Introduction: Adenoviruses are important in public health. They are used as indicators for microbial pollution source tracking (MST), and as vaccine vectors. Knowledge of host specificity and pre-existing immunity are critical for the two applications. Bovine and porcine adenoviruses are expected to be widespread in the environment through agriculture. Here we examined if bovine and porcine adenovirus strains are truly distinctive from other adenovirus strains. Methods: 46 adenovirus strains with complete genome were downloaded from the RefSeq database of Gen-Bank. 450 bp of nucleotides each at positions 1- 450, 18001-18450, and 27001 – 27450 of the respective strains were subjected to the Disparity Index Test using Mega 7 software. Analysis focused on four adenovirus strains: Bo-vine B, Bovine D, Porcine C and Porcine 3. The total number of strains that were significantly different (P
Introduction:The incidence of pertussis has been said to increase over the years, and the affected patient-age group has also changed with the increasing number of cases amongst adolescents and adults. Therefore, adults require booster vaccination for protection against pertussis infection. Vaccination among healthcare workers (HCW) should be prioritized when a country implements an adult vaccine. However, the coverage of pertussis vaccination is still deficient among HCW due to low-risk perception. This study focused on finding the risk perception of pertussis in-fection amongst the HCWs based on the Protection Motivation Theory (PMT) and their acceptance to take pertussis vaccination. Methods: This was a cross-sectional study using online survey. The website link is given to the Health-care workers consisting of doctors, Assistant Medical Officers, nurses, and Environmental Health Officers. Results: A total of 853 responders responded to the questionnaire. Most of the respondents (81.5%) are willing to receive the pertussis vaccine. Independent t-test showed that the PMT score was significantly different between those willing and those not willing to take the vaccine (p-value < 0.001, t statistics (df)= 7.729 (325). Robust path analysis showed that sociodemographic factors (age, the institution of working and prior pertussis vaccination) (p=0.004), threat (p
Introduction: Implantation is one of critical step in human reproductive processes. There are many factors that affect successful implantation. Good quality embryo or blastocyst is a prerequisite to successful implantation together with a receptive endometrium. The purpose of this study is to describe the patient clinical profile and to investigate the factors of interest association with implantation status. Methods: This is a cross sectional study involving patients planned for in vitro fertilization (IVF) treatment in the hospital infertility clinic. All demographic data and clinical profile data of the patient in each visit was recorded. Among the data taken were, physical examination data, patient history, causes of infertility, hormonal investigation and outcome at the end of treatment (presence of fetal heart). Successful implantation is indicated by presence of fetal heart. Results: A total of 246 patients record were collected. Mean age of the patient was 34.2 (SD = 4.12) years old. Mean BMI was 24.5 kg/m2 (SD=4.70). Mean of infertility years among the patients was 5.9 years (SD= 3.40). Most cause of infertility was tubal issues 87 cases (35.4%). The prevalence of successful implantation was 12.8% ((95% CI 7.8%, 17.8%). None of the factors of interest (age, BMI, infertility duration, progesterone at baseline, progesterone at trigger day) were found associated with successful implantation. Out of 224 patients, 53 (21.5%) were having elevated progesterone level at trigger day. However, in this study, there is no conclusive evidence that level of progesterone is associated with successful implantation. Conclusion: The successful implantation in our setting is approximately 1/10 of IVF treatment. Implantation involved a complex mechanism, thus there is wide variety of etiologies to predict for successful implantation. Thus, further study on wide comprehensive of risk factors is warranted.
