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Fulltext Diabetic foot care practice and its associated factors among type 2 diabetes mellitus patients attending primary health clinics in kuantan, malaysia: a cross sectional study.

Azmi NH, Abdul Hadi A, Md Aris MA, Nasreen HE, Che-Ahmad A

IIUM Medical Journal Malaysia, 2020;19(2):13-19.
MyJurnal

One of the most important and debilitating complication of diabetes mellitus is foot problem such as ulcers, infections and amputations. However, these complications are preventable by simple intervention such as regular foot care practice. This study aims to assess the foot care practice and its associated factors among type 2 diabetes mellitus patients attending primary health clinics in Kuantan. MATERIALS AND METHODS: This was a cross-sectional study conducted at four primary health clinics in Kuantan involving 450 study participants who were selected by using universal sampling method. Level of awareness and practice toward diabetic foot care was assessed using validated self-administered questionnaire. Multiple logistic regressions were performed to identify factors associated with poor foot care practice among the respondents. RESULTS:About 59.6% of respondents had poor foot care practice and 50.9% had poor awareness level. Multivariate logistic regression analysis identified that, increasing age (OR0.97, 95% CI: 0.955-0.993) and good awareness towards foot problem (OR0.43, 95%CI: 0.289-0.643) were less likely to have poor foot care practice. However, Malay ethnicity (OR 1.81, 95% CI: 1.002-3.271) and obesity (OR1.9, 95% CI: 1.225-2.976) were associated with poor foot care practice after controlling other variables. CONCLUSION:Majority of the respondents had poor foot care practice and poor awareness. Respondents who are older and have better awareness are less likely to have poor foot care practice. Diabetic patients who are Malays and/or obese are predicted to have poor diabetic foot practice and hence must be prioritized for a sustainable patient education and compliance towards foot care practice at primary care level.
Fulltext Prevalence and associated factors of diabetic foot at risk among type 2 diabetes mellitus patients attending primary health clinics in kuantan.

Azmi NH, Abdul Hadi A, Md Aris MA, Nasreen HE, Che-Ahmad A

IIUM Medical Journal Malaysia, 2020;19(3):11-19.
MyJurnal

The diabetic foot at risk is the diabetic foot which is at risk of ulceration, hence the importance of identifying the foot at this stage. This study aims to assess the prevalence of diabetic foot at risk and its associated factors among type 2 diabetes mellitus patients’ attending primary health clinics in Kuantan.Methods and methods: This was a cross-sectional study conducted at four primary health clinics in Kuantan involving 450 study participants who were selected by using universal sampling method. Foot examination was carried out and foot at risk was classified based on the Kings’ Classification. Multiple logistic regressions were performed to identify the predictors for diabetic foot at risk. Results: The prevalence of diabetic foot at risk was 31.3%. Multivariate logistic regression analysis identified age (OR 1.04, 95% CI: 1.01-1.06), smoker (OR 4.11, 95% CI: 1.96-8.63) and duration of diabetes more than 10 years (OR1.77, 95% CI: 1.05-2.98) as risk factors for diabetic foot at risk. Respondents with higher diabetic foot practice score (OR 0.87, 95% CI: 0.77-0.98) have lesser risk of developing diabetic foot at risk. Conclusion: Patients who are older, smoker and/or have chronic diabetes are predicted to be at higher risk to develop the diabetic foot at risk. This study also showed that patients with better foot care practice has lesser risk. Therefore, these are the groups of patients that need to be targeted for early detection and intervention to prevent serious complications.
Fulltext "I can't stop worrying about everything"—experiences of rural Bangladeshi women during the first postpartum months

Edhborg M, Nasreen HE, Kabir ZN

Int J Qual Stud Health Well-being, 2015;10:26226.
PMID: 25595913 DOI: 10.3402/qhw.v10.26226

Over recent years, researchers have found evidence which indicates that the prevalence of postpartum depressive symptoms crosses cultural boundaries and is reported to be at least as high in non-Western countries as in Western countries. However, qualitative studies about new mothers' experiences from non-Western countries, such as Bangladesh, are rare, particularly in rural areas. This study aims to describe the experiences and concerns of rural Bangladeshi mothers with postpartum depressive symptoms. Open narrative interviews were conducted with 21 mothers with depressive symptoms 2-3 months postpartum, consecutively selected from a longitudinal study about prevalence and risk factors of perinatal depressive symptoms. Inductive content analysis was used to analyse data and three themes emerged: family dynamics, living at the limits of survival, and role of the cultural context after childbirth. These themes were based on six categories and 15 subcategories. The findings show that troublesome family relationships, including intimate partner violence and violence in the family, influenced the mothers' mental well-being. They and their families lived at the limit of survival and the mothers expressed fear and worries about their insecure situation regarding economic difficulties and health problems. They felt sorry for being unable to give their infants a good start in life and sad because they could not always follow the traditional norms related to childbirth. Thus, it is important to focus on the depressive symptoms among new mothers and offer counselling to those showing depressive symptoms, as the cultural traditions do not always alleviate these symptoms in the changing Bangladeshi society today.
Intimate partner violence and its association with maternal depressive symptoms 6-8 months after childbirth in rural Bangladesh

