Displaying publications 321 - 340 of 341 in total

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  1. He L, Ayub AFBM, Amri SB
    BMC Public Health, 2024 Sep 02;24(1):2387.
    PMID: 39223514 DOI: 10.1186/s12889-024-19844-5
    BACKGROUND: Students' physical fitness has always been the focus of attention of the Chinese government, and the school as an important way to improve students' physical fitness, there are many studies on the current status of the implementation of physical education in schools, and there are many studies that use self-made questionnaires to investigate the implementation of physical education in schools, but most of the studies do not adequately validate the self-made questionnaires, so the purpose of this study was to develop a questionnaire to assess the level of implementation of physical education programmes in Chinese junior secondary schools and to test its reliability and validity.

    METHOD: The content of the questionnaire was developed based on the content of Annex 1 of the Assessment Measures for Physical Education in Primary and Secondary Schools issued by the Ministry of Education of China in 2014 and was modified based on feedback from the expert panel and pre-test participants. The questionnaire was initially tested for validity by 5 expert reviewers, and then we collected data information from 350 participants and conducted exploratory factor analysis (EFA) to explore the factor structure of the initial version. One week later, 40 of the 350 participants were randomly selected to assess test-retest reliability.

    RESULTS: The I-CVI and KAPPA value analysis results of the expert review results show that the questionnaire has extremely high reliability and consistency among experts. EFA results indicate that the five dimensions of this questionnaire are highly reliable. In the test-retest reliability, the Pearson correlation coefficients of the initial test data and the retest data of each dimension are all greater than 0.7, and the significance probability values are all less than 0.05, reaching the significance level, the results show that the questionnaire has good stability.

    CONCLUSIONS: This study concluded that the 5 dimensions and 38 items of this questionnaire had high reliability and validity and could be used as a preliminary tool to measure the implementation level of physical education programs in junior high schools in China. However, future research should explore the potential need for adjustment to suit different regions and cultures.

  2. Bauman A, McNeil N, Nicholson M, O'Halloran P, Seal E, Randle E, et al.
    BMC Public Health, 2023 Feb 15;23(1):333.
    PMID: 36793043 DOI: 10.1186/s12889-023-15091-2
    INTRODUCTION: Addressing gender inequalities in physical activity is an important public health goal. A major campaign, 'This Girl Can' (TGC) was conducted by Sport England from 2015, and TGC was licenced in 2018 by VicHealth in Australia for development and use in a 3-year mass media campaign. The campaign was adapted through formative testing to Australian conditions and implemented within the state of Victoria. The purpose of this evaluation was to assess the initial population impact of the first wave of the TGC-Victoria.

    METHODS: We assessed campaign impact using serial population surveys, with the target population being women living in Victoria who were not meeting the current physical activity guidelines. Two surveys were carried out before the campaign (October 2017 and March 2018), and the post-campaign survey immediately following the first wave of TGC-Victoria mass media (May 2018). Analyses were primarily on the cohort sample of 818 low-active women followed across all three surveys. We measured campaign effects using campaign awareness and recall, and self-report measures of physical activity behaviour and perceptions of being judged. Changes in perceptions of being judged and in reported physical activity were assessed in relation to campaign awareness over time.

    RESULTS: Overall, TGC-Victoria campaign recall increased from 11.2% pre-campaign to 31.9% post-campaign, with campaign awareness more likely among younger and more educated women. There was a slight increase of 0.19 days in weekly physical activity following the campaign. Feeling that being judged was a barrier to physical activity declined at follow up, as did the single item perceptions of feeling judged (P 

  3. Ramzi NH, Hoong ATC, Johari NA, Nathan AM, Teh CSJ, Sulaiman NA, et al.
    BMC Public Health, 2024 Aug 20;24(1):2255.
    PMID: 39164673 DOI: 10.1186/s12889-024-19789-9
    BACKGROUND: S. pneumoniae (SPN) is the most common cause of pneumonia. The disease can be effectively prevented through immunisation. Since December 2020, the Malaysian Government has included the 10-valent pneumococcal conjugate vaccine (PCV10) for all infants born on or after 1 January 2020 as part of the National Immunisation Programme (NIP). However, the epidemiology of pneumonia remains poorly understood. To fill the knowledge gap, we established a multicentre surveillance study to understand the burden of pneumococcal pneumonia among young children in Peninsular Malaysia.

    METHODS: MY-Pneumo is a multicentre prospective case-control study conducted in three sentinel sites located in three different states of Peninsular Malaysia - Kuala Lumpur, Pahang, and Kelantan. A cohort of at least 500 incident cases and 500 controls is enrolled beginning in October 2021 and matched for age. Cases are hospitalised children 

  4. Kabir MA, Goh KL, Khan MH
    BMC Public Health, 2013 Apr 23;13:379.
    PMID: 23617464 DOI: 10.1186/1471-2458-13-379
    BACKGROUND: Tobacco consumption (TC) among youths poses significant public health problem in developing countries. This study utilized the data of Global Youth Tobacco Survey (GYTS), 2007 to examine and compare youth TC behavior in Bangladesh, Nepal and Sri Lanka.