Introduction: Collecting mosquitoes is essential for research in mosquito-borne diseases, but the light traps used for that purpose are expensive and often difficult to obtain around research fields. We designed a new 3D-printable mosquito light trap that can be made inexpensively anywhere where electricity is available (Hoshi et al, Scientific Reports, in press). In this study, we produced that trap in Sabah and demonstrated its usefulness in the field. Meth-ods: With a 3D printer, the main parts of the trap - body, lid, lamp stand and collection box - were printed in Kota Kinabalu using black polylactic acid (PLA) filaments purchased online. All other parts such as the computer fan and batteries were commercially available at local shops in Sabah. The parts were assembled into the complete units at Universiti Malaysia Sabah’s Rural Medical Education Centre (RMEC) in Sikuati, Kudat. Demonstration was performed at two sites in the Kudat district: RMEC campus and the premises of a local farm in Kampung Paradason. Results: The 3D traps collected 6 and 7 different species of mosquitoes at RMEC and Paradason sites, respectively. The numbers of mosquito species collected by the commercially-available CDC model-512 traps in parallel experiments were 2 (RMEC) and 10 (Paradason). The species collected by the 3D traps included Aedes albopictus (vector transmitting Dengue virus), Anopheles barbumbrosus (malaria), Culex quinquefasciatus (Wuchereria bancrofti, avian malaria, and arboviruses including Japanese encephalitis and Zika viruses) and Mansonia indiana (Brugia malayi). Conclu-sion: The 3D light trap which was produced in Sabah demonstrated its usefulness in the field tests performed in the Kudat district. This model can be used as an alternative to the rather expensive commercial light traps to collect the vector insects transmitting mosquito-borne diseases such as malaria, dengue, Japanese encephalitis, Zika fever and filariasis.
Introduction:Dermatoglyphics have been used extensively to characterize populations, analyse the nature and origin of human variation and population structure and evaluate the micro-differentiation of populations. Dermato-glyphics is considered as a sensitive indicator of intrauterine anomalies and known to be one of the best available diagnostic tools in genetic disorders. KadazanDusun and Bajau are the major ethnic groups of Sabah. The aim of the study was to study the distribution of fingerprint patterns on different digits in these two ethnicities of Sabah and to find if any variation occurs in fingerprint pattern qualitatively between these ethnicities. Methods: This cross-section-al study was conducted from March’ 2016 to February’ 2018 at different villages of Kudat, Ranau, Kota Belud, Kota Kinabalu and Papar, Sabah. After obtaining informed consent 400 persons (KadazanDusun 250, Bajau 150) were included in this study by stratified random sampling. Demographic data and history of present and past illness were obtained from each subject through a valid questionnaire. Finger and palm prints were photographed using Nikon D5200 camera and later were grouped into different types manually. Results: There were 205 female and 195 male participants in the study. Among the three types of fingerprints, whorls were more abundant (>50%) in the thumbs, index, ring and little fingers whereas loops were observed more (>55%) in the middle fingers. The arches were the least (0-3%) observed pattern in all the fingers. The dermatoglyphic pattern of right and left index fingers were only significantly different (p0.05) difference in respect of left and right hands and gender. Conclusion: The study findings would serve as a baseline data for further studies to develop data base of the dermatoglyphic pattern of major ethnic groups of Sabah which would facilitate non-invasive diagnosis of congenital anomalies and various genetic disorders.
Introduction: The objective of this presentation is to carry out a review of the historical status and possible future outlook of the practice of ethnomedicine in the State of Sabah. As in many parts of the world, there are many types of traditional medicines that have been used for hundreds of years among the various native cultural groups in Sabah. Methods: A literature survey was conducted with the aid of online database, and text books using keywords such as the current as well as previous names of Sabah and various related terminology such as ethnomedicine, CAM, complementary and alternative medicine, TCM, traditional and complementary medicine, herbalism, reflexology, spiritualism, ethnobiology ethnology, ethnoanthropology, biological activities, ethnobotanical uses, medicinal prop-erties, toxicity studies, etc. The status of ethnomedicine in Sabah is largely unknown. Results: Based on a review of previous literature, the study discovered that there is limited empirical documentation on the use of ethnomedicine in Sabah. In this preliminary review, a total number of 25 publications were recorded in the databases for the period up to 2019. There is still a need to realise the full potential of the biocultural diversity of Sabah, and that there is a strong need to focus more on socially relevant research. Ethnomedicine in Sabah consists mainly of herbalism, ma-nipulative practices and spiritualism. Plants can be said to be the central player in race-based traditional medicine. While data on ethnomedicine may be based on original field research, several are primarily derivative, drawing as they do from earlier published accounts and, importantly, anecdotes. Traditional massage and other manipula-tive-practices, based on manipulation and movement of body parts, are also popular because of their simplicity and apparent immediate relief that can be experienced by the patient or client. Spiritualism, which may be considered as a peculiar dimension of the mind-body medicine subset of traditional medicine, continues to have its adherents among the natives of Sabah. Conclusion: List and catalogs and sociological and ethnohistorical data were the fa-voured perspective of research in the past; but future evolution of ethnomedical studies need to address some of the debates related to biological, medical and social sciences . Future research should include systematic inves-tigation into efficacy and risk besides the possible incorporation of some parts of ethnomedicine into the existing healthcare services. Ethnomedicine occupies a distinct place in healthcare in the world in general, and Sabah in particular.
