Displaying publications 1 - 20 of 47 in total

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  1. Teo CH, Ng CJ, Ho CC, Tan HM
    Public Health, 2015 Jan;129(1):60-7.
    PMID: 25542745 DOI: 10.1016/j.puhe.2014.11.009
    OBJECTIVE: There is currently no documentation on the availability and implementation of policies related to men's health in Asia. This Delphi study aimed to achieve an Asian consensus on men's health policy based on the opinions and recommendations from men's health key opinion leaders.
    STUDY DESIGN: A two-phase Delphi online survey was used to gather information from men's health stakeholders across Asian countries.
    METHODS: All stakeholders were invited to participate in the survey through men's health conferences, personal contacts, recommendations from international men's health organizations and snowballing method. Stakeholders were asked about their concerns on 17 men's health key issues as well as their opinion on the availability and recommendations on men's health policies and programmes in their countries.
    RESULTS: There were a total of 128 stakeholders (policy makers, clinicians, researchers and consumers), from 28 Asian countries, who responded in the survey. Up to 85% of stakeholders were concerned about various men's health issues in Asia and in their respective country, particularly in smoking, ischaemic heart disease and high blood pressure. There is a lack of men's health policies and programmes in Asia (availability = 11.6-43.5%) and up to 92.9% of stakeholders recommended that these should be developed.
    CONCLUSIONS: These findings call for policy change and development, and more importantly a concerted effort to elevate men's health status in Asia.
  2. Rajah R, Hassali MAA, Murugiah MK
    Public Health, 2019 Feb;167:8-15.
    PMID: 30544041 DOI: 10.1016/j.puhe.2018.09.028
    OBJECTIVES: Health literacy is increasingly recognized as a public health concern. Most of the literature on health literacy concentrate in the Western countries. Therefore, this study aimed to systematically review and examine the available studies on health literacy in Southeast Asian countries and estimate its prevalence in this region.

    STUDY DESIGN: Systematic review.

    METHODS: A search for relevant articles was carried out using Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE (via EBSCOhost), Scopus, Science Direct, PubMed and Google Scholar with multiple search terms. Inclusion criteria comprised articles published in English language and assessing general health literacy. Risk of bias reduced with the involvement of two independent reviewers in the screening of the literature and the quality assessment process.

    RESULTS: A total of 11 studies were included, which only consist of studies from five countries out of 11 making up the Southeast Asian region. The overall prevalence of limited health literacy varied considerably, 1.6%-99.5% with a mean of 55.3% (95% confidence interval [CI]: 35.1%-75.6%). A much higher prevalence was noted in studies conducted in healthcare settings, 67.5% (95% CI: 48.6%-86.3%). The most common factors associated with limited health literacy were education attainment, age, income and socio-economic background. Other factors identified were gender and health behaviours.

    CONCLUSIONS: In summary, despite the little evidence available and existences of high heterogeneity among studies, limited health literacy is still prevalent in Southeast Asian countries. Urgent strategies to improve and promote health literacy in the region are highly warranted. Besides, more studies on health literacy with better quality on the methodology aspect are needed.

    Matched MeSH terms: Public Health
  3. Shafie AA, Azman AW
    Public Health, 2015 Sep;129(9):1278-84.
    PMID: 25931434 DOI: 10.1016/j.puhe.2015.03.016
    Food handler's knowledge, attitude and practice regarding food allergies are important to prevent debilitating and sometimes fatal reactions. This study aimed to assess their food allergy knowledge, attitude and practice, which could help to maintain the safety and hygiene of food consumed by the public.
  4. Lim HH, Ong CN, Domala Z, Phoon WO, Khoo HE
    Public Health, 1985 Jan;99(1):23-9.
    PMID: 3991872
  5. Wei R, Wang Z, Zhang X, Wang X, Xu Y, Li Q
    Public Health, 2023 Sep;222:75-84.
    PMID: 37531713 DOI: 10.1016/j.puhe.2023.06.034
    OBJECTIVES: Understanding iodine deficiency (ID) burdens and trends in Asia can help guide effective intervention strategies. This study aims to report the incidence, prevalence, and disability-adjusted life years (DALYs) of ID in 48 Asian countries during the period 1990-2019.

    STUDY DESIGN: Data on ID were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 and estimated by age, sex, geographical region, and sociodemographic index (SDI).

