Displaying publications 21 - 40 of 40 in total

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  1. Anwar M, Mustapha F, Abdullah MN, Mustapha M, Sallih N, Ahmad A, et al.
    Sensors (Basel), 2024 Aug 12;24(16).
    PMID: 39204921 DOI: 10.3390/s24165225
    The detection of impact and depth defects in Glass Fiber Reinforced Polymer (GFRP) composites has been extensively studied to develop effective, reliable, and cost-efficient assessment methods through various Non-Destructive Testing (NDT) techniques. Challenges in detecting these defects arise from varying responses based on the geometrical shape, thickness, and defect types. Long Pulse Thermography (LPT), utilizing an uncooled microbolometer and a low-resolution infrared (IR) camera, presents a promising solution for detecting both depth and impact defects in GFRP materials with a single setup and minimal tools at an economical cost. Despite its potential, the application of LPT has been limited due to susceptibility to noise from environmental radiation and reflections, leading to blurry images. This study focuses on optimizing LPT parameters to achieve accurate defect detection. Specifically, we investigated 11 flat-bottom hole (FBH) depth defects and impact defects ranging from 8 J to 15 J in GFRP materials. The key parameters examined include the environmental temperature, background reflection, background color reflection, and surface emissivity. Additionally, we employed image processing techniques to classify composite defects and automatically highlight defective areas. The Tanimoto Criterion (TC) was used to evaluate the accuracy of LPT both for raw images and post-processed images. The results demonstrate that through parameter optimization, the depth defects in GFRP materials were successfully detected. The TC success rate reached 0.91 for detecting FBH depth defects in raw images, which improved significantly after post-processing using Canny edge detection and Hough circle detection algorithms. This study underscores the potential of optimized LPT as a cost-effective and reliable method for detecting defects in GFRP composites.
  2. Mohd Hafiz Ngoo SK, Mukunda Devan S, Yusoff YK, Mustapha F, Abdul Hameed A, Mohd Nor F
    Trop Biomed, 2026 Sep 01;43(3):298-303.
    PMID: 42960648 DOI: 10.47665/tb.43.3.008
    Amoebiasis, caused by Entamoeba histolytica, is a prevalent cause of dysentery in Southeast Asia. Conventional diagnosis heavily relies on non-invasive modalities like stool microscopy and serology; however, these diagnostic modality frequently suffer from low sensitivity and are confounded by regional endemicity. We present a rare case of invasive extraintestinal amoebiasis in a 78-year-old immunocompromised male with a history of diffuse large B-cell lymphoma. The patient presented with a three-week history of severe watery diarrhea, fever, and significant weight loss, ending in hypovolemic shock. Serial stool wet mount examinations were repeatedly negative for parasites, and Clostridioides difficile testing was negative. Due to his immunosuppressed status, a diagnostic colonoscopy was performed, revealing diffuse mucosal inflammation and severe sigmoid ulcerations. Histopathological examination of targeted colonic biopsies provided the definitive diagnosis, revealing numerous tissueinvasive trophozoites exhibiting erythrophagocytosis, which was further enhanced via Periodic acid- Schiff staining. The patient was successfully initiated on oral metronidazole. On day 22 of admission, hepatobiliary ultrasound screening revealed a concurrent 11 cm amoebic liver abscess, which required ultrasound-guided percutaneous drainage. Systemic exposure was retrospectively validated by a strong positive amoebic IgG serology. Following a sequential course of luminal eradication with paromomycin and targeted antibiotics, the patient achieved complete clinical recovery and was discharged well. This case highlights that when conventional non-invasive screening tools fail, an unconventional, multi-modal diagnostic approach utilizing early histopathology and proactive imaging is essential to optimize survival outcomes in complex, immunocompromised hosts.
  3. Rashid AA, Devaraj NK, Mohd Yusof H, Mustapha F, Wong SV, Ismail AF, et al.
    BMJ Open, 2020 Jul 02;10(7):e037653.
    PMID: 32616493 DOI: 10.1136/bmjopen-2020-037653
    INTRODUCTION: Medical doctors are often subjected to long working hours with minimal rest in between the shifts. This has led to many fatal and non-fatal road crash involvement (RCI). This study aims to determine the prevalence and predictors of RCI among medical doctors in Malaysia.

