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  1. Lim SY, Harun UB, Gobil AR, Mustafa NA, Zahid NA, Amin-Nordin S, et al.
    PLoS One, 2021;16(9):e0256896.
    PMID: 34469489 DOI: 10.1371/journal.pone.0256896
    Determining the level of customer satisfaction in cleanliness regarding a product or service is a significant aspect of businesses. However, the availability of feedback tools for consumers to evaluate the cleanliness of a restaurant is a crucial issue as several aspects of cleanliness need to be evaluated collectively. To overcome this issue, this study designed a survey instrument based on the standard form used for grading the food premises and transformed it into a seven Likert scale questionnaire and consists of seven questions. This study employed fuzzy conjoint analysis to measure the level of satisfaction in cleanliness in food premises. This pilot study recruited 30 students in Universiti Teknologi MARA (UiTM) Seremban 3. The student's perception was represented by the scores calculated based on their degree of similarities and corresponding levels of satisfaction, whereby, only scores with the highest degree of similarity were selected. Furthermore, this study identified the aspects of hygiene that assessed based on the customers' satisfaction upon visiting the premises. The results indicated that the fuzzy conjoint analysis produced a similar outcome as the statistical mean, thus, was useful for the evaluation of customer satisfaction on the cleanliness of food premises.
  2. Okafor CO, Zulkefli NAM, Muthiah SG
    Afr Health Sci, 2022 Sep;22(3):34-46.
    PMID: 36910385 DOI: 10.4314/ahs.v22i3.6
    BACKGROUND: The aim of this study is to determine the current practice level of family planning and the associated factors among public secondary school teachers in Enugu East Senatorial District.

    METHOD: A cross-sectional study was carried out among public secondary school teachers, aged 18 - 60 years, in Enugu East Senatorial District, using probability proportional to size sampling and systematic random sampling to select 1000 participants. Binary and multiple logistic regression analyses were used to determine association. An odds ratio with a 95% confidence interval (CI) was computed to determine the level of significance.

    RESULTS: The current practice level of family planning is 26.5%. Respondents with bachelor in education were 2 times more likely to be a current user of family planning (AOR=2.39; 95% CI: 1.25-4.55). However, respondents in age group 38 years and above were less likely to be a current user of family planning (AOR=0.64; 95% CI: 0.43-0.95), likewise female respondents (AOR=0.66; 95% CI: 0.44-0.98). Additionally, respondents who mentioned radio (AOR=0.64; 95%CI: 0.44-0.93), social media (AOR=0.73; 95% CI: 0.53-0.99) and healthcare (AOR=0.61; 95%CI: 0.43-0.88) as source of information were less likely to be current user of family planning. Whereas, partner who encouraged the use of family planning (AOR=2.54; 95% CI: 1.71-3.78) span style="font-family:'Times New Roman'; font-weight:bold">, partner who allow each other to decide on family planning methods (AOR=4.47; 95% CI: 2.67-7.48) and those who had good knowledge of family planning (AOR=1.96; 95% CI: 1.40-2.67) were more likely to be current user of family planning.

    CONCLUSION: The level of current practice of family planning is low and a significant number of factors predict the current practice of family planning. A family planning educational workshop among teachers is needed to improve teacher's knowledge on family planning to address the issue of adolescent sexual reproduction as teachers are vessels of knowledge impartation to students.

  3. Rahim NIA, Kadir Shahar H, Zulkefli NAM, Mohd Nazan AIN
    PLoS One, 2023;18(8):e0282995.
    PMID: 37585377 DOI: 10.1371/journal.pone.0282995
    BACKGROUND: Unintentional injury is a global burden that occurs everywhere, including in our homes. Young children are most vulnerable to home injuries because they still develop their physical and psychological skills and spend most of their time at home. Despite being largely preventable, three consecutive national surveys show no reduction in the rate of injury among children under five. More surprisingly, children from high-income families were found to have the highest incidence of injury, contradicting the findings from other countries.

