Displaying publications 1 - 20 of 179 in total

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  1. Al-Mekhlafi MH, Surin J, Atiya AS, Ariffin WA, Mahdy AK, Abdullah HC
    Trans R Soc Trop Med Hyg, 2008 Oct;102(10):1046-52.
    PMID: 18617209 DOI: 10.1016/j.trstmh.2008.05.012
    A cross-sectional study to determine the current prevalence of anaemia and iron deficiency anaemia (IDA) and to investigate the possible risk factors for IDA was carried out on 241 aboriginal schoolchildren (120 boys, 121 girls) aged 7-12 years and living in remote areas in Pos Betau, Pahang, Malaysia. Haemoglobin (Hb) level was measured and serum iron status was assessed by serum ferritin (SF), serum iron (SI) and total iron binding capacity measurements. Socioeconomic data were collected using pre-tested questionnaires. All children were screened for intestinal parasitic infections. Overall, 48.5% (95% CI 42.3-54.8) of children were anaemic (Hb<12 g/dl). The prevalence of IDA was 34% (95% CI 28.3-40.2), which accounted for 70.1% of the anaemia cases. The prevalence of IDA was significantly higher in females than males. Low levels of mothers' education and low household income were identified as risk factors for IDA. Severe trichuriasis also found to be associated with low SF and SI. Logistic regression confirmed low levels of mothers' education and gender as significant risk factors for IDA. Improvement of socioeconomic status and health education together with periodic mass deworming should be included in public health strategies for the control and prevention of anaemia and IDA in this population.
  2. Ross IN, Abraham T
    Trans R Soc Trop Med Hyg, 1987;81(3):374-7.
    PMID: 3686631
    We used Bayes' theorem to calculate the probability of enteric fever in 260 patients presenting with undiagnosed fever, without recourse to blood or stool culture results. These individuals were divided into 110 patients with enteric fever (63 culture positive, 47 culture negative) and 150 patients with other causes of fever. Comparison of the frequencies of occurrence of 19 clinical and laboratory events, said to be helpful in the diagnosis of enteric fever, in the two groups revealed that only 8 events were significantly more frequent in enteric fever. These were: a positive Widal test at a screening dilution of 1:40; a peak temperature greater than = 39 degrees C; previous treatment for the fever; a white blood cell count less than 9 X 10(6)/litre; a polymorphonuclear leucocyte count less than 3.5 X 10(6)/litre; splenomegaly; fever duration greater than 7 d; and hepatomegaly. When the probability of enteric fever was determined prospectively in 110 patients, using only 6 of these discriminating events, the probability of patients with a positive prediction having enteric fever (diagnostic specificity) was 0.80 (95% confidence interval: 0.68 to 0.91) and the probability of those with a negative prediction not having enteric fever (diagnostic sensitivity) was 0.92 (0.85 to 0.99). Using all 19 events did not alter the diagnostic specificity or diagnostic sensitivity. This study shows that a small number of clinical and laboratory features can objectively discriminate enteric fever from other causes of fever in the majority of patients. Calculating the probability of enteric fever can aid in diagnosis, when culturing for salmonella is either unavailable or is negative.
  3. Sahimin N, Low ZX, Hassandarvish P, Mohd Hanapi IR, Mohd Zain SN, Yahaya H, et al.
    PMID: 38226501 DOI: 10.1093/trstmh/trad097
    BACKGROUND: Mosquito-borne diseases pose a significant global public health threat, with Malaysia's Klang Valley experiencing numerous outbreaks in densely populated urban areas.

    METHODS: This study aimed to estimate the seroprevalence of anti-dengue and anti-chikungunya antibodies among urban refugees in the Klang Valley, Malaysia, and identify associated risk factors.

    RESULTS: High seroprevalence of anti-dengue immunoglobulin G (IgG) and IgM (60.0% [confidence interval {CI} 55.39 to 64.48] and 9.2% [CI 6.77 to 12.25], respectively) were observed among refugees >18 years of age (χ22=11.720, p=0.003), Kachin ethnicity (χ28=72.253, p<0.001), without formal education (χ21=3.856, p=0.050), homes near waste disposal sites (χ21=10.378, p=0.001) and refugees who have experienced flooding (χ21=5.460, p=0.019). Meanwhile, the overall seroprevalence of anti-chikungunya IgG and IgM was 9.7% (CI 7.15 to 12.73) and 10.8% (CI 8.09 to 13.93), respectively, with ages 12-18 years (χ22=6.075, p=0.048), Rohingya ethnicity (χ28=31.631, p<0.001) and homes close to waste disposal sites (χ21=3.912, p=0.048) being significant risk factors. Results showed a link to poor environmental living conditions, with an increase in the vector population with higher availability of breeding sites and thus exposure to dengue and chikungunya virus.

