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  1. Ahmad N., Osman, E., Abdul Ghani, N.A., Leong, W.Y., Arzaee, M.Z., Seow, Y.Y., et al.
    Medicine & Health, 2020;15(2):108-123.
    MyJurnal
    Toksoplasmosis pendam dapat menyebabkan pelbagai gangguan hormon dan tingkah laku dalam hos terjangkit. Kami berhasrat untuk mengkaji sero-prevalens Toxoplasma gondii (T. gondii) pendam serta hubungan antara jangkitan dengan pengetahuan dan tingkah laku dalam kalangan 400 ibu hamil. Sampel plasma diuji untuk kehadiran antibodi IgG T. gondii dan soal selidik berstruktur digunakan untuk merekodkan ciri-ciri sosio-demografi responden, maklumat umum dan pengetahuan mengenai faktor risiko, gejala, masa jangkitan, pengetahuan pencegahan serta tingkah laku pencegahan toksoplasmosis. Sero-prevalensi toksoplasmosis pendam dalam wanita hamil adalah 31.8%. Kajian menunjukkan, 69.5% daripada mereka mempunyai kurang pengetahuan mengenai toksoplasmosis. Walau bagaimanapun, majoritinya (99.8%) mengamalkan tingkah laku pencegahan. Analisis regresi logistik berganda menunjukkan wanita hamil dengan tahap pendidikan rendah mempunyai hampir dua kali lebih risiko (nisbah ods terlaras: 1.91, 95% SK 1.18, 3.10; p = 0.008) untuk T. gondii IgG seropositif. Wanita hamil yang mempunyai sejarah perubatan lalu mempunyai dua kali lebih kemungkinan (nisbah ods terlaras: 2.32, 95% SK 1.32, 4.06; p = 0.003) untuk T. gondii IgG seropositif. Selain itu, wanita yang tidak pasti mengenai mod penyebaran penyakit melalui pemindahan darah mempunyai empat kali lebih ods (nisbah ods terlaras: 3.93, 95% SK 1.54, 10.01; p = 0.004) untuk sero-prevalens kronik toksoplasmosis. Wanita yang tidak pasti mengenai keperluan menghindari kucing liar mempunyai nisbah ods terlaras: 0.42 (95% SK 0.24, 0.71, p = 0.001) untuk sero-prevalens kronik toksoplasmosis. Penterjemahan pengetahuan tentang toksoplasmosis kepada amalan tingkah laku pencegahan melalui program pendidikan kesihatan adalah penting untuk mengurangkan risiko penularan penyakit ini dalam kalangan wanita hamil.
  2. Mustapha N, Amin N, Chakravarty S, Mandal PK
    Comput Biol Med, 2009 Oct;39(10):896-906.
    PMID: 19665698 DOI: 10.1016/j.compbiomed.2009.07.004
    Flow of an electrically conducting fluid characterizing blood through the arteries having irregular shaped multi-stenoses in the environment of a uniform transverse magnetic-field is analysed. The flow is considered to be axisymmetric with an outline of the irregular stenoses obtained from a three-dimensional casting of a mild stenosed artery, so that the physical problem becomes more realistic from the physiological point of view. The marker and cell (MAC) and successive-over-relaxation (SOR) methods are respectively used to solve the governing unsteady magnetohydrodynamic (MHD) equations and pressure-Poisson equation quantitatively and to observe the flow separation. The results obtained show that the flow separates mostly towards the downstream of the multi-stenoses. However, the flow separation region keeps on shrinking with the increasing intensity of the magnetic-field which completely disappears with sufficiently large value of the Hartmann number. The present observations certainly have some clinical implications relating to magnetotherapy which help reducing the complex flow separation zones causing flow disorder leading to the formation and progression of the arterial diseases.
  3. Khan I, Ali Shah N, Tassaddiq A, Mustapha N, Kechil SA
    PLoS One, 2018;13(1):e0188656.
    PMID: 29304161 DOI: 10.1371/journal.pone.0188656
    This paper studies the heat transfer analysis caused due to free convection in a vertically oscillating cylinder. Exact solutions are determined by applying the Laplace and finite Hankel transforms. Expressions for temperature distribution and velocity field corresponding to cosine and sine oscillations are obtained. The solutions that have been obtained for velocity are presented in the forms of transient and post-transient solutions. Moreover, these solutions satisfy both the governing differential equation and all imposed initial and boundary conditions. Numerical computations and graphical illustrations are used in order to study the effects of Prandtl and Grashof numbers on velocity and temperature for various times. The transient solutions for both cosine and sine oscillations are also computed in tables. It is found that, the transient solutions are of considerable interest up to the times t = 15 for cosine oscillations and t = 1.75 for sine oscillations. After these moments, the transient solutions can be neglected and, the fluid moves according with the post-transient solutions.
  4. Al-Hadi IAA, Sharef NM, Sulaiman MN, Mustapha N, Nilashi M
    PeerJ Comput Sci, 2020;6:e331.
    PMID: 33816980 DOI: 10.7717/peerj-cs.331
