INTRODUCTION: Malaysia participated in the second phase of the Global Adult Tobacco Survey (GATS) in 2011. GATS, a new component of the Global Tobacco Surveillance System, is a nationally representative household survey of adults 15 years old or above. The objectives of GATS Malaysia were to (i) systematically monitor tobacco use among adults and track key indicators of tobacco control and (ii) track the implementation of some of the Framework Convention of Tobacco Control (FCTC)-recommended demand related policies.
METHODS: GATS Malaysia 2011 was a nationwide cross-sectional survey using multistage stratified sampling to select 5112 nationally representative households. One individual aged 15 years or older was randomly chosen from each selected household and interviewed using handheld device. GATS Core Questionnaire with optional questions was pre-tested and uploaded into handheld devices after repeated quality control processes. Data collectors were trained through a centralized training. Manuals and picture book were prepared to aid in the training of data collectors and during data collection. Field-level data were aggregated on a daily basis and analysed twice a week. Quality controls were instituted to ensure collection of high quality data. Sample weighting and analysis were conducted with the assistance of researchers from the Centers for Disease Control and Prevention, Atlanta, USA.
RESULTS: GATS Malaysia received a total response rate of 85.3% from 5112 adults surveyed. Majority of the respondents were 25-44 years old and Malays.
CONCLUSIONS: The robust methodology used in the GATS Malaysia provides national estimates for tobacco used classified by socio-demographic characteristics and reliable data on various dimensions of tobacco control.
Study name: Global Adults Tobacco Survey (GATS-2011)
Introduction In Malaysia although mortality rate among women of reproductive ages has
reduced over the years, the reduction has been stagnant for the past ten years.
In order to achieve the 5th Millennium Development Goal, several measures
need to be taken including a proper implementation of pre-pregnancy
services in this country. This study explores the awareness, intention and
usage of pre-pregnancy care (PPC) services and its determinant among
women of reproductive ages in Kedah, Malaysia.
Methods This is a qualitative study, which consisted of a focus group discussion
(FGD) among women in the ages of 18 to 45 years old from all ethnic groups
who attended four government clinics in the state of Kedah. The mothers
were chosen through purposive sampling from twelve districts that were
selected through a multistage random sampling. A semi-structured
questionnaire was utilized during the FGD. The results from the FGD were
recorded verbatim and thematic analysis was finalized once saturation of
information from respondents was achieved.
Results These are two themes was identified, namely personal reasons and reasons of
service and there are several subthemes under two main themes. Under the
Personal reason themes, the subthemes including awareness and intention to
used the services, knowledge, perception, social support and history of
medical illness. While under pre-pregnancy care services themes, the
subthemes including the promotion of the services, the communication
relationship with the health staff, the waiting time and also the accessibility
of the service.
Conclusions As a conclusion, there is still part of society who was unaware of prepregnancy
services and its importance in reducing maternal mortality rate as
well as producing good pregnancy outcome. Information and knowledge on
pre-pregnancy care services should be disseminated among community
members through various means including roadshows and pre wedding
Introduction: Rheumatic Heart Disease (RHD) has been thought as a disease of poor socioeconomic status. It is more prevalent in underdeveloped and developing countries than in developed countries. It is also common among the population with multiple social issues such as overcrowded dwellings, undernutrition, poor sanitation and suboptimal medical care. This study was done to review the socio demographic profiles of RHD patients in Hospital Queen Elizabeth (HQE) II, Kota Kinabalu, Sabah.
Methods: A secondary data review of all patients registered under the RHD registry in HQE II for one- year starting from July 2013 to June 2014.
Results: 204 RHD patients were included. Nearly three quarter (74.0%) were female. The mean age was 40.43 (14.75) years old. 61.1% has completed secondary
education. 42.7% were housewives. The mean monthly income was RM 1363.83 (1297.05) which was categorized under the vulnerable income group. When they were categorized under the poverty level and the vulnerable income group, 42.6% and 76.5% of them fell under those categories respectively. The nearest health facilities to their houses were district hospitals (33.3%) with the mean distance of 9.17 km and health clinics (30.8%) with the mean distance of 4.27 km. Only 11.5% of them lived near the specialist hospitals with the mean distance of 21.32 km.
