Adherence to antiretroviral therapy (ART) plays an important role in the treatment outcomes of human immunodeficiency virus (HIV) infection. Poor adherence would result in failure to prevent viral replication as well as an increased risk of developing drug resistance. Adherence to a life long treatment such as antiretroviral therapy is usually a complicated issue that requires careful and continuous collaboration of patient, family and healthcare provider. The objective of this study was to assess adherence to antiretroviral therapy and its associated factors among people living with HIV. This is a health facility-based cross sectional study conducted among adults’ people living with HIV in Omdurman HIV/AIDS centre, Sudan. Data was collected through direct interview using semi-structured questionnaire. There were only 144/846 (17.02%) who adhered to antiretroviral therapy as prescribed by their doctors. The remaining 51.18% were taking the therapy but not regularly, 31.21% were taking it but currently not and 0.59% stated that they have never taken any antiretroviral therapy. Factors associated with poor adherence that have been identified include female gender (Adj. OR = 3.46 (95%CI: 1.46-8.21), P = 0.005), younger age (Adj. OR = 1.14 (95%CI: 1.02-1.28), P = 0.022), being unemployed (Adj. OR = 5.94 (95%CI: 1.51-23.40), P = 0.011), those who were divorced, separated or widowed (Adj. OR = 11.35 (95%CI: 1.74-73.96), P = 0.011) and respondents who perceived that their health status is poor (Adj. OR = 5.21 (95%CI: 1.44-18.81), P = 0.012) or very poor (Adj. OR = 4.04 (95%CI: 1.27-12.81), P = 0.018). Educational level and social support against HIV-related stigma and discrimination were not significantly associated with adherence. Adherence to antiretroviral therapy among the respondents is very poor. Urgent interventions based on modifiable factors and mainly targeting females and younger age group are needed to improve adherence to antiretroviral therapy among people living with HIV.
Achieving smoking cessation is an arduous process, where smokers try different methods or approaches to achieve cessation. Quit smoking attempts play an important role in smoking cessation.Thus, this study was conducted to determine the factors associated with attempt-to-quit smoking among the currentsmokers in Sarawak.This cross-sectional study was conducted among adult smokers in Sarikei, Sarawak by face-to-face interview using an adapted and validated questionnaire. Non-probability sampling method was used to select the study place. An adult smoker was selected systematically from each selected household. A total of 482 smoker households were identified with a response rate of 92.3%. Data was analysed using IBM SPSS Version 22.0. A p-value of <0.05 was considered statistically significant. The mean (SD) age of the smokers was 36.3(13.3) years. However, the mean (SD) age of smoking initiation was 18.5(4.8) years. Majority of the smokers were male (91.5%), with the male to female ratio being 1:0.1. Mean (SD) score on The Fagerström Test for Nicotine Dependence was 4.75(2.4), while motivation to quit smoking score was 3.04(1.0). Majority of the smokers (83.1%) hadever seen pictorial health warnings on cigarette packs. More than half of the smokers (54.8%) had ever tried to quit smoking. Binary logistic regression analysis revealed that marital status, religion, ethnicity, pictorial health warnings on cigarette packs and motivation to quit smoking appeared to be the significant predictors of attempt-to-quit smoking (p<0.05). Understanding the attempts to quit smoking will assist inclinical expectations. Thus, a smoking cessation programme should be designed in line with these factors, to aid quit smoking attempts.
This paper investigates the antenatal care (ANC) services utilization in currently pregnant women during their visits to maternal and child health (MCH) clinics of rural (Kinabatangan) and urban (Sandakan), Sabah. A community clinic based, cross-sectional descriptive study was performed. In total, 800 currently pregnant women attending two MCH clinics, from April to September 2012, were participated using tested set questionnaires. Descriptive analysis was used for background characteristics and chi-square analysis was applied to identify the rural-urban differences among the variables.In both study areas, previous births delivered by skilled birth personnel were same. In pregnant women from rural, less income, more grand-multiparity, earlier antenatal care booking, more frequent post-natal care, more use of contraception compared to those in urban. In comparison, urban pregnant women had more anti-tetanus toxoid injection in their previous pregnancies, past history of antenatal care for at least four times, increase in household members. As this study found the differences in ANC services utilization at Rural and Urban, further study is needed to explore concrete reasons for above findings. By delivering services according to the needs of all clients, irrespective of their place of residence, it will improve ANC services utilization in both areas of Sabah and hence will improve more on existing health status of the Nation.
