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  1. Leder K, Openshaw JJ, Allotey P, Ansariadi A, Barker SF, Burge K, et al.
    BMJ Open, 2021 01 08;11(1):e042850.
    PMID: 33419917 DOI: 10.1136/bmjopen-2020-042850
    INTRODUCTION: Increasing urban populations have led to the growth of informal settlements, with contaminated environments linked to poor human health through a range of interlinked pathways. Here, we describe the design and methods for the Revitalising Informal Settlements and their Environments (RISE) study, a transdisciplinary randomised trial evaluating impacts of an intervention to upgrade urban informal settlements in two Asia-Pacific countries.

    METHODS AND ANALYSIS: RISE is a cluster randomised controlled trial among 12 settlements in Makassar, Indonesia, and 12 in Suva, Fiji. Six settlements in each country have been randomised to receive the intervention at the outset; the remainder will serve as controls and be offered intervention delivery after trial completion. The intervention involves a water-sensitive approach, delivering site-specific, modular, decentralised infrastructure primarily aimed at improving health by decreasing exposure to environmental faecal contamination. Consenting households within each informal settlement site have been enrolled, with longitudinal assessment to involve health and well-being surveys, and human and environmental sampling. Primary outcomes will be evaluated in children under 5 years of age and include prevalence and diversity of gastrointestinal pathogens, abundance and diversity of antimicrobial resistance (AMR) genes in gastrointestinal microorganisms and markers of gastrointestinal inflammation. Diverse secondary outcomes include changes in microbial contamination; abundance and diversity of pathogens and AMR genes in environmental samples; impacts on ecological biodiversity and microclimates; mosquito vector abundance; anthropometric assessments, nutrition markers and systemic inflammation in children; caregiver-reported and self-reported health symptoms and healthcare utilisation; and measures of individual and community psychological, emotional and economic well-being. The study aims to provide proof-of-concept evidence to inform policies on upgrading of informal settlements to improve environments and human health and well-being.

    ETHICS: Study protocols have been approved by ethics boards at Monash University, Fiji National University and Hasanuddin University.

    TRIAL REGISTRATION NUMBER: ACTRN12618000633280; Pre-results.

  2. Chan KY, Adeloye D, Asante KP, Calia C, Campbell H, Danso SO, et al.
    J Glob Health, 2019 Dec;9(2):020103.
    PMID: 31893025 DOI: 10.7189/jogh.09.020103
  3. Jahan NK, Ahmad MP, Dhanoa A, Meng CY, Ming LW, Reidpath DD, et al.
    Infect Dis Poverty, 2016;5(1):76.
    PMID: 27510731 DOI: 10.1186/s40249-016-0172-3
    Globally, dengue infections constitute a significant public health burden. In recent decades, Malaysia has become a dengue hyper-endemic country with the co-circulation of the four dengue virus serotypes. The cyclical dominance of sub-types contributes to a pattern of major outbreaks. The consequences can be observed in the rising incidence of reported dengue cases and dengue related deaths. Understanding the complex interaction of the dengue virus, its human hosts and the mosquito vectors at the community level may help develop strategies for addressing the problem.
  4. Dhanoa A, Hassan SS, Jahan NK, Reidpath DD, Fatt QK, Ahmad MP, et al.
    Infect Dis Poverty, 2018 Jan 16;7(1):1.
    PMID: 29335021 DOI: 10.1186/s40249-017-0384-1
    BACKGROUND: The frequency and magnitude of dengue epidemics continue to increase exponentially in Malaysia, with a shift in the age range predominance toward adults and an expansion to rural areas. Despite this, information pertaining to the extent of transmission of dengue virus (DENV) in the rural community is lacking. This community-based pilot study was conducted to establish DENV seroprevalence amongst healthy adults in a rural district in Southern Malaysia, and to identify influencing factors.

    METHODS: In this study undertaken between April and May 2015, a total of 277 adult participants were recruited from households across three localities in the Sungai Segamat subdistrict in Segamat district. Sera were tested for immunoglobulin G (IgG) (Panbio® Dengue Indirect IgG ELISA/high-titer capture) and immunoglobulin M (IgM) (Panbio®) antibodies. The plaque reduction neutralization test (PRNT) was conducted on random samples of IgG-positive sera for further confirmation. Medical history and a recall of previous history of dengue were collected through interviews, whereas sociodemographic information was obtained from an existing database.