    METHODS: The estimated annual percentage change (EAPC) was calculated to evaluate the changing trend of age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized DALYs rate (ASDR) related to ID during the period 1990-2019.

    RESULTS: In Asia, there were 126,983,965.8 cases with 5,466,213.1 new incidence and 1,765,995.5 DALYs of ID in 2019. Between 1999 and 2019, the EAPC in ASIR, ASPR and ASDR were -0.6 (95% confidence interval [CI], -0.8 to -0.4), -0.9 (95% CI, -1.2 to -0.7), and -1.6 (95% CI, -1.8 to -1.5), respectively. Malaysia charted the largest decrease in ASIR, ASPR, and ASDR (82.4%, 85.3%, and 80.9% separately), whereas the Philippines and Pakistan were the only two countries that witnessed an increase in ASIR and ASPR. ID burdens were more pronounced in women, countries located to the south of the Himalayas, and low-middle SDI regions.

    CONCLUSIONS: The incidence, prevalence, and DALYs of ID in Asia substantially decreased from 1990 to 2019. Women and low-middle SDI countries have relatively high ID burdens. Governments need to pay constant attention to the implementation and monitoring of universal salt iodization.

  6. Lim KK, Chan YY, Noor Ani A, Rohani J, Siti Norfadhilah ZA, Santhi MR
    Public Health, 2017 Dec;153:52-57.
    PMID: 28915402 DOI: 10.1016/j.puhe.2017.08.001
    OBJECTIVES: The success of the Expanded Program on Immunization among children will greatly reduce the burden of illness and disability from vaccine preventable diseases. The aim of the study was to evaluate the complete immunization coverage and its determinants among children aged 12-23 months in Malaysia.
    STUDY DESIGN: Cross-sectional study.
    METHODS: Data on immunization were extracted from the 2016 National Health and Morbidity Survey. Complete immunization coverage was classified as received all recommended primary vaccine doses by the age of 12 months and verified by vaccination cards, and incompletely immunized if they received partially recommended vaccine dose or not received any recommended vaccine dose or had no vaccination card. The multiple logistic regression analyses were conducted to determine the sociodemographic factors associated with complete immunization coverage.
    RESULTS: The overall complete immunization coverage among children (verified by cards) was 86.4% (n = 8920, 95% confidence interval: 85.4-87.4). Multivariable logistic regression analyses model revealed that factors significantly associated with complete immunization coverage were ethnicity, occupation of the mother, head of household's education level, and head of household's occupation. While sex, citizenship, household income, mother's age, and marital status were not significantly associated with complete immunization coverage.
    CONCLUSIONS: According to the World Health Organization criteria, the present study demonstrated that the immunization coverage of 86.4% is still unsatisfactory. Thus, the current intervention program should be enhanced in order to achieve the 95% coverage for all antigens in the national vaccination program.
    Study name: National Health and Morbidity Survey (NHMS-2016)
  7. Tang KHD, Chin BLF
    Public Health, 2021 Sep;198:96-101.
    PMID: 34391039 DOI: 10.1016/j.puhe.2021.07.007
    OBJECTIVES: The transmission of COVID-19 has sent Malaysia into cycles of tightening and relaxation of movement control, which are still continuing currently in line with local fluctuations of new COVID-19 cases. During movement control, measures comprising physical distancing, hand cleaning or sanitizing, and sanitization of premises are consistently implemented while self-isolation and travel restrictions are adaptively enforced. This study aims to examine if the control of COVID-19 transmission has an effect on the national influenza occurrences as some measures for COVID-19 control are similar to those for influenza.

    STUDY DESIGN: For this study, data of weekly new cases of influenza and COVID-19 were obtained from official platforms for non-parametric statistical analysis.

    METHODS: This study compared the influenza occurrences before and after the onset of COVID-19 using the Mann-Whitney U-test and explored Spearman's correlations between COVID-19 and influenza incidences after the onset of COVID-19.

    RESULTS: It shows that influenza incidences before and after the onset of COVID-19 were significantly different and that influenza cases have significantly reduced after the onset of COVID-19. The weekly cases of influenza and COVID-19 were significantly and negatively correlated.

    CONCLUSIONS: This study underscores the co-benefits of COVID-19 control measures and alleviates the concern for the risk of COVID-19 and influenza co-infection.

