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Fulltext Reliability and Accuracy of 2D Photogrammetry: A Comparison With Direct Measurement

Lim YC, Abdul Shakor AS, Shaharudin R

Front Public Health, 2021;9:813058.
PMID: 35155360 DOI: 10.3389/fpubh.2021.813058

Objective: Facial anthropometric data is important for the design of respirators. Two-dimensional (2D) photogrammetry has replaced direct anthropometric method, but the reliability and accuracy of 2D photogrammetry has not been quantified. This study aimed to assess inter-rater reliability of 2D photogrammetry and to examine the reliability and accuracy of 2D photogrammetry with direct measurement.
Design: A cross-sectional study.
Setting: Malaysia.
Participants: A subset of 96 participants aged 18 and above.
Primary and secondary outcomes: Ten facial dimensions were measured using direct measurement and 2D photogrammetry. An assessment of inter-rater reliability was performed using intra-class correlation (ICC) of the 2D images. In addition, ICC and Bland-Altman analyses were used to assess the reliability and agreement of 2D photogrammetry with direct measurement.
Results: Except for head breadth and bigonial breadth, which were also found to have low inter-rater reliability, there was no significant difference in the inter-rater mean value of the 2D photogrammetry. The mean measurements derived from direct measurement and 2D photogrammetry were mostly similar. However, statistical differences were noted for two facial dimensions, i.e., bizygomatic breadth and bigonial breadth, and clinically the magnitude of difference was also significant. There were no statistical differences in respect to the remaining eight facial dimensions, where the smallest mean difference was 0.3 mm and biggest mean difference was 1.0 mm. The ICC showed head breadth had poor reliability, whilst Bland-Altman analyses showed seven out of 10 facial dimensions using 2D photogrammetry were accurate, as compared to direct measurement.
Conclusion: Only certain facial measurements can be reliably and accurately measured using 2D photogrammetry, thus it is important to conduct a reliability and validation study before the use of any measurement methods in anthropometric studies. The results of this study also suggest that 2D photogrammetry can be used to supplement direct measurement for certain facial dimensions.
Workplace injuries and risk reduction practices in Malaysia

Ali R, Shaharudin R, Omar A, Yusoff F

Int J Occup Environ Health, 2012 Oct-Dec;18(4):299-306.
PMID: 23433290 DOI: 10.1179/1077352512Z.00000000031

INTRODUCTION: This study on workplace injuries and risk reduction practices was part of the Malaysia National Health Morbidity Survey III (NHMS III) conducted in 2006.
METHODS: This cross-sectional population-based survey was conducted to determine the incidence of workplaces injuries and assess the magnitude of some important risk reduction practices among workers. Data were gathered through face-to-face household interviews using a pre-coded questionnaire.
RESULTS: Of the 22 880 eligible respondents, 88·2% (20 180) responded. The incidence rate for injuries at the workplace was 4·9 per 100 (95% CI: 4·6-5·2). The overall proportion of workers who had received occupational safety and health (OSH) training before or within 1 month of starting work was 33·6%. Among respondents who perceived that personal protective equipment (PPE) was required at their workplace, only 38·9% (95% CI: 37·8-39·4) were provided with it by their employers.
DISCUSSION: Further studies are urgently needed to identify reasons for and management of the low uptake of risk reduction practices. This issue needs to be addressed to ensure the safety and health of our working population.
Study name: National Health and Morbidity Survey (NHMS-2006)
DETECTION OF BURKHOLDERIA PSEUDOMALLEI FROM POST-FLOOD SOIL SAMPLES IN KELANTAN, MALAYSIA

Shaharudin R, Ahmad N, Kamaluddin MA, Veloo Y

Southeast Asian J. Trop. Med. Public Health, 2016 Sep;47(5):951-6.
PMID: 29620800

Burkholderia pseudomallei is an important causative organism of fatal community bacteremia especially in Southeast Asia and northern Australia. Outbreaks of melioidosis have been reported post-floods and -typhoons. A cross sectional study was conducted in January 2015, following a major flood in Kelantan, Malaysia to detect presence of B. pseudomallei from soil. A total of 89 soil samples were cultured for B. pseudomallei on Ashdown agar. Putative colonies underwent further staining and biochemical testing prior to confirmation by PCR. Rate of detection was 1%, although low, it nevertheless indicated a risk for melioidosis among flood victims in Kelantan. Flood affected individuals should be made aware of symptoms of melioidosis and healthcare providers must have a high index of suspicion of patients presenting with fever. Such subjects should be screened for the possibility of melioidosis and given prompt treatment to avoid preventable death.
Fulltext Urinary Concentrations of Metals and Metalloids in Malaysian Adults

