The objective of this study was to elucidate the association of various risk factors with dengue cases reported in Lundu district, Sarawak, by analyzing the interaction between environmental, entomological, socio-demographic factors. Besides conventional entomological, serological and house surveys, this study also used GIS technology to generate geographic and environmental data on Aedes albopictus and dengue transmission. Seven villages were chosen based on the high number of dengue cases reported. A total of 551 households were surveyed. An overall description of the socio-demographic background and basic facilities was presented together with entomological and geographical profiles. For serological and ovitrap studies, systematic random sampling was used. Serological tests indicated that 23.7% of the 215 samples had a history of dengue, either recent or previous infections. Two samples (0.9%) were confirmed by IgM ELISA and 49 samples (22.8%) had IgG responses. A total of 32,838 Aedes albopictus eggs were collected in 56 days of trapping. Cluster sampling was also done to determine whether any of the risk factors (entomological or geographical) were influenced by geographical location. These clusters were defined as border villages with East Kalimantan and roadside villages along Lundu/Biawas trunk road. The data collected were analyzed using SPSS version 10.01. Descriptive analysis using frequency, means, and median were used. To determine the association between variables and dengue cases reported, and to describe the differences between the two clusters of villages, two-sample t-test, and Pearson's Chi-Square were used. Accurate maps were produced with overlay and density function, which facilitates the map visualization and report generating phases. This study also highlights the use of differential Global Positioning System in mapping sites of 1m accuracy. Analysis of the data revealed there are significant differences in clusters of villages attributable to container density, house density, distance of the house from the main road, and number of Ae. albopictus eggs from ovitraps set indoor, outdoor and in dumping sites (Person's Chi-Square = 6.111, df = 1, p < 0.01). Further analysis using t-test showed that house density, container density, indoor mosquitoes egg count, outdoor mosquitoes egg count, and dumping sites mosquitoes egg count were higher at the roadside villages compared to border villages. A number of potential risk factors including those generated from GIS were investigated. None of the factors investigated in this study were associated with the dengue cases reported.
Underlying causes of most nutrition related problems are diverse, including biological, social, cultural, and economic factors. Qualitative approaches complement quantitative methods in identifying the underlying meanings and patterns of relationships involved in managing malnutrition. This study examined perceptions regarding malnutrition among health workers from 7 clinics (community and health clinics) in Tumpat, Kelantan. A total of 18 nurses and 2 doctors, who were involved in monitoring child health and nutrition, were included in the study. These health workers were interviewed using a semi-structured questionnaire adapted from Sastry's framework on malnutrition (Sastry, 1996). The questionnaire included biological, behavioral and environmental factors that influence child health and nutrition. All the health workers perceived that mothers/caregivers play the main role in improving the health of malnourished children. The quality of childcare was rated as moderately satisfactory by the health workers. Most of the affected families who were given the Food Baskets did not fully use all the items for the malnourished child. Child feeding practice was based on the needs of the whole family rather than according to the target child's needs. Most of the mothers preferred processed cereals than rice porridge because the former is easier to prepare for the child. Although they were from a low socioeconomic background, most of the mothers were not earning additional income for the family. The qualitative methodology provided information that can be used as a basis for the designing of quantitative questionnaires to assess malnutrition among children. The induction characteristic of qualitative methods was used to gain an understanding of the underlying reasons or phenomena such as behaviours that are directly observable.
Study site: Klinik kesihatan, Tumpat, Kelantan, Malaysia
The objective of this study was to explore the perception of, feelings and attitudes toward overweight or obesity, and the perceived barriers to weight loss among native adults from lower socio-economic background. A total of six gender- and ethnic-specific focus groups consisted of 38 overweight and obese purposefully and criterion selected adults (21 women and 17 men), participated in this study. An unstructured discussion guide based on the study objectives were used for the focus groups. The results showed that some participants perceived themselves as ugly, felt ashamed of their body size and were frustrated because they did not desire to be overweight. Due to their excess weight, most also expressed they were less effective in their work performances. Although some participants had negative attitudes toward themselves because of excess weight, this appeared to link to self-stigmatization rather than anti-obesity discrimination. The participants remained in the Pre-contemplation stage of losing weight probably because of perceived barriers such as difficulty to resist eating, lack of know how and previous failed attempts to lose weight. Importantly, this study provided some evidence that individuals in the Pre-contemplation stage are unable to take action to lose weight, even if effective strategies are suggested.
