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  1. Self-reported practice of smoking cessation intervention (SCI) among primary care doctors at public health clinics in Kuala Lumpur, Malaysia
    Rahmah K, Zuhra H, Tohid H, Noor Azimah M
    Med J Malaysia, 2020 01;75(1):1-6.
    PMID: 32008011
    BACKGROUND: Primary care doctors are responsible to provide smoking cessation intervention (SCI) to smokers in a community. This study aimed to assess the SCI practice among primary care doctors themselves and its associated factors.

    METHODS: This cross-sectional study was conducted from July to October 2016. All the 140 doctors in 12 public primary care clinics in Kuala Lumpur were invited to participate in this study. However, only 122 doctors (females, 82.8%) completed the self-administered questionnaire that assessed their demography, clinical experience, SCI practice and its barriers, self-efficacy in delivering and knowledge on smoking and SCI.

    RESULTS: Only 42.6% of the doctors had good SCI practice. Almost all doctors assessed the smoking status of their patients (98.4%) and advised them to quit (98.4%). However, lesser proportions of the doctors followed up the practice of patients (50.0%), taught smokers on various methods of quit smoking (46.70%) and discussed about the barriers and resources to quit prior to the quit date (27.9%). Less than one-fourth of the doctors were confident in providing SCI. Although 69.7% had previous training in SCI, many felt they had inadequate knowledge (56.6%) and skills (47.5%). Only 11.5% of doctors thought their previous training was enough. Having higher level of knowledge on smoking and SCI was significantly associated with good SCI practice [adjusted Odds Ratio (95% Confidence Intervals): 1.21 (1.02, 1.43), p=0.026].

    CONCLUSION: The SCI practiced by the primary care doctors in this study was sub-standard, particularly in assisting smokers to quit and arranging follow up. Low self-efficacy in providing SCI was also common. These inadequacies may be due to poor knowledge and skills, which needs to be improved through effective clinical training.

  2. Fulltext Meal skipping among patients with Type 2 Diabetes Mellitus (T2DM) and its associations with glycaemic control, eating out of home and binge eatingbetes Mellitus (T2DM) and its associations with glycaemic control, eating out of home and binge eating
    Tohid, H., Md Monoto, E.M., Ooi, C.F., Leong, Y.H., Mohamad Ngasri, N.E., Ismail, M.I., et al.
    Medicine & Health, 2020;15(2):246-261.
    MyJurnal
    Tabiat langkau waktu makan adalah kaedah lazim untuk mengawal diet. Namun, amalan kaedah permakanan ini oleh pesakit diabetes melllitus (T2DM) masih belum diketahui berikutan kekangan kajian. Matlamat utama kajian ini adalah untuk mengenal pasti selazim mana pesakit T2DM melangkau waktu makan. Kaitannya dengan faktor sosiodemografi dan klinikal, HbA1c, makan di luar rumah dan kecelaruan gaya pemakanan turut dikaji. Kajian keratan lintang ini telah dijalankan pada tahun 2015 dalam kalangan 203 pesakit di klinik kesihatan awam di Kuala Lumpur. Borang soal selidik yang diisi sendiri oleh subjek termasuk borang Skala Kecelaruan Gaya Pemakanan dalam Bahasa Melayu. Seramai 41.4% subjek kerap melangkau waktu makan dan 61.6% subjek sering makan di luar. Hanya 2% sahaja yang mempunyai masalah kecelaruan gaya pemakanan. Regresi logistik berbilang menunjukkan subjek berbangsa Cina mempunyai kaitan yang kuat dengan tabiat melangkau waktu makan berbanding dengan subjek berbangsa Melayu (nisbah ganjil selaras: 0.36; 95% sela keyakinan: 0.16-0.77; nilai p: 0.009) setelah mengambil kira faktor usia, status pekerjaan, tahap pendidikan, HbA1c, komplikasi, jenis rawatan, makan di luar dan kecelaruan gaya pemakanan. Kesimpulannya, tabiat melangkau waktu makan merupakan satu amalan lazim begitu juga dengan makan di luar rumah. Namun, kecelaruan gaya pemakanan jarang dijumpai. Tabiat melangkau waktu makan tiada kaitan dengan amalan pemakanan ini dan juga kawalan gula dalam darah. Faktor budaya dan keagamaan berkemungkinan mempengaruhi amalan pemakanan individu. Kajian lanjut perlu dijalankan bagi mengenal pasti tahap keselamatan dan penerimaan berkaitan dengan amalan ini. Walau bagaimanapun, kesannya daripada sudut klinikal perlu diperiksa dengan teliti untuk mengelakkan komplikasi kesihatan.