Conclusions: Results from this review suggested that majority of RHD patients were in the low socioeconomic group with less access to health care facilities with specialist care. They are the most vulnerable groups and need to be prioritized in the specialized care program. .
Introduction Sleep has played a very important role in maintaining our health with good
living quality therefore the aim of this study is to determine the pattern of
sleep duration, especially short sleep and its associated factors among
workers in a tertiary institution.
Methods A cross-sectional study was conducted from January until May 2012 among
128 randomly selected Universiti Kebangsaan Malaysia Medical Centre
(UKMMC) staffs. Data was collected using a guided standardized data sheet
which consist of three sections; (1):sociodemographic &socioeconomic, (2):
lifestyle and, (3): anthropometric measurement and sleep diary. Data entry
and analysis were done using Statistical Package for Social Sciences (SPSS)
Results Majority of the staffs had normal sleep duration (67.2%) followed by short
sleep duration (26.6%) and long sleep duration (6.3%). Simple logistic
regression analysis indicated that late night snacking was significantly related
to short sleep (cOR=3.47, 95% CI: 1.12, 12.23, p=0.048).
Conclusions Adequate sleep is important to maintain one’s health. Steps can be taken to
limit late night snacking in order to improve the sleep pattern in this study
Introduction Prevalence of adolescents involved in sexual and reproductive problems is on
rise and it was associated with its knowledge. Several factors found to be
associated with the knowledge and various sources of knowledge are chosen
by adolescents for this information. Thus, this study was to determine the
knowledge score, its influencing factors and the preference of the sources of
Methods A cross-sectional study was done using adopted questionnaire involving 330
respondents aged 18 and 19 years old in Kolej MARA Seremban selected by
simple random sampling. They were gathered in the halls and 338
adolescents from 454 students consented to involve in this study. Selfadministered
questionnaire was used whereby a correct response was given a
score of 2, 0 for an incorrect response and 1 for an answer of don’t know.
Total score for all correct answers was 42. Descriptive analysis, bivariate and
multivariate analysis was done in the analysis.
Results The mean knowledge score was 37.32 (±2.967) with a significant difference
for gender. Internets were the most common and preferred sources of the
knowledge among them. There was 5.2% of them had heard on SMS
intervention and 37.0% of them disagreed on SMS intervention.
Conclusions The result showed that the knowledge score was lower in males than females
and internets were the most preferred source of the knowledge. Thus,
interventions for knowledge improvement should be more on male
Introduction The prevalence of non-communicable diseases (NCDs) in Malaysia shows a
rising trend that influences the society in many respects. Country specific
evidence is vital for effective intervention. The aims of this study were to
identify the role of gender and urbanisation status on NCDs prevalence and
its effect on health care demand, specifically doctor visits among elderly in
Malaysia. We focused on two of the highest occurrence NCDs in the country
– diabetes mellitus and hypertension.
Methods A total of 1,414 respondents aged 60 years and above were selected using a
multistage sampling for face-to-face interview. We started the analysis with
descriptive analysis of the prevalence, taking the effect of gender and
urbanisation status of residing area. We extended the study with parametric
analysis to find the effect of these health problems on the likelihood of doctor
visits as it reflects the equity for access and utilisation issues.
Results Results showed that there were no significant difference of prevalence by
gender and urbanisation for hypertension and diabetes mellitus. By utilising
probit model, we found that those with diabetes mellitus or hypertension,
controlling for other variables, were more likely to utilise doctor services.
Conclusion This result implies that the prevalence of NCDs may further increase demand
for health care, especially in the state with a high proportion of older age
Introduction Drug abuse has been a global threat not only in Malaysia but worldwide,
especially among adolescents. This is alarming issue had been a serious
public health problem worldwide. The aim of the study is to access the
knowledge and attitude on drug abuse among Pahang Matriculation students
Methods A cross¬-sectional study was conducted involving 217 matriculation
students. A self-determined questionnaire was distributed among the students
regarding knowledge and attitude about drugs.
Results The prevalence of good knowledge on drug abuse was (82.03%). The
prevalence of students’ attitude on drug abuse has higher number of good
attitude with the sum of 182 (83.9 %). Only gender showed a significant
association with students’ knowledge (P= 0.046).
Conclusion The knowledge, attitude, and practice of drug abuse among Pahang
Matriculation students are good.
