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  1. Zulkiply SH, Rosliza AM
    Med J Malaysia, 2022 Nov;77(6):755-763.
    PMID: 36448396
    INTRODUCTION: Suicide is recognized as an important public health concern, as it is the second leading cause of death among young people. About 80% of all suicide cases occur in low- and middle-income countries (LMICs). Understanding the risk factors for suicidal behaviours among young people in LMIC is important in developing preventive strategies; however, evidence on this is still lacking. Socio-ecological model (SEM) is a suitable framework in explaining the factors of suicidal behaviour. The aim of this review is to identify the factors associated with suicidal ideation and suicidal attempt among young people in LMIC, guided by the SEM model, and eventually develop its preventive strategies.

    MATERIALS AND METHODS: This review has two parts. The first part is a scoping review of the factors associated with suicidal ideation and attempt among young people. The search was conducted in Pubmed, Scopus, and PsycInfo. The second part is the development of preventive strategies according to the identified factors. Both parts will be guided by the SEM model.

    RESULTS: A total of ten studies with 45,278 participants that matched the criteria are included in this review. The review found that the risk factors for suicidal ideation among young people in LMIC are being female, psychiatric illness, psychology problem, smoking, alcohol intake, victim of abuse, bullied, and food insecurity. The preventive strategies include policy, mental healthcare services, awareness programme, and coping strategies.

    CONCLUSION: More epidemiological studies are needed to evaluate the risk factors of suicide that are unique in LMIC, such as help-seeking behaviour and available mental healthcare services. Suicide prevention requires concerted effort of policymakers, healthcare services, community and individual; thus, SEM framework is suitable as a guidance for suicide prevention.

    Matched MeSH terms: Developing Countries
  2. Zulkifli, Y., Alitheen, N.B., Raha, A.R., Yeap, S.K., Marlina, Son, R., et al.
    MyJurnal
    Vibrio parahaemolyticus is one of the most widely recognized pathogenic Vibrio species due to numerous outbreaks and its’ wide occurrence in marine environment. In this study, 32 isolates of V. parahaemolyticus isolated from cockles were tested for sensitivity to 16 antibiotics and the presence of plasmids. All the isolates were multi-resistance, defined as resistant to atleast three different antibiotics with multiple antibiotic resistance indexes ranging from 0.31 to 0.69, indicating the isolates originate from high risk sources of contamination where antibiotics are often used. In the plasmid profiling test, only 15 isolates (47%) harbored plasmid DNA, which ranged in size from 2.7 to 56.2 kb, separating the isolates into 14 plasmid profiles. Hence, food contaminated with antibiotic resistant V. parahaemolyticus could be a major threat to public health due to the distinct possibility that they can be a significant reservoir of genes encoding antibiotic resistance determinants that can be transferred intra or interspecies. As in many developing countries, raw food hygiene and antimicrobial resistance epidemiology is still in the infancy stage in the locality of the study and thus our data provide a current baseline profile of antimicrobial resistance and plasmid of V. parahaemolyticusfrom cockles in Padang, Indonesia.
    Matched MeSH terms: Developing Countries
  3. Zulkifli SN, Yun-Low W, Yusof K
    Asia Pac J Public Health, 1998;10(1):10-6.
    PMID: 10050201
    This paper assessed the role of public health schools on maternal and child health programmes in the Asia Pacific region. Economic development and its associated effects, particularly in the ASEAN countries, for example, migrant labour, ageing, environmental health, turbulence and social climate, has a tremendous impact on maternal and child health. Based on these current issues, it is evident that public health schools can play a major role in maternal and child health in terms of policy formulation and programme development. Several areas were proposed as to what schools of public health can do, namely, through networking, communication, research and training.
    Matched MeSH terms: Developing Countries*
  4. Zou X, Azam M, Islam T, Zaman K
    Environ Sci Pollut Res Int, 2016 Feb;23(4):3641-57.
    PMID: 26493298 DOI: 10.1007/s11356-015-5591-3
    The objective of the study is to examine the impact of environmental indicators and air pollution on "health" and "wealth" for the low-income countries. The study used a number of promising variables including arable land, fossil fuel energy consumption, population density, and carbon dioxide emissions that simultaneously affect the health (i.e., health expenditures per capita) and wealth (i.e., GDP per capita) of the low-income countries. The general representation for low-income countries has shown by aggregate data that consist of 39 observations from the period of 1975-2013. The study decomposes the data set from different econometric tests for managing robust inferences. The study uses temporal forecasting for the health and wealth model by a vector error correction model (VECM) and an innovation accounting technique. The results show that environment and air pollution is the menace for low-income countries' health and wealth. Among environmental indicators, arable land has the largest variance to affect health and wealth for the next 10-year period, while air pollution exerts the least contribution to change health and wealth of low-income countries. These results indicate the prevalence of war situation, where environment and air pollution become visible like "gun" and "bullet" for low-income countries. There are required sound and effective macroeconomic policies to combat with the environmental evils that affect the health and wealth of the low-income countries.
    Matched MeSH terms: Developing Countries/economics*
  5. Zin CS
    J Pharm Bioallied Sci, 2020 Nov;12(Suppl 2):S846-S851.
    PMID: 33828388 DOI: 10.4103/jpbs.JPBS_252_19
    Background: It was reported that opioid consumption in developing countries was stagnated or decreased, but precise data on the consumption are unclear. This study examined the trends and patterns of opioid consumption in Malaysia and other four Southeast Asian countries.