Introduction:Lymphatic filariasis (LF) is a neglected tropical disease that can cause significant morbidity. In Malay-sia, National Programme for the Elimination of Lymphatic Filariasis started in 2001 with the initial target of achiev-ing Lymphatic Filariasis elimination status by 2018 but it has been revised to year 2020. Mass Drug Administration (MDA) Programme was performed from 2004 to 2008 in all endemic areas (Red Implementation Unit, IU) in Malay-sia including Terengganu state to stop disease transmission. Transmission Assessment Surveys (TAS) were conducted later on and for Terengganu, they were done in 2011 (TAS 1), 2015 (TAS 2) and 2017 (TAS 3) and had passed all the surveys based on critical cut off (CCO) point given. Methods: A cross sectional analysis of 10-year Terengganu filariasis records (2009-2018) was initiated in June 2019 using data source from eVekpro and filariasis cases line-list-ing. Results: Majority of filariasis cases in Terengganu were among males (n=147, 76.6%) with the highest number among 30-39 year-old age group (n=35, 18.2%). Majority of cases were Malaysian citizens (n=162, 84.4%) with main filariasis species identified were Brugia Malayi (n=149, 77.6%). The number of cases diagnosed was slightly higher from Green Implementation Unit area (n=102, 53.1%) compared to Red Implementation Unit area. Conclu-sion: The number of lymphatic filariasis cases among Terengganu citizens was below critical cut off point after the accomplishment of MDA programme and in accordance with the aim of lymphatic filariasis elimination status in Malaysia by 2020.
Introduction: Cardiovascular diseases remain as the principal cause of death in Malaysia. The rural areas in Sabah still suffer from shortage of doctors and specialists. Health Indicators 2018 from Ministry of Health Malaysia shows the ratio of doctor to population in Sabah is 1:1029. The lack of specialist care for the rural population is a major concern. To overcome the barrier of healthcare services, deployment of telecardiology system is necessary. The objective of this project is to develop a real-time telecardiology system that can transmit and guarantee the quality of the ECG signal. Methods: The proposed real-time telecardiology system used an ECG sensor AD8232 to collect the ECG signal. Arduino ESP32 as a main controller of the system. It uploads the collected ECG data to the online database in real-time through Wi-Fi or cellular network with MQTT protocol. A website is developed for displaying the real-time ECG signal. Results: The proposed system has successfully displayed the ECG signal in real-time with 10000 ECG raw data were tested and stored in online database with no package loss and package error during the data transmission. The online system able to display real-time ECG signal and BPM on webpage. The real-time BPM is extracted from the real-time ECG raw data. Conclusion: The proposed real-time telecardiology system has success-fully transmitted ECG in real-time with high data integrity. Telecardiology is one of the best solutions to resolve the issue of shortage of healthcare professionals in rural areas and improve the healthcare quality in rural areas.