    OBJECTIVE: This study aims to identify the determinants of non-adherence to unintentional home injury prevention practice among parents of under-five children in the North Seberang Perai district, Penang.

    METHODS: This sequential explanatory mixed-methods study consists of two phases consisting of a quantitative study which looks into respondents and their child's sociodemographic status, their home injury prevention practice and the independent variables, followed by a qualitative study that interviews parents with non-adherence to home injury prevention practice and explore their barriers. In phase I, the parent or primary caregiver of a child age less than five years old who age 18 or older and is a Malaysian will be included in the study while being disabled or having a severe psychiatric disorder or having the index child diagnosed with chronic disease will make them not eligible to participate in the study. Derived using the two-group proportion formula, a sample size of 453 parents will be sampled among those with under-five children following up at the Maternal Child Health Department in the health clinics of North Seberang Perai using stratified systematic sampling. Chi-square/Fisher Exact test, simple logistic regression and multiple logistic regression will be used for data analysis. The sample will be stratified according to household income to look for associated factors and determinants of low prevention practice. In phase II, parents with a low score from the quantitative study will be selected to participate in the qualitative study using purposive sampling. A semi-structured interview using the help of an interview guide will be carried out and recorded with a voice recorder. The thematic analysis approach will be used to analyse the qualitative data.

    RESULTS: The study has been registered under the National Medical Research Registry.

    CONCLUSION: It is hoped that findings from this study can shed light on the barriers faced by under-five parents in carrying out preventive measures at home.

  4. Balami AD, Said SM, Zulkefli NAM, Bachok N, Balami EL
    BMC Med Res Methodol, 2019 07 18;19(1):157.
    PMID: 31319810 DOI: 10.1186/s12874-019-0803-z
    BACKGROUND: Sleeping under a long-lasting insecticidal net (LLIN) is recommended for all pregnant women in sub-Saharan Africa, due to the high prevalence of malaria infection and its associated complications in the region. Despite this, LLIN use has still remained sub-optimal among pregnant women in Maiduguri, Nigeria. Understanding the interplay of factors influencing this important health behaviour would guide the development of interventions to promote its adoption.

    METHODS: Data was collected from 380 randomly selected antenatal care attendees of a hospital in Maiduguri, using structured questionnaires. This data was then used to test the Information-Motivation-Behavioural Skills (IMB) model, for model fit, and interrelations among the constructs, using the structural equation modelling analysis with Smart-PLS.

    RESULTS: Information and motivation were significantly related to behavioural skills (r = 0.29, p 

  5. Balami AD, Said SM, Zulkefli NAM, Bachok N, Audu B
    Malar J, 2019 Feb 20;18(1):41.
    PMID: 30786906 DOI: 10.1186/s12936-019-2676-3
    BACKGROUND: The levels of insecticide-treated net use among pregnant women and uptake of intermittent preventive treatment in pregnancy, have been sub-optimal in Nigeria. Previous studies have reported positive correlations between knowledge, attitude and practice of malaria preventive measures. It has also been reported that information and motivation, act through a mediator (behavioural skills), to cause a health behaviour change. The aim of this study was as such to develop, implement, and assess the effects of a health educational intervention based on the information-motivation-behavioural skills (IMB) model on the levels of knowledge, motivation, and behavioural skills for ITN use and IPTp uptake among pregnant women in a hospital in north-eastern Nigeria.

    METHODS: This was a randomized controlled parallel-group trial in which 372 antenatal care attendees were randomly assigned to either an intervention or control group after collecting baseline data using a structured questionnaire. The intervention group received a 4-h health education on malaria, guided by a module developed based on the IMB theory, while the control group received health education on breastfeeding for a similar duration and by the same facilitator. Follow-up data were subsequently collected at 2 months and at 4 months post-intervention using the same questionnaire. The generalized linear mixed models analysis was used to determine the between-group and within-group effects of the intervention. The intention-to-treat analysis was used after missing data had been replaced. This was followed by a sensitivity analysis, where the analyses were repeated without replacing the missing values.

