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  1. Lim, Kuang Hock, Sumarni Mohd Ghazali, Kee, Chee Cheong, Hejar Abdul Rahman, Amal Nasir Mustafa
    Int J Public Health Res, 2012;2(1):85-92.
    MyJurnal
    Accepted 8 February 2012.
    Introduction Social norms, though an important contributing factor of adolescent smoking in developed countries, has not been extensively studied in Malaysia. The objective of this study was to determine the association between certain perceived norms regarding smoking with smoking status among Malaysian secondary school students in Kota Tinggi, Johor.
    Methods Data were collected from 2311 respondents consisting of 1379 male and 923 female secondary school students in Kota Tinggi district via a self administered questionnaire. Five perceived norms regarding smoking were assessed, namely: perceived peer smoking prevalence, perceived parental reaction towards adolescent smoking, perceived public perception of adolescent smoking, ever noticed peers smoking inside and outside school and perceived enforcement of anti-smoking policy in school and their association with smoking status. Multiple logistic regressions controlling for gender, peer smoking and family smoking was performed.
    Results Of the five perceived norms, four were associated with smoking status, (perceived peer smoking prevalence (p
  2. Lim Hui Li, Heng Pei Pei, Teh Chien Huey, Kee Chee Cheon, Sumarni Mohd Ghazali, Lim Kuang Hock, et al.
    MyJurnal
    Introduction: Minimizing smoking initiation among adolescents has been identified as a strategy to reduce the preva- lence of tobacco induced diseases among Malaysian adults. The aims of this study were to investigate the prevalence and factors associated with smoking among secondary school- going adolescents in the state of Kelantan, Malaysia. Methods: A school-based survey was carried out in Kelantan to determine the prevalence and associated factors of smoking among Kelantanese adolescents. Two-stage cluster sampling was used to ensure the representativeness of the sample. A self-administered validated questionnaire was utilised to obtain data from the selected respondents. Multiple logistic regression analysis was used to determine the factors associated with smoking behaviour among school-going adolescents. Results: The study revealed that 10.1% (95 CI 8.5-11.9%) of the selected respondents were current smokers. The prevalence of male who smoked was significantly higher compared to female. MLR revealed that, males, respondents with at least one smoking parent/guardian, as well as the respondents with less supportive parents/ guardian were more likely to smoke. However, by having a few numbers of close friends and helpful peers in the school had shown no significant association for being the current smokers. Conclusion: The study showed that the prevalence of smoking was a bit lower than the national prevalence, and smoking behaviour was predominant among male adolescents in Kelantan state. Comprehensive measures with the involvement of parents/guardians were imperative to tackle smoking habits among adolescents by targeting high-risk groups identified in the study.
  3. Lim, Hui Li, Chong, Siew Man, Heng, Pei Pei, Lim, Kuang Kuay, Sumarni Mohd Ghazali, Kee, Chee Cheong, et al.
    Int J Public Health Res, 2020;10(2):1215-1218.
    MyJurnal
    Introduction Community-based health promotion programme has been recognised to reduce modifiable lifestyle risk behaviours for non-communicable diseases. The aim of this study was to evaluate the proportion of the awareness, knowledge and acceptance of a community-based intervention programme, “Komuniti Sihat, Pembina Negara“ (KOSPEN) (Healthy Community, Developed Nation). This cross-sectional study employed a two-stage proportionate sampling method to select a representative sample of communities in the Southern states of Peninsular Malaysia, Negeri Sembilan, Malacca, and Johor. Face-to-face interviews by trained research assistants using pre-validated questionnaires was the study tool applied. The study revealed that approximately two thirds of respondents were aware of the KOSPEN programme (65.5%) and almost half (45.4%) of them were involved in the health promotion activities, namely health screenings (84.8%), health talks (66.4%), and providing plain water in formal occasion (52.9%). About two thirds and one-quarter of them have a very good (73.4%) and good (24.1%) general view on this programme. Four out of ten respondents faced difficulties joining the activities. Lack of time (83.0%) was reported as the main barrier. The KOSPEN programme in overall was moderately accepted by the community. However, the need for future improvement has to be highlighted in order to enhance the involvement and participation of the communities.