Study site: Klinik Kesihatan, Kinabatangan and Sandakan, Sabah, Malaysia
A cross sectional survey was conducted in Kampung Datuk Kerarnat, an urbanized residential area in Kuala Lumpur from August to November ZOO5 to assess knowledge, attitude and preventive practices on dengue among its residents. A two stage sampling strategy was used to select survey household. An adult aged at least 21 years old was identified from each selected household and interviewed using a standardized questionnaire. Data was collected on demographics, dengue related KAP and house-types. Knowledge, attitude and practice were assessed using a scoring system. Each appropriate answer was given a point and the points for each section of the questionnaire were totalled. Knowledge was assessed as ‘good' or ‘moderate to poor’ based on arbitrary cut-off point. Out of 133 respondents interviewed, 78.2% were able to identify at least one clinical sign of dengue, 73% knew that dengue fever was caused by the bite of dengue infected Aedes mosquitoes, 71 % correctly identified breeding sites, 69.2% correctly identified the Aedes mosquito and 42% correctly reported biting times ofthe mosquito vector. Overall, knowledge
was categorized as poor, attitude was good and dengue control and prevention practices was moderately poor. There was a weak but significant positive correlation between knowledge and practice (r=0.271, p=0.002) but there was no significant correlation between attitude with practice and between attitude with knowledge (p>0.05) . The results suggested that inspite of good attitude l
on dengue fever, it did not correlate with good practices and good knowledge in dengue prevention. We conclude that there is a need to increase health promotion activities to increase knowledge which forms the basis for preventive practices as part of the strategy to control dengue. Preventive strategies are the only means of controlling the disease.
Analysis of count event data such as mortality cases, were often modelled using Poisson regression model. Maximum likelihood procedures were used by using SAS software to estimate the model parameters of a Poisson regression model. However, the Negative Binomial distribution has been widely suggested as the alternative to the Poisson when there is proof of overdispersion phenomenon. We modelled the mortality cases as the dependent variable using Poisson and Negative Binomial regression and compare both of the models. The procedures were done in SAS by using the function PROC GENMOD. The results showed that the mortality data in Poisson regression exhibit large ratio values between deviance to degree of freedom which indicate model misspecification or overdispersion. This large ratio was found to be reduced in Negative Binomial regression. The Normal probability plot of Pearson residual confirmed that the Negative Binomial regression is a better model than Poisson regression in modelling the mortality data. The objective of this study is to compare the goodness of fit of Poisson regression model and Negative Binomial regression model in the application of air pollution epidemiologic time series study by using SAS software.
Misuse of alcohol among adolescents, particularly schoolchildren has become one of the public health concerns in Malaysia due to its serious effects and an increased risk of alcohol related injuries, especially motor vehicle injuries. This is the most common type of youthful fatal injury in Malaysia. However the availability of data on the extent of alcohol abuse particularly among school children in this country is limited. Therefore, we conducted this study with the objectives of identifying the prevalence of alcohol drinking among school children in Kuala Lumpur, factors rekited to alcohol drinking among the adolescents and to assess health status of their parents through the presence of any related alcohol diseases and the habits of alcohol drinking among their parents.
In this baseline study a two stage stratified sampling design was used to recruit 8532 eligible students from the selected secondary schools in Kuala Lumpur. The prevalence of alcohol drinking was 9.0% (771 / 8532) . Significant factors identihed related to alcohol consumption were akoholic father (OR=1.29), akoholic mother (1 .55) ; elder siblings consume alcohol (2 .49) and the Chinese ethnic group (1 .55) . The study revealed that factors which signihcantly contributed to the habit of alcohol drinking were related to whether their parents consumed alcohol or not or either their eMer siblings were ako taking alcohol. Therefore, the, results from this study could be used as a baseline data to describe the level of alcohol consumption among adolescents particularly school children. Ehfective public health interventions that focus on the familial context of adolescents' drinking habits may be developed.