  3. Fulltext E-cigarette use, its impact on tobacco smoking and the intention to quit
    Nurasyikin MS, Leelavathi M, Tohid H
    Medicine & Health, 2019;14(1):78-90.
    MyJurnal
    E-cigarettes have rapidly gained worldwide popularity. Since its use still poses a health risk to the users, it is important to assess their intention to quit this habit. This study aimed to determine the characteristics of e-cigarette use, its effect on cigarette smoking and users’ intention to quit vaping and smoking. A total of 377 e-cigarette users were recruited from three vape retail stores in Bandar Baru Bangi, Selangor. E-cigarette usage pattern, tobacco cigarette consumption and their intention to quit were assessed using a self-administered questionnaire. Most (70%) participants were e-cigarettes only users while 30% were dual users. The median duration of e-cigarette use was 2 (IQR 2) years. Almost all (98.4%) participants used third-generation devices and majority (63.7%) preferred liquid containing 6mg nicotine. About 92% participants, especially heavy smokers, smoked fewer tobacco cigarettes after initiating e-cigarette. Majority (79.6%) of dual users also had reduction in tobacco cigarette consumption with a median current consumption of 5 (IQR 5.0) cigarettes per day. Most (87%) e-cigarette users intend to quit the habit someday. However, many (63.1%) were in the pre-contemplation stage. E-cigarette users of less than 2 years duration tend to have the intention to quit compared to users of more than 2 years (p=0.005). In conclusion, there was more e-cigarette only users than the dual users. E-cigarette use could significantly reduce tobacco smoking, especially among heavy smokers. Most e-cigarette users had the intention to quit vaping but not in the near future and longer e-cigarette use may deter their intention to quit.
  4. Fulltext Post dengue neurological complication
    Hasliza AH, Tohid H, Loh KY, Santhi P
    Malays Fam Physician, 2015;10(2):49-51.
    PMID: 27099661 MyJurnal
    Dengue infection is highly endemic in many tropical countries including Malaysia. However, neurological complications arising from dengue infection is not common; Gullain-Barre syndrome (GBS) is one of these infrequent complications. In this paper, we have reported a case in which a 39-year-old woman presented with a neurological complication of dengue infection without typical symptoms and signs of dengue fever. She had a history of acute gastroenteritis (AGE) followed by an upper respiratory tract infection (URTI) weeks prior to her presentation rendering GBS secondary to the post viral URTI and AGE as the most likely diagnosis. Presence of thrombocytopenia was the only clue for dengue in this case.
  5. Fulltext Contact dermatitis presenting as non-healing wound: case report
    Leelavathi M, Le Y, Tohid H, Hasliza A
    Asia Pac Fam Med, 2011 May 15;10(1):6.
    PMID: 21575147 DOI: 10.1186/1447-056X-10-6
    Topical antiseptics are commonly used in the management of minor wounds, burns, and infected skin. These agents are widely used by health professionals and are often self-prescribed by patients as they are easily available over-the-counter. This case illustrates a 73 year old man who presented with a non-healing wound on his right forearm for 4 weeks. The wound started from an insect bite and progressively enlarged with increasing pruritus and burning sensation. Clinically an ill-defined ulcer with surrounding erythema and erosion was noted. There was a yellow crust overlying the center of the ulcer and the periphery was scaly. Further inquiry revealed history of self treatment with a yellow solution to clean his wound for 3 weeks. Patient was provisionally diagnosed to have allergic contact dermatitis secondary to acriflavine. Topical acriflavine was stopped and the ulcer resolved after treatment with non-occlusive saline dressing. Skin patch test which is the gold standard for detection and confirmation of contact dermatitis showed a positive reaction (2+) to acriflavine. Acriflavine is widely used as a topical antiseptic agent in this part of the world. Hence, primary care physicians managing a large variety of poorly healing wounds should consider the possibility of contact allergy in recalcitrant cases, not responding to conventional treatment. Patient education is an important aspect of management as this would help curb the incidence of future contact allergies.
  6. Isolation of Mycobacterium fortuitum in sputum specimens of a patient with chronic cough: Is it clinically significant?
    Radzniwan MR, Tohid H, Ahmad S, Mohd AF, Md Anshar F
    Malays Fam Physician, 2014;9(3):38-41.
    PMID: 26425304 MyJurnal
    Managing chronic cough is diagnostically challenging especially in primary care. This case report highlights the difficulties experienced in approaching a case of chronic cough from a primary care perspective. The discussion also involves the clinical significance and treatment dilemma of M. fortuitum chelonae complex that was isolated from the sputum cultures of an elderly woman who presented with chronic cough for more than a year.
  7. Fulltext A study on pregnant adolescents residing in a government home: common characteristics and their views on the pregnancy
    Tan P, Tohid H, Su X, Tan K, Azimah M, Khairani O
    Malays Fam Physician, 2012;7(1):11-5.
    PMID: 25606239 MyJurnal DOI: 10.4066/MFP.2012.1710
    BACKGROUND: Adolescent pregnancy has emerged to be a significant public health and social issue in Malaysia as its prevalence is increasing in our population.