Many studies had shown that poor growth in children is associated with malnutrition. The underlying factors are diverse, multisectoral and interrelated, ranging from biological to social, cultural and economically related. Because the highest levels of under-nutrition worldwide are found in South Asia, it is essential that policymakers in the region understand the underlying determinants, in order to design effective public health intervention programs. This is especially so if public resources are limited. The purpose of this cross-sectional study was to examine causal relationships among the biological, behavioural and environmental factors related to malnutrition in children aged 5 years and under.
Dental caries is a major health problem affecting an estimated 90% of school children worldwide. This cross-sectional study aimed to evaluate oral health knowledge, attitude, and practices among secondary school students in Kuching, Sarawak. Data was collected using a pretested questionnaire on 209 randomly selected students from four schools. Results showed no significant differences between the gender and age groups in terms of knowledge level, but significant differences were observed between the schools. The students had positive attitude towards the dental services, but their dental visits were still low due to fear of dental needle and handpieces. Toothbrush and toothpaste were still the most commonly used oral hygiene aids. As compared to parents and friends, dentist was perceived to have more influence on oral hygiene practices among the students. Girls consumed more sweets, snacks and soft drinks than boys. However, girls spent longer time to brush their teeth and brush more frequently. Oral health education should be a life-long practice and incorporated into the school environment with the support of teachers and parents.
BACKGROUND: Overweight and obesity rates among adolescents have increased substantially over the years. This study aimed to determine the body mass index (BMI) of students and parents and the relationship among media use, BMI, socio-demographic profiles, and snacking behaviour during television watching of secondary school students in Kuching South City.
METHODS: In accordance with the two-stage sampling method, a total of 316 adolescents aged 13-17 years from 7 secondary schools participated. Data were collected using questionnaire and anthropometric measurement. Independent t test, one-way ANOVA, Mann-Whitney U test, and chi-square test were performed.
RESULTS: The mean BMI was 20.56 kg/m(2) (SD 4.33) for boys and 20.15 kg/m(2) (SD 3.91) for girls. No significant difference in terms of z score for BMI-for-age or socio-demographic factors was found. The mean duration of time devoted to media use was 4.69 hours (SD 2.93) on weekdays and 5.69 hours (SD 2.87) on weekends. Boys were found to spend more hours on media use than did the girls (t = 4.293, P < 0.01). Respondents were reported to consume more cereal compared with soft drinks and junk foods. Respondents whose fathers worked in the private sector devoted the fewest hours to media use, whereas those with self-employed fathers devoted the most time to media use. Respondents with mothers who were employed spent more time on media use than did respondents whose mothers were housewives (F = 4.067, P < 0.01). No significant difference was found between BMI and media time or snacking habits.
CONCLUSION: This finding indicated that media time has no effect on body weight, because respondents were found to have normal weight and to consume less unhealthy food.
KEYWORDS: adolescent; behaviour; body mass index; public health; urban population
Introduction: This study reports on the prevalence of diabetic retinopathy (DR) and risk factors among diabetic patients, who underwent fundus photography screening in a primary care setting of Borneo Islands, East Malaysia. We aimed to explore the preliminary data to help in the planning of more effective preventive strategies of DR at the primary health care setting.
Materials and Methods: A cross-sectional study on 738 known diabetic patients aged 19-82 years was conducted in 2004. Eye examination consists of visual acuity testing followed by fundus photography for DR assessment. The fundus pictures were reviewed by a family physician and an ophthalmologist. Fundus photographs were graded as having no DR, NPDR, PDR and maculopathy. The data of other parameters was retrieved from patient’s record. Bi-variate and multivariate analysis was used to elucidate the factors associated with DR.