Kabir ZN, Nasreen HE, Edhborg M

Glob Health Action, 2014 Dec;7(1):24725.
PMID: 28672475 DOI: 10.3402/gha.v7.24725

Background The prevalence of intimate partner violence (IPV), a gross violation of human rights, ranges widely across the world with higher prevalence reported in low- and middle-income countries. Evidence related mainly to physical health shows that IPV has both direct and indirect impacts on women's health. Little is known about the impact of IPV on the mental health of women, particularly after childbirth. Objective To describe the prevalence of IPV experienced by women 6-8 months after childbirth in rural Bangladesh and the factors associated with physical IPV. The study also aims to investigate the association between IPV and maternal depressive symptoms after childbirth. Design The study used cross-sectional data at 6-8 months postpartum. The sample included 660 mothers of newborn children. IPV was assessed by physical, emotional, and sexual violence. The Edinburgh Postnatal Depression Scale assessed maternal depressive symptoms. Results Prevalence of physical IPV was 52%, sexual 65%, and emotional 84%. The husband's education (OR: 0.41, CI: 0.23-0.73), a poor relationship with the husband (OR: 2.64, CI: 1.07-6.54), and emotional violence by spouse (OR: 1.58, CI: 1.35-1.83) were significantly associated with physical IPV experienced by women. The perception of a fussy and difficult child (OR: 1.05, CI: 1.02-1.08), a poor relationship with the husband (OR: 4.95, CI: 2.55-9.62), and the experience of physical IPV (OR: 2.83, CI: 1.72-4.64) were found to be significant predictors of maternal depressive symptoms among women 6-8 months after childbirth. Neither forced sex nor emotional violence by an intimate partner was found to be significantly associated with maternal depressive symptoms 6-8 months postpartum. Conclusions It is important to screen for both IPV and depressive symptoms during pregnancy and postpartum. Since IPV and spousal relationships are the most important predictors of maternal depressive symptoms in this study, couple-focused interventions at the community level are suggested.
Prevalence and Associated Factors of Depressive Symptoms Among Disadvantaged Adolescents: Results from a Population-Based Study in Bangladesh

Nasreen HE, Alam MA, Edhborg M

J Child Adolesc Psychiatr Nurs, 2016 Aug 23.
PMID: 27553260 DOI: 10.1111/jcap.12150

Few studies have examined the adolescents' depression in low-income countries and no research has yet been carried out in Bangladesh. This study estimated the prevalence of depressive symptoms and explored the associated factors and help seeking behavior among adolescents in Bangladesh.
Pesticides Exposure and Cardiovascular Hemodynamic Parameters Among Male Workers Involved in Mosquito Control in East Coast of Malaysia

Samsuddin N, Rampal KG, Ismail NH, Abdullah NZ, Nasreen HE

Am J Hypertens, 2016 Feb;29(2):226-33.
PMID: 26112865 DOI: 10.1093/ajh/hpv093

Research findings have linked exposure to pesticides to an increased risk of cardiovascular (CVS) diseases. Therefore, this study aimed to assess the impact of chronic mix-pesticides exposure on CVS hemodynamic parameters.
Impact of parental perinatal depressive and anxiety symptoms trajectories on early parent-infant impaired bonding: a cohort study in east and west coasts of Malaysia

Nasreen HE, Pasi HB, Aris MAM, Rahman JA, Rus RM, Edhborg M

Arch Womens Ment Health, 2022 Apr;25(2):377-387.
PMID: 34313824 DOI: 10.1007/s00737-021-01165-w

The association between maternal depressive and anxiety symptoms and impaired bonding with infants were widely studied, but not in fathers and none in Malaysia. We investigated the impact of different trajectories of perinatal depressive and anxiety symptoms on parent-infant impaired bonding during 2-3 months postpartum in both mothers and fathers in two areas of Malaysia. This study originated from a psychiatric morbidity cohort study carried out in health clinics in east and west Malaysia. Edinburgh Postnatal Depression Scale and anxiety subscale of Depression, Anxiety, and Stress Scale at late pregnancy and 2-3 months postpartum and Postpartum Bonding Questionnaire were completed by 566 mothers and 457 fathers. About 11.7% mothers and 16.1% fathers reported depressive symptoms during pregnancy, 6.5% mothers and 10.5% fathers during 2-3 months postpartum, and 3-4% mothers and fathers both depressive and anxiety symptoms 2-3 months postpartum. The mean impaired bonding score was highest in mothers and fathers who had both depressive and anxiety symptoms 2-3 months postpartum. Impaired bonding is associated with higher EPDS and DASS (anxiety subscale) scores 2-3 months postpartum in both parents. Physical partner violence and deteriorated marital relationship were associated with increased risk of impaired bonding in mothers. The association between depressive, anxiety, and comorbidity of depressive and anxiety symptoms in both mothers and fathers and parent-infant impaired bonding during 2-3 months postpartum urges for screening and treatment of depressive and anxiety symptoms in both parents during early parenthood.
Fulltext Prevalence and determinants of antepartum depressive and anxiety symptoms in expectant mothers and fathers: results from a perinatal psychiatric morbidity cohort study in the east and west coasts of Malaysia

