Information on unmet health care needs reveal problems that are related to unavailability and inaccessibility of services. The study objectives were to determine the prevalence, and the reasons for unmet service needs among children with disabilities in the state of Penang, Malaysia. Caregivers of children with disabilities aged 0 to 12 years registered with the Penang Social Welfare Department in 2012 answered a self-administered mailed questionnaire. A total of 305 questionnaires were available for analysis (response rate 37.9%). Services that were very much needed and yet highly unmet were dental services (49.6% needed, 59.9% unmet), dietary advice (30.9% needed, 63.3% unmet), speech therapy (56.9% needed, 56.8% unmet), psychology services (25.5% needed, 63.3% unmet), and communication aids (33.0% needed, 79.2% unmet). Access problems were mainly due to logistic issues and caregivers not knowing where to obtain services. Findings from this study can be used to inform strategies for service delivery and advocacy for children with disabilities in Penang, Malaysia.
This study examines the rate of decline of estimated glomerular filtration rate (eGFR) over a 10-year period and the associated risk factors in type 2 diabetes mellitus (T2DM) patients. Medical records of T2DM patients were randomly selected. The rate of fall in eGFR (simplified modification of diet in renal disease formula) was used as a measure of decline. Univariate and multivariate analysis were performed to determine the factors associated with decline of kidney function. A total of 504 patients were selected. Mean age was 57.8 ± 9 years; 65.3% were females. The mean decline rate of eGFR was 0.89 ± 2.16 mL/min/1.73 m(2)/y. Baseline proteinuria, glycosylated hemoglobin level, duration of T2DM, and Malay race were associated with faster decline in eGFR. The expected greater deterioration in kidney function in this cohort was not seen. Treatment of proteinuria and glycemia should be optimized early to retard the decline in kidney function in patients with T2DM.
Study site: Primary care clinics, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
This study aimed to assess the prevalence and factors associated with bullying victimization from a nationwide school-based survey among 27 458 students aged 13 to 17 years. The overall prevalence of having been bullied in the past 30 days was 16.2%; this decreased with age. Multivariate logistic regression analysis revealed that factors most strongly associated with bullying victimization were exposure to physical attacks (adjusted odds ratio [aOR] = 2.46, 95% confidence interval [CI] = 2.17-2.79), illicit drug use (aOR = 2.44, 95% CI = 1.78-3.34), involvement in physical fights (aOR = 1.97, 95% CI = 1.74-2.23), being younger than 14 years (aOR =1.95, 95% CI = 1.59-2.38), and having ever attempted suicide (aOR = 1.83, 95% CI = 1.51-2.21). Other significantly associated factors include loneliness, truancy, making suicidal plans, and symptoms of depression, anxiety, and stress. Exposure to bullying victimization can result in negative lifelong sequelae and important associated factors should be considered in planning effective school-based anti-bullying interventions.
Active aging is important for promoting the health, wellbeing, and participation of older adults. This study investigated the association between active aging and mortality risk among 2 230 respondents aged 60 and older. Principal component analysis extracted a five-factor structure from 15 indicators of active aging. The mean active aging score was 55.57 and the median was 53.33. The Kaplan-Meier curve showed that individuals with active aging scores of 53.33 and above had significantly longer survival than those below the median. Cox regression analysis indicated the significance of active aging in reducing mortality risk by 2.5% after adjusting for sex, marital status, age, ethnicity, chronic diseases, and risk factors. The active aging approach comprising health, economic, and social factors is crucial in improving survival among older adults. Hence, policies and programs that promote active aging should be encouraged to enhance the health and wellbeing of older adults and their engagement in society.
Alkylphenols and most pesticides, especially organochlorine pesticides are endocrine-disrupting chemicals and they usually mimic the female hormone, estrogen. Using these chemicals in our environment would eventually lead us to consume them somehow in the food web. Several rivers in the State of Selangor, Malaysia were selected to monitor the level of alkylphenols and pesticides contamination for several months. The compounds were extracted from the water samples using liquid-liquid extraction method with dichloromethane and ethyl acetate as the extracting solvents. The alkylphenols and pesticides were analyzed by selected ion monitoring (SIM) mode using the quadrapole detector in Shimadzu QP-5000 gas chromatograph-mass spectrometer (GCMS). Recovery of most alkylphenols and pesticides were in the range of 50% to 120%. Trace amounts of the compounds were detected in the river water samples, mainly in the range of parts per trillion. This technique of monitoring the levels of endocrine-disruptors in river water is consistent and cost effective.