    METHODS AND ANALYSIS: This is a cross-sectional study among 375 Malaysian medical doctors who met the inclusion criteria. A predetermined self-administered questionnaires will be used to collect information regarding the sociodemographic, health status, workplace information, work commuting information, driving behaviour, history of RCI, fatigue, sleep quality, mental health status and work engagement. The questionnaires consist of the following instruments: (1) sociodemographic, health status, workplace information, work commuting information, driving behaviour and history of RCI; (2) Checklist of Individual Strength Questionnaire; (3) Pittsburgh Sleep Quality Index; (4) 21-item Depression Anxiety and Stress Scale; and (5) Utrecht's Work Engagement Scale. The data will be analysed using SPSS program V.24. Descriptive and inferential statistics will be used to determine the prevalence and predictors of RCI.

    ETHICS AND DISSEMINATION: This study protocol has received ethics approval from the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia (NMRR-18-3983-40609) and the Ethics Committee for Research Involving Human Subject, University Putra Malaysia (JKEUPM). Online written informed consent will be obtained from each study participant by the researchers. Results of the study will be disseminated through relevant journals and conferences.

    TRIAL REGISTRATION NUMBER: NCT04243291.

  4. Arumugam S, Kandasamy J, Md Shah AU, Hameed Sultan MT, Safri SNA, Abdul Majid MS, et al.
    Polymers (Basel), 2020 Jul 06;12(7).
    PMID: 32640502 DOI: 10.3390/polym12071501
    This study aims to explore the mechanical properties of hybrid glass fiber (GF)/sisal fiber (SF)/chitosan (CTS) composite material for orthopedic long bone plate applications. The GF/SF/CTS hybrid composite possesses a unique sandwich structure and comprises GF/CTS/epoxy as the external layers and SF/CTS/epoxy as the inner layers. The composite plate resembles the human bone structure (spongy internal cancellous matrix and rigid external cortical). The mechanical properties of the prepared hybrid sandwich composites samples were evaluated using tensile, flexural, micro hardness, and compression tests. The scanning electron microscopic (SEM) images were studied to analyze the failure mechanism of these composite samples. Besides, contact angle (CA) and water absorption tests were conducted using the sessile drop method to examine the wettability properties of the SF/CTS/epoxy and GF/SF/CTS/epoxy composites. Additionally, the porosity of the GF/SF/CTS composite scaffold samples were determined by using the ethanol infiltration method. The mechanical test results show that the GF/SF/CTS hybrid composites exhibit the bending strength of 343 MPa, ultimate tensile strength of 146 MPa, and compressive strength of 380 MPa with higher Young's modulus in the bending tests (21.56 GPa) compared to the tensile (6646 MPa) and compressive modulus (2046 MPa). Wettability study results reveal that the GF/SF/CTS composite scaffolds were hydrophobic (CA = 92.41° ± 1.71°) with less water absorption of 3.436% compared to the SF/CTS composites (6.953%). The SF/CTS composites show a hydrophilic character (CA = 54.28° ± 3.06°). The experimental tests prove that the GF/SF/CTS hybrid composite can be used for orthopedic bone fracture plate applications in future.
  5. Chew BH, Shariff-Ghazali S, Lee PY, Cheong AT, Mastura I, Haniff J, et al.
    Med J Malaysia, 2013 Oct;68(5):397-404.
    PMID: 24632869 MyJurnal
    INTRODUCTION: Diabetes care at different healthcare facilities varied from significantly better at one setting to no difference amongst them. We examined type 2 diabetes patient profiles, disease control and complication rates at four public health facilities in Malaysia.
    MATERIALS AND METHODS: This study analyzed data from diabetes registry database, the Adult Diabetes Control and Management (ADCM). The four public health facilities were hospital with specialist (HS), hospital without specialist (HNS), health clinics with family physicians (CS) and health clinic without doctor (CND). Independent risk factors were identified using multivariate regression analyses.
