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  1. Noor Artika Hassan, Hashim JH, Wan Puteh SE, Wan Mahiyuddin WR, Faisal MS
    MyJurnal
    Introduction: Altered weather patterns and changes in precipitation, temperature and humidity resulting
    from climate change could affect the distribution and incidence of cholera. This study is to quantify climateinduced increase in morbidity rates of cholera. Material and Methods: Monthly cholera cases and monthly
    temperature, precipitation, and relative humidity data from 2004 to 2014 were obtained from the Malaysian
    Ministry of Health and Malaysian Meteorological Department, respectively. Poisson generalized linear models
    were developed to quantify the relationship between meteorological parameters and the number of reported
    cholera cases. Results: The findings revealed that the total number of cholera cases in Malaysia during the 11
    year study period was 3841 cases with 32 deaths. Out of these, 45.1% of the cases were among children below
    12 years old and 75% of the cases were from Sabah. Temperature and precipitation gave significant impact on
    the cholera cases in Sabah, (p
  2. Hassan NA, Hashim JH , Hassan NA, Wan Puteh SE, Hassan NA , Hashim JH, Hashim JH, Wan Mahiyuddin WR, et al.
    MyJurnal
    Altered weather patterns and changes in precipitation, temperature and humidity resulting from climate change could affect the distribution and incidence of cholera. This study is to quantify climate-induced increase in morbidity rates of cholera. Material and Methods:Monthly cholera cases and monthly temperature, precipitation, and relative humidity data from 2004 to 2014 were obtained from the Malaysian Ministry of Health and Malaysian Meteorological Department, respectively. Poisson generalized linear models were developed to quantify the relationship between meteorological parameters and the number of reported cholera cases. Results:The findings revealed that the total number of cholera cases in Malaysia during the 11 year study period was 3841 cases with 32 deaths. Out of these, 45.1% of the cases were among children below 12 years old and 75% of the cases were from Sabah. Temperature and precipitation gave significant impact on the cholera cases in Sabah, (p
  3. Phung VLH, Ueda K, Sahani M, Seposo XT, Wan Mahiyuddin WR, Honda A, et al.
    Int J Epidemiol, 2022 Feb 18;51(1):155-165.
    PMID: 34148080 DOI: 10.1093/ije/dyab100
    BACKGROUND: Studies on the association between smoke haze (hereafter 'haze') and adverse health effects have increased in recent years due to extreme weather conditions and the increased occurrence of vegetation fires. The possible adverse health effects on under-five children (U5Y) is especially worrying due to their vulnerable condition. Despite continuous repetition of serious haze occurrence in Southeast Asia, epidemiological studies in this region remained scarce. Furthermore, no study had examined the association accounting for three important aspects (time lag, duration and intensity) concurrently.

    OBJECTIVE: This study aimed to examine the association between haze and U5Y mortality in Malaysia, considering time lag, duration and intensity of exposure.

    METHODS: We performed a time-stratified case-crossover study using a generalized additive model to examine the U5Y mortality related to haze in 12 districts in Malaysia, spanning from 2014 to 2016. A 'haze day' was characterized by intensity [based on concentrations of particulate matter (PM)] and duration (continuity of haze occurrence, up to 3 days).

    RESULTS: We observed the highest but non-significant odds ratios (ORs) of U5Y mortality at lag 4 of Intensity-3. Lag patterns revealed the possibility of higher acuteness at prolonged and intensified haze. Stratifying the districts by the 95th-percentile of PM distribution, the 'low' category demonstrated marginal positive association at Intensity-2 Duration-3 [OR: 1.210 (95% confidence interval: 1.000, 1.464)].

    CONCLUSIONS: We found a null association between haze and U5Y mortality. The different lag patterns of the association observed over different duration and intensity suggest consideration of these aspects in future studies.

