
60
Nephroscope Ureteroscope Ureteroscope
Population Resectoscope
(rigid) (flexible) (rigid)

Malaysia 26.64 95 100 4 56 100 2 23 100 1 79 100 3
Sector
Public - 40 42 24 43 9 39 28 35
Private - 55 58 32 57 14 61 51 65
State
Johor 3.17 10 11 3 7 13 2 3 13 1 12 15 4
Kedah & Perlis 2.11 6 6 3 5 9 2 1 4 0 6 8 3
Kelantan 1.53 4 4 3 4 7 3 2 8 1 5 6 3
Melaka 0.73 6 6 8 3 5 4 3 13 4 7 9 10
N. Sembilan 0.96 1 1 1 1 2 1 0 0 0 1 1 1
Pahang 1.45 3 3 2 3 5 2 1 4 1 3 4 2
Perak 2.28 8 8 4 3 5 1 0 0 0 2 3 1
Terengganu 1.04 4 4 4 1 2 1 0 0 0 2 3 2
Pulau Pinang 1.49 8 8 5 6 11 4 1 4 1 9 11 6
Sabah 3 4 4 1 2 4 1 0 0 0 3 4 1
Sarawak 2.36 13 15 6 8 14 3 4 17 2 8 10 3
Selangor & W.P
6.43 28 29 4 13 23 2 8 35 1 21 27 3
Kuala Lumpur
Population Cystoscope (flexible) Cystoscope (rigid)

Malaysia 26.64 62 100 2 124 100 5
Sector
Public - 25 40 64 52
Private - 37 60 60 48
State
Johor 3.17 6 10 2 19 15 6
Kedah & Perlis 2.11 7 11 3 7 6 3
Kelantan 1.53 3 5 2 5 4 3
Melaka 0.73 4 6 5 6 5 8
Pahang 1.45 3 5 2 3 2 2
Perak 2.28 2 3 1 9 7 4
Terengganu 1.04 1 2 1 1 1 1
Pulau Pinang 1.49 8 13 5 12 10 8
Sabah 3 3 5 1 6 5 2
Sarawak 2.36 7 11 3 15 12 6
Selangor & W.P Kuala Lumpur 6.43 17 28 3 37 30 6
61
Endoscopic and percutaneous technology has revolutionized the practice of urology and this is
reflected in the various types of endoscopes both rigid and flexible. The rigid cystoscope is the most
common because it is also used by the non-urologist.
The resectoscope is the most common tool of the urologist (n= 95).
The rigid ureteroscope, rigid nephroscope and flexible cystoscope are the workhorses for the urologist
and average about 60 in each category.
Flexible ureteronephroscopes number 23.
Although 2/3 of all hospitals offering the standard urology services are private institutions, the
numbers of scopes are distributed almost equally between private and public hospitals reflecting the
difference in workload.
Summary
There are 50 hospitals offering the full range of urological services with a resident urologist(s). 13 are
public and 37 private. Urolithiasis constitutes the main workload of Malaysian urologists and all 50
of these hospitals are considered stone centers with 90% having ESWL machines. Of the 45 ESWL
machines in the country, 30% are in public hospitals and 40% are in the Klang Valley. Most of the
public urological centers are also urodynamic centers. Transplant and Robotic services are mainly in
public hospitals.
There are probably another 40 hospitals that offer limited urology services provided by a visiting
urologists or a general surgeon with an interest in urology.
The resectoscope is the most common instrument, followed by the flexible cystoscope, rigid
ureteroscope and rigid nephroscope. The most common intracorporeal devices are the lithoclast and
ultrasonic.
62
CHAPTER 16
DERMATOLOGY FACILITIES AND DEVICES
Edited by :
Pn Sri Datin Dr. Suraiya H Hussein1, Dr. Rohna Ridzwan2

Dr. Choon Siew Eng3, Dr. Asmah Johar1
1 Kuala Lumpur Hospital MOH, 2 Selayang Hospital MOH, 3 Hospital Tengku Ampuan Aminah MOH
HIGH TECHNOLOGY DEVICES IN DERMATOLOGY SERVICES
INTRODUCTION
The introduction of medical technology in clinical practice has expanded the Dermatology services
from mere office consultation to that of investigative and therapeutic Dermatology services. The
medical devices range from simple cryosurgical units to the sophisticated and bulky Phototherapy
cabins and Laser surgical machines. Table 1 shows the devices in decreasing order of cost.
Table 1 Dermatology Devices - Indication and Credentialed Operators

Mode of
Medical Device Indication of usage Credentialed operator
Management
1 Cryosurgical unit Benign skin tumours Therapeutic Trained doctors & nurses
Nodular dermatitis
Basal cell carcinoma Therapeutic Trained dermatologist
2 Electrosurgical unit Benign skin tumours Therapeutic Trained doctors
3 Iontophoresis Palmar & plantar Hyperhidrosis Interim therapy Doctors and trained
physiotherapist
4 Phototherapy unit
Full body phototherapy cabin Psoriasis Therapeutic Dermatologists
(broad band UVB & UVA) Vitiligo (extensive) and trained
Mycosis Fungoides Physiotherapists
Others
and nurses under
Full body phototherapy cabin Psoriasis Therapeutic supervision by
(narrow band UVB) Scleredema
Vitiligo Dermatologists.
Mycosis Fungoides
Full body phototherapy cabin Mycosis Fungoides Adjuvant
(UVA1) Scleredema therapy
Morphoea
Hand & feet phototherapy unit Hand & foot psoriasis Therapeutic
Hand & feet vitiligo
Hand held phototherapy Scalp psoriasis Therapeutic
Localized vitiligo
PUVA ten (UV lamps) Localized vitiligo Therapeutic
Multi tester Unit (UVA & UVB) Investigative
5 Laser surgical unit
Carbon dioxide laser system Benign skin tumours Trained
Resurfacing of scars Dermatologist
Intense pulse light laser Hair removal, resurfacing of scars, Therapeutic
system photo rejuvenation &
Cosmesis
Pigment laser system Hyperpigmented disorders, tattoos,
hair removal
Vascular laser system Port wine stains, haemangioma,
telangiectasia / varices
63
Table 2: Available Therapeutic and Diagnostic Facilities in Dermatology
No Data to Date
Table 3: Available Medical Devices in Dermatology

CO2 Laser Other Laser Phototherapy Phototherapy
Population
system systems UVB PUVA
Malaysia 26.64 7 100 0 7 100 0 12 100 0 27 100 1
Sector
State
Johor 3.17 1 14 0 0 0 0 2 17 1 2 7 1
Kedah & Perlis 2.11 1 14 0 0 0 0 1 8 0 2 7 1
Kelantan 1.53 0 0 0 0 0 0 0 0 0 1 4 1
Melaka 0.73 1 14 1 1 17 1 0 0 1 2 7 3
Negeri Sembilan 0.96 1 14 1 2 33 2 1 8 1 1 4 1
Pahang 1.45 1 0 1 0 0 0 1 8 1 1 4 1
Perak 2.28 0 0 0 0 0 0 1 8 0 2 7 1
Terengganu 1.04 0 0 0 0 0 0 0 0 0 0 0 0
Pulau Pinang 1.49 1 14 1 0 0 0 0 0 0 1 4 1
Sabah 3 0 0 0 0 0 0 1 8 0 1 4 0
Sarawak 2.36 0 0 0 1 17 0 2 17 1 2 7 1
Selangor & W.P
6.43 1 14 0 2 33 0 3 25 0 12 44 2
Kuala Lumpur
Population Cryosurgical Unit Electrosurgical Unit Iontophoresis Unit