    Recommendation systems suggest peculiar products to customers based on their past ratings, preferences, and interests. These systems typically utilize collaborative filtering (CF) to analyze customers' ratings for products within the rating matrix. CF suffers from the sparsity problem because a large number of rating grades are not accurately determined. Various prediction approaches have been used to solve this problem by learning its latent and temporal factors. A few other challenges such as latent feedback learning, customers' drifting interests, overfitting, and the popularity decay of products over time have also been addressed. Existing works have typically deployed either short or long temporal representation for addressing the recommendation system issues. Although each effort improves on the accuracy of its respective benchmark, an integrative solution that could address all the problems without trading off its accuracy is needed. Thus, this paper presents a Latent-based Temporal Optimization (LTO) approach to improve the prediction accuracy of CF by learning the past attitudes of users and their interests over time. Experimental results show that the LTO approach efficiently improves the prediction accuracy of CF compared to the benchmark schemes.
  5. Mustafa H, Cheng CH, Radzi R, Fong LS, Mustapha NM, Dyary HO
    Pol J Vet Sci, 2021 Sep;24(3):365-373.
    PMID: 34730299 DOI: 10.24425/pjvs.2021.138727
    Periodontitis is a highly prevalent, chronic immune-inflammatory disease of the periodontium that results in the periodontium and alveolar bone loss's progressive destruction. In this study, the induction of periodontal disease via retentive ligature, lipopolysaccharide, and their combination at three different times were compared in a rat model. Seventy-two Sprague Dawley rats were distributed into four treatment groups: 1) control group with no treatment; 2) application of 4/0 nylon ligature around second maxillary molars; 3) combination of ligature and LPS injection (ligature-LPS); 4) intragingival injection of Porphyromonas gingivalis lipopolysaccharide (Pg-LPS) to the palatal mucosa of the second maxillary molars. Six rats were sacrificed from each group after 7, 14, and 30 days of periodontal disease induction. Alveolar bone loss, attachment loss, number of inflammatory cells, and blood vessels were evaluated histologically. A micro-CT scan was used as a parameter to know the rate of alveolar bone loss. Parametric data were analyzed using two-way ANOVA followed by Bonferroni correction with a significance set at 5%. Non-parametric data were analyzed using Kruskal-Wallis, followed by multiple comparisons with Bonferroni correction. The histological results revealed significant destructive changes in the periodontal tissues and alveolar bone following the ligature and ligature-LPS induction techniques. These changes were evident as early as seven days, maintained until 14 days post-treatment, and declined with time. The ligature technique was effective in inducing acute periodontal disease. The LPS injection technique did not induce alveolar bone loss, and its combination to ligature added insignificant effects.
  6. Hassan MR, Mustapha NR, Zawawi FM, Earnest BS, Voralu K, Pani SP
    Singapore Med J, 2011 Feb;52(2):86-9.
    PMID: 21373733
    This study was conducted to compare the genotype and markers of disease severity of chronic hepatitis C (CHC), namely viral load, alanine transaminase (ALT) levels and histopathological findings on liver biopsy, in patients with and without end-stage renal disease (ESRD).
  7. Mohd Zohdi R, Abu Bakar Zakaria Z, Yusof N, Mohamed Mustapha N, Abdullah MN
    PMID: 21941590 DOI: 10.1155/2012/843025
    A novel cross-linked honey hydrogel dressing was developed by incorporating Malaysian honey into hydrogel dressing formulation, cross-linked and sterilized using electron beam irradiation (25 kGy). In this study, the physical properties of the prepared honey hydrogel and its wound healing efficacy on deep partial thickness burn wounds in rats were assessed. Skin samples were taken at 7, 14, 21, and 28 days after burn for histopathological and molecular evaluations. Application of honey hydrogel dressings significantly enhanced (P < 0.05) wound closure and accelerated the rate of re-epithelialization as compared to control hydrogel and OpSite film dressing. A significant decrease in inflammatory response was observed in honey hydrogel treated wounds as early as 7 days after burn (P < 0.05). Semiquantitative analysis using RT-PCR revealed that treatment with honey hydrogel significantly (P < 0.05) suppressed the expression of proinflammatory cytokines (IL-1α, IL-1β, and IL-6). The present study substantiates the potential efficacy of honey hydrogel dressings in accelerating burn wound healing.
  8. Nahanthiran S, Nik Mustapha NH, Yasin N, Idris FB, Md Noor SB
    Malays J Pathol, 2024 Aug;46(2):315-320.
    PMID: 39207009
    INTRODUCTION: Thalassemia and haemoglobinopathies are relatively common among Malaysians. One of the rare haemoglobinopathies reported is Haemoglobin (Hb) Arya, which occurs due to substitution of aspartic acid at residue 47 of the alpha chain by asparagine. Here, we report the detection of Hb Arya in a Malaysian family, which was detected incidentally during family screening.