Anual ZF, Mohammad Sham N, Ambak R, Othman F, Shaharudin R

Expo Health, 2021;13(3):391-401.
PMID: 34722950 DOI: 10.1007/s12403-021-00390-z

Exposure to environmental pollutants in humans can be conducted through direct measurement of biological media such as blood, urine or hair. Assessment studies of metals and metalloids in Malaysia is very scarce although cross-sectional nationwide human biomonitoring surveys have been established by the USA, Canada, Germany, Spain, France, and Korea. This study aims to assess urinary metal levels namely cadmium (Cd), nickel (Ni), lead (Pb) and arsenic (As) among Malaysian adults. This was a cross-sectional study involving 1440 adults between the age of 18 and 88 years old. After excluding those with 24 h urine samples of less than 500 ml, urine creatinine levels 3.0 g/L and those who refuse to participate in the study, a total of 817 respondents were included for analysis. A questionnaire with socio-demographic information such as age, gender, occupation, ethnic, academic qualification and medical history was administered to the respondents. Twenty-four-hour urine samples were collected in a container before being transported at 4 °C to the laboratory. Samples were then aliquoted into 15 ml tubes and kept at - 80 °C until further analysis. Urine was diluted ten-fold with ultrapure water, filtered and analysed for metals and metalloids using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). The geometric mean of urinary As, Ni, Cd and Pb concentrations among adults in Malaysia was 48.21, 4.37, 0.32, and 0.80 µg/L, respectively. Males showed significantly higher urinary metal concentrations compared to females for As, Cd and Pb except for Ni. Those who resided in rural areas exhibited significantly higher As, Cd and Pb urinary concentrations than those who resided in urban areas. As there are no nationwide data on urinary metals, findings from this study could be used to identify high exposure groups, thus enabling policy makers to improve public health strategically.
Fulltext Development of a web-geographical information system application for plotting tuberculosis cases

Mohidem NA, Osman M, Muharam FM, Mohd Elias S, Shaharudin R, Hashim Z

Geospat Health, 2021 Oct 19;16(2).
PMID: 34672178 DOI: 10.4081/gh.2021.980

In the last few decades, public health surveillance has increasingly applied statistical methods to analyze the spatial disease distributions. Nevertheless, contact tracing and follow up control measures for tuberculosis (TB) patients remain challenging because public health officers often lack the programming skills needed to utilize the software appropriately. This study aimed to develop a more user-friendly application by applying the CodeIgniter framework for server development, ArcGIS JavaScript for data display and a web application based on JavaScript and Hypertext Preprocessor to build the server's interface, while a webGIS technology was used for mapping. The performance of this approach was tested based on 3325 TB cases and their sociodemographic data, such as age, gender, race, nationality, country of origin, educational level, employment status, health care worker status, income status, residency status, and smoking status between 1st January 2013 and 31st December 2017 in Gombak, Selangor, Malaysia. These data were collected from the Gombak District Health Office and Rawang Health Clinic. Latitude and longitude of the location for each case was geocoded by uploading spatial data using Google Earth and the main output was an interactive map displaying location of each case. Filters are available for the selection of the various sociodemographic factors of interest. The application developed should assist public health experts to utilize spatial data for the surveillance purposes comprehensively as well as for the drafting of regulations aimed at to reducing mortality and morbidity and thus minimizing the public health impact of the disease.
Fulltext Environment as the risk factor for tuberculosis in Malaysia: a systematic review of the literature

Mohidem NA, Hashim Z, Osman M, Muharam FM, Elias SM, Shaharudin R

Rev Environ Health, 2021 Dec 20;36(4):493-499.
PMID: 34821116 DOI: 10.1515/reveh-2020-0096