    RESULTS: The means age and duration of diabetes in years were significantly older and longer in HS (ANOVA, p< 0.0001). There were significantly more patients on insulin (31.2%), anti-hypertensives (80.1%), statins (68.1%) and antiplatelets (51.2%) in HS. Patients at HS had significantly lower means BMI, HbA1c, LDL-C and higher mean HDL-C. A significant larger proportion of type 2 diabetes patients at HS had diabetes-related complications (2-5 times). Compared to the HS, the CS was more likely to achieve HbA1c ≤ 6.5% (adjusted OR 1.2) and BP target < 130/80 mmHg (adjusted OR 1.4), the HNS was 3.4 times more likely not achieving LDL-C target < 2.6 mmol/L.
    CONCLUSION: Public hospitals with specialists in Malaysia were treating older male Chinese type 2 diabetes patients with more complications, and prescribed more medications. Patients attending these hospitals achieved better LDL-C target but poorer in attaining BP and lower HbA1c targets as compared to public health clinics with doctors and family physicians.
  6. Parra-Mujica F, Roope LS, Abdul-Aziz A, Mustapha F, Ng CW, Rampal S, et al.
    Soc Sci Med, 2024 Jan;340:116426.
    PMID: 38016309 DOI: 10.1016/j.socscimed.2023.116426
    In the context of the escalating burden of diabetes in low and middle-income countries (LMICs), there is a pressing concern about the widening disparities in care and outcomes across socioeconomic groups. This paper estimates health poverty measures among individuals with type 2 diabetes mellitus (T2DM) in Malaysia. Using data from the National Diabetes Registry between 2009 and 2018, the study linked 932,855 people with T2DM aged 40-75 to death records. Cox proportional hazards models were used to estimate the 5-year survival probabilities for each patient, stratified by age and sex, while controlling for comorbidities and area-based indicators of socio-economic status (SES), such as district-level asset-based indices and night-time luminosity. Measures of health poverty, based on the Foster-Greer-Thorbecke (FGT) measures, were employed to capture excessive risk of premature mortality. Two poverty line thresholds were used, namely a 5% and 10% reduction in survival probability compared to age and sex-adjusted survival probability of the general population. Counterfactual simulations estimated the extent to which comorbidities contribute to health poverty. 43.5% of the sample experienced health poverty using the 5% threshold, and 8.9% were health poor using the 10% threshold. Comorbidities contribute 2.9% for males and 5.4% for females, at the 5% threshold. At the 10% threshold, they contribute 7.4% for males and 3.4% for females. If all patients lived in areas of highest night-light intensity, poverty would fall by 5.8% for males and 4.6% for females at the 5% threshold, and 4.1% for males and 0.8% for females at the 10% threshold. In Malaysia, there is a high incidence of health poverty among people with diabetes, and it is strongly associated with comorbidities and area-based measures of SES. Expanding the application of health poverty measurement, through a combination of clinical registries and open spatial data, can facilitate simulations for health poverty alleviation.
  7. Wan KS, Mustapha F, Chandran A, Ganapathy SS, Zakariah N, Ramasamy S, et al.
    Sci Rep, 2023 Oct 13;13(1):17338.
    PMID: 37833402 DOI: 10.1038/s41598-023-44564-y
    Diabetes is one of the quickest-growing global health emergencies of the twenty-first century, and data-driven care can improve the quality of diabetes management. We aimed to describe the formation of a 10-year retrospective open cohort of type 2 diabetes patients in Malaysia. We also described the baseline treatment profiles and HbA1c, blood pressure, and lipid control to assess the quality of diabetes care. We used 10 years of cross-sectional audit datasets from the National Diabetes Registry and merged 288,913 patients with the same identifying information into a 10-year open cohort dataset. Treatment targets for HbA1c, blood pressure, LDL-cholesterol, HDL-cholesterol, and triglycerides were based on Malaysian clinical practice guidelines. IBM SPSS Statistics version 23.0 was used, and frequencies and percentages with 95% confidence intervals were reported. In total, 288,913 patients were included, with 62.3% women and 54.1% younger adults. The commonest diabetes treatment modality was oral hypoglycaemic agents (75.9%). Meanwhile, 19.3% of patients had ≥ 3 antihypertensive agents, and 71.2% were on lipid-lowering drugs. Metformin (86.1%), angiotensin-converting enzyme inhibitors (49.6%), and statins (69.2%) were the most prescribed antidiabetic, antihypertensive, and lipid-lowering medications, respectively. The mean HbA1c was 7.96 ± 2.11, and 31.2% had HbA1c > 8.5%. Only 35.8% and 35.2% attained blood pressure 
