Displaying publications 1721 - 1740 of 1808 in total

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  1. Spatiotemporal spread of chikungunya virus in Sarawak, Malaysia
    Dass S, Ngui R, Gill BS, Chan YF, Wan Sulaiman WY, Lim YAL, et al.
    Trans R Soc Trop Med Hyg, 2021 08 02;115(8):922-931.
    PMID: 33783526 DOI: 10.1093/trstmh/trab053
    BACKGROUND: We studied the spatiotemporal spread of a chikungunya virus (CHIKV) outbreak in Sarawak state, Malaysia, during 2009-2010.

    METHODS: The residential addresses of 3054 notified CHIKV cases in 2009-2010 were georeferenced onto a base map of Sarawak with spatial data of rivers and roads using R software. The spatiotemporal spread was determined and clusters were detected using the space-time scan statistic with SaTScan.

    RESULTS: Overall CHIKV incidence was 127 per 100 000 population (range, 0-1125 within districts). The average speed of spread was 70.1 km/wk, with a peak of 228 cases/wk and the basic reproduction number (R0) was 3.1. The highest age-specific incidence rate was 228 per 100 000 in adults aged 50-54 y. Significantly more cases (79.4%) lived in rural areas compared with the general population (46.2%, p<0.0001). Five CHIKV clusters were detected. Likely spread was mostly by road, but a fifth of rural cases were spread by river travel.

    CONCLUSIONS: CHIKV initially spread quickly in rural areas mainly via roads, with lesser involvement of urban areas. Delayed spread occurred via river networks to more isolated areas in the rural interior. Understanding the patterns and timings of arboviral outbreak spread may allow targeted vector control measures at key transport hubs or in large transport vehicles.

  2. Fulltext Effect of Pharmacist-Led Intervention on Progression of Diabetic Complications at Two Tertiary Care Hospitals of Malaysia
    Iqbal MZ, Khan AH, Sulaiman SAS, Ibrahim A, Azmi NSBY, Iqbal MS, et al.
    J Pharm Bioallied Sci, 2021 05 26;13(2):193-198.
    PMID: 34349479 DOI: 10.4103/jpbs.JPBS_488_20
    Background and Objective: Diabetes mellitus is a chronic disease which can lead to different complications in patients if not treated properly. An appropriate intervention from health care providers is needed to stop and decrease the progression of diabetic complication in diabetic patients. This study aimed to measure the effect of pharmacist intervention on improvement in sign and symptoms and progression of diabetic complications in diabetic patients.

    Methodology: Diabetic patients were randomly selected and divided into two groups from two tertiary care hospitals. Control group contained those 200 patients who were receiving usual treatment from hospitals. In contrast, the intervention group included those 200 patients who were receiving conventional treatment from hospitals together with separate counselling sessions with pharmacists from Diabetes Medication Therapy Adherence Clinic departments. The study continued for 1 year and two follow-up visits for both groups. A prevalidated data collection form was used to measure the improvement in sign and symptoms and progression of diabetic complication in diabetic patients. Statistical Package for the Social Sciences (SPSS) version 24 was used to analyze the data.

    Results: The average hemoglobin A1c (HbA1c) values decreased up to 1.43% in the control group and 2.82% in the intervention group. The intervention group showed significant improvement in HbA1c between groups (P < 0.05). The results of univariate and multivariate regression analysis showed that a statistically significant (P < 0.001) improvement was observed in all the predictors of diabetic complications among in the intervention group when compared with the control group.

    Conclusion: Statistically significant reduction in the sign and symptoms of diabetic complications was observed in the intervention group at the end of 1 year. The progression of diabetic neuropathy was significantly reduced in the pharmacist intervention group.

