Displaying publications 1 - 20 of 44 in total

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  1. Bhattacharya S, Tripathi S, Marzo RR, Gokdemir O, Borocco M
    J Family Med Prim Care, 2023 Feb;12(2):397-399.
    PMID: 37091001 DOI: 10.4103/jfmpc.jfmpc_1218_22
    "Health for All" will never be attained if sociocultural bias and pervasive hypocrisy are not eliminated. The patient mentioned in this case study had difficulty gaining access to health care for more than two decades. The seizure history was modified due to social pressure. The primary healthcare workers' ability to provide timely access to healthcare regardless of caste, religion, or gender, even in the most remote regions of the country, is of paramount importance. The patient was diagnosed with hypoparathyroidism and treated with calcium and vitamin D in high oral doses. The case also illustrates the significance of medical examination in preventing future difficulties in patients with presenile cataract.
  2. Marzo RR, Singh A, Mukti RF
    PMID: 33462563 DOI: 10.1016/j.cegh.2020.100693
    INTRODUCTION: Previous studies conducted on the psychological impact of infectious outbreaks have found heavy psychological burdens among general population with more severe affect in the current pandemic. The main aim of this study is to examine the level of psychological distress during COVID-19 in Bangladesh and explore factors associated with higher psychological distress.

    METHODS: An internet-based, cross-sectional survey was conducted from March to April 2020 in Bangladesh among adults 18 years old and above using structured online questionnaires distributed through emails and other social media throughout Bangladesh with an overall response rate of 34%. Modified version of the Covid19 peritraumatic distress index (CPDI) was used to measure distress. Univariate and Bivariate analysis was used to estimate prevalence of CPDI symptoms and test for the associations between CPDI and the exposure variables. Logistic regression analyses were used to estimate the odds ratios of our outcome variable by exposure variables.

    RESULTS: Overall, 44.3% of respondents were suffering from mild to moderate distress and 9.5% were suffering from severe distress. Female respondents were 2.435 times more likely to suffer from CPDI mild to severe distress than males. As compared to Dhaka and Mymensing region of Bangladesh, odds of distress was 1.945 times more in Chittagong/Sylhet region (p-value = 0.035).

    CONCLUSION: Large proportion of adult population in Bangladesh are experiencing psychological distress, with level of distress varies by different symptoms and predictors. This study suggest the need to develop comprehensive crisis prevention system including epidemiological monitoring, screening, and referral with targeted intervention to reduce psychological distress.

  3. Marzo RR, Chen HWJ, Abid K, Chauhan S, Kaggwa MM, Essar MY, et al.
    Front Public Health, 2022;10:998272.
    PMID: 36187682 DOI: 10.3389/fpubh.2022.998272
    BACKGROUND: Misinformation has had a negative impact upon the global COVID-19 vaccination program. High-income and middle-income earners typically have better access to technology and health facilities than those in lower-income groups. This creates a rich-poor divide in Digital Health Literacy (DHL), where low-income earners have low DHL resulting in higher COVID-19 vaccine hesitancy. Therefore, this cross-sectional study was undertaken to assess the impact of health information seeking behavior on digital health literacy related to COVID-19 among low-income earners in Selangor, Malaysia.

    METHODS: A quantitative cross-sectional study was conducted conveniently among 381 individuals from the low-income group in Selangor, Malaysia. The remote data collection (RDC) method was used to gather data. Validated interviewer-rated questionnaires were used to collect data via phone call. Respondents included in the study were 18 years and older. A normality of numerical variables were assessed using Shapiro-Wilk test. Univariate analysis of all variables was performed, and results were presented as means, mean ranks, frequencies, and percentages. Mann-Whitney U test or Kruskal Wallis H test was applied for the comparison of DHL and health information seeking behavior with characteristics of the participants. Multivariate linear regression models were applied using DHL as dependent variable and health information seeking behavior as independent factors, adjusting for age, gender, marital status, educational status, employment status, and household income.