    METHODS: The GYTS covered a total of 2,242 Bangladeshi, 1,444 Nepalese and 1,377 Sri-Lankan youths aged 13-15 years. They represented response rates of 88.9%, 94.6%, and 85.0% for the three countries, respectively. Socioeconomic, environmental, motivating, and programmatic predictors of TC were examined using cross tabulations and logistic regressions.

    RESULTS: Prevalence of TC was 6.9% (9.1% in males, 5.1% in females) in Bangladesh, 9.4% (13.2% in males, 5.3% in females) in Nepal and 9.1% (12.4% in males, 5.8% in females) in Sri Lanka. The average tobacco initiation age was 9.6, 10.24 and 8.61 years, respectively. Cross tabulations showed that gender, smoking among parents and friends, exposure to smoking at home and public places, availability of free tobacco were significantly (P < 0.001) associated with TC in all three countries. The multivariable analysis [odds ratio (95% confidence interval)] indicated that the common significant predictors for TC in the three countries were TC among friends [1.9 (1.30-2.89) for Bangladesh, 4.10 (2.64-6.38) for Nepal, 2.34 (1.36-4.02) for Sri Lanka], exposure to smoking at home [1.7 (1.02-2.81) for Bangladesh, 1.81 (1.08-2.79) for Nepal, 3.96 (1.82-8.62) for Sri Lanka], exposure to smoking at other places [2.67 (1.59-4.47) for Bangladesh, 5.22 (2.76-9.85) for Nepal, 1.76 (1.05-2.88) for Sri Lanka], and the teaching of smoking hazards in schools [0.56 (0.38-0.84) for Bangladesh, 0.60 (0.41-0.89) for Nepal, 0.58 (0.35-0.94) for Sri Lanka].

    CONCLUSIONS: An understanding of the influencing factors of youth TC provides helpful insights for the formulation of tobacco control policies in the South-Asian region.

  5. Supramaniam P, Beh YS, Junus S, Devesahayam PR
    BMC Public Health, 2024 Dec 19;24(1):3542.
    PMID: 39702047 DOI: 10.1186/s12889-024-21056-w
    BACKGROUND: Mobile health applications (mHealth apps) offer potential benefits for improving diabetes management, such as better glucose monitoring and patient engagement, but their widespread adoption faces challenges, including privacy concerns and user adherence. This research investigates mHealth app usage among patients living with diabetes in Kinta District, Perak, exploring experiences, challenges and patient perceptions regarding diabetes management using mHealth apps.

    METHODOLOGY: A cross-sectional community survey was conducted in September till November 2020 across nine government health clinics focusing on diabetes mellitus (Type 1 or Type 2) patients, aged 18 years and older, receiving Diabetes Medication Adherence Counseling (DMTAC) services and able to use smart devices. A self-developed questionnaire with four sections was used to gather demographic information, explore mHealth apps usage and understand both users and non-users' experiences and perceptions. The questionnaire was tested through cognitive debriefing, translated into Malay, pre-tested and finalized by the expert committee. The questionnaire was digitally implemented using Google® Form and QR code. After obtaining informed consent, data collection was performed by the trained DMTAC pharmacists. Statistical analyses involved descriptive and inferential analyses.

    RESULTS: The study analyzed the engagement of 295 patients living with diabetes with mHealth apps. Females (54.9%), of Malay ethnicity (58.3%) and with a mean age of 53.8 years (SD: 12.38) constituted the majority. Diabetes duration had a median of 6 years (IQR: 3.0, 10.0) with prevalent comorbidities like hypertension (58.0%) and dyslipidemia (42.7%). Most patients were employed (44.7%) and their primary source of diabetes management information was through healthcare providers (92.5%). Despite the high app use for social interaction, only 13.6% used mHealth apps for disease management. Users were influenced by social media (65.0%) and favored for wellness apps and disease monitoring. Users perceived the mHealth app as useful (97.5%), yet faced challenges over the app initiation, charges and data security. Non-users cited lack of awareness (70.2%), struggled with app startup (22.4%) and preference for conventional healthcare visits (22.0%). In multivariable analysis, longer diabetes duration reduced mHealth app usage (p = 0.046), while multimorbidity increased the likelihood (p = 0.001). Awareness of the availability of health apps significantly influenced the usage of mHealth apps (p 

  6. Du X, Wei H, Zhang X
    BMC Public Health, 2024 Oct 28;24(1):2984.
    PMID: 39468484 DOI: 10.1186/s12889-024-20422-y
    The rising healthcare costs due to population aging present a complex issue, with debate centering on whether these costs are driven by aging or end-of-life care. This study examines healthcare expenditures in Chinese households using data from the 2005 and 2018 Chinese Longitudinal Healthy Longevity Survey. By applying the Heckman select model and a two-part model, the research innovatively includes time to death, income, social security and health level in the benchmark regression in order to validate the recent some new Red Herring hypothesis. The findings show that time to death is the primary determinant of healthcare expenditures, while the effect of aging is minimal. Income, social security, and health status also significantly influence health expenditure, but they do not function as Red Herring variables.
  7. Supramaniam P, Junus S, Hashim L, Chiew SC, Devesahayam PR
    BMC Public Health, 2024 Jun 06;24(1):1520.
    PMID: 38844906 DOI: 10.1186/s12889-024-19027-2
    BACKGROUND: This study addresses the persistent global burden of road traffic fatalities, particularly in middle-income countries like Malaysia, by exploring the impact of the COVID-19 pandemic on Road Traffic Accident (RTA) fatalities in Perak state, Malaysia, with a secondary focus on applying Years of Life Lost (YLL) to understand the implications of these premature deaths.