OBJECTIVE: To investigate the prevalence and incidence of TB by focusing on its environmental risk factor in Malaysia.
CONTENT: Databases search of Scopus, ScienceDirect, PubMed, Directory of Open Access Journals (DOAJ), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, MyJournal, Biblioteca Regional de Medicina (BIREME), BioMed Central (BMC) Public Health, Medline, Commonwealth Agricultural Bureaux (CAB), EMBASE (Excerpta Medica dataBASE) OVID, and Web of Science (WoS) was performed, which include the article from 1st January 2008 until 31st August 2018 using medical subject heading (MeSH). Articles initially identified were screened for relevance.
SUMMARY: Out of 744 papers screened, nine eligible studies did meet our inclusion criteria. Prison and housing environments were evaluated for TB transmission in living environment, while the other factor was urbanization. However, not all association for these factors were statistically significant, thus assumed to be conflicting or weak to end up with a strong conclusion.
OUTLOOK: Unsustainable indoor environment in high congregate setting and overcrowding remained as a challenge for TB infection in Malaysia. Risk factors for transmission of TB, specifically in high risk areas, should focus on the implementation of specialized program. Further research on health care environment, weather variability, and air pollution are urgently needed to improve the management of TB transmission.
Prediction of tuberculosis cases based on sociodemographic and environmental factors in gombak, Selangor, Malaysia: A comparative assessment of multiple linear regression and artificial neural network models

Mohidem NA, Osman M, Muharam FM, Elias SM, Shaharudin R, Hashim Z

Int J Mycobacteriol, 2021 12 18;10(4):442-456.
PMID: 34916466 DOI: 10.4103/ijmy.ijmy_182_21

Background: Early prediction of tuberculosis (TB) cases is very crucial for its prevention and control. This study aims to predict the number of TB cases in Gombak based on sociodemographic and environmental factors.
Methods: The sociodemographic data of 3325 TB cases from January 2013 to December 2017 in Gombak district were collected from the MyTB web and TB Information System database. Environmental data were obtained from the Department of Environment, Malaysia; Department of Irrigation and Drainage, Malaysia; and Malaysian Metrological Department from July 2012 to December 2017. Multiple linear regression (MLR) and artificial neural network (ANN) were used to develop the prediction model of TB cases. The models that used sociodemographic variables as the input datasets were referred as MLR1 and ANN1, whereas environmental variables were represented as MLR2 and ANN2 and both sociodemographic and environmental variables together were indicated as MLR3 and ANN3.
Results: The ANN was found to be superior to MLR with higher adjusted coefficient of determination (R2) values in predicting TB cases; the ranges were from 0.35 to 0.47 compared to 0.07 to 0.14, respectively. The best TB prediction model, that is, ANN3 was derived from nationality, residency, income status, CO, NO2, SO2, PM10, rainfall, temperature, and atmospheric pressure, with the highest adjusted R2 value of 0.47, errors below 6, and accuracies above 96%.
Conclusions: It is envisaged that the application of the ANN algorithm based on both sociodemographic and environmental factors may enable a more accurate modeling for predicting TB cases.
Air pollution and cardiorespiratory hospitalization, predictive modeling, and analysis using artificial intelligence techniques

Usmani RSA, Pillai TR, Hashem IAT, Marjani M, Shaharudin R, Latif MT

Environ Sci Pollut Res Int, 2021 Oct;28(40):56759-56771.
PMID: 34075501 DOI: 10.1007/s11356-021-14305-7