  3. Fulltext Contrasting evolutionary patterns between two haplogroups of Haematobia exigua (Diptera: Muscidae) from the mainland and islands of Southeast Asia
    Low VL, Tan TK, Prakash BK, Vinnie-Siow WY, Tay ST, Masmeatathip R, et al.
    Sci Rep, 2017 07 19;7(1):5871.
    PMID: 28724923 DOI: 10.1038/s41598-017-05921-w
    Uncovering the hidden diversity and evolutionary history of arthropods of medico-veterinary importance could have significant implications for vector-borne disease control and epidemiological intervention. The buffalo fly Haematobia exigua is an obligate bloodsucking ectoparasite of livestock. As an initial step towards understanding its population structures and biogeographic patterns, we characterized partial cytochrome c oxidase subunit I (COI) and cytochrome b (Cytb) sequences of H. exigua from three distinct geographic regions in Southeast Asia. We detected two distinct mitochondrial haplogroups of H. exigua in our surveyed geographic regions. Haplogroup I is widespread in the Southeast Asian mainland whereas haplogroup II is generally restricted to the type population Java Island. Both haplogroups were detected co-occurring on Borneo Island. Additionally, both haplogroups have undergone contrasting evolutionary histories, with haplogroup I exhibited a high level of mitochondrial diversity indicating a population expansion during the Pleistocene era dating back to 98,000 years ago. However, haplogroup II presented a low level of mitochondrial diversity which argues against the hypothesis of recent demographic expansion.
  4. Fulltext Spatial distribution of Plasmodium knowlesi cases and their vectors in Johor, Malaysia: in light of human malaria elimination
    Pramasivan S, Ngui R, Jeyaprakasam NK, Liew JWK, Low VL, Mohamed Hassan N, et al.
    Malar J, 2021 Oct 29;20(1):426.
    PMID: 34715864 DOI: 10.1186/s12936-021-03963-0
    BACKGROUND: Plasmodium knowlesi, a simian malaria parasite infection, increases as Plasmodium falciparum and Plasmodium vivax infections decrease in Johor, Malaysia. Therefore, this study aimed to identify the distribution of vectors involved in knowlesi malaria transmission in Johor. This finding is vital in estimating hotspot areas for targeted control strategies.

    METHODS: Anopheles mosquitoes were collected from the location where P. knowlesi cases were reported. Cases of knowlesi malaria from 2011 to 2019 in Johor were analyzed. Internal transcribed spacers 2 (ITS2) and cytochrome c oxidase subunit I (COI) genes were used to identify the Leucosphyrus Group of Anopheles mosquitoes. In addition, spatial analysis was carried out on the knowlesi cases and vectors in Johor.

    RESULTS: One hundred and eighty-nine cases of P. knowlesi were reported in Johor over 10 years. Young adults between the ages of 20-39 years comprised 65% of the cases. Most infected individuals were involved in agriculture and army-related occupations (22% and 32%, respectively). Four hundred and eighteen Leucosphyrus Group Anopheles mosquitoes were captured during the study. Anopheles introlatus was the predominant species, followed by Anopheles latens. Spatial analysis by Kriging interpolation found that hotspot regions of P. knowlesi overlapped or were close to the areas where An. introlatus and An. latens were found. A significantly high number of vectors and P. knowlesi cases were found near the road within 0-5 km.

    CONCLUSIONS: This study describes the distribution of P. knowlesi cases and Anopheles species in malaria-endemic transmission areas in Johor. Geospatial analysis is a valuable tool for studying the relationship between vectors and P. knowlesi cases. This study further supports that the Leucosphyrus Group of mosquitoes might be involved in transmitting knowlesi malaria cases in Johor. These findings may provide initial evidence to prioritize diseases and vector surveillance.

  5. Fulltext Semen characteristics, extension, and cryopreservation of Rusa deer (Rusa timorensis)
    Fitri WN, Wahid H, Rosnina Y, Jesse FFA, Aimi-Sarah ZA, Mohd-Azmi ML, et al.
    Vet World, 2017 Jul;10(7):779-785.
    PMID: 28831222 DOI: 10.14202/vetworld.2017.779-785
    AIM: The objective of this research is to report parameters for breeding soundness evaluation, semen extension, and cryopreservation in Rusa timorensis.

    MATERIALS AND METHODS: Seven healthy stags were chosen for semen collection using an electroejaculator. The collections were performed twice in a breeding season between February and June 2016. Samples were collected between 2 and 3 weeks interval, collected twice for each animal. Semen was evaluated, extended, and cryopreserved using four different extenders; Andromed®, BioXcell®, Triladyl®, and a modified Tris-egg yolk combined with Eurycoma longifolia Jack.

