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Prevalence and risk factors for positive lymphatic filariasis antibody in Sabah, Malaysia: a cross-sectional study

Zakaria ND, Avoi R

Trans R Soc Trop Med Hyg, 2021 Aug 28.
PMID: 34453834 DOI: 10.1093/trstmh/trab132

BACKGROUND: Lymphatic filariasis (LF) is a public health problem in Sabah, Malaysia. In the subdistrict of Tangkarason, nine rounds of mass drug administration (MDA) were probably not effective in reducing the prevalence of microfilaria to the <1% threshold recommended by the World Health Organization for stopping MDA. This cross-sectional study was conducted to identify the risk factors associated with positive LF antibody in Tangkarason.
METHODS: Eligible adults >18 y of age in seven endemic villages in Tangkarason, Beluran, Sabah, were interviewed and tested for LF antibody using the Brugia Rapid kit. Multivariable logistic regression was employed to analyse the associated factors.
RESULTS: A total of 244 respondents were included in this study. Their median age was 40 y (interquartile range 30-53). The antibody prevalence of brugian filariasis in the study population was 31.1% (95% confidence interval [CI] 25.7 to 37.2). Older age (adjusted odds ratio [aOR] 1.04 [95% CI 1.02 to 1.06]) and outdoor jobs (aOR 2.26 [95% CI 1.05 to 4.85]) were identified as independent risk factors for positive LF antibody. Participating in the MDA program previously (aOR 0.24 [95% CI 0.10 to 0.57]) was found to be a protective factor for LF infection.
CONCLUSIONS: A high prevalence of microfilariae was confirmed in all the study sites, which was above the target of <1%. Important factors associated with positive LF antibody were identified, which could be used as a guide for program managers to design more focused control measures in LF-endemic areas.
Fulltext Tuberculosis Death Epidemiology and Its Associated Risk Factors in Sabah, Malaysia

Avoi R, Liaw YC

Int J Environ Res Public Health, 2021 Sep 16;18(18).
PMID: 34574665 DOI: 10.3390/ijerph18189740

Tuberculosis (TB) is a leading killer from a single infectious agent globally. In 2019, Malaysia's TB incidence rate was 92 per 100,000 population, and the TB mortality rate was estimated at 4 cases per 100,000 population per year. However, the state of Sabah had a higher burden of TB with a notification rate of 128 per 100,000 population and a TB case fatality rate of 8% compared to the national figure. This study aims to provide a comprehensive report on TB deaths epidemiology and its associated factors at a sub-national level. This nested case-control study used Sabah State Health Department TB surveillance data from the Malaysia national case-based TB registry (MyTB) between 2014 and 2018. Cases were defined as all-cause TB deaths that occurred before anti-TB treatment completion from the time of TB diagnosis. Controls were randomly selected from TB patients who completed anti-TB treatment. The TB mortality rate had increased significantly from 9.0/100,000 population in 2014 to 11.4/100,000 population in 2018. The majority of TB deaths occurred in the first two months of treatment. TB-related deaths were primarily due to advanced disease or disseminated TB, whereas non-TB-related deaths were primarily due to existing comorbidities. Many important independent risk factors for TB deaths were identified which are useful to address the increasing TB mortality rate.
Fulltext Treating More with Less: Effectiveness and Event Outcomes of Antituberculosis Fixed-dose Combination Drug versus Separate-drug Formulation (Ethambutol, Isoniazid, Rifampicin and Pyrazinamide) for Pulmonary Tuberculosis Patients in Real-world Clinical Practice

Lai JML, Yang SL, Avoi R

J Glob Infect Dis, 2019 3 1;11(1):2-6.
PMID: 30814828 DOI: 10.4103/jgid.jgid_50_18