    CONCLUSIONS: Health education among the community is the key to disease prevention, as there are no specific antiviral drugs for treatment and limited vaccine availability.

  4. Alharazi TH, Al-Mekhlafi HM
    Trans R Soc Trop Med Hyg, 2021 06 02;115(6):687-698.
    PMID: 33130880 DOI: 10.1093/trstmh/traa115
    BACKGROUND: This cross-sectional survey aimed to assess the knowledge, attitudes and practices (KAP) towards schistosomiasis among rural schoolchildren in Taiz governorate, southwestern Yemen.

    METHODS: A total of 406 children were screened for urogenital and intestinal schistosomiasis. A pretested questionnaire was used to collect the children's demographic and socio-economic information and their KAP towards schistosomiasis.

    RESULTS: Overall, 73 children (18%) were found to be infected by Schistosoma mansoni. None of the children were positive for Schistosoma haematobium. The prevalence of intestinal schistosomiasis was significantly higher among boys than girls (22.1% vs 12%; p=0.010). Approximately two-thirds (63.3% [257/406]) of the children had heard about schistosomiasis, however, only 38.5%, 53.6%, 28.4% and 38.1% had correct knowledge concerning the causes, symptoms, transmission and prevention, respectively. A significantly higher level of knowledge was observed among boys and Schistosoma-infected children compared with girls and non-infected children (p<0.05). However, a better level of knowledge does not seem to translate directly into the performance of hygienic practices. Multivariate logistic regression showed that sex and infection status were the significant predictors of good knowledge.

    CONCLUSIONS: Intestinal schistosomiasis is prevalent among schoolchildren in rural Yemen. The findings reveal that children's knowledge about schistosomiasis is inadequate. Therefore, besides mass drug administration, integrated control programmes should also include health education and the provision of improved drinking water and proper sanitation.

  5. Al-Ashwal MA, Atroosh WM, Al-Adhroey AH, Al-Subbary AA, Yee-Ling L, Al-Mekhlafi HM
    Trans R Soc Trop Med Hyg, 2023 Dec 04;117(12):823-838.
    PMID: 37486252 DOI: 10.1093/trstmh/trad044
    BACKGROUND: Cutaneous leishmaniasis (CL) is a major health problem in Yemen and is endemic in many rural areas across the country.

    METHODS: A community-based cross-sectional survey followed by unmatched case-control comparisons was conducted among 612 participants in Utmah district, western Yemen. A total of 223 participants were included in the case-control analysis to identify the significant risk factors. Skin scrapping samples were examined by microscopy and internal transcribed spacer 1 nested polymerase chain reaction.

    RESULTS: Overall, 33% (202/612) of the participants had active skin lesions and/or scars that met the clinical criteria for CL. A total of 90 (14.7%) participants had suspected active CL lesions; however, a prevalence of 8.7% (53/612) was obtained based on molecular and parasitological examination, with Leishmania tropica being the only causative agent identified. Multivariable logistic regression analyses showed that being ≤10 y old, being female, living in houses with cracked walls, living in the presence of other family members with typical ulcerating skin diseases and sleeping outside were factors significantly associated with an increased likelihood of having CL. Moreover, keeping livestock on the ground floor of the house was significantly associated with a decreased likelihood of having CL.

    CONCLUSION: The study reveals an alarmingly high prevalence of CL among the studied population. Therefore there is an urgent need for effective control measures and improved treatment efforts against this devastating disease.

  6. Mohammed Mahdy AK, Lim YA, Surin J, Wan KL, Al-Mekhlafi MS
    Trans R Soc Trop Med Hyg, 2008 May;102(5):465-70.
    PMID: 18377940 DOI: 10.1016/j.trstmh.2008.02.004
    This study was conducted to reassess the risk factors for giardiasis in communities of the Orang Asli (indigenous people) in Pahang, Malaysia. Stool samples were collected from 321 individuals (2-76 years old; 160 males, 161 females). Data were collected via laboratory analysis of faecal samples and a pre-tested standard questionnaire. River water samples were tested for Giardia cysts and Cryptosporidium oocysts. The overall prevalence of G. intestinalis infection was 23.7%. Children < or =12 years old had the highest infection rate and have been identified as a high risk group (odds ratio (OR)=6.2, 95% CI 1.5-27.0, P<0.005). The risk of getting giardiasis also appeared to be significantly associated with drinking piped water (OR=5.1, 95% CI 0.06-0.7, P<0.005) and eating raw vegetables (OR=2.4, 95% CI 0.2-0.6, P<0.005). In conclusion, sociodemographic factors have always been associated with the high prevalence of Giardia infections in Malaysia. However, the present study also highlights the need to look into the possibility of other risks such as water and food transmission routes. In future, it is necessary that these two aspects be considered in control strategies.
  7. Zakaria ND, Avoi R
    PMID: 34453834 DOI: 10.1093/trstmh/trab132
    BACKGROUND: Lymphatic filariasis (LF) is a public health problem in Sabah, Malaysia. In the subdistrict of Tangkarason, nine rounds of mass drug administration (MDA) were probably not effective in reducing the prevalence of microfilaria to the <1% threshold recommended by the World Health Organization for stopping MDA. This cross-sectional study was conducted to identify the risk factors associated with positive LF antibody in Tangkarason.