Air pollution has a serious and adverse effect on human health, and it has become a risk to human welfare and health throughout the globe. One of the major effects of air pollution on health is hospitalizations associated with air pollution. Recently, the estimation and prediction of air pollution-based hospitalization is carried out using artificial intelligence (AI) and machine learning (ML) techniques, i.e., deep learning and long short-term memory (LSTM). However, there is ample room for improvement in the available applied methodologies to estimate and predict air pollution-based hospital admissions. In this paper, we present the modeling and analysis of air pollution and cardiorespiratory hospitalization. This study aims to investigate the association between cardiorespiratory hospitalization and air pollution, and predict cardiorespiratory hospitalization based on air pollution using the artificial intelligence (AI) techniques. We propose the enhanced long short-term memory (ELSTM) model and provide a comparison with other AI techniques, i.e., LSTM, DL, and vector autoregressive (VAR). This study was conducted at seven study locations in Klang Valley, Malaysia. The utilized dataset contains the data from January 2006 to December 2016 for five study locations, i.e., Klang (KLN), Shah Alam (SA), Putrajaya (PUJ), Petaling Jaya (PJ), and Cheras, Kuala Lumpur (CKL). The dataset for Banting contains data from April 2010 to December 2016, and the data for Batu Muda, Kuala Lumpur, contains data from January 2009 to December 2016. The prediction results show that the ELSTM model performed significantly better than other models in all study locations, with the best RMSE scores in Klang study location (ELSTM: 0.002, LSTM: 0.013, DL: 0.006, VAR: 0.066). The results also indicated that the proposed ELSTM model was able to detect and predict the trends of monthly hospitalization significantly better than the LSTM and other models in the study. Hence, we can conclude that we can utilize AI techniques to accurately predict cardiorespiratory hospitalization based on air pollution in Klang Valley, Malaysia.
Fulltext Arsenic in drinking water, hair, and prevalence of arsenicosis in Perak, Malaysia

Ramly N, Ahmad Mahir HM, Wan Azmi WNF, Hashim Z, Hashim JH, Shaharudin R

Front Public Health, 2023;11:998511.
PMID: 36875418 DOI: 10.3389/fpubh.2023.998511

Arsenic is a carcinogen element that occurs naturally in our environment. Humans can be exposed to arsenic through ingestion, inhalation, and dermal absorption. However, the most significant exposure pathway is via oral ingestion. Therefore, a comparative cross-sectional study was conducted to determine the local arsenic concentration in drinking water and hair. Then, the prevalence of arsenicosis was evaluated to assess the presence of the disease in the community. The study was conducted in two villages, namely Village AG and Village P, in Perak, Malaysia. Socio-demographic data, water consumption patterns, medical history, and signs and symptoms of arsenic poisoning were obtained using questionnaires. In addition, physical examinations by medical doctors were performed to confirm the signs reported by the respondents. A total of 395 drinking water samples and 639 hair samples were collected from both villages. The samples were analyzed using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) to determine arsenic concentration. The results showed that 41% of water samples from Village AG contained arsenic concentrations of more than 0.01 mg/L. In contrast, none of the water samples from Village P exceeded this level. Whilst, for hair samples, 85 (13.5%) of total respondents had arsenic levels above 1 μg/g. A total of 18 respondents in Village AG had at least one sign of arsenicosis and hair arsenic levels of more than 1 μg/g. Factors significantly associated with increased arsenic levels in hair were female, increasing age, living in Village AG and smoking. The prevalence of arsenicosis in the exposed village indicates chronic arsenic exposure, and immediate mitigation action needs to be taken to ensure the wellbeing of the residents in the exposed village.
Fulltext Exposure Assessment of methyl mercury from consumption of fish and seafood in Peninsular Malaysia

Ahmad NI, Mahiyuddin WRW, Azmi WNFW, Azlee RSR, Shaharudin R, Sulaiman LH

Environ Sci Pollut Res Int, 2022 Apr;29(17):24816-24832.
PMID: 34826068 DOI: 10.1007/s11356-021-17483-6

The concentration of meHg in freshwater fish and seafood was investigated, as well as the consumption patterns of fish and seafood by different demographic groups (age, ethnicity, gender). A potential alarm for human health hazards was also assessed, and the results were compared to the provisional tolerable weekly intakes (PTWIs) and the hazard quotient parameter (HQ). The results showed that meHg levels of 67 species ranged from 0.013 to 0.252 mg/kg of wet weight (WW) with significant differences between different fish and seafood groups (χ2KW = 49.09; p pelagic fish (0.0686 mg/kg WW) > freshwater fish 0.045 mg/kg WW) > cephalopods (0.0405 mg/kg WW) crustaceans (0.0356 mg/kg WW). The results revealed that older population (> 40 years old) consumed significantly (p = 0.000) more fish compared to younger generations and the elderly consumed the highest amounts of fish (104.0 ± 113.0 g/day). The adolescents (10-17 years old) consumed more than double of amount for both cephalopod and crustacean compared to the older populations (p
Fulltext Association of sociodemographic and environmental factors with spatial distribution of tuberculosis cases in Gombak, Selangor, Malaysia