    RESULTS: The overall seroprevalence for DENV infection was 86.6% (240/277) (95% CI: 83-91%). Serological evidence of recent infection (IgM/high-titer capture IgG) was noted in 11.2% (31/277) of participants, whereas there was evidence of past infection in 75.5% (209/277) of participants (indirect IgG minus recent infections). The PRNT assay showed that the detected antibodies were indeed specific to DENV. The multivariate analysis showed that the older age group was significantly associated with past DENV infections. Seropositivity increased with age; 48.5% in the age group of <25 years to more than 85% in age group of >45 years (P 

  5. McGrattan A, Mohan D, Chua PW, Mat Hussin A, Soh YC, Alawad M, et al.
    BMJ Open, 2020 08 27;10(8):e035453.
    PMID: 32859661 DOI: 10.1136/bmjopen-2019-035453
    INTRODUCTION: Global population ageing is one of the key factors linked to the projected rise of dementia incidence. Hence, there is a clear need to identify strategies to overcome this expected health burden and have a meaningful impact on populations' health worldwide. Current evidence supports the role of modifiable dietary and lifestyle risk factors in reducing the risk of dementia. In South-East Asia, changes in eating and lifestyle patterns under the influence of westernised habits have resulted in significant increases in the prevalence of metabolic, cardiovascular and neurodegenerative non-communicable diseases (NCDs). Low vegetable consumption and high sodium intake have been identified as key contributors to the increased prevalence of NCDs in these countries. Therefore, nutritional and lifestyle strategies targeting these dietary risk factors are warranted. The overall objective of this randomised feasibility trial is to demonstrate the acceptability of a dietary intervention to increase the consumption of high-nitrate green leafy vegetables and reduce salt intake over 6 months among Malaysian adults with raised blood pressure.

    METHODS AND ANALYSIS: Primary outcomes focus on feasibility measures of recruitment, retention, implementation and acceptability of the intervention. Secondary outcomes will include blood pressure, cognitive function, body composition and physical function (including muscle strength and gait speed). Adherence to the dietary intervention will be assessed through collection of biological samples, 24-hour recall and Food Frequency Questionnaire. A subgroup of participants will also complete postintervention focus groups to further explore the feasibility considerations of executing a larger trial, the ability of these individuals to make dietary changes and the barriers and facilitators associated with implementing these changes.

    ETHICS AND DISSEMINATION: Ethical approval has been obtained from Monash University Human Research Ethics Committee and Medical Research and Ethics Committee of Malaysia. Results of the study will be disseminated via peer-reviewed publications and presentations at national and international conferences.ISRCTN47562685; Pre-results.

  6. Koly KN, Tasnim Z, Ahmed S, Saba J, Mahmood R, Farin FT, et al.
    BMC Psychiatry, 2022 Dec 19;22(1):797.
    PMID: 36529761 DOI: 10.1186/s12888-022-04414-z
    BACKGROUND: Mental health remains a highly stigmatized area of healthcare, and people often conceal their concerns rather than seek assistance or treatment. The Women Support Initiative Forum (WSIF) is a social media platform established in 2018 to provide expert and peer-led psychosocial support services to women of all ages in Bangladesh. The anonymous nature of the forum means that mental health concerns can be aired without fear of identification.

    METHOD: A content analysis was conducted on the anonymous posts retrieved from the WSIF platform between 8th March 2020 and 7th July 2022. Around 1457 posts were initially selected for analysis which was reduced to 1006 after removing duplicates and non-relevant posts, such as queries about the addresses of the doctors and other non-mental health-related issues. A thematic analysis of the data was conducted using an inductive approach.