    RESULTS: R. timorensis semen characteristics according to volume (ml), color, sperm concentration (106/ml), general motility (%), progressive motility (%), and % morphology of normal spermatozoa are 0.86±0.18 ml, thin milky to milky, 1194.2±346.1 106/ml, 82.9±2.8%, 76.1±4.8%, and 83.9±4.8%, respectively.

    CONCLUSION: Semen characteristics of R. timorensis collected by electroejaculation is good allowing for cryopreservation and future artificial insemination work. The most suitable extender for Rusa deer semen is Andromed®.

  6. Fulltext Fine-scale population structure of Malays in Peninsular Malaysia and Singapore and implications for association studies
    Hoh BP, Deng L, Julia-Ashazila MJ, Zuraihan Z, Nur-Hasnah M, Nur-Shafawati AR, et al.
    Hum Genomics, 2015 Jul 22;9:16.
    PMID: 26194999 DOI: 10.1186/s40246-015-0039-x
    Fine scale population structure of Malays - the major population in Malaysia, has not been well studied. This may have important implications for both evolutionary and medical studies. Here, we investigated the population sub-structure of Malay involving 431 samples collected from all states from peninsular Malaysia and Singapore. We identified two major clusters of individuals corresponding to the north and south peninsular Malaysia. On an even finer scale, the genetic coordinates of the geographical Malay populations are in correlation with the latitudes (R(2) = 0.3925; P = 0.029). This finding is further supported by the pairwise FST of Malay sub-populations, of which the north and south regions showed the highest differentiation (FST [North-south] = 0.0011). The collective findings therefore suggest that population sub-structure of Malays are more heterogenous than previously expected even within a small geographical region, possibly due to factors like different genetic origins, geographical isolation, could result in spurious association as demonstrated in our analysis. We suggest that cautions should be taken during the stage of study design or interpreting the association signals in disease mapping studies which are expected to be conducted in Malay population in the near future.
  7. Assessment of contaminants in sand production from petroleum wells offshore Sabah
    Shayuti MSM, Zainal S, Ya TMYST, Abdullah MZ, Shahruddin MZ, Othman NH, et al.
    Environ Sci Pollut Res Int, 2023 Feb;30(7):17122-17128.
    PMID: 35469382 DOI: 10.1007/s11356-022-20389-6
    Sand production remains a huge obstacle in many oil and gas fields around the world, but the hazards of contaminants riding on the produced sand are often not emphasised. Improper disposal of the sand could see the toxic leaching into the environment including the food chain, endangering all living organisms. The impending sand production from an oilfield offshore Sabah also suffers from the lack of hazards identification; hence, this study was conducted to assess the contaminant on the produced sand. Sand samples were collected from multiple wells in the area, with the contaminants extracted using n-hexane and subjected to chemical and thermal analyses. FTIR and GC-MS detected traces of harmful pollutants like naphthalene, amine substances, cyclohexanol, and short-chain alkanes. It was discovered that the volatile fraction of the contaminants was able to evaporate at 33 °C, while high energy was needed to remove 100% of the contaminants from the sand. Overall, the produced sand from the oilfield was unsafe and required treatment before it could be dumped or used.
  8. Fulltext Natural Wolbachia infection in field-collected Anopheles and other mosquito species from Malaysia
    Wong ML, Liew JWK, Wong WK, Pramasivan S, Mohamed Hassan N, Wan Sulaiman WY, et al.
    Parasit Vectors, 2020 Aug 12;13(1):414.
    PMID: 32787974 DOI: 10.1186/s13071-020-04277-x
    BACKGROUND: The endosymbiont bacterium Wolbachia is maternally inherited and naturally infects some filarial nematodes and a diverse range of arthropods, including mosquito vectors responsible for disease transmission in humans. Previously, it has been found infecting most mosquito species but absent in Anopheles and Aedes aegypti. However, recently these two mosquito species were found to be naturally infected with Wolbachia. We report here the extent of Wolbachia infections in field-collected mosquitoes from Malaysia based on PCR amplification of the Wolbachia wsp and 16S rRNA genes.