    OBJECTIVES: This study aimed to identify the common characteristics of pregnant adolescents residing in a government shelter home. Their reasons for pregnancy, sources of information on contraception, and views on abortion and future care of the baby were explored.

    METHODS: A cross-sectional study was performed on 26 universally sampled pregnant adolescents in the centre. The adolescents responded to a set of self-administered questionnaire on their socio-demographic profiles, reasons of their pregnancy, contraception and future plans including abortion as well as care of the newborn.

    RESULTS: Almost all (92%) of the adolescents were unmarried. Majority of them were in late adolescence, age between 16 to 19 years (73.1%), from urban areas (73.1%) and of low income families (53.8%). There were 69.3% of the adolescents who were school dropouts. The reasons for pregnancy were consensual sexual activity (63.0%), coercion by boyfriend (18.5%), and rape (11.5%). The main sources of information on contraception were friends (50%), partners (50%) and the internet or mass media (42.3%). 54% had considered abortion earlier, but majority (92.0%) disagreed that abortion should be legalised in Malaysia. Most of the adolescents planned to parent their child with or without help from significant others and only 42.3% planned to relinquish their child for adoption.

    CONCLUSION: To curb teenage pregnancy-related problems, efforts on educating the adolescents about sexual reproductive health and assertive communication skills should be implemented, especially to the late adolescents, school dropouts and those from poor urban families. Parenthood support may be necessary to the pregnant adolescents who opted to care for their own child.

  8. Fulltext Clinical and Sociodemographic Predictors of the Quality of Life among Patients with Type 2 Diabetes Mellitus on the East Coast of Peninsular Malaysia
    Jusoh Z, Tohid H, Omar K, Muhammad NA, Ahmad S
    Malays J Med Sci, 2018 Feb;25(1):84-95.
    PMID: 29599638 MyJurnal DOI: 10.21315/mjms2018.25.1.10
    Background: The quality of life (QoL) describes the multidimensional self-perceived well-being of a person, which is an important diabetes outcome. This study aimed to measure the QoL scores among patients with type 2 diabetes mellitus (T2DM), as well as their clinical and sociodemographic predictors.

    Methods: This cross-sectional study involved 180 randomly sampled patients at a primary care clinic on the East Coast of Peninsular Malaysia. A self-administered questionnaire containing the Audit of Diabetes Dependent Quality of Life-18 (ADDQoL-18) was used.

    Results: Most of the respondents (96.7%) were Malay, with a median (interquartile range, IQR) age of 54.0 (14.0) years old. The majority of them were females (60.0%), married (81.1%) and from low-income families (63.3%), who attained a secondary education or lower (75.6%). Only 49.4% of them were employed. The mean (standard deviation, SD) ADDQoL-18 average weighted impact score was -4.58 (2.21) and all 18 domains were negatively affected, particularly the living condition, family life and working life. The multiple linear regression analysis showed that the age (adjusted B = 0.05,P= 0.004) and insulin use (adjusted B = -0.84,P= 0.011) were QoL predictors.