  8. Muzahid NH, Hussain MH, Huët MAL, Dwiyanto J, Su TT, Reidpath D, et al.
    Microb Genom, 2023 Apr;9(4).
    PMID: 37018035 DOI: 10.1099/mgen.0.000977
    Acinetobacter baumannii is a common cause of multidrug-resistant (MDR) nosocomial infections around the world. However, little is known about the persistence and dynamics of A. baumannii in a healthy community. This study investigated the role of the community as a prospective reservoir for A. baumannii and explored possible links between hospital and community isolates. A total of 12 independent A. baumannii strains were isolated from human faecal samples from the community in Segamat, Malaysia, in 2018 and 2019. Another 15 were obtained in 2020 from patients at the co-located tertiary public hospital. The antimicrobial resistance profile and biofilm formation ability were analysed, and the relatedness of community and hospital isolates was determined using whole-genome sequencing (WGS). Antibiotic profile analysis revealed that 12 out of 15 hospital isolates were MDR, but none of the community isolates were MDR. However, phylogenetic analysis based on single-nucleotide polymorphisms (SNPs) and a pangenome analysis of core genes showed clustering between four community and two hospital strains. Such clustering of strains from two different settings based on their genomes suggests that these strains could persist in both. WGS revealed 41 potential resistance genes on average in the hospital strains, but fewer (n=32) were detected in the community strains. In contrast, 68 virulence genes were commonly seen in strains from both sources. This study highlights the possible transmission threat to public health posed by virulent A. baumannii present in the gut of asymptomatic individuals in the community.
  9. Wan KS, Hairi NN, Mustapha F, Mohd Yusoff MF, Mat Rifin H, Ismail M, et al.
    Sci Rep, 2024 Mar 25;14(1):7074.
    PMID: 38528132 DOI: 10.1038/s41598-024-57723-6
    The actual prevalence of diabetic kidney disease (DKD) in patients with type 2 diabetes (T2D) in Malaysia is unknown. We aimed to determine the prevalence of DKD and its associated risk factors among T2D patients in Malaysia. An analytical cross-sectional study was conducted using the year 2022 clinical audit dataset from the National Diabetes Registry. DKD was defined as albuminuria, a decreased glomerular filtration rate, or both. Among 80,360 patients, 62.2% were female, 68.4% were Malay, and the mean age was 61.4 years. A total of 56.7% (95% CI 56.4-57.1%) of patients were found to have DKD. Increasing age, male sex, Malay ethnicity, longer duration of diabetes, overweight, obesity, hypertension, diabetic retinopathy, diabetic foot ulcer, nontraumatic lower-extremity amputation, ischaemic heart disease, stroke, insulin, higher numbers of antihypertensive agents, antiplatelet agents, poorer HbA1c control, higher systolic blood pressure, non-achievement of triglyceride target, and non-attainment of HDL-cholesterol goal were independent risk factors associated with DKD. Clinicians, program managers, and health policymakers should target modifiable factors to manage DKD and prevent its progression to end-stage kidney disease in Malaysia.
  10. Harun SNF, Jasman N, Mustapha F, Jaafar N, Mat Nadzir SNB, Zaini Z, et al.
    PLoS One, 2025;20(3):e0318381.
    PMID: 40117227 DOI: 10.1371/journal.pone.0318381
    BACKGROUND: COVID-19 has greatly affected the population, especially those in the low socio-economic group, including residents of the People's Housing Project (PPR) in Malaysia. Adolescents residing in PPR communities are among the most vulnerable groups of young people in urban areas, given their pre-existing conditions of vulnerability, face even greater challenges due to the pandemic. Understanding their mental health and coping strategies is vital to grasp how the pandemic impacts their well-being. Hence, this study aims to explore the coping strategies and barriers to help-seeking behaviour among adolescents living in the Malaysia's PPR communities, focusing on the unique mental health challenges exacerbated by the COVID-19 pandemic. Given the socio-economic vulnerabilities and the heightened mental health challenges during the pandemic, this study provides critical insights into how adolescents in PPR communities navigate psychological distress and mental health support.