    METHODOLOGY: The cross-sectional study retrospectively reviewed certified RTA fatalities from 2018 to 2021, individually counting fatalities in accidents and excluding cases with incomplete death profiles. Data were collected from all Forensic Departments in the government hospitals in Perak. RTA fatalities were confirmed by medical officers/physicians following established procedures during routine procedures. A total of 2517 fatal accident and victim profiles were transcribed into data collection form after reviewing death registration records and post-mortem reports. Inferential analyses were used for comparison between pre- and during COVID-19 pandemic. The standard expected YLL was calculated by comparing the age of death to the external standard life expectancy curve taking into consideration of age and gender in Malaysia.

    RESULTS: This study included 2207 (87.7%) of the RTA fatalities in Perak State. The analysis revealed a decreasing trend in RTA deaths from 2018 to 2021, with a remarkable Annual Percent Change (APC) of -25.1% in 2020 compared to the pre-pandemic year in 2019 and remained stable with lower APC in 2021. Comparison between pre-pandemic (2018-2019) and pandemic years (2020-2021) revealed a difference in the fatality distribution with a median age rise during the pandemic (37.7 (IQR: 22.96, 58.08) vs. 41.0 (IQR: 25.08, 61.00), p = 0.002). Vehicle profiles remained consistent, yet changes were observed in the involvement of various road users, where more motorcycle riders and pedestrian were killed during pandemic (p = 0.049). During pandemic, there was a decline in vehicle collisions, but slight increase of the non-collision accidents and incidents involving pedestrians/animals (p = 0.015). A shift in accident from noon till midnight were also notable during the pandemic (p = 0.028). YLL revealed differences by age and gender, indicating a higher YLL for females aged 30-34 during the pandemic.

    CONCLUSION: The decline in RTA fatalities during COVID-19 pandemic underscores the influence of pandemic-induced restrictions and reduced traffic. However, demographic shifts, increased accident severity due to risky behaviors and gender-specific impacts on YLL, stress the necessity for improved safety interventions amidst evolving dynamics.

  8. Mo W, Saibon JB, Li Y, Li J, He Y
    BMC Public Health, 2024 Feb 19;24(1):517.
    PMID: 38373997 DOI: 10.1186/s12889-024-18043-6
    OBJECTIVE: The objective of this study was to conduct a systematic review to summarize and assess the advancements lately made on the enjoyable impacts of game-based physical education interventions on children and adolescents. Additionally, it attempted to identify the effects and variables influencing the enjoyable outcomes of children and adolescents' engagement in physical education games, through meta-analysis.

    METHODS: This study involves a comprehensive search of different databases like Web of Science, PubMed, Embase, EBSCOhost, Cochrane, and Scopus. Specific criteria are established for the selection process to make sure the relevant literature included. The quality assessment of the included researches is conducted based on the guidelines outlined in the Cochrane 5.1 handbook. Review Manager 5.3 software is employed to synthesis the effect sizes. Additionally, bias is assessed using funnel plots, and to identify potential sources of heterogeneity, subgroup analyses are performed.

    RESULTS: A total of 1907 academic papers, out of which 2 articles were identified via other data sources. The present study examined the impact of a pedagogical intervention involving physical education games on the enjoyment experienced by children and adolescents. The results indicated a significant positive effect (MD = 0.53, 95%CI:[0.27,0.79], P 

  9. Suwanbamrung C, Mehraj SK, Kercho MW, Stanikzai MH, Ageru TA, Jaroenpool J, et al.
    BMC Public Health, 2024 Nov 28;24(1):3315.
    PMID: 39609747 DOI: 10.1186/s12889-024-20767-4
    INTRODUCTION: By the time the globe started to tackle the COVID-19 pandemic, Southeast Asian countries had faced an increased dengue incidence, which has eventually become an important public health problem. However, effective and sustainable disease control measures in the area are still lacking. Therefore, the current study is aimed to evaluate the development and implementation of high school-based dengue solution model in Southern Thailand.

    METHODS: Integrated community participatory action research (CPAR) was employed using preparation, planning, implementation, and evaluation. Data was collected using quantitative and qualitative methods from high school students. Descriptive statistics such as frequency and percentage, chi-square and fisher's exact test were used to summarize and compare quantitative data before and after intervention. Similarly, qualitative data was collected through interviews and focus group discussion (FGD) and then analyzed through thematic analysis.

