Physical inactivity is strongly associated with obesity and an increased risk of cardiovascular disease in children and adolescents. A cross-sectional study using multistage random sampling was conducted to determine associations between demographic characteristics, sedentary behaviours and physical activity among adolescents. Data were collected from 785 (414 males and 371 females) Form four students attending 15 schools in Petaling District, Selangor using an adapted self-administered questionnaire. Results showed that more females (50.1%) were physically inactive compared to males (39.6%) (Adjusted odds ratio (OR): 1.55, 95% confidence interval (CI): 1.12-2.15). Physically inactive adolescents were less likely to participate in intramural/house league sports (OR: 1.71, 95% CI: 1.19-2.44), school team sports (OR: 1.45, 95% CI: 1.03-2.04) and individual physical activities outside school (OR: 1.53, 95% CI: 1.11-2.12) compared to their physically active counterparts. Physically inactive adolescents were also less engaged in sedentary activities, such as television watching (OR: 0.69, 95% CI: 0.50-0.94), playing computer/video game (OR: 0.44, 95% CI: 0.28-0.72), talking on the telephone/mobile phone text messaging (OR: 0.47, 95% CI: 0.32-0.69) and reading (OR:0.45, 95% CI: 0.24-0.86) compared to those who were physically active. In this study, physical activity coexists with sedentary behaviour in adolescents. Sedentary activities may not necessarily displace physical activity among youth. In addition, these data suggest that promoting organised sports in school and outside the school among youths may be a potential strategy for increasing physical activity in this population.
The World Health Organization (WHO) estimates that injury will be the second leading cause of morbidity of disease burden worldwide by the year 2020. We conducted a community-based survey to determine the prevalence of recent illness and injury, in Malaysia. The survey was a cross sectional population-based household survey conducted using face to face interviews. The information was on self-reported recent illness and injury (SRRII) over the previous 2 weeks. This study was conducted during April - August 2006 and as a part of the third National Health and Morbidity Survey of Malaysia. A total of 56,710 respondents were interviewed with a response rate of 98.2% (55,660/56,710). The overall prevalence of combined SRRII was 23.6%; for injuries the prevalence was 3.1%. The groups with the highest SRRII were children 0-5 years old (31.2%), males (24.3%), Indians (26.9%), those with secondary education level (22.9%), those earning RM 1,000/ month (25.0%) and rural dwellers (25.5%). Age, sex, ethnicity, and locality were significantly associated with SRRII while monthly household income and educational level were marginally associated. On multivariate analysis, age, gender, race, ethnicity, education, income and locality were significantly associated with SRRII. The most common reported recent illness was related to the respiratory system (42.0%). The information obtained from this survey is useful to policy makers in the Ministry of Health to review and strengthen existing health programs.
Study name: National Health and Morbidity Survey (NHMS-2006)
About 1.8 million people die annually from acute diarrheal disease globally. A nationwide cross-sectional survey was conducted via face-to-face interview with eligible subjects to determine the incidence and health seeking behavior of Malaysians with acute diarrheal disease (ADD). An acute diarrheal episode was defined as having three or more loose stools in any 24 hour period during the four weeks period prior to the interview. The exclusion criteria included pre-existing chronic diarrhea, such as with cancer of the bowel, ulcerative colitis or Chrohn's disease. Forty three point three percent of those with ADD (95% CI 41.3-45.4) sought treatment for the illness. Younger age groups (0-4 years, 67.7%; 95% CI 61.5-73.4; 5-9 years, 56.5%; 95% CI 48.6-64.1) were more likely to seek care for ADD. Seventy-one point eight percent of those seeking treatment, (95% CI 69.0-74.4) did so within 12 hours of the onset of symptoms. Most people with ADD sought treatment at private clinics. The main reasons given for not seeking treatment were the illness was mild and did not warrant treatment and the practice of self-medication (22.4%; 95% CI 20.0-24.9). These findings show self-medication is a major health seeking behavior among Malaysians with ADD. Self-medication of ADD deserves more in-depth study to ensure it is safe.