Malaysia 26.64 38 100 1 26 100 1 14 100 0
Sector
Public - NC - NC - NC -
Private - NC - NC - NC -
State
Johor 3.17 5 13 2 3 12 1 3 21 1
Kedah & Perlis 2.11 4 11 2 4 15 2 3 21 1
Kelantan 1.53 1 3 1 1 4 1 0 0 0
Melaka 0.73 2 5 3 3 12 4 0 0 0
Negeri Sembilan 0.96 2 5 2 2 8 2 1 7 1
Pahang 1.45 2 5 1 1 4 1 0 0 0
Perak 2.28 4 11 2 2 8 1 1 7 0
Terengganu 1.04 2 5 2 1 4 1 0 0 0
Pulau Pinang 1.49 4 11 3 2 8 1 1 7 1
Sabah 3 2 5 1 2 8 1 1 7 0
Sarawak 2.36 5 13 2 2 8 1 1 7 0
Selangor & W.P
6.43 5 13 1 3 12 0 3 21 0
Kuala Lumpur
64
The National Medical Device Survey was conducted by the Clinical Research Center in year 2007.
Two hundred and fifty three hospitals were surveyed. The response to the survey is shown in Fig. 1
Fig. 1 National Medical Device Survey 2007 Respondents
Hospital surveyed
n=253
Hospital with Hospital with no

Dermatology services Dermatology services
n=78 n=175
Hospital with Dermatology Hospital with Dermatology

services that responded services that did not respond
n=47 n=31
MOH & Army Hospitals with Private Hospitals with University Hospitals with
Dermatology services Dermatology services Dermatology services
n=31 n=13 n=3
Johor Pahang Malacca UMMC

n=3 n=1 n=2
Malacca Terengganu Selangor

UKM
n=1 n=1 n=5
Wilayah
N. Sembilan Kelantan
Persekutuan USM
n=2 n=3
n=1
Selangor Perlis Perak

n=5 n=1 n=1
Wilayah Sabah Penang

Persekutuan n=3 n=1
n=1
Perak Sarawak Sabah

n=3 n=2 n=1
Kedah Penang Sarawak

n=4 n=1 n=1
65
The National survey investigation enabled a more comprehensive understanding of the availability
and use of dermatological devices both in the public and private sectors. Nevertheless the response
rate of only 60.2 % could be improved in the future surveys.
Fig. 2 Malaysian Population Accessibility to Dermatology Medical Devices in Year 2007
PERLIS 2.11 Million

1 4
3
4
KEDAH
1
1 1
PENANG
1.49 Million 1
1
1 1
1
2
4 2
1 2 KELANTAN 1
1
4 2 1.53 Million TERENGGANU
1 1.53 Million
PERAK
2.28 Million
PAHANG
1.45 Million
1 1
1 2
1 2
SELANGOR & 1
3 12
WILAYAH PERSEKUTUAN
2.11 Million 5 3
3
N. SEMBILAN
2.36 Million
Key : 1 2 1
1
1 2 2
CO2 Laser System
1 1
2 JOHOR
Other Laser System 2
MELAKA 3 2.36 Million

2.36 Million 1 2 2
Phototherapy (UVB)
2 3
3
Phototherapy (PUVA)
Cryosurgical Unit
Electrosurgical Unit
Iontophoresis Unit
* The numbers in the figures above denote the quantity of equipment available.
66
1 1
2 2
SABAH
2.36 Million
1 2
2 5
1
2
SARAWAK
2.36 Million
The data in this report is limited by the absence of data from stand alone clinics providing Dermatology
service which was not surveyed and the under reporting of availability of the device in private hospitals.
Nevertheless, the effort by the National Medical Device Survey team has enabled the government
as well as the private sector to plan for the future expansion and assure availability of appropriate
dermatological devices both in private and public sectors to meet the needs of the Malaysian public
and for medical tourism.
67
CHAPTER 17
OTORHINOLARYNGOLOGY AND AUDIOLOGY
Authors/Contributors :
Prof Madya Dr. Rahmat Omar1, Dato’ Dr. Abdul Majid Md Nasir2, Dr. Junainah Sabirin3, Muhammad
Almyzan Awang4, Nor Shahrina Mohd Zawawi4

1 Pusat Perubatan Universiti Malaya, 2 Hospital Kuala Lumpur, 3 Cawangan Penilaian Teknologi Kesihatan,
4 Pusat Perubatan Universiti Kebangsaan Malaysia.
Response Rates
Otorhinolaryngology : 47 hospitals and medical centers did not respond to the NMDS survey despite
the availability of ORL services. These include 22 within Selangor and Kuala Lumpur, which are
expected to be within reach of this survey. The results are expected to change dramatically as more
centers respond in the future.
Audiology : 59 hospitals that responded have no audiology services. These include several well-
established hospital likes Pusat Pakar Tawakal, Pantai Cheras Medical Center and Hospital PUSRAWI
Sdn Bhd. Even high bed strength hospitals like Likas Hospital and Sultan Ismail Hospital, Johor
Bahru have no audiology services.
Table 1: Available Therapeutic and Diagnostic Facilities in Otorhinolaryngology and Audiology.
Population Sound Treated Room Speech Lab

Malaysia 26.64 10 100 0 4 100 0
Sector
Public - 4 40 2 50
Private - 6 60 2 50
State
Johor 3.17 1 10 0 1 25 0
Kedah & Perlis 2.11 0 0 0 0 0 0
Kelantan 1.53 1 10 1 0 0 0
Melaka 0.73 0 0 0 1 25 1
Pahang 1.45 0 0 0 0 0 0
Perak 2.28 0 0 0 0 0 0
Terengganu 1.04 0 0 0 0 0 0
Pulau Pinang 1.49 2 20 1 0 0 0
Sabah 3 1 10 0 0 0 0
Sarawak 2.36 2 20 1 0 0 0
69
Figures in the table above reflected under-reporting and does not correspond with the expected
availability especially in the city like those within Selangor and W.P.Kuala Lumpur as well as Johor
Bahru.
Table 2: Available Medical Devices in Otorhinolaryngology and Audiology.
Auditory
Portable Otoacoustic
Brainstem Portable
Auditory Emission (OAE)
Response (ABR) Otoacoustic
Population Brainstem Unit
Unit Emission
Response (ABR) (portable and
(portable and (OAE) Unit
Unit static)
static)
Malaysia 26.64 55 100 2 24 100 1 65 100 2 42 100 2
Sector
Public - 38 69 16 67 45 69 30 71
Private - 17 31 8 33 20 31 12 29
State
Johor 3.17 4 7 1 2 8 1 7 11 2 4 10 1
Kedah & Perlis 2.11 2 4 1 1 4 0 3 5 1 2 5 1
Kelantan 1.53 3 5 2 1 4 1 7 11 5 5 12 3
Melaka 0.73 2 4 3 1 4 1 2 3 3 2 5 3
Negeri Sembilan 0.96 3 5 3 1 4 1 3 5 3 2 5 2
Pahang 1.45 4 7 3 1 4 1 4 6 3 3 7 2
Perak 2.28 4 7 2 3 13 1 3 5 1 3 7 1
Terengganu 1.04 2 4 2 1 4 1 2 3 2 2 5 2
Pulau Pinang 1.49 7 13 5 4 17 3 6 9 4 5 12 3
Sabah 3 3 5 1 2 8 1 3 5 1 1 2 0
Sarawak 2.36 3 5 1 1 4 0 4 6 2 2 5 1
Selangor & W.P