    RESULTS: The intervention was significant in achieving a 12.75% (p 

  6. Balami AD, Said SM, Zulkefli NAM, Norsa'adah B, Audu B
    Malar J, 2021 Jan 21;20(1):55.
    PMID: 33478529 DOI: 10.1186/s12936-021-03586-5
    BACKGROUND: The prevalence of malaria in pregnancy and its complications, remain very high in Nigeria. This study aimed to determine the effects of a malaria health educational intervention based on the information-motivation-behavioural skills (IMB) model on malaria preventive practices and pregnancy outcomes.

    METHODS: The study was a randomized controlled parallel-group study, where 372 randomly selected antenatal care attendees were randomly assigned to one of either two groups after collecting baseline data. The intervention group then received a four-hour health education intervention in Hausa language, which was developed based on the IMB model, while the control group received a similarly designed health education on breastfeeding. Follow up data were then collected from the participants at a first (2 months post-intervention) and second (4 months post-intervention) follow up, and at the end of their pregnancies.

    RESULTS: For both groups, reported ITN use had increased from baseline (Intervention: Often-14.0%, Almost always-9.1; Control: Often-12.4%; Almost always 16.1%) to the time of second follow up (Intervention: Often -28.10%, Almost always-24.5; Control: Often-17.2%; Almost always 19.5%). Reported IPTp uptake at second follow up was also higher for the intervention group (Intervention: Two doses-59.0%, Three doses 22.3%; Control group: Two doses-48.4%, Three doses-7.0%). The drop in the haematocrit levels was greater for the control group (32.42% to 30.63%) compared to the intervention group (33.09% to 31.93%). The Generalized Linear Mixed Models (GLMM) analysis revealed that the intervention had significantly improved reported ITN use, reported IPTp uptake, and haematocrit levels, but had no significant effect on the incidence of reported malaria diagnosis or babies' birth weights.

    CONCLUSIONS: The intervention was effective in improving ITN use, IPTp uptake, and haematocrit levels. It is, therefore, recommended for the modules to be adopted and incorporated into the routine antenatal care programmes in health centres with predominantly Hausa speaking clients.

    TRIAL REGISTRATION: Pan African Clinical Trial Registry, PACTR201610001823405. Registered 26 October 2016, www.pactr.org .

  7. Balami AD, Said SM, Zulkefli NAM, Norsa'adah B, Audu B
    Malar J, 2018 Oct 12;17(1):359.
    PMID: 30314438 DOI: 10.1186/s12936-018-2518-8
    BACKGROUND: Despite the high prevalence of malaria among pregnant women and its associated complications, the level of compliance with insecticide-treated nets (ITN) remains very low. Motivation and self-efficacy have been reported as important determinants of health behaviour, and may be important factors to consider in developing health intervention programmes. The aim of this study was to determine the knowledge, motivation and self-efficacy of ITN use, and their association with its practice, among pregnant women in a secondary health centre in Maiduguri.

    METHODS: The study utilized a cross-sectional study design, using a structured and pre-tested questionnaire to obtain information from 380 respondents. Respondents were classified as ITN users if they slept under an ITN for at least 3 days in a week, while those who did not at all, or slept under it less frequently were classified as ITN non-users. Chi squared test was performed to test the bivariate association between ITN use and each of the items of the questionnaire. A further multivariate logistic regression was performed to determine the predictors of ITN use.

    RESULTS: The respondents' ages ranged from 15 to 45 years, with median (interquartile range) age of 25 (8) years. Eighty percent of them were aware of ITN, but 50.5% believed ITNs could be dangerous. Only 5.5% and 0.8% respectively felt that sleeping under and ITN was either just bad or very bad for their health. Thirty-five percent of the respondents were ITN users. Not having a previous miscarriage (OR = 2.38; 95% CI 1.41-4.03, p = 0.001), knowledge that ITNs were not to be washed after every 1 month (OR = 3.60; 95% CI 1.18-11.06), significant others thinking they should sleep under an ITN (OR = 3.06; 95% CI 1.35-6.96), ability to effectively persuade others to sleep under an ITN (OR = 2.37; 95% CI 1.14-4.94) were significantly associated with ITN use.