Mohidem NA, Osman M, Hashim Z, Muharam FM, Mohd Elias S, Shaharudin R

PLoS One, 2021;16(6):e0252146.
PMID: 34138899 DOI: 10.1371/journal.pone.0252146

Tuberculosis (TB) cases have increased drastically over the last two decades and it remains as one of the deadliest infectious diseases in Malaysia. This cross-sectional study aimed to establish the spatial distribution of TB cases and its association with the sociodemographic and environmental factors in the Gombak district. The sociodemographic data of 3325 TB cases such as age, gender, race, nationality, country of origin, educational level, employment status, health care worker status, income status, residency, and smoking status from 1st January 2013 to 31st December 2017 in Gombak district were collected from the MyTB web and Tuberculosis Information System (TBIS) database at the Gombak District Health Office and Rawang Health Clinic. Environmental data consisting of air pollution such as air quality index (AQI), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2), and particulate matter 10 (PM10,) were obtained from the Department of Environment Malaysia from 1st July 2012 to 31st December 2017; whereas weather data such as rainfall were obtained from the Department of Irrigation and Drainage Malaysia and relative humidity, temperature, wind speed, and atmospheric pressure were obtained from the Malaysia Meteorological Department in the same period. Global Moran's I, kernel density estimation, Getis-Ord Gi* statistics, and heat maps were applied to identify the spatial pattern of TB cases. Ordinary least squares (OLS) and geographically weighted regression (GWR) models were used to determine the spatial association of sociodemographic and environmental factors with the TB cases. Spatial autocorrelation analysis indicated that the cases was clustered (p<0.05) over the five-year period and year 2016 and 2017 while random pattern (p>0.05) was observed from year 2013 to 2015. Kernel density estimation identified the high-density regions while Getis-Ord Gi* statistics observed hotspot locations, whereby consistently located in the southwestern part of the study area. This could be attributed to the overcrowding of inmates in the Sungai Buloh prison located there. Sociodemographic factors such as gender, nationality, employment status, health care worker status, income status, residency, and smoking status as well as; environmental factors such as AQI (lag 1), CO (lag 2), NO2 (lag 2), SO2 (lag 1), PM10 (lag 5), rainfall (lag 2), relative humidity (lag 4), temperature (lag 2), wind speed (lag 4), and atmospheric pressure (lag 6) were associated with TB cases (p<0.05). The GWR model based on the environmental factors i.e. GWR2 was the best model to determine the spatial distribution of TB cases based on the highest R2 value i.e. 0.98. The maps of estimated local coefficients in GWR models confirmed that the effects of sociodemographic and environmental factors on TB cases spatially varied. This study highlighted the importance of spatial analysis to identify areas with a high TB burden based on its associated factors, which further helps in improving targeted surveillance.
Fulltext Prevalence of Antibiotic-Resistant Pathogenic Bacteria and Level of Antibiotic Residues in Hospital Effluents in Selangor, Malaysia: Protocol for a Cross-sectional Study

Bakon SK, Mohamad ZA, Jamilan MA, Hashim H, Kuman MY, Shaharudin R, et al.