Keywords: NHMS-2006
Study name: National Health and Morbidity Survey (NHMS-2006)
The third National Health Morbidity Survey was conducted in 2006 on a nationally representative sample of population in Malaysia in order to obtain community-based data and information on the prevalence of chronic illness. Of 57,500 eligible respondents 56710 (98.6%) participated in the study. Estimated overall prevalence of chronic illness in the Malaysian population within a recall period of one year was 15.5% (95% CI 15.1% - 15.9%). Chronic illness was reported significantly higher among the females, 16.8% (16.3 - 17.3). The most common chronic illness was hypertension (7.9%, 7.6 - 8.2), followed by diabetes mellitus (4.0%, 3.8 - 4.2) and highest reported by the Indians (19.7%, 18.4 - 21.0). Among the respondents who had sought treatment for chronic illness from government health facilities, Malays (65.8%) and those with monthly household income of less than RM400 (76.6%) were the highest. Chinese (44.5%) and those with household income of RM5000 and above (54.3%) were the highest groups who sought treatment from the private health facilities. Most of the respondents reported mild illness was the main reason for not seeking treatment for their chronic illness. It is hoped that the results of this survey will help the Ministry of Health Malaysia to enhance health programmes and planning resource allocation in order to improve health status of the population.
Study name: National Health and Morbidity Survey (NHMS-2006)
Misuse of alcohol among adolescents, particularly schoolchildren has become one of the public health concerns in Malaysia due to its serious effects and an increased risk of alcohol related injuries, especially motor vehicle injuries. This is the most common type of youthful fatal injury in Malaysia. However the availability of data on the extent of alcohol abuse particularly among school children in this country is limited. Therefore, we conducted this study with the objectives of identifying the prevalence of alcohol drinking among school children in Kuala Lumpur, factors rekited to alcohol drinking among the adolescents and to assess health status of their parents through the presence of any related alcohol diseases and the habits of alcohol drinking among their parents.
In this baseline study a two stage stratified sampling design was used to recruit 8532 eligible students from the selected secondary schools in Kuala Lumpur. The prevalence of alcohol drinking was 9.0% (771 / 8532) . Significant factors identihed related to alcohol consumption were akoholic father (OR=1.29), akoholic mother (1 .55) ; elder siblings consume alcohol (2 .49) and the Chinese ethnic group (1 .55) . The study revealed that factors which signihcantly contributed to the habit of alcohol drinking were related to whether their parents consumed alcohol or not or either their eMer siblings were ako taking alcohol. Therefore, the, results from this study could be used as a baseline data to describe the level of alcohol consumption among adolescents particularly school children. Ehfective public health interventions that focus on the familial context of adolescents' drinking habits may be developed.
Acute diarrhoea is a major health problem in many parts of the world, contributing to about 1.8 million deaths globally. The objectives of the study were to assess the incidence, determinants, and severity of acute diarrhoea in the population. A nation-wide cross-sectional survey involving about 57,000 respondents was conducted via face-to-face interview among eligible respondents of all ages. An acute diarrhoeal episode was defined as having three or more episodes of loose stools in any 24-hour period within the past four weeks before the interview. The severity was measured by duration of acute diarrhoea and associated symptoms. The variables tested as determinants were age, sex, ethnicity, the highest educational level, total monthly household income, and locality. Univariate, bivariate and multivariate procedures meant for complex study design were used in the analyses. The four-week incidence of acute diarrhoea was 5% [95% confidence interval (CI) 4.8-5.2]. The incidence of acute diarrhoea among the estimated population was the highest among young adults aged 20-29 years, Other Bumiputras (the pre-dominant ethnic group in East Malaysia), those with tertiary-level of education, those earning a monthly household income of less than RM 400, and rural dwellers. Only age, ethnicity, the highest level of education attained, and locality were significantly associated with acute diarrhoea in bivariate analysis. In multivariate analysis, these four variables were found to be the determinants of acute diarrhoea. Sex and monthly household income were excluded from the model. The mean duration of acute diarrhoea was 2.0 days (standard deviation 1.3). Forty-six percent of the respondents reported stomach cramps as an associated symptom. The findings revealed that acute diarrhoea is still a major public-health concern in Malaysia and grossly under-notified. There is a need for intensification of public-health intervention efforts to reduce the incidence of acute diarrhoea while improving surveillance and notification of the disease.
