Pregnancy among unmarried women may have negative social and health implications in Malaysia. The number of pregnancies among unmarried women has increased in Malaysia, but the socio-demographic profile of these women is unclear. This study aims to evaluate the characteristics of unmarried pregnant women and the factors associated with unmarried pregnancies among young women in Malaysia. We conducted a cross sectional study at six hospitals and six women's shelters in Peninsular Malaysia during 2011-2012. Unmarried pregnant women were compared with married pregnant women. Participants were interviewed using a structured questionnaire asking for socio-demographic data, family background, risky sexual behavior, social support and pregnancy details. A total of 484 women (239 unmarried and 245 married) were included in the study. Most unmarried subjects were adolescents, from urban areas, from a low socioeconomic group, and lived with parents prior to pregnancy. Age (OR=0.67; 95% CI: 0.61-0.74), studying status (OR=17.33; 95% CI: 2.65-113.19), alcohol use (OR=40.46; 95% CI: 2.51-652.38) exposure to pornographic material (OR=13.48; 95% CI: 3.24-56.01), contraceptive use (OR=0.20; 95% CI: 0.08-0.51), and social support (OR=0.90; 95% CI: 0.86-0.94) were all associated with unmarried pregnancy. These factors need to be considered when.designing an intervention program.
Numerous studies have reported the prevalence of toxoplasmosis among Malaysians and various domestic animals; but there is paucity of information on its prevalence among rodents which could potentially contribute to the transmission of Toxoplasma gondii in both domestic and sylvatic fauna. Five hundred twenty-six rodents were captured from six locations in Malaysia and identified to species. Serum samples were collected from these rodents and tested for T.gondii antibodies using an immunofluorescent antibody test (IFAT). T.gondii antibodies were found in 5.9% (31/526) of the tested samples. Most of the positive antibodies were from commensal rats: Rattus exulans (9/64, 14.0%), Rattus argentiventer (2/8, 25%), Rattus rattus diardii (10/166, 6.0%) and Rattus tiomanicus (6/215, 2.7%). Only two of the forest rats were positive: Maxomys rajah (1/9, 11.1%) and Rattus bowersi (1/12, 8.3%). Eighteen point one percent of ground squirrels (Tupaia glis) tested (2/11) were positive for antibodies. The highest antibodies titer (1:1024) was found in Rattus exulans followed by T.glis (1:256). Sabak Bernam, Selangor had the highest prevalence (10.8%) followed by Baling, Kedah (5.0%) and Bagan Terap, Selangor (4.0%). None of the serum samples of rodents collected from Gua Musang, Kelantan; Jasin, Malacca; or Labis, Johor were positive. Our study reports for the first time the serologic prevalence of T.gondii antibodies among rodents in Peninsular Malaysia. Further studies are needed to confirm T.gondii infection among wild rodents, such as a bioassay, to assess their potential role in transmission of the parasite.