    Materials and Methods: Data of five strong opioids consumption (morphine, oxycodone, fentanyl, pethidine, and methadone) between 2005 and 2014 from Malaysia, Singapore, Indonesia, Thailand, and Vietnam were extracted from the Pain and Policy Studies Group. Defined daily doses per 1000 inhabitants per day (DDD/1000 inhabitants/day) was used for calculating the annual amount of opioid use.

    Results: The total consumption of five strong opioids was increased in all five Southeast Asian countries during a 10-year study period. Malaysia was recorded with the largest increase of the opioid consumption (993.18%), followed by Indonesia (530.34%), Vietnam (170.17%), Singapore (116.16%), and Thailand (104.66%). Malaysia also had the highest total strong opioid consumption (11.2 DDD/1000 inhabitants/day), primarily for methadone. Among the opioids used for pain management, fentanyl was primarily used in Malaysia and Singapore but the greatest increase in these two countries was for oxycodone. Fentanyl was also primarily used in Indonesia while morphine was predominantly used in Thailand and Vietnam.

    Conclusion: Growing trends of strong opioids consumption in all five Southeast Asian countries demonstrated in this study may indicate improved access to opioid analgesics in these countries. Given the increasing trends, it is important to ensure that the utilization of opioids is according to the guideline to prevent the negative consequences of opioids particularly when used in chronic non-cancer pain.

    Matched MeSH terms: Developing Countries
  6. Zhu G
    Chin J Popul Sci, 1994;6(4):403-15.
    PMID: 12319210
    Matched MeSH terms: Developing Countries
  7. Zhu G
    Chin J Popul Sci, 1990;2(3):229-46.
    PMID: 12284987
    Matched MeSH terms: Developing Countries
  8. Zaslansky R, Chapman CR, Baumbach P, Bytyqi A, Castro Lopes JM, Chetty S, et al.
    Pain Rep, 2019 01 25;4(1):e705.
    PMID: 30801045 DOI: 10.1097/PR9.0000000000000705
    Introduction: The burden of untreated postoperative pain is high.

    Objective: This study assessed feasibility of using quality improvement (QI) tools to improve management of perioperative pain in hospitals in multiple developing countries.