    RESULTS: Two hundred and thirty-nine (96.3%, n = 239/248) and 232 (93.5, n = 232/248) participants were included in the interventions before and after, respectively. School-based dengue prevention was developed with input from a variety of stakeholders, including students, community leaders, health educators, district officials, and community health volunteers. As demonstrated by pre- to post-test results, students understanding of dengue and the larval indices surveillance system has increased. Students who received the training were not only inspired but created a sense of community responsibility with a high commitment to teaching and sharing information in their circle to enhance overall community wellbeing. Being female and higher educational attainment was associated with students understanding of dengue and larval indices surveillance.

    CONCLUSION: This participatory action research not only improved students' understanding of dengue but also empowered them to be proactive in various community health initiatives. The positive correlation between educational attainment and students understanding of dengue solution and larval indices surveillance underscores the need for tailored educational interventions that address diverse learning needs within the community. Collaborative efforts to establish dengue health information center based at primary schools and above can better improve reduction of dengue incidence.

  10. Pashazade H, Maarefvand M, Abolfathi Momtaz Y, Abdi K
    BMC Public Health, 2024 Dec 04;24(1):3373.
    PMID: 39633325 DOI: 10.1186/s12889-024-20327-w
    OBJECTIVE: The sandwich generation refers to individuals who are simultaneously responsible for caring for their aging parents and their own children. Research shows that the number of sandwich generation caregivers is increasing, and they face significant physical, psychological, social, and economic challenges. Therefore, it is crucial for these caregivers to develop effective coping strategies. This study aimed to identify the coping mechanisms used by sandwich generation caregivers.

    METHODS: In 2022, during the COVID-19 pandemic, we conducted a qualitative study involving semi-structured interviews with 18 sandwich generation caregivers in Tehran, Iran, who were responsible for both elderly parents and their own children. These interviews were conducted either in person or by telephone. Subsequently, the collected data were analyzed using the inductive content analysis method within the MAXQDA software (2018 version).

    RESULTS: Data analysis revealed three categories of coping strategies: "distancing from the situation", "self-soothing" (including sub categories of spiritual matters, establishing relationships, emotional outlet, and engaging in favorite activities), and "diversifying responses to needs" (including transferring responsibility to the family members, prioritizing needs for responsiveness, utilizing available community services, mediating to reduce conflict, and remote monitoring of the older adult).

    CONCLUSION: Sandwich generation caregivers use various coping strategies, each with different outcomes. This study found that self-care and using social resources can greatly reduce caregiving burdens. Therefore, providing these caregivers with training in problem-solving and self-care skills is recommended to better prepare them for their responsibilities.

  11. Kumar SS, Hartner AM, Chandran A, Gaythorpe KAM, Li X
    BMC Public Health, 2023 Nov 28;23(1):2351.
    PMID: 38017415 DOI: 10.1186/s12889-023-17082-9
    BACKGROUND: Malaysia introduced the two dose measles-mumps-rubella (MMR) vaccine in 2004 as part of its measles elimination strategy. However, despite high historical coverage of MCV1 and MCV2, Malaysia continues to report high measles incidence. This study suggests a novel indicator for investigating population immunity against measles in the Malaysian population.

    METHODS: We define effective vaccine coverage (EVC) of measles as the proportion of a population vaccinated with measles-containing vaccine (MCV) and effectively protected against measles infection. A quantitative evaluation of EVC throughout the life course of Malaysian birth cohorts was conducted accounting for both vaccine efficacy (VE) and between-dose correlation (BdC). Measles vaccination coverage was sourced from WHO-UNICEF estimates of Malaysia's routine immunisation coverage and supplementary immunisation activities (SIAs). United Nations World population estimates and projections (UNWPP) provided birth cohort sizes stratified by age and year. A step wise joint Bernoulli distribution was used to proportionate the Malaysian population born between 1982, the first year of Malaysia's measles vaccination programme, and 2021, into individuals who received zero dose, one dose and multiple doses of MCV. VE estimates by age and doses received are then adopted to derive EVC. A sensitivity analysis was conducted using 1000 random combinations of BdC and VE parameters.

    RESULTS: This study suggests that no birth cohort in the Malaysian population has achieved > 95% population immunity (EVC) conferred through measles vaccination since the measles immunisation programme began in Malaysia.

    CONCLUSION: The persistence of measles in Malaysia is due to pockets of insufficient vaccination coverage against measles in the population. Monitoring BdC through immunisation surveillance systems may allow for the identification of susceptible subpopulations (primarily zero-dose MCV individuals) and increase the coverage of individuals who are vaccinated with multiple doses of MCV. This study provides a tool for assessment of national-level population immunity of measles conferred through vaccination and does not consider subnational heterogeneity or vaccine waning. This tool can be readily applied to other regions and vaccine-preventable diseases.

  12. Bushi G, Khatib MN, Balaraman AK, Ballal S, Bansal P, Tomar BS, et al.
    BMC Public Health, 2024 Nov 18;24(1):3200.
    PMID: 39558300 DOI: 10.1186/s12889-024-20746-9
    BACKGROUND: As e-cigarettes gain popularity as potential tobacco cessation aids, concerns arise about their dual use with traditional cigarettes, especially among pregnant women, potentially subjecting both women and fetuses to heightened risks. This systematic review and meta-analysis aimed to determine the overall prevalence of dual use of tobacco smoking and e-cigarette use in pregnant women.