JMIR Res Protoc, 2023 May 29;12:e39022.
PMID: 37247207 DOI: 10.2196/39022

BACKGROUND: Antimicrobial resistance (AMR) has emerged as a major global public health challenge due to the overuse and misuse of antibiotics for humans and animals. Hospitals are among the major users of antibiotics, thereby having a large contribution to AMR.
OBJECTIVE: The aim of this study is to determine the prevalence of antibiotic-resistant pathogenic bacteria and the level of antibiotic residues in the hospital effluents in Selangor, Malaysia.
METHODS: A cross-sectional study will be performed in the state of Selangor, Malaysia. Tertiary hospitals will be identified based on the inclusion and exclusion criteria. The methods are divided into three phases: sample collection, microbiological analysis, and chemical analysis. Microbiological analyses will include the isolation of bacteria from hospital effluents by culturing on selective media. Antibiotic sensitivity testing will be performed on the isolated bacteria against ceftriaxone, ciprofloxacin, meropenem, vancomycin, colistin, and piperacillin/tazobactam. The identification of bacteria will be confirmed using 16S RNA polymerase chain reaction (PCR) and multiplex PCR will be performed to detect resistance genes (ermB, mecA, blaNDM-L, blaCTX-M, blaOXA-48, blaSHV, VanA, VanB, VanC1, mcr-1, mcr-2, mcr-3, Intl1, Intl2, and qnrA). Finally, the level of antibiotic residues will be measured using ultrahigh-performance liquid chromatography.
RESULTS: The expected outcomes will be the prevalence of antibiotic-resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter (ESKAPE) bacterial species from the hospital effluents, the occurrence of antibiotic resistance genes (ARGs) from the isolated ESKAPE bacteria, and the level of antibiotic residues that may be detected from the effluent. Sampling has been conducted in three hospitals. Data analysis from one hospital showed that as of July 2022, 80% (8/10) of E. faecium isolates were resistant to vancomycin and 10% (1/10) were resistant to ciprofloxacin. Further analysis will be conducted to determine if the isolates harbor any ARGs and effluent samples are being analyzed to detect antibiotic residues. Sampling activities will be resumed after being suspended due to the COVID-19 pandemic and are scheduled to end by December 2022.
CONCLUSIONS: This study will provide the first baseline information to elucidate the current status of AMR of highly pathogenic bacteria present in hospital effluents in Malaysia.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39022.
Fulltext Compliance to Infection Prevention and Control Practices Among Healthcare Workers During COVID-19 Pandemic in Malaysia

Mohamad N, Pahrol MA, Shaharudin R, Md Yazin NKR, Osman Y, Toha HR, et al.

Front Public Health, 2022;10:878396.
PMID: 35923958 DOI: 10.3389/fpubh.2022.878396

Healthcare workers (HCWs) are at risk of contracting coronavirus disease-2019 (COVID-19) in their workplace. Infection prevention guidelines and standard operating procedures were introduced to reduce risk of exposure and prevent transmission. Safe practices during interaction with patients with COVID-19 are crucial for infection prevention and control (IPC). This study aimed to assess HCWs' compliance to IPC and to determine its association with sociodemographic and organizational factors. A cross-sectional study was conducted between March and April 2021 at public healthcare facilities in the east coast of Peninsular Malaysia. HCWs who were involved with COVID-19-related works were invited to participate in the online survey. The questionnaire was adapted from the World Health Organization (WHO) Interim Guidance: WHO Risk Assessment and Management of Exposure of Healthcare Workers in the Context of COVID-19. Respondents were categorized as compliant or non-compliant to IPC. A total of 600 HCWs involved in COVID-19-related works participated in the survey. Most of them (63.7%) were compliant to IPC as they responded to all items as "always, as recommended" during interaction with patients with COVID-19. The multivariate analysis showed that non-compliance was significantly associated with working in the emergency department (AOR = 3.16; 95% CI = 1.07-9.31), working as laboratory personnel (AOR = 15.13; 95% CI = 1.36-168.44), health attendant (AOR = 4.42; 95% CI = 1.74-11.24), and others (AOR = 3.63; 95% CI = 1.1-12.01), as well as work experience of more than 10 years (AOR = 4.71; 95% CI = 1.28-17.27). The odds of non-compliance among respondents without adequate new norms and personal protective equipment training were 2.02 (95% CI = 1.08-3.81) more than those with adequate training. Although most of the respondents complied to IPC protocols, compliance status differed according to department, work category, and years of service. Ensuring adequate training that will hopefully lead to behavioral change is crucial to prevent breach in IPC and thus minimize the risk of exposure to and transmission of COVID-19 in healthcare facilities.
Fulltext Source of cigarettes among youth smokers in Malaysia: Findings from the tobacco and e-cigarette survey among Malaysian school adolescents (TECMA)

Lim KH, Teh CH, Heng PP, Pan S, Ling MY, Yusoff MFM, et al.

Tob Induc Dis, 2018;16:51.
PMID: 31516448 DOI: 10.18332/tid/96297

INTRODUCTION: Understanding how and where youth obtain tobacco products are major factors in the development of suitable intervention programs to reduce youth smoking. This study aimed to determine the source of cigarettes and the associated factors among Malaysian school adolescent smokers.

METHODS: Our sample consisted of 1348 youth aged 10-17 years who were current smokers (having smoked at least once in the last 30 days). The source of cigarettes (commercial, over-the-counter purchases; or social, borrowing or obtaining from someone else) was the dependent variable, and multivariable logistic regression was employed to determine its association with independent variables (i.e. sociodemographics, smoking behavior, and knowledge of laws prohibiting sales of cigarettes to youth).