    Methods: The International Pain Registry and Developing Countries working groups, from the International Association for the Study of Pain (IASP), sponsored the project and PAIN OUT, a QI and research network, coordinated it, and provided the research tools. The IASP published a call about the project on its website. Principal investigators (PIs) were responsible for implementing a preintervention and postintervention study in 1 to 2 surgical wards in their hospitals, and they were free to choose the QI intervention. Trained surveyors used standardized and validated web-based tools for collecting findings about perioperative pain management and patient reported outcomes (PROs). Four processes and PROs, independent of surgery type, assessed effectiveness of the interventions.

    Results: Forty-three providers responded to the call; 13 applications were selected; and PIs from 8 hospitals, in 14 wards, in 7 countries, completed the study. Interventions focused on teaching providers about pain management. Processes improved in 35% and PROs in 37.5% of wards.

    Conclusions: The project proved useful on multiple levels. It offered PIs a framework and tools to perform QI work and findings to present to colleagues and administration. Management practices and PROs improved on some wards. Interpretation of change proved complex, site-dependent, and related to multiple factors. PAIN OUT gained experience coordinating a multicentre, international QI project. The IASP promoted research, education, and QI work.

    Matched MeSH terms: Developing Countries
  9. Zaiton Nasir, Illina Ishak, Osman Ali
    MyJurnal
    Dengue and dengue hemorrhagic jiever are still a serious public health problem among people in developing countries. The study was conducted to assess the knowledge, attitude and practice among students in University Technology of MARA in Shah Alam Selangor, Malaysia, and to determine its association withprevious infection. A total of 218 students were selected randomly fom several residential colleges within the university main campus. They were interviewed for their perception of risk to dengue and their blood were taken for serological examination (Dengue IgG). It was found that 49.1% of students have had previous infection, however onlv 0.9% had history of symptomatic dengue infection. Males students originating fom urban areas were more at risk of being infected. The perception of risk to dengue was good among students but this factor is
    unable to explain the magnitude of infection among them. Further study should look at the interaction between behaviour and environment among students who are sero negative.
    Matched MeSH terms: Developing Countries
  10. Zainuddin AA, Grover SR, Shamsuddin K, Mahdy ZA
    J Pediatr Adolesc Gynecol, 2013 Dec;26(6):296-304.
    PMID: 23507003 DOI: 10.1016/j.jpag.2012.08.004
    Congenital adrenal hyperplasia (CAH) is the commonest cause of ambiguous genitalia for female newborns and is one of the conditions under the umbrella term of "Disorders of Sex Development" (DSD). Management of these patients require multidisciplinary collaboration and is challenging because there are many aspects of care, such as the most appropriate timing and extent of feminizing surgery required and attention to psychosexual, psychological, and reproductive issues, which still require attention and reconsideration, even in developed nations. In developing nations, however, additional challenges prevail: poverty, lack of education, lack of easily accessible and affordable medical care, traditional beliefs on intersex, religious, and cultural issues, as well as poor community support. There is a paucity of long-term outcome studies on DSD and CAH to inform on best management to achieve optimal outcome. In a survey conducted on 16 patients with CAH and their parents in a Malaysian tertiary center, 31.3% of patients stated poor knowledge of their condition, and 37.5% did not realize that their medications were required for life. This review on the research done on quality of life (QOL) of female patients with CAH aims: to discuss factors affecting QOL of female patients with CAH, especially in the developing population; to summarize the extant literature on the quality of life outcomes of female patients with CAH; and to offer recommendations to improve QOL outcomes in clinical practice and research.
    Matched MeSH terms: Developing Countries*
  11. Zainal D, Loo CS
    Singapore Med J, 1995 Aug;36(4):379-82.
    PMID: 8919150
    Acute (stab) peritoneal dialysis is commonly practised in Malaysia. This study is designed to improve the management of peritoneal dialysis (PD) in Hospital University Science Malaysia (HUSM). Consecutive peritoneal dialysis (PD) on adult inpatients from May 1992 to September 1992 were reviewed prospectively. There were 40 episodes of peritoneal dialysis on 27 patients during this period given at the rate of 2 PD per week. The mean age of patients were 53 +/- 15 years. Uraemia was the main indication for dialysis, while hyperkalaemia and pulmonary oedema were indications for urgent dialysis. Complications occurred in 14 episodes of dialysis (35%). The most common complication was bleeding in the peritoneal cavity while peritonitis was the second most common complication. Dialysis episodes complicated by peritonitis were done by less experienced performers compared to uncomplicated dialysis episodes. Overall mean time spent on each dialysis and time per cycle were longer than recommended (59 +/- 24 hours and 77 +/- 14 minutes). In conclusion, acute PD performed on patients admitted in Hospital University Malaysia was safe and had complication rates comparable to other established centres. However, improvements are possible through closer supervision of new doctors and tighter nursing precautions.
    Matched MeSH terms: Developing Countries*
  12. Zain Z
    Addiction, 2002 Aug;97(8):960-1, discussion 961-2.
    PMID: 12144596
    Matched MeSH terms: Developing Countries
  13. Zain RB, Athirajan V, Ghani WM, Razak IA, Raja Latifah RJ, Ismail SM, et al.
    Cell Tissue Bank, 2013 Mar;14(1):45-52.
    PMID: 22373599 DOI: 10.1007/s10561-012-9298-0
    Identification of diagnostic markers for early detection and development of novel and therapeutic agents for effective patient management are the main motivation for cancer research. Biological specimens from large cohort and case-control studies which are crucial in providing successful research outcomes are often the limiting factor that hinders research efforts, especially in developing countries. Therefore, the Malaysian Oral Cancer Database and Tissue Bank System (MOCDTBS) were established to systematically collect large number of samples with comprehensive sociodemographic, clinicopathological, management strategies, quality of life and associated patient follow-up data to facilitate oral cancer research in Malaysia. The MOCDTBS also promotes sharing among researchers and the development of a multidisciplinary research team. The following article aims to describe the process of setting-up and managing the MOCDTBS.
    Matched MeSH terms: Developing Countries*
  14. Zain RB, Ghani WM, Razak IA, Latifah RJ, Samsuddin AR, Cheong SC, et al.
    Asian Pac J Cancer Prev, 2009 Jul-Sep;10(3):513-8.
    PMID: 19640201
    BACKGROUND: The rising burden of cancer in the developing world calls for a re-evaluation of the treatment strategies employed to improve patient management, early detection and understanding of the disease. There is thus an increasing demand for interdisciplinary research that integrates two or more disciplines of what may seemed to be highly unrelated and yet very much needed as strategies for success in research. This paper presents the processes and barriers faced in building partnerships in oral cancer research in a developing country.