    CASE REPORT: A 16 years-old girl, clinically asymptomatic was noted to have low mean corpuscular haemoglobin (MCV) with normal Hb level. Hb analysis using capillary electrophoresis (CE) showed reduced Hb A of 76.5%, Hb A2 of 1.6% with presence of small peak at Zone 1 likely A2'. There was also a small peak noted at Hb D zone and Hb S zones which quantified as 1.5% and 20% respectively. Supplementary test by high performance liquid chromatography (HPLC) showed a prominent peak at D-window (19.6%) and a small peak at S-window (0.6%). DNA analysis revealed a heterozygous state of α2 codon 47 Hb Arya mutation. Subsequent family study showed a similar mutation in the father and sister of the index case.

    CONCLUSION: Very few reports are available up to date regarding Hb Arya. This report highlights the rare haemoglobinopathy in a Malay family in Malaysia that contributes to the growing literature of this rare haemoglobin variant.

  9. Muhamad NA, Buang SN, Jaafar S, Jais R, Tan PS, Mustapha N, et al.
    BMC Public Health, 2018 Dec 22;18(1):1402.
    PMID: 30577816 DOI: 10.1186/s12889-018-6316-6
    BACKGROUND: In 2006, 4 years of planning was started by the Ministry of Health, Malaysia (MOH), to implement the HPV (human papillomavirus) vaccination programme. An inter-agency and multi-sectoral collaborations were developed for Malaysia's HPV school-based immunisation programme. It was approved for nationwide school base implementation for 13-year-old girls or first year secondary students in 2010. This paper examines how the various strategies used in the implementation over the last 7 years (2010-2016) that unique to Malaysia were successful in achieving optimal coverage of the target population.

    METHODS: Free vaccination was offered to school girls in secondary school (year seven) in Malaysia, which is usually at the age of 13 in the index year. All recipients of the HPV vaccine were identified through school enrolments obtained from education departments from each district in Malaysia. A total of 242,638 girls aged between 12 to 13 years studying in year seven were approached during the launch of the program in 2010. Approximately 230,000 girls in secondary schools were offered HPV vaccine per year by 646 school health teams throughout the country from 2010 to 2016.

    RESULTS: Parental consent for their daughters to receive HPV vaccination at school was very high at 96-98% per year of the programme. Of those who provided consent, over 99% received the first dose each year and 98-99% completed the course per year. Estimated population coverage for the full vaccine course, considering also those not in school, is estimated at 83 to 91% per year. Rates of adverse events reports following HPV vaccination were low at around 2 per 100,000 and the majority was injection site reactions.

    CONCLUSION: A multisectoral and integrated collaborative structure and process ensured that the Malaysia school-based HPV immunisation programme was successful and sustained through the programme design, planning, implementation and monitoring and evaluation. This is a critical factor contributing to the success and sustainability of the school-based HPV immunisation programme with very high coverage.