Introduction Cardiovascular diseases are a major component of non-communicable
diseases and include coronary heart disease, stroke and peripheral vascular
disease. Public health strategies to address cardiovascular disease require
three elements: surveillance, health promotion, and individual health care.
Methods Surveillance includes monitoring of mortality and morbidity as well as
surveys to monitor risk factors levels in the community. Data on mortality
from cardiovascular diseases are readily available and analysed by age and
sex specific rates looking are secular trends, geographical and ethnical group
variations and international comparisons. However many deaths from
cardiovascular disease occur suddenly and the cause of death may be
registered without autopsy or any other validation. Cardiovascular morbidity
information is more difficult to collate and interpret as it is closely related to
availability and access to health care. Periodic surveys of cardiovascular risk
factors are essential in monitoring the underlying trends in blood pressure,
smoking, cholesterol, obesity, and diabetes as they predict future trends, and
support planning for prevention and healthcare.
Results Prevention and health promotion activities are informed by the levels and
trends in cardiovascular disease and its risk factors. There has been debate
about population health promotion and individual health care strategies, but
both are necessary. Cigarette smoking, nutrition and physical exercise are the
main behaviours to be addressed but these are complex and require
multifaceted approaches. Education alone is insufficient to change health
behaviours and health promotion needs to look to changing attitudes.
Legislation, taxation and other fiscal interventions have been shown to be
effective however these can be difficult for legislators as there are other
competing interests, particularly in the area of nutrition and tobacco. Creating
health promoting environments that make healthy behaviour choices easier
can be beneficial.
Conclusions Health care interventions are also effective in reducing the burden of
cardiovascular disease. A balanced approach of health promotion and
individual health care is recommended in the development of a strategy for
Introduction Food labeling regulation has been implemented to enable consumers,
including those with chronic diseases to make healthy informed choices
before purchasing pre-packaged foods. The purpose of this study is to
determine the prevalence of obese adults in Malaysia who practice reading
food labels. It explored types of labels read and understanding of the
Methods Findings presented in this study were captured from the secondary analysis of
National Health and Morbidity Survey’s (NHMS, 2006) food label study
which focused only on obese adults (BMI > 30 kg/m2) aged 18 and above.
This nation-wide cross sectional study was conducted from April to August
2006 using an interview-based questionnaire. Complex data analysis was
done using Stata version 12.0.
Results There were 4565 obese respondents with the mean age of 33 ± 9.7 (18 – 60
years old). About 54.7% completed high-school and 9.9% were higher degree
holders. Prevalence of obese adults who claimed to read label was 80.5%
(95%CI: 79.3, 81.6). Findings showed significant results in reading and
understanding labels among all age group categories, Malay, Indian and other
Bumiputras, all education categories and married respondents. Expiry date
was the highest percentage being read (74.5%), followed by fat content
(15.3%), vitamin (11.8%) and carbohydrate (10.9%).
Conclusions The obese population in Malaysia claimed to read and understand the food
label but did not focus on specific macronutrients related to their health
condition. Findings can be used to implement effective education
programmes targeting the relevant groups to instill an awareness to read,
understand and use the label information as one of the means in combating
Introduction Low bone mineral density is a significant problem in children with Thalassemia which may lead to increased risk for fragility fractures and suboptimal peak bone mass. This cross-sectional study was conducted to
determine the bone health status of Thalassemia children Universiti Kebangsaan Malaysia Medical Centre and Paediatrics Insititute Kuala Lumpur Hospital.
Methods A total of 81 respondents diagnosed with transfusion dependant beta Thalassemia (41 boys and 40 girls) aged between 7 to 19 years old completed the study. The data collected were demographic information, anthropometric measurements, dairy frequency questionnaires, dietary habits of the respondents and their parents, dietary intakes and bone densitometry using Ultrasound Bone Densitometer.
Results For Quantitative Ultrasound (QUS) parameters, T-score of 9.8% participants were lower than -1.0 and 30.9% of the participants had lower Speed of Sound (SOS) than healthy SOS. This study showed there was no difference in bone density by sex (p>0.05). The median bone density of boys was 1616.00 m/sec (IQR= 39.00) and girls’ was 1579.00 m/ sec (IQR= 116.00). SOS was not increased with age, height and weight; but girls’ Body Mass Index (BMI). Malay children had significantly higher SOS than non-Malay children.