We conducted a cross sectional study of cardiovascular risk factors among healthcare workers at four government hospitals in Kelantan, Malaysia. We randomly selected 330 subjects fulfilling the following study criteria: those who had been working for at least one year at that health facility, Malaysians citizens and those with some form of direct contact with patients. We conducted an interview, obtained physical measurements, a fasting blood sugar and fasting lipid profiles among 308 subjects. The mean age of the subjects was 43.5 years, 82% were female; 30.8%, 14.3%, 10.4%, 1.3% and 1.6% of the subjects had dyslipidemia, hypertension, diabetes mellitus, a history of stroke and a history of ischemic heart disease, respectively. Forty-two percent of subjects had at least one medical condition. The mean body mass index (BMI) was 27.0 kg/M2 (SD=4.8) and 24.3% had a BMI > or =30 kg/M2. The mean systolic and diastolic blood pressures were 121.5 mmHg (SD=14.0) and 76.5 mmHg (SD=9.7), respectively and the mean waist-hip ratio was 0.84 (SD=0.1). The mean fasting blood sugar, total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein were 5.8 mmol/l (SD=2.4), 5.5 mmol/l (SD=1.0), 1.4 mmol/l (SD=0.9), 1.5 mmol/l (SD=0.3) and 3.5 mmol/l (SD=0.9), respectively. Our study population had a smaller proportion of hypertension than that of the general Malaysian population. They had higher fasting total cholesterol, slightly lower fasting blood sugar, with a large proportion of them, obese and had diabetes. Immediate intervention is needed to reduce the traditional cardiovascular risk factors in this population. Keywords: cardiovascular risk factors, health care workers, Malaysia
Annual influenza vaccination is the most important preventive strategy against influenza illness in healthcare workers (HCWs), who could acquire influenza from and transmit influenza to patients and other HCWs. Despite the well established benefits and strong recommendations for influenza vaccination for all HCWs, influenza vaccination uptake at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for the past 3 years has been low and is decreasing. We aimed to determine the factors associated with influenza vaccination uptake among HCWs at UKMMC. We conducted a cross sectional study via questionnaire among 211 randomly selected HCWs, consisting of 106 HCWs who were vaccinated in 2011 and 105 HCWs who were not vaccinated in 2010 or 2011. We had a 100% response rate. Influenza vaccination uptake was significantly associated with age and previous vaccination history, with older HCWs being more likely to be vaccinated (adjusted OR = 12.494; 95% CI:6.278-24.863; p < 0.001) and HCWs with previous vaccination history being more likely to be vaccinated (adjusted OR = 1.038; 95% CI:1.001-1.077; p = 0.045). Influenza vaccination uptake was not associated with gender (p = 0.926) or job category (p = 0.220). Publicity at the workplace was the main source of information about the vaccine (51.2% of respondents), followed by colleagues (29.9%). Despite the low uptake, 85.3% of respondents believed influenza vaccination was important for disease prevention. The most common reason given for vaccination was protection against influenza infection (73.6%). The most common reason for not having the vaccine was time constraints (56.2%). An evidenced-based strategy needs to be developed to improve vaccine uptake or having mandatory vaccination.
Antibiotic resistance is a major problem globally. Awareness of the impact and significance of antibiotic resistance is a first step in hindering its progression. We conducted this survey to evaluate knowledge, attitudes and practices regarding antibiotic use in Malaysia. A total of 373 respondents were surveyed, 219 (58.1%) were female and 312 (83%) were Malay ethnicity. Eighty-four point two percent (314) had used antibiotics more than once (> 1) during the previous year. We found respondents who were less likely to take antibiotics (≤ 1) during the previous year were more likely to agree that antibiotic resistance was a serious public health issue compared to those that took antibiotic more than once during the previous year (p < 0.0001). A significantly greater number of patients (67.2%) who took antibiotics more than once during the previous year did not complete the full course than those who took antibiotics no more than once (55.9%) during the previous year (p < 0.01). We found the frequency of antibiotic use was related to knowledge about antibiotics among the study population. It is essential to develop educational interventions to correct the misuse and misunderstanding of antibiotics.
Study site: general public in Kuantan (Pahang) and Kuala Lumpur, Malaysia
Partial gene sequences of phenylalanyl-tRNA synthase alpha subunit (pheS) and RNA polymerase alpha subunit (rpoA) were evaluated for species delineation and detection of recombination among enterococci populations recovered from a bathing beach impacted by low tide river flow. At inter-species level, a maximum similarity of 86.5% and 94.8% was observed among the enterococci pheS and rpoA sequence, respectively. A superimposed plot of delimited pairwise similarity values obtained for 266 pair-wise observations revealed that while there was a harmony between species identity obtained from both genes, pheS was more discriminatory than rpoA. The difference was more pronounced for inter-species comparison. A number of putative recombination events between indigenous and non-indigenous strains was detected based on a library of aligned sequences. Virulence genes cyl, esp, gelE and asa were detected in 7, 22, 100 and 63%, respectively among river isolates but at lower proportion of 0, 20, 67 and 42%, respectively among beach water isolates. Random amplified polymorphic DNA profiling presented evidence suggesting low tide river as a source of fecal enterococci entering the recreation beach water. Multilocus sequence typing analysis of a number of Enterococcus faecalis isolates presented four sequence types, ST59, 117, 181 and 474. The presence of genetically diverse fecal enterococci with associated virulence traits and a background of recombination events in surface recreational water could present a potential public health risk.