Introduction: Conventionally, a combination of four separate drugs (ethambutol, isoniazid, rifampicin, and pyrazinamide [EHRZ]) is the first-line pharmacotherapy for pulmonary tuberculosis (TB). In recent years, fixed-dose combination (FDC) formulation, where a single tablet contains the active ingredients of four aforementioned drugs, is gaining popularity due to its ease of administration.
Objective: To compare the real-world effectiveness of EHRZ and FDC treatment groups on a cohort registry by investigating the sputum conversion rate and treatment outcomes of both groups.
Methods: A total of 11,489 patients' data were extracted from the Sabah TB registry between January 2012 and June 2016, including EHRZ (n = 4188) and FDC (n = 7301) patients. Then, 1:1 propensity score matching was adopted to reduce the baseline bias. Caliper matching was conducted with maximum tolerance score set at 0.001. Confounders included in the propensity score matching were gender, nationality, diabetes, HIV status, smoking status, and chest X-ray status. Successful matching provided 4188 matched pairs (n = 8376) for final analysis.
Results: In this matched cohort of 4188 pairs, the 2-month sputum conversion rate of FDC group was significantly higher than the EHRZ group (96.3% vs. 94.3%; P < 0.001) whereas 6-month sputum conversion of both groups showed no significant difference. Treatment outcomes such as noncompliance rate, failure rate, and success rate have no significant difference (P > 0.05) in both the treatment groups. There was an incidental finding of reduced death rate among FDC group compared to the EHRZ group (0.2% vs. 0.5%; P = 0.034).
Conclusion: The FDC formulation has better sputum conversion rate at 2 months compared to conventional EHRZ regime as separate-drug formulation. It was also observed that FDC has a slight protective effect against all-cause death among TB patients. This protective effect of FDC, however, still needs to be proven further.
Developing a dengue prediction model based on climate in Tawau, Malaysia

Jayaraj VJ, Avoi R, Gopalakrishnan N, Raja DB, Umasa Y

Acta Trop, 2019 Sep;197:105055.
PMID: 31185224 DOI: 10.1016/j.actatropica.2019.105055

Dengue is fast becoming the most urgent health issue in Malaysia, recording close to a 10-fold increase in cases over the last decade. With much uncertainty hovering over the recently introduced tetravalent vaccine and no effective antiviral drugs, vector control remains the most important strategy in combating dengue. This study analyses the relationship between weather predictors including its lagged terms, and dengue incidence in the District of Tawau over a period of 12 years, from 2006 to 2017. A forecasting model purposed to predict future outbreaks in Tawau was then developed using this data. Monthly dengue incidence data, mean temperature, maximum temperature, minimum temperature, mean relative humidity and mean rainfall over a period of 12 years from 2006 to 2017 in Tawau were retrieved from Tawau District Health Office and the Malaysian Meteorological Department. Cross-correlation analysis between weather predictors, lagged terms of weather predictors and dengue incidences established statistically significant cross-correlation between lagged periods of weather predictors-namely maximum temperature, mean relative humidity and mean rainfall with dengue incidence at time lags of 4-6 months. These variables were then employed into 3 different methods: a multivariate Poisson regression model, a Seasonal Autoregressive Integrated Moving Average (SARIMA) model and a SARIMA with external regressors for selection. Three models were selected but the SARIMA with external regressors model utilising maximum temperature at a lag of 6 months (p-value:0.001), minimum temperature at a lag of 4 months (p-value:0.01), mean relative humidity at a lag of 2 months (p-value:0.001), and mean rainfall at a lag of 6 months (p-value:0.001) produced an AIC of 841.94, and a log-likelihood score of -413.97 establishing it as the best fitting model of the methodologies utilised. In validating the models, they were utilised to develop forecasts with the model selected with the highest accuracy of predictions being the SARIMA model predicting 1 month in advance (MAE: 7.032, MSE: 83.977). This study establishes the effect of weather on the intensity and magnitude of dengue incidence as has been previously studied. A prediction model remains a novel method of evidence-based forecasting in Tawau, Sabah. The model developed in this study, demonstrated an ability to forecast potential dengue outbreaks 1 to 4 months in advance. These findings are not dissimilar to what has been previously studied in many different countries- with temperature and humidity consistently being established as powerful predictors of dengue incidence magnitude. When used in prognostication, it can enhance- decision making and allow judicious use of resources in public health setting. Nevertheless, the model remains a work in progress- requiring larger and more diverse data.
Fulltext Respiratory Symptoms Among Domestic Waste Collectors