    METHODS: Eligible adults >18 y of age in seven endemic villages in Tangkarason, Beluran, Sabah, were interviewed and tested for LF antibody using the Brugia Rapid kit. Multivariable logistic regression was employed to analyse the associated factors.

    RESULTS: A total of 244 respondents were included in this study. Their median age was 40 y (interquartile range 30-53). The antibody prevalence of brugian filariasis in the study population was 31.1% (95% confidence interval [CI] 25.7 to 37.2). Older age (adjusted odds ratio [aOR] 1.04 [95% CI 1.02 to 1.06]) and outdoor jobs (aOR 2.26 [95% CI 1.05 to 4.85]) were identified as independent risk factors for positive LF antibody. Participating in the MDA program previously (aOR 0.24 [95% CI 0.10 to 0.57]) was found to be a protective factor for LF infection.

    CONCLUSIONS: A high prevalence of microfilariae was confirmed in all the study sites, which was above the target of <1%. Important factors associated with positive LF antibody were identified, which could be used as a guide for program managers to design more focused control measures in LF-endemic areas.

  8. Sasidharan S, Uyub AM, Azlan AA
    Trans R Soc Trop Med Hyg, 2008 Dec;102(12):1226-32.
    PMID: 18586289 DOI: 10.1016/j.trstmh.2008.05.006
    HeIicobacter pylori infection rate was determined in 697 consecutive patients with ulcer, gastritis, duodenitis and non-ulcer dyspepsia by endoscopy at a Malaysian hospital in 1999-2002. Biopsies of the gastric antrum and body were subjected to the urease test, Gram staining of impression smears and culture examination. Infection was defined as a positive result in at least one test. The infection rates were 32.1, 10.4, 20.0 and 16.2% in ulcer, gastritis, duodenitis and non-ulcer dyspepsia patients, respectively. Overall, the prevalence of H. pylori infection was 14.6%, with the rate among the Indian (21.7%), Chinese (19.2%) and Bangladeshi foreign worker (23.1%) groups significantly higher (P<0.05) than that of the Malays (5.8%). Generally, the prevalence rate among males (18.9%) was significantly higher (P<0.001) than that among females (9.0%), but for a particular ethnic group, such trend and significant differences (P<0.05) were observed only among the Malays. In terms of gender, the prevalence rates of Malay males and females were also significantly lower (P<0.05) than those of Chinese and Indians. In conclusion, there is a significant difference in H. pylori infection prevalence rates among ethnic groups (highest in Indians, then Chinese and unusually low in Malays) and gender groups (highest in males) in Malaysia.
  9. Balasundaram R
    Trans R Soc Trop Med Hyg, 1970;64(4):607-14.
    PMID: 5485621 DOI: 10.1016/0035-9203(70)90085-4
    The pattern and incidence of cardiovascular disease was studied in a general practice in an urban-rural area in the west coast of West Malaysia. Hypertension, rheumatic heart disease and congenital heart disease accounted for 85% of the 476 patients with evidence of cardiovascular disease. Ischaemic heart disease, arteriosclerotic heart disease and other conditions accounted for the rest. Emphasis is laid on the salient features of incidence in general practice. Comparison is made with previous clinical and pathological studies from this region.
    Study site: General practjce clinic, Telok Anson [Teluk Intan], District of Lower Perak, Malaysia
  10. Desmarchelier P, Lew A, Caique W, Knight S, Toodayan W, Isa AR, et al.
    Trans R Soc Trop Med Hyg, 1992 7 1;86(4):448-50.
    PMID: 1440833
    The H2S water screening test and the membrane filtration faecal coliform count were compared with Escherichia coli counts for water samples collected from household water sources and domestic drinking water in rural Malaysia. Water samples were taken from 151 wells, 44 taps supplying water from the treated municipal supply and 192 domestic stored water supplies. E. coli were detected in 20% of the samples (42% of wells, 7% of tap water and 6% of drinking water). Excellent correlation (Spearman's rank correlation rs = 0.93) was found between the faecal coliform and E. coli counts for all sample types. The H2S method was poorly correlated whether read at 18 or 30 h. False positive rates were highest for well water, and false negative rates were highest for both well and drinking water samples, with low E. coli counts. The faecal coliform test was an excellent predictor of the presence of E. coli in these water samples, while the H2S test was very inadequate.
  11. Laghari M, Talpur BA, Sulaiman SAS, Khan AH, Bhatti Z
    Trans R Soc Trop Med Hyg, 2021 08 02;115(8):904-913.
    PMID: 33382889 DOI: 10.1093/trstmh/traa161
    BACKGROUND: Information on the extent of patient medication adherence and the use of interventions to advance adherence are scarce in clinical practice. This study aimed to assess medication adherence and risk factors for non-adherence among the caregivers of children with tuberculosis (TB).