    METHODS: This qualitative study used a phenomenological research design and was conducted from January to December 2022, involving 47 adolescents aged 10 to 17 years old from 37 PPRs in the Klang Valley. Participants were recruited using the purposive sampling method as this study purposely selected adolescents with moderate, moderately severe, and severe for PHQ-9 and/or moderate and severe for GAD-7 based on the screening. Participants who agreed to participate were recruited (with consent from parents/guardians) and interviews were set at the participants' convenience. Data were collected using a semi-structured interview guide to conduct the in-depth interviews (IDI). After each IDI session, the recorded interviews were transcribed. Data from the voice recorder were stored on a password-protected computer, and participants' names were replaced with specific codes to ensure confidentiality. The researchers coded all transcripts independently. The transcripts were analysed inductively using a thematic approach to identify recurring themes.

    RESULTS: From the 37 PPRs, 194 adolescents were identified as having psychological distress based on the screening. Among them, 47 agreed to participate in the IDIs, which revealed that these adolescents utilized mainly maladaptive coping strategies, such as avoidance (cognitive distancing, externalization, and internalization), self-harm, vaping, and smoking to deal with stressors related to COVID-19. As for hindrances to help-seeking, three themes were identified such as lack of trust, perceived ineffectiveness of support, and personality.

    CONCLUSION: Psychological distress among adolescents was prevalent during the pandemic, and they faced hindrances in seeking help. Coping strategies have been identified to help adolescents manage their psychological distress during the pandemic. It is concerning that some had resorted to maladaptive coping mechanisms. These findings emphasized the need for targeted mental health interventions and support systems tailored to vulnerable communities. These interventions could inform policies aimed at strengthening mental health services, fostering better coping strategies and promoting help-seeking behaviours among adolescents in socio-economically challenged communities.

  11. Mafauzy M, Khoo EM, Hussein Z, Yusoff Azmi NS, Siah GJ, Mustapha FI, et al.
    Med J Malaysia, 2020 07;75(4):419-427.
    PMID: 32724007
    INTRODUCTION: Prediabetes, typically defined as blood glucose levels above normal but below diabetes thresholds, denotes a risk state that confers a high chance of developing diabetes. Asians, particularly the Southeast Asian population, may have a higher genetic predisposition to diabetes and increased exposure to environmental and social risk factors. Malaysia alone was home to 3.4 million people with diabetes in 2017; the figure is estimated to reach 6.1 million by 2045. Developing strategies for early interventions to treat prediabetes and preventing the development of overt diabetes and subsequent cardiovascular and microvascular complications are therefore important.

    METHODS: An expert panel comprising regional experts was convened in Kuala Lumpur, for a one-day meeting, to develop a document on prediabetes management in Malaysia. The expert panel comprised renowned subject-matter experts and specialists in diabetes and endocrinology, primary-care physicians, as well as academicians with relevant expertise.