Salvaraji L, Jeffree MS, Avoi R, Akhir HM, Rahim SSSA, Lukman KA

Medeni Med J, 2020;35(4):304-309.
PMID: 33717622 DOI: 10.5222/MMJ.2020.82246

Objective: Increasing amount of waste concurrently increases the risk of exposure to hazardous materials among waste collectors. Vigorous exertion in the field intensifies the abundance of contaminated inspirable droplets. If left undetected and untreated, it may provoke significant pernicious health effects and redundant burdens to employees and employers. The purpose of this study is to determine the prevalence of respiratory symptoms and their associated factors among domestic waste collectors.
Method: A cross-sectional study was conducted in Kota Kinabalu, Sabah between January and April 2020. Data were collected using a validated questionnaire which encompasses details about sociodemographic, health status, environment, and employment characteristics.
Results: A total of 290 waste collectors with a mean age of 40 (±9) years old were participated in the study. Most of them were from Kadazan-Dusun-Murut ethnic origin with educational background till secondary school. The average monthly income of the workers was USD 298.45 (±171.9) per month, and they had been in service for 11 (±9.04) years. Respiratory symptoms were seen in 21% of the workers. The identified significant risk factors were determined as underlying chronic diseases (OR=2.34; 95% CI=1.054, 5.219) and contact with pets (OR=1.87; 95% CI=1.004, 3.288).
Conclusion: Respiratory symptoms are prevalent amidst domestic waste collectors and related to their health and field activities.
Fulltext Exposure risk assessment of the municipal waste collection activities during COVID-19 pandemic

Salvaraji L, Jeffree MS, Avoi R, Atil A, Mohd Akhir H, Shamsudin SBB, et al.

J Public Health Res, 2020 Oct 14;9(4):1994.
PMID: 33312989 DOI: 10.4081/jphr.2020.1994

An increasing amount of waste concurrently further extends the risk of exposure to hazardous material among waste collectors. In light of the COVID-19 crisis, municipal waste collectors are one of the most at-risk groups of SARS-Cov-2 exposure. Risk assessment included hazard identification, evaluation of existing control level at the workplace, estimation of likelihood and severity of hazard, risk determination, and control measure recommendations. Five waste collection activities were identified and reviewed. High-risk exposure includes collection of garbage, mechanical manipulation of compactor lorries and unloading of garbage at the disposal site. There is poor practice of personal hygiene and unestablished continuous monitoring of personal protective equipment supplies. The preventive measures in the waste collection industry are influenced by several factors. Until the preventive measures are adopted into practice and adapted according to each company's requirements, biological agents continue to be risk factor to the health workers.
Fulltext Prevalence of upper limb musculoskeletal disorders and its associated risk factors among janitorial workers: A cross-sectional study

Lim MC, Lukman KA, Giloi N, Lim JF, Avoi R, Syed Abdul Rahim SS, et al.

Ann Med Surg (Lond), 2022 Jan;73:103201.
PMID: 35070282 DOI: 10.1016/j.amsu.2021.103201

Introduction: Janitorial workers are considered a high-risk group to develop WRMSDs based on their numerous hazardous job tasks and frequent non-fatal injuries being reported. This study aimed to determine the prevalence of upper limb musculoskeletal disorders (ULMSDs) and its associated risk factors among janitorial workers.
Methods: This cross-sectional study involved janitorial workers in a university in Sabah, Malaysia. The participants, who included supervisors, cleaners, and landscape workers, were recruited via universal sampling. Those with at least 12-months of experience in their present employment were included, while those with prior musculoskeletal injuries were excluded. Data were collected through interviews using the Malay version of Standardized Nordic Musculoskeletal Questionnaire (SNMQ), and Job Content Questionnaire (JCQ), followed by Ergonomic Risk Assessment (ERA). Data were analyzed and produced using SPSSv.26, encompassing descriptive statistics, Pearson's Chi-Square, and Multiple Logistic Regression analysis. Ethical approval and respondents' informed consents were obtained prior to the study.
Results: Among 142 respondents, ULMSDs were found to be prevalent in 76.8% of janitorial workers, with the highest prevalence (71.6%) reported in the shoulder regions. None was at negligible risk, with 95.1% in the medium or high-risk categories for RULA assessment. The significant associated factors were landscape workers [aOR = 3.07,95% CI = 1.04, 9.91], more than three years of employment [aOR = 2.47,95% CI = 1.06, 5.79], and low job control [aOR = 2.69,95% CI = 1.16, 6.23].
Conclusions: Given the high prevalence of ULMSDs, risky awkward postures, and low job control, amendments in working apparatuses and improvements in administrative procedures, are highly recommended to prevent the occurrence of ULMSDs.
Fulltext Children's eating behaviour: A comparison between normal, overweight and obese children

Kimin LS, Liew Sat Lin C, Avoi R, Hayati F, Mohd Daud MN, Mandrinos S, et al.