Bisphenol A is the monomer used in the manufacture of polycarbonate. Bisphenol A is also known to mimic the female hormone estrogen. In this study, the possibility of the leaching of bisphenol A from polycarbonate babies' bottles and feeding teats was investigated. Bisphenol A was extracted from water samples exposed to the bottles and teats using liquid-liquid extraction. Bisphenol A was analysed by gas chromatograph-mass spectrometer with quadrapole detector in selected ion monitoring mode. Mean leaching of bisphenol A from 100 used babies' bottles when filled with water at 25 degrees C and 80 degrees C were 0.71 +/- 1.65 ng/cm2 (mean +/- standard deviation) and 3.37 +/- 5.68 ng/cm2 respectively. Mean leaching of bisphenol A from 30 new babies' bottles when filled with water at 25 degrees C and 80 degrees C were 0.03 +/- 0.02 ng/cm2 and 0.18 degrees 0.30 ng/cm2 respectively. Bisphenol A was observed to have leached from babies' feeding teats into 37 degrees C water ranged from non-detectable to 22.86 ng/g. The technique employed in this study is fast, reliable and economical.
The purpose of this study was to examine the sociodemographic and health-lifestyle factors that affect the likelihood of obesity among Malaysians. Data were obtained from the Malaysian Non-Communicable Disease Surveillance-1. The cross-sectional population-based survey consisted of 2447 observations, with an obesity prevalence rate of 17.2%. Based on logit regression analysis, the results suggest that obesity risks in Malaysia are affected by gender, education level, family history, health conditions, smoking status, and ethnic backgrounds. Specifically, Malaysians more likely to be obese are females (5.3%), lower educated (0.9%), those with history of family illnesses (4.8%), and nonsmokers (6.4%). However, Chinese (9.3%) and other (5.5%) ethnic groups are less likely to be obese when compared with Malays. Based on these results, several policy implications are discussed vis-à-vis obesity risks in Malaysia.
Study name: Malaysia Non-Communicable Disease Surveillance-1 (MyNCDS-1) survey
Obesity is an emerging public health threat in the elderly population in developing countries. Hence, the Third National Health and Morbidity Survey has assessed 4746 individuals aged 60 years and older recruited through a household survey to determine the prevalence of adiposity using body mass index and waist circumference. The national's prevalence of overweight and obesity in men was 29.2% (95% confidence interval [CI] = 27.2-31.3) and 7.4% (95% CI = 6.4-8.6), respectively. However, the prevalence decreased with age. The figures in women were 30.3% (95% CI = 28.5-32.1) and 13.8% (95% CI = 12.5-15.2), respectively. The prevalence of abdominal obesity was 21.4% (95%CI = 20.2-22.6), with 7.7% (95% CI = 6.7-9.0) in men and 33.4% (95% CI = 31.4-35.3) in women. Predictors of adiposity include the following: Malay and Indian ethnicity, higher education level, higher household income, from urban area, and being married. In conclusion, adiposity affects about one third of the Malaysian elderly population, especially those of the younger age group, women, and those with higher socioeconomic status.
Study name: National Health and Morbidity Survey (NHMS-2006)
Leptospirosis is an important zoonotic disease globally and is endemic in Malaysia. A study was conducted in the Rejang basin of Sarawak from June 2011 to May 2013 to determine the seroprevalence of leptospirosis among the communities and dominant infecting Leptospira serovars. A total of 508 human sera were analyzed using ELISA and the microscopic agglutination test (MAT). The seroprevalence of leptospirosis in the study area was 37.4%, with the highest prevalence in Kapit division. More women were positive for leptospirosis (59.5%), and the mean age of seropositive individuals was 42.2 (SD = 18.7) years. Antibody titers between 1:50 and 1:1600 were reported, and serovars djasiman (22.1%), shermani (13.2%), and pomona (7.9%) predominated, with varied distribution between geographical locations. This study highlighted the endemicity and diversity of existing Leptospira serovars within the community. This information should be communicated to local health personnel and communities at risk, and rapid diagnostic capability should be made available to local health facilities.