  4. Lim, Hui Li, Ling, Miaw Yn, Teh, Chien Huey, Heng, Pei Pei, Kee, Chee Cheong, Sumarni Mohd Ghazali, et al.
    MyJurnal
    Introduction: Self-esteem is important for the development of adolescent’s psychological well-being. The Rosenberg
    Self-Esteem Scale (RSES) is the most commonly used instrument for measuring self-esteem. However, the Malay-language version of the RSES (RSES-M) has not been validated among upper secondary school students in Malaysia.
    Methods: We administered the RSES-M to 3349 students who participated in the Malaysia Adolescent Health Risk
    Behavior (MyAHRB) study. The construct validity of the RSES-M was assessed using exploratory factor analysis while
    internal consistency was evaluated by Cronbach alpha. Results: The study identified two factors in the RSES-M.
    The variance for the first and second factor was 30.32% and 19.91%, respectively, Item 7 (I wish I could have
    more respect to myself) which showed a positive correlation with the positive wording contrasted with the original
    RSES. Such contrary may be due to social and cultural background difference. Conclusion: The translated version
    of RSES-M can be considered as a valid tool to measure self-esteem in upper school going adolescents in Malaysia.
    However, future studies to determine the psychometric properties of item 7 in the Malaysian setting are strongly
    recommended to enhance the validity of RSES-M.
  5. Lim, Kuang Hock, Lim, Hui Li, Kee, Chee Cheong, Sumarni Mohd Ghazali, Heng, Pei Pei, Cheah, Yong Kang, et al.
    MyJurnal
    Introduction: Total restriction on smoking in the home is an effective tool to reduce Second-hand smoke (SHS) expo- sure in private dwellings. The aim of this study is to determine the prevalence of total smoking restrictions in Malay- sian homes and factors associated with its adoption. Methods: We analyzed data from a cross-sectional, household study – the Global Adult Tobacco Survey 2011, which involved a representative sample of Malaysian adults. Factors associated with the adoption of a totally smoke free home policy was determined by multivariable logistic regression. Results: Out of the 4250 respondents studied, 40.9% (95% CI 38.1-43.8) adopted a total smoking restriction within their homes. Adoption of total smoke-free home policy was significantly higher among Chinese and Indians, those without smokers in the house, non-smokers and government employees. The likelihood of adopting the total smok- ing restriction at home was lower among current smokers, of Malay ethnicity, low education attainment, having at least one house member who smoked, residing in rural areas, single or widow/widower/divorcee, those working in the private sector or self-employed. Conclusions: Less than half of Malaysian households implemented a total smok- ing restriction in their residence. Targeted activities to encourage the adoption of voluntary smoke-free rules among groups least likely to implement 100% smoking restrictions in the home are urgently needed with participation of all stakeholders to ensure its success.
  6. Sumarni Mohd G, Muhammad Amir K, Ibrahim Md S, Mohd Rodi I, Izzuna Mudla MG, Nurziyana I
    Trop Biomed, 2006 Dec;23(2):148-54.
    PMID: 17322816
    Childhood obesity is an established problem in many countries and emerging in others. Epidemiological data on obesity in children is essential in order to plan public health policy and services. A study was conducted to determine the prevalence of obesity in schoolchildren in the fifth grade of elementary school (10-12 years old) in the district of Kuala Selangor. Ten schools of which five are in urban and five in rural areas were selected consisting of 699 eleven year old schoolchildren from the three major ethnic groups. Using international cut-off points for obesity, we report an overall prevalence of obesity of 7.2%. Prevalence of obesity in urban children is 7.2% whereas in rural children it is 7.0 %. Analysed by gender, there were 8.9% obese boys and 5.3% obese girls. Among the 3 major ethnic groups, the Malays had the highest prevalence of obesity at 9.3% followed by the Chinese with 6.6% while among Indians 3.0%. The data obtained from this study suggests that obesity in Kuala Selangor children is a cause for concern in urban and rural areas.
  7. Kee CC, Sumarni MG, Lim KH, Selvarajah S, Haniff J, Tee GHH, et al.
    Public Health Nutr, 2017 May;20(7):1226-1234.
    PMID: 28077198 DOI: 10.1017/S136898001600344X
    OBJECTIVE: To determine the relationship between BMI and risk of CVD mortality and all-cause mortality among Malaysian adults.