    RESULTS: Fifteen key clinical statements were proposed. The expert panel reached agreements on several important issues related to the management of prediabetes providing recommendations on the screening, diagnosis, lifestyle and pharmacological management of prediabetes. The expert panel also proposed changes in forthcoming clinical practice guidelines and suggested that the government should advocate early screening, detection, and intensive management of prediabetes.

    CONCLUSION: This document provides a comprehensive approach to the management of prediabetes in Malaysia in their daily activities and offer help in improving government policies and the decision-making process.
  12. Chan WK, Tan SS, Chan SP, Lee YY, Tee HP, Mahadeva S, et al.
    J Gastroenterol Hepatol, 2022 May;37(5):795-811.
    PMID: 35080048 DOI: 10.1111/jgh.15787
    The Malaysian Society of Gastroenterology and Hepatology saw the need for a consensus statement on metabolic dysfunction-associated fatty liver disease (MAFLD). The consensus panel consisted of experts in the field of gastroenterology/hepatology, endocrinology, bariatric surgery, family medicine, and public health. A modified Delphi process was used to prepare the consensus statements. The panel recognized the high and increasing prevalence of the disease and the consequent anticipated increase in liver-related complications and mortality. Cardiovascular disease is the leading cause of mortality in MAFLD patients; therefore, cardiovascular disease risk assessment and management is important. A simple and clear liver assessment and referral pathway was agreed upon, so that patients with more severe MAFLD can be linked to gastroenterology/hepatology care, while patients with less severe MAFLD can remain in primary care or endocrinology, where they are best managed. Lifestyle intervention is the cornerstone in the management of MAFLD. The panel provided a consensus on the use of statin, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, sodium-glucose cotransporter-2 inhibitor, glucagon-like peptide-1 agonist, pioglitazone, vitamin E, and metformin, as well as recommendations on bariatric surgery, screening for gastroesophageal varices and hepatocellular carcinoma, and liver transplantation in MAFLD patients. Increasing the awareness and knowledge of the various stakeholders on MAFLD and incorporating MAFLD into existing noncommunicable disease-related programs and activities are important steps to tackle the disease. These consensus statements will serve as a guide on MAFLD for clinicians and other stakeholders.
  13. Lew B, Kõlves K, Lester D, Chen WS, Ibrahim NB, Khamal NRB, et al.
    Front Psychiatry, 2021;12:770252.
    PMID: 35069279 DOI: 10.3389/fpsyt.2021.770252
    Background: Suicide is a preventable cause of death. Examining suicide rates and trends are important in shaping national suicide prevention strategies. Therefore, the objectives of this study were to analyze age-standardized suicide trends of Malaysia between 2000 and 2019 using the WHO Global Health Estimates data, and to compare the 2019 rate with countries from the Association of South-East Asian Nations (ASEAN), Muslim majority countries, and the Group of Seven (G7). Methods: The age-standardized suicide rates data were extracted from the WHO Global Health Estimates. We calculated the average age-standardized suicide rates of the last 3 years from 2017 to 2019. Joinpoint regression analysis was conducted to calculate the average annual percentage change (APC) of the age-standardized suicide rates in Malaysia from 2000 to 2019. Results: Between 2000 and 2019, the minimum and maximum suicide rates for both sexes in Malaysia were 4.9 and 6.1 per 100,000 population respectively, whilst the past 3-year (2017-2019) average rates were 5.6, 8.8, and 2.4 for both sexes, males, and females, respectively. The suicide rates decreased significantly for both sexes between 2000 and 2013. Between 2014 and 2019, the suicide rates increased significantly for males. In 2019, Malaysia recorded the rate of 5.8 per 100,000 population, with an estimated 1,841 suicide deaths, i.e., ~5 deaths per day. The Malaysian suicide rate was the second highest amongst selected Muslim majority countries, in the middle range amongst ASEAN countries, and lower than all G7 countries except Italy. Conclusions: There is a need to further explore factors contributing to the higher suicide rates among Malaysian males. In light of the rising suicide rates in Malaysia, national mental health and suicide prevention initiatives are discussed and the importance of high-quality suicide surveillance data is emphasized.
  14. Wan KS, Mat Rifin H, Mohd Yusoff MF, Yoga Ratnam KK, Chan WK, Mohamad M, et al.
    BMJ Open, 2023 Oct 27;13(10):e074432.
    PMID: 37890968 DOI: 10.1136/bmjopen-2023-074432
    INTRODUCTION: Metabolic syndrome (MetS) is a cluster of cardio-metabolic dysfunctions characterised by increased fasting plasma glucose, waist circumference, blood pressure, triglycerides and reduction in high-density lipoprotein cholesterol. Meanwhile, metabolic dysfunction-associated fatty liver disease (MAFLD) is the new term for fatty liver associated with MetS. People with MetS or MAFLD have higher risks for adverse cardiovascular outcomes and mortalities. However, large-scale data on MetS and MAFLD prevalence in Malaysia is mainly unknown. This study aims to determine the prevalence of MetS and MAFLD among the general adult population in Malaysia.