Results: Any DR was detected in 23.7% (95% CI=21 to 27%) of the patients and 3.2% had proliferative DR. The risk factors associated with any DR was duration of DM (OR =2.5, CI=1.6 to 3.9 for duration of five to 10 years when compared to <5 years) and lower BMI (OR=1.8, CI=1.1 to 3.0). Moderate visual loss was associated with DR (OR=2.1, CI=1.2 to 3.7).
Conclusions: This study confirms associations of DR with diabetic duration, body mass index and visual loss. Our data provide preliminary findings to help to improve the screening and preventive strategies of DR at the primary health care setting.
Keywords: Diabetic retinopathy, epidemiology, screening, primary health care, Malaysia
Study site: Klinik Kesihatan Jalan Masjid, Kuching, Sarawak, Malaysia
The aim of the study was to identify the factors associated with undernutrition indicators in children 5 years and younger in a rural community in Malaysia. A total of 295 children and their carers were selected from community clinics based on a multistage sampling method. Pretested questionnaire, anthropometric measurement, and dietary assessment were used for data collection. There was 69% stunting, 63.4% underweight, 40% wasting, and 26.8% with mid-upper-arm circumference (MUAC) for age below a z score of -2 among children. In all, 10 factors were found to be associated with different indicators of undernutrition. Age was the only factor that had association with all the undernutrition indicators. Total household income and total expenditure showed significant association with underweight. Birth weight was reported to have significant association with underweight, stunting, and low MUAC-for-age. The findings suggest that the factors of undernutrition were different for different indicators of undernutrition and thus give a more comprehensive picture on factors contributing to acute and chronic malnutrition.
Background: Coronary heart disease (CHD) was the second leading cause of death in Malaysia in 2006. CHD has known risk factors including hypertension, diabetes mellitus, and obesity.
Methods: This cross-sectional study examined the prevalence of cardiovascular risk factors among 260 participants aged 20 to 65 years in a rural community in Sarawak.
Results: The prevalences of overweight and obesity in this study were 39.6% and 11.9%, respectively. Approximately 13% of participants had hypertension, and 1.5% had a random blood sugar greater than 11.1 mmol/L. Chi-square tests showed significant associations between obesity and gender (P = 0.007), low high-density lipoprotein cholesterol and race (P = 0.05), high total cholesterol and age (P = 0.007), age and hypertension (P = 0.011), smoking and gender (P < 0.001), and smoking and income (P = 0.050). Age-adjusted logistic regression showed that women were 0.246 times more likely to be obese, that older participants (> 45 years) were 0.395 times more likely to have high cholesterol and that those with a higher monthly household income (> RM830) were 2.471 times more likely to smoke.
Conclusion: These findings indicate that we should be concerned about the high rates of overweight in this rural community to prevent obesity.
Study site: 8 villages, Serian district, Sarawak, Malaysia
Keywords: adult; cardiovascular diseases; epidemiology; obesity; prevalence; risk factors.
This study aimed to determine the perception and level of safety satisfaction of staff nurses with regards to Occupational Safety and Health (OSH) management practice in the Sabah Health Department, and to associate the OSH management dimensions, to Safety Satisfaction and Safety Feedback.
This study aimed to determine the perceptions and expectations of bone cancer patients with respect to their doctors and the breaking of bad news as well as the environment in which the news was delivered.
Diabetes is a chronic disease that affects a patient's quality of life. This cross-sectional study aimed to determine the socio-demographic and disease profile factors associated with poor quality of life among patients with diabetes. The study was conducted at a primary health care clinic in Kuching between August to November 2010. Short Form - 36 (SF - 36) questionnaire was used to assess the quality of life of diabetic patients aged ≥ 18. A total of 142 respondents participated in the survey. After adjusting for age, those with no education scored lower at vitality (p=0.043) and emotional health (p=0.033) compared with those who have tertiary education. Those working in the private sector scored better for physical functioning (p=0.042) compared with pensioners and the unemployed. Patients with uncontrolled diabetes scored lower in the role-emotional domain (p=0.003). Participants who were on <3 (p=0.014) and ≥3 (p=0.024) oral medications had better score for role-physical than those on insulin. Those on insulin had worse score for bodily pain than those on oral medication only (vs <3 oral drugs, p=0.026; vs ≥3 oral drugs, p=0.001). Various socio-demographic factors, uncontrolled diabetes and insulin usage were found to have negative impact on a diabetic patient's quality of life. Programmes addressing the physical and emotional needs of diabetic patients at the primary health care setting are essential to help improve their quality of life.