    RESULTS: The mean age of the study participants was 38.16 ± 14.40 years ranging from 18 to 84 years. The vast majority (94.6%) of participants stated that information seeking regarding COVID-19 was easy or very easy. Around 7 percent of the respondents cited reading information about COVID-19 on the internet as very difficult. The higher mean rank of DHL search, content, reliability, relevance, and privacy was found among participants who were widowed, had primary education, or unemployed. An inverse relationship was found between overall DHL and confidence in the accuracy of the information on the internet regarding COVID-19 (β = -2.01, 95% CI = -2.22 to -1.79).

    CONCLUSION: It is important to provide support to lower-income demographics to assist access to high-quality health information, including less educated, unemployed, and widowed populations. This can improve overall DHL.

  4. Bhattacharya S, Pradhan KB, Bashar MA, Tripathi S, Semwal J, Marzo RR, et al.
    J Family Med Prim Care, 2019 Nov;8(11):3461-3464.
    PMID: 31803636 DOI: 10.4103/jfmpc.jfmpc_155_19
    In this paper, we have described the health care problem (maldistribution of doctors) in India. Later, we have introduced the concept of artificial intelligence and we have described this technology with various examples, how it is rapidly changing the health care scenario across the world. We have also described the various advantages of artificial intelligence technology. At the end of the paper, we have raised some serious concerns regarding complete replacement of human based health care technology with artificial intelligence technology. Lastly, we concluded that we have to use artificial intelligent technology to prevent human sufferings/health care problems with proper caution.
  5. Patil M, Hedaoo RP, Shah RP, Tauseef SM, Marzo RR, Ching SM, et al.
    Inquiry, 2023;60:469580231167010.
    PMID: 37029552 DOI: 10.1177/00469580231167010
    The burden of hypertension has been growing over recent decades. In addition to risk of stroke and cardiovascular disease development, data indicates that hypertension may also pose a hazard to the quality of life (QoL) of individuals. Patient reported outcomes such as QoL are often overlooked, with physicians and healthcare professionals not routinely evaluating or customizing treatments according to QoL. In this study we aimed to assess the QoL of hypertensive men (n = 500) undergoing treatment who visited a charitable hospital in Pune, India. Clinic blood pressure was determined and the Mini Cuestionario de Calidad de Vida en Hipertensión Arterial (MINICHAL) scale was used to assess the health-related (HR)-QoL of patients. More than half of the participants (62%) had uncontrolled hypertension, with a mean systolic blood pressure (BP) of 151 ± 12 mmHg and diastolic blood pressure of 87 ± 6 mmHg as compared to those with controlled blood pressure (mean systolic blood pressure 123 ± 6 mmHg and diastolic blood pressure 84 ± 5 mmHg; P 
  6. Marzo RR, Khaled Y, ElSherif M, Abdullah MSAMB, Zhu Thew H, Chong C, et al.
    Front Public Health, 2022;10:1021497.
    PMID: 36530707 DOI: 10.3389/fpubh.2022.1021497
    BACKGROUND: Healthcare workers have to deal with highly demanding work situations, making healthcare as one of the most challenging professions. Up to now, far too little attention has been paid to burnout, resilience and the quality of life among Malaysian healthcare workers. Therefore, this paper explores the correlation between burnout, resilience and quality of life among Malaysian healthcare workers during the COVID-19 pandemic.

    METHOD: A total of 394 healthcare workers reported their responses on Maslach Burnout Inventory questionnaire, World Health Organization Quality of Life (WHOQOL)-BREF, and Brief Resilience Scale. Respondents were contacted through convenience sampling method and targeted population constituted Malaysian healthcare workers aged 18 years and above.

    RESULTS: For occupational exhaustion, about 50.5% of participants have moderate degree, 40.6% have high degree, and 8.9% have low degree of burnout. Health workers from age 25 to 35 years have lower physical health compared to health workers aged <25 years (coefficient = -0.77, p = 0.021). Similarly, healthcare workers who were working more than 10 h every day were more likely to report poor psychological health (coefficient = -2.49, p = 0.06). Positive correlation between physical and psychological health was observed. Further, a negative correlation was found between occupational exhaustion and the quality of life.