  4. Dapari R, Bashaabidin MSM, Hassan MR, Dom NC, Rahim SSSA, Wan Mahiyuddin WR
    Int J Environ Res Public Health, 2022 Nov 21;19(22).
    PMID: 36430081 DOI: 10.3390/ijerph192215362
    Depression, anxiety, and stress (DAS) among adolescents have become a public health concern. The aim of this study was to develop, implement, and measure an IMB-based health education intervention module for reducing DAS among adolescents in boarding schools in the state of Negeri Sembilan, Malaysia. A single-blinded cluster randomised control trial (RCT) was conducted among students with abnormal DASS-21 scores. They were divided into an intervention group (three schools, 62 participants) and a control group (three schools, 57 participants). Participants in the intervention group received IMB-based health education, while participants in the control group underwent the standard care session. To determine the effectiveness of the intervention, the Generalised Linear Mixed Model (GLMM) analysis was conducted. A total of 119 students participated in this study, and no loss to follow-up was reported. Both intervention and control groups showed significantly reduced DAS scores (p < 0.005). However, the reduction of these scores was greater in the intervention group. The GLMM analysis revealed that the intervention was effective in reducing depression (ß = -2.400, t = -3.102, SE = 0.7735, p = 0.002, 95% CI = -3.921, -0.878), anxiety (ß = -2.129, t = -2.824, SE = 0.7541, p = 0.005, 95% CI = -3.612, -0.646), and stress (ß = -1.335, t = -2.457, SE = 0.536, p = 0.015, 95% CI = -2.045, -0.266) among adolescents. The IMB-based health education module was effective in reducing DAS among adolescents in boarding schools.
  5. Ab Rashid MA, Ahmad Zaki R, Wan Mahiyuddin WR, Yahya A
    Cureus, 2023 Sep;15(9):e44676.
    PMID: 37809275 DOI: 10.7759/cureus.44676
    Background The application of the Box-Jenkins autoregressive integrated moving average (ARIMA) model has been widely employed in predicting cases of infectious diseases. It has shown a positive impact on public health early warning surveillance due to its capability in producing reliable forecasting values. This study aimed to develop a prediction model for new tuberculosis (TB) cases using time-series data from January 2013 to December 2018 in Malaysia and to forecast monthly new TB cases for 2019. Materials and methods The ARIMA model was executed using data gathered between January 2013 and December 2018 in Malaysia. Subsequently, the well-fitted model was employed to make projections for new TB cases in the year 2019. To assess the efficacy of the model, two key metrics were utilized: the mean absolute percentage error (MAPE) and stationary R-squared. Furthermore, the sufficiency of the model was validated via the Ljung-Box test. Results The results of this study revealed that the ARIMA (2,1,1)(0,1,0)12 model proved to be the most suitable choice, exhibiting the lowest MAPE value of 6.762. The new TB cases showed a clear seasonality with two peaks occurring in March and December. The proportion of variance explained by the model was 55.8% with a p-value (Ljung-Box test) of 0.356. Conclusions The application of the ARIMA model has developed a simple, precise, and low-cost forecasting model that provides a warning six months in advance for monitoring the TB epidemic in Malaysia, which exhibits a seasonal pattern.
  6. Sapari H, Selamat MI, Isa MR, Ismail R, Wan Mahiyuddin WR
    JMIR Res Protoc, 2023 Oct 16;12:e44702.
    PMID: 37843898 DOI: 10.2196/44702
    BACKGROUND: Heat waves significantly impact ecosystems and human health, especially that of vulnerable populations, and are associated with increased morbidity and mortality. Besides being directly related to climate-sensitive health outcomes, heat waves have indirectly increased the burden on our health care systems. Although the existing literature examines the impact of heat waves and morbidity, past research has mostly been conducted in high-income countries (HICs), and studies on the impact of heat waves on morbidity in low- or middle-income countries (LMICs) are still scarce.

    OBJECTIVE: This paper presents the protocol for a systematic review that aims to provide evidence of the impact of heat waves on health care services in LMICs.

    METHODS: We will identify peer-reviewed studies from 3 online databases, including the Web of Science, PubMed, and SCOPUS, published from January 2002 to April 2023, using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Quality assessment will be conducted using the Navigation Guide checklist. Key search terms include heatwaves, extreme heat, hospitalization, outpatient visit, burden, health services, and morbidity.

    RESULTS: This systematic review will provide insight into the impact of heat waves on health care services in LMICs, especially on emergency department visits, ambulance call-outs, hospital admissions, outpatient department visits, in-hospital mortality, and health care operational costs.

    CONCLUSIONS: The results of this review are anticipated to help policymakers and key stakeholders obtain a better understanding of the impact of heat waves on health care services and prioritize investments to mitigate the effects of heat waves in LMICs. This entails creating a comprehensive heat wave plan and ensuring that adequate infrastructure, capacity, and human resources are allocated in the health care sector. These measures will undoubtedly contribute to the development of resilience in health care systems and hence protect the health and well-being of individuals and communities.

    TRIAL REGISTRATION: PROSPERO CRD42022365471; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=365471.

    INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44702.