Introduction:Orang Asli (OA) in Malaysia is considered vulnerable to social, economic and legal abuse. The in-crease in prevalence of Non-Communicable Diseases (NCDs) among OA was reported due to their lifestyle changes. Our study aimed to determine the level of knowledge on NCDs among OA community and its’ association with demographic factors. Methods: A cross-sectional study by face-to-face interview was conducted among consented adult OA in Jelebu, Negeri Sembilan using a validated questionnaire. Their knowledge on risk factors, complica-tions and treatment of cardiovascular diseases, diabetes mellitus, and chronic obstructive pulmonary diseases was asked. Respective thresholds and ranges for poor, moderate and good categories were set as 0-15, 15–21 and 21-28. Mann-Whitney and Kruskal-Wallis test was used to test the association between the demographic profile and knowledge score since the data was not normally distributed. Results: A total of 325 respondents with mean age 39.94 (±13.196) ranged from 18 to 83-year-old participated in this study. Majority were females (71.1%) with pri-mary education (39.1%) and mean household income of RM 615.47 (± 446.79). Their mean knowledge score was 12.82 (±9.671). Majority of them had poor knowledge (51.7%). The respondents with higher education background had significantly better knowledge score compared to lower education background (p
Introduction: Methadone Maintenance Treatment (MMT) is the commonly used intervention for opioid dependents among Malays in FELDA settlements. However, relapse is common. Since majority of Malays are Muslims, Islamic Rehabilitation Intervention Module (ISRIM) using Health Belief Model (HBM) can be implemented as an intervention for reduction of relapse among opioid dependents in FELDA community. The objective of this study were to develop, implement and evaluate the effectiveness of ISRIM in the reduction of relapse among opioids dependent Malay males in FELDA communities in Jengka, Pahang. Methods: A single blind, cluster randomized controlled trial utilizing simple randomization was conducted, involving 10 MMT clinics. Intervention group received ISRIM for one session per week for four consecutive weeks, while control group were put on wait-list. Outcome was relapse, measured monthly for 6 months follow-up by the positive urine for drugs rapid test. Generalized Estimating Equations (GEE) was used as the main effectiveness analysis. Intention-to-treat (ITT), per protocol (PP) analysis, interaction terms, construct terms and key assumption terms were utilized. Results: Individual participation rate was 88.3%. All group comparisons at baseline were not significant (p>0.05). Cumulative relapse after 6-months follow-up for intervention and control group was 13.8% and 31.2%. There was significant difference in relapse between baseline, post-inter-vention and 6-months follow-up within intervention and control group (Q=29.06 vs 61.39,p
Introduction: Universal HBV and HCV screening among pregnant women is not a current practice in Malaysia. It is aimed to conduct a systematic review on available evidences in an effort to strengthen the national hepatitis screen-ing programs. Methods: Systematic search was performed from databases; Medline, Cochrane, PubMed and IN-AHTA. Relevant studies according to inclusion/exclusion criteria were critically appraised and evidence graded. Re-sults: From 782 titles identified, two systematic reviews, two retrospective cohort studies, two cross-sectional studies, one cost-utility analysis and one cost-effectiveness analysis were included. Universal antenatal HBV screening was associated with almost complete vaccination coverage for newborns. Replacing targeted screening with universal HBV screening was associated with increased identification of newborns indicated for HBV-immunization from 50% to 96%. Universal antenatal HBV screening had incremental cost-effectiveness ratio (ICER)s ranged from €2,032 to €26,181 per life year (LY) gained. As for HCV, targeted antenatal screening was associated with low HCV prevalence. Universal screening did not detect significantly more women with HCV infection than did targeted screening. One cost-effectiveness analysis found that universal antenatal HCV screening had ICER of €52,473 per LY gained and one cost-utility analysis reported ICER of £9,139 per QALY gained. Conclusion: Based on the above review, universal HBV screening in pregnant women is effective in increasing vaccination coverage for newborns. However, the ICERs had wide range. Therefore, local economic evaluation is needed to estimate cost implications before considering addition into national screening program. While for HCV, both universal and targeted screening in pregnant women had low detection rate thus high-risk approach screening is appropriate in Malaysia.