In the wake of the east Asian economic crisis, the health budget for the public sector in Malaysia was cut by 12%. The Ministry of Health responded swiftly with a series of broad-based and specific strategies. There was a careful examination of the operating expenditure and where possible measures were taken to minimise the effects of the budget constraints at the service interface. The MOH reprioritised the development of health projects. Important projects such as rural health projects and training facilities, and committed projects, were continued. In public health, population-based preventive and promotive activities were expected to experience some form of curtailment. There is a need to refocus priorities, maximise the utilisation of resources, and increase productivity at all levels and in all sectors, both public and private, in order to minimise the impact of the economic downturn on health.
The Work-Related Quality of Life Scale-2 (WRQLS-2) has been used to measure quality of working life (QOWL) in the United Kingdom. In this study, the scale was translated and normalized into Malay. The scale was translated using the back-translation method, pretesting, and pilot testing. It was conducted among health care and office workers. It was tested in 3 stages; confirmatory factor analysis at stages 1 and 3 and exploratory factor analysis at stage 2. The Malaysian WRQLS-2 had 5 factors: "General Well-Being," "Job and Career Satisfaction," "Employee Engagement," "Home-Work Interface," and "Stress at Work." The scale showed good convergent and construct validity and also reliability. Perception of good QOWL may differ because of cultural influences and varying work environments. The validated Malaysian WRQLS-2 can be used to determine the QOWL of Malaysian office and health care workers.
The objective of this study was to assess the perceptions of Malaysian HIV-positive subjects towards the attitude of dental personnel in providing oral care to them. The study design was cross-sectional with the sampling frame comprising of 27 Government Drug Rehabilitation Centres throughout Malaysia. A convenience sample was then taken from 20 centres with the highest enrolment of HIV-positive subjects. A self-administered questionnaire was used to elicit information on the perception of HIV-positive subjects towards the attitude of dental personnel in providing oral care to the patient with HIV-positive. The study sample consisted of 509 HIV-positive individuals with a mean age of 31.3+/-12.9 years old. Of these, only 15.1% attended a dental clinic after confirmation of HIV-positive status. The study demonstrated that 67.5% of the HIV-positive subjects disclosed their status voluntarily to the dentists and majority of the dentists (76.9%) did not show any negative reaction on knowing their HIV positive status. There was also no difference in the attitude of auxiliary staff toward the above disclosure. In conclusion, the study showed that oral health care personnel are more receptive to the HIV-positive subjects receiving dental care and treatment.
The objective of the study is to identify user's perception of key quality aspects of the hospital and its influence on willingness to pay. The study was conducted in 2001 in Dhading District Hospital, Nepal. This was a descriptive, cross-sectional study design using quantitative and qualitative methods: questionnaire exit interview and focus group discussions with inpatients and outpatients, focus group discussion with service providers, and key informant interviews. The research identified attitude, technical and interpersonal skills of health personnel, availability of drugs and services as important quality aspects to be improved. Users were motivated to use this hospital and were ready to pay if they received proper treatment from skilled and communicative staff. This study highlights the importance of identifying the quality factors important to service users as a first step in improving quality. For the users within this study, this meant improving attitude, interpersonal skills, and technical skills of service personnel.
This study aimed to assess the reliability and concurrent validity of the Bahasa Melayu version of the Global Physical Activity Questionnaire (GPAQ-M) by comparing it with the short form of the International Physical Activity Questionnaire (IPAQ-S) and objectively measuring physical activity using a Yamax DigiWalker (Yamax, Tokyo, Japan) pedometer. A total of 100 adults aged between 20 and 58 years from Kelantan in Malaysia voluntarily participated in this study. The Wilcoxon signed-rank analysis showed no significant differences in 2-week test-retest scores for total metabolic equivalent∙minutes∙per week and 4 domains of the GPAQ-M. There was a low but significant relationship between time spent on total physical activity measured by the GPAQ-M and average steps per day recorded using the pedometer (r s = .265, P = .013). Significant correlations were also found between GPAQ-M and the IPAQ-S for varying levels of intensity during physical activities (r s = .309-.466, P < .01).