Increasing prevalence of chronic diseases is a major contributor for rapid rise in healthcare cost in developing countries since the last decade. It was estimated that around 54% of deaths in developing countries are due to chronic non-communicable diseases which is predicted to rise by 65% by 2030. Diabetes mellitus is among the most prevalent chronic diseases suffered by more than 180 million people worldwide. By 2030 it is estimated that around 400 million people in the world will be afflicted with diabetes. Annual deaths attributable to diabetes are probably as high as 3 million with more than 80% occur in developing countries. India, China and Indonesia are three countries in the Asian region with most number of people with diabetes. The total number of cases in these three countries is expected to increase more than double from 61 million in 2000 to 163 million in 2030. China and India will suffer cumulative GDP loss of 13.8% and 16.7% respectively, over the next ten year period. Assessing economic burden of diabetes is a challenging task for researchers because identification of direct and indirect cost of the disease is often complex since patients with diabetes also suffers from other complications and co-morbidities. In conclusion, the heavy economic burden of diabetes pose major challenges to health policy makers in developing countries to assess the current approach in managing this chronic disease. Serious efforts should be made on focusing and up-scaling activities on health promotion and prevention of diabetes so that to provide a more cost-effective solution to this condition with huge and increasing economic loss.
On March 17, 2003 the Kelantan Health Department was notihed about a possible typhoid outbreak following a wedding party. An investigation was carried out to identiy the source and recommend control measures. Active case detection, yield investigation and case»control study were conducted. Cases were symptomatic attendees with a stool or blood culture positive for Salmonella
typhii. Each control had a negative culture and denied symptoms. Of the more than 1 OOO guests, 477 experienced fever; 152 met the case definition. The party hostess was found to be an Salmonelb typhii carrier. Syrup prepared with untreated well water was identified as the most likely source for this outbreak, with an odds ratio 14.0 (95% C1: 2.9, 104.1). This was a common source
outbreak of typhoid. We recommend that all food handlers at large parties be screened for typhoid and other foodborne diseases and samples of higherisk foods should be kept for few days after each event in case they are needed for testing.
A study was conducted in Kelantan, Mabysia, in the year 2001 , to assess the typhoid reporting coverage and timeliness, and to estimate the annual incidence. Cases were persons given the diagnosis of typhoid clinically, and conhrmed cases are those with positive laboratory results. In all, 174/252 (69%) cases (95% CI = 63%-75%) were reported, ofwhich 89/131 (83%) within 7 days of diagnosis. The estimated annual typhoid incidence in Kelantan is 37/ 1 00,000.
Research on environmental ergonomics of train/commuter is very limited. Thus, this study was conducted with aims
to determine the environmental ergonomic of public transport, whether it is in accordance to indoor air quality
standard inside women coach cabin train during operations. Although the number of passengers is increasing, some
claimed that the indoor air quality for the Malaysian commuter train is uncertain, especially at peak times.
Unsatisfactory feedback from some respondents—especially female passengers—will affect other passengers to
remain loyal to use this facility as one of the main transportation to reduce the traffic congestion that will be faced
if using private vehicles. The study conducted during peak hours on the weekends and the trip took exactly two hours
and covered 18 main stations. The measurement devices placed at the centre of the cabin Komuter using Air Quality
Meter (AIRFLOW Instrument Model TA465). The main parameters measured were temperature, humidity, and carbon
dioxide (CO2). This study also counts the number of passengers riding the train. The results showed that the indoor
air quality (AIQ) level of the morning hour will affect passengers’ health more compared to the evening hour (this is
due to the CO2 level that has exceeded the safety standard). Morning hour gave higher reading of CO2 (43.8%) and
relative humidity (17%) compared to evening hour. Evening hours also showed greater temperature at 3%. The
findings can give awareness to the train company to improve the IAQ by installing a suitable ventilation system and
can give comfort to the passengers when travelling using Malaysian commuter train.