Introduction: Evidently, stigma has potentially prompted the negative outcome in Tuberculosis (TB) control through delayed diagnosis and poor adherence to treatment. Amidst accelerating treatment interruption in Selangor, little attention is paid to the quantitative assessment of stigma, thus warrant further characterisation of TB stigma in ur-ban districts, Selangor. This study aimed to determine the predictors of internalised stigma among newly diagnosed PTB smear positive in urban districts, Selangor. Methods: A multi-centric longitudinal study recruited 345 newly diagnosed PTB smear positive patients who started TB treatment from November 2018 until June 2019. Baseline assessments utilised pre-tested self-administered questionnaire and standardised data collection form. Using IBM SPSS version 25.0, multiple linear regression was computed to determine the predictors. Results: The response rate was 84.7% with most of respondents were married and attained educational level up to secondary school. Other than low mean score of social support [mean (SD)=33.39(5.86)], the prominent findings were lacking knowledge of anti-TB side effect and wrongly perceived damaging effect of anti-TB drug to internal organ. The mean internalised stigma score was 24.88 (SD=4.70), which predicted by age, educational level (no formal education), employment status (retiree), alternative medicine practice, baseline symptoms score, perceived barrier, and social support, with entire group of variables significantly predicted TB stigma (F [9, 331] =21.476, p
Introduction: Overweight and obesity among adults, especially young adults have been increasing for the past 20 years and is an emerging public health concern all over the world, including Malaysia. This study aims to explore the determinants of overweight and obesity among undergraduate students residing in Universiti Putra Malaysia. Methods: A cross-sectional study using random sampling was conducted in three residential colleges. Independent variables include socio-demographic factors, knowledge on physical activity and dietary intake, lifestyle (physical activity, dietary intake, sleep duration and quality and smoking status) and stress. Data was collected using a vali-dated and reliable self-administered questionnaire and anthropometric measurement (weight and height were mea-sured to determine body mass index). IBM Statistical Package for Social Science (SPSS) version 23 was used for data analysis. Multiple logistic regression was employed to find the determinants of overweight and obesity among the respondents. Significant level was set at less than 0.05. Results: A total of 494 respondents participated with 98.8% response rate. Overweight and obesity prevalence among the respondents was 38.1% with 22.9% and 15.9% of the respondents were overweight and obese respectively. The significant associated factors were age group of 24 years and above (AOR=2.671, p=0.04), male (AOR=1.818, p=0.04), Malay ethnicity (AOR=5.34, p=0.008) and Indian ethnicity (AOR=7.155, p = 0.018). Conclusion: Overweight and obesity prevalence among undergraduate students were more than one third. Programmes and policies should be directed to these high-risk groups as identified in this study.
Introduction: Secondhand tobacco smoke is a known carcinogen and has shown positive association with smok-ing status, susceptibility and cessation. Smoke free environment policy seem to reduce this exposure and influence intention to quit and frequency of quit attempts. Despite having a smoke free policy, smokers are still exposed to second hand smoke and this might influence their smoking behaviour and cessation. The objective of this study was to examine the association between environmental tobacco smoke exposures with intention to quit smoking among young adults in college with smoke free policy. Methods: Data were drawn from a cluster based randomised controlled trial in 10 government colleges in Selangor. Baseline characteristics of 160 college smokers were mea-sured using adapted questionnaire. Intention to quit was measured using Transtheoretical Model and environmental influence of tobacco smoke exposure. Results: Majority of the smokers were male (99.4%), single (100%), of Malay ethnicity (94.4%) and Muslim (95.6%). Most of them are in pre-contemplation stage where they do not have any intention to quit (65.6%). On environmental influence, at work or college environmental exposure, majority were exposed between 1 to 2 hours (36.9%) and 3 to 8 hours (40.6%). On exposure at home or hostel, majority were exposed between 1 to 4 hours (44.4%) and 5 to 14 hours (21.9%). In terms of friend’s exposures, majority have most of their friends smoking (68.1%). We found no statistically significant association between environmental influence and intention to quit smoking. Conclusion: Although we found no relationship, future research should examine the pathway between environmental influence and smoking behaviour.