Nasreen HE, Rahman JA, Rus RM, Kartiwi M, Sutan R, Edhborg M

BMC Psychiatry, 2018 06 15;18(1):195.
PMID: 29902985 DOI: 10.1186/s12888-018-1781-0

BACKGROUND: Research on antepartum psychiatric morbidities investigating depressive and anxiety symptoms in expectant mothers and fathers is lacking in low- and middle-income countries. This study aimed to estimate the prevalence of antepartum depressive, anxiety and co-occurring significant symptoms and explore the associated factors in a cross-section of Malaysian expectant mothers and fathers.

METHODS: We used cross-sectional data from a prospective cohort study of 911 expectant mothers and 587 expectant fathers during their third trimester of pregnancy, from health clinics of two states in the east and west coasts of Malaysia. The validated Malay version of Edinburgh Postnatal Depression Scale and the anxiety sub-scale of Depression, Anxiety and Stress Scale were used to measure the depressive and anxiety symptoms. Multiple logistic regression analyses identified the determinants of antepartum depressive and anxiety symptoms (ADS and AAS).

RESULTS: Prevalence of ADS was 12.2% in expectant mothers and 8.4% in expectant fathers, while AAS was 28.8% in expectant mothers and 13.3% in expectant fathers, and co-occurring significant symptoms was 8.0% in expectant mothers and 4.0% in expectant fathers. Expectant mothers and fathers having perceived social/family support were less likely to suffer from ADS. Intimate partner violence, poor relationship with husbands, depression in earlier pregnancy and husband's depression in current pregnancy in expectant mothers, and living in rented house, sex preference for the unborn child, stressful life events and wife's depression in current pregnancy in expectant fathers were associated with a greater likelihood of ADS. The determinants for AAS were living in rented house and with parents/in-laws, poor relationship with husbands, restrictions during pregnancy and stressful life events for expectant mothers, and stressful life events and being unsupportive towards wives in household chores for expectant fathers.

CONCLUSION: Both ADS and AAS are prevalent in expectant mothers and fathers, and largely an undetected problem in Malaysia. Administration of couple-based screening and referral program during antenatal check-up should be universal practices to identify and treat the psychiatric morbidities.
Fulltext Impact of maternal antepartum depressive and anxiety symptoms on birth outcomes and mode of delivery: a prospective cohort study in east and west coasts of Malaysia

Nasreen HE, Pasi HB, Rifin SM, Aris MAM, Rahman JA, Rus RM, et al.

BMC Pregnancy Childbirth, 2019 Jun 14;19(1):201.
PMID: 31200677 DOI: 10.1186/s12884-019-2349-9

BACKGROUND: Antepartum depressive and anxiety symptoms (ADS and AAS) are prevalent in Malaysia. Prior evidence linking maternal ADS and AAS with adverse birth outcomes and caesarean section (CS) or instrumental delivery is conflicting. There is no research in Malaysia on the association between maternal mental disorders and adverse birth outcomes and mode of delivery. This study aims to investigate the independent effect of maternal ADS and AAS on low birth weight (LBW), preterm birth (PTB) and CS or instrumental delivery among women in east and west coasts of Malaysia.
METHODS: We used data from a prospective cohort study of 799 pregnant women from health clinics of two states in east and west coasts of Malaysia. Baseline data were measured at the third trimester of pregnancy on ADS, AAS, socioeconomic condition, anthropometric status, reproductive history and intimate partner violence. Birth outcomes and mode of delivery were determined at the time of delivery. Univariate and multiple Cox's regressions were applied to assess the association between ADS and AAS and LBW, PTB and CS or instrumental delivery.
RESULTS: ADS was significantly associated with an increased risk of giving birth to LBW babies in both east coast (RR = 3.64; 95% CI 1.79-7.40) and west coast (RR = 3.82; 95% CI 1.86-7.84), but not with PTB. AAS was associated with increased risk of both LBW (RR = 2.47; 95% CI 1.39-4.38) and PTB (RR = 2.49; 95% CI 1.16-5.36) in the east coast, but not in west coast. The risk of CS or instrumental delivery was evident among women with ADS (RR = 2.44; 95% CI 1.48-4.03) in west coast only.
CONCLUSION: ADS predicts LBW in both coasts, AAS predicts LBW and PTB in east coast, and ADS predicts CS or instrumental delivery in west coast. Policies aimed at detection and management of ADS and AAS during antenatal check-up in health clinics may help improve birth outcomes and reduce obstetric interventions.