    CONCLUSION: It is important to target physical as well as psychological wellbeing of the healthcare workers. Also, it is important to understand the contribution of long working hours in declining the quality of life of the healthcare workers. Thus, allocating fixed working hours for healthcare workers would bring a much-required change.

  7. Bhattacharya S, Saleem SM, Singh DK, Marzo RR, Singh A
    PMID: 33688550 DOI: 10.4103/jehp.jehp_280_20
    INTRODUCTION: We know that risk communication is equally important as risk identification, which is usually not communicated properly to the patients and resulting in poor outcomes, especially in hypertensive patients.

    OBJECTIVE: Our study objective was to evolve and test a colour coded client segmentation based public health approach to educate the community to deal with problem of hypertension.

    METHODOLOGY: This cross-sectional pilot study was done in March 2020 among purposively approached in a primary health centre to 100 people aged above 18 years, among them 41 gave written consent for the study and their demographic information was noted. They were given colour coded cards as per the current blood pressure level and previous history of hypertension. On each colour coded card, specific advice was written for that category. For all the participants, blood pressure and treatment seeking behaviour was noted. For hypertensive patients, adherence to medication and non-pharmacological measures was noted.

    RESULTS: Mean age of the participants was 46.5 ± 13.06 years. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the participants were 135 ± 16.85 mm Hg and 86 ± 11.42 mm Hg, respectively. Among the participants, 10 (24.39%) had a known history of hypertension. Among them, as per the blood pressure levels measured on the day of the study 50% (5) had their blood pressure levels under control. Interestingly 16 (39%) participants were found hypertensive incidentally.

    DISCUSSION: It is evident from the studies that colour coded approach is used in multiple ways, in multiple settings, for multiple diseases. To our knowledge, little focus has been given for hypertensive disorders in the community level. We merely bother about making their risk profiling, even in the digital age. Sometimes physicians in emergency become puzzled whenever patients collapsed in front of them and we missed the "Golden Hour" for the treatment by searching patients' medical details.

    CONCLUSION AND RECOMMENDATIONS: The above problem can be solved by risk profiling of chronic patients by colour coded OPD/Health cards.

  8. Marzo RR, ElSherif M, Abdullah MSAMB, Thew HZ, Chong C, Soh SY, et al.
    Front Public Health, 2022;10:1021495.
    PMID: 36589987 DOI: 10.3389/fpubh.2022.1021495
    INTRODUCTION: The healthcare setting is a stressful and demanding work environment, and healthcare workers face a continuous expansion of their job roles and responsibilities. Past studies have shown that factors affecting burnout, resilience, and quality of life among healthcare workers merit further research, as there were inconsistent findings, especially with regards to the influence of demographic and work-related factors. Therefore, this study aims to determine whether demographic and work-related factors are associated with burnout, resilience, and quality of life among healthcare workers.

    METHOD: This cross-sectional study was conducted between February 15, 2022 and March 15, 2022, among 394 healthcare workers from Putrajaya and Selangor hospitals, Malaysia. Maslach Burnout Inventory, World Health Organization Quality of Life-BREF 26 inventory, and Brief Resilience Scale were utilized to capture information on burnout, quality of life, and resilience, respectively.

    RESULTS: The mean score of physical health of participants who work more than 10 h (11.38) is lower than participants who work from 8 to 10 h (13.00) and participants who work 7 h daily (13.03), p-value < 0.001. Similarly, the mean score of psychological health of participants who work more than 10 h (12.35) is lower than participants who work from 8 to 10 h (13.72) and participants who work 7 h daily (13.68), p-value = 0.001. Higher income levels were associated with high resilience and quality of life.

    CONCLUSION: It is imperative that healthcare practitioners and policy makers adopt and implement interventions to promote a healthy workplace environment, address ethical concerns, and prevent burnout among healthcare workers during the COVID-19 pandemic. Managing the issue of long working hours could possibly result in improved resilience, burnout, and quality of life among healthcare workers. Despite this study able to tickle out some policy specific areas where interventions are needed, identifying effective solutions and evaluating their efficiency will require larger and interventional studies.