Burkholderia pseudomallei, the causative agent of melioidosis is an important cause of morbidity and mortality particularly among diabetics. We evaluated 228 isolates of B. pseudomallei for antimicrobial sensitivity during 2005-2010 using the disc diffusion technique, of which 144 were obtained from blood culture. More than 90% of the strains were susceptible to cefoperazone, ceftazidime, chloramphenicol and imipenem. Eighty-two percent of the isolates were susceptible to tetracycline and amoxicillin/clavulanate. The susceptibilities to ciprofloxacin was 78% and to trimethoprim-sulfamethoxezole was 47%. The susceptibilities to aminoglycoside antibiotics were low (21% to gentamicin and 6% to amikacin). The susceptibilities were similar between isolates from females and males, bacteremic and abacteremic cases, diabetics and non-diabetics, pneumonia and non-pneumonia cases and between those who died and those who survived. Our findings show antibiotic susceptibility patterns are not a major factor in determining outcomes of B. pseudomallei infection. Monitoring the drug susceptibilities among B. pseudomallei isolates needs to be conducted regularly to guide empiric therapy for melioidosis, as it causes high mortality, especially among diabetic cases.
Observation on predation activities of guppies (Poecilia reticulata) on the larvae of three species of mosquito, namely Aedes albopictus, Aedes aegypti, and Culex quinquefasciatus was carried out under laboratory conditions. Male and female guppies were used as predators for predation experiments on the 4th instars of mosquito larvae. The daily feeding rates comparing male and female guppies on mosquito larvae were different; the female guppies consumed more mosquito larvae than male guppies did. The daily feeding rates of female guppies were 121.3 for Ae. aegypti, 105.6 for Ae. albopictus, and 72.3 for Cx. quinquefasciatus. The daily feeding rates of male guppies were 98.6 for Ae. aegypti, 73.6 for Ae. albopictus, and 47.6 for Cx. quinquefasciatus. In terms of prey preference, there was greater preference towards mosquito larvae of Ae. aegypti, followed by Ae. albopictus, and the least preferred was Cx. quinquefasciatus. Male and female guppies consumed more mosquito larvae during lights on (day time) compared with lights off (night time). The water volume, prey species, number of fish predators available, prey densities, and prey's sex also influenced the predation activities.
Tooth agenesis in Malay children, hitherto unreported, was assessed retrospectively from orthopantomograms of 834 healthy children aged 12-16 years who attended the Dental Clinic of Universiti Sains Malaysia. All teeth, including third molars, were assessed for agenesis. On an average, 2.3 teeth were missing per child. Missing third molars were found in 25.7% of children with one or two third molars found to be missing in 18.3% of children. Three point two percent of children had missing teeth other than third molars. After third molars, the upper lateral incisors were found to be the most common missing tooth (1.7%), followed by upper and lower second premolars (1.5%). Eight missing upper canines were also seen (1%). Bilateral agenesis was more common than unilateral agenesis. There were no significant differences between males and females. There was a significant difference between missing teeth between the maxilla and the mandible and right and left side, with more missing teeth in the maxilla and on the right side. The odds of any 3rd molar missing were increased 3.3 times when there was any other missing tooth. In conclusion, the prevalence of tooth agenesis among the studied population was within the normal range, but less than some Asian countries. Unlike other Asian countries, the upper lateral incisor was the most common missing tooth. The prevalence of maxillary canine agenesis was higher than most previous reports. Missing teeth were associated with missing third molars, which is likely due to a genetic abnormality.