    METHODS: A literature search was conducted across databases including PubMed, Embase, Web of Science, and Cochrane on October 20, 2023. The included studies reported the number of pregnant women and the count of those who were dual users. Quality assessment was undertaken using the JBI tool. The pooled prevalence of dual use was determined via a random-effects model. All statistical analyses were executed using R software, version 4.3.

    PROSPERO: CRD42023486020.

    RESULTS: Eighteen studies were analyzed, encompassing 5,983,363 pregnant women. The meta-analysis indicated an overall prevalence of 4.6% (95% CI: 2.0-10.3) for dual users with significant heterogeneity (I2 = 100%). Subgroup analysis based on the country showed a prevalence of 4.9% (95% CI: 2.0 to 11.6) for USA and 8.1% (95% CI: 0.00 to 1.00) for UK. Meta-regression revealed reduction of prevalence of dual use from 2019 to 2023. A potential publication bias was indicated by the LFK index and the Doi plot.

    CONCLUSION: The dual consumption of e-cigarettes and traditional tobacco in pregnant women is a significant health concern, with a notable prevalence. Given the established risks of tobacco smoking during pregnancy and the uncertainties surrounding e-cigarettes, more comprehensive research and public health interventions are urgently needed to address this issue.

  13. Ling A, Teo EW, Chin NS
    BMC Public Health, 2024 Dec 05;24(1):3386.
    PMID: 39639249 DOI: 10.1186/s12889-024-20843-9
    BACKGROUND: Presently, where inactivity is an overarching problem globally, participation in recreational sports activities has become an important outlet for promoting healthy lifestyles. However, there is a lack of instruments to evaluate the commitment of recreational and leisure sports users. This study aimed to adapt, develop and provide preliminary validation of the Recreational Sport Commitment Questionnaire (RESQ).

    METHODS: The development and validation process in this study consisted of four stages: Stage One involved item pool generation, Stage Two focused on content and face validation, Stage Three encompassed data collection, and Stage Four included the assessment of the psychometric properties of the RESQ. This final stage was conducted through Exploratory Factor Analysis (EFA; n = 275) and Confirmatory Factor Analysis (CFA; n = 313) to evaluate convergent validity, discriminant validity, and composite reliability.

    RESULTS: The initial item pool generated 60 items, whereby 42 items were retained after the content validity evaluation process by the panel of experts. Next, EFA analysis suggested 31 items distributed across seven factors. Lastly, psychometric properties of RESQ with 26 items were established through CFA (GFI = 0.91, CFI = 0.97, RMSEA = 0.04, TLI = 0.96, X²/df = 1.52) and other psychometrics evidence.

    CONCLUSION: Based on the collected psychometrics evidence, RESQ is a valid questionnaire to evaluate the commitment of recreational sports users. The newly developed questionnaire allows sports organizations to assess the factors influencing sport commitment among recreational sports users. Based on the results of RESQ, sport programmes can be tailored made to optimize sports engagement and promote continued commitment.

  14. Zhao Y, Geok SK, Saad HBA, Rong W, Liu C, Wang X
    BMC Public Health, 2024 Dec 18;24(1):3482.
    PMID: 39695572 DOI: 10.1186/s12889-024-21011-9
    BACKGROUND: Mental health significantly impacts college students' academic performance and overall happiness. Active video games (AVGs) have gained popularity among college students due to their ample entertainment, and there is growing interest in utilizing them to address mental health issues. However, there has not been a comprehensive summary and systematic review of research on the effects of AVGs on college students' mental health.

    METHODS: As of October 18th, 2024, searches were conducted in six internationally renowned databases (PubMed, SCOPUS, Web of Science, CINAHL Plus, EBSCOhost, Cochrane Library). Inclusion and exclusion criteria were developed based on the PICOS principles. A systematic review was conducted following the PRISMA guidelines, and compliant studies using randomised controlled trial design (RCT) were included. The methodological quality of the included studies was evaluated using the PEDro scale.

    RESULTS: A total of 3471 articles were retrieved, of which 17 met the criteria inclusion. The PEDro scores of the 17 studies ranged from four to nine. The results indicate that AVGs can effectively improve college students' poor mental health, such as stress, anxiety, and depression, as well as increase their happiness and psychological satisfaction. Moreover, AVGs have been shown to increase motivation for exercise, improve college students' attitudes toward other forms of exercise, and promote sustained physical activity. Additionally, AVGs have demonstrated efficacy in improving sleep quality.

    CONCLUSION: Overall, AVGs can serve as an effective intervention to reduce dysphoria and promote positive psychological states among college students, thus improving mental health. Using the theory-based design of AVGs will further increase the effect. However, the effects of AVGs vary depending on their type and initial design purpose. Therefore, when using AVGs to improve college students' mental health, it is necessary to carefully consider the students' original state, select AVGs with rich game content that can provide at least moderate-intensity physical activity, and adopt the correct intervention strategy to achieve good results. AVG can potentially become a valuable tool for improving college students' mental health.

    SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero , identifier: CRD42024510488.