Two methods of identifying smokers with high nicotine dependence, the heaviness of smoking index (HSI) and number of cigarettes per day (CPD) were compared with the Fagerstrom test for nicotine dependence (FTND). The HSI, CPD and the FTND were administered to 316 adult Malaysian male, daily smokers aged between 25-64 years old in the Malaysian NCD Surveillance-1 Survey using a two-stage stratified random sampling of enumeration blocks and living quarters, via an interview based on a validated questionnaire. The cut-off point for classification of high nicotine dependence on the HSI was a score of four or higher, and for the heavy smoking category, smoking more than 20 cigarettes per day. Classification using each method was compared with classification by the FTND (score of six or more) as the reference standard. Sensitivity, specificity and kappa statistics for concordance between both measures and the FTND were evaluated. The HSI gave a similar prevalence rate of high nicotine dependence as the FTND. There was substantial agreement between the HSI and the FTND (kappa=0.63.), with moderate sensitivity (69.8%) and high specificity (92.5%). However, prevalence of high nicotine dependence using the CPD was 7% lower than the FTND. The heavy smoking category also showed fair agreement with the FTND (kappa=0.45) and moderate sensitivity (67.0%), but specificity was high (86.9%). The findings indicate that the HSI can be used as an alternative to the FTND in screening for high nicotine dependence among daily smokers in large population-based studies, while CPD may not be a suitable alternative to the FTND.
Malaysia experienced its first outbreak of chikungunya virus (CHIKV) infection in late 1998 in Klang District in Selangor; six years later the virus re-emerged in the state of Perak. All the CHIKV isolates in 1988 and 2006 shared high sequence similarities and belonged to the Asian genotype. In 2007 and 2008 CHIKV infection again reemerged but the genotype was the Central/East African genotype. This strain was found to be similar to the strains causing outbreaks in the India Ocean. In 2009, the strains circulating in Malaysia, including the state of Kelantan, based on the partial E1 gene, also belong to the Central/East African genotype.
A systematic approach to death registration and reporting is essential for studies and comparison within or between countries. One of the accepted methods in the system is to have medically certified death. The objective of this study was to improve the proportion of medically certified death (MCD) in the state of Malacca. Structured questionnaires were used by Medical Assistants (MAs) in the investigation of the cause of death for non-medically certified deaths. Data on certification of death by MAs in Malacca was analysed and compared with the total deaths obtained from the Department of Statistics. Possible determinants of deaths were investigated. Total deaths in the state of Malacca during the study period from 2000 - 2001 were 5941. About 35% (883/2493) of the total deaths in year 2000 and 45% (1550/3448) in 2001 certified by MAs were examined. By districts, 50.6% were certified in the district of Malacca Tengah, 13.4% Jasin and 36.0% Alor Gajah in 2000; 65.9% occurred in Malacca Tengah, 11.0% Jasin and 23.2% Alor Gajah in 2001. This project helped to increase the percentage of the medically certified deaths in Malacca from 49.8% in year 1998, 49% in 1999 to 73% in 2000 and 85% in 2001. The proportion of MCD in Malacca in 2000 (73%) may be increased to 93% if all MCDs done by MAs were accepted by the Department of Statistics. There is still a high proportion (23.6%) of ill-defined conditions such as old age and sudden death being diagnosed by MAs. The study shows that the quality of mortality data particularly in the percentage of medically certified deaths can be improved.