  9. Marzo RR, Vinay V, Bahari R, Chauhan S, Ming DAF, Nelson Fernandez SFA, et al.
    PMID: 34549098 DOI: 10.1016/j.cegh.2021.100868
    INTRODUCTION: The outbreak of coronavirus posits deleterious consequences on global healthcare system while affecting human life in every aspect. Despite several measures undertaken to limit the socio-economic effect of coronavirus, various challenges remain pervasive, and one such challenge is mental health, particularly depression and anxiety. Therefore, this study examines the prevalence and determinants of depression and anxiety in Malaysian population during third wave of COVID-19.

    METHODS: A cross-sectional online survey was carried out via social media platforms and 1544 Malaysians were selected. The level of depression was assessed by Patient Health Questionnaires (PHQ-9) and scored accordingly for categorization. Zung's Self-Rating Anxiety Scale (SAS) was used as a self-assessment survey to quantify the level of anxiety of persons experiencing anxiety-related symptoms. Percentage distribution and logistic regression analysis were used in the data analysis.

    RESULTS: Results showed that one-fourth (25.1%) of the participants had severe depressive symptoms. Almost one-sixth (18.7%) had mild depressive symptoms and one-third (34.1%) had mild to moderate anxiety symptoms. Age, gender, and friends infected with virus were the three important predictors of depression and anxiety. The odds of having depression (OR = 1.44; C·I. = 1.32-1.62) and anxiety (OR = 1.36; C·I. = 1.27-1.47) were significantly higher among females than in males.

    CONCLUSION: A significant proportion of the study participants were facing mild to severe depression and anxiety symptoms which is very alarming as the pandemic is still now increasing across the country. Immediate interventions including community counselling programmes, TV and social media campaigns are urgently needed to reduce the psychological stress among the Malaysian population.

  10. Marzo RR, Khanal P, Shrestha S, Mohan D, Myint PK, Su TT
    Front Public Health, 2023;11:1193789.
    PMID: 37435519 DOI: 10.3389/fpubh.2023.1193789
    INTRODUCTION: Population demography across the globe shows an increasing trend in the aging population due to better healthcare, improved nutrition, advanced health-related technology, and decreased fertility rate. Despite these advancements, there remains a knowledge gap in understanding the association between active aging determinants and quality of life (QoL) among older adults, particularly within diverse cultural contexts, which has not been adequately explored in previous research. Therefore, understanding the association between active aging determinants and QoL can help policymakers plan early interventions or programs to assist future older adults in both aging actively and optimizing their quality of life (QoL), as these two factors have a bidirectional relationship.

    OBJECTIVE: This study aimed to review evidence regarding the association between active aging and quality of life (QoL) among older adults and to determine the most widely used study designs and measurement instruments in studies conducted between 2000 and 2020.

    METHODS: Relevant studies were identified by a systematic search of four electronic databases and cross-reference lists. Original studies examining the association between active aging and QoL in individuals aged 60 years or older were considered. The quality of the included studies and the direction and consistency of the association between active aging and QoL were assessed.

    RESULTS: A total of 26 studies met the inclusion criteria and were included in this systematic review. Most studies reported a positive association between active aging and QoL among older adults. Active aging had a consistent association with various QoL domains including physical environment, health and social services, social environment, economic, personal, and behavioral determinants.

    CONCLUSION: Active aging had a positive and consistent association with several QoL domains among older adults, backing the notion that the better the active aging determinants, the better the QoL among older adults. Considering the broader literature, it is necessary to facilitate and encourage the active participation of older adults in physical, social, and economic activities for the maintenance and/or improvement of QoL. Identifying other possible determinants and enhancing the methods to improve those determinants may help improve the QoL among older adults.