    DESIGN: Population-based, retrospective cohort study. Participants were followed up for 5 years from 2006 to 2010. Mortality data were obtained via record linkages with the Malaysian National Registration Department. Multiple Cox regression was applied to compare risk of CVD and all-cause mortality between BMI categories adjusting for age, gender and ethnicity. Models were generated for all participants, all participants the first 2 years of follow-up, healthy participants, healthy never smokers, never smokers, current smokers and former smokers.

    SETTING: All fourteen states in Malaysia.

    SUBJECTS: Malaysian adults (n 32 839) aged 18 years or above from the third National Health and Morbidity Survey.

    RESULTS: Total follow-up time was 153 814 person-years with 1035 deaths from all causes and 225 deaths from CVD. Underweight (BMI<18·5 kg/m2) was associated with a significantly increased risk of all-cause mortality, while obesity (BMI ≥30·0 kg/m2) was associated with a heightened risk of CVD mortality. Overweight (BMI=25·0-29·9 kg/m2) was inversely associated with risk of all-cause mortality. Underweight was significantly associated with all-cause mortality in all models except for current smokers. Overweight was inversely associated with all-cause mortality in all participants. Although a positive trend was observed between BMI and CVD mortality in all participants, a significant association was observed only for severe obesity (BMI≥35·0 kg/m2).

    CONCLUSIONS: Underweight was associated with increased risk of all-cause mortality and obesity with increased risk of CVD mortality. Therefore, maintaining a normal BMI through leading an active lifestyle and healthy dietary habits should continue to be promoted.

  8. Teh CH, Teh MW, Lim KH, Kee CC, Sumarni MG, Heng PP, et al.
    BMC Public Health, 2019 Aug 27;19(1):1177.
    PMID: 31455283 DOI: 10.1186/s12889-019-7516-4
    BACKGROUND: Lifestyle risk behaviours such as smoking, alcohol consumption, physical inactivity, sedentary behaviour and low fruit/vegetable intake have been identified as the major causes of chronic diseases. Such behaviours are usually instigated in adolescence and tend to persist into adulthood. Studies on the clustering of lifestyle risk behaviours among adolescents are scarce, particularly in developing countries. Therefore, the present paper aimed to determine the clustering of lifestyle risk behaviours and its determinants among school-going adolescents in Malaysia.

    METHODS: Data were extracted from a cross-sectional study, the Malaysian Adolescent Health Risk Behaviour (MyAHRB) study, which was conducted from May to September 2013 across 11 states in Peninsular Malaysia. A two-stage proportionate-to-size sampling method was employed to select a total of 3578 school-going adolescents aged 16-17 years from 20 selected schools in urban and rural settlements, respectively. The MyAHRB study adopted a set of self-administered questionnaires adapted from the Global School-based Student's Health Survey (GSHS) and the Youth Risk Behaviour Surveillance.

    RESULTS: The results from the analysis of 2991 school-going adolescents aged 16-17 years showed that 16 (in boys) and 15 (in girls) out of 32 combinations of lifestyle risk behaviours clustered. Girls (aOR 2.82, 95% CI: 2.32-3.43) were significantly more likely to have clustered risk behaviours than boys; however, no significant associated factors were observed among girls. In contrast, boys of Malay descent (aOR 0.64, 95% CI: 0.46-0.89) or boys who had at least three friends (aOR 0.65, 95% CI: 0.43-0.99) were less likely to engage in multiple risk behaviours.

    CONCLUSION: The present study demonstrated the clustering of multiple risk behaviours that occurred in both genders; these results suggest that multiple behaviour intervention programmes, instead of programmes based on siloed approaches, should be advocated and targeted to the high-risk sub-populations identified in the present study.