The evolution in lifestyle and dietary habits of the Malaysian people that have taken place over the last few decades can be largely attributed to both family and social environment. These factors are known to affect the nutritional status of the community, in both children and adults. Reduced physical activity and changes in their diet have been one of the contributing factors to the rising prevalence of overweight and obesity. However, in Malaysia, in which nutrition transition has been a norm, it is worrying when the trends of overweight and obesity have been rising steadily over the years especially among children. Although numerous strategies to control obesity in Malaysia have been taking place, many had shown little effect. Analysing strategies implemented at national level is thus crucial in order to ascertain reasons for the shortfalls of these strategies especially among children. Obesity most commonly begins as early as the ages of 5 and 6 years, or during adolescence. Obesity is indeed a major public health concern due to its huge negative impact on the society at large which is well supported by evidence-based literatures. Managing this issue is complex and holistic approach is thus crucial in reducing its incidence and prevalence.
Introduction: Transboundary haze occurred was primarily derived from seasonal forest fires which has highly been concerned of the health effect on the local community. As awareness of the source and dangers of smoke haze spread, Malaysian government increasingly came under pressure from the public and civil society at the national, state, and district level to address the haze issues. However, the knowledge, attitude, and practice (KAP) inequalities of urban and rural community could be a barrier in promoting awareness on haze. Objective: To determine the urban and rural inequality in KAP on haze. Methodology: A total of 400 urban and rural residents from Klang Valley was recruited to participate in this study. A validated survey form was used as the study instrument which composed of four parts: (1) Sociodemographic information, (2) Haze knowledge, (3) Attitude (concerns) during haze episodes, (4) Practices (protective behaviors) to prevent against the health effects of haze. Result: There were significant differences of KAP on transboundary haze among urban-rural population. Urban population has higher knowledge and protective behaviors on hazes; however, both the rural-urban residents presented moderate levels of concerns on hazes. Conclusion: It is necessary to provide timely information (knowledge and practices) on haze to rural residents, at the same time, improve the urban residents’ concerns (attitudes) over the haze phenomenon. This will help to raise the overall awareness level to transboundary haze by translating into a state of the resilient community.
Introduction: Transboundary haze occurred was primarily derived from seasonal forest fires which has highly been concerned of the health effect on the local community. As awareness of the source and dangers of smoke haze spread, Malaysian government increasingly came under pressure from the public and civil society at the national, state, and district level to address the haze issues. However, the knowledge, attitude, and practice (KAP) inequalities of urban and rural community could be a barrier in promoting awareness on haze. Objective: To determine the urban and rural inequality in KAP on haze. Methodology: A total of 400 urban and rural residents from Klang Valley was recruited to participate in this study. A validated survey form was used as the study instrument which composed of four parts: (1) Sociodemographic information, (2) Haze knowledge, (3) Attitude (concerns) during haze episodes, (4) Practices (protective behaviors) to prevent against the health effects of haze. Result: There were significant differences of KAP on transboundary haze among urban-rural population. Urban population has higher knowledge and protective behaviors on hazes; however, both the rural-urban residents presented moderate levels of concerns on hazes. Conclusion: It is necessary to provide timely information (knowledge and practices) on haze to rural residents, at the same time, improve the urban residents’ concerns (attitudes) over the haze phenomenon. This will help to raise the overall awareness level to transboundary haze by translating into a state of the resilient community.