Ann Med Surg (Lond), 2022 Dec;84:104890.
PMID: 36536714 DOI: 10.1016/j.amsu.2022.104890

BACKGROUND: Childhood obesity has become a major global health concern and has been increasing dramatically over the years. Previous study has shown that specific eating behaviours may have been associated with obesity especially under-responsiveness to internal satiety cues and over-responsiveness to external food cues such as the taste, smell, availability and emotions. However, there is still inadequate number of studies present to describe the association between the children's body mass index (BMI) and their eating behaviours, especially in Sabah, Malaysia. Therefore, the objective of this study is to established the association between the children's eating behaviours with their nutritional status based on their body mass index.
MATERIALS AND METHODS: A cross-sectional study involving 484 children aged 6-12 years old was conducted in Kota Kinabalu, which is a developing urban area in Sabah. The children were recruited from five primary schools that were selected based on multistage stratified and convenience sampling method. Sociodemographic details and anthropometric measures both parents and children, and eating behaviours of children were assessed using Children Eating Behaviour Questionnaires (CEBQ). Age-adjusted BMI z-scores were then calculated according to the World Health Organization recommendations to assess nutritional status.
RESULTS: The prevalence of childhood obesity among children aged 6-12 years old is 13.2%. The mean scores of 'Food Approach' subscales from the CEBQ showed higher mean score in overweight and obese groups as compared to the mean score in normal weight group. The mean scores of 'Food Avoidance' subscales showed lower mean score in overweight and obese groups as compared to mean score in normal weight group.
CONCLUSION: This study provides evidence that childhood obesity is yet to be a prevalent health problem in a developing urban area considering the "Food approach" subscales were positively associated with the excess weight in children.
Fulltext Analysis of serum and gene expression profile of cytokines (IL-6, TNF-α and TGF-β1) in chronic hepatitis C virus infection

Che Noh I, Avoi R, Abdullah Nurul A, Ahmad I, Abu Bakar R

PeerJ, 2022;10:e13330.
PMID: 35469194 DOI: 10.7717/peerj.13330

BACKGROUND: Chronic hepatitis C virus (HCV) infection is one of the major causes of liver cirrhosis and liver carcinoma. Studies have indicated that an imbalance of cytokine activities could contribute to the pathogenesis of chronic HCV infection. This study aimed to investigate serum levels and gene expression of cytokines (IL-6, TNF-α and TGF-β1) in chronic HCV infection among Malay male subjects.
METHODS: Thirty-nine subjects were enrolled from various health clinics in Kelantan, Malaysia, and divided into two groups: patients with chronic HCV infection (HP) and healthy control (HS). The serum cytokines IL-6, TNF-a-were measured using Luminex assay, and serum TGF-β1 was measured by ELISA. The mRNA gene expression for IL-6, TNF-α and TGF-β1 was measured by real-time reverse transcriptase polymerase chain reaction (RT-PCR).
RESULTS: There were statistically significant differences in the mean serum levels of IL-6, and TGF-β1 in HP compared to HS group (p = 0.0180 and p = 0.0005, respectively). There was no significant difference in the mean serum level of TNF-α in HP compared to HS group. The gene expression for the studied cytokines showed no significant differences in HP compared to HS group.
CONCLUSION: Serum IL-6 was significantly associated with chronic HCV infection.
Concentrated specimen smear microscopy utilising a polymer membrane sandwich filtration vessel for the detection of acid-fast bacilli in health facilities in Sabah, East Malaysia

Paul DC, Ngeow YF, Yap SF, Dony JF, Avoi R, Mohammad R, et al.