6.43 18 34 3 6 25 1 21 31 3 11 25 2
Kuala Lumpur
70
Functional
Audiometer
Portable Endoscopic Microdebrider
Population (static and
Audiometer Sinus Surgery System
portable)
system (FESS)
Malaysia 26.64 22 100 1 65 100 2 40 100 2 32 100 1
Sector
Public - 12 55 31 48 25 62 19 59
Private - 10 45 34 52 15 38 13 41
State
Johor 3.17 2 8 1 5 8 2 3 7 1 2 6 1
Kedah & Perlis 2.11 0 0 0 5 8 2 3 7 1 3 9 1
Kelantan 1.53 1 5 1 4 6 3 3 7 2 5 16 3
Melaka 0.73 1 5 1 6 9 8 1 3 1 3 9 4
N. Sembilan 0.96 1 5 0 2 3 2 1 3 1 2 6 1
Pahang 1.45 2 8 1 3 5 2 2 5 1 3 9 2
Perak 2.28 1 5 0 6 9 3 10 25 4 3 9 1
Terengganu 1.04 1 5 0 1 2 1 1 3 1 0 0 0
Pulau Pinang 1.49 3 14 2 7 11 5 6 15 4 3 9 2
Sabah 3 2 8 1 4 6 1 0 0 0 1 4 0
Sarawak 2.36 3 14 1 5 8 2 3 7 1 1 4 0
Selangor & W.P
6.43 5 23 1 17 25 3 7 18 1 6 19 1
Kuala Lumpur
ORL Endoscopic Camera System

Population
(flexible and rigid)
Malaysia 26.64 142 100 5
Sector
Public - 80 56
Private - 62 44
State
Johor 3.17 10 7 3
Kelantan 1.53 8 6 5
Melaka 0.73 7 5 10
Pahang 1.45 7 5 5
Perak 2.28 13 9 6
Sabah 3 8 6 3
Sarawak 2.36 13 9 6
As expected, there were more FESS systems as compared to microdebrider systems as the former
is more commonly used for sinus surgery. However the microdebrider system is gaining more
acceptance as technology advances.
71
CHAPTER 18
OPHTHALMOLOGY AND OPTOMETRY
Edited by :
Datin Dr. Mariam Ismail1, Dr. Goh Pik Pin1
With contribution from :

Dato’ Dr. Balaravi Pillai2; Dato’ Dr.Vasantha Kumar3, Dr. Mutalib Othman4, Dr. Jamalia Rahmat5
1 Selayang Hospital, 2 Ipoh Hospital, 3 Hospital Tengku Ampuan Afzan, 4 Queen Elizabeth Hospital,
5 Kuala Lumpur Hospital
INTRODUCTION
Ophthalmology and optometry services are amongst the highly technology dependent services, where
devices are used in the examination of patients, investigation and procedures to arrive at a diagnosis
and plan patient management. In addition, devices in these fields are being revised, improved with
new features and newer technology introduced all the time.
Results of the first 2007 National Medical Device Survey have a poor response rate. Out of the
256 health care providers, 141 (55.1%) responded to the survey. Response rate was slightly higher
among Ministry of Health (MOH only) facilities, 60.6% as compared to private facilities (48.7%).
Among the 141 respondents, 95(67.4%) provide and 46 (32.6%) did not provide ophthalmology and
optometry service. Hence, the 2007 survey findings are not really representative and only findings on
essential facilities and devices that are considered fairly reliable are reported.
A subsequent phone survey was conducted from 21 July to 25 July 2008 on 36 MOH
ONLY Ophthalmology departments and 9 district hospitals with Optometrists but without
Ophthalmologist. These data collated by the expert panel replaced the NMDS data where they
were deemed necessary.
Results
Therapeutic and Diagnostic Facilities
Of the 95 centres with ophthalmology services that responded, 28 (29.5%) have an eye casualty
clinic, a clinic which see ‘walk –in’ patients with acute or emergency eye problems. More than half
of the eye care facilities have a laser room (53, 55.8%).
Ophthalmology and Optometry Medical Devices

Though the survey includes all types of medical devices used in ophthalmology and optometry
services, we report only essential devices required to provide eye care service such as A scan and
phacoemulsification unit for cataract surgery, imaging such as B scan, fundus camera and Ophthalmic
laser systems.
A Scan, B Scan and Phacoemulsification Machine

Survey findings indicated that there are 118 A scan, 64 B Scan and 76 phacoemulsification units. The
states with the highest number of these devices are Selangor and Wilayah Persekutuan and Penang.
The state with the highest number of A and B Scan per million population is Penang whilst Melaka
ranks highest for phacoemulsification unit. (Table 2)
73
Fundus camera
Survey results showed availability of 40 fundus cameras in ophthalmology clinics that is one fundus
camera per million population in Malaysia. Of these, more than half are in the public eye care
facilities. The state with the highest number of fundus camera is Selangor and Wilayah Persekutuan
and Penang. (Table 2). This survey did not include fundus cameras located at the Ministry of Health
Klinik Kesihatan for the screening of diabetic retinopathy.
Ophthalmic Laser System

The most common laser machine available is Argon laser (58 units), followed by Nd YAG laser (46
units), Diode laser (26 units) and Endolaser (19 units). Most of these lasers are located in public
hospitals. (Table 2)
DISCUSSION / CONCLUSION
Data collected from the National Medical Device survey 2007 are incomplete and thus not
representative. Effort in getting more complete return with better approach will be done for
2008 survey.
Table 1: Available Therapeutic and Diagnostic Facilities in Ophthalmology and Optometry Specialties.
Eye Casualty Ophthalmology

Population Refraction Room
Clinic Laser Room
Malaysia 26.64 28 100 1 53 100 2 - - -
Sector
Public - 22 79 33 62 46 -
Private - 6 21 20 38 ND -
State
Johor 3.17 2 7 1 4 8 1 4 10 1
Kedah & Perlis 2.11 4 14 2 4 8 2 5 12 2
Kelantan 1.53 1 4 1 3 6 2 2 5 1
Melaka 0.73 3 11 4 4 8 5 1 2 1
Negeri Sembilan 0.96 2 7 2 2 4 2 2 5 2
Pahang 1.45 1 4 1 2 4 1 1 2 1
Perak 2.28 3 11 1 5 9 2 4 10 2
Terengganu 1.04 1 4 1 1 2 1 2 5 2
Pulau Pinang 1.49 3 11 2 7 13 5 2 5 1
Sabah 3 0 0 0 3 6 1 6 14 2
Sarawak 2.36 0 0 0 5 9 2 6 14 3
Selangor & W.P Kuala Lumpur 6.43 8 29 1 13 25 2 7 17 1
74
Table 2: Available Medical Devices in Ophthalmology and Optometry Specialties.
Phaco-
Population A scan B Scan emulsification Fundus Camera
machine
Malaysia 26.64 118 100 4 64 100 2 76 100 3 40 100 1
Sector
Public - 71 60 38 59 44 58 22 55
Private - 47 40 26 41 32 42 18 45
State
Johor 3.17 10 8 3 4 6 1 8 11 3 3 8 1
Kedah & Perlis 2.11 10 8 5 5 8 2 6 8 3 4 10 2
Kelantan 1.53 5 4 3 2 3 1 3 4 2 1 2 1
Melaka 0.73 3 3 4 3 5 4 7 9 10 1 2 1
N. Sembilan 0.96 5 4 5 3 5 3 2 3 2 1 2 1
Pahang 1.45 7 6 5 3 5 2 3 4 2 1 2 1
Perak 2.28 7 6 3 4 6 2 5 7 2 1 2 0
Terengganu 1.04 2 2 2 2 3 2 2 3 2 1 2 1
Pulau Pinang 1.49 20 17 13 16 25 11 11 14 7 6 15 4
Sabah 3 9 8 3 3 5 1 3 4 1 2 5 1
Sarawak 2.36 9 8 3 2 3 1 2 3 1 4 10 2
Selangor & W.P
6.43 31 26 5 17 27 3 24 32 4 15 38 2
Kuala Lumpur
Indirect Anterior Segment Operating

