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Fulltext Effects of Population Weighting on PM10 Concentration Estimation

Abdul Shakor AS, Pahrol MA, Mazeli MI

J Environ Public Health, 2020;2020:1561823.
PMID: 32351580 DOI: 10.1155/2020/1561823

Particulate matter with an aerodynamic diameter of 10 μm or less (PM10) pollution poses a considerable threat to human health, and the first step in quantifying health impacts of human exposure to PM10 pollution is exposure assessment. Population-weighted exposure level (PWEL) estimation is one of the methods that provide a more refined exposure assessment as it includes the spatiotemporal distribution of the population into the pollution concentration estimation. This study assessed the population weighting effects on the estimated PM10 concentrations in Malaysia for years 2000, 2008, and 2013. Estimated PM10 annual mean concentrations with a spatial resolution of 5 kilometres retrieved from satellite data and population count obtained from the Gridded Population of the World version 4 (GPWv4) from the Centre for International Earth Science Information Network (CIESIN) were overlaid to generate the PWEL of PM10 for each state. The calculated PWEL of PM10 concentrations were then classified based on the World Health Organization (WHO) and the national Air Quality Guidelines (AQG) and interim targets (IT) for comparison. Results revealed that the annual mean PM10 concentrations in Malaysia ranged from 31 to 73 µg/m3 but became generally lower, ranging from 20 to 72 µg/m3 after population weighting, suggesting that the PM10 population exposure in Malaysia might have been overestimated. PWEL of PM10 distribution showed that the majority of the population lived in areas that complied with the national AQG, but were vulnerable to exposure level 3 according to the WHO AQG and IT, indicating that the population was nevertheless potentially exposed to significant health effects from long-term exposure to PM10 pollution.
Fulltext Cardiovascular, respiratory and all-cause (natural) health endpoint estimation using a spatial approach in Malaysia

Mazeli MI, Pahrol MA, Abdul Shakor AS, Kanniah KD, Omar MA

Sci Total Environ, 2023 May 20;874:162130.
PMID: 36804978 DOI: 10.1016/j.scitotenv.2023.162130

In 2016, the World Health Organization (WHO) estimated that approximately 4.2 million premature deaths worldwide were attributable to exposure to particulate matter 2.5 μm (PM2.5). This study assessed the environmental burden of disease attributable to PM2.5 at the national level in Malaysia. We estimated the population-weighted exposure level (PWEL) of PM10 concentrations in Malaysia for 2000, 2008, and 2013 using aerosol optical density (AOD) data from publicly available remote sensing satellite data (MODIS Terra). The PWEL was then converted to PM2.5 using Malaysia's WHO ambient air conversion factor. We used AirQ+ 2.0 software to calculate all-cause (natural), ischemic heart disease (IHD), stroke, chronic obstructive pulmonary disease (COPD), lung cancer (LC), and acute lower respiratory infection (ALRI) excess deaths from the National Burden of Disease data for 2000, 2008 and 2013. The average PWELs for annual PM2.5 for 2000, 2008, and 2013 were 22 μg m-3, 18 μg m-3 and 24 μg m-3, respectively. Using the WHO 2005 Air Quality Guideline cut-off point of PM2.5 of 10 μg m-3, the estimated excess deaths for 2000, 2008, and 2013 from all-cause (natural) mortality were between 5893 and 9781 (95 % CI: 3347-12,791), COPD was between 164 and 957 (95 % CI: 95-1411), lung cancer was between 109 and 307 (95 % CI: 63-437), IHD was between 3 and 163 deaths, according to age groups (95 % CI: 2-394) and stroke was between 6 and 155 deaths, according to age groups (95 % CI: 3-261). An increase in estimated health endpoints was associated with increased estimated PWEL PM2.5 for 2013 compared to 2000 and 2008. Adhering the ambient PM2.5 level to the Malaysian Air Quality Standard IT-2 would reduce the national health endpoints mortality.
Fulltext Compliance to Infection Prevention and Control Practices Among Healthcare Workers During COVID-19 Pandemic in Malaysia

Mohamad N, Pahrol MA, Shaharudin R, Md Yazin NKR, Osman Y, Toha HR, et al.

