Typhoid fever continues to pose public health problems in Selangor where cases are found sporadically with occasional outbreaks reported. In February 2009, Hospital Tengku Ampuan Rahimah (HTAR) reported a cluster of typhoid fever among four children in the pediatric ward. We investigated the source of the outbreak, risk factors for the infection to propose control measures. We conducted a case-control study to identify the risk factors for the outbreak. A case was defined as a person with S. typhi isolated from blood, urine or stool and had visited Sungai Congkak recreational park on 27th January 2010. Controls were healthy household members of cases who have similar exposure but no isolation of S. typhi in blood, urine or stool. Cases were identified from routine surveillance system, medical record searching from the nearest clinic and contact tracing other than family members including food handlers and construction workers in the recreational park. Immediate control measures were initiated and followed up. Twelve (12) cases were identified from routine surveillance with 75 household controls. The Case-control study showed cases were 17 times more likely to be 12 years or younger (95% CI: 2.10, 137.86) and 13 times more likely to have ingested river water accidentally during swimming (95% CI: 3.07, 58.71). River water was found contaminated with sewage disposal from two public toilets which effluent grew salmonella spp. The typhoid outbreak in Sungai Congkak recreational park resulted from contaminated river water due to poor sanitation. Children who accidentally ingested river water were highly susceptible. Immediate closure and upgrading of public toilet has stopped the outbreak.
Patient and public involvement and engagement (PPIE) in health care research has been advocated to ensure that the research is relevant, acceptable and beneficial to the communities that it serves. However, there remains a significant gap in research projects incorporating PPIE among the transgender communities, particularly from the global South. In this narrative summary the authors describe the methodology of PPIE through a novel collaboration with community members for the design and development of a bilingual and culturally sensitive educational intervention that was tailor made for transgender women in Malaysia. The educational intervention named Ms Radiance was aimed at creating oral health awareness, improving oral health care utilization and promoting safe oral sex practices among transgender women. The PPIE team included local transgender community advocates and artists who played a pivotal role in making the educational content accessible, engaging and suitable for delivery through a popular social media platform, Instagram®. PPIE enhanced the intervention's relevance and effectiveness through community friendly, culturally appropriate content creation, delivery and trust-building. Instructional designs such as the ADDIE (analyse, design, develop, implement and evaluate) ensure that educational interventions are well-planned and effective. A structed PPIE approach in the research project was seamlessly integrated with the ADDIE instructional design that guided the effective planning and delivery of oral health and sexual health education The research highlights the impact of PPIE on the project and offers insights for future interventions in marginalized communities from the global South.