  15. Selamat R, Raib J, Aziz NAA, Zulkafly N, Ismail AN, Mohamad WNAW, et al.
    BMC Public Health, 2025 Jan 09;24(Suppl 1):3624.
    PMID: 39789494 DOI: 10.1186/s12889-024-21090-8
    BACKGROUND: The increasing global and national prevalence of childhood obesity particularly among schoolchildren has warranted a more viable school-based obesity intervention. Apart from physical activity, nutrition is important in any obesity intervention package. This study examined the effects of the MyBFF@school program with nutrition education intervention (NEI) on nutrition knowledge and attitude of overweight and obese secondary schoolchildren.

    METHODS: This is a cluster randomized controlled trial which involved schoolchildren aged 13, 14 and 16 years old from 15 out of 415 government secondary schools in central Peninsular Malaysia which were randomly assigned into six intervention (N = 579 schoolchildren) and nine control (N = 462 schoolchildren). The intervention group was given NEI consisting of a nutrition education module carried out by trained personnel for 24 weeks on top of the existing curriculum while the control group only followed the existing school curriculum by the Ministry of Education. The primary outcomes were the nutrition knowledge and attitude score. The mixed effect model taking into consideration the cluster effect was used to assess the changes of nutrition knowledge and attitude scores from baseline until 6 months.

    RESULTS: Overall, there was no significant increase in the adjusted mean difference (AMD) of nutrition knowledge score (AMD = 0.33%, Confident Interval (95 CI): -4.35% to 5.01) between the intervention and control group after 6 months of intervention after controlling for nutrition knowledge score at baseline, gender, location and ethnicity. Similarly, after controlling for the nutrition attitude score at baseline, ethnicity, location and gender as well as taking into account the cluster effects, there was no significant increase on the AMD of nutrition attitude score in the overall (AMD = 0.194, (95 CI): -1.17 to 1.56) and also among girls, location (urban vs rural) and Malays. There was also no significant reduction of AMD in the nutrition attitude score among boys and non-Malays.

    CONCLUSION: MyBFF@school with NEI resulted with no significant improvement for nutrition knowledge and attitude among older schoolchildren. Therefore, to effectively impart the nutrition knowledge and change their nutrition attitude requires an in-depth study and multi-pronged and customized approach.

    TRIAL REGISTRATION: Clinical trial number: NCT04155255, November 7, 2019 (Retrospective registered). National Medical Research Register: NMRR-13-439-16563. Registered July 23, 2013. The intervention program was approved by the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia and Educational Planning and Research Division (EPRD), Ministry of Education Malaysia. It was funded by the Ministry of Health Malaysia.

  16. Mokhtar AH, Kamarudin MA, Choong A, Singh L, Genisan V, Yahya A, et al.
    BMC Public Health, 2025 Jan 09;24(Suppl 1):3623.
    PMID: 39789464 DOI: 10.1186/s12889-024-20723-2
    BACKGROUND: MyBFF@school program consisting physical activity in the formed small-sided games (SSG), nutrition and psychology education was designed to combat obesity among schoolchildren in Malaysia. It was expected to improve cardiorespiratory fitness, hence, contributing to obesity treatment and prevention. Thus, we aimed to study the effects of the MyBFF@school program on the cardiorespiratory fitness of overweight and obese primary schoolchildren.

    METHODS: Twenty-three out of 1196 government primary schools in central Peninsular Malaysia participated in this cluster-randomized control study. Schoolchildren aged 9-11 years with a body mass index (BMI) z-score greater than + 1 SD (WHO) were eligible for the study. The intervention group participated in the MyBFF@school program while the control followed the existing standard curriculum. The primary outcome was cardiorespiratory fitness using physical fitness score (PFS) measured by the modified Harvard step test. Data were collected at baseline, month-3 and month-6 and were analyzed according to the intention-to-treat principle using mixed linear models.

    RESULTS: A total of 954 schoolchildren completed six months follow up, with 439 (n = 439) in the intervention group (n = seven schools), while 515 (n = 515) in the control group (n = 16 schools). In the first three months, there was significant within-group PFS improvement in overall (both), girls (both) and obese (control). Comparing between-groups, the mean differences favored the control in most parameters, but were not significant: overall (-0.15(-0.75, 0.45), p = 0.83), boys (-0.07(-0.98, 0.83), p = 0.83), girls (-0.27(-1.27, 0.73), p = 0.81), overweight (-0.16(-1.28, 0.94), p = 0.97), obese (-0.05(-1.03, 0.92), p = 0.93), morbidly obese (-0.68(-2.43, 1.05), p = 0.26), urban (0.07(-0.79, 0.94), p = 0.45), and rural (-0.35(-1.34, 0.62), p = 0.30). At month-six, the within-group improvements maintained. However, the mean differences now favored the intervention group although they remained not significant: overall (0.05(-0.98, 1.07), p = 0.69), boys (0.06(-1.35, 1.46), p = 0.86), girls (0.10(-1.31, 1.51), p = 0.74), overweight (0.15(-1.07, 1.36), p = 0.93), obese (0.28(-0.98, 1.55), p = 0.75), morbidly obese (-0.79(-2.74, 1.15), p = 0.47), urban (0.61(-0.56, 1.77), p = 0.47), and rural (-0.69(-2.52, 1.14), p = 0.17).