Population Slit Lamp
Ophthalmoscope Camera Microscope
Malaysia 26.64 - - - - - - - - - - - -
Sector
Public - 267 - 143 - 18 - 83 -
Private - ND - ND - ND - ND -
State
Johor 3.17 27 10 9 11 8 3 1 6 0 8 10 3
Kedah & Perlis 2.11 28 10 13 13 9 6 4 22 2 10 12 5
Kelantan 1.53 11 4 7 7 5 5 0 0 0 3 4 2
Melaka 0.73 15 6 21 5 3 7 0 0 0 2 2 3
N. Sembilan 0.96 10 4 10 5 3 5 0 0 0 4 5 4
Pahang 1.45 13 5 9 10 7 7 1 6 1 4 5 3
Perak 2.28 25 9 11 10 7 4 3 17 1 6 7 3
Terengganu 1.04 13 5 13 9 6 9 2 11 2 3 4 3
Pulau Pinang 1.49 20 7 13 8 6 5 1 6 1 6 7 4
Sabah 3 15 6 5 3 2 1 1 6 0 8 10 3
Sarawak 2.36 14 5 6 13 9 6 1 6 0 7 8 3
Selangor & W.P
6.43 76 28 12 49 34 8 4 22 1 22 27 3
Kuala Lumpur
75
Population Cryo Machine Vitrectomy Machine

Malaysia 26.64 - - - - - -
Sector
Public - 32 - 28 -
Private - ND - ND -
State
Johor 3.17 1 3 0 3 11 1
Kedah & Perlis 2.11 6 19 3 5 18 2
Kelantan 1.53 2 6 1 1 4 1
Melaka 0.73 0 0 0 1 4 1
Pahang 1.45 2 6 1 1 4 1
Perak 2.28 3 9 1 0 0 0
Terengganu 1.04 1 3 1 1 4 1
Pulau Pinang 1.49 1 3 1 1 4 1
Sabah 3 1 3 0 1 4 0
Sarawak 2.36 3 9 1 2 7 1
Selangor & W.P Kuala Lumpur 6.43 10 31 2 11 39 2
Ophthalmic Laser Systems
Population Nd. YAG Endolaser Nd. Argon Diode
Malaysia 26.64 46 100 2 19 100 1 58 100 2 26 100 1
Sector
Public - 23 50 15 79 37 64 22 85
Private - 23 50 4 21 21 36 4 15
State
Johor 3.17 3 7 1 0 0 0 5 9 2 3 11 1
Kedah & Perlis 2.11 4 8 2 4 21 2 4 7 2 3 11 1
Kelantan 1.53 0 0 0 1 5 1 3 5 2 2 8 1
Melaka 0.73 3 7 4 1 5 1 3 5 4 1 4 1
N. Sembilan 0.96 0 0 0 0 0 0 2 3 2 1 4 1
Pahang 1.45 2 4 1 0 0 0 2 3 1 3 12 2
Perak 2.28 3 7 1 1 5 0 4 7 2 2 8 1
Terengganu 1.04 1 2 1 1 5 1 1 1 1 0 0 0
Pulau Pinang 1.49 8 17 5 3 16 2 7 12 5 2 8 1
Sabah 3 4 9 1 1 5 0 5 9 2 1 4 0
Sarawak 2.36 2 4 0 1 5 0 4 7 2 1 4 0
Selangor & W.P
6.43 16 35 2 6 32 1 18 31 3 7 27 1
Kuala Lumpur
76
Population Excimer
Malaysia 26.64 4 100 0
Sector
Public - 1 25
Private - 3 75
State
Johor 3.17 1 25 0
Kelantan 1.53 0 0 0
Melaka 0.73 0 0 0
Pahang 1.45 0 0 0
Perak 2.28 0 0 0
Sabah 3 1 25 0
Sarawak 2.36 0 0 0
77
CHAPTER 19
GAPS IN MEDICAL TECHNOLOGY IN MALAYSIA
Table 19.1 Imaging & Diagnostic Technologies.
Gaps in Medical Technology Rank of

# Expert Opinion
in Malaysia Importance
1. High Resolution Computed Availability: Marketed.

Tomography (CT) system for Function: Diagnostic.
Neuroradiology and Cardiac Existing Alternative Options: MRI, angiography
work. Clinical Effectiveness: Capable to reduce up to 25% of
interventional neuroangiography, excellent perfusion CT
angiography.
Life-Saving Outcomes: Improves selection criteria
1
for interventional neuroangiography with improved
outcomes.
Health-Cost Implications: Will increase health cost but
maybe offset by more selective neuro –angiograms.
Safety Issues: Increase radiation dose.
Prioritization: Required in the next 5 years.
2. Cone-beam Breast Computed Availability: Experimental
Tomography (CBBCT) Function: Diagnostic.
Existing Alternative Options: Mammography,
ultrasonography.
Clinical Effectiveness: Higher resolution hence more
sensitive. Radiation dose comparable to 2-view
mammography, imaging post op breast with deformity.
Life-Saving Outcomes: Improves image quality with 3-D 2
images, hence improving cancer detection rates.
Health-Cost Implications: Increase true put, duration of
scan less than 1 minute.
Safety Issues: -
Prioritization: To be introduced within the next 5 years.
3. Magnetic resonance Availability: Marketed

spectroscopy Function: Diagnostic
Existing Alternative Options: -
Clinical Effectiveness: -
Life-Saving Outcomes: Faster and more accurate
diagnosis. 3
Health-Cost Implications: Increased access to MRI and
increased unit cost compared to alternative.
Safety Issues: Quick and less radiation.
79
Table 19. 2 Oncology Technologies.

# Expert Opinion
1. Helical TomoTherapy machine. Availability: Marketed.

Function: Therapeutic.
Existing Alternative Options: Linear accelerator.
Clinical Effectiveness: Less morbidity associated with
treatment, better dose escalation. Good to consider
technological improvement in terms of reduction
radiation exposure.
Life-Saving Outcomes: Better with more precise 1
treatment.
Health-Cost Implications: Very expensive machine,
treatment cost per patient is very much higher
Safety Issues: Increased risk if used by inexperienced
doctors
80
Table 19. 3 Anaesthesiology and Intensive Care Technologies.