RESULTS: Over half (54.3%) of current smokers obtained cigarettes from commercial sources, with a proportion nearly two times higher (84.2% vs 43.7%) among frequent smokers (i.e. those smoking more than 20 days per month) compared to less-frequent smokers, and among young males (56.5% vs 32.0%) compared young females. Multivariable logistic regression indicated that in urban areas, young females (AOR=12.5, 95% CI: 1.38-99.8) frequent smokers (AOR=4.41, 95% CI: 2.05-9.46), and those studying in lower (AOR=3.76, 95% CI: 1.41-10.02) and upper secondary (AOR=4.74, 95% CI: 1.72-13.06) school students were more likely to obtain cigarettes from a commercial source. On the other hand, in rural areas, only frequent smokers were more likely to get their cigarettes from commercial sources, whilst other variables were not significant.

CONCLUSIONS: The proportion of youth smokers who obtained cigarettes from commercial sources appeared to be high, suggesting that law enforcement and health promotion activities should be enhanced to reduce the rate of smoking among Malaysian youth.
Fulltext Fish consumption pattern among adults of different ethnics in Peninsular Malaysia

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.
Environmental surface sampling of SARS-CoV-2 in selected hospitals in Malaysia

Rajendiran S, Thahir SSA, Veloo Y, Suppiah J, Pahrol MA, Shakor ASA, et al.

Trop Biomed, 2021 Sep 01;38(3):462-468.
PMID: 34608120 DOI: 10.47665/tb.38.3.089

COVID-19 has spread rapidly worldwide. The role of fomites in facilitating onward transmission is plausible. This study aimed to determine the presence of viable virus and its persistence on the surfaces of fomites in wards treating COVID-19 patients in Malaysia. This study was conducted in two stages. First, environmental sampling was performed on random days in the intensive care unit (ICU) and general wards. Then, in the second stage, samples were collected serially on alternate days for 7 days in two selected general wards. In Stage 1, a total of 104 samples were collected from the surfaces of highly touched and used areas by patients and healthcare workers. Only three samples were tested positive for SARS-COV-2. In Stage 2, three surface samples were detected positive, but no persistence of the virus was observed. However, none of the SARS-CoV-2 RNA was viable through tissue culture. Overall, the environmental contamination of SARS-CoV-2 was low in this hospital setting. Hospitals' strict infection control and the compliance of patients with wearing masks may have played a role in these findings, suggesting adherence to those measures to reduce occupational exposure of COVID-19 in hospital settings.
Fulltext Concerns, perceived impact, practices, preventive measures, and stress among healthcare workers during COVID-19 pandemic in Malaysia

Pahrol MA, Ismail R, Mohamad N, Lim YC, Muhamad Robat R, Rajendiran S, et al.

Front Public Health, 2023;11:1028443.
PMID: 36935685 DOI: 10.3389/fpubh.2023.1028443

INTRODUCTION: Healthcare workers (HCWs) have been continually exposed to patients with COVID-19 and are at higher risk of contracting the disease. Their psychological health is important for overall wellbeing and productivity, which could lead to a reduction in human errors during the pandemic crisis. This study aimed to measure the level of concerns, work practices, adequacy of preventive measures among HCWs, and the impacts on their life and work, including mental health status during the second wave of the COVID-19 pandemic in Malaysia.
METHODS: An online questionnaire was distributed randomly to 1,050 HCWs from the Ministry of Health facilities in the Klang Valley who were involved directly in managing or screening COVID-19 cases from May to August 2020. The questionnaire was divided into five domains, which were concerns, impact on life and work, practice, perceived adequacy of preventive measures, and Revised Impact of Event Scale (IES-R). Logistic regression was used to identify sociodemographic predictors of the five domains.
RESULTS: A total of 907 respondents (86.4%) participated in this survey. Approximately half of the respondents had a low concern (50.5%), most of them had a good practice (85.1%), with 67.5% perceiving there were adequate preventive measures, and they perceived the outbreak had a low impact (92%) on their life and work. From the IES-R domain, 18.6% of respondents potentially suffered from post-traumatic stress disorder (PTSD).
CONCLUSION: During the second wave of the COVID-19 outbreak in Malaysia, HCWs practiced high levels of precautions and preventive measures because they were aware of the risk of infection as an occupational hazard. With the adequate implementation of policy and control measures, the psychological wellbeing of the majority HCWs remained well and adequately supported.
Fulltext The effect of N95 designs on respirator fit and its associations with gender and facial dimensions

Khairul Hasni NA, Ismail R, Muhamad Robat R, Mohamad N, Suib FA, Pahrol MA, et al.