Tuberculosis (Edinb), 2022 Mar;133:102183.
PMID: 35180496 DOI: 10.1016/j.tube.2022.102183

A simple, ready-to-use concentrated specimen smear microscopy method employing a nanometer silicon polyvinylidene fluoride (PVDF) polymer membrane sandwich filtration vessel to concentrate acid-fast bacilli (AFB) in samples (SFV-CSSM, Hunan-Tech New Medical System Co. Ltd. China) was compared with direct sputum smear microscopy (DSSM) to determine its performance using culture on modified Ogawa agar as reference. The results for 4114 clinical samples collected from health facilities in Sabah were interpreted with reference to culture results, sample collection-transportation conditions and clinical data including responses to anti-TB drug treatment. The SFV-CSSM showed higher sensitivity than DSSM (79.4% versus 60.5%) and less background interference. Its ability to detect low levels of AFB at an affordable cost makes it an excellent tool for the screening of pauci-bacillary samples as well as for active case finding in TB control programs.
Observations on malnutrition and anti-TB drugs in Ghana

Muyou AJ, Kunasagran PD, Syed Abdul Rahim SS, Avoi R, Hayati F

Int J Tuberc Lung Dis, 2021 Sep 01;25(9):778-779.
PMID: 34802506 DOI: 10.5588/ijtld.21.0258
Fulltext Translation, Cross-Cultural Adaptation to Malay, and psychometric evaluation of the AIM-IAM-FIM questionnaire: Measuring the implementation outcome of a community-based intervention programme

Salleh H, Avoi R, Abdul Karim H, Osman S, Kaur N, Dhanaraj P

PLoS One, 2023;18(11):e0294238.
PMID: 37972041 DOI: 10.1371/journal.pone.0294238

BACKGROUND: The implementation outcomes determine the success and progress of a community-based intervention programme. The community is an important stakeholder whose effects should be assessed. Nevertheless, Malaysia has limited instruments for determining outcome measurements. This research aimed to develop Malay versions of the Acceptability, Appropriateness, and Feasibility Intervention Measures (AIM-IAM-FIM) questionnaire, which evaluates the implementation outcome of the programme.
METHODS: A methodological study of the translation and validation of the implementation outcome measures was conducted from March 2022 until December 2022. Three key analyses were conducted: (1) translation and validation; (2) factor investigation and extraction (n = 170); and (3) scale evaluation (n = 235).
RESULT: The Malay version measuring the implementation outcome measures of a community-based intervention programme was produced after extensive translation and modification, and it consisted of a single dimension with seven items. The content validity index was 0.9, the exploratory factor analysis showed that the KMO measure of sample adequacy was 0.9277, and Bartlett's sphericity test was statistically significant. Cronbach's alpha was good, with a level of 0.938. The single factor structure fitted the data satisfactorily [χ2 (p-value of 0.002), SRMR = 0.030, CFI = 0.999, RMSEA = 0.079, TLI = 0.998]. Factor loading for all items was > 0.7.
CONCLUSION: The 7-item Malay version of the AIM-IAM-FIM survey instrument is valid and reliable for assessing the acceptability of a community-based intervention study and is applicable to other fields. Future studies in psychometric evaluation are recommended in other states due to the variety of Malay dialects spoken across Asia. The scale may also benefit other areas where the language is spoken.
Fulltext Predictors of severe COVID-19 among healthcare workers in Sabah, Malaysia

Joo LK, Sazali MF, Goroh M, Zefong AC, Maluda MCM, Avoi R, et al.

BMC Health Serv Res, 2022 Dec 17;22(1):1541.
PMID: 36528610 DOI: 10.1186/s12913-022-08920-4