  7. Abdullah NA, Wan Mahiyuddin WR, Muhammad NA, Ali ZM, Ibrahim L, Ibrahim Tamim NS, et al.
    Asian Pac J Cancer Prev, 2013;14(8):4591-4.
    PMID: 24083707
    Breast cancer is the most common cancer among Malaysian women. Other than hospital-based results, there are no documented population-based survival rates of Malaysian women for breast cancers. This population- based retrospective cohort study was therefore conducted. Data were obtained from Health Informatics Centre, Ministry of Health Malaysia, National Cancer Registry and National Registration Department for the period from 1st Jan 2000 to 31st December 2005. Cases were captured by ICD-10 and linked to death certificates to identify the status. Only complete data were analysed. Survival time was calculated from the estimated date of diagnosis to the date of death or date of loss to follow-up. Observed survival rates were estimated by Kaplan- Meier method using SPSS Statistical Software version 17. A total of 10,230 complete data sets were analysed. The mean age at diagnosis was 50.6 years old. The overall 5-year survival rate was 49% with median survival time of 68.1 months. Indian women had a higher survival rate of 54% compared to Chinese women (49%) and Malays (45%). The overall 5-year survival rate of breast cancer patient among Malaysian women was still low for the cohort of 2000 to 2005 as compared to survival rates in developed nations. Therefore, it is necessary to enhance the strategies for early detection and intervention.
  8. Ghazali SM, Othman Z, Cheong KC, Hock LK, Wan Mahiyuddin WR, Kamaluddin MA, et al.
    Asian Pac J Cancer Prev, 2013;14(2):1141-5.
    PMID: 23621202
    Delay in seeking treatment for breast cancer is a barrier to the early diagnosis and management of the disease, resulting in a poorer prognosis. We here estimated the prevalence of delayed presentation for breast cancer and identified possible influential sociodemographic factors in a cross-sectional study of 250 patients diagnosed with primary breast cancer at the Radiotherapy and Oncology Clinic in Kuala Lumpur Hospital. Data were collected by face-to-face interview using a structured questionnaire and from medical records. We examined associations between delayed presentation (presenting to a physician more than 3 months after self-discovery of a symptom) and sociodemographic characteristics, practice of breast self examination (BSE), history of benign breast disease, family history of breast cancer and type of symptom, symptom disclosure and advice from others to seek treatment using multiple logistic regression. Time from self-discovery of symptom to presentation ranged from tghe same day to 5 years. Prevalence of delayed presentation was 33.1% (95%CI: 27.4, 39.3). A significantly higher proportion of delayers presented with late stages (stage III/IV) (58.3% vs. 26.9%, p<0.001). Divorced or widowed women (OR: 2.23, 95% CI: 1.11, 4.47) had a higher risk of delayed presentation than married women and women who never performed breast self examination were more likely to delay presentation compared to those who regularly performed BSE (OR: 2.74, 95% CI: 1.33, 5.64). Our findings indicate that delayed presentation for breast cancer symptoms among Malaysian women is high and that marital status and breast self examination play major roles in treatment-seeking for breast cancer symptoms.
  9. Sahani M, Sulaiman NS, Tan BS, Yahya NA, Anual ZF, Mahiyuddin WR, et al.
    J Air Waste Manag Assoc, 2016 Nov;66(11):1077-1083.
    PMID: 27192328 DOI: 10.1080/10962247.2016.1188866
    Dental amalgam in fillings exposes workers to mercury. The exposure to mercury was investigated among 1871 dental health care workers. The aim of the study was to evaluate the risk of mercury exposure among dental compared to nondental health care workers and to determine other risk factors for mercury exposure. Respondents answered questionnaires to obtain demographic, personal, professional, and workplace information and were examined for their own amalgam fillings. Chronic mercury exposure was assessed through urinary mercury levels. In total, 1409 dental and 462 nondental health care workers participated in the study. Median urine mercury levels for dental and nondental health care workers were 2.75 μg/L (interquartile range [IQR] = 3.0175) and 2.66 μg/L (IQR = 3.04) respectively. For mercury exposure, there were no significant risk factor found among the workers involved within the dental care. The Mann-Whitney test showed that urine mercury levels were significantly different between respondents who eat seafood more than 5 times per week compared to those who eat it less frequently or not at all (p = 0.003). The urinary mercury levels indicated significant difference between dental workers in their practice using squeeze cloths (Mann-Whitney test, p = 0.03). Multiple logistic regression showed that only the usage of cosmetic products that might contain mercury was found to be significantly associated with the urinary mercury levels (odds ratio [OR] = 15.237; CI: 3.612-64.276). Therefore, mean urinary mercury levels of health care workers were low. Exposure to dental amalgam is not associated with high mercury exposure. However, usage of cosmetic products containing mercury and high seafood consumption may lead to the increase of exposure to mercury.