    METHODS: A case study was undertaken in a developing country (Malaysia) to assess the strengths and weaknesses of the situation leading to the formation of a multidisciplinary research partnership in oral cancer. Following the formalization of the partnership, further evaluation was undertaken to identify measures that can assist in sustaining the partnership.

    RESULTS: The group identifies its strength as the existence of academia, research-intensive NGOs and good networking of clinicians via the existence of the government's network of healthcare provider system who are the policy makers. The major weaknesses identified are the competing interest between academia and NGOs to justify their existence due to the lack of funding sources and well trained human resources.

    CONCLUSIONS: With the growing partnership, the collaborative group recognizes the need to develop standard operating procedures (SOPs) and guidelines for the sharing and usage of resources in order to safeguard the interest of the original partners while also attending to the needs of the new partners.
    Matched MeSH terms: Developing Countries*
  15. Zahidi I, Wilson G, Brown K, Hou FKK
    J Health Pollut, 2020 Dec;10(28):201207.
    PMID: 33324504 DOI: 10.5696/2156-9614-10.28.201207
    Background: Rivers are susceptible to pollution and water pollution is a growing problem in low- and middle-income countries (LMIC) with rapid development and minimal environmental protections. There are universal pollutant threshold values, but they are not directly linked to river activities such as sand mining and aquaculture. Water quality modelling can support assessments of river pollution and provide information on this important environmental issue.