    METHODS: The prevalence of Wolbachia in Culicinae mosquitoes was assessed via PCR with wsp primers. For some of the mosquitoes, in which the wsp primers failed to amplify a product, Wolbachia screening was performed using nested PCR targeting the 16S rRNA gene. Wolbachia sequences were aligned using Geneious 9.1.6 software, analyzed with BLAST, and the most similar sequences were downloaded. Phylogenetic analyses were carried out with MEGA 7.0 software. Graphs were drawn with GraphPad Prism 8.0 software.

    RESULTS: A total of 217 adult mosquitoes representing 26 mosquito species were screened. Of these, infections with Wolbachia were detected in 4 and 15 mosquito species using wsp and 16S rRNA primers, respectively. To our knowledge, this is the first time Wolbachia was detected using 16S rRNA gene amplification, in some Anopheles species (some infected with Plasmodium), Culex sinensis, Culex vishnui, Culex pseudovishnui, Mansonia bonneae and Mansonia annulifera. Phylogenetic analysis based on wsp revealed Wolbachia from most of the mosquitoes belonged to Wolbachia Supergroup B. Based on 16S rRNA phylogenetic analysis, the Wolbachia strain from Anopheles mosquitoes were more closely related to Wolbachia infecting Anopheles from Africa than from Myanmar.

    CONCLUSIONS: Wolbachia was found infecting Anopheles and other important disease vectors such as Mansonia. Since Wolbachia can affect its host by reducing the life span and provide resistance to pathogen infection, several studies have suggested it as a potential innovative tool for vector/vector-borne disease control. Therefore, it is important to carry out further studies on natural Wolbachia infection in vector mosquitoes' populations as well as their long-term effects in new hosts and pathogen suppression.