  8. Atif M, Sulaiman SA, Shafie AA, Babar ZU
    Public Health, 2015 Jun;129(6):777-82.
    PMID: 25999175 DOI: 10.1016/j.puhe.2015.04.010
    BACKGROUND: Despite evidence of an association between tuberculosis (TB) treatment outcomes and the performance of national tuberculosis programmes (NTP), no study to date has rigorously documented the duration of treatment among TB patients. As such, this study was conducted to report the durations of the intensive and continuation phases of TB treatment and their predictors among new smear-positive pulmonary tuberculosis (PTB) patients in Malaysia.
    STUDY DESIGN: Descriptive, non-experimental, follow-up cohort study.
    METHODS: This study was conducted at the Chest Clinic of Penang General Hospital between March 2010 and February 2011. The medical records and TB notification forms of all new smear-positive PTB patients, diagnosed during the study period, were reviewed to obtain sociodemographic and clinical data. Based on standard guidelines, the normal benchmarks for the durations of the intensive and continuation phases of PTB treatment were taken as two and four months, respectively. A patient in whom the clinicians decided to extend the intensive phase of treatment by ≥2 weeks was categorized as a case with a prolonged intensive phase. The same criterion applied for the continuation phase. Multiple logistic regression analysis was performed to find independent factors associated with the duration of TB treatment. Data were analyzed using Predictive Analysis Software Version 19.0.
    RESULTS: Of the 336 patients included in this study, 261 completed the intensive phase of treatment, and 226 completed the continuation phase of treatment. The mean duration of TB treatment (n = 226) was 8.19 (standard deviation 1.65) months. Half (49.4%, 129/261) of the patients completed the intensive phase of treatment in two months, whereas only 37.6% (85/226) of the patients completed the continuation phase of treatment in four months. On multiple logistic regression analysis, being a smoker, being underweight and having a history of cough for ≥4 weeks at TB diagnosis were found to be predictive of a prolonged intensive phase of treatment. Diabetes mellitus and the presence of lung cavities at the start of treatment were the only predictors found for a prolonged continuation phase of treatment.
    CONCLUSIONS: The average durations of the intensive and continuation phases of treatment among PTB patients were longer than the targets recommended by the World Health Organization. As there are no internationally agreed criteria, it was not possible to judge how well the Malaysian NTP performed in terms of managing treatment duration among PTB patients.
    KEYWORDS: Duration of continuation phase; Duration of intensive phase; Duration of tuberculosis treatment; Malaysia; Penang; Smear-positive pulmonary tuberculosis
  9. Babar ZD, Izham MI
    Public Health, 2009 Aug;123(8):523-33.
    PMID: 19665741 DOI: 10.1016/j.puhe.2009.06.011
    Previous studies on anti-infective and cardiovascular drugs have shown extraordinary price increases following privatization of the Malaysian drug distribution system. Therefore, it was felt that there was a need to undertake a full-scale study to evaluate the effect of privatization of the Malaysian drug distribution system on drug prices.
  10. Cheah YK, Azahadi M, Phang SN, Hazilah N
    Public Health, 2017 May;146:84-91.
    PMID: 28404478 DOI: 10.1016/j.puhe.2017.01.009
    OBJECTIVES: The rapid rise in the prevalence of physical inactivity-related diseases has become a serious public health issue worldwide. The objective of the present study is to examine the factors affecting participation in physical activity among urban dwellers in Malaysia.
    STUDY DESIGN: This cross-sectional study measures physical activity using a rigorous regression model.
    METHODS: Data are obtained from the National Health and Morbidity Survey 2011 (NHMS 2011). A lognormal hurdle model is used to analyse the participation decision and the amount decision of physical activity.
    RESULTS: The results show that income, gender, ethnicity, marital status and employment status are significantly associated with participation decision and amount decision. However, age, insurance and self-rated health only affect participation decision, whereas family size, education and smoking only affect amount decision.
    CONCLUSIONS: It can, thus, be concluded that sociodemographic, insurance, lifestyle and health factors play an important role in determining physical activity behaviour among urban dwellers. When formulating policies, special attention must be paid to these factors.
    Study name: National Health and Morbidity Survey (NHMS-2011)
  11. M Yatim H, Wong YY, Neoh CF, Lim SH, Hassali MA, Hong YH
    Public Health, 2019 Aug;173:5-8.
    PMID: 31207425 DOI: 10.1016/j.puhe.2019.04.020
    OBJECTIVE: The objective of this study was to explore factors influencing patients with hypertension to participating in a hypertension self-management education (HSME) programme and challenges of sustaining the learnt self-care practices.