    IMPLICATIONS: Exposure to the high levels of mercury from dental amalgam can lead to serious health effects among the dental health care workers. Nationwide chronic mercury exposure among dental personnel was assessed through urinary mercury levels. Findings suggest low urinary mercury levels of these health care workers. Exposure to dental amalgam is not associated with high mercury exposure. However, the usage of cosmetic products containing mercury and high seafood consumption may lead to the increase of exposure to mercury.
  10. Phung VLH, Oka K, Honda Y, Hijioka Y, Ueda K, Seposo XT, et al.
    Environ Res, 2023 Feb 01;218:114988.
    PMID: 36463996 DOI: 10.1016/j.envres.2022.114988
    BACKGROUND: Climate change and its subsequent effects on temperature have raised global public health concerns. Although numerous epidemiological studies have shown the adverse health effects of temperature, the association remains unclear for children aged below five years old and those in tropical climate regions.

    METHODS: We conducted a two-stage time-stratified case-crossover study to examine the association between temperature and under-five mortality, spanning the period from 2014 to 2018 across all six regions in Malaysia. In the first stage, we estimated region-specific temperature-mortality associations using a conditional Poisson regression and distributed lag nonlinear models. We used a multivariate meta-regression model to pool the region-specific estimates and examine the potential role of local characteristics in the association, which includes geographical information, demographics, socioeconomic status, long-term temperature metrics, and healthcare access by region.

    RESULTS: Temperature in Malaysia ranged from 22 °C to 31 °C, with a mean of 27.6 °C. No clear seasonality was observed in under-five mortality. We found no strong evidence of the association between temperature and under-five mortality, with an "M-" shaped exposure-response curve. The minimum mortality temperature (MMT) was identified at 27.1 °C. Among several local characteristics, only education level and hospital bed rates reduced the residual heterogeneity in the association. However, effect modification by these variables were not significant.

    CONCLUSION: This study suggests a null association between temperature and under-five mortality in Malaysia, which has a tropical climate. The "M-" shaped pattern suggests that under-fives may be vulnerable to temperature changes, even with a small temperature change in reference to the MMT. However, the weak risks with a large uncertainty at extreme temperatures remained inconclusive. Potential roles of education level and hospital bed rate were statistically inconclusive.