    RESULT: The 1006 posts generated four themes and nine sub-themes. All the women mentioned mental health symptoms (n = 1006; 100%). Most also mentioned reasons for seeking mental healthcare (n = 818; 81.31%), healthcare-seeking behavior (n = 667; 66.30%), and barriers to seeking mental healthcare (n = 552; 54.87%). The majority of women described symptoms of stress, depression, and anxiety-like symptoms, which were aggregated under common mental health conditions. Mental health symptoms were ascribed to various external influences, including marital relationship, intrafamilial abuse, and insecurities related to the COVID-19 pandemic. A large proportion of posts were related to women seeking information about mental healthcare services and service providers (psychologists or psychiatrists). The analysis found that most women did not obtain mental healthcare services despite their externalized mental health symptoms. The posts identified clear barriers to women accessing mental health services, including low mental health literacy, the stigma associated with mental healthcare-seeking behavior, and the poor availability of mental health care services.

    CONCLUSION: The study revealed that raising mass awareness and designing culturally acceptable evidence-based interventions with multisectoral collaborations are crucial to ensuring better mental healthcare coverage for women in Bangladesh.

  7. Allotey P, Reidpath DD, Devarajan N, Rajagobal K, Yasin S, Arunachalam D, et al.
    Glob Health Action, 2014 Dec;7(1):23176.
    PMID: 28672450 DOI: 10.3402/gha.v7.23176
    Background Community engagement is an increasingly important requirement of public health research and plays an important role in the informed consent and recruitment process. However, there is very little guidance about how it should be done, the indicators for assessing effectiveness of the community engagement process and the impact it has on recruitment, retention, and ultimately on the quality of the data collected as part of longitudinal cohort studies. Methods An instrumental case study approach, with data from field notes, policy documents, unstructured interviews, and focus group discussions with key community stakeholders and informants, was used to explore systematically the implementation and outcomes of the community engagement strategy for recruitment of an entire community into a demographic and health surveillance site in Malaysia. Results For a dynamic cohort, community engagement needs to be an ongoing process. The community engagement process has likely helped to facilitate the current response rate of 85% in the research communities. The case study highlights the importance of systematic documentation of the community engagement process to ensure an understanding of the effects of the research on recruitment and the community. Conclusions A critical lesson from the case study data is the importance of relationships in the recruitment process for large population-based studies, and the need for ongoing documentation and analysis of the impact of cumulative interactions between research and community engagement.
  8. Foo CY, Andrianopoulos N, Brennan A, Ajani A, Reid CM, Duffy SJ, et al.
    Sci Rep, 2019 12 27;9(1):19978.
    PMID: 31882674 DOI: 10.1038/s41598-019-56353-7
    Literature studying the door-to-balloon time-outcome relation in coronary intervention is limited by the potential of residual biases from unobserved confounders. This study re-examines the time-outcome relation with further consideration of the unobserved factors and reports the population average effect. Adults with ST-elevation myocardial infarction admitted to one of the six registry participating hospitals in Australia were included in this study. The exposure variable was patient-level door-to-balloon time. Primary outcomes assessed included in-hospital and 30 days mortality. 4343 patients fulfilled the study criteria. 38.0% (1651) experienced a door-to-balloon delay of >90 minutes. The absolute risk differences for in-hospital and 30-day deaths between the two exposure subgroups with balanced covariates were 2.81 (95% CI 1.04, 4.58) and 3.37 (95% CI 1.49, 5.26) per 100 population. When unmeasured factors were taken into consideration, the risk difference were 20.7 (95% CI -2.6, 44.0) and 22.6 (95% CI -1.7, 47.0) per 100 population. Despite further adjustment of the observed and unobserved factors, this study suggests a directionally consistent linkage between longer door-to-balloon delay and higher risk of adverse outcomes at the population level. Greater uncertainties were observed when unmeasured factors were taken into consideration.
  9. Hwong WY, Bots ML, Selvarajah S, Sivasampu S, Reidpath DD, Law WC, et al.
    Int J Stroke, 2019 10;14(8):826-834.
    PMID: 30843480 DOI: 10.1177/1747493019832995
    BACKGROUND: Sex differences in cardiovascular diseases generally disadvantage women, particularly within developing regions.

    AIMS: This study aims to examine sex-related differences in stroke metrics across Southeast Asia in 2015. Furthermore, relative changes between sexes are compared from 1990 to 2015.

    METHODS: Data were sourced from the Global Burden of Disease Study. Incidence and mortality from ischemic and hemorrhagic strokes were explored with the following statistics derived: (1) women-to-men incidence/mortality ratio and (2) relative percentage change in rate.