Although the association between non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome has been previously firmly established, the prevalence of NAFLD and its risk factors in rural communities remains incompletely defined. This study aimed to determine the prevalence and factors associated with ultrasound-diagnosed NAFLD amongst a rural community in Sarawak. An indigenous village was randomly selected where all adults aged 21 years and above underwent an abdominal ultrasound, biochemical tests and an anthropometric assessment. Respondents with a score > or =8 on an alcohol-use disorders-identification test (AUDIT) indicating harmful or hazardous drinking were excluded. Seventy-seven respondents (46.8% male, mean age 48.4 SD 16.64), met inclusion criteria. The prevalence of ultrasound diagnosed NAFLD was 44.2% (n=34), among them 52.9% had moderate NAFLD. There were no significant age or gender differences between respondents with and without NAFLD, although those with NAFLD were older. Respondents with NAFLD had a significantly higher BMI t,han those without NAFLD (p<0.001). Both male and female respondents with NAFLD had a significantly higher waist circumference than those without NAFLD (p<0.001). Prevalence of diabetes, hypertension, hyperglycemia and hypertriglyceridemia were significantly higher among those with NAFLD. However, there were no significant differences in terms of percentage of unhealthy body fat and muscle, and serum HDL levels. Risk factors independently associated with NAFLD included male gender (odd ratio 0.06; 95% CI 0.008-0.523) and waist circumference (odd ratio 1.2; 95% CI 1.036-1.421). There was a high prevalence of NAFLD and the presence of more severe stages of disease in this indigenous population. Life-style related diseases, such as fatty liver disease, can occur in rural as well as urban populations.
Objective: To determine the perception of medical students towards mentor-mentee system in Faculty of Medicine and Health Sciences of UNIMAS. Method: It was a cross-sectional study involving all 104 second year and 80 fifth year medical students. A self-administered questionnaire consisting of socio-demographic details, general perceptions on mentor-mentee system, academic support, personal development, and emotional and psychological support was distributed. The data was analysed using the SPSS version 19. Result: Majority of the subjects had a positive outlook towards the mentor-mentee system with a range of 45.6% to 57%. Three of the top rated perceptions were ‘mentor analyses mentee’s examination results and provides constructive feedback’, ‘mentor advises how to improve academic performance’, and ‘mentor gives encouragement and support for the challenges faced’ (66.8%, 68.0% and 62.9% respectively). Pre-cinical medical students had significantly better perception on mentor-mentee system than clinical students (p≤0.002) while those with non-clinician mentors significantly had better perceptions than those with clinician mentors (p≤0.003) on the system. No significant difference was found between the perceptions of males and females for all components (p=0.234 to 0.722). Conclusion: The mentor-mentee system was found to be successful as more than half of the respondents had posititve perception on the system and its aspects. However, pre-clinical students benefited more compared to clinical students, which reflects the need to look at the support given to clinical students. It was recommended that future studies should incorporate the perceptions of mentors.
Introduction: Peer mentoring is one of the mentoring essential components in any higher institution of learning. In the Medical Faculty of Universiti Malaysia Sarawak (UNIMAS), this mentoring system has existed long but has not undergone any formal evaluation. Objective: The main objective of this study is to determine the perception of peer mentoring among medical students of Faculty of Medicine and Health Sciences (FMHS), UNIMAS. Method: It was a cross-sectional study using self-administered questionnaire. All medical undergraduate students of FMHS were recruited. Data was analyzed using SPSS version 22. Result: A total of 234 respondents participated in this study. Peer mentoring system was preferred against other mentoring system. Majority of the respondents reported that academic gain was the main benefits they gained from peer mentoring system. Negative attitude of the mentee and poor time management for the meeting were the top two worst experience encountered by both mentors and mentees respectively. More than half of the mentor and mentee perceived that peer mentoring system was beneficial to them compared to other systems, with reason that the interaction between student themselves were more easier and comfortable. Nevertheless, there should be more interaction between the mentors and mentees. Conclusion: The findings indicated there is a positive contribution of peer mentoring towards the mentoring system of the faculty. There is a need to relook at the current mentoring system and consider peer mentoring to improve the student support.