Extreme events, both natural and anthropogenic, increasingly affect cities in terms of economic losses and impacts on health and well-being. Most people now live in cities, and Asian cities, in particular, are experiencing growth on unprecedented scales. Meanwhile, the economic and health consequences of climate-related events are worsening, a trend projected to continue. Urbanization, climate change and other geophysical and social forces interact with urban systems in ways that give rise to complex and in many cases synergistic relationships. Such effects may be mediated by location, scale, density, or connectivity, and also involve feedbacks and cascading outcomes. In this context, traditional, siloed, reductionist approaches to understanding and dealing with extreme events are unlikely to be adequate. Systems approaches to mitigation, management and response for extreme events offer a more effective way forward. Well-managed urban systems can decrease risk and increase resilience in the face of such events.
Although current trends indicate that the rate of cigarette smoking tends to be low among women in the Western Pacific Region (<10%), recent epidemiologic data from South Asia (India, Bangladesh) and Southeast Asia (Cambodia, Vietnam, Indonesia, Malaysia) identify that a large proportion of women of reproductive age and older chew tobacco--often as part of a betel quid mixture that includes other potentially harmful ingredients (eg, areca nut). Our findings from currently pregnant women identified during a nationwide survey of adult tobacco use in Cambodia indicate that 13.0% (95% confidence interval [CI] = 8% to 17%) were current users of smoked or smokeless (in the form of a betel quid) tobacco. Most pregnant women who used tobacco indicated that their habit was either initiated (29.1%; 95% CI = 16.3-46.3) or increased (33.7%; 95% CI = 18.3-53.5) during pregnancy. Pregnancy-related symptoms such as morning sickness were reported as the reason for more than half (54.9%; 95% CI = 34.8-73.4) of the currently pregnant users to have started a tobacco habit during their lifetime. Among those pregnant women who did not use tobacco, we found strong associations (odds ratios from 2 to 14) with beliefs about the harmful effects of tobacco on adult health, faith-based beliefs in addictive substances, and beliefs that influential members of the community, health professionals, and children should not use tobacco. Our findings indicate that tobacco cessation and prevention programs in Cambodia should specifically target pregnant and reproductive-age women.
The anthropogenic disturbance of pristine natural areas caused by land use and transformation from one use to another as a result of increased pressure from demographic changes and the economics of this shrinking resource can result in adverse health hazards for the community. This paper appraises the consequential impact of land use dynamics, its assessment and measures required to assuage this overlooked public health issue. The anthropogenic impact from land use in Malaysia from the industrial sector alone points toward the potential capacity to cause adverse health hazards. A deficiency in assessing this impact due to limited information has resulted in the inability to establish the extent of this problem. Several necessary measures to establish the extent of the problem involving ways to characterise contaminated land and the evolution of a strategy to resolve it are discussed.
The aim of our study was to develop and validate the return and disposal of unused medications (ReDiUM), as there are currently no validated tools available (worldwide) to assess this. The ReDiUM was developed by an expert panel. It was then administered to community-dwelling adults, who could understand English, at baseline and 2 weeks later. A total of 338/354 participants agreed to participate (response rate = 95.4%). Flesch reading ease was 60. The overall Cronbach's α was 0.703 (range = 0.609-0.762). At test-retest, κ values ranged from 0.244 to 0.523. Median total knowledge score was 60% (interquartile range = 40% to 70%). The majority of participants (94.4%) knew that improper drug disposal has harmful effects on the environment. However, their knowledge was low (11.2%) regarding the disposal of pressurized metered-dose inhalers in the garbage. The ReDiUM was found to be a valid and reliable instrument to assess the knowledge, attitude, and practice on the ReDiUM in Malaysia.
Dietary supplements use is relatively widespread in some countries but knowledge of supplements consumption in Malaysia is limited, more so among adolescents. This study aimed to investigate the determinants of dietary supplements use among Malaysian adolescents using multiple logistic regressions analysis. Data from the Malaysia School-based Nutrition Survey 2012 based on a 2-stage stratified sampling was used. The prevalence of vitamin/mineral supplements and food supplements intake among adolescents was 54.1% and 40.2%, respectively. Usage was significantly higher among younger adolescents and among boys. Dietary supplements were also taken mostly by those who thought they were underweight. The most common vitamin/mineral supplements and food supplements consumed were vitamin C and bee products. The main reason for taking supplements was parents' instruction. These findings can be useful for developing health communications on supplement use targeted to adolescents and their parents.