Using data from the Third National Health and Morbidity Survey (NHMS III) in 2006, this study examined the association between socio-demographic factors and physical inactivity in a sample of 33,949 adults aged 18 years and above by gender. Physical activity levels were measured using the Global Physical Activity Questionnaire (GPAQ vers 1). Physical inactivity was defined as having a total physical activity level of less than 600 metabolic equivalents-minutes per week (METs-minutes/week) contributed by all three different life domains.Logistic regression analyses were conducted.The prevalence of overall physical inactivity was 43.7% (95% CI: 42.9-44.5). The mean total physical activity level was 894.2 METs-minutes/ week. The means METs-minutes/week for the domain of work, travelling, and leisure time were 518.4, 288.1, and 134.8, respectively. Multivariable logistic regression analyses indicated that females were more likely to be physically inactive than males were (aOR=1.62; 95% CI: 1.53-1.72). Among women, being a housewife (aOR = 1.78; 95% CI: 1.56-2.03), widow/divorcee (aOR = 1.23; 95% CI: 1.05-1.43), and those with no formal education (aOR = 1.20; 95% CI: 1.01-1.43) were found to be significantly associated with physical inactivity.Urban residents, older adults aged 65 years and above, private employees, nonworking group, and those with a monthly household income level of MYR5,000 and above appeared to be consistently associated with physical inactivity across men, women, and combined group (both). Specific health intervention strategies to promote physical activity should be targeted on population subgroups who are inactive.
Study name: National Health and Morbidity Survey (NHMS-2006)
Job Content Questionnaire (JCQ) has been proven a reliable and valid instrument to assess job stress in many countries and among various occupations. In Malaysia, both English and Malay versions of the JCQ have been administered to automotive workers, schoolteachers, and office workers. This study assessed the reliability and validity of the instrument with research laboratory staff in a university. A cross sectional study was conducted among 258 research laboratory staff in Universiti Putra Malaysia (UPM). Malaysian laboratory staff who have worked for at least one year were randomly selected from nine faculties and institutes in the university that have research laboratory. A self-administered English and Malay version of Job Content Questionnaire (JCQ) was used. Three major scales of JCQ: decision latitude, psychological job demands, and social support were assessed. Cronbach's alpha coefficients of two scales were acceptable, decision latitude and psychological job demands (0.70 and 0.72, respectively), while Cronbach's alpha coefficient for social support (0.86) was good. Exploratory factor analysis showed five factors that correspond closely to the theoretical construct of the questionnaire. The results of this research suggest that the JCQ is reliable and valid for examining psychosocial work situations and job strain among research laboratory staff. Further studies should be done for confirmative results, and further evaluation is needed on the decision authority subscale for this occupation.
Metabolic syndrome (MetS) is common among patients with type 2 diabetes mellitus (T2DM) and increases the risk of cardiovascular disease (CVD) and all-cause mortality. The objective of this study was to investigate the association between the components of MetS and the prevalence of CVD among patients with T2DM. We studied 313 patients aged > or = 30 years diagnosed with T2DM at two tertiary care hospitals. Patients were recruited by systematic random sampling. Clinical data was obtained using an interviewer-administered structured questionnaire and from a review of their medical records. MetS was diagnosed using NCEP ATP III, WHO, IDF and the new Harmonized definitions. Specific MetS components such as BMI, waist circumference, waist-to-hip ratio, hypertension, HDL-C and triglyceride levels were evaluated to determine if they had an association with CVD. Thirty-six point one percent of the subjects had CVD. The mean age of the subjects was 55.7 +/- 9.2 years and the mean duration of having diabetes was 10.1 +/- 8.1 years. The overall prevalences of MetS (> or = 3 of 5 components) (95% CI) were 96.1% (94.0-98.3), 95.8% (93.6-98.1), 84.8% (80.8-88.9) and 97.7% (96.1-99.4) using NCEP ATP III, WHO, IDF and Harmonized definitions, respectively. Patients with MetS had a higher prevalence of CVD using NCEP ATP III (98.2% vs 93.5%), WHO (98.2% vs 93.0%), IDF (87.6% vs 82.0%) and Harmonized criteria (98.2% vs 96.0%). The greater the number of MetS components, the greater the chance of having CVD using three definitions for diagnosing MetS: WHO, IDF and Harmonized (p < 0.05). MetS and the combination of the individual components of MetS were significantly associated with CVD among type 2 diabetic patients in Malaysia. Aggressive treatment of MetS components is required to reduce cardiovascular risk in T2DM.