BACKGROUND: Healthcare workers (HCWs) is the high-risk group for COVID-19 infection due to increased workplace exposure. However, evidence of the disease burden and factors associated with severe COVID-19 infection among HCWs is limited. Therefore, this article aims to describe the prevalence of severe COVID-19 disease among HCWs in Sabah, Malaysia, and to determine the factors associated with severe COVID-19 infection.
METHOD: A retrospective cross-sectional study was carried out by assessing the data of COVID-19-infected HCWs in Sabah, Malaysia, from 1st March 2021 until 30th September 2021. Logistic regression analysis was used in this study.
RESULTS: Three thousand and forty HCWs were diagnosed with COVID-19 from 1st March 2021 until 30th September 2021. Of the 3040 HCWs, 2948 (97.0%) HCWs were mild, whereas 92 (3.0%) were severe. The multivariate logistic regression model showed that severe COVID-19 among HCWs in Sabah was associated with those do not receive any COVID-19 vaccination (aOR 6.061, 95% CI 3.408 - 10.780), underlying co-morbidity (aOR 3.335, 95% CI 2.183 - 5.096), and female (aOR 1.833, 95% CI 1.090 - 3.081).
CONCLUSION: HCWs should strictly adhere to preventive measures, including vaccination, personal protective equipment, and early referral to a physician upon identifying severe COVID-19 infection. Early screening and aggressive co-morbidity treatment among HCWs are essential for public health practitioners to prevent severe COVID-19 disease. Regardless of co-morbidity status, HCWs should stay up to date with COVID-19 vaccination, including booster doses.
Fulltext Whole genome sequencing data and analysis of a rifampicin-resistant Mycobacterium tuberculosis strain SBH162 from Sabah, Malaysia

Jani J, Mustapha ZA, Jamal NB, Stanis CS, Ling CK, Avoi R, et al.

Data Brief, 2019 Oct;26:104445.
PMID: 31534995 DOI: 10.1016/j.dib.2019.104445

A Mycobacterium tuberculosis strain SBH162 was isolated from a 49-year-old male with pulmonary tuberculosis. GeneXpert MDR/RIF identified the strain as rifampicin-resistant M. tuberculosis. The whole genome sequencing was performed using Illumina HiSeq 4000 system to further investigate and verify the mutation sites of the strain through genetic analyses namely variant calling using bioinformatics tools. The de novo assembly of genome generated 100 contigs with N50 of 156,381bp. The whole genome size was 4,343,911 bp with G + C content of 65.58% and consisted of 4,306 predicted genes. The mutation site, S450L, for rifampicin resistance was detected in the rpoB gene. Based on the phylogenetic analysis using the Maximum Likelihood method, the strain was identified as belonging to the Europe America Africa lineage (Lineage 4). The genome dataset has been deposited at DDBJ/ENA/GenBank under the accession number SMOE00000000.
Fulltext Epidemiology of tuberculosis in Sabah, Malaysia, 2012-2018

Goroh MMD, Rajahram GS, Avoi R, Van Den Boogaard CHA, William T, Ralph AP, et al.

Infect Dis Poverty, 2020 Aug 26;9(1):119.
PMID: 32843089 DOI: 10.1186/s40249-020-00739-7

BACKGROUND: Tuberculosis (TB) is of high public health importance in Malaysia. Sabah State, located on the island of Borneo, has previously reported a particularly high burden of disease and faces unique contextual challenges compared with peninsular Malaysia. The aim of this study is to describe the epidemiology of TB in Sabah to identify risk groups and hotspots of TB transmission.
METHODS: We conducted a retrospective review of TB cases notified in Sabah, Malaysia, between 2012 and 2018. Using data from the state's 'myTB' notification database, we calculated the case notification rate and described trends in the epidemiology, diagnostic practices and treatment outcomes of TB in Sabah within this period. The Chi-squared test was used for determining the difference between two proportions.
RESULTS: Between 2012 and 2018 there were 33 193 cases of TB reported in Sabah (128 cases per 100 000 population). We identified several geographic hotspots, including districts with > 200 cases per 100 000 population per year. TB rates increased with age and were highest in older males. Children
Fulltext Knowledge, attitude and practice on diabetic wound care management among healthcare professionals and impact from a short course training in Sabah, Borneo

Bondi ME, Rahim SSSA, Avoi R, Hayati F, Ahmedy F, Omar A, et al.

Medeni Med J, 2020;35(3):188-194.
PMID: 33110670 DOI: 10.5222/MMJ.2020.02929

Objective: Healthcare professionals with an advanced level of knowledge and skills on diabetic wound care management are needed to effectively manage complex wounds. This study aimed to determine the effects of an educational intervention to enhance the management of wound care among healthcare professionals.