  11. Ahmad NI, Noh MF, Mahiyuddin WR, Jaafar H, Ishak I, Azmi WN, et al.
    Environ Sci Pollut Res Int, 2015 Sep;22(17):12960-74.
    PMID: 25916470 DOI: 10.1007/s11356-015-4415-9
    This study is to determine total mercury in edible tissues of eight species of cephalopods and 12 species of crustaceans purchased from 11 identified major fish landing ports and wet markets throughout Peninsular Malaysia. The concentration of mercury was measured by cold vapor atomic absorption spectrometry (AAS) technique using the Perkin Elmer Flow Injection Mercury System (FIMS-400). In general, the mercury levels were low with concentrations in cephalopods ranging from 0.099 to 2.715 mg/kg dry weight (or 0.0184-0.505 mg/kg wet weight) and in crustaceans ranging from 0.057 to 1.359 mg/kg dry weight (or 0.0111-0.265 mg/kg wet weight). The mercury levels showed no significant differences (P > 0.05) between species for both cephalopods and crustaceans. There was no significant correlation between mercury concentrations and the body size of individual for both groups as well. Comparisons with mercury levels obtained found from other previous studies and/or species noted that they were of the same magnitude or relatively low compared to various locations reported worldwide.
  12. Ahmad NI, Noh MF, Mahiyuddin WR, Jaafar H, Ishak I, Azmi WN, et al.
    Environ Sci Pollut Res Int, 2015 Mar;22(5):3672-86.
    PMID: 25256581 DOI: 10.1007/s11356-014-3538-8
    This study was conducted to determine the concentration of total mercury in the edible portion of 46 species of marine fish (n = 297) collected from selected major fish landing ports and wholesale markets throughout Peninsular Malaysia. Samples were collected in June to December 2009. Prior to analysis, the fish samples were processed which consisted of drying at 65 °C until a constant weight was attained; then, it was grounded and digested by a microwave digestion system. The analytical determination was carried out by using a mercury analysis system. Total mercury concentration among fish species was examined. The results showed that mercury concentrations were found significantly higher (p 20 cm) and were positively related with fish size (length and weight) in all fish samples. Despite the results, the level of mercury in marine fish did not exceed the permitted levels of Malaysian and JECFA guideline values at 0.5 mg/kg methylmercury in fish.
  13. Hassan NA, Hashim JH, Wan Puteh SE, Wan Mahiyuddin WR, Mohd MSF, Shaharudin SM, et al.
    PLoS One, 2023;18(10):e0283133.
    PMID: 37862373 DOI: 10.1371/journal.pone.0283133
    This study is an attempt to investigate climate-induced increases in morbidity rates of food poisoning cases. Monthly food poisoning cases, average monthly meteorological data, and population data from 2004 to 2014 were obtained from the Malaysian Ministry of Health, Malaysian Meteorological Department, and Department of Statistics Malaysia, respectively. Poisson generalised linear models were developed to assess the association between climatic parameters and the number of reported food poisoning cases. The findings revealed that the food poisoning incidence in Malaysia during the 11 years study period was 561 cases per 100 000 population for the whole country. Among the cases, females and the ethnic Malays most frequently experienced food poisoning with incidence rates of 313 cases per 100,000 and 438 cases per 100,000 population over the period of 11 years, respectively. Most of the cases occurred within the active age of 13 to 35 years old. Temperature gave a significant impact on the incidence of food poisoning cases in Selangor (95% CI: 1.033-1.479; p = 0.020), Melaka (95% CI: 1.046-2.080; p = 0.027), Kelantan (95% CI: 1.129-1.958; p = 0.005), and Sabah (95% CI: 1.127-2.690; p = 0.012) while rainfall was a protective factor in Terengganu (95% CI: 0.996-0.999; p = 0.034) at lag 0 month. For a 1.0°C increase in temperature, the excess risk of food poisoning in each state can increase up to 74.1%, whereas for every 50 mm increase in rainfall, the risk of getting food poisoning decreased by almost 10%. The study concludes that climate does affect the distribution of food poisoning cases in Selangor, Melaka, Kelantan, Sabah, and Terengganu. Food poisoning cases in other states are not directly associated with temperature but related to monthly trends and seasonality.
  14. Williams CR, Gill BS, Mincham G, Mohd Zaki AH, Abdullah N, Mahiyuddin WR, et al.
    Epidemiol Infect, 2015 Oct;143(13):2856-64.
    PMID: 25591942 DOI: 10.1017/S095026881400380X
    We aimed to reparameterize and validate an existing dengue model, comprising an entomological component (CIMSiM) and a disease component (DENSiM) for application in Malaysia. With the model we aimed to measure the effect of importation rate on dengue incidence, and to determine the potential impact of moderate climate change (a 1 °C temperature increase) on dengue activity. Dengue models (comprising CIMSiM and DENSiM) were reparameterized for a simulated Malaysian village of 10 000 people, and validated against monthly dengue case data from the district of Petaling Jaya in the state of Selangor. Simulations were also performed for 2008-2012 for variable virus importation rates (ranging from 1 to 25 per week) and dengue incidence determined. Dengue incidence in the period 2010-2012 was modelled, twice, with observed daily weather and with a 1 °C increase, the latter to simulate moderate climate change. Strong concordance between simulated and observed monthly dengue cases was observed (up to r = 0·72). There was a linear relationship between importation and incidence. However, a doubling of dengue importation did not equate to a doubling of dengue activity. The largest individual dengue outbreak was observed with the lowest dengue importation rate. Moderate climate change resulted in an overall decrease in dengue activity over a 3-year period, linked to high human seroprevalence early on in the simulation. Our results suggest that moderate reductions in importation with control programmes may not reduce the frequency of large outbreaks. Moderate increases in temperature do not necessarily lead to greater dengue incidence.