    CONCLUSIONS: MyBFF@school program showed positive trend in cardiorespiratory fitness changes especially after six months. MyBFF@school intervention program has the potential to combat obesity in primary schoolchildren and should be at least six months.

    TRIAL REGISTRATION: Clinical trial number: NCT04155255, November 7, 2019 (Retrospective registered). National Medical Research Register: NMRR-13-439-16563. Registered July 23, 2013. The intervention program was approved by the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia and, the Educational Planning and Research Division (EPRD), Ministry of Education, Malaysia. It was funded by the Ministry of Health, Malaysia.

  17. Hawary NUM, Warif NMA, Ishak I, Ludin AFM, Muttiah B, Kumari P N, et al.
    BMC Public Health, 2025 Jan 09;25(1):119.
    PMID: 39789525 DOI: 10.1186/s12889-024-19834-7
    BACKGROUND: After two years of the COVID-19 pandemic, Malaysia began the transition to the endemic phase. students at higher education institutes are among those who were affected by the COVID-19 outbreak and deserve further attention. Hence, this study aimed to assess the knowledge, attitude, and practice (KAP) associated with COVID-19 among public university undergraduate students in Malaysia during the endemic phase. This study would be able to provide valuable insights that can enhance public health strategies, improve educational efforts, and prepare better for future health challenges.

    METHODS: An online cross-sectional study was conducted among undergraduate students at public universities in Malaysia. KAP towards COVID-19 were measured using a structured Malay and English version questionnaire consisting of (i) sociodemographic characteristics, (ii) knowledge of COVID-19 (10 items), attitudes associated with COVID-19 (five items) and practice on COVID-19 preventive measures (six items). Validity and reliability tests were conducted to assess the level of consistency of KAP content with Cronbach alpha values of 0.617, 0.616 and 0.722 for each section, respectively. Descriptive statistics, independent t-tests, one-way analysis of variance (ANOVA), Mann-Whitney test, Kruskal Wallis test and Pearson correlation were conducted.

    RESULTS: Around 73% of the respondents had good knowledge of COVID-19, 58.6% possessed positive attitudes, and 54.6% were classified as having good practices in COVID-19 prevention. There was no significant difference in knowledge scores among sociodemographic data. A significant difference in attitude scores was observed among race, zones of the public university and household incomes. Besides that, a significant difference in practice scores was also observed among gender, race and student accommodation. A weak positive and significant correlation existed between knowledge and practices (r = 0.220 and p = 0.001). Meanwhile, there was no correlation between knowledge and attitude (r = 0.039 and p = 0.517).

    CONCLUSION: Undergraduate students from Malaysian public universities had good KAP associated with COVID-19. Still, appropriate health promotion activities are needed to provide the students with adequate knowledge, positive attitudes and good practice of COVID-19 prevention measures in the future.

  18. Kamil NZIA, Mokhtar AH, Yahya A, Zain FM, Selamat R, Ishak Z, et al.
    BMC Public Health, 2025 Jan 09;24(Suppl 1):3625.
    PMID: 39789486 DOI: 10.1186/s12889-024-20725-0
    BACKGROUND: Effective and feasible large-scale interventions are urgently needed to reverse the current rise in childhood obesity. The objective of this study was to evaluate the efficacy of a multicomponent intervention program, MyBFF@school, on anthropometric indices and body composition metrics among overweight and obese adolescent schoolchildren in Malaysia.

    METHODS: This is a cluster randomized controlled trial which involved schoolchildren aged 13, 14 and 16 years old from 15 out of 415 government secondary schools in central Peninsular Malaysia which were randomly assigned into six intervention (N = 579 schoolchildren) and nine control (N = 462 schoolchildren).The intervention group followed MyBFF@school program carried out by trained personnel for 6 month while the control group only followed the existing school curriculum by the Ministry of Education. The primary outcomes presented in this study were body mass index adjusted for age (BMI z-score), waist circumference (WC), percentage body fat (PBF) and skeletal muscle mass (SMM), measured at baseline, three and six months. Analyses of all outcomes except for the baseline characteristics were conducted according to the intention-to-treat principle. Mixed linear models adjusted for baseline outcome value and gender were used to evaluate the effectiveness after three and six months of intervention.

    RESULTS: Overall, there was no significant difference in the mean difference (MD) of BMI z-score (MD = 0.05, Confident Interval (95%CI: -0.077 to 0.194), WC (MD = 0.437, (95%CI:-3.64 to 0.892), PBF (MD = 0.977,95%CI:-1.04 to 3.0) and SMM (MD = 0.615,95%CI:-2.14,0.91) between the intervention and control group after 6 months of intervention after controlling for outcomes measured at baseline and gender.

    CONCLUSIONS: Although the MyBFF@school programme appeared promising in engaging children and promoting awareness of healthy behaviors, it did not lead to significant improvements in the anthropometric outcomes. Possible reasons for the lack of effectiveness could include the need for more intensive or targeted interventions, parental involvement, or challenges in sustaining behavior changes outside of school settings.