  10. Hamdan A, Ab Latip MQ, Abu Hassim H, Mohd Noor MH, Tengku Azizan TRP, Mohamed Mustapha N, et al.
    Sci Rep, 2020 08 24;10(1):14105.
    PMID: 32839483 DOI: 10.1038/s41598-020-71047-1
    Mirror-induced behaviour has been described as a cognitive ability of an animal to self-direct their image in front of the mirror. Most animals when exposed to a mirror responded with a social interactive behaviour such as aggressiveness, exploratory and repetitive behaviour. The objective of this study is to determine the mirror-induced self-directed behaviour on wildlife at the Royal Belum Rainforest, Malaysia. Wildlife species at the Royal Belum Rainforest were identified using a camera traps from pre-determined natural saltlick locations. Acrylic mirrors with steel frame were placed facing the two saltlicks (Sira Batu and Sira Tanah) and the camera traps with motion-detecting infrared sensor were placed at strategically hidden spot. The behavioural data of the animal response to the mirror were analysed using an ethogram procedure. Results showed that barking deer was the species showing the highest interaction in front of the mirror. Elephants displayed self-directed response through inspecting behaviour via usage of their trunk and legs while interacting to the mirror. Interestingly, the Malayan tapir showed startled behaviour during their interaction with the mirror. However, the absence of interactive behaviour of the Malayan tiger signalled a likelihood of a decreased social response behaviour. These results suggested that the ability to self-directed in front of the mirror is most likely related to the new approach to study the neural mechanism and its level of stimulus response in wildlife. In conclusion, research on mirror-induced self-directed behaviour in wildlife will have profound implications in understanding the cognitive ability of wildlife as an effort to enhance the management strategies and conservation.
  11. Othman AH, Goh YM, Mohamed Mustapha N, Raghazli R, Kaka U, Imlan JC, et al.
    Anim Sci J, 2021 Dec;92(1):e13610.
    PMID: 34390058 DOI: 10.1111/asj.13610
    This preliminary trial investigated the effect of transportation and lairage periods on physiological parameters of goats subjected to slaughter. Nine male Boer cross goats aged 8-12 months were transported for 6 h and kept at lairage for 3, 6, or 16 h (n = 3). Blood samples were collected at pre- (pre-T) and post-transportation (post-T), and post-slaughter (post-S) for determination of hematological parameters, serum enzyme, protein, and cortisol concentrations. Electroencephalogram readings were taken at pre-T, post-T, pre-slaughter (pre-S), and post-S to determine the median frequency (F50 ) and total power (Ptot) values. At post-T, there were manifestations of stress leukogram; increase in hematocrit, total protein, and muscle enzyme concentrations; and decrease in Ptot (p 
  12. Muhamad NA, Ma'amor NH, Mustapha N, Leman FN, Rosli IA, Umar M, et al.
    Interact J Med Res, 2023 Mar 31;12:e43969.
    PMID: 37000482 DOI: 10.2196/43969
    BACKGROUND: Hematological malignancies disturb the blood, lymph nodes, and bone marrow. Taking medications for treating opportunistic infections (OIs) in these individuals may enhance the risk of medication interaction as well as adverse drug reactions.

    OBJECTIVE: This review aims to evaluate the effectiveness of nondrug interventions in reducing OIs among patients with hematological cancers.

    METHODS: The PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), and Embase databases were searched on December 26, 2022, for all randomized controlled trials (RCTs). The primary endpoint was OIs. The quality of included studies was assessed by the Cochrane Risk-of-Bias tool.

    RESULTS: A total of 6 studies were included in this review with 4 interventions: (1) types of mouthwash received, (2) presence of coating on central venous catheters (CVCs), (3) use of well-fitted masks, and (4) types of diet consumed. The results were presented in 8 different comparisons: (1) chlorhexidine-nystatin versus saline mouth rinse, (2) chlorhexidine versus saline mouth rinse, (3) nystatin versus saline mouth rinse, (4) chlorhexidine silver sulfadiazine-coated CVCs versus uncoated catheters, (5) well-fitted masks versus no mask, (6) amine fluoride-stannous fluoride versus sodium fluoride mouthwash, (7) low-bacterial diet versus standard hospital diet, and (8) herbal versus placebo mouthwash. No clear differences were reported in any of the outcomes examined in the first 3 comparisons. There were also no clear differences in the rate of catheter-related bloodstream infection or insertion site infection between the use of chlorhexidine silver sulfadiazine-coated CVCs versus uncoated catheters in the patients. Further, no significant differences were seen between patients who used a well-fitted mask and those without a mask in the incidence of OI. The all-cause mortality and mortality due to OI were similar between the 2 groups. There was no clear difference in all-cause mortality, although common adverse effects were reported in patients who used sodium fluoride mouthwash compared with those using amine fluoride-stannous fluoride mouthwash. There was no evidence of any difference in the incidence of possible invasive aspergillosis or candidemia between patients who consumed a low-bacterial diet and a standard diet. For the last comparison, no significant difference was seen between patients who received herbal and placebo mouthwash.