Front Public Health, 2022;10:878396.
PMID: 35923958 DOI: 10.3389/fpubh.2022.878396

Healthcare workers (HCWs) are at risk of contracting coronavirus disease-2019 (COVID-19) in their workplace. Infection prevention guidelines and standard operating procedures were introduced to reduce risk of exposure and prevent transmission. Safe practices during interaction with patients with COVID-19 are crucial for infection prevention and control (IPC). This study aimed to assess HCWs' compliance to IPC and to determine its association with sociodemographic and organizational factors. A cross-sectional study was conducted between March and April 2021 at public healthcare facilities in the east coast of Peninsular Malaysia. HCWs who were involved with COVID-19-related works were invited to participate in the online survey. The questionnaire was adapted from the World Health Organization (WHO) Interim Guidance: WHO Risk Assessment and Management of Exposure of Healthcare Workers in the Context of COVID-19. Respondents were categorized as compliant or non-compliant to IPC. A total of 600 HCWs involved in COVID-19-related works participated in the survey. Most of them (63.7%) were compliant to IPC as they responded to all items as "always, as recommended" during interaction with patients with COVID-19. The multivariate analysis showed that non-compliance was significantly associated with working in the emergency department (AOR = 3.16; 95% CI = 1.07-9.31), working as laboratory personnel (AOR = 15.13; 95% CI = 1.36-168.44), health attendant (AOR = 4.42; 95% CI = 1.74-11.24), and others (AOR = 3.63; 95% CI = 1.1-12.01), as well as work experience of more than 10 years (AOR = 4.71; 95% CI = 1.28-17.27). The odds of non-compliance among respondents without adequate new norms and personal protective equipment training were 2.02 (95% CI = 1.08-3.81) more than those with adequate training. Although most of the respondents complied to IPC protocols, compliance status differed according to department, work category, and years of service. Ensuring adequate training that will hopefully lead to behavioral change is crucial to prevent breach in IPC and thus minimize the risk of exposure to and transmission of COVID-19 in healthcare facilities.
Environmental surface sampling of SARS-CoV-2 in selected hospitals in Malaysia

Rajendiran S, Thahir SSA, Veloo Y, Suppiah J, Pahrol MA, Shakor ASA, et al.

Trop Biomed, 2021 Sep 01;38(3):462-468.
PMID: 34608120 DOI: 10.47665/tb.38.3.089

COVID-19 has spread rapidly worldwide. The role of fomites in facilitating onward transmission is plausible. This study aimed to determine the presence of viable virus and its persistence on the surfaces of fomites in wards treating COVID-19 patients in Malaysia. This study was conducted in two stages. First, environmental sampling was performed on random days in the intensive care unit (ICU) and general wards. Then, in the second stage, samples were collected serially on alternate days for 7 days in two selected general wards. In Stage 1, a total of 104 samples were collected from the surfaces of highly touched and used areas by patients and healthcare workers. Only three samples were tested positive for SARS-COV-2. In Stage 2, three surface samples were detected positive, but no persistence of the virus was observed. However, none of the SARS-CoV-2 RNA was viable through tissue culture. Overall, the environmental contamination of SARS-CoV-2 was low in this hospital setting. Hospitals' strict infection control and the compliance of patients with wearing masks may have played a role in these findings, suggesting adherence to those measures to reduce occupational exposure of COVID-19 in hospital settings.
Fulltext Concerns, perceived impact, practices, preventive measures, and stress among healthcare workers during COVID-19 pandemic in Malaysia

Pahrol MA, Ismail R, Mohamad N, Lim YC, Muhamad Robat R, Rajendiran S, et al.

Front Public Health, 2023;11:1028443.
PMID: 36935685 DOI: 10.3389/fpubh.2023.1028443

INTRODUCTION: Healthcare workers (HCWs) have been continually exposed to patients with COVID-19 and are at higher risk of contracting the disease. Their psychological health is important for overall wellbeing and productivity, which could lead to a reduction in human errors during the pandemic crisis. This study aimed to measure the level of concerns, work practices, adequacy of preventive measures among HCWs, and the impacts on their life and work, including mental health status during the second wave of the COVID-19 pandemic in Malaysia.
METHODS: An online questionnaire was distributed randomly to 1,050 HCWs from the Ministry of Health facilities in the Klang Valley who were involved directly in managing or screening COVID-19 cases from May to August 2020. The questionnaire was divided into five domains, which were concerns, impact on life and work, practice, perceived adequacy of preventive measures, and Revised Impact of Event Scale (IES-R). Logistic regression was used to identify sociodemographic predictors of the five domains.
RESULTS: A total of 907 respondents (86.4%) participated in this survey. Approximately half of the respondents had a low concern (50.5%), most of them had a good practice (85.1%), with 67.5% perceiving there were adequate preventive measures, and they perceived the outbreak had a low impact (92%) on their life and work. From the IES-R domain, 18.6% of respondents potentially suffered from post-traumatic stress disorder (PTSD).
CONCLUSION: During the second wave of the COVID-19 outbreak in Malaysia, HCWs practiced high levels of precautions and preventive measures because they were aware of the risk of infection as an occupational hazard. With the adequate implementation of policy and control measures, the psychological wellbeing of the majority HCWs remained well and adequately supported.
Fulltext The effect of N95 designs on respirator fit and its associations with gender and facial dimensions