Method: This study was part of a quasi-experimental pre-post research design where 82 healthcare professionals were recruited and assigned to intervention and control groups. The participants in the intervention group attended two days of educational intervention training on diabetic wound care management, while there was no intervention in the control group. A questionnaire on knowledge, attitude, and practice was applied before and one-month post-intervention to both groups.

Results: Pre-test resulted in a low level of knowledge 72.1% and 74.4%, negative level of attitude 67.4% and 66.7%, and a moderate level of practice 79.1% and 76.9% in both intervention and control groups respectively. Post-test resulted in increasing levels of knowledge (76.7%), positive attitude (100%), and practice (76.7%) in the intervention group. At the same time, there was no significant change in the control group. Repeated Measure ANOVA for within-subject and between-subject effects resulted in a statistically significant p-value of 0.001 for knowledge, attitude, and practice after the educational intervention.

Conclusion: Health professionals have only a moderate level of knowledge on diabetic wound care management. It is important to improve this level by specific trainings and by using a good training module.
Fulltext Ecological Study of Sick Building Syndrome among Healthcare Workers at Johor Primary Care Facilities

Salvaraji L, Shamsudin SB, Avoi R, Saupin S, Kim Sai L, Asan SB, et al.

Int J Environ Res Public Health, 2022 Dec 19;19(24).
PMID: 36554980 DOI: 10.3390/ijerph192417099

INTRODUCTION: Persistent exposure to indoor hazards in a healthcare setting poses a risk of SBS. This study determines the prevalence of and risk factors for SBS among healthcare workers in health clinics.
METHODS: A cross-sectional study was conducted across four health clinics from February 2022 to May 2022. As part of the study, self-administered questionnaires were completed to determine symptoms related to SBS. An indoor air quality (IAQ) assessment was conducted four times daily for fifteen minutes at five areas in each clinic (laboratory, lobby, emergency room, pharmacy, and examination room).
RESULT: Most of the areas illustrated poor air movement (<0.15 m/s), except for the laboratory. The total bacterial count (TBC) was above the standard limit in both the lobby and emergency room (>500 CFU/m3). The prevalence of SBS was 24.84% (77) among the healthcare workers at the health clinics. A significant association with SBS was noted for those working in the examination room (COR = 2.86; 95% CI = 1.31; 6.27) and those experiencing high temperature sometimes (COR = 0.25; 95% CI = 0.11; 0.55), varying temperature sometimes (COR = 0.31; 95% CI = 0.003), stuffy air sometimes (COR = 0.17; 95% CI = 0.005; 0.64), dry air sometimes (COR = 0.20; 95% CI = 0.007; 0.64), and dust sometimes (COR = 0.25; 95% CI = 0.11; 0.60) and everyday (COR = 0.34; 95% CI = 0.14; 0.81). Only healthcare workers in the examination room (AOR = 3.17; 95% CI = 1.35; 7.41) were found to have a significant risk of SBS when controlling for other variables.
CONCLUSION: SBS is prevalent among healthcare workers at health clinics.
Fulltext Risk factor of plasmodium knowlesi infection in Sabah Borneo Malaysia, 2020: A population-based case-control study

Chin AZ, Avoi R, Atil A, Awang Lukman K, Syed Abdul Rahim SS, Ibrahim MY, et al.

PLoS One, 2021;16(9):e0257104.
PMID: 34506556 DOI: 10.1371/journal.pone.0257104

BACKGROUND: In the Malaysian state of Sabah, P. knowlesi notifications increased from 2% (59/2,741) of total malaria notifications in 2004 to 98% (2030/2,078) in 2017. There was a gap regarding P. knowlesi acquisition risk factors related to practice specifically in working age group. The main objective of this study was to identify the risk factors for acquiring P. knowlesi infection in Sabah among the working age group.
METHODS AND METHODS: This retrospective population-based case-control study was conducted in Ranau district to assess sociodemographic, behavioural and medical history risk factors using a pretested questionnaire. The data were entered and analyzed using IBM SPSS version 23. Bivariate analysis was conducted using binary logistic regression whereas multivariate analysis was conducted using multivariable logistic regression. We set a statistical significance at p-value less than or equal to 0.05.
RESULTS: A total of 266 cases and 532 controls were included in the study. Male gender (AOR = 2.71; 95% CI: 1.63-4.50), spending overnight in forest (AOR = 1.92; 95% CI: 1.20-3.06), not using mosquito repellent (AOR = 2.49; 95% CI: 1.36-4.56) and history of previous malaria infection (AOR = 49.34; 95% CI: 39.09-78.32) were found to be independent predictors of P. knowlesi infection.
CONCLUSIONS: This study showed the need to strengthen the strategies in preventing and controlling P. knowlesi infection specifically in changing the practice of spending overnight in forest and increasing the usage of personal mosquito repellent.
Fulltext Factors of Never Screened with Faecal Occult Blood Test in Public Primary Care Facilities