    RESULTS: Women had lower incidence and mortality from stroke compared to men. Notable findings include higher ischemic stroke incidence for women at 30-34 years in high-income countries (women-to-men ratio: 1.3, 95% CI: 0.1, 16.2 in Brunei and 1.3, 95% CI: 0.5, 3.2 in Singapore) and the largest difference between sexes for ischemic stroke mortality in Vietnam and Myanmar across most ages. Within the last 25 years, greater reductions for ischemic stroke metrics were observed among women compared to men. Nevertheless, women below 40 years in some countries showed an increase in ischemic stroke incidence between 0.5% and 11.4%, whereas in men, a decline from -4.2% to -44.2%. Indonesia reported the largest difference between sexes for ischemic stroke mortality; a reduction for women whereas an increase in men. For hemorrhagic stroke, findings were similar: higher incidence among young women in high-income countries and greater reductions for stroke metrics in women than men over the last 25 years.

    CONCLUSIONS: Distinct sex-specific differences observed across Southeast Asia should be accounted in future stroke preventive guidelines.

  10. Nwameme A, Dako-Gyeke P, Asampong E, Allotey P, Reidpath DD, Certain E, et al.
    PLoS Negl Trop Dis, 2023 Mar;17(3):e0011139.
    PMID: 36961830 DOI: 10.1371/journal.pntd.0011139
    The Special Programme for Research and Training in Tropical Diseases developed a massive open online course (MOOC) on implementation research with a focus on infectious diseases of poverty (IDPs) to reinforce the explanation of implementation research concepts through real case studies. The target MOOC participant group included public health officers, researchers and students. By reshaping institutions and building resilience in communities and systems, implementation research will allow progress towards universal health coverage and sustainable development goals. This study evaluates learners' knowledge in implementation research after completing the MOOC using anonymous exit survey responses. Of the almost 4000 enrolled in the two sessions of the MOOC in 2018, about 30% completed all five modules and the assessments, and were awarded certificates. The majority of the participants were early to mid-career professionals, under the age of 40, and from low- and middle-income countries. They were slightly more likely to be men (56%) with a Bachelor or a Master's degree. Participants were public health researchers (45%), public health officers (11%) or students (11%). On completion of the course, an exit survey revealed that 80.9% of respondents indicated significant improvement to strong and very strong implementation research knowledge. This evaluation clearly shows the usefulness of the MOOC on implementation research for reaching out to field researchers and public health practitioners who are facing problems in the implementation of control programmes in low- and middle-income countries.
  11. Schliemann D, Hoe WMK, Mohan D, Allotey P, Reidpath DD, Tan MM, et al.
    PLoS One, 2022;17(5):e0267308.
    PMID: 35594267 DOI: 10.1371/journal.pone.0267308
    INTRODUCTION: Breast cancer patients in low- and middle-income countries often present at an advanced stage. This qualitative study elicited views regarding the challenges and opportunities for breast cancer screening and early detection among women in a low-income semi-rural community in Segamat district, Malaysia.

    METHODS: Individual semi-structured interviews with 22 people (health professionals, cancer survivors, community volunteers and member from a non-governmental organization) and four focus group discussions (n = 22 participants) with women from a local community were conducted. All participants were purposively sampled and female residents registered with the South East Asia Community Observatory aged ≥40 years were eligible to participate in the focus group discussions. Data were transcribed verbatim and analyzed using thematic analysis.

    RESULTS: The thematic analysis illuminated barriers, challenges and opportunities across six domains: (i) personal experiences and barriers to help-seeking as well as financial and travel access barriers; (ii) primary care challenges (related to delivering clinical breast examination and teaching breast-self-examination); (iii) secondary care challenges (related to mammogram services); (iv) disconnection between secondary and primary care breast cancer screening pathways; and (v) opportunities to improve breast cancer early detection relating to community civil service society activities (i.e. awareness raising, support groups, addressing stigma/embarrassment and encouraging husbands to support women) and vi) links between public healthcare personnel and community (i.e. improving breast self-examination education, clinical breast examination provision and subsidised mammograms).