    METHODS AND ANALYSIS: This is a community-based nationwide cross-sectional study in Malaysia. The data collection period is from July 2023 until September 2023, with a planned sample size of 1296 participants. We use a two-stage proportionate stratified random sampling method to ensure national representativeness. The definition of MetS follows the Harmonised Joint Interim Statement in 2009. A diagnosis of MAFLD is made if a participant has fatty liver, defined as having a Fatty Liver Index ≥60 and has type 2 diabetes, a body mass index ≥23 kg/m2, or ≥2 metabolic risk abnormalities. Complex sample analysis will be conducted, and the disease prevalence will be reported with 95% CIs, unweighted counts and estimated populations.

    ETHICS AND DISSEMINATION: The protocol has been approved by the Medical Research and Ethics Committee of the Ministry of Health Malaysia (NMRR ID-22-02845-GUT). The findings will be disseminated through a formal report, policy brief, scientific publications, conference presentations, social media, print media and stakeholder engagement activities.

  15. Risso-Gill I, Balabanova D, Majid F, Ng KK, Yusoff K, Mustapha F, et al.
    BMC Health Serv Res, 2015;15:254.
    PMID: 26135302 DOI: 10.1186/s12913-015-0916-y
    The growing burden of non-communicable diseases in middle-income countries demands models of care that are appropriate to local contexts and acceptable to patients in order to be effective. We describe a multi-method health system appraisal to inform the design of an intervention that will be used in a cluster randomized controlled trial to improve hypertension control in Malaysia.
  16. Wan KS, Moy FM, Mohd Yusoff MF, Mustapha F, Ismail M, Mat Rifin H, et al.
    Sci Rep, 2024 Jun 01;14(1):12625.
    PMID: 38824234 DOI: 10.1038/s41598-024-63617-4
    Treatment intensification is essential to ensure guideline targets are attained in diabetes patients. The failure to intensify treatment when the targets are not achieved is therapeutic inertia. This study aimed to determine the proportions and factors associated with treatment intensification and therapeutic inertia of antihypertensive therapy in type 2 diabetes patients with uncontrolled hypertension in Malaysia. A retrospective cohort analysis was conducted utilising registry data. Diabetes hypertensive patients with uncontrolled baseline systolic or diastolic blood pressure were included. Treatment intensification was the increase in the number of antihypertensive agents from the index treatment. Therapeutic inertia was the absence of treatment intensification when the second blood pressure reading was still uncontrolled. About 6956 patients were followed up over 2.5 ± 1.1 person-years. Treatment intensification was observed in 29.8% of patients, while 38.6% had therapeutic inertia. Chinese, Indian, and 'others' ethnic groups, retinopathy, more antihypertensive agents, and higher systolic blood pressure were associated with therapeutic inertia. Underweight, overweight patients and those with dyslipidaemia had lower risks for therapeutic inertia. The results indicate suboptimal quality of care in public health clinics in Malaysia. Further studies are needed to determine the underlying causes to formulate precise interventions to tackle the problem in Malaysia.
  17. Mustapha F, Omar Z, Mihat O, Md Noh K, Hassan N, Abu Bakar R, et al.
    BMC Public Health, 2014;14 Suppl 2:S4.
    PMID: 25080846 DOI: 10.1186/1471-2458-14-S2-S4
    The prevalence of non-communicable diseases (NCDs) and NCD risk factors in Malaysia have risen substantially in the last two decades. The Malaysian Ministry of Health responded by implementing, "The National Strategic Plan for Non-Communicable Diseases (NSP-NCD) 2010-2014", and the "NCD Prevention 1Malaysia" (NCDP-1M) programme. This paper outlines the primary health system context in which the NCDP-1M is framed. We also discuss the role of community in facilitating the integration of this programme, and outline some of the key challenges in addressing the sustainability of the plan over the next few years. The paper thus provides an analysis of an integration of a programme that involved a multi-sectoral approach with the view to contributing to a broader discourse on the development of responsive health systems.
  18. Sureshkumar S, Mwangi KJ, Gathecha G, Marcus K, Kohlbrenner B, Issom D, et al.
    Pan Afr Med J, 2023;44:153.
    PMID: 37455892 DOI: 10.11604/pamj.2023.44.153.38616
    INTRODUCTION: over one third of total Disability-Adjusted-Life-Years lost in Kenya are due to non-communicable diseases (NCD). In response, the Government declared significant commitment towards improving NCD care. The COVID-19 pandemic increased the burden on the already overstretched health systems in Kenya. The aims of this study are to assess whether health care providers perceived NCD care to be optimal during the pandemic and explore how to improve responses to future emergencies.