  9. Fulltext Knowledge, attitude and practice on dengue prevention and dengue seroprevalence in a dengue hotspot in Malaysia: A cross-sectional study
    Selvarajoo S, Liew JWK, Tan W, Lim XY, Refai WF, Zaki RA, et al.
    Sci Rep, 2020 Jun 12;10(1):9534.
    PMID: 32533017 DOI: 10.1038/s41598-020-66212-5
    Dengue has become a global public health problem. Despite reactive efforts by the government in Malaysia, the dengue cases are on the increase. Adequate knowledge, positive attitude and correct practice for dengue control are essential to stamp out the disease. Hence, this study aims to assess the factors associated with dengue knowledge, attitude and practice (KAP), as well as the association with dengue IgM and IgG seropositivity. A community-based cross-sectional study was conducted in a closed, dengue endemic area with multi-storey dwellings . Five hundred individuals (aged 18 years and above) were approached for pre-tested KAP and seroprevalences assessment. The study showed only half of the total participants have good knowledge (50.7%) but they had insufficient knowledge about dengue during pregnancy. 53.2% of people had poor attitude and 50.2% reported poor practice for dengue control. Out of 85 respondents who agreed to participate in the dengue seroprevalence study, 74.1% (n = 63) were positive for dengue IgG and 7.1% (n = 6) were positive for dengue IgM. Among all sociodemographic variable, race is the only independent predicator for all KAP levels (P 
  10. Fulltext Genetic Diversity Assessment of MPOB-Senegal Oil Palm Germplasm Using Microsatellite Markers
    Myint KA, Yaakub Z, Rafii MY, Oladosu Y, Samad MYA, Ramlee SI, et al.
    Biomed Res Int, 2021;2021:6620645.
    PMID: 33997027 DOI: 10.1155/2021/6620645
    Molecular characterization of oil palm germplasm is crucial in utilizing and conserving germplasm with promising traits. This study was conducted to evaluate the genetic diversity structures and relationships among 26 families of MPOB-Senegal oil palm germplasm using thirty-five microsatellite markers. High level of polymorphism (P = 96.26%), number of effective allele (N e = 2.653), observed heterozygosity (H o = 0.584), expected heterozygosity (H e = 0.550), total heterozygosity (H T = 0.666), and rare alleles (54) were observed which indicates that MPOB-Senegal germplasm has a broad genetic variation. Among the SSR markers, sMo00053 and sMg00133 were the most informative markers for discrimination among the MPOB-Senegal oil palm germplasm for having the highest private alleles and the rare alleles. For selection and conservation, oil palm populations with high rare alleles and Nei's gene diversity index should be considered as these populations may possess unique genes for further exploitation.
  11. Fulltext Design, Operation and Optimization of Constructed Wetland for Removal of Pollutant
    Rahman ME, Bin Halmi MIE, Bin Abd Samad MY, Uddin MK, Mahmud K, Abd Shukor MY, et al.
    Int J Environ Res Public Health, 2020 Nov 11;17(22).
    PMID: 33187288 DOI: 10.3390/ijerph17228339
    Constructed wetlands (CWs) are affordable and reliable green technologies for the treatment of various types of wastewater. Compared to conventional treatment systems, CWs offer an environmentally friendly approach, are low cost, have fewer operational and maintenance requirements, and have a high potential for being applied in developing countries, particularly in small rural communities. However, the sustainable management and successful application of these systems remain a challenge. Therefore, after briefly providing basic information on wetlands and summarizing the classification and use of current CWs, this study aims to provide and inspire sustainable solutions for the performance and application of CWs by giving a comprehensive review of CWs' application and the recent development of their sustainable design, operation, and optimization for wastewater treatment. To accomplish this objective, thee design and management parameters of CWs, including macrophyte species, media types, water level, hydraulic retention time (HRT), and hydraulic loading rate (HLR), are discussed. Besides these, future research on improving the stability and sustainability of CWs are highlighted. This article provides a tool for researchers and decision-makers for using CWs to treat wastewater in a particular area. This paper presents an aid for informed analysis, decision-making, and communication. The review indicates that major advances in the design, operation, and optimization of CWs have greatly increased contaminant removal efficiencies, and the sustainable application of this treatment system has also been improved.
  12. Fulltext Effect of education modules on the job dissatisfaction of teachers in community- based rehabilitation centres in Kelantan, Malaysia
    Shazlin Umar, Azriani Ab Rahman, Aziah Daud, Azizah Othman, Normastura Abd Rahman, Azizah Yusoff, et al.
    Education in Medicine Journal, 2015;7(2):1-8.
    MyJurnal
    Objective: The objectives of this study were to determine the effect of a one and a half year educational intervention on the job dissatisfaction of teachers in 30 Community Based Rehabilitation (CBR) centres in Kelantan, Malaysia, and to identify the factors influencing changes in job dissatisfaction following the intervention. Method: Ten educational modules were administered to the teachers. A validated Malay version of Job Content Questionnaire (JCQ) was used pre intervention, mid intervention and post intervention. Result: Repeated Measure ANOVA revealed there was a statistically significant reduction in the mean of job dissatisfaction (p = 0.048). Multiple Linear Regression revealed that co- worker support (β= 0.034 (95% CI = 0.009, 0.059)), having less decision authority (β: -0.023; 95% CI: -0.036, -0.01) and being single (β: -0.107; 95% CI: -0.176,-0.038) were significantly associated with decreases in job dissatisfaction. Conclusion: The intervention program elicited improvement in job satisfaction. Efforts should be made to sustain the effect of the intervention in reducing job dissatisfaction by continuous support visits to CBR centres.
  13. Fulltext The first Malay database toward the ethnic-specific target molecular variation
    Halim-Fikri H, Etemad A, Abdul Latif AZ, Merican AF, Baig AA, Annuar AA, et al.
    BMC Res Notes, 2015;8:176.
    PMID: 25925844 DOI: 10.1186/s13104-015-1123-y
    The Malaysian Node of the Human Variome Project (MyHVP) is one of the eighteen official Human Variome Project (HVP) country-specific nodes. Since its inception in 9(th) October 2010, MyHVP has attracted the significant number of Malaysian clinicians and researchers to participate and contribute their data to this project. MyHVP also act as the center of coordination for genotypic and phenotypic variation studies of the Malaysian population. A specialized database was developed to store and manage the data based on genetic variations which also associated with health and disease of Malaysian ethnic groups. This ethnic-specific database is called the Malaysian Node of the Human Variome Project database (MyHVPDb).
  14. Fulltext Plasmodium knowlesi malaria an emerging public health problem in Hulu Selangor, Selangor, Malaysia (2009-2013): epidemiologic and entomologic analysis
    Vythilingam I, Lim YA, Venugopalan B, Ngui R, Leong CS, Wong ML, et al.
    Parasit Vectors, 2014;7:436.
    PMID: 25223878 DOI: 10.1186/1756-3305-7-436
    While transmission of the human Plasmodium species has declined, a significant increase in Plasmodium knowlesi/Plasmodium malariae cases was reported in Hulu Selangor, Selangor, Malaysia. Thus, a study was undertaken to determine the epidemiology and the vectors involved in the transmission of knowlesi malaria.
  15. The thermoluminescence glow curve and the deconvoluted glow peak characteristics of erbium doped silica fiber exposed to 70-130 kVp x-rays
    Alawiah A, Bauk S, Marashdeh MW, Nazura MZ, Abdul-Rashid HA, Yusoff Z, et al.
    Appl Radiat Isot, 2015 Oct;104:197-202.
    PMID: 26188687 DOI: 10.1016/j.apradiso.2015.07.011
    In regard to thermoluminescence (TL) applied to dosimetry, in recent times a number of researchers have explored the role of optical fibers for radiation detection and measurement. Many of the studies have focused on the specific dopant concentration, the type of dopant and the fiber core diameter, all key dependencies in producing significant increase in the sensitivity of such fibers. At doses of less than 1 Gy none of these investigations have addressed the relationship between dose response and TL glow peak behavior of erbium (Er)-doped silica cylindrical fibers (CF). For x-rays obtained at accelerating potentials from 70 to 130 kVp, delivering doses of between 0.1 and 0.7 Gy, present study explores the issue of dose response, special attention being paid to determination of the kinetic parameters and dosimetric peak properties of Er-doped CF. The effect of dose response on the kinetic parameters of the glow peak has been compared against other fiber types, revealing previously misunderstood connections between kinetic parameters and radiation dose. Within the investigated dose range there was an absence of supralinearity of response of the Er-doped silica CF, instead sub-linear response being observed. Detailed examination of glow peak response and kinetic parameters has thus been shown to shed new light of the rarely acknowledged issue of the limitation of TL kinetic model and sub-linear dose response of Er-doped silica CF.
  16. Fulltext UFO registry: final analysis of baseline data from patients with advanced prostate cancer in Asia
    Ye D, Kanesvaran R, Chiong E, Lojanapiwat B, Pu YS, Rawal SK, et al.
    Ther Adv Med Oncol, 2024;16:17588359241293393.
    PMID: 39583953 DOI: 10.1177/17588359241293393
    BACKGROUND: The incidence of prostate cancer (PC) is increasing in Asian countries. The epidemiology of PC, its treatment including the use of novel therapeutic options, impacts on quality of life, and clinical outcomes of patients with PC in Asia, are not well documented.