  15. Chai SJ, Pua KC, Saleh A, Yap YY, Lim PV, Subramaniam SK, et al.
    J Clin Virol, 2012 Sep;55(1):34-9.
    PMID: 22739102 DOI: 10.1016/j.jcv.2012.05.017
    Nasopharyngeal carcinoma (NPC) is an Epstein-Barr Virus (EBV)-associated cancer that is the fifth most common cancer in Malaysia. Early and accurate diagnoses are critical for patient prognosis. Unfortunately, early detection of NPC is still a challenge and the cost of more accurate imaging protocols is prohibitive in developing countries like Malaysia.
  16. Ahmad NI, Wan Mahiyuddin WR, Tengku Mohamad TR, Ling CY, Daud SF, Hussein NC, et al.
    Food Nutr Res, 2016;60:32697.
    PMID: 27534846 DOI: 10.3402/fnr.v60.32697
    Understanding different patterns of fish consumption is an important component for risk assessment of contaminants in fish. A few studies on food consumption had been conducted in Malaysia, but none of them focused specifically on fish consumption. The objectives of this study were to document the meal pattern among three major ethnics in Malaysia with respect to fish/seafood consumption, identify most frequently consumed fish and cooking method, and examine the influence of demographic factors on pattern of fish consumption among study subjects.
  17. Kwan SC, Zakaria SB, Ibrahim MF, Wan Mahiyuddin WR, Md Sofwan N, A Wahab MI, et al.
    Environ Res, 2023 Jan 01;216(Pt 2):114524.
    PMID: 36228692 DOI: 10.1016/j.envres.2022.114524
    Road transport contributes over 70% of air pollution in urban areas and is the second largest contributor to the total carbon dioxide emissions in Malaysia at 21% in 2016. Transport-related air pollutants (TRAPs) such as NOx, SO2, CO and particulate matter (PM) pose significant threats to the urban population's health. Malaysia has targeted to deploy 885,000 EV cars on the road by 2030 in the Low Carbon Mobility Blueprint (LCMB). This study aims to quantify the health co-benefits of electric vehicle adoption from their impacts on air quality in Malaysia. Two EV uptake projections, i.e. LCMB and Revised EV Adoption (REVA) projections, and five electricity generation mix scenarios were modelled up to 2040. We used comparative health risk assessment to estimate the potential changes in mortality and burden of diseases (BoD) from the emissions in each scenario. Intake fractions and exposure-risk functions were used to calculate the burden from respiratory diseases (PM2.5, NOx, SO2, CO), cardiovascular diseases and lung cancer (PM2.5). Results showed that along with a net reduction of carbon emissions across all scenarios, there could be reduced respiratory mortality from NOx by 10,200 mortality (176,200 DALYs) and SO2 by 2600 mortality (45,400 DALYs) per year in 2040. However, there could also be additional 719 mortality (9900 DALYs) per year from PM2.5 and 329 mortality (5600 DALYs) from CO per year. The scale of reduction in mortality and BoD from NOx and SO2 are significantly larger than the scale of increase from PM2.5 and CO, indicating potential net positive health impacts from the EV adoption in the scenarios. The health cost savings from the reduced BoD of respiratory mortality could reach up to RM 7.5 billion per year in 2040. In conclusion, EV is a way forward in promoting a healthy and sustainable future transport in Malaysia.
  18. Wan Puteh SE, Aazmi MS, Aziz MN, Kamarudin N', Sam JI, Thayan R, et al.
    PLoS One, 2024;19(3):e0301068.
    PMID: 38517867 DOI: 10.1371/journal.pone.0301068
    BACKGROUND AND OBJECTIVES: While influenza circulates year-round in Malaysia, research data on its incidence is scarce. Yet, this information is vital to the improvement of public health through evidence-based policies. In this cross-sectional study, we aimed to determine the trends and financial costs of influenza.

    METHODS: Data for the years 2016 through 2018 were gathered retrospectively from several sources. These were existing Ministry of Health (MOH) influenza sentinel sites data, two teaching hospitals, and two private medical institutions in the Klang Valley, Malaysia. Expert consensus determined the final estimates of burden for laboratory-confirmed influenza-like illness (ILI) and severe acute respiratory infection (SARI). Economic burden was estimated separately using secondary data supplemented by MOH casemix costing.

    RESULTS: Altogether, data for 11,652 cases of ILI and 5,764 cases of SARI were extracted. The influenza B subtype was found to be predominant in 2016, while influenza A was more prevalent in 2017 and 2018. The distribution timeline revealed that the highest frequency of cases occurred in March and April of all three years. The costs of influenza amounted to MYR 310.9 million over the full three-year period.

    CONCLUSIONS: The study provides valuable insights into the dynamic landscape of influenza in Malaysia. The findings reveal a consistent year-round presence of influenza with irregular seasonal peaks, including a notable influenza A epidemic in 2017 and consistent surges in influenza B incidence during March across three years. These findings underscore the significance of continuous monitoring influenza subtypes for informed healthcare strategies as well as advocate for the integration of influenza vaccination into Malaysia's national immunization program, enhancing overall pandemic preparedness.

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