Khairul Hasni NA, Ismail R, Muhamad Robat R, Mohamad N, Suib FA, Pahrol MA, et al.

PLoS One, 2023;18(11):e0288105.
PMID: 38019763 DOI: 10.1371/journal.pone.0288105

This study examined the association of various brands of NIOSH-certified N95 filtering face-piece respirators (FFR) fit with facial dimensions and gender. One hundred and thirty-five participants (77 females and 58 males) were recruited from the previous facial anthropometry study among Malaysians in 2020. Quantitative respirator fit testing of six FFR were performed using the TSI Portacount Pro+ 8038 which comprised of four exercises (bending over, talking, up-down head movement, and side to side head movement). An overall fit factor (FF) of ≥ 100 was considered a pass for each FFR. Analysis was done using T-test, Pearson's correlations, and generalised linear regression. The passing rates for the six FFR were 36.3% (Cup B), 50.4% (Trifold A), 54.1% (Duckbill A), 57.0% (Cup A), 74.1% (Trifold B), and 83.7% (Duckbill B). Both Duckbill B and Trifold B had the highest passing rates for both genders. However, certain FFR models (Cup B, Trifold A, Trifold B, and Duckbill A) fit better for participants with large facial size who were mostly males, while others (Cup A and Duckbill B) specifically fit better for those with small facial size, who were mostly females. This study showed significant positive effect of nose protrusion, nasal root and subnasale-sellion and the negative effect of menton-sellion, bigonial breadth and nose breadth on fit factors of various FFR. The results of this study emphasized the importance of choosing and designing FFR based on local anthropometry data, with careful consideration on the dimensions that affect the respirator fit. Since N95 are commonly used in the healthcare settings to prevent airborne transmission, the practice of respirator fit testing and selecting N95 with high passing rates for healthcare workers need to be emphasized.
Fulltext Droplet digital PCR application for the detection of SARS-CoV-2 in air sample

Rashid SA, Nazakat R, Muhamad Robat R, Ismail R, Suppiah J, Rajendran K, et al.

Front Public Health, 2023;11:1208348.
PMID: 37965510 DOI: 10.3389/fpubh.2023.1208348

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) may transmit through airborne route particularly when the aerosol particles remain in enclosed spaces with inadequate ventilation. There has been no standard recommended method of determining the virus in air due to limitations in pre-analytical and technical aspects. Furthermore, the presence of low virus loads in air samples could result in false negatives. Our study aims to explore the feasibility of detecting SARS-CoV-2 ribonucleic acid (RNA) in air samples using droplet digital polymerase chain reaction (ddPCR). Active and passive air sampling was conducted between December 2021 and February 2022 with the presence of COVID-19 confirmed cases in two hospitals and a quarantine center in Klang Valley, Malaysia. SARS-CoV-2 RNA in air was detected and quantified using ddPCR and real-time reverse transcriptase-polymerase chain reaction (RT-PCR). The comparability of two different digital PCR platforms (QX200 and QIAcuity) to RT-PCR were also investigated. Additionally negative staining transmission electron microscopy was performed to visualize virus ultrastructure. Detection rates of SARS-CoV-2 in air samples using ddPCR were higher compared to RT-PCR, which were 15.2% (22/145) and 3.4% (5/145), respectively. The sensitivity and specificity of ddPCR was 100 and 87%, respectively. After excluding 17 negative samples (50%) by both QX200 and QIAcuity, 15% samples (5/34) were found to be positive both ddPCR and dPCR. There were 23.5% (8/34) samples that were detected positive by ddPCR but negative by dPCR. In contrast, there were 11.7% (4/34) samples that were detected positive by dPCR but negative by ddPCR. The SARS-CoV-2 detection method by ddPCR is precise and has a high sensitivity for viral RNA detection. It could provide advances in determining low viral titter in air samples to reduce false negative reports, which could complement detection by RT-PCR.