A cross-sectional study was conducted among form four students of secondary schools in the District of Petaling, Selangor, Malaysia from February 2008 to June 2008 with the aim of quantifying the prevalence of smoking and identifying the psychosocial factors related to smoking among adolescents in this district. A two-stage stratified sampling strategy was used to obtain a sample of 1300 students based on an estimated prevalence of 10%. The response rate was 80.5% (1045 out of 1298 students). Results showed that prevalence of smoking was higher among male students (22.3%) compared to females (5.5%) and the median age at smoking initiation was lower among males compared to female smokers (14 years old vs 15 years old). Modifiable risk factors associated with smoking were "percentage of friends who smoke" (OR 2.94, 95% CI [1.71- 5.06]) and "having a brother who smokes" (OR 1.97, 95% CI [1.20-3.31]). There was also a correlation between smoking prevalence and the number of risk factors present. Intensification of health education and anti-smoking programmes and modification of external factors in early adolescence are recommended to prevent smoking initiation.
This study aims to determine the level of knowledge and to understand their attitude towards smoking and secondly to determine how sociodemographic background, smoking status and knowledge on the health risks of smoking contribute toward the development of such attitude. A total of 10,545 respondents age 18 years and above across Malaysia were interviewed. Results indicated that level of knowledge and attitude varied by gender, education level, smoking status, age, ethnicity and smoker category. Smokers' low education, poor knowledge on the dangers of smoking and being males had more positive or greater impact on their attitudes towards smoking. Formulation and implementation of a holistic programme aimed at increasing knowledge and attitude change that accounts for sociodemographic background of the population is recommended in order to bring down smoking rates and thus reduce smoking related health problems in this country.
This study was performed to determine the effects of dietary vitamin E and soybean oil (a rich source of polyunsaturated fatty acids) on the sperm concentration and motility in male Sprague-Dawley rats. Rats with body weights between 250 - 300 gms were randomly allotted into five treatment groups with three animals each. The trial lasted 63 weeks inclusive of a one week acclimatization period. Rats were fed either CTRL (Base Diet + 5 % Soybean Oil + 3000 IU Vitamin E), BD Only (Base Diet Only), BDVitE (Base Diet + 3000 IU Vitamin E Only), BDSBO (Base Diet + Soybean Oil Only) or COMM (Imported Commercial Rat Pellets). At the end of the trial, the rats were euthanized and sperm concentration and motility were evaluated for both left and right testicles. It was found that although sperm motility had no significant difference across treatment groups, animals supplemented with adequate vitamin E and soybean oils had significantly higher concentration of sperms. It was also shown that vitamin E supplementation alone is more important than dietary fat supplementation in influencing sperm concentration in rats.
Smoking among adolescent is a public health concern in Malaysia. Multiple studies on smoking prevalence and its related factors have been conducted in Malaysia, however, they were specific to either urban or rural areas alone. Studies in mixed settlement areas (urban, rural, land development area) had not been intensively investigated. This study reports the prevalence, demographic and factors related to smoking amongst form four students in the district of Kota Tinggi, Johor. A cross-sectional study of 16-year old secondary school students in Kota Tinggi district was conducted using two-stage stratified, proportionate sampling in July 2005. The study instrument used was a validated structured questionnaire on smoking and its related factors. Smoking prevalence was found to be 29.7%. More than 50% of male students were smokers. Prevalence was highest in FELDA (Federal Land Development Authority) settlement areas. Smoking was associated with having a brother or friend who smokes and poor academic performance. The study revealed that smoking prevalence was high, especially among male students in land development schemes. This situation will contribute to high smoking-related health problems in the future if proper preventive measures are not taken accordingly.
Adolescents who overestimate the prevalence of smoking among their peers or other teens are at higher risk to take up smoking. The purpose of this study is to elucidate the factors which are related to adolescents’ overestimation of smoking. We surveyed form four (16 years old) students in Petaling District, Selangor. A sample was selected using two-stage stratified sampling, and data were collected using standardised, self-administered questionnaires. A response rate of 80.4% (n=1045/1298) was obtained, and a total of 943 students were included in the final analysis. About 73 percent (n=688/943) of the respondents overestimated the prevalence of smoking among their peers. The odds of overestimating increased as the number of close friends who smoke increased [Two close friends, OR=3.10(1.67-5.75), three close friends OR=10.81(4.44-26.3) and four-five close friends OR= 12.91(5.31-31.43)]. Those who had an elder brother who smoked (OR=1.95 (1.18-3.24)) and females [2.08(1.37-3.33) were more likely to overestimate peer smoking prevalence. Intervention programmes to correct the misperception of peer smoking prevalence are recommended, in addition to measures to modify the other factors that are amenable to intervention, so as to reduce the risk of smoking initiation among adolescents.