A study was conducted at Greentown Health Clinic, Ipoh to assess and classify asthma by levels of control based on the Global Initiative for Asthma (GINA). The secondary objective was to identify those patients whose control was suboptimal. A total of 102 patients were included in this study based on random sampling between 25th April 2008 and 6th June 2008. Standard Asthma Control Questionnaires were used to classify asthma and levels of control. Baseline Peak Expiratory Flow Rate (PEFR) measurements and PEFR at audit visits were also recorded. All data were analysed using SPSS version 13. The study showed that only 39.2 % of the patients were classified as having controlled asthma, 34.3 % had asthma that was partly controlled and 26.5 % of the patients had uncontrolled asthma. Among those patients who had inadequate asthma control, more than half of them had nocturnal attacks and exacerbations. These findings demonstrate the need by the attending doctor to improve assessment of the patient’s control of asthma by actively questioning the patients and subsequently improving management to achieve optimal control of asthma.
Study site: Klinik Kesihatan Greentown, Ipoh, Perak, Malaysia
Indoor air quality is an essential aspect for occupational health including in a densely populated university. This study aimed to assess the indoor airborne microorganisms via biochemical and molecular approaches in five enclosed workplaces, and their resistance towards six commonly used antibiotics. Cfu/dm2/h for five enclosed workplaces was determined using settle plate technique with 1/1/1 scheme and Gram staining was performed for all pure strains isolated. Two strains with the highest count and with different morphologies were identified using biochemical test as well as 16S rRNA amplification and direct sequencing. Minimum inhibitory concentration for antibiotics was carried out for these two strains. In this study, 27 microbial strains with different morphologies were obtained from all workplaces and 2 strains with the highest count were strain J in café and strain M in library, which were identified as Bacillus cereus and Staphylococcus cohnii, respectively. Both of them were highly susceptible to ampicillin and tetracycline. With resistance up to 0.78 µg/mL; B. cereus was less sensitive to kanamycin and neomycin whereas S. cohnii was less sensitive to streptomycin. In conclusion, antibiotics resistant B. cereus and S. cohnii were two of the microorganisms showing the most abundance in the café and library of a Malaysian public university, respectively. This study may serve as the baseline for the prescriptions of antibiotics to airborne microbial related infections especially to the community in the university who seek for medical treatments; particularly for respiratory and digestive infections which often associated with indoor microenvironment.
The paucity of published literature on periodontal treatment needs and services in developing countries has undermined the significance of periodontal disease burden on healthcare systems. This study analyses periodontal status and population treatment needs of Malaysians, and patterns of periodontal services provided at public sector dental clinics. A retrospective approach to secondary data analysis was employed. Data for population treatment needs were extracted from three decennial national oral health surveys for adults (1990, 2000 and 2010). Annual reports from the dental subsystem of the government Health Information Management System (HIMS) provided information on oral health care delivery for years 2006-2010. They were based on summaries of aggregated data; analyses were limited to reporting absolute numbers and frequency distributions. Periodontal disease prevalence declined between 1990 (92.8%) to 2000 (87.2%) but a sharp rise was observed in the 2010 survey (94.0%). The proportion of participants demonstrating periodontal pockets of 6 mm and more increased in 2010 survey after showing improvements in 2000. Individuals not requiring periodontal treatment (TN0) increased in proportion from 1990 to 2000, only to drop in 2010. An increase in utilisation was observed alongside a growing uptake of periodontal procedures (62.2% in 2006 to 73.6% in 2010). Only about 10% of treatment was surgeries. While the clinical burden of periodontal disease is observed to be substantial, the types of treatment provided did not reflect the increasing needs for complex periodontal treatment. Emphasis on downstream and multi-collaborative efforts of oral health care is deemed fit to contain the burden of periodontal disease.
This study is to determine the prevalence and the associated factors of low-back pain (LBP), which has multifactorial causes, among ambulance workers in Kelantan, Malaysia. The cross-sectional study involved ambulance workers in the emergency department in all government hospitals in Kelantan. Those who did not consent, complete or return the questionnaire as well as having rheumatic diseases were excluded from the study. The participants were asked to answer a self-administered questionnaire in English. Descriptive analyses and Chi-square test were used. A total of 168 respondents had completed the questionnaires with a response rate of 85.0%. Questionnaires with more than 95.0% items completed were included in the analysis (n=143). The respondents had a higher proportion of male than female (63.6% versus 36.4%). Assistant Medical Officer comprised of 60.0% of all respondents and the rest were nurses. The respondents’ age ranged between 23 to 58 years old with a mean age of 38.27 and standard deviation (SD) of 7.27. The mean duration of involvement in ambulance service was 9.68 years (SD 6.97). The majority (98.5%) of the respondents were Malay. Gender, smoking status and hobbies were the associated factors of LBP among ambulance workers. The modifiable risk factors should be emphasized to the ambulance workers as a measure to prevent the development of LBP.