  9. Kuang Hock L, Hui Li L, Chien Huey T, Yuvaneswary V, Sayan P, Muhd Yusoff MF, et al.
    BMJ Open, 2019 Feb 12;9(2):e020304.
    PMID: 30760510 DOI: 10.1136/bmjopen-2017-020304
    OBJECTIVE: Public opinion and support can be powerful mandates for smoke-free policy. However, the scarcity of evidence on public opinion among Malaysians necessitates further investigation. Therefore, this study aimed to determine the level of support for smoke-free policy at various public domains and its associated factors among Malaysian adults.

    DESIGN: Data were derived from the Global Adult Tobacco Survey, Malaysia (GATS-M). GATS-M is a nationwide study that employed a multistage, proportionate-to-size sampling strategy to select a representative sample of 5112 Malaysian adults aged 15 years and above. Multiple logistic regression was used to identify factors associated with support for smoke-free policy in selected public domains that is, workplaces, restaurants, bars, hotels, casinos, karaoke centres, public transport terminals and shopping centres.

    RESULTS: The level of support for enactment of a smoke-free policy at selected public domains varied from 37.8% to 94.4%, with the highest support was for gazetted smoke-free domains, namely, shopping centres (94.4%, 95% CI: 93.2% to 95.3%) and public transport terminals (85.2%, 95% CI: 83.3% to 86.9%). Multiple logistic regression revealed that non-smokers were more likely to support smoke-free policy at all domains. In addition, respondents who worked in workplaces with total or partial smoking restrictions were more likely to support a smoke-free policy ((total restriction adjusted OR (AOR): 14.94 (6.44 to 34.64); partial restriction AOR: 2.96 (1.138 to 6.35); non-restriction was applied as a reference).

    CONCLUSION: A majority of the Malaysian adult population supported the smoke-free policy, especially at gazetted smoke-free domains. Therefore, expansion of a total smoking ban to workplaces, restaurants, bars, hotels, casinos and karaoke centres is strongly recommended to reduce exposure to secondhand smoke and to denormalise smoking behaviour.

  10. Md Nadzri MN, Md Zamri ASS, Singh S, Sumarni MG, Lai CH, Tan CV, et al.
    Front Public Health, 2024;12:1289622.
    PMID: 38544725 DOI: 10.3389/fpubh.2024.1289622
    INTRODUCTION: Since the COVID-19 pandemic began, it has spread rapidly across the world and has resulted in recurrent outbreaks. This study aims to describe the COVID-19 epidemiology in terms of COVID-19 cases, deaths, ICU admissions, ventilator requirements, testing, incidence rate, death rate, case fatality rate (CFR) and test positivity rate for each outbreak from the beginning of the pandemic in 2020 till endemicity of COVID-19 in 2022 in Malaysia.

    METHODS: Data was sourced from the GitHub repository and the Ministry of Health's official COVID-19 website. The study period was from the beginning of the outbreak in Malaysia, which began during Epidemiological Week (Ep Wk) 4 in 2020, to the last Ep Wk 18 in 2022. Data were aggregated by Ep Wk and analyzed in terms of COVID-19 cases, deaths, ICU admissions, ventilator requirements, testing, incidence rate, death rate, case fatality rate (CFR) and test positivity rate by years (2020 and 2022) and for each outbreak of COVID-19.

    RESULTS: A total of 4,456,736 cases, 35,579 deaths and 58,906,954 COVID-19 tests were reported for the period from 2020 to 2022. The COVID-19 incidence rate, death rate, CFR and test positivity rate were reported at 1.085 and 0.009 per 1,000 populations, 0.80 and 7.57%, respectively, for the period from 2020 to 2022. Higher cases, deaths, testing, incidence/death rate, CFR and test positivity rates were reported in 2021 and during the Delta outbreak. This is evident by the highest number of COVID-19 cases, ICU admissions, ventilatory requirements and deaths observed during the Delta outbreak.

    CONCLUSION: The Delta outbreak was the most severe compared to other outbreaks in Malaysia's study period. In addition, this study provides evidence that outbreaks of COVID-19, which are caused by highly virulent and transmissible variants, tend to be more severe and devastating if these outbreaks are not controlled early on. Therefore, close monitoring of key epidemiological indicators, as reported in this study, is essential in the control and management of future COVID-19 outbreaks in Malaysia.

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