    STUDY DESIGN: This was a qualitative study with focus group discussions.

    METHODS: Focus group discussions using a semistructured moderator guide were conducted among participants who had attended the HSME programme. Data were audio recorded, transcribed verbatim and analysed using a thematic analysis approach.

    RESULTS: Three focus groups involving 19 participants were conducted. Four major themes emerged from the data collected. Most participants enjoyed the group-based HSME sessions because sharing experiences with those having similar health problems can reduce their sense of isolation. However, the participants highlighted the difficulty in sustaining self-care practices in the presence of friends and family influences.

    CONCLUSION: A number of patient-, family- and community-level motivators and barriers to patients' hypertension self-management have been identified. Efforts to tailor behavioural interventions to sustain daily self-care activities during social and cultural events are imperative.
  12. Romli MH, Tan MP, Mackenzie L, Lovarini M, Suttanon P, Clemson L
    Public Health, 2017 Apr;145:96-112.
    PMID: 28359399 DOI: 10.1016/j.puhe.2016.12.035
    OBJECTIVES: The older population in the Southeast Asian region is accelerating and is expected to surpass the proportion of the ageing population in North America and Europe in the future. This study aims to identify the research literature related to falls among older people in Southeast Asia, to examine current practice and discuss the future direction on falls prevention and interventions in the region.

    STUDY DESIGN: A scoping review design was used.

    METHODS: A systematic literature search was conducted using the Medline, CINAHL, AMED, Ageline, PsycINFO, Web of Sciences, Scopus, Thai-Journal Citation Index, MyCite and trial registries databases.

    RESULTS: Thirty-seven studies and six study protocols were included, from Thailand, Malaysia, Singapore, Vietnam, Indonesia and the Philippines. One-sixth of the studies involved interventions, while the remainder were observational studies. The observational studies mainly determined the falls risk factors. The intervention studies comprised multifactorial interventions and single interventions such as exercises, educational materials and visual correction. Many of the studies replicated international studies and may not have taken into account features unique to Southeast Asia.

    CONCLUSION: Our review has revealed studies evaluating falls and management of falls in the Southeast Asian context. More research is required from all Southeast Asian countries to prepare for the future challenges of managing falls as the population ages.

  13. Vo MTH, Thonglor R, Moncatar TJR, Han TDT, Tejativaddhana P, Nakamura K
    Public Health, 2023 Sep;222:215-228.
    PMID: 36229238 DOI: 10.1016/j.puhe.2022.08.012
    OBJECTIVES: The aim of this study was to provide a comprehensive overview of the prevalence, measurement scales, related factors and interventions for fear of falling (FOF) among older adults in Southeast Asia.

    STUDY DESIGN: This was a systematic review.

    METHODS: Published research studies on FOF among older adults were searched using the following databases: PubMed, Cochrane Library, Scopus, ASEAN Citation Index, Thai Journal Citation Index, Malaysian Journal Citation Report and Google Scholar. All observational and experimental studies investigating FOF among community-dwelling older adults in Southeast Asia were eligible. A narrative synthesis was used to describe the findings. The Joanna Briggs Institute checklist was used to assess the quality and risk of bias of the included studies.

    RESULTS: A total of 15 observational studies and three experimental studies were included after screening 2112 titles and abstracts. These studies, published between 2011 and 2021, were conducted in Malaysia, Singapore, Thailand and Vietnam. The FOF prevalence ranged from 21.6% to 88.2%. The most commonly used FOF assessment tool was the Falls Efficacy Scale-International. Well-reported related factors of FOF were female sex, advanced age, balance impairment and fall history. All experimental studies utilising single- or multi-component interventions comprised an exercise approach. Limited studies have considered environmental factors.

    CONCLUSIONS: Various related factors of FOF and the interventions implemented were revealed. Public health researchers and policymakers should consider the factors related to FOF in practical FOF intervention and prevention strategies. Further evidence on FOF issues is required to understand the multidimensional characteristics of FOF, specifically the environmental aspects of older adults in Southeast Asia.

  14. Gewirtz-Meydan A, Koós M, Nagy L, Kraus SW, Demetrovics Z, Potenza MN, et al.
    Public Health, 2024 Apr;229:13-23.
    PMID: 38382177 DOI: 10.1016/j.puhe.2023.12.031
    OBJECTIVES: This study aimed to examine the psychometric properties of the P4 suicide screener in a multinational sample. The primary goal was to evaluate the reliability and validity of the scale and investigate its convergent validity by analyzing its correlation with depression, anxiety, and substance use.