    CONCLUSIONS: Very limited evidence was available to measure the effectiveness of nondrug interventions in hematological cancers. The effectiveness of the interventions included in this review needs to be evaluated further in high-quality RCTs in a dedicated setting among patients with hematological malignancies.

    TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020169186; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=169186.

  13. Aliyu A, Shaari MR, Ahmad Sayuti NS, Reduan FH, Sithambaram S, Mohamed Mustapha N, et al.
    Sci Prog, 2021 Oct;104(4):368504211004272.
    PMID: 34886737 DOI: 10.1177/00368504211004272
    Moringa oleifera (M. oleifera) Lam belongs to the family Moringaceae. It is an important multipurpose tree that is largely distributed globally and has been used almost in every aspect of traditional medicine for the treatment of various illnesses including cancers, diabetes mellitus, asthma, arthritis, etc. This study investigated the effects of oral acute and sub-acute administration of M. oleifera hydroethanolic leaf extract (MOHE) in ICR-mice. Its major phenolic compounds were also determined. Ten (10) female, 8-week old mice were grouped into control and treatment groups for acute toxicity study. A dose of 2000 mg/kg MOHE was given once to the treatment group via oral gavage. However, for the sub-acute toxicity study, 25 mice were grouped into groups A (control), B (125 mg/kg), C (250 mg/kg), D (500 mg/kg) and E (1000 mg/kg). MOHE was given via oral gavage to groups B, C, D and E daily for 28 days. Group A received only distilled water. The mice were sacrificed at the end of the experiments and samples were collected for evaluation. The results of the chemical profiling of MOHE revealed the presence of glucomoringin, niaziminine, quercetin and kaempferol as the major compounds. The treated mice in the acute toxicity study were slightly anaemic and showed evidence of stress leukogram. Moreover, a slight increase in creatinine, significant increases in AST and CK, hepatic degeneration and necrosis, none-obstructive sinusoidal dilatation, renal tubular necrosis, interstitial nephritis and renal interstitial oedema were observed. It is concluded that the LD50 of MOHE is higher than 2000 mg/kg. However, oral administration of MOHE causes acute mild anaemia and moderate hepato-nephrotoxicity in ICR-mice. Its major phenolic compounds are glucomoringin, niaziminine, quercetin and kaempferol.
  14. Zhou YJ, Gao F, Liu WY, Wong GL, Mahadeva S, Raihan Nik Mustapha N, et al.
    Aliment Pharmacol Ther, 2021 08;54(4):470-480.
    PMID: 34152626 DOI: 10.1111/apt.16487
    BACKGROUND: Recently, Papatheodoridi et al proposed to refine the Baveno VI elastography dual-cutoffs and introduce an algorithm for the detection of compensated advanced chronic liver disease (cACLD) in asymptomatic European patients with chronic liver diseases.

    AIMS: To validate the performance of the dual-cutoffs (8/12 kPa) and the proposed algorithm to identify patients with cACLD in three well-characterised Asian nonalcoholic fatty liver disease (NAFLD) cohorts.

    METHODS: We included 830 patients with biopsy-proven NAFLD. Liver stiffness was measured using transient elastography (FibroScan).

    RESULTS: cACLD was found in 21.8% of patients. Compared with the original Baveno VI elastography criteria (10/15 kPa), the new cutoffs showed a comparable specificity and a higher sensitivity for identifying cACLD. We developed a simplified risk model incorporating age, liver stiffness value, and platelet count, which outperformed liver stiffness measurement alone in two Chinese cohorts (P = 0.001), and was further validated in a Malaysian cohort (P = 0.04). Overall, the "two-step" screening of cACLD improved classification rates from 73.5% by the original dual-cutoffs to 86.7%. Notably, usage of our simplified risk model resulted in significantly lower false-negative rate than the refined screening approach by Papatheodoridi et al (27.1% vs 41.4%; P = 0.01).

    CONCLUSIONS: The dual elastography cutoffs of 8 and 12 kPa are more appropriate to identify cACLD in Asian patients with NAFLD. In combination with a simplified risk model in unclassified patients, the two-step approach showed a classification rate of about 85%.