Patient waiting time was introduced to orthodontic clinics in 2009 as a Key Performance Indicator (KPI) in the Ministry of Health Malaysia (MOH) as a measure of client satisfaction. A cross-sectional pilot study was carried out in 2009 in all four main government orthodontic clinics in Selangor. The objectives were to measure patient actual waiting time and evaluate conformance to this KPI. The sample comprised of 5,286 patients; 9.2% from Tanjung Karang, 37.1% Kajang, 29.3% Klang and 24.4% Shah Alam. There were 33.8% punctual, 44.2% early and 21.9% late patients. The mean actual waiting time (AWT) in Selangor was 30 min (SD 24.7); shortest in Tanjung Karang (16.5min, SD 15.3) and longest in Shah Alam (47.9min, SD29.6). AWT was 21.9 min (SD 17.4) for patients punctual for appointments, 40.3 min (SD 40.3) for early patients and 21.9min (SD19.8) for late patients respectively. Although the mean AWT was long for early patients, 20% of them were seen earlier than their appointment time. All four clinics complied with the MOH KPI performance target (>50%) with a mean compliance of 87.5% for Selangor. There is statistically significant difference in punctuality of patients in different clinics (p
Nowadays, community pharmacist plays an important role in medication counseling, patients’ side effects monitoring and
drug information delivery. The need of patient counseling has become a vital part of the pharmacy practice and
pharmaceutical care. Through Continuing Pharmacy Education (CPE) program, pharmacists can develop into professions in
different areas including drug delivery, drug information, technology and patient education. This study was conducted to
evaluate the perception of community pharmacists towards patient counseling and continuing education program in
Sabah and Sarawak, East Malaysia. A cross-sectional study design utilizing questionnaires was prepared by an extensive
literature review. The research was carried out in four major areas in Sarawak; Sibu, Kuching, Bintulu and Miri and in
three major areas Sabah; Kota kinabalu, Sepilok, Tawau by convenience sampling method. Descriptive analysis was
conducted using SPSS version 18. Perception of community pharmacists towards patients counseling and continuing
education program was analysed using scaling method. A cut-off score of 25.8 was used to indicate the perception of
community pharmacists. The Pharmacists scored a cut-off point of 25.8 and above were considered to have good
perception. A sample of 174 community pharmacists from Sabah and Sarawak were participated in this study. All of the
respondents except one had positive perception towards patient counseling and continuing education program. Overall,
almost all the community pharmacists had positive perception towards patient counseling and continuing education
program in Sabah and Sarawak, East Malaysia. Further research is needed to evaluate perception of community
pharmacists in different states of Malaysia and explore more on continuing education program in Malaysia.
Aedes mosquito-borne Dengue morbidity is predominantly high in the tropics and subtropics regions. Dengue is also a
public health problem in Malaysia since the first epidemic in 1973. Reducing the vector population and personal
protection still plays an important role in dengue prevention and control. With the information of community’s dengue
knowledge, attitude and practices (KAP), the authorities could construct evidence-based, community- empowered vector
control program. Upon the understanding of the value of baseline data, a cross-sectional study was carried out in dengue
hotspot areas in Seberang Takir using universal sampling. The study results showed that 54.6% of the population had high
level of knowledge, 18.6% had good attitude and 91.7% were performing good practices against Dengue infection. After
adjusting confounding variables, age and educational levels of respondents, knowledge as well as attitude were found to
be significant associated factors for having good practice against Dengue. The study findings provide the need for further
information to undertake a holistic approach which is in need of community participation and cooperatio