    OBJECTIVES: To describe the demographic and disease features of the full cohort of patients enrolled in the United in Fight against prOstate cancer (UFO) registry.

    DESIGN: The UFO registry was a multi-national, longitudinal, observational study of patients with PC presenting to participating tertiary care hospitals in eight Asian countries/regions.

    METHODS: Patients with high-risk localized PC (HRL), non-metastatic biochemically recurrent, or metastatic PC were consecutively enrolled from September 14, 2015 until September 1, 2020 and followed for up to 5 years.

    RESULTS: Among the full cohort of 3635 patients, 425 had HRL, 389 had non-metastatic biochemically recurrent, and 2821 had metastatic PC. Median follow-up time was 4.2, 4.2, and 2.6 years, respectively. At first diagnosis, the mean age ranged from 65.7 to 69.1 years, 38.5% had extra-capsular tumor extension, 34.0% had regional lymph node metastases, and 65.1% had distant metastases. Quality-of-life scores at enrollment were significantly worse in patients with metastatic disease. Decisions to start therapy were mainly driven by treatment guidelines and disease progression. The decision to discontinue hormonal therapy was often due to disease progression. Few patients received novel hormonal therapies despite their availability.

    CONCLUSION: The UFO registry provides a detailed, contemporary picture of the characteristics, treatment, and outcomes of patients with PC in Asia. There is an unmet medical need to improve access to novel agents in Asia, aiming to improve quality of life and clinical outcomes.

    TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02546908, Registry Identifier: NOPRODPCR4001.