  11. Bhattacharya S, Bhattacharya S, Vallabh V, Marzo RR, Juyal R, Gokdemir O
    Int J MCH AIDS, 2023;12(1):e588.
    PMID: 36683649 DOI: 10.21106/ijma.588
    "No man is an island unto himself" - John Donne According to the World Health Organization, health is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity." Our healthcare industry, public behaviors, and environment have grown exponentially with digital technologies in the era of the 4th industrial revolution. Due to rapid digitalization and easy availability of the internet, we are now online round the clock on our digital devices, leaving behind digital traces/information. These digital footprints serve as an increasingly fruitful data source for social scientists, including those interested in demographic research. The collection and use of digital data (quantitative and qualitative) also present numerous statistical and computational opportunities, further motivating the development of new research approaches to address health issues. In this paper, we have described the concept of digital well-being and proposed how we can use digital information for good health.
  12. Marzo RR, Su TT, Ismail R, Htay MNN, Essar MY, Chauhan S, et al.
    Front Public Health, 2022;10:998234.
    PMID: 36187686 DOI: 10.3389/fpubh.2022.998234
    INTRODUCTION: It is clear that medical science has advanced much in the past few decades with the development of vaccines and this is even true for the novel coronavirus outbreak. By late 2020, COVID-19 vaccines were starting to be approved by national and global regulators, and across 2021, there was a global rollout of several vaccines. Despite rolling out vaccination programs successfully, there has been a cause of concern regarding uptake of vaccine due to vaccine hesitancy. In tackling the vaccine hesitancy and improving the overall vaccination rates, digital health literacy (DHL) could play a major role. Therefore, the aim of this study is to assess the digital health literacy and its relevance to the COVID-19 vaccination.

    METHODS: An internet-based cross-sectional survey was conducted from April to August 2021 using convenience sampling among people from different countries. Participants were asked about their level of intention to the COVID-19 vaccine. Participants completed the Digital Health Literacy Instrument (DHLI), which was adapted in the context of the COVID Health Literacy Network. Cross-tabulation and logistic regression were used for analysis purpose.

    RESULTS: Overall, the mean DHL score was 35.1 (SD = 6.9, Range = 12-48). The mean DHL score for those who answered "Yes" for "support for national vaccination schedule" was 36.1 (SD 6.7) compared to 32.5 (SD 6.8) for those who either answered "No" or "Don't know". Factors including country, place of residence, education, employment, and income were associated with the intention for vaccination. Odds of vaccine intention were higher in urban respondents (OR-1.46; C.I.-1.30-1.64) than in rural respondents. Further, higher competency in assessing the relevance of online information resulted in significantly higher intention for vaccine uptake.

    CONCLUSION: Priority should be given to improving DHL and vaccination awareness programs targeting rural areas, lower education level, lower income, and unemployed groups.

  13. Irasanti SN, Respati T, Januarita R, Yuniarti Y, Chen HWJ, Marzo RR
    Front Public Health, 2023;11:1157837.
    PMID: 37529438 DOI: 10.3389/fpubh.2023.1157837
    The COVID-19 outbreak demonstrates how unprepared the world is for a different type of crisis, especially non-physical calamities. Revitalizing community involvement in disaster management is essential for making a community resilient. Due to differing sociocultural contexts, the resilience perceptions of communities in different parts of the world may vary. This study aims to understand community resilience factors after the COVID-19 disaster in Indonesia and Malaysia. Data from 2034 questionnaires using 5-interrelated domains in the Communities Advancing Resilience (CART) Toolkit Survey were collected. This study was conducted across Indonesia and Malaysia from March to April 2022. A quantitative-based cross-sectional study design and convenience sampling were applied. Respondents for this study were Indonesian and Malaysian citizens above 18 years of age who met the inclusion criteria. A total of 2034 respondents, 715 from Indonesia and 1,315 from Malaysia responded to the survey. The results suggest that Indonesian and Malaysian communities' Transformative Potential and Informative-Communication domains differ significantly. Indonesian communities demonstrated a higher mean value on Transformative Potential domains than Malaysian communities did, while Malaysian communities indicated a higher mean value on Informative-Communication domains. This study concludes that compared to Malaysian communities, Indonesian communities have a more significant potential for transformation because they can frame collective experiences, gather, and analyze pertinent data, evaluate community performance, and develop resilience-building abilities. On the other hand, Malaysian communities are more resilient in providing information and communication. We found the need to develop a community resilience model that incorporates specific cultural and local requirements. Cooperation between the two countries would open many possibilities to emphasize the capability to bounce back sooner after a catastrophe such as the COVID-19 pandemic and achieve Sustainable Development Goals.
  14. Shikha D, Kushwaha P, Gokdemir O, Marzo RR, Bhattacharya S
    Front Public Health, 2023;11:1128257.
    PMID: 37056654 DOI: 10.3389/fpubh.2023.1128257
  15. Marzo RR, Bhattacharya S, Ravichandran S, Lakshmanan P, Jeffery VR, Moralitheran P, et al.
    PMID: 32002422 DOI: 10.4103/jehp.jehp_192_19
    INTRODUCTION: Smoking is one of the leading factors of mortality in Malaysia. Most youngsters start at adolescence, fascinated by the concept of smoking. Interventions that harness the broad availability of mobile phones, as well as adolescents' interest in their appearance, may be an innovative way to advance school-based prevention. This study aims to determine the perceptions of facial-aging apps among secondary school students.