    TRIAL REGISTRATION: Clinical trial number: NCT04155255, November 7, 2019 (Retrospective registered). National Medical Research Register: NMRR-13-439-16,563. Registered July 23, 2013. The intervention program was approved by the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia and Educational Planning and Research Division (EPRD), Ministry of Education Malaysia. It was funded by the Ministry of Health Malaysia.

  19. Mokhtar AH, Zin RMWM, Yahya A, Zain FM, Selamat R, Ishak Z, et al.
    BMC Public Health, 2025 Jan 10;24(Suppl 1):3626.
    PMID: 39794750 DOI: 10.1186/s12889-024-20726-z
    BACKGROUND: Childhood obesity has increased rapidly in recent years and is now a global epidemic. To combat this, MyBFF@school program, a multi-faceted obesity intervention incorporating physical activity in the form of small-sided games (SSG), nutrition, and psychology components for schoolchildren was designed. This paper is aimed at describing the protocol of the MyBFF@school program and presenting the baseline findings including the overweight and obesity prevalence.

    METHODS: MyBFF@school is a school-based, cluster randomized controlled trial (C-RCT) study. The investigators selected government schools from Federal Territory of Kuala Lumpur, Selangor and Negeri Sembilan by stratified proportionate random sampling based on the multi-ethnic population and the urban-rural location of schools. Subsequently, the schools were assigned randomly to intervention and control groups. The intervention schools underwent MyBFF@school program, whereas the control followed standard school curriculum for a duration of six months. The intervention modules replaced the existing two physical education classes and one co-curriculum activity per week. Three assessments i.e. at baseline, month-3 and month-6 were conducted. Anthropometric, clinical examination, blood, physical fitness, nutrition, and psychology parameters were collected.

    RESULTS: Twenty-three out of 1,196 primary schools (seven interventions and 16 controls) and 15 out of 416 secondary schools (six interventions and nine controls). The investigators screened 11,950 primary (age 9-11 years) and 10,866 secondary (age 13, 14, 16 years) schoolchildren. The investigators found 3,516 primary schoolchildren (29.4%) and 2,910 secondary schoolchildren (26.8%) had BMI z-score of more than + 1SD who were eligible for the study. Of these, 39.7% (N = 1397) of the primary and 35.8% (N = 1041) of the secondary schoolchildren agreed to participate in the study. The mean (SD) characteristics for the participating primary and secondary schoolchildren were: BMI z-score, + 2.29 (± 0.81) and + 2.10 (± 0.71); waist circumference, 75.06 (± 9.6) cm and 85.5 (± 10.9) cm; percentage body fat, 37.8% (± 6.5%) and 39.2% (± 7.3%); and muscle mass, 14.7 (± 2.9) and 23.1 (± 5.2) kg respectively.

    CONCLUSION: MyBFF@school program, a school-based multi-pronged intervention was designed to combat childhood obesity. Screening of 22,816 primary and secondary schoolchildren found 29.4% of primary schoolchildren and 26.8% of secondary schoolchildren to be overweight and obese which reflected the urgency for an effective intervention.

    TRIAL REGISTRATION: Clinical trial number: NCT04155255, November 7, 2019 (Retrospective registered). National Medical Research Register: NMRR-13-439-16563. Registered July 23, 2013. The intervention program was approved by the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia and Educational Planning and Research Division (EPRD), Ministry of Education Malaysia. It was funded by the Ministry of Health Malaysia.

  20. Zin RMWM, Mokhtar AH, Yahya A, Zain FM, Selamat R, Ishak Z, et al.
    BMC Public Health, 2025 Jan 14;24(Suppl 1):3627.
    PMID: 39810108 DOI: 10.1186/s12889-024-20724-1
    BACKGROUND: Recently, there has been an increase in the prevalence of childhood obesity in Malaysia, raising concerns about increased cardiometabolic morbidity. MyBFF@school is a multifaceted program comprising physical activity, nutritional education, and psychological empowerment introduced to combat childhood obesity in Malaysia. The efficacy of a six-month intervention on the body composition of overweight and obese primary schoolchildren was evaluated.

    METHODS: This is a school-based, cluster randomized controlled trial involving selected primary schools in Kuala Lumpur, Selangor, and Negeri Sembilan. A total of 1,397 primary-school students aged 9-11 with a body mass index (BMI) z -score (corrected for age) greater than + 1 standard deviation based on the World Health Organization 2007 Growth Reference were assigned to intervention ( n = 647 ) and control ( n = 750 ) groups. BMI z-score, waist circumference (WC), percentage body fat (PBF), and skeletal muscle mass (SMM) were assessed at baseline and after three and six months of the study. Analyses of all outcomes except for the baseline characteristics were conducted according to the intention-to-treat principle.

    RESULTS: After three months, there was no significant difference in the BMI z-score or PBF between the control and intervention groups, but SMM and WC were significantly higher in the intervention group versus the control group with mean difference of 0.15 kg; 95% confidence interval [CI]: 0.07-0.22, p 

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