    Conclusion: T2DM negatively impacts the patient's QoL in all aspects of their life. The QoL improvement with age suggests that the older patients had accepted and adapted to their illness. The need to improve the QoL among insulin users was also highlighted.
    Study site: Klinik Kesihatan, Malaysia
  9. Fulltext Factors influencing insulin acceptance among type 2 diabetes mellitus patients in a primary care clinic: a qualitative exploration
    Abu Hassan H, Tohid H, Mohd Amin R, Long Bidin MB, Muthupalaniappen L, Omar K
    BMC Fam Pract, 2013;14:164.
    PMID: 24164794 DOI: 10.1186/1471-2296-14-164
    BACKGROUND: Many Type 2 Diabetes Mellitus (T2DM) patients refuse insulin therapy even when they require this modality of treatment. However, some eventually accept insulin. This study aimed to explore the T2DM patients' reasons for accepting insulin therapy and their initial barriers to use insulin.
    METHODS: This qualitative study interviewed twenty-one T2DM patients at a primary care clinic who had been on insulin for more than a year through three in-depth interviews and three focus group discussions. A semi structured interview protocol was used and the sessions were audio-recorded. Subsequently, thematic analysis was conducted to identify major themes.
    RESULTS: The participants' acceptance of insulin was influenced by their concerns and beliefs about diabetes and insulin. Concerns about complications of poorly controlled diabetes and side effects of other treatment regime had resulted in insulin acceptance among the participants. They also had a strong belief in insulin benefits and effectiveness. These concerns and beliefs were the results of having good knowledge about the diabetes and insulin, experiential learning, as well as doctors' practical and emotional support that helped them to accept insulin therapy and become efficient in self-care management. These factors also allayed their negative concerns and beliefs towards diabetes and insulin, which were their barriers for insulin acceptance as it caused fear to use insulin. These negative concerns were related to injection (self-injection, needle phobia, injection pain), and insulin use (inconvenience, embarrassment, lifestyle restriction, negative social stigma, and poor self-efficacy), whereas the negative beliefs were 'insulin could cause organ damage', 'their diabetes was not serious enough', 'insulin is for life-long', and 'insulin is for more severe disease only'.
    CONCLUSIONS: Exploring patients' concerns and beliefs about diabetes and insulin is crucial to assist physicians in delivering patient-centered care. By understanding this, physicians could address their concerns with aim to modify their patients' misconceptions towards insulin therapy. In addition, continuous educations as well as practical and emotional support from others were found to be valuable for insulin acceptance.
    TRIAL REGISTRATION: Universiti Kebangsaan Malaysia FF-214-2009.
    Study site: Primary Care clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
  10. Fulltext Do patients with type 2 diabetes mellitus know about specific dietary recommendations?
    Tohid H, Saharuddin A, Teh RJ, Noor Azimah M, Wan Farzihan WA, Mohd Radzniwan AR
    International Medical Journal Malaysia, 2017;16(2):93-99.
    MyJurnal
    INTRODUCTION: Diabetic patients generally have a good idea about healthy diet however their awareness regarding specific dietary recommendations is questionable. Thus, this paper aims to examine the awareness regarding specific dietary components among diabetic patients at a primary care clinic and its influence on self-reported dietary practice.
    MATERIALS AND METHODS: The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire (English-Malay version) was used. It was adapted with additional questions to assess respondents’ awareness on: (1) healthful eating plan, (2) the quantity of one serving of fruits and vegetables, (3) choices and the allowed quantity of high fat food intake, (4) meaning of carbohydrate, and (5) carbohydrate spacing per day.
    RESULTS: From the 360 respondents, 85.0% knew about healthful eating plan. However, those who were unaware of the meaning of carbohydrate, carbohydrate spacing, the allowed high fat food intake, and the quantity of one serving of fruits and vegetables were 34.1%, 47.5%, 40.0%, and 30.8% respectively. Generally, the dietary practice reported by those who knew ‘one serving of fruits and vegetables’ (p<0.001), ‘allowed quantity of high fat food intake’ (p=0.001), ‘meaning of carbohydrate’ (p<0.001), or ‘carbohydrate spacing’ (p<0.001) was significantly different than those who were unaware of these terms.