    Objectives: The objective of the present study was to demonstrate water quality modelling methodology in reviewing existing policies for Malaysian river catchments based on an example case study.

    Methods: The MIKE 11 software developed by the Danish Hydraulic Institute was used to model the main pollutant point sources within the study area - sand mining and aquaculture. Water quality data were obtained for six river stations from 2000 to 2015. All sand mining and aquaculture locations and approximate production capacities were quantified by ground survey. Modelling of the sand washing effluents was undertaken with the advection-dispersion module due to the nature of the fine sediment. Modelling of the fates of aquaculture deposits required both advection-dispersion and Danish Hydraulic Institute ECO Lab modules to simulate the detailed interactions between water quality determinants.

    Results: According to the Malaysian standard, biochemical oxygen command (BOD) and ammonium (NH4) parameters fell under Class IV at most of the river reaches, while the dissolved oxygen (DO) parameter varied between Classes II to IV. Total suspended solids (TSS) fell within Classes IV to V along the mid river reaches of the catchment.

    Discussion: Comparison between corresponding constituents and locations showed that the water quality model reproduced the long-term duration exceedance for the main body of the curves. However, the water quality model underestimated the infrequent high concentration observations. A standard effluent disposal was proposed for the development of legislation and regulations by authorities in the district that could be replicated for other similar catchments.

    Conclusions: Modelling pollutants enables observation of trends over the years and the percentage of time a certain class is exceeded for each individual pollutant. The catchment did not meet Class II requirements and may not be able to reach Class I without extensive improvements in the quality and reducing the quantity of both point and non-point effluent sources within the catchment.

    Competing Interests: The authors declare no competing financial interests.

    Matched MeSH terms: Developing Countries
  16. Zahari N, Mat Bah MN, A Razak H, Thong MK
    Eur J Pediatr, 2019 Aug;178(8):1267-1274.
    PMID: 31222391 DOI: 10.1007/s00431-019-03403-x
    Limited data are available on the survival of patients with Down syndrome and congenital heart disease (CHD) from middle-income countries. This retrospective cohort study was performed to determine the trends in the prevalence and survival of such patients born from January 2006 to December 2015 in Malaysia. Among 754 patients with Down syndrome, 414 (55%) had CHD, and no significant trend was observed during the 10 years. Of these 414 patients, 30% had lesions that closed spontaneously, 35% underwent surgery/intervention, 9% died before surgery/intervention, and 10% were treated with comfort care. The overall mortality rate was 23%, the median age at death was 7.6 months, and no significant changes occurred over time. The early and late post-surgery/intervention mortality rates were 0.7% and 9.0%, respectively. Most deaths were of non-cardiac causes. The overall 1-, 5-, and 10-year survival rates were 85.5%, 74.6%, and 72.9%, respectively. Patients with severe lesions, persistent pulmonary hypertension of the newborn, atrioventricular septal defect, and pulmonary hypertension had low survival at 1 year of age.Conclusion: The prevalence of CHD in patients with Down syndrome is similar between Malaysia and high-income countries. The lower survival rate is attributed to limited expertise and resources which limit timely surgery. What is Known: • The survival of patients with Down syndrome with congenital heart disease (CHD) has improved in high-income countries. However, little is known about the survival of patients with Down syndrome with CHD from middle-income countries. • In the Caucasian population, atrioventricular septal defect is the most common type of CHD associated with Down syndrome. What is New: • In middle-income countries, the prevalence of CHD is the same as in high-income countries, but with a lower survival rate. • In the Asian population, ventricular septal defect is the most common type of CHD in patients with Down syndrome.
    Matched MeSH terms: Developing Countries
  17. Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, et al.
    Lancet, 2020 03 07;395(10226):795-808.
    PMID: 31492503 DOI: 10.1016/S0140-6736(19)32008-2
    BACKGROUND: Global estimates of the effect of common modifiable risk factors on cardiovascular disease and mortality are largely based on data from separate studies, using different methodologies. The Prospective Urban Rural Epidemiology (PURE) study overcomes these limitations by using similar methods to prospectively measure the effect of modifiable risk factors on cardiovascular disease and mortality across 21 countries (spanning five continents) grouped by different economic levels.