    CONCLUSION: The results point to a variety of reasons for low uptake and, therefore, to the complex nature of improving breast cancer screening and early detection. There is a need to adopt a systems approach to address this complexity and to take account of the socio-cultural context of communities in order, in turn, to strengthen cancer control policy and practices in Malaysia.

  12. Partap U, Young EH, Allotey P, Soyiri IN, Jahan N, Komahan K, et al.
    Int J Epidemiol, 2017 Oct 01;46(5):1370-1371g.
    PMID: 29024948 DOI: 10.1093/ije/dyx113
  13. Naftalin CM, Wong NS, Chan DP, Wong KH, Reidpath DD, Lee SS
    Int J STD AIDS, 2015 Oct;26(11):803-9.
    PMID: 25281539 DOI: 10.1177/0956462414553826
    To explore the heterogeneity of CD4 responses following highly active antiretroviral therapy, the patterns of CD4 recovery of HIV-1-infected Chinese patients who have been on their first antiretroviral regimen for ≥5 years were analysed. The CD4 trajectories were traced, smoothed and differentiated into three defined profiles. Half (56.3%) were 'satisfactory responders', with CD4 gain of >100 cells/μL and a peak of >350 cells/μL, plateauing before the end of Year 5. Thirty-three (24.4%) were 'continuing responders' whose CD4 rise persisted at Year 4-5. The remaining 26 (19.3%) were 'poor responders'. Presentation with AIDS before therapy was common not just among 'poor' but also paradoxically the 'continuing' responders. While a majority had responded well to antiretroviral therapy, older patients and those with AIDS diagnosis before initiation of therapy may never achieve a satisfactory level even with effective treatment. Categorization of HIV patients by their CD4 trajectory may support the prediction of immunological outcome over time, and ultimately inform treatment choices.
  14. Jahan N, Allotey P, Arunachalam D, Yasin S, Soyiri IN, Davey TM, et al.
    BMC Public Health, 2014;14 Suppl 2:S8.
    PMID: 25081203 DOI: 10.1186/1471-2458-14-S2-S8
    Health services can only be responsive if they are designed to service the needs of the population at hand. In many low and middle income countries, the rate of urbanisation can leave the profile of the rural population quite different from the urban population. As a consequence, the kinds of services required for an urban population may be quite different from that required for a rural population. This is examined using data from the South East Asia Community Observatory in rural Malaysia and contrasting it with the national Malaysia population profile.
  15. Reidpath DD, Davey TM, Kadirvelu A, Soyiri IN, Allotey P
    Prev Med, 2014 Feb;59:37-41.
    PMID: 24270054 DOI: 10.1016/j.ypmed.2013.11.011
    OBJECTIVES: Evidence that age of smoking initiation represents a risk factor for regular smoking in adolescence is complicated by inconsistencies in the operational definition of smoking initiation and simultaneous inclusion of age as an explanatory variable. The aim of this study was to examine the relationship between age, age of smoking initiation and subsequent regular smoking.
    METHODS: A secondary analysis was conducted of the U.S. Youth Risk Behavior Survey 2011. A sex stratified multivariable logistic regression analysis was used to model the likelihood of regular smoking with age and age of smoking initiation as explanatory variables and race/ethnicity as a covariate.
    RESULTS: After controlling for race/ethnicity, age and age of smoking initiation were independently associated with regular smoking in males and females. Independent of age, a one year's decrease in the age of smoking initiation was associated with a 1.27 times increase in odds of regular smoking in females (95% CI: 1.192-1.348); and similar associations for males (OR: 1.28; 95% CI: 1.216-1.341).
    CONCLUSION: While the majority of high school students do not become regular smokers after initiating smoking, earlier initiation of smoking is associated with subsequent regular smoking irrespective of sex or race/ethnicity. These findings have potentially important implications for intervention targeting.
    KEYWORDS: Adolescent; Epidemiology; Smoking
  16. Reidpath DD, Cheah JC, Lam FC, Yasin S, Soyiri I, Allotey P
    Nutr J, 2013;12:135.
    PMID: 24093886 DOI: 10.1186/1475-2891-12-135
    BACKGROUND: Measures of central adiposity are better predictors of adverse health events than BMI. Nonetheless, BMI is more widely used in health research. One reason for this may be the limited research supporting the self-measurement of waist and hip circumference. The lack of validity studies is particularly acute in Asia. The main objective was to establish the validity of self-measurement of waist and hip circumference in a community setting and the correlation of those measures with BMI, blood pressure, and blood glucose levels.