    METHODS: this cross-sectional online survey included healthcare personnel with non-clinical roles (public health workers and policy-makers) and those delivering health care (doctors and nurses). Respondents were recruited between May and September 2021 by random sampling, completed by snowball sampling.

    RESULTS: among 236 participants (42% in clinical, 58% in non-clinical roles) there was an overall consensus between respondents on NCD care being disrupted and compromised during the pandemic in Kenya. Detracted supplies, funding, and technical resources affected the continuity of NCDs' response, despite government efforts. Respondents agreed that the enhanced personnel capacity and competencies to manage COVID-19 patients were positive, but noted a lack of guidance for redirecting care for chronic diseases, and advocated for digital innovation as a solution.

    CONCLUSION: this paper explores the perceptions of key stakeholders involved in the management of NCDs in Kenya to improve planning for future emergency responses. Gaps were identified in health system response and preparedness capacity during the pandemic including the perceived need to strengthen NCD services, with solutions offered to guide resilience efforts to protect the health system from disruption.

  19. Sureshkumar S, Mustapha F, Yusoff H, Mwangi KJ, Marcus K, Kohlbrenner B, et al.
    Int J Public Health, 2023;68:1605861.
    PMID: 37304500 DOI: 10.3389/ijph.2023.1605861
    Objectives: This study assesses the opinions of health professionals in Malaysia on the disruption of non-communicable disease (NCD) services during the COVID-19 pandemic from March 2020 to January 2022. Methods: We conducted a cross-sectional online survey with 191 non-clinical public health workers and clinical health service workers in Malaysia from November 2021 to January 2022. Participants were recruited by the Malaysian Ministry of Health using major networks including key experts and practitioners. Secondary respondents were subsequently enrolled through snowballing. Results: The most notable issues raised by the survey participants relate to NCD service disruption, the redirection of NCD care resources, and NCD care being overburdened post-pandemic. Respondents also reported accounts of resilience and prompt reaction from the healthcare system, as well as calls for innovation. Conclusion: Most respondents perceived that the challenges arising from COVID-19 were mostly managed well by the healthcare system, which was able to provide the necessary services to NCD patients during this health emergency. However, the study identifies gaps in the health system response and preparedness capacity, and highlights solutions for strengthening NCD services.
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