    CONCLUSION: Although most respondents knew about healthful eating plan, majority of them were unaware of the specific dietary components, suggesting superficial dietary knowledge. Unfortunately, poor dietary awareness significantly influenced their self-reported dietary practice which could be considered as inaccurate. Thus, strategies to improve their dietary knowledge is necessary at the primary care setting.
    Keywords: Type 2 diabetes mellitus, diet, awareness, self-care, primary care
    Study site: Klinik Kesihatan Sungai Buloh, Selangor, Malaysia
  11. Fulltext Testosterone deficiency syndrome among males with type 2 diabetes mellitus in East Malaysia
    Ahmad S, Jerampang P, Tohid H, Ali MF, Jamil TR, Kong CHC
    Nagoya J Med Sci, 2020 Nov;82(4):613-621.
    PMID: 33311792 DOI: 10.18999/nagjms.82.4.613
    Type 2 diabetes mellitus (T2DM) may be independently associated with testosterone deficiency syndrome (TDS). Both conditions are linked with reduced quality of life and cardiovascular comorbidities. The magnitude of TDS among T2DM men and its predictors has still not been well established in Malaysia. This study aimed to determine the prevalence of TDS and its predictors among men with T2DM attending a government health clinic in Kuching, Sarawak. TDS severity and level of serum total testosterone were also explored. A cross-sectional study was conducted involving 360 respondents. Aging Males Symptoms Scale (AMS) score > 26 and serum total testosterone ≤ 12 nmol/L were used to diagnose TDS. The prevalence of TDS in current study was 19.7%. Multivariate analysis showed that determinants for TDS included age (Adjusted OR 1.061: 95% CI 1.020; 1.103), Iban ethnicity (Adjusted OR 2.469: 95% CI 1.154; 5.283) and a waist circumference equal or greater than 90 cm (Adjusted OR 3.655: 95% CI 1.472; 9.081). However, there was no significant association between TDS and the level of serum total testosterone (p = 0.581). We concluded that the prevalence of TDS in this study was relatively low. The severity of this condition may not be influenced by testosterone level. Physicians might consider a diagnosis of TDS if elder diabetic men with abdominal obesity present to primary care clinics with clinical features of hypogonadism. Health care providers also might consider lowering their threshold to screen for TDS among Iban men with T2DM.
  12. Fulltext Physical and psychosocial impacts of pregnancy on adolescents and their coping strategies: a descriptive study in Kuala Lumpur, Malaysia
    Su XV, Muhammad NA, Tan PS, Tan KTM, Tohid H, Omar K
    Malaysian Journal of Public Health Medicine, 2014;14(3):0-0.
    MyJurnal
    Teenage pregnancy carries serious impacts on adolescent health. This study aimed to examine the effects of pregnancy on adolescents and to explore how they cope with the problems they faced during the pregnancy. It involved 26 adolescents residing in a government shelter home in Kuala Lumpur. A self-administered questionnaire containing a mixture of open- and closed-ended questions was used. Among physical (sleeping problem and self-care problem), psychological (emotional difficulties and low self-efficacy) and social (stigma and discrimination, financial difficulty, friendship problem and school dropout) problems, emotional difficulties were the most common problems, whereas stigma and discrimination was the least common. Young adolescents aged less than 16 years old were significantly associated with poor self-care (p=0.01). To cope with their problems, the adolescents generally used avoidance, withdrawal, and social support, particularly from parents and peers. Doctors were the least popular among all. In conclusion, holistic and individualised care is needed. Strategies to reduce emotional problem experienced by pregnant adolescents should be implemented. The available healthcare services for teenage pregnancy should also be promoted.
  13. The cost and quality of life of Malaysian type 2 diabetes mellitus patients with chronic kidney disease and anemia
    Azmi S, Goh A, Muhammad NA, Tohid H, Rashid MRA
    Value Health Reg Issues, 2018 May;15:42-49.
    PMID: 29474177 DOI: 10.1016/j.vhri.2017.06.002
    BACKGROUND: Anemia is common among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) and an independent risk factor for renal disease progression. Health economic evidence is important in Malaysia and yet cost and quality-of-life (QOL) data are scarce.

