EVIDENCE-BASED PUBLIC HEALTH POLICY FOR ZIKA INFECTION MANAGEMENT IN MALAYSIA

Abstract

Zika has re-emerged as a pandemic between year 2007-2018. Research progress on Zika is much slower in the Asia region compared to America counterpart and there is much under-reporting and inadequate preparedness for any future Zika outbreak. A review of current disease management policies/guidelines can provide evidence-based information to improve preparedness and response to Zika epidemic in Malaysia. A systematic literature search using a Population, Intervention, Comparison, and Outcome (PICO) framework and a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) workflow across four scientific databases and snowball sampling review of guidelines from international health authorities yielded 189 relevant articles from 2013-2018, from which 37 articles screened by titles fulfilling inclusion and exclusion criteria were subjected to abstract scrutiny, resulting in eight articles for full text analysis using a Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment system of Cochrane’s checklist. Meticulous, systematic quality ratings conducted by independent reviewers yielded four important Zika intervention domains. Narrative and qualitative assessments on their effectiveness in intervention and relevant public health effects were evaluated. Two domains, namely, vaccine development and blood product management, were rated as having a high quality of evidence, and therefore considered critically important to the management of Zika and were strongly recommended for implementation by the Ministry of Health, Malaysia. The other two domains, vector control and family planning, were deemed important and were recommended, if feasible, for inclusion into a Zika management program. In conclusion, evaluation of the scientific quality in disease management produced four domains, inclusion of which into public health policies should strengthen the preparedness and management of future Zika epidemic in Malaysia.