Introduction: Mentoring medical students is one of the essential responsibilities or missions of a medical school faculty. Objective: This study aimed to determine the perceptions of mentorship and mentoring practices among mentors using a convergent parallel method. Method: Quantitative data was collected by using an adopted validated self- administered questionnaire and analyzed using SPSS version 20. Qualitative data was done using one-to-one interview based on semi structured interview guide and analyzed using thematic analysis. Result: A total of 61 respondents participated in the quantitative survey. Approximately 75% of the respondents had 5 to 10 mentees, with majority rated themselves as satisfactory mentor. More than 60% of them met their mentees at least once every six months. Most respondents were friendly (86.9%) and frank to their mentees (68.9%) and were interested in their mentees’ professional development (95.1%). Phone calling (93.4%) and E-mail (95.1%) were preferred as modes of contact. Mentees were allowed to call their mentors anytime of the day (74.1%). Respondents preferred to counsel their mentees (80.3%) and would refer them for professional help whenever necessary (70.5%). For qualitative data, a total of 5 participants participated with themes emerged: concepts of mentoring, factors contributing to ineffective mentoring and ways to improve mentoring practices. Conclusion: The respondents had positive perceptions regarding their mentorship and practices. A more structured approach with clear mentoring guideline and proper training should be in place.
The objective of this study was to describe the differences in physical activity with socio-demographic factors and its association with cardiovascular risk factors. It was a cross-sectional study among selected urban and rural Malays communities in Kuching and Samarahan. Physical activity data was obtained using International Physical Activity Questionnaire (IPAQ) short version. Assessment of cardiovascular risk factors was based on blood pressure, fasting cholesterol and glucose and body mass index (BMI). Data was analysed using SPSS version 20. A total of 223 participated with higher response from rural areas (60.1%) and females (61.9%). More than half of the respondents (58.5%) were overweight and obese, with a mean BMI of 25.9 kg/m2 (SD=4.9). About 25% of the respondents were found to have blood pressure in the at-risk range. The prevalence of at-risk blood glucose was 52.3% with a mean value of 7.3mmol/L (SD=3.46). The prevalence of at-risk cholesterol were lower with 31.8%, mean value of 3.5 mmol/L (SD=2.94). There were more active respondents living in rural area (p=0.02). Logistics regression analysis showed that urban area (OR=1.988 95% CI 1.082 to 3.652), systolic blood pressure (OR1.020 95% CI 1.003 to 1.037) and blood cholesterol (OR0.884 95% CI 0.785 to 0.996) were associated with physical activity level. Change of physical activity due to urbanization can increase the risk of obesity and other chronic diseases. Efforts to include physical activity in intervention programme should be more intensified, with more provision of suitable built environment.
Background. Recognizing the needs of cancer survivors is one of the important aspects in healthcare delivery. This study aimed to determine the prevalence of unmet supportive care needs and its associated factors among the breast cancer survivors of community-based support group in Kuching, Sarawak. Materials and Methods. This was a cross-sectional study using Supportive Care Needs Survey (SCNS-SF34). All the members of community-based breast cancer support groups in Kuching were invited. A total of 101 respondents were face-to-face interviewed after the consent was obtained. Data was entered and analyzed using SPSS version 20. Results. The respondents endorsed health system and information domain with the highest mean score (2.48; 95% CI: 2.32-2.64). Top 10 items with "moderate to high" level unmet needs had a prevalence of 14.9% to 34.7% of respondents indicating need. Significantly higher level of unmet needs was associated with survivors who were younger (less than 60 years old), had higher education attainment, were unemployed, had survival duration of up to 5 years, and were undergoing active treatment. Conclusion. Systematic delivery of health information which is targeted, culturally sensitive, and linguistically appropriate for addressing younger age, education level, employment status, length of survivorship, and treatment stage should be considered not only at hospital-based setting but also at the community-based support groups.