# Expert Opinion
1. Whole-body cooling system. Availability: Marketed.

Function: Assistive.
Existing Alternative Options: Water blankets/ mattresses.
Clinical Effectiveness: Avoids immediate and long- term
morbidity associated with hypothermia. Ease of use and
easier monitoring.
Life-Saving Outcomes: Reduces mortality and morbidity 1
associated with newborn hypothermia.
Health-Cost Implications: Less costly than selective head
cooling system.
Safety Issues:
Prioritization: To be reintroduced within the next 2 years
2. Amplitude-integrated Availability: Marketed
Electroencephalography (aEEG) Function: Diagnostic and assistive
Existing Alternative Options: Clinical assessment. The
conventional full 12-lead EEG for the same indication is
impractical.
Clinical Effectiveness: Detection of seizures, level of
consciousness, state of sleep or sedation of baby. Able
to provide trending over a period of time especially for 2
newborns with moderate to severe birth asphyxia.
Life-Saving Outcomes:
Health-Cost Implications:
Safety Issues: Need to interpret aEEG correctly.
3. Infant Transport Mattress Availability: Marketed.

Existing Alternative Options: None.
Clinical Effectiveness: This chemical mattress is used
together with the overhead radiant warmer during the
resuscitation of extremely low birth weight babies and
transport to the neonatal intensive care (NICU) following
the resuscitation. This would avoid the complications of 3
hypothermia.
Life-Saving Outcomes: Reduces mortality.
Health-Cost Implications: -
Safety Issues: May occasionally overheat the baby.
81
4. Olympic Cool Cap System for Availability: Marketed.
Selective Head Cooling Function: Therapeutic.
Existing Alternative Options: Supportive therapy, no
definitive therapy available.
Clinical Effectiveness: Has been shown to reduce mortality
and neuro-developmental abnormalities associated with
birth asphyxia. Induced hypothermia needs to be carefully
controlled and Cool Cap is often used with amplitude
EEG monitoring.
Life-Saving Outcomes: Reduces mortality.
1. Expensive system may not be easily available.
2. Total cost with EEG is about RM200,000.
However, if effective in reducing disabilities, it
may save cost of rehabilitation for both parents
and the Ministry of Health.
Safety Issues: 4
1. FDA approved.
2. Complications associated with hypothermia
3. Sinus bradycardia, arrhythmias, hypotension,
coagulopathy and increased risk of infections
4. Does technology reduce mortality but increase
major disability in survivors?
Additional comments:
1. Although theoretically, the whole body cooling
system is more effective, there are no studies
comparing these two modalities and results of
3 large multicentre randomized clinical trials on
the safety and effectiveness of the whole body
cooling systems are still pending.
82
Table 19.4 Orthopaedic and Traumatology Technologies.

# Expert Opinion
1. ISO-C C-ARM Imaging System. Availability: Marketed.

Clinical Effectiveness: Very good reduced morbidity. 1
Life-Saving Outcomes: Very good.
Health-Cost Implications: Cost effective.
Safety Issues: X-ray precautions are required.
Prioritization: Urgent introduction required.
2. Radiolucent operating tables. Availability: Marketed.
Clinical Effectiveness: Very good reduced morbidity 2
Life-Saving Outcomes: Very good
Safety Issues: -
3. Navigation systems for trauma Availability: Marketed
surgery. Function: Assistive
Clinical Effectiveness: Very good reduced morbidity.
Life-Saving Outcomes: Very good. 3
Health-Cost Implications: Cost effective
Safety Issues: Nil
4. SomatoSensory Evoked Availability: Marketed

Potential (SSEP) device for Function: Assistive
intraoperative monitoring during Existing Alternative Options: -
cervical spine surgery. Clinical Effectiveness: Very good reduced morbidity 4
(Used in combination with Life-Saving Outcomes: Very good
Motor Evoked Potential (MEP)) Health-Cost Implications: Cost effective.
Safety Issues: -
5 Bone morphogenic proteins. Availability: Marketed
Existing Alternative Options: Other modalities such
as Autologous Bone Graft and Synthetic. Bone Graft. 5
Clinical Effectiveness: For faster fracture union and very
good reduced morbidity.
Life-Saving Outcomes: Very good.
Safety Issues: -
Prioritization: see other existing technologies currently
being used.
83
Table 19.5 Physiotherapy and Occupational Therapy Technologies.
Gaps in medical Technology Rank of

# Expert Opinion
1. Real Time Ultrasound Imaging Availability: Marketed

(Physiotherapy) Function: Diagnostic and therapeutic
Existing Alternative Option: Nil
Clinical Effectiveness: Enables identification of
inflammation, tears and ruptures, lesions, fluid
collections and soft tissues masses so that intervention
can be specific to the problems. Muscle actions can be
viewed and used to assist patients to work effectively.
Life – saving outcomes: Improves quality of patients’ life 1
Health – Cost Implication: RM60,000,00. It is cost
effective in the long term because it can be applied and
used in measurement and reeducation of muscles in
musculoskeletal and uro-gynaecological cases.
Safety Issues: minimal effects
Prioritization: to introduced in the next 2 years.
2. VO2max Indirect Spirometry with Availability: Marketed

gas analysis - O2 consumption and Function: Diagnostic purpose
CO2 production Existing Alternative Option: Portable oxymeter.
Clinical Effectiveness: To determine lung function, gas
exchange & secretion retention in the lung.
Life-Saving outcomes: Improves quality of life 1
Health-Cost Implication: RM 50,000.00
(Moderate cost)
Safety Issues: Minimal effects
Prioritization: High
3. Acapella Counterweighted plug Availability: Marketed.

and accessories Function: Therapeutic and Assistive.
Existing Alternative Option: Flutter.
Clinical Effectiveness: Effective in secretion clearance
and improves lung ventilation.
Life-Saving outcomes: Small device easy to use, can
be administered by patient with minimal supervision 1
from clinicians.
Health-Cost Implication: Low cost below RM
5000.00
Safety Issues: Minimal effects.
Prioritization: Urgent introduction required
4. E-link Upper and Lower Availability: Marketed

Extremity evaluation and exercise Function: Therapeutic / Preventive / Diagnostic
system Existing Alternative Option: Manual techniques and
varieties of evaluation tools e.g goniometer, measuring
tape, sensory evaluation tools etc.
Clinical Effectiveness: Able to accurately and
objectively assesses joints and motor performance and
to plan appropriate therapeutic interventions according
to patients’ needs. 2
Life – Saving outcomes: Improve patients’ quality of
life
Health – Cost Implication: RM200,000.00. Reduce
cost of hospitalization as precise plan of treatment can
be undertaken according to the patients’ impairment.
Prioritization: To be introduced within next 5 years.
84
5. High Frequency Radial Availability: Marketed.
Shockwave Therapy Function: Therapeutic.
Existing Alternative Option: Ultrasound therapy and
laser therapy.
Clinical Effectiveness: Shown to be effective in pain
management of musculoskeletal conditions based
on the mechanical application of vibrating pulses to
tensed, shortened or overstretched muscles and tendons
by means of the shock frequencies.
Life-Saving outcomes: Improves quality of patients’ 3
life.
Health-Cost Implication: RM70,000,00. Effective
treatment outcome is effective and duration of treatment
is shortened compared to conventional therapeutic
devices.
Prioritization: to be introduced in next 5 years.
6. Muscle tester with Mega EMG Availability: Marketed

system Function: Diagnostic
Existing Alternative Option: Nil
Clinical Effectiveness: Measurement of muscles
performance and biomechanic analysis and its’ data can
be processed for research purposes. Easy application
in the field, treatment room or in biomechanics
laboratory 4
Life-Saving outcomes: Evidence based measurement
Health-Cost Implication: Low cost. (Below RM100,
000)
Safety Issues: Relatively very safe
Prioritization: To introduced in the next 2 years.
7. Pediatric Lokomat, Intensive Availability: Marketed

Locomotion Therapy for children Function: Therapeutic and Assistive
Existing Alternative Option: Manually assisted
ambulation.
Clinical Effectiveness: Effective intervention
for improving walking function in children with
disabilities.
Life-Saving Outcomes: Reduced the manual labour 5
required for ambulation training. More efficient in
achieving treatment goals.
Health-Cost Implication: High cost more than RM100,
000.00
Prioritization: To introduced in next 5 years.
8. Gait analyzer Availability: Marketed.