    METHODS: A community based, cross-sectional survey. A "healthy living expo" at a shopping mall in a rural town on peninsular Malaysia One hundred and thirty six (136) individuals volunteered to participate in the study, 125 of whom met the inclusion criteria. The ethnic distribution of the participants was 80% Chinese, 17% Malay and 3% Indian. Most participants were female (60%), with participants' ages ranging from 18 to 78 years (mean, 47.2). Self and assisted measurements of waist and hip were taken. Blood pressure, non-fasting blood glucose, height, and weight were also measured. Bland Altman plots and Lin's concordance coefficient were used to measure agreement between self and assisted measures. Pearson's correlation was used to examine the association of self and assisted measures with blood pressure, blood glucose, and BMI.
    RESULTS: There was a downwards bias in self measured waist (-0.81 cm) and hip (-1 cm) circumferences compared with assisted measures. The concordance for the self and assisted measures of waist, hip and the ratio of the two were, respectively, .96, .93 , and .84. The correlation between measures of central adiposity and BMI, blood pressure and blood glucose were similar for self and assisted measures.
    CONCLUSION: The results provide additional support for the use of self-measurement of waist and hip circumference studies of central adiposity, but is limited by the specificity of the setting.
  17. Allotey P, Yasin S, Tang S, Chong SL, Cheah JC, Reidpath DD
    BMC Public Health, 2012;12 Suppl 1:S1.
    PMID: 22992275
  18. Allotey P, Reidpath DD, Yasin S, Chan CK, de-Graft Aikins A
    Lancet, 2011 Feb 5;377(9764):450-1.
    PMID: 21074257 DOI: 10.1016/S0140-6736(10)61856-9
  19. Allotey PA, Reidpath DD, Evans NC, Devarajan N, Rajagobal K, Bachok R, et al.
    Glob Health Action, 2015 Jan;8(1):28219.
    PMID: 28156759 DOI: 10.3402/gha.v8.28219
    Background Verbal autopsies have gained considerable ground as an acceptable alternative to medically determined cause of death. Unlike with clinical or more administrative settings for data collection, verbal autopsies require significant involvement of families and communities, which introduces important social and cultural considerations. However, there is very little clear guidance about the methodological issues in data collection. The objectives of this case study were: to explore the range of bereavement rituals within the multi-ethnic, multi-faith population of the district; to investigate the preparedness of communities to talk about death; to describe the verbal autopsy process; to assess the effects of collecting verbal autopsy data on data collectors; and to determine the most accurate sources of information about deaths in the community. Methods A case study approach was used, using focus group discussions, indepth interviews and field notes. Thematic analyses were undertaken using NVivo. Results Consideration of cultural bereavement practices is importance to acceptance and response rates to verbal autopsies. They are also important to the timing of verbal autopsy interviews. Well trained data collectors, regardless of health qualifications are able to collect good quality data, but debriefing is important to their health and well being. This article contributes to guidance on the data collection procedures for verbal autopsies within community settings.
  20. Tan MM, Reidpath DD, Ting RS, Allotey P, Su TT
    J Relig Health, 2021 Jul 29.
    PMID: 34324099 DOI: 10.1007/s10943-021-01371-x
    Research has shown that religion is associated with a better quality of life (QoL). This study aims to examine ethnic differences in the association between religion and the QoL of older adults in a predominantly Muslim population within a multicultural setting. Two-wave data of 3,810 participants consisting of mostly Muslims and older adults aged ≥ 55 years were collected as part of the community health surveys conducted in 2013 and 2018 in the South East Asia Community Observatory (SEACO). Both cross-sectional analyses of baseline data and prospective analyses of longitudinal data were conducted. The associations between religiosity and quality of life were mainly positive in the cross-sectional analysis. In the two-wave analysis, religious importance was negatively associated with QoL among the Malays (B = - 1.103, SE B = 0.029, p 
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