We conducted mosquito surveillance at outdoor breeding habitat in 459 households at 7 urban locations in Putrajaya, Malaysia from January to December 2010 to determine the predominant species and breeding locations. The most common species found at all locations was Aedes albopictus. Gardening utensils were the most common breeding sites. Of the 1,885 mosquito larvae specimens found, 1,774 (94.1%) were Ae. albopictus larvae, 84 (4%) were Ae. aegypti larvae and 27 (1%) were Culex quinquefasciatus larvae. The Aedes index for each of the locations was higher than the goal set by the Ministry of Health for Malaysia. However, the container index at each of the locations was within the goal. The Breateau index was above the goal set by the Ministry of Health at Precinct 9B1 but the other locations were within the goal.
Peripheral vascular injuries result from penetrating or blunt trauma to the extremities. We describe here an unusual cause of a radial artery injury by the spine from the pectoral fin of Pangasius sutchi in a 51 year-old man and we review the literature.
Onychomycosis increases the risk of developing secondary bacterial infection and cellulitis if left untreated. The aim of this study was to determine the prevalence of onychomycosis among diabetics and its associated factors. A cross sectional study using universal sampling of all type 1 and 2 diabetic patients attending a primary care facility of the Universiti Kebangsaan Malaysia (UKM) from January to March 2011 was conducted. Samples were taken from clinically abnormal nails and from the first right toenail in the absence of nail abnormalities and cultured for fungal elements. A total of 151 diabetics participated in the study. The mean patient age was 60.7 +/- 9.1 years. A total of 123 nail samples (81.5%) were culture positive for fungal elements. A positive correlation was found between onychomycosis and increasing age (p = 0.011) and clinically abnormal nails (p < 0.05). There were no significant correlations with gender, ethnic group, duration of diabetes, types of diabetes or glycemic control. The prevalence of onychomycosis among diabetics in our study was high.
Salmonella sp are important causes of meningitis among neonates and young children in Malaysia. We present a case of Salmonella enteritidis meningitis in a six week old female who presented with a one week history of fever, diarrhea and seizures which was unsuccessfully treated with a third generation cephalosporin. She had a relapse of meningitis complicated with ventriculitis and hydrocephalus, requiring an eleven week course of meropenem. She improved clinically, but did not have improvement in the cerebrospinal fluid (CSF) glucose level despite prolonged antibiotic use. This case illustrates the dilemma in determining the duration of antibiotic needed to successfully treat Salmonella enteritidis ventriculitis.
Rubella infection in pregnant women during the first trimester of pregnancy can lead to fetal anomalies, commonly known as congenital rubella syndrome (CRS). The objective of our study was to analyze the serological test results among infants suspected of having CRS aged < or = 12 months compared with their clinical status. Between January 2002 and December 2011, 3,279 serum samples from infants aged < or = 12 months from government hospitals in Malaysia were examined for rubella specific IgM and IgG antibodies using a Axsym, automated analyzer (Abbott Laboratories). Forty-eight samples were positive for rubella specific IgM antibodies and 494 samples were positive for rubella specific IgG antibodies. These were then age stratified and their clinical history reviewed for any CRS symptoms. Fifteen of 38 rubella IgM positive infants (39.5%) aged < 3 months, had a clinical appearance compatible with CRS. However, only 1 IgM positive infant aged 3 to 6 months and one infant aged 7 to 11 months had clinical appearance compatible with CRS. The most common abnormal findings in these cases were congenital heart defects and cataracts. Forty-eight point eight percent of IgM positive cases and 53.1% of IgG positive cases, had inadequate information in the chart to determine the presence of CRS. Clinical findings and timely laboratory diagnosis to determine the presence of CRS are important in infants born with congenital defects. Physicians should also be aware of the appropriate interpretation of these findings.