Function: Assessment of impairment.
Existing Alternative Option: digital video camera.
Clinical Effectiveness: Shown to be accurate in
analyzing gait impairment enable the therapist to make
appropriate physiotherapy impression in order to plan
physiotherapy management.
Life-Saving Outcomes: Improve patients’ quality of 6
life.
Health-Cost Implication: RM 500,00.00. Reduce cost
of hospitalization as precise plan of treatment can be
undertaken according to the patients’ impairments.
Safety Issues: minimal effects
Prioritization: to be introduced within next 5 years
85
9. Balance system – static and Availability: Marketed.
dynamic balance testing and Function: Therapeutic and diagnostic.
training with five interactive Existing Alternative Option: Balance foam for balance
training modes (Biodex) training.
Clinical Effectiveness: Effective in balance training
for patients with vestibular impairment or neurological
conditions especially in geriatrics. Provides fast and
accurate fall risk assessment plus closed chain, weight
bearing assessment and training for lower extremity 7
training.
Life-Saving Outcomes: Improves quality of life.
Health-Cost Implication: Moderate cost RM100,
000.00.
Prioritization: To be introduced in the next 5 years.
Note:
1. The Acapella and Vo2 max indirect spirometry with gas analysis are urgently required for effective chest care and
respiratory rehabilitation.
2. Real Time Ultrasound Imaging (Physiotherapy) is our top priority in view of physiotherapists’ expanded role in the
care of musculoskeletal problems and urogynaecology cases. With this machine, we are able to provide more effective
treatment by active participation from patients through viewing of images of muscle work on the screen which is in
line with our evidence-based practice.
3. The DBC is the least priority among others because of its high costs and maintenance, and also the space required to
place the machine. Besides this, there is a requirement for staff to be well and intensively trained before they are
confident enough to handle the machine. Though it is a machine with high technology but it only benefits a small
client group such as the industrial workers for the purposes of compensation.
86
Table 19.6 Obstetrics and Gynaecology Technologies.
Gaps in Medical Technology in Rank of

# Expert Opinion
Malaysia Importance
1. Polar probe. Availability: Marketed

Function: Diagnostic (Screening for cervical cancer)
Existing Alternative Options: PAP Smear or
spectrometry.
Clinical Effectiveness: Can be used on its own or as
an additional test for screening. Studies have shown
that use of polar probe increases overall detection
and reduces the false negative rate by pap smear.
Many previous trials conducted with sensitivity and 1
specificity of 98 and 91% respectively.
Life-Saving Outcomes: Reduces morbidity and
mortality associated with cervical cancer.
Health-Cost Implications: This system offer faster,
simpler and cost effective standardized diagnosis.
Safety Issues: -
Prioritization: Required in the next 5 yrs.
2. Cryoprobe. Availability: Marketed.
Existing Alternative Options: Conventional
treatment.
Clinical Effectiveness: Enables cervical cryosurgery
to be conducted. The equipment is cheap, easy to
maintain and has a short learning curve.
Life-Saving Outcomes: Treatment failure is observed
in about 5-10% of women.
Safety Issues:
Limitations include:
1. Cryosurgery is not usually feasible for large
abnormal areas.
2. The procedure removes abnormal, but 2
noncancerous, tissue by freezing it.
3. As a result of the procedure, some patients
experience cramping, watery discharges,
temporary changes in menstrual periods and
increased risk of transmissibility of HIV
infection.
However, cryosurgical treatment is very well
tolerated by patient as there is little to no discomfort
in most cases, negating the requirement of
anaesthesia. It is considered safe with minimal
complication and less than 1% develops cervical
incompetence and no effect on fertility.
87
3. AmniSure Placental Alpha Availability: Marketed
Microglobulin-1 Rapid Function: Diagnostic
Immunoassay Existing Alternative Options: - All current methods
used are deficient in diagnosing Premature Rupture
of Membrane (PROM).
Clinical Effectiveness: A rapid bedside strip test that
can detect rupture of foetal membranes with a high
degree of predictive accuracy. Testing for PAMG-1
increases the sensitivity of detecting small quantities 3
of amniotic fluid in the vagina.
Life-Saving Outcomes: Reduces both maternal and
foetal morbidity and mortality related to premature
ruptures of membranes.
Health-Cost Implications: As above
Safety Issues: -
4. Robotics surgery equipment Availability: Marketed

Function: Diagnostic
Existing Alternative Options: Conventional medical
treatment / surgery including laparoscopic surgery.
Clinical Effectiveness: It utilizes high definition 3-
dimension vision and intuitive motion and therefore,
gives greater ability to dissect compromised anatomy
and tissue places as well as ability to operate on
large pathology and obese patients. There is superior
visualization of tissue planes, superior ability to
reconstruct defect and more precise and potentially 4
safer dissection of pelvic pathology.
Life-Saving Outcomes: As above.
Health-Cost Implications: Less pain with fewer
complications and shorter hospital stays. Therefore,
patients may have faster recoveries.
Safety Issues: -
Prioritization: Robotics is a surgical avenue
that has to be assessed for its potential in future
gynaecological surgery.
88
Table 19.7 Neurology Technologies.

# Expert Opinion
1. Stroke unit facility. Availability: -

Clinical Effectiveness: Various clinical papers on
effectiveness of having a stroke unit.
1
Life-Saving Outcomes: Improve outcome morbidity.
Safety Issues: -
2. 256-slice computed Availability: Marketed

tomography (CT) system. Function: Diagnostic
Existing Alternative Options: MRI, angiography.
Clinical Effectiveness: Capable to reduce up to 25%
interventional neuroangiographies, excellent perfusion
CT angiography.
Life-Saving Outcomes: Improve selection criteria for
interventional neuro-angiographies with improved 2
outcomes.
Health-Cost Implications: Will increase health cost but
maybe offset by more selective neuroangiograms.
Safety Issues: Increase radiation dose.
Prioritization: Urgent introduction required (should be
come along with stroke unit facility)
3. Computer software to register Availability: Marketed

all stroke patients. Function: Assistive
Clinical Effectiveness: Facilitate clinical audit/
research studies.
3
Life-Saving Outcomes: -
Safety Issues: -
Prioritization: Required urgently in public hospitals.
4. Serology testing for Availability: Marketed.

paraneoplastic panel/ Function: Diagnostic.
antibodies Existing Alternative Options: serology conducted in
Australia.
Clinical Effectiveness: Detect and confirm
paraneoplastic syndromes based on presence of
paraneoplastic antibodies.
Life-Saving Outcomes: Early treatment with 4
immunomodulating therapies.
Health-Cost Implications: Improve quality of life,
reduce mortality.
Safety Issues:
5. MERCI Clot Retriever. Availability: Marketed

Existing Alternative Options:
Clinical Effectiveness: MERCI trial published.
Life-Saving Outcomes: Improves morbidity outcomes. 4
Health-Cost Implications:-
Safety Issues:-
89
6. VNS Therapy device. Availability: Marketed/ experimental.
Clinical Effectiveness: Used for treatment-resistant
epilepsy and in treatment-resistant depression, VNS
Therapy may provide limited relief as an adjunctive
treatment for long-term depression patients.
Life-Saving Outcomes: Reduces the number of suicides 6
in the long term.
Safety Issues: No new evidence for safety and
effectiveness.
Prioritization: -
Table 19.8 Psychiatry and Mental Health Technologies.