Generalised obesity and central obesity are risk factors for Type II diabetes mellitus and cardiovascular diseases. Waist circumference (WC) has been suggested as a single screening tool for identification of overweight or obese subjects in lieu of the body mass index (BMI) for weight management in public health program. Currently, the recommended waist circumference cut-off points of > or = 94cm for men and > or =80cm for women (waist action level 1) and > or = 102cm for men and > or = 88cm for women (waist action level 2) used for identification of overweight and obesity are based on studies in Caucasian populations. The objective of this study was to assess the sensitivity and specificity of the recommended waist action levels, and to determine optimal WC cut-off points for identification of overweight or obesity with central fat distribution based on BMI for Malaysian adults. Data from 32,773 subjects (14,982 men and 17,791 women) aged 18 and above who participated in the Third National Health Morbidity Survey in 2006 were analysed. Sensitivity and specificity of WC at waist action level 1 were 48.3% and 97.5% for men; and 84.2% and 80.6% for women when compared to the cut-off points based on BMI > or = 25kg/m2. At waist action level 2, sensitivity and specificity were 52.4% and 98.0% for men, and 79.2% and 85.4% for women when compared with the cut-off points based on BMI (> or = 30 kg/m2). Receiver operating characteristic analyses showed that the appropriatescreening cut-off points for WC to identify subjects with overweight (> or = 25kg/m2) was 86.0cm (sensitivity=83.6%, specificity=82.5%) for men, and 79.1cm (sensitivity=85.0%, specificity=79.5%) for women. Waist circumference cut-off points to identify obese subjects (BMI > or = 30 kg/m2) was 93.2cm (sensitivity=86.5%, specificity=85.7%) for men and 85.2cm (sensitivity=77.9%, specificity=78.0%) for women. Our findings demonstrated that the current recommended waist circumference cut-off points have low sensitivity for identification of overweight and obesity in men. We suggest that these newly identified cut-off points be considered.
Study name: National Health and Morbidity Survey (NHMS-2006)
A hospital-based case-control study of viral encephalitis was carried out at Port Dickson Hospital, in the state of Negeri Sembilan, Malaysia. Between March and May 1999, 69 clinically diagnosed viral encephalitis cases and 31 controls were interviewed. Job histories on pig farming activities were assessed by a group of epidemiologists and veterinary surgeons. Results show that among clinical cases of viral encephalitis, 52 (75.4%) cases were diagnosed to have Nipah virus infection based on positive serology for antibodies to the cross-reacting Hendra virus antigen. The Nipah virus encephalitis was significantly associated with a history of working in pig farms (p < 0.001, OR = 196.0, 95% CI = 20.4-4741.6), history of contact with animals (p < 0.001, OR = 38.3, 95% CI = 8.2-209.0) and with history of direct contact with pigs (p = 0.002, OR = 34.4, 95% CI = 2.6-1,024.4). The Nipah virus infection was also significantly associated with history of feeding/cleaning pigs (p < 0.001, OR = 102, 95% CI = 11.9-2,271.5). These results provide evidence that involvement in pig farming activities is significantly associated with the risk of getting Nipah virus infection. They are potential risk factors for Nipah virus transmission in the major pig-producing area of Bukit Pelandok, Port Dickson Negeri Sembilan.
Chikungunya infection has become a public health threat in Malaysia since the 2008 nationwide outbreaks. Aedes albopictus Skuse has been identified as the chikungunya vector in Johor State during the outbreaks. In 2009, several outbreaks had been reported in the State of Kelantan. Entomological studies were conducted in Kelantan in four districts, namely Jeli, Tumpat, Pasir Mas and Tanah Merah to identify the vector responsible for the virus transmission.