Conclusions This study highlights a need of proper intervention for the high risk group to achieve optimal bone health.
Study site: inpatient or outpatient, Institut Pediatrik (Hospital Kuala Lumpur), Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Introduction It is well known that low back pain among working population is a global
problem throughout the world. However, the current situation of occupational
low back pain in Malaysia is still vague due to limited number of studies
Objective A cross sectional study was conducted among three automotive industry
workers in Selangor, Malaysia from October 2010 to April 2011.
Methods This study aims to determine the prevalence and risk factors of low back pain
among automotive industry workers performing manual material handling
tasks using self-administered questionnaire survey.
Results A modified Standardised Nordic Questionnaire was used to assess low back
pain problem, to obtain personal and psychosocial risk factors information.
The prevalence of low back pain showed increment in the point prevalence of
57.9%, 49.5%, and 35.1 % for 12 months, one month, and of 7 days
respectively. Working hour, frequency of overtime, stress at work, work
pace, and faster movement were found to be significantly associated with the
12 months prevalence for low back pain.
Conclusions This finding indicates that psychosocial risk factors are associated to the
occurrence of low back pain.
Introduction This study investigates work engagement of employed breast cancer
survivors in comparison to unmatched control samples of healthy working
women without cancer and any other chronic diseases from the general
Methods A case-control study design using unmatched controls was adopted in this
study. The case comprised of 80 female breast cancer survivors who have
returned to full-time employment selected using purposive sampling
technique. Meanwhile, controls were 88 healthy female working women in
full time paid employment, selected using quota sampling. Questionnaire
covering socio-demographic characteristics and self-rated work engagement
measured using Utrecht Work Engagement Scale (UWES) was distributed to
the cancer survivors through face-to-face meeting during their hospital visits.
For the healthy controls the questionnaires were distributed using drop-andcollect
method through the human resource personnel of the participating
Results The results revealed, after controlling for age, marital status, ethnic group and
tenure with organization, no significant differences in the overall work
engagement was found between the breast cancer survivors [mean (SD) =
4.66 (0.92)] and the healthy controls [mean (SD) = 4.75 (0.85)]; F(1, 163)
=1.70. In comparison to the work engagement domains, only the Vigor
domain was found to be significantly lower for the survivors, survivors [F (1,
163) =14.94; p
Introduction Healthy dietary practice is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing the rate of diabetes complication development. It is, therefore, important at all levels of diabetes prevention. The objective of this study was to determine the association of dietary practice with glycaemic control among Type 2 diabetes mellitus (T2DM) patients, who received treatment from an urban Health Clinic in Kuala Lumpur.
Methods A total of 307 patients with T2DM aged 18 years and above participated in this study. A pre-tested structured questionnaire with guided interview was used to collect information on socio-demographic, clinical and dietary practice. Anthropometric and biological measurements were also taken. Descriptive statistics and Chi-square were used in the data analysis. Good glycaemic control was defined as HbA1c level less than 6.5%.
Results The prevalence of good glycaemic control was only 27% (n=83). The highest percentage of good glycaemic control were among male patients (29.1%), aged 60 and above (33.3%), educational level of primary school (35.4%) and those with monthly income group between RM1001 to RM1500 (32.0%). About three quarter of T2DM patient (n=224) had poor control of HbA1c (≥6.5%). Age (p=0.045) and working status (p=0.039) had significant relationship with the level of HbA1c. Dietary practice showed no significant relationship with the HbA1c level.
Conclusions Effective interventional health education strategies are needed, focussing on modification of dietary behaviour in order to achieve glycaemic control among diabetic patients.
Introduction Breast cancer is ranked number one from the ten most frequent cancers in
female, Peninsular Malaysia. Various studies provide negative evidence on
malignancies and one of the end results is impaired quality of life (QOL).
Studies show lifestyle approaches are key factors in enhancing the QOL
among cancer survivors. The purpose of this study is to describe the lifestyle
practices (LP) among breast cancer survivors (BCS) which consist of dietary
intake, exercise habits, and stress management and to determine whether
these practices have influence on the QOL among Malaysian BCS.