  15. Lazarus BA, Che-Amat A, Abdul Halim Shah MM, Hamdan A, Abu Hassim H, Mustaffa Kamal F, et al.
    Sci Rep, 2021 05 19;11(1):10596.
    PMID: 34012045 DOI: 10.1038/s41598-021-89980-0
    Natural salt lick (sira) is a strategic localisation for ecological wildlife assemblage to exhibit geophagy which may act as a population dynamic buffer of prey and predators. Undoubtedly, many agree that geophagy at natural licks is linked to nutritional ecology, health and assembly places facilitating social interaction of its users. Overall, natural salt licks not only save energy of obtaining nutrient leading to health maintenance but also forms the basis of population persistence. The Royal Belum Rainforest, Malaysia (Royal Belum) is a typical tropical rainforest in Malaysia rich in wildlife which are mainly concentrated around the natural salt lick. Since this is one of the most stable fauna ecology forest in Malaysia, it is timely to assess its impact on the Malayan tiger (Panthera tigris) home range dynamics. The three-potential home ranges of the Malayan tiger in this rainforest were selected based on animal trails or foot prints surrounding the salt lick viz (e.g. Sira Kuak and Sira Batu; Sira Rambai and Sira Buluh and Sira Papan) as well as previous sightings of a Malayan tiger in the area, whose movement is dependent on the density and distribution of prey. Camera traps were placed at potential animal trails surrounding the salt lick to capture any encountered wildlife species within the area of the camera placements. Results showed that all home ranges of Malayan tiger were of no significance for large bodied prey availability such as sambar deer (Rusa unicolor), and smaller prey such as muntjacs (Muntiacus muntjac) and wild boar (Sus scrofa). Interestingly, all home range harbour the Malayan tiger as the only sole predator. The non-significance of prey availability at each home range is attributed to the decline of the Malayan tiger in the rainforest since tigers are dependant on the movement of its preferred prey surrounding natural salt licks. Thus, the information from this study offers fundamental knowledge on the importance of prey-predator interaction at salt lick which will help in designing strategy in rewilding or rehabilitation programs of the Malayan tiger at the Royal Belum Rainforest.
  16. Muhamad NA, Subhas N, Mustapha N, Abdullah N, Muhamad Rasat MA, Ab Ghani RM, et al.
    PLOS Glob Public Health, 2023;3(4):e0001823.
    PMID: 37058465 DOI: 10.1371/journal.pgph.0001823
    INTRODUCTION: The COVID-19 pandemic has become the greatest challenge of the new millennium. Most healthcare workers (HCWs) experienced unprecedented levels of workload since the pandemic. This study aims to identify the prevalence and factors of depression, anxiety and stress among HCWs in Malaysian healthcare facilities in the midst of the pandemic due to the SARs-CoV-2.

    METHODS: An emergency response programme on mental health was conducted from June to September 2020. A standardized data collection form was distributed among the HCWs in the government hospital in Klang Valley. The form contained basic demographic information and the self-reported Malay version of the Depression, Anxiety and Stress scale (BM DASS-21).

    RESULTS: Of the1,300 staff who attended the Mental Health and Psychosocial Support in Covid-19 (MHPSS COVID-19) programme, 996 staff (21.6% male, 78.4% female) completed the online survey (response rate: 76.6%). Result showed that staff aged above 40 years old were almost two times more likely to have anxiety (AOR = 1.632; 95% CI = 1.141-2.334, p:0.007) and depression (AOR = 1.637; 95% CI = 1.1.06-2.423, p:0.014) as compared to staff who were less than 40 years old. Those who had direct involvement with COVID-19 patients were likely to suffer stress (AOR = 0.596; 95% CI = 0.418-0.849, p:0.004), anxiety (AOR = 0.706; 95% Ci = 0.503-0.990, p:0.044) and depression (AOR = 0.630; 95% Ci = 0.427-0.928, p:0.019). HCWs with stress (AOR = 0.638; 95% CI of 0.476-0.856, p = 0.003), anxiety (AOR = 0.720; 95% CI 0.542-0.958, p = 0.024) and depression (AOR = 0.657; 95% CI 0.480-0.901, p = 0.009) showed less confidence to treat critically ill patients and need psychological help during outbreak.

    CONCLUSION: This study showed the importance of psychosocial support to reduce psychological distress among HCWs when working or coping during the COVID-19 pandemic or outbreak.

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