    METHODS: This prospective study was conducted among the caregivers of 443 child TB patients registered during the study. Caregivers of children were queried using a structured questionnaire consisting of sociodemographic and socio-economic factors and the role of healthcare workers during the treatment course. Risk factors for non-adherence were estimated using a logistic regression model.

    RESULTS: In multivariate analysis, the independent variables that had a statistically significant positive association with non-adherence were male sex (adjusted odds ratio [AOR] 5.870 [95% confidence interval {CI} 1.99 to 17.29]), age ≥45 y (AOR 5.627 [95% CI 1.88 to 16.82]), caregivers with no formal education (AOR 3.905 [95% CI 1.29 to 11.79]), financial barriers (AOR 30.297 [95% CI 6.13 to 149.54]), insufficient counselling by healthcare workers (AOR 5.319 [95% CI 1.62 to 17.42]), insufficient counselling by health professionals (AOR 4.117 [95% CI 1.05 to 16.05]) and unfriendly attitude and poor support from healthcare professionals (AOR 11.150 [95% CI 1.91 to 65.10]).

    CONCLUSIONS: Treatment adherence in the present study was 86% using the Morisky Green Levine Medication Adherence Scale and 90.7% using the visual analogue scale tool. Predictors of non-adherence need to be a focus and caregivers should be given complete knowledge about the importance of adherence to TB treatment.

  12. Southgate BA, Bryan JH
    Trans R Soc Trop Med Hyg, 1992 9 1;86(5):523-30.
    PMID: 1475823
    Quantitative understanding of the transmission dynamics of lymphatic filarial parasites is essential for the rational planning of control strategies. One of the most important determinants of transmission dynamics is the relationship between parasite yield, the success rate of ingested microfilariae (mf) becoming infective larvae in a mosquito vector, and mf density in the source of the human blood meal. Three types of relationship have been recognized in human filaria/mosquito couples--limitation, facilitation and proportionality; facilitation has hitherto been observed only in the couple Wuchereria bancrofti/Anopheles gambiae in Burkina Faso, in experimental studies on a high density mf carrier. The present paper demonstrates facilitation in W. bancrofti/An. gambiae and W. bancrofti/An. arabiensis in lower mf density carriers in The Gambia and Tanzania, and in W. bancrofti/An. funestus in Tanzania. Facilitation was not found in An. melas in The Gambia nor in An. merus in Tanzania. Analysis of published data shows limitation at low level mf densities in W. bancrofti/Culex quinquefasciatus in Sri Lanka, and in the same couple in India. Limitation also occurs in Brugia malayi/Aedes togoi in experimental cats; proportionality occurs in B. malayi/Mansonia bonneae in Malaysia. The epidemiological significance of these host/parasite relationships is discussed, and supporting evidence for its validity is presented from the published results of large-scale control programmes.
  13. Kan SP, Guyatt HL, Bundy DA
    Trans R Soc Trop Med Hyg, 1989 11 1;83(6):817-20.
    PMID: 2617652
    This study compares levels of geohelminth infection in children living in rural estates and urban slum areas of Malaysia. The statistical characteristics of geohelminth infection in 1499 children from birth up to 15 years of age, living in rural estates, were analysed according to age, sex and ethnic origin and compared with the same statistics for 1574 slum-dwelling children of similar age groups and ethnic origins. The prevalence and intensity of ascariasis and trichuriasis were significantly higher among children from the urban slums. Slum-dwelling ethnic Indians and Malays had higher levels of infection with Ascaris lumbricoides and Trichuris trichiura than their rural counterparts, but the infection status of the ethnic Chinese in the 2 areas was similar. Hookworm infection was similar in both areas, indicating that hookworm infection is neither necessarily nor solely a rural disease. These results suggest that urban slum children are at greater risk of ascariasis and trichuriasis than their rural counterparts.
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