Methods This study adopts a cross-sectional study design using a self-administered
questionnaire. A total of 280 BCS from public and private hospitals
throughout Peninsular Malaysia had participated. The questionnaire covers
QOL and LP items which consist of dietary intake (consumption of high-fat
food, high-fibre food, fruits and vegetables), exercise habits, and stress
management. Descriptive statistics and one-way ANOVA were used to
determine the relationship between LP and QOL.
Results Mean age of the study sample was at 41 (SD=7.37). Majority of them were
Malay (74%), 53% were diagnosed with breast cancer between 1 to 2 years
whereas 54% were presented with stage 2 at diagnosis. There was a
statistically significant difference (p
Introduction The aim of this study was to examine the aspect of information disclosure by
doctor-investigator during the process of obtaining informed consent in
Methods This research employed a mixed-method data collection that is library
research and interview. A qualitative methodology and analysis were used in
an open-ended, face-to-face interviews with 17 patient-subjects. The
interview questions were based on information that needed to be disclosed to
patient-subjects during the process of obtaining informed consent. Each
interview took place in Kajang Hospital and National Heart Institute and
lasted 25-30 minutes. Interviews were conducted in Bahasa Melayu and
English. The interviews were tape-recorded, and the main points from the
interviews were jotted down to ensure that all information was adequately
gathered. Interviewed occurred in Kajang Hospital and National Heart
Institute. The participants were patients who had been referred to the Kajang
Hospital and National Heart Institute. They were recruited (8 from Kajang
Hospital and 9 from National Heart Institute) by their own doctors to
participate in a study to evaluate the safety and effectivenes of the
investigational stent after been diagnosed with coronary artery disease and
also in a study to investigate drug for antidepressant. respectively.
Results The study revealed that doctor-investigators fail to disclose full information
to patient-subjects. Instead, doctor-investigators only disclosed information
which they thought were necessary for the patient-subjects to know. The
study also showed that there were doctor-investigators who did not disclose
information at all to the patient-subjects.
Conclusions This study implies that the aspect of information disclosure in the process of
obtaining informed consent in clinical trials is rather poor and did not fulfill
the criterion of good medical practice. A random monitoring task to be
conducted by the research ethics commitees during the informed consent
process is suggested.
Introduction Iodine deficiency disorders (IDD), is one of the most important micronutrient
deficiencies which has multiple adverse effects on growth and development.
The aim of this study was to determine the prevalence of IDD among school
children and to elucidate the distribution of iodized salt at household level in
Sarawak, East Malaysia.
Methods This cross-sectional study was conducted among school children aged 8 to 10
years in 2008. A multi-stage probability proportionate to population size
(PPS) cluster sampling method was used to obtain a representative state
sample of 1200 school children. Spot urine samples were collected for the
determination of urinary iodine concentration while the iodine content in salt
was determined using field rapid test kits. The thyroid status was determined
Results Response rate was 92.0% (n=1104/1200). The prevalence of goitre among
school children in Sarawak was 2.9% (5.2% in urban, 0.7% in rural). The
median urinary iodine concentration (UIC) among the school children was
102.1 μg/L (IQR, 62.3-146.5 μg/L). Urban children had significantly higher
median UIC of 109.3 μg/L (IQR, 72.4-159.0 μg/L) than their rural
counterparts [91.9 μg/L (IQR, 55.7-140.2 μg/L)]. The salt samples tested by
rapid test kit (RTK) showed only 46.0% of household salt contained iodine.
Conclusions The present study revealed that the population in Sarawak were of borderline
iodine sufficient with mild IDD seen in rural areas. Hence, the state IDD
control programmes need to encourage and advocate the consumption of
iodized salt in order to eliminate IDD-related health problems in Sarawak.
Introduction In light of the important role of health-promoting expenditure in health, the
objective of this study was to investigate the socio-demographic determinants
of health-promoting expenditure such as purchase of medical equipment and
services, food supplements and health education services and products among
Methods Third National Health and Morbidity Survey (NHMS III) consisting of 28771
observations was used for analysis. It was the latest nationally representative
cross-sectional population-based survey conducted by the Ministry of Health
Malaysia from April 2006 to January 2007. A censored regression model
(Tobit) was applied to examine the factors affecting health-promoting
Results The results showed that age, income, gender, ethnicity, education, marital
status, employment status and location of residence were able to affect healthpromoting
expenditure. In particular, individuals who were younger, poor,
males, Indian/others, less educated, unmarried, unemployed and residing in
rural areas tended to spend less money on health promotion compared to
Conclusions This study reached a conclusion that socio-demographic factors were
significantly associated with individual’s preferences for health promotion.