Introduction: The need for client feedback in assessing healthcare services is widely recognized. However, little is known about the satisfaction of adolescent clients utilising healthcare services in Malaysia. To the best of our knowl-edge, there is no validated instrument to measure the satisfaction of adolescent clients attending health clinics in Malaysia. The objective of this study was to determine the reliability of the Malay Version of the Ministry of Health’s Adolescent Client Satisfaction Questionnaire among adolescents attending health clinics in North-eastern Malaysia. Methods: A cross-sectional study was conducted in January 2019 among adolescents aged ten to nineteen years old that attended four designated health clinics in the Kelantan state of Malaysia. The test for Cronbach’s alpha was per-formed to determine the internal consistency reliability. Results: There were a total of 85 adolescent clients involved in this study. The mean age of the respondents was 15.6 years old. Majority of respondents were female, Malay, students and attained secondary level of education. The internal consistency reliability was good as the Cronbach’s alpha of the domain was 0.854. The corrected item-total correlation for the domain was acceptable as it was 0.4 and above. Conclusion: The Malay Version of the Ministry of Health’s Adolescent Client Satisfaction Questionnaire showed excellent internal consistency reliability. Therefore, it may be recommended to be used as a tool to measure the satisfaction level among adolescents attending health clinics in Malaysia.
Introduction: Undernutrition among under-five children is a very common issue in Malaysia, especially among the Orang Asli population. Therefore, identifying the prevalence and factors associated with undernutrition will assist in tackling the issue of undernutrition and reducing the morbidity and mortality rate associated with it. Methods: A total of 47 conveniently selected Orang Asli children aged 6 to 59 months from Kampung Paya Bungor, Gambang, Kuantan, Pahang participated in this cross-sectional study. A face-to-face interview was carried out by using the validated Questionnaire for the Study of Malnutrition in Rural Malaysia 2009. The weight and height of the children were measured and plotted on the growth chart. All the data were analyzed using IBM SPSS Statistics Version 24.0. Descriptive statistics was used to describe the background characteristics of the respondents and univariate analyses were used to identify suitable factors to be included in multivariate analysis. Binary logistic regression was done to determine independent factors associated with undernutrition. Results: The overall prevalence of undernutrition was 55.3%. The prevalence of underweight, stunting and wasting was 34.0%, 34.0% and 14.9% respectively. This research also revealed that gender (p=0.042) and family size (p=0.024) was shown to have a statistically significant association with undernutrition. However, there were no significant associations between undernutrition with other factors. Conclusion: The prevalence of undernutrition among under-five Orang Asli children was a concern. It was found that the factors associated with undernutrition were female children and children from small families. Prompt interventions aimed at the Orang Asli community should be done to overcome these problems.