    METHODOLOGY: For this research, descriptive cross-sectional study using simple random sampling method was used. Population sampling was targeted toward three government schools. The total number of respondents is 383, with all of them aged between 13 and- 16 years of age. Legal considerations were taken to maintain the confidentiality of respondents. The specific objectives are: 1. To determine the level of change of intention on smoking, 2. To know the perceived reactions of the peer groups on the appearances of students as nonsmokers, 3. To determine whether the students learned new benefits of nonsmokingand, 4. To measure the impact of a facial-aging app among students.

    RESULTS: The number of respondents who smoke was 40 (10.4%), while the number of respondents who do not smoke was 343 (89.6%). About 89% of the respondents agree that their three-dimensional selfie image motivates them not to smoke. In addition, 87.8% of respondents admit that the perceived reactions of their classmates make them think that they look better as nonsmokers. After learning the effects of smoking, about 86.4% of the respondents acknowledged that they would educate their peer groups. Furthermore, 85.9% of the respondents found this "Smokerface" app enjoyable.

    CONCLUSION: The facial-aging intervention was effective in motivating Malaysian pupils to stay away from tobacco use. Thus, the analysis on the study of facial app usage in smoking prevention among youngsters concludes that most of the adolescents concur that the "Smokerface" app helps in the prevention of smoking among youths.

  16. Adhikaree J, Shrestha R, Bomjan P, Shrestha A, Pokharel S, Acharya R, et al.
    Post Reprod Health, 2023 Dec;29(4):195-200.
    PMID: 37907067 DOI: 10.1177/20533691231213301
    Background: The ovarian follicular cell's degradation and subsequent decrease in the synthesis of estrogen results in the decreased cardiovascular protection. As a result, the incidence of cardiovascular disease (CVD) increases in postmenopausal women and is characterized by change in lipid profile. This study sought to ascertain the extent of the impact that menstrual status might have on lipid profiles among premenopausal and postmenopausal women. Methods: A cross-sectional study was conducted with 260 premenopausal and postmenopausal women (1: 1) and serum lipid component concentrations (high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), and total cholesterol (TC)) were measured. A comparison between two groups was made between premenopausal and postmenopausal women, and regression was carried out to estimate the effect of menstrual status on lipid components. Results: Compared with premenopausal women, the concentrations of the lipid components (HDL-C, LDL-C, TG, and TC) were found to be significantly higher in postmenopausal women. Using the linear regression, menstruation status was able to predict 11.7%-13.3% of the lipid components (TG and TC) when age and weight were adjusted. Conclusion: The difference in lipid components between premenopausal women and postmenopausal women exists, with menstrual status explaining 11.7%-13.3% variance for the observed lipid level. The factors influencing the lipid profile beside the menstrual status should also be explored. External intervention such as estrogen replacement therapy is also recommended in case of deviation of lipid profile from the suggested normal clinical range.
  17. Marzo RR, Aye SS, Naing TW, Mon Kyaw T, Win MT, Kyaw Soe HH, et al.
    J Public Health Res, 2021 Nov 08;10(2 Suppl).
    PMID: 34751532 DOI: 10.4081/jphr.2021.2279
    BACKGROUND: COVID-19 pandemic reached a public health emergency status of international concern. The impacts and events associated with this were associated with adverse psychological impacts among the general public globally. This study aimed to determine the prevalence of psychological distress and to identify predictors associated with psychological distress due to the COVID-19 pandemic among the population in Myanmar.