Therefore, the government should devote its attention to these factors when
formulating nationwide health policies.
Introduction The health of newborns is inextricably linked to that of their mothers. Some
maternal factors can influence neonatal survival, particularly for low birth
weight babies who are more vulnerable to diseases than normal weight
babies. The aim of this study is to assess the impact of maternal factors on
neonatal mortality among low birth weight babies in Aceh Province,
Methods Study design was unmatched case control. Data collected from 2010 to 2012
in 8 districts in Aceh province, Indonesia. Total sample was 500, divided into
250 LBW who died in neonatal period (case group) and 250 who did not die
in neonatal period (control group). There were 6 maternal variables analysed.
Results Three of six variables analysed were not associated with neonatal mortality
among LBW (P > 0.05); these were: maternal death, parity and education
level. The age of the mother had a significant association with neonatal
mortality among LBW (P < 0.05), but was not a determinant factor. The
maternal illness and birth interval were determinant factors of neonatal
mortality among LBW(P < 0.05); maternal illness (Adj OR= 2.6; 95 % CI:
1.68 - 4.0) and birth interval (Adj OR= 1.8; 95 % CI: 1.20 - 2.91).
Conclusions Maternal illness and birth interval were determinant factors of neonatal
mortality among LBW. Appropriate care throughout stages of pregnancy and
increasing women’s knowledge on high risk pregnancy are the key factors to
the decrease of the neonatal mortality related to the maternal factors.
Introduction The risk factors associated with mental health among adolescents are usually
described by researchers at an individual level. Neighbourhood factors and
health have opened a new insight into the field of epidemiology. The aim of
this study was to assess the reliability and validity of a newly developed
Neighbourhood Factors on Mental Health Questionnaire among Malaysian
Methods A cross-sectional study was conducted in four secondary schools in Kuala
Lumpur, Malaysia using a newly developed questionnaire which comprised
of two main domains and seven items. Exploratory factor analysis and
Cronbach‟s alpha were used to measure the instrument‟s construct validity
Results A total of 106 adolescents participated in this research. The majority of
adolescents were 13 years old (40.6%), female (55.7%), Malays (68.9%),
have parents who only studied until secondary school (66.0%) and lived in
flats (32.1%). Bartlett‟s Test of Sphericity was significant (Chi-square =
Introduction During haze, at what level should Air Pollutant Index (API) showed, public
or private school be closed is not without controversy and is very much
debated. Therefore, the aim of this paper is to objectively quantify the
potential inhaled dose of PM10 associated with exposure at school and home
microenvironments during haze. The result of the health risk assessment will
be used to propose the API level for closing the school during haze episode.
Methods A hypothetical haze exposure scenario was created using the breakpoints of
PM10 concentration for calculation of API and respective inhaled dose during
haze. To determine the potential inhaled dose, we have considered many
factors that include time spent for specific physical intensity at school and
home microenvironments, age-specific and physical intensity-specific
inhalation rate (m3/min), and the indoor/outdoor ratio of PM10. To calculate
risk quotient (RQ), the inhaled dose was compared with the health reference
dose computed based on the concentration of PM10 in the Malaysian
Ambient Air Quality Standard.
Results When considering the specific exposure at each microenvironment (school
and home), the potential inhaled dose of PM10 was substantially lower when
school is closed for both primary and secondary school. The calculated risk
quotient (RQ) indicates that primary school children are likely to be affected
at slightly lower PM10 concentration (equivalent to API of 197) as compared
to secondary school children. Short duration of high physical activity
intensity during school breaks has contributed to a large proportion of inhaled
dose among school children indicating the important to avoid physical
activities during haze.
Conclusion Based on the assessment, taking into account the uncertainty of risk
assessment methodology, we proposed school to be closed when API reach
190 for both primary and secondary schools. These findings and
recommendations are only valid for naturally ventilated school and applicable
in the context of the current API calculation system and the existing
Recommended Air Quality Guideline values in Malaysia.