    METHODS: In this multinational, prospective cohort study, we examined associations for 14 potentially modifiable risk factors with mortality and cardiovascular disease in 155 722 participants without a prior history of cardiovascular disease from 21 high-income, middle-income, or low-income countries (HICs, MICs, or LICs). The primary outcomes for this paper were composites of cardiovascular disease events (defined as cardiovascular death, myocardial infarction, stroke, and heart failure) and mortality. We describe the prevalence, hazard ratios (HRs), and population-attributable fractions (PAFs) for cardiovascular disease and mortality associated with a cluster of behavioural factors (ie, tobacco use, alcohol, diet, physical activity, and sodium intake), metabolic factors (ie, lipids, blood pressure, diabetes, obesity), socioeconomic and psychosocial factors (ie, education, symptoms of depression), grip strength, and household and ambient pollution. Associations between risk factors and the outcomes were established using multivariable Cox frailty models and using PAFs for the entire cohort, and also by countries grouped by income level. Associations are presented as HRs and PAFs with 95% CIs.

    FINDINGS: Between Jan 6, 2005, and Dec 4, 2016, 155 722 participants were enrolled and followed up for measurement of risk factors. 17 249 (11·1%) participants were from HICs, 102 680 (65·9%) were from MICs, and 35 793 (23·0%) from LICs. Approximately 70% of cardiovascular disease cases and deaths in the overall study population were attributed to modifiable risk factors. Metabolic factors were the predominant risk factors for cardiovascular disease (41·2% of the PAF), with hypertension being the largest (22·3% of the PAF). As a cluster, behavioural risk factors contributed most to deaths (26·3% of the PAF), although the single largest risk factor was a low education level (12·5% of the PAF). Ambient air pollution was associated with 13·9% of the PAF for cardiovascular disease, although different statistical methods were used for this analysis. In MICs and LICs, household air pollution, poor diet, low education, and low grip strength had stronger effects on cardiovascular disease or mortality than in HICs.

    INTERPRETATION: Most cardiovascular disease cases and deaths can be attributed to a small number of common, modifiable risk factors. While some factors have extensive global effects (eg, hypertension and education), others (eg, household air pollution and poor diet) vary by a country's economic level. Health policies should focus on risk factors that have the greatest effects on averting cardiovascular disease and death globally, with additional emphasis on risk factors of greatest importance in specific groups of countries.

    FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments).

    Matched MeSH terms: Developing Countries*
  18. Yusof K, Zulkifli SN
    Malays J Reprod Health, 1985;3(1):31-45.
    PMID: 12268887
    Matched MeSH terms: Developing Countries
  19. Yuen FK
    Noise Health, 2014 Nov-Dec;16(73):427-36.
    PMID: 25387540 DOI: 10.4103/1463-1741.144429
    Environmental noise remains a complex and fragmented interplay between industrialization, population growth, technological developments, and the living environment. Next to the circulatory diseases and cancer, noise pollution has been cited as the third epidemic cause of psychological and physiological disorders internationally. A reliable and firm relationship between the cumulative health implications with the traffic annoyance and occupational noise has been established. This agenda has called for an integrated, coordinated, and participatory approach to the reliable protection of noise interference. Despite several fragmented policies, legislation and global efforts have been addressed; the noise pollution complaints have been traditionally neglected in developing countries, especially in Malaysia. This paper was undertaken to postulate an initial platform to address the dynamic pressures, gigantic challenges, and tremendous impacts of noise pollution scenario in Malaysia. The emphasis is speculated on the traffic interference and assessment of industrial and occupational noise. The fundamental importance of noise monitoring and modeling is proposed. Additionally, the confronting conservation program and control measure for noise pollution control are laconically elucidated.
    Matched MeSH terms: Developing Countries
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