    DESIGN AND METHODS: A cross-sectional survey was conducted from March to April 2020 among adults, 18 years old and above, who reside in Myanmar through a structured questionnaire distributed in social media platforms. Univariate and Bivariate analyses were used to estimate the prevalence of COVID-19 Peritraumatic Distress Index (CPDI) symptoms and to test the associations between CPDI and the exposure variables. Logistic Regression Analysis was done to identify significant predictors of distress.

    RESULTS: There were 530 participants in this study.37.4% of them did not have psychological distress,55.6% experienced mild to moderate psychological distress, and 7% experienced severe psychological distress due to COVID-19 pandemic. Simple and Multiple Logistic Regression Analyses were performed to determine the factors associated with psychological distress due to COVID-19.

    CONCLUSIONS: It was shown that the self-employed group and age group older than 45 years old had more psychological distress than others. However, Buddhists and people from the capital city had less distress than other religions and districts. This study recommends the government to develop better strategies for self-employed groups, elders, and the poor for a support, relief, and resettlement of their ruined status.

  18. Marzo RR, Chakraborty R, Soh SY, Thew HZ, Chong C, Siau CS, et al.
    Front Public Health, 2023;11:1091015.
    PMID: 37261237 DOI: 10.3389/fpubh.2023.1091015
    INTRODUCTION: Vaccination programs have been rolled out across the globe to contain and mitigate the spread of the COVID-19 infection. Until recently, such programs were limited to adults and the older population, thereby limiting children from getting vaccinated. Recently, the Malaysian government rolled out vaccination for children aged 5-11 years. However, there are certain factors that might affect vaccination uptake among children. This study explores factors influencing parents' hesitancy to vaccinate children in Malaysia.

    METHOD: A nationwide online cross-sectional convenience sampling survey from April 21, 2022 to June 3, 2022 was conducted. The study used descriptive statistics to inform about vaccine hesitancy among parents. Cross-tabulation was performed to calculate the frequency and percentage of vaccine hesitancy, quality of life, e-health literacy, and the 5C psychological antecedents of vaccination among parents with children 5-11 years in Malaysia. Graphical methods were used to portray the levels of e-health literacy and levels of 5C psychological antecedents of vaccination. The study used both bi-variate and multivariate analysis to understand the relationship between vaccine hesitancy and the socio-demo-economic factors, quality of life, e-health literacy and 5C psychological antecedents.

    RESULTS: Of 382 participants, almost one-third (33%) of participants reported vaccine hesitancy for their children. For 5C's psychological antecedents of vaccination, around one quarter (26.96%) reported disagreement for confidence in vaccination, almost half (52.36%) reported disagreement for vaccination complacency, three-fifths (60.99%) reported vaccination constraint, one quarter (25.92%) reported calculation antecedent, and almost one-third reported disagreement over collective responsibility antecedent (25.92%). Chi-square test revealed that gender, employment status, and parents' COVID-19 vaccination status were significantly associated (p<0.05) with vaccine hesitancy among parents. Assessing the influence of transactional e-health literacy, only the communication component contained a significant association (p<0.05). Among the 5C psychological antecedents, confidence, calculation, and collective responsibility were significantly associated (p<0.05) with vaccine hesitancy. Parents with secondary [OR: 8.80; CI: 2.44-31.79, (p<0.05)], post-secondary [OR: 5.21; CI: 2.10-13.41, (p<0.05)], and tertiary education [OR: 6.77; CI: 2.25-20.35, (p<0.05)] had significantly higher likelihood of vaccine hesitancy than those with primary education.

    CONCLUSION: Highly educated parents are more skeptical and are more likely to perceive the vaccine as unsafe and ineffective for their children. It is critical to disseminate the required information about the vaccine safety to the educated group.

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