# Expert Opinion
1. Transcranial Magnetic Availability: Experimental.

Stimulation (TMS) device. Function: Therapeutic.
Existing Alternative Options: Antidepressant Therapy,
Psychotherapeutic Interventions & Electroconvulsive
Therapy
Clinical Effectiveness: Uncertain.
Life-Saving Outcomes: No.
Health-Cost Implications: Cost of purchasing To be
machines considered when
Safety Issues: Not reported. more evidence
Prioritization: Required within the next 5 years. available
Comments:
It is currently considered an alternative when
everything else fails, or those who are not keen to
undergo ECT.
In USA, it is not approved yet by FDA and its use is
for research purposes.
90
Table 19. 9 Cardiology and Cardiothoracic Surgery Technologies.

# Expert Opinion
1. Emerging Biomarkers Availability: Experimental

Function: Preventive and diagnostic.
Clinical Effectiveness: Research purposes. (need for
local community data)
Life-Saving Outcomes: Potentially life-saving. 1
Health-Cost Implications: Cost will be higher at the
initial stages.
Safety Issues: -
2. Hand held Echocardiography Availability: Marketed
unit (community based use). Function: Preventive and Diagnostic.
Existing Alternative Options: Currently available
hospital based.
Clinical Effectiveness: Reasonable but technologies
continue to improve.
Life-Saving Outcomes: Enables earlier referrals well
as avoids unnecessary referrals. 2
Health-Cost Implications: Earlier diagnosis of heart
failure and valvular heart disease.
Safety Issues: -
Prioritization: Community-based use should be
introduced urgently or at least within the next five years.
3. Percutaneous valvular Availability: Marketed/ Experimental

interventions. Function: Therapeutic.
Clinical Effectiveness: There has been continuous
improvement in this technology and will definitely
replace surgery.
Life-Saving Outcomes: Life–saving. 3
Health-Cost Implications: Technology will
progressively be cheaper compared to surgery.
Safety Issues: -
Prioritization: Technology should be introduced
urgently or at least within the next five years.
4. Percutaneous Left Ventricular Availability: Marketed
Assist device. Function: Assistive
Existing Alternative Options: Intra-aortic balloon
pump.
Clinical Effectiveness: Bridge to transplant.
4
Life-Saving Outcomes: Prolongs life.
Health-Cost Implications: $200,000 initial cost
Safety Issues: Unsuitable for long term use
5. Stereotactic Intervention Availability: Marketed/ Experimental
Function: Diagnostic and therapeutic.
Clinical Effectiveness: Allows remote control
without the need for radiation.
Life-Saving Outcomes: Technology is replacing the
5
current percutaneous techniques.
Health-Cost Implications: Need to be looked into.
Safety Issues: -
Prioritization: To be introduced within the next
five years. To be considered
91
Table 19. 10 Respiratory Technologies.

# Expert Opinion
1. Positive Expiratory Pressure Availability: Marketed and available
Devices (PAP) with mask/ Function: Therapeutic.
mouthpiece Existing Alternative Options:
1) Autogenic drainage techniques.
2) Active cycles of breathing techniques.
Clinical Effectiveness: Provide constant
backpressure to airways during expiration to assist 1
/ improve secretion clearance by building up gas
behind mucus via collateral ventilation. Shown to
be effective in secretion clearance.
Health-Cost Implications: Low cost.
Safety Issues: -
2. Smartinhaler. Availability: Experimental. Not available
Clinical Effectiveness: A digital asthma
management device that incorporates a
microcomputer for automated collection of data on
medication usage, lung function and dose reminder
alarm. The data are uploaded online by the patient, 2
and is accessible to their clinician.
Life-Saving Outcomes: Reduces morbidity,
improves quality of life of patient and potential
decrease in use of emergency care.
Health-Cost Implications: Increased cost compared
to alternative treatment option. The increased cost
in capital investment may be offset by the potential
reduction in emergency care due to improved
patient management.
Safety Issues: Diarrhoea.
Prioritization: Urgent introduction needed
3. Serum Procalcitonin (PCT) test kit. Availability: Marketed.
Function: Diagnostic and assistive.
Existing Alternative Options: Blood cultures (lower
sensitivity and specificity especially in nosocomial
infection).
Clinical Effectiveness: Effective in diagnosing and
identifying nosocomial pneumonia accurately. It is 3
useful as a marker of severe sepsis.
Life-Saving Outcomes: Patients have good
outcome. It is critical in the intensive care setting.
Health-Cost Implications: It is very cost-
effective as patients with SIRS and sepsis can be
differentiated. It avoids unnecessary treatment.
Safety Issues: -
92
4. Pneumococcal Antigen test Availability: Marketed.
Function: Diagnostic.
Existing Alternative Options: Culture and
sensitivity tests. Organism identification is difficult
to obtain due to poor yield via sputum or blood. In
addition, they are lengthy and less reliable.
Clinical Effectiveness: Provides quick results
to identify definite organism (Streptococcus
Pneumonia)
Life-Saving Outcomes: Patients have better 4
outcome as appropriate antibiotic choice will be
given to patients.
Health-Cost Implications: This 15- minute urine
dipstick test is able to diagnose Pneumococcal
Pneumonia and cuts down unnecessary invasive
investigations.
Safety Issues:
5. Anti-viral Resistance Study for Availability: Marketed.

Influenza. Function: Preventive and Therapeutic.
Existing Alternative Options: None.
Clinical Effectiveness:
Life-Saving Outcomes: 5
Health-Cost Implications: Assist MOH in
stockpiling of antiviral drug against influenza as
part of National Influenza Pandemic Preparedness
Plan
Safety Issues: Not applicable.
6. Hand held (portable) “Exhaled Availability: Marketed. Not in use

nitric oxide measurement” Function: Preventive and diagnostic.
devices - more user friendly. Existing Alternative Options: Exhaled nitric oxide
measurement device.
Clinical Effectiveness: For early management
intervention and follow up of asthmatic patients
Life-Saving Outcomes: 6
Health-Cost Implications: It is very cost effective
and should be made available in all centre of
excellence for respiratory - for both, patient
management and research purposes.
Safety Issues: -
Prioritization: Required within the next 2 years.
7. Automated lung sound analysis Availability: Educational

Function: Diagnostic.
Existing Alternative Options: Radiological 7
examination
Safety Issue : -
Prioritization: Required within the next 5 years
93
8. Obstructive Sleep Apnea (OSA) Availability: Marketed/ experimental and not
detector with alertness index to available
monitor SpO2 level. Function: Preventive and Diagnostic.
Existing Alternative Options: Overnight
Polysomnography in Sleep Lab/ Home 8
(ambulatory) PSG and CPAP machine.
Clinical Effectiveness:
Life-Saving Outcomes:
Safety Issues: Prototype may not be user friendly
and experimental.
Prioritization: Introduction required within next 5 years.
9. SLE 5000 ventilator Availability: Marketed.

Existing Alternative Options: Bear cup ventilator.
Clinical Effectiveness: Improves patient outcome. 9
Life-Saving Outcomes: Improve the quality of life.
Health-Cost Implications: Reduce hospital stay
Safety Issues:
Prioritization Required within the next 5 years.
94
Table 19.11 Urology Technologies.