PLoS One, 2023;18(11):e0288105.
PMID: 38019763 DOI: 10.1371/journal.pone.0288105

This study examined the association of various brands of NIOSH-certified N95 filtering face-piece respirators (FFR) fit with facial dimensions and gender. One hundred and thirty-five participants (77 females and 58 males) were recruited from the previous facial anthropometry study among Malaysians in 2020. Quantitative respirator fit testing of six FFR were performed using the TSI Portacount Pro+ 8038 which comprised of four exercises (bending over, talking, up-down head movement, and side to side head movement). An overall fit factor (FF) of ≥ 100 was considered a pass for each FFR. Analysis was done using T-test, Pearson's correlations, and generalised linear regression. The passing rates for the six FFR were 36.3% (Cup B), 50.4% (Trifold A), 54.1% (Duckbill A), 57.0% (Cup A), 74.1% (Trifold B), and 83.7% (Duckbill B). Both Duckbill B and Trifold B had the highest passing rates for both genders. However, certain FFR models (Cup B, Trifold A, Trifold B, and Duckbill A) fit better for participants with large facial size who were mostly males, while others (Cup A and Duckbill B) specifically fit better for those with small facial size, who were mostly females. This study showed significant positive effect of nose protrusion, nasal root and subnasale-sellion and the negative effect of menton-sellion, bigonial breadth and nose breadth on fit factors of various FFR. The results of this study emphasized the importance of choosing and designing FFR based on local anthropometry data, with careful consideration on the dimensions that affect the respirator fit. Since N95 are commonly used in the healthcare settings to prevent airborne transmission, the practice of respirator fit testing and selecting N95 with high passing rates for healthcare workers need to be emphasized.
Fulltext Droplet digital PCR application for the detection of SARS-CoV-2 in air sample

Rashid SA, Nazakat R, Muhamad Robat R, Ismail R, Suppiah J, Rajendran K, et al.

Front Public Health, 2023;11:1208348.
PMID: 37965510 DOI: 10.3389/fpubh.2023.1208348

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) may transmit through airborne route particularly when the aerosol particles remain in enclosed spaces with inadequate ventilation. There has been no standard recommended method of determining the virus in air due to limitations in pre-analytical and technical aspects. Furthermore, the presence of low virus loads in air samples could result in false negatives. Our study aims to explore the feasibility of detecting SARS-CoV-2 ribonucleic acid (RNA) in air samples using droplet digital polymerase chain reaction (ddPCR). Active and passive air sampling was conducted between December 2021 and February 2022 with the presence of COVID-19 confirmed cases in two hospitals and a quarantine center in Klang Valley, Malaysia. SARS-CoV-2 RNA in air was detected and quantified using ddPCR and real-time reverse transcriptase-polymerase chain reaction (RT-PCR). The comparability of two different digital PCR platforms (QX200 and QIAcuity) to RT-PCR were also investigated. Additionally negative staining transmission electron microscopy was performed to visualize virus ultrastructure. Detection rates of SARS-CoV-2 in air samples using ddPCR were higher compared to RT-PCR, which were 15.2% (22/145) and 3.4% (5/145), respectively. The sensitivity and specificity of ddPCR was 100 and 87%, respectively. After excluding 17 negative samples (50%) by both QX200 and QIAcuity, 15% samples (5/34) were found to be positive both ddPCR and dPCR. There were 23.5% (8/34) samples that were detected positive by ddPCR but negative by dPCR. In contrast, there were 11.7% (4/34) samples that were detected positive by dPCR but negative by ddPCR. The SARS-CoV-2 detection method by ddPCR is precise and has a high sensitivity for viral RNA detection. It could provide advances in determining low viral titter in air samples to reduce false negative reports, which could complement detection by RT-PCR.

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