    STUDY DESIGN: The study design is a cross-sectional self-report study conducted across 42 countries.

    METHODS: A cross-sectional, self-report study was conducted in 42 countries, with a total of 82,243 participants included in the final data set.

    RESULTS: The study provides an overview of suicide ideation rates across 42 countries and confirms the structural validity of the P4 screener. The findings indicated that sexual and gender minority individuals exhibited higher rates of suicidal ideation. The P4 screener showed adequate reliability, convergence, and discriminant validity, and a cutoff score of 1 is recommended to identify individuals at risk of suicidal behavior.

    CONCLUSIONS: The study supports the reliability and validity of the P4 suicide screener across 42 diverse countries, highlighting the importance of using a cross-cultural suicide risk assessment to standardize the identification of high-risk individuals and tailoring culturally sensitive suicide prevention strategies.

  15. Salari N, Khoshbakht Y, Hemmati M, Khodayari Y, Khaleghi AA, Jafari F, et al.
    Public Health, 2023 Sep 19;224:58-65.
    PMID: 37734277 DOI: 10.1016/j.puhe.2023.08.016
    OBJECTIVE: Urinary tract infection (UTI) is a prevalent infection during pregnancy that can lead to complications for both the mother and the foetus. The objective of this systematic review and meta-analysis is to determine the global prevalence of UTIs (both symptomatic and asymptomatic) during pregnancy, based on previous studies in this area. Furthermore, this study aims to identify any factors that contribute to heterogeneity in the prevalence of UTIs during pregnancy.

    STUDY DESIGN: Systematic review and meta-analysis.

    METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines on August 8, 2022. To conduct the systematic review and meta-analysis, a search was performed using the keywords "urinary tract system", "UTI", "pregnancy", and "gestation" was performed in several databases, including Web of Science (WoS), PubMed, Scopus, ScienceDirect, Embase, and Google Scholar, without a time limit until September 18, 2022. The analysis was performed using a random-effects model, and the heterogeneity of the studies was assessed using the I2 index. The Comprehensive Meta-Analysis software (Version 2) was used for data analysis.

    RESULTS: The systematic review and meta-analysis of 27 studies, which included a total of 30,641 pregnant women, showed an overall prevalence of UTI (both symptomatic and asymptomatic) to be 23.9% (95% confidence interval: 16.2-33.8). Meta-regression analysis was conducted to examine the impact of two factors, namely study sample size and study year, on the heterogeneity of the meta-analysis. The results revealed that an increase in sample size, and the study year was associated with a decrease in the prevalence of UTI in pregnant women (P 

  16. Mahmood MI, Daud F, Ismail A
    Public Health, 2016 Jun;135:56-65.
    PMID: 26976488 DOI: 10.1016/j.puhe.2015.07.043
    OBJECTIVES: To determine the prevalence of glycaemic control and factors associated with poor glycaemic control [glycosylated haemoglobin (HbA1c) ≥6.5%] among patients with type 2 diabetes treated in public health clinics in Johor, Malaysia.

    STUDY DESIGN: Cross-sectional study.

    METHODS: A review of all patients aged over 18 years and with a diagnosis of type 2 diabetes for >1 year. The National Diabetic Registry was used as the database for attendees at public health clinics in Johor Bahru between January and December 2013. A required sample of 660 was calculated, and a random sampling method was applied to acquire patient information across the 13 public health clinics in Johor Bahru. All relevant information (e.g. HbA1c, type of treatment and other parameters for glycaemic control) were abstracted from the registry.

    RESULTS: Sixty-eight percent of 706 patients had HbA1c >6.5%, and mean HbA1c was 7.8%. Younger patients (72.3%) had poorer glycaemic control than older patients (63.0%), and most patients with poor glycaemic control were obese (79.2%). Approximately 31.7% of patients did not achieve the target blood pressure <130/80 mmHg, and 58.5% did not achieve the target lipid profile. Multiple logistic regression analysis revealed that age (<60 years), sex (male), duration of diabetes (>5 years), body mass index (obese), type of treatment (diet therapy vs combination therapy) and abnormal lipid profile were significantly associated with increased odds of HbA1C >6.5%.