Introduction: Hepatitis C virus (HCV) infection is a major leading cause of morbidity and mortality worldwide. Per-sistent HCV infection is associated with major liver complications such as liver failure, liver cancer and fatality. It is estimated that 5.6 million people who inject drugs (PWID) were chronically infected with HCV globally, meanwhile, 59% of those diagnosed as HCV in Malaysia were PWID. The objective of this study was to determine the social determinants of HCV infection among PWID in Negeri Sembilan, Malaysia. Methods: A cross-sectional study was conducted based on stratified proportionate to size sampling among registered Methadone Maintenance Therapy (MMT) clients with PWID attending health clinics in Negeri Sembilan from February 2018 to July 2018. All eligi-ble respondents were randomly selected. Data were collected using an interviewer-guided questionnaire and was analysed using Statistical Package of IBM SPSS version 23. Independent T test and Chi-square test (χ2) were used to determine the associations between the variables. Results: Majority of the respondents in this study were between 20 and 63 years of age, Malay (90.1%) and infected with HCV (89%). There was a significant association between the respondent’s age (p
Introduction: The Ministry of Health Malaysia introduced the national best practices for adolescent-friendly health services in 2018 and it served as an assessment tool in the accreditation of adolescent-friendly clinic status. This study was conducted in Kelantan with the objective to determine the proportion of adolescent-friendly clinics and its determinants and perceptions of healthcare providers regarding the facilitating factors in providing adoles-cent-friendly health services. Methods: The research design was sequential explanatory mixed method. State wide clinics assessment was done to estimate the proportion of adolescent-friendly clinics and to determine the factors associated with adolescent-friendly health services provision. Perceptions of healthcare providers on the facilitating factors for adolescent-friendly health services were explored through in-depth interviews. Descriptive statistics and linear regression analysis were performed for quantitative data, and thematic analysis for qualitative data. Results: Out of 85 health clinics, 30 (35.3%) clinics were accredited as adolescent-friendly. Availability of trained health-care providers in adolescent health modules, private room for adolescent counselling, dedicated team in charge of adolescent programme and adolescent health promotional activities were the statistically significant determinants for adolescent-friendly health services (p
Introduction: Psychological insulin resistance is the reluctance of diabetes patients or physicians to initiate or in-tensify insulin therapy. The insulin usage among Malaysian type 2 diabetes mellitus (T2DM) patients is low, only 21.4% of audited T2DM patients were on insulin therapy despite 76.2% of the audited T2DM patients had poorly controlled diabetes with HbA1c ≥ 6.5% in year 2012. This study aims to identify the predictors of psychological insulin resistance (PIR) among insulin naïve T2DM patients. Methods: A cross-sectional study using interviewer assisted questionnaires was conducted among adult insulin naïve T2DM patients in government health clinics at a district of Penang, Malaysia. Insulin Treatment Appraisal Scale (ITAS) was used to assess the dependent variable (PIR) and validated self-developed questionnaires were used for assess the independent variables (socio-demographic characteristics, diabetes profile, and individual factors). Multiple linear regression analysis was performed to identify the predictors of PIR. Results: As high as 72.7% out of 385 participants were reluctant to initiate insulin therapy. Emotional factors (fears), perceived personal failure and perceived severity significantly predicted higher PIR whereas perceived benefit and self-efficacy significantly predicted lower PIR. Total 49.8% variability of PIR was explained by the entire individual predictors (R2=49.8%, p = 0.001). Emotional factor was the strongest predictor. Conclusion: This study revealed a high level of PIR among Malaysian T2DM patients. It is vital to tackle the predictors that predict high PIR and strengthen the predictors that lead to low PIR in our health education and health intervention programs.
Introduction: Family planning practice is important among the high-risk mothers. Thus, the knowledge, attitude and practice of family planning among health care workers are very important in influencing the use of contraception among them. The objective of this study was to determine level of knowledge, attitudes and practices related to contraception among doctors and nurses in Petaling District, Selangor, Malaysia. Methods: A cross-sectional study involving 300 doctors and nurses working in the Maternal and Child Health Unit from six large public health clin-ics in Petaling district was conducted in May 2019. A self-administered questionnaire was used for data collection. Results: A total of 109 doctors and 149 nurses participated in this study. The response rate was 86%. The median duration of service in KKM and working in MCH were 9 years (IQR 6.0) and 3 years (IQR 6.0) respectively. Majority (74%) had attended CME on family planning. The mean score of knowledge was 9.0 (out of 13) (SD 1.899). In terms of attitude, 51.6% would often suggest family planning to relatives or friends. Three common perceived barriers for effective counselling on family planning were too many patients (94.5%), time constraint (91.7%) and inadequate knowledge on contraception (60.4%). Common preferred methods of contraception among users were hormonal method (33.1%), followed by barrier (condom) method (29.5%). Medical officers had better knowledge score as compared to nurses (p