    OBJECTIVES: To investigate prevalence, factors associated with anemia, and cost and QOL among T2DM patients with CKD. Here, we present the estimated 1-year cost and QOL related to anemia in this group.

    METHODS: A cross-sectional, observational study was performed at 20 government clinics. Treatment cost was calculated on the basis of resource utilization ascertained through data extracted from medical records and patient recall. QOL was elicited using the short form 36 health survey version 2 questionnaire. Propensity score matching was performed and costs and QOL were analyzed by anemia status and CKD stage.

    RESULTS: Data for 816 patients were obtained. The propensity score matching enabled a comparison of 257 patients with and without anemia. Annual treatment costs were significantly higher for patients with anemia (Ringgit Malaysia [RM] 4219 [US $983] vs. RM2705 [US $630]; P = 0.01). QOL scores were lower for patients with anemia but not statistically significant (physical component summary score: 44.8 vs. 46.2; P = 0.052; mental component summary score: 51.3 vs. 51.7; P = 0.562). Costs were higher and QOL lower among CKD stage 5 patients.

    CONCLUSIONS: This study was the first to examine anemia in this group of patients. Costs were significantly higher among anemic patients compared with nonanemic patients; patients with higher CKD stage 5 fared less well than did those in lower stages. This information suggests the need to increase detection, prevention, and early treatment of anemia when managing T2DM patients, particularly those with CKD.
  14. Fulltext Perceived effects of the Malaysian National Tobacco Control Programme on adolescent smoking cessation: a qualitative study
    Tohid H, Ishak N, Muhammad NA, Ahmad FN, Aziz AA, Omar K
    Malays J Med Sci, 2012 Apr;19(2):35-47.
    PMID: 22973136 MyJurnal
    BACKGROUND: The prevalence of teenage smoking has decreased over the past decade following the implementation of the national tobacco control programme. However, the effect of the programme on smoking cessation in teenagers has not been determined.
    METHODS: Twenty-eight participants (12 teenagers, 8 teachers, and 8 doctors) were interviewed using 5 in-depth interviews and 3 group discussions. Social cognitive theory (SCT) was applied as the theoretical framework. Semi-structured interview protocols were used, and thematic analysis and analytic generalisation utilising SCT were performed.
    RESULTS: The current national tobacco control programme was found to be ineffective in promoting smoking cessation among teenagers. The participants attributed the ineffective campaign to the followings: inadequacy of message content, lack of exposure to the programme, and poor presentation and execution. In addition, the participants perceived the developed tobacco control policies to be a failure based on poor law enforcement, failure of retailers to comply with the law, social availability of cigarettes to teenagers, and easy availability of cheap, smuggled cigarettes. This study highlighted that the programme-related problems (environmental factors) were not the only factors contributing to its perceived ineffectiveness. The cunning behaviour of the teenagers (personal factor) and poor self-efficacy to overcome nicotine addiction (behavioural factor) were also found to hinder cessation.
    CONCLUSION: Tobacco control programmes should include strategies beyond educating teenagers about smoking and restricting their access to cigarettes. Strategies to manage the cunning behaviour of teenagers and strategies to improve their self-efficacy should also be implemented. These comprehensive programmes should have a foundation in SCT, as this theory demonstrates the complex interactions among the environmental, personal, and behavioural factors that influence teenage smoking.
    KEYWORDS: adolescent; health campaigns; qualitative research; tobacco cessation; tobacco smoking
  15. Fulltext Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD): a multicentred cross-sectional study
    Idris I, Tohid H, Muhammad NA, A Rashid MR, Mohd Ahad A, Ali N, et al.
    BMJ Open, 2018 12 22;8(12):e025125.
    PMID: 30580276 DOI: 10.1136/bmjopen-2018-025125
    OBJECTIVES: This study aimed to determine the prevalence of anaemia among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) at primary care settings and its associated factors.
    DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study involved 808 adult patients with T2DM and CKD who were recruited via systematic sampling from 20 public primary care clinics in Peninsular Malaysia. Their sociodemographic, clinical and biomedical profiles were collected through interviews, examination of medical records and blood testing.
    RESULTS: The prevalence of anaemia was 31.7% (256/808). The anaemia was mainly mild (61.5%) and normocytic normochromic (58.7%). About 88.7% of the patients with anaemia were not known to have anaemia prior to the study. Among 36 patients with documented history of anaemia, 80.6% were still anaemic, and only a half received iron therapy. Multivariate regression analysis showed that women (adjusted odd ratio (AOR): 1.57, 95% CI: 1.12 to 2.21, p=0.009) and those with older age (AOR: 1.04, 95% CI: 1.01 to 1.06, p<0.001), CKD stage 3a (AOR: 2.47; 95% CI: 1.25 to 4.87, p=0.009), CKD stage 3b (AOR: 4.36; 95% CI: 2.14 to 8.85, p<0.001), CKD stage 4 (AOR: 10.12; 95% CI: 4.36 to 23.47, p<0.001), CKD stage 5 (AOR: 10.80; 95% CI: 3.32 to 35.11, p<0.001) and foot complication (AOR 3.12, 95% CI: 1.51 to 6.46, p=0.002) were more likely to have anaemia. Having higher body mass index (AOR 0.95, 95% CI: 0.92 to 0.99, p=0.012) and higher diastolic blood pressure (AOR 0.97, 95% CI: 0.95 to 0.99, p<0.001) were associated with lower odds to have anaemia.
    CONCLUSION: Anaemia among patients with T2DM and CKD in primary care was common, and the majority was unrecognised. Inadequate treatment of anaemia was also prevalent. Therefore, screening of anaemia should be incorporated into the routine assessment of diabetic complications particularly for those with significant associated factors. It is hoped that such strategy could lead to early treatment and hence improve their overall care.

    TRIAL REGISTRATION NUMBER: NMRR-15-660-24324.
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