# Expert Opinion
1. Hexaminolevulinate fluorescence Availability: Marketed

blue-light cystoscopy Function: Diagnostic
Existing Alternative Options: Cystoscopy and
urine cytology.
Clinical Effectiveness: Improves detection of
precursor lesions, dysplasia, and CIS
1
Life-Saving Outcomes: earlier detection with
earlier treatment may translate to better outcomes
Safety Issues: -
2. Brachytherapy Availability: Marketed

Function: Therapeutic
Existing Alternative Option: Surgery or
Radiotherapy
Clinical Effectiveness: Proven for low grade low
stage tumours.
Life-Saving Outcomes: Reduces morbidity and
2
mortality of patients.
Health-Cost Implications: Cost of radioactive
seeds
Safety Issues: Precaution needed to handle
radioactive material.
Prioritization: High.
Table 19.12 Dermatology Technologies.
Gap in medical technology Rank of

# Expert opinion
1. Excimer Laser Availability: Marketed.
for Treatment of Psoriasis and Function: Therapeutic.
Vitiligo Existing Alternative Option: Regional
phototherapy unit.
Clinical Effectiveness: Localised resistant
psoriasis and vitiligo. 1
Life-Saving outcome: Nil of note.
Health-Cost Implication: Costly.
Safety Issue: Safe.
Prioritization: Within 5 years.
2. Compliment of Laser System Availability: Marketed

for Cosmetic Dermatology Function: Therapeutic
Existing Alternative Option: Laser’s with
varied dermatological specific function.
Clinical Effectiveness: Pigmentary, vascular
and ablative tumour/scar related skin problem 2
Life-Saving outcome: Nil of note
Health-Cost Implication: Costly
Safety issue: safe
Prioritization: Within 5 years
95
3. Photodynamic therapy (PDT). Availability: Marketed.
Existing Alternative Option: Nil.
Clinical Effectiveness: Useful for solar
keratosis, Bowen’s disease and Squamous
Cell Carcinoma. 3
Life-Saving outcome: Nil of note.
Health-Cost Implication: Costly.
Safety Issue: safe.
Prioritization: Within 5 years.
4. Extracorporeal Photophoresis Availability: Marketed.
for Sezary Syndrome and Function: Therapeutic.
Mycosis Fungoides. Existing Alternative Option: Electron beam or
chemotherapy.
Clinical Effectiveness: Sezary syndrome or
Mycosis Fungoides requiring electron beam
or chemotherapy. 4
Life-Saving outcome: Prolong survival
Health-Cost Implication: Costly
Safety Issue: Potential procedure related
complications
Prioritization: Within 5 years
96
Table 19.13 Otorhinolaryngology and Audiology Technologies.

# Expert Opinion
1. Tinnitus retraining therapy Availability: Marketed.
devices. Function: Therapeutic.
Existing Alternative Options: Ear level devices
(tinnitus maskers, hearing aids).
Life-Saving Outcomes: Nil 1
Health-Cost Implication: -
Safety Issues: -
2. Middle ear implant. Availability: Marketed.

Existing Alternative Options: Conventional
hearing aid.
Clinical Effectiveness: Improves quality of
life.
Life-Saving Outcomes: Nil.
Health-Cost Implications: Reduced cost of 2
maintenance and disposable battery compared
to conventional hearing aid.
Safety Issues: Must be conducted by
credentialed surgeon.
Prioritization: Required in the next 2/3 years
3. Auditory brainstem implant. Availability: Marketed.

Function: Advance Assistive.
Existing Alternative Options: Nil
Clinical Effectiveness: For selected/suitable
patients.
Life-Saving Outcomes: Nil of note. 3
Health-Cost Implications: Very costly.
Safety Issues: Possible migration
97
Table 19.14 Ophthalmology & Optometry Technologies

# Expert Opinion
1. Nd:YAG laser for Selective Availability: Marketed
Laser Trabeculoplasty. Function: Therapeutic
Existing Alternative Options: Argon Laser
trabeculoplasty.
Clinical Effectiveness: The technique can
successfully lower intraocular pressure in
about 80% of cases and treatment is painless
or nearly painless for most patients. 1
Health-Cost Implications: Can be performed
on an outpatient basis.
Safety Issues: It causes no burning or scarring
of the trabecular meshwork and is repeatable
with minimal risk.
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Malaysian Statistics On Medical Devices 2007

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Malaysian Statistics On Medical Devices 2007

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Malaysian Statistics On

Tel. : (603) 4043 9300

Y. BHG. DATUK IR. M.S. PILLAY

National Medical Device Survey,

• Participating private hospitals for cooperating with the survey

Sponsors and Organization of the NMDS

Premise of the NMDS

CO-CHAIRPERSON: Mr. Zamane Abdul Rahman,

CO-CHAIRPERSON: Mr. Chin Goo Chai.

Medical Device Bureau MOH Mr. Ahmad Sharif Hambali

Engineering Services Division MOH Pn. T. Sasikala Devi

Procurement Division MOH Pn. Hamidah Bidin

Malaysian Medical Association -

Malaysian Dental Association (MDA) -

Malaysian Private Dental Practitioner’s -

Association of Private Hospitals Malaysia Dr. Hooshmana M Palany

Malaysian Medical Device Association Mr. Yong Tuan Heng

Association of Malaysian Medical Mr. Peter Ring

2. Nuclear Medicine Facilities And Devices

3. Oncology Facilities And Devices

4. Anaesthesiology and Intensive Care Facilities And Devices

5. General Surgery Facilities And Devices

6. Orthopedic & Traumatology Facilities And Devices

8. Obstetrics & Gynecology Facilities And Devices

9. Neurology Facilities And Devices

10 Psychiatry Facilities And Devices

12. Respiratory Medicine Facilities And Devices

13. Gastroenterology Facilities And Devices

14. Nephrology Facility And Devices

16. Dermatology Facilities And Devices

17. Otorhinolaryngology And Audiology Facilities And Devices

18. Ophthalmology And Optometry Facilities And Devices

Clinical Research Manager Dr. Ariza Zakaria.

Clinical Research Coordinator -

Economist Mr. Adrian Goh

Statistician Dr. Hoo Ling Ping

IT Manager Ms. Celine Tsai Pao Chien

Database Developer/ Administrator Ms Tang Roh Yu

Network Administrator Mr. Kevin Ng Hong Heng

Desktop Publisher & Webmaster Ms. Azizah Alimat

Survey Population, Sampling And Response (Coverage) Rate

# Site Classification Survey population MaximumResponse Minimum Response

1. Public sector 137 71 43

The variables required were divided into 3 sections:

Each entry is recorded for quality assurance purposes.

5. Data is then exported to Datamed Bio-Statistics for further data processing.

The total is estimated by T = Σ Wi Ti

Wi is the sampling weight of the ith facility

2. Adjustment for non-response.

With contributions from :

Table 2: Available Medical Devices in Imaging and Diagnostic Medicine

No in million No % pmp No % pmp No % pmp No % pmp

Population Ultrasound with Doppler

Scope of Nuclear Medicine

a) Clinical Nuclear Medicine

b) Section of Nuclear Pharmacy

c) Nuclear Medicine Physics Section

Table 1: Available Therapeutic and Diagnostic Facilities in Nuclear Medicine

Hospital with Radionuclide

No in million No % pmp No % pmp

With contributions from:

Improvements in technology have resulted in improved treatment delivery by improved radiation

Brachytherapy is an important modality in radiotherapy especially in gynaecological malignancies.