    CONCLUSIONS: A large proportion of pregnant women in this study were not sleeping under ITNs. The development of health promotion interventions aimed at boosting their self-efficacies for ITN use, and improving social support from their spouses are, therefore, recommended. Health education on ITN use should also be incorporated into post-abortal management.

  8. Galadima AN, Zulkefli NAM, Said SM, Ahmad N
    BMC Public Health, 2021 07 28;21(1):1475.
    PMID: 34320942 DOI: 10.1186/s12889-021-11466-5
    BACKGROUND: Vaccine preventable diseases are still the most common cause of childhood mortality, with an estimated 3 million deaths every year, mainly in Africa and Asia. An estimate of 29% deaths among children aged 1-59 months were due to vaccine preventable diseases. Despite the benefits of childhood immunisation, routine vaccination coverage for all recommended Expanded Programme on Immunization vaccines has remained poor in some African countries, such as Nigeria (31%), Ethiopia (43%), Uganda (55%) and Ghana (57%). The aim of this study is to collate evidence on the factors that influence childhood immunisation uptake in Africa, as well as to provide evidence for future researchers in developing, implementing and evaluating intervention among African populations which will improve childhood immunisation uptake.

    METHODS: We conducted a systematic review of articles on the factors influencing under-five childhood immunisation uptake in Africa. This was achieved by using various keywords and searching multiple databases (Medline, PubMed, CINAHL and Psychology & Behavioral Sciences Collection) dating back from inception to 2020.

    RESULTS: Out of 18,708 recorded citations retrieved, 10,396 titles were filtered and 324 titles remained. These 324 abstracts were screened leading to 51 included studies. Statistically significant factors found to influence childhood immunisation uptake were classified into modifiable and non-modifiable factors and were further categorised into different groups based on relevance. The modifiable factors include obstetric factors, maternal knowledge, maternal attitude, self-efficacy and maternal outcome expectation, whereas non-modifiable factors were sociodemographic factors of parent and child, logistic and administration factors.

    CONCLUSION: Different factors were found to influence under-five childhood immunisation uptake among parents in Africa. Immunisation health education intervention among pregnant women, focusing on the significant findings from this systematic review, would hopefully improve childhood immunisation uptake in African countries with poor coverage rates.

  9. Fiidow OA, Minhat HS, Zulkefli NAM, Ahmad N
    PLoS One, 2022;17(2):e0263372.
    PMID: 35113927 DOI: 10.1371/journal.pone.0263372
    INTRODUCTION: Khat is a flowering plant with stimulant effect on the nervous system and produce psychological dependence. Despite its harmful effects, the ingestion of khat has been part of cultural norms and the legality of khat varies by region.

    OBJECTIVE: This systematic review aimed at critically evaluating the available evidence on the risk factors of khat chewing among adolescents.

    METHODS: A systematic review was conducted on published research studies from five databases Scopus, PubMed, Science-direct, Ovid and google scholar using keywords khat chewing OR qat chewing AND associated factors OR risk factors OR contributing factors AND adolescents OR teenagers. Articles included were either cross-sectional, cohort, case-control or qualitative studies which were published between the year 1990 till present. Excluded articles were the non-English written articles, descriptive studies and irrelevant topics being studied.

    RESULTS: Out of 2617 records identified and screened, six were included for the analysis and interpretation of the data. All included studies were cross-sectional study design. All six studies reported having family members who chewed khat significantly predict khat chewing among adolescents, followed by five articles for friends or peers who also chewed khat and four articles for male gender. Smoking was also found to have the highest odds (OR = 18.2; 95% CI: 12.95-25.72) for khat chewing among adolescents.

    CONCLUSION: The review highlights the crucial role of family members, friends or peers and male gender to predict khat chewing among adolescents. Effectiveness of health promotion programs to educate and reduce khat chewing among adolescents will require active participation of family members and friends.

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