  17. Heart Failure in Africa, Asia, the Middle East and South America: The INTER-CHF study
    Dokainish H, Teo K, Zhu J, Roy A, AlHabib KF, ElSayed A, et al.
    Int J Cardiol, 2016 Feb 1;204:133-41.
    PMID: 26657608 DOI: 10.1016/j.ijcard.2015.11.183
    There are few data on heart failure (HF) patients from Africa, Asia, the Middle East and South America.
  18. Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data
    Khatib R, McKee M, Shannon H, Chow C, Rangarajan S, Teo K, et al.
    Lancet, 2016 Jan 2;387(10013):61-9.
    PMID: 26498706 DOI: 10.1016/S0140-6736(15)00469-9
    BACKGROUND: WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to their lack of availability or poor affordability.
    METHODS: We analysed information about availability and costs of cardiovascular disease medicines (aspirin, β blockers, angiotensin-converting enzyme inhibitors, and statins) in pharmacies gathered from 596 communities in 18 countries participating in the Prospective Urban Rural Epidemiology (PURE) study. Medicines were considered available if present at the pharmacy when surveyed, and affordable if their combined cost was less than 20% of household capacity-to-pay. We compared results from high-income, upper middle-income, lower middle-income, and low-income countries. Data from India were presented separately given its large, generic pharmaceutical industry.
    FINDINGS: Communities were recruited between Jan 1, 2003, and Dec 31, 2013. All four cardiovascular disease medicines were available in 61 (95%) of 64 urban and 27 (90%) of 30 rural communities in high-income countries, 53 (80%) of 66 urban and 43 (73%) of 59 rural communities in upper middle-income countries, 69 (62%) of 111 urban and 42 (37%) of 114 rural communities in lower middle-income countries, eight (25%) of 32 urban and one (3%) of 30 rural communities in low-income countries (excluding India), and 34 (89%) of 38 urban and 42 (81%) of 52 rural communities in India. The four cardiovascular disease medicines were potentially unaffordable for 0·14% of households in high-income countries (14 of 9934 households), 25% of upper middle-income countries (6299 of 24,776), 33% of lower middle-income countries (13,253 of 40,023), 60% of low-income countries (excluding India; 1976 of 3312), and 59% households in India (9939 of 16,874). In low-income and middle-income countries, patients with previous cardiovascular disease were less likely to use all four medicines if fewer than four were available (odds ratio [OR] 0·16, 95% CI 0·04-0·57). In communities in which all four medicines were available, patients were less likely to use medicines if the household potentially could not afford them (0·16, 0·04-0·55).
    INTERPRETATION: Secondary prevention medicines are unavailable and unaffordable for a large proportion of communities and households in upper middle-income, lower middle-income, and low-income countries, which have very low use of these medicines. Improvements to the availability and affordability of key medicines is likely to enhance their use and help towards achieving WHO's targets of 50% use of key medicines by 2025.
    FUNDING: Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.
  19. Assessing global risk factors for non-fatal injuries from road traffic accidents and falls in adults aged 35-70 years in 17 countries: a cross-sectional analysis of the Prospective Urban Rural Epidemiological (PURE) study
    Raina P, Sohel N, Oremus M, Shannon H, Mony P, Kumar R, et al.
    Inj Prev, 2016 Apr;22(2):92-98.
    PMID: 26512093 DOI: 10.1136/injuryprev-2014-041476
    To assess risk factors associated with non-fatal injuries (NFIs) from road traffic accidents (RTAs) or falls.
  20. Fulltext Behaviour change strategies for reducing blood pressure-related disease burden: findings from a global implementation research programme
    GACD Hypertension Research Programme, Writing Group, Peiris D, Thompson SR, Beratarrechea A, Cárdenas MK, Diez-Canseco F, et al.
    Implement Sci, 2015;10:158.
    PMID: 26553092 DOI: 10.1186/s13012-015-0331-0
    The Global Alliance for Chronic Diseases comprises the majority of the world's public research funding agencies. It is focussed on implementation research to tackle the burden of chronic diseases in low- and middle-income countries and amongst vulnerable populations in high-income countries. In its inaugural research call, 15 projects were funded, focussing on lowering blood pressure-related disease burden. In this study, we describe a reflexive mapping exercise to identify the behaviour change strategies undertaken in each of these projects.
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