    CONCLUSIONS: More than half (68%) of the patients with diabetes had HbA1c >6.5%. This highlights the importance of providing organized care to manage patients with diabetes in the primary care setting, such as weight reduction programmes, proper prescribing treatment, and age- and gender-specific groups to ensure good glycaemic control.
    Matched MeSH terms: Public Health
  17. Sulaiman AH, Seluakumaran K, Husain R
    Public Health, 2013 Aug;127(8):710-5.
    PMID: 23474376 DOI: 10.1016/j.puhe.2013.01.007
    To investigate listening habits and hearing risks associated with the use of personal listening devices among urban high school students in Malaysia.
  18. Liu N, Babazono A, Jamal A, Yoshida S, Yamao R, Ishihara R, et al.
    Public Health, 2024 Feb;227:63-69.
    PMID: 38118244 DOI: 10.1016/j.puhe.2023.11.032
    OBJECTIVES: This study aimed to evaluate the impact of the policy to reduce the reimbursement fee for percutaneous endoscopic gastrostomy (PEG) on the number of PEG procedures performed among older adults with dementia.

    STUDY DESIGN: Interrupted time series (ITS).

    METHODS: We used the monthly aggregated data of the number of PEG procedures in older adults with dementia (both broad and narrow definitions), between 2012 and 2018, from the claims data in Fukuoka Prefecture, Japan. A single ITS design was used to estimate changes in the outcome following each intervention (i.e., first, second, and third interventions performed in 2014, 2015, and 2016, respectively). A controlled ITS design was applied to estimate the effects after the sequence of interventions (pre-intervention: 2012-2014; post-intervention: 2016-2018). The control group comprised patients with malignant head and neck tumors who underwent PEG procedures outside the scope of this policy restriction.

    RESULTS: The number of PEG procedures decreased significantly only in the month wherein the third intervention was introduced (broad definition: IRR = 0.11, CI = 0.03-0.49; narrow definition: IRR = 0.15, CI = 0.03-0.75). No significant difference was observed between the treatment and control groups during the post-intervention phase.

    CONCLUSIONS: The impact of fee-revision policy for PEG on the decrease in PEG procedures among older adults with dementia is remarkably minimal. It is difficult to reduce unnecessary PEG procedures by relying on this financial incentive alone. Policy decision-makers should consider methods to prevent inappropriate use of artificial nutrition for older adults at their end-of-life stage by reforming the health delivery system.

  19. Kc B, Heydon S, Norris P
    Public Health, 2019 Mar;168:157-163.
    PMID: 30415826 DOI: 10.1016/j.puhe.2018.09.018
    OBJECTIVE: The objective is to investigate trekkers' changing demographics, travel patterns and experience of illness in the Annapurna region.

    STUDY DESIGN: A mixed method study comprising a cross-sectional survey was carried out with trekkers who had completed trekking in the Annapurna region.

    METHODS: Interviews were carried out with trekkers using a standardised questionnaire from September to December (main trekking season) 2014 and 2016. The interview format included trekkers' demographic characteristics, travel patterns, preparation and logistics and experiences of illness and treatment.

    RESULTS: The demographic composition of trekkers had changed. Chinese and Nepalese trekkers were the most dominant groups along with other international trekkers from 16 different countries. In terms of the trekking pattern, the Chinese and the Nepalese trekkers spent a median of 7 days each in the trek and trekked to a median altitude of 3500 m, while other international trekkers spent a median of 10 days and trekked to a median altitude of 4000 m. In general, trekkers' food habits and travel patterns were good. They undertook some health preparation by using the Internet, consulting friends and travel guidebooks and consulting a doctor, pharmacist and other healthcare providers and brought medicines accordingly. However, 25% of trekkers, most commonly Chinese, Korean and Nepalese, came without any health preparation and with no medicines. Thirty percent of the trekkers became sick during the trek with common illnesses such as diarrhoea, vomiting, the common cold, headache, fever and altitude-related symptoms.

    CONCLUSIONS: Trekkers' demographic composition has changed from that found in previous studies, and this was reflected in their trekking pattern. Trekkers' health preparations for high-altitude trekking were still inadequate, especially among the newer groups such as the Nepalese, Chinese and Korean trekkers. Issues such as trekkers' health preparation and practice, eating patterns, the length of trek and altitude and health and safety provision need further improvement, especially in the context of these changing trekker demographics.

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