Sazali MF, Syed Abdul Rahim SS, Avoi R, Hassan MR, Hayati F, Azhar ZI, et al.

Asian Pac J Cancer Prev, 2021 Jan 01;22(1):163-169.
PMID: 33507695 DOI: 10.31557/APJCP.2021.22.1.163

BACKGROUND: Colorectal cancer (CRC) is still a major public health threat. In the effort to reduce CRC incidence and mortality, faecal occult blood test (FOBT) is currently the screening tools used for early detection of CRC. However, the uptake of FOBT screening is less than promising. This study aims to identify the prevalence and predictors of Never Screened with FOBT (NS-FOBT).
METHODS: A cross sectional study was conducted in five health clinics under Kota Kinabalu district, Sabah, Malaysia Borneo involving 162 attendees with age of 50 years old and above. A validated self-administered questionnaire was used to collect the data. Multiple logistic regression analysis was used to determine the predictors of NS-FOBT.
RESULTS: The prevalence of NS-FOBT was 85.8% (n=139). Important predictors of NS-FOBT were age (aOR: 0.922; 95% CI: 0.855, 0.995; p=0.035), Bumiputera ethnicity (vs Non Bumiputera; aOR: 4.285; 95% CI: 1.384, 13.263; p=0.012), knowledge score (aOR: 0.921; 95% CI: 0.856, 0.99; p=0.027), and attitude score (aOR: 0.801; 95% CI: 0.702, 0.913; p=0.001).
CONCLUSION: There is high prevalence of NS-FOBT. Age, ethnicity, knowledge, and attitude were important predictors of NS-FOBT. Strategies are needed to improve FOBT screening rate among the public. Socio-culturally tailored health promotion strategies as well as strengthening the communication, collaboration, and education to enhance the role of family physician is vital in improving the CRC prevention and care.
Fulltext Factors and outcomes in Severe Fever with Thrombocytopenia Syndrome (SFTS): A systematic review

Dualis H, Zefong AC, Joo LK, Dadar Singh NK, Syed Abdul Rahim SS, Avoi R, et al.

Ann Med Surg (Lond), 2021 Jul;67:102501.
PMID: 34188913 DOI: 10.1016/j.amsu.2021.102501

BACKGROUND: An emerging infectious zoonosis known as Severe Fever with Thrombocytopenia Syndrome (SFTS) is discovered mainly in Japan, South Korea and China. SFTS virus (SFTSV) which is recently recognised as bunyavirus is borne by ticks such as Haemaphysalis longicornis. It has the capabilities to spread as develop clusters and become a considerable public health threat as this virus could experience rapid evolution via gene mutation. Case fatality rate has been reported up to higher than 30%. The aim of this review is to determine the associated risk factors of SFTS and its outcome.
MATERIALS AND METHODS: Literature search was conducted using online databases PubMed, ScienceDirect, and Scopus. A total of 517 records were identified from searches in PubMed, ScienceDirect, and Scopus. From the final exclusions, a total of 26 studies were included for final analysis.
RESULTS: Associated risk factors to getting SFTS infection include occupation, history of bite from a tick, biological susceptibility, and owning of domestic animal. Fatality rates apart from single case reports range from 15.1% to 50% and are contributed by various factors including delay in hospital admission, high viral load, older age group and presence of comorbid and complication.
CONCLUSION: A seroprevalence study can be conducted amongst the high-risk occupation group such as farmers and agricultural workers, as well as testing cases where viral fever is suspected but available tests for other diseases turns out negative.

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