CMPH eBulletin - Issue no 5 (July 2018) eISSN 2636-9729

This is an eBulletin produced by the Department of Community Medicine and Public Health of the Faculty of Medicine and Health Sciences. It contains articles, researches write up, opinion pieces related to public health from members and students of the department

Socio-demography, nutritional status and physical activity among elderly in Samarahan division, Sarawak, Malaysia

The physical activity among elderly has been associated with reduction of risk from all-cause mortality and improve physical, mental, and social well-being. The objectives were to determine the physical activity status among elderly in Samarahan Division, Sarawak and its association with socio- demographic characteristics and nutritional status. A cross-sectional study was carried out on 199 elderly, aged between 60 to 90 years, from rural area in Samarahan Division (Asajaya and Simunjan district), Malaysia. Socio-demographic characteristic was taken via questionnaire, nutritional status and body composition of the elderly was measured using anthropometric measurement, and physical activity using pedometer. Data were analyzed using IBM SPSS version 26. The proportion of physically active among elderly was 12.6% and mean daily steps are 3946 steps (SD=1669 steps). Multiple linear regressions revealed that age, body mass index (BMI), and sex were significant associated with physical activity. Lack of physical activity among elderly remain a problem. Understanding these predictors related to physical activity is important for designing intervention program

Predictors of physical activity for weekdays and weekends among adolescent – a cross-sectional study in Sarawak, Malaysia

This study aimed to describe the patterns of physical activities both at weekends and on weekdays and to identify their associated factors. Material/Methods This was a cross-sectional study conducted among secondary school students aged 13-15 years old in Kuching Division, Sarawak, Malaysia. A self-administered questionnaire was used to collect socio-demographic information and to measure perceived barriers, self-efficacies and social influences. Anthropometric measurements were taken and used to determine BMI-for-age, while pedometers were used to assess the physical activity levels. Data were analyzed using SPSS. Results A total of 474 students from six secondary schools participated. About 16% of the respondents were overweight and obese, majority of them males. The mean BMI was 21.21±12.93, higher among males. The mean steps per day were 6251.37±3085.31, with weekends recorded a higher number of steps. The number of steps among males was higher than among females. On weekdays, self-motivation scores significantly predicted the participants’number of steps/physical activity rate (b = 521.43, 95% CI -72.78 to 1050.19). At weekends, lack of interest and knowledge scores (b = -427.82, 95% CI -837.72 to 17.92) and making choices scores (b = 737.41, 95% CI -197.94 to 1276.88) were significant to predict the number of steps/physical activity levels. Conclusions These findings indicated the importance of investigating predictors of physical activity for weekdays and weekends. Thus, efforts should focus on how to motivate adolescents to be more physically active targeting the identified predictors for weekdays and week ends

Patient’s Experiences of Violence as Perpetrator: A Qualitative Study from Patients with Schizophrenia in Indonesia

BACKGROUND: Individuals with schizophrenia are at an increased risk for violence – limited study on exploring the experience of violence in patients with schizophrenia as a perpetrator. AIM: This research aimed to investigate the perception of violence as a perpetrator in Indonesia in patients with schizophrenia. METHODS: This study used phenomenology using a purposive sampling technique. A total of 40 patients were from the psychiatric ward of significant mental hospitals in West Java, Indonesia. The inclusion criteria for patients were the following: Age over 18 years old confirmed diagnosis with schizophrenia. Focus group discussion of patients comprised four groups. Each group consisted of tens of patients. RESULTS: The patient’s experiences as a perpetrator were categorized into six subthemes: Committing physical violence to family, quarreling with family, verbal abuse to family, a perpetrator of verbal violence to neighbors, expression of anger to object, and physical violence to nurse. CONCLUSION: The patient’s experiences of violence were not linear, but rather it was a complex experience of being a perpetrator, yet at the same time as of perpetrator violence. A staff training program to reduce patient violence is needed

Disordered eating and body image issues and their associated factors among adolescents in urban secondary schools in Sarawak, Malaysia

Eating disorders are common health issues among the adolescents. The objective of this study was to determine the prevalence of eating disorders and their relationship with body mass index, body part satisfaction and perception on body weight among urban secondary school children. It was a cross-sectional study conducted in Kuching, Sarawak. Data was collected using a self-administered questionnaire that consist of the Eating Attitude Test-26 (EAT-26), perception on body part satisfaction and body weight, and anthropometric measurement. Data was entered and analysed using SPSS version 22. A total of 329 respondents participated in this study with 59% females and 60.5% Malays. There were 14.3% of the respondents overweight and obese, with higher percentage among males (19.3%). About 18.5% of the respondents were found to be at risk of eating disorders with higher prevalence among males (19.3%). More females reported to have higher prevalence of body part dissatisfaction (46.9%) and body weight (37.6%) compared to males (40%, 28.1%). The statistical results indicated there were significant associations between EAT-26 and body mass index (BMI) (p = 0.039), body part satisfaction (p = 0.004), and perception of body weight (p = 0.038). Eating disorders are becoming more prevalent amongst adolescents, particularly among males. As eating disorder are strongly associated with adolescent mental and physical health, intervention programme on their developmental challenges and issues for both males and females should be in place particularly in the school education syllabus

Late antenatal booking and its predictors in Lundu district of Sarawak, Malaysia

Introduction: Antenatal care is widely acknowledged as an effective tool to prevent adverse outcomes in antenatal mother and their children. In Malaysia, early entry to antenatal care refers to first visit within the 12th week of gestation. Delayed access to antenatal care has not been extensively studied in Malaysia, whereas several literatures reported high prevalence of late antenatal booking in the developing countries. The objective of this study was to determine factors and barriers associated with late antenatal booking and level of knowledge on timing of antenatal booking among child bearing age mother in Lundu District of Sarawak. Method: This was a cross sectional study among 284 pregnant women in all five Maternal and Child Health (MCH) Clinics of Lundu. Results: The prevalence of late antenatal booking in Lundu was 28.2%. Unmarried women were more likely to book their pregnancy late compared to the married women. The prevalence of late antenatal booking was also higher among the unemployed women than those who were employed. Respondents without their own income also tend to book their pregnancy later than those who had their own income. Significantly high percentage of late antenatal booking were also reported among those who never utilise any contraceptive method, unplanned their pregnancy, without past medical illness or history of complication in previous pregnancy and among those who has problem with marriage certificate. Those who booked their pregnancy beyond the 12th week of gestation also reported to have lower level of knowledge on antenatal booking as compared to those who started their antenatal care early. Conclusions: In conclusion, intervention strategies should be formulated and to be carried out in order to tackle issues related to late entry to antenatal care in order to prevent unwanted adverse outcome associated with delayed antenatal care

Exposure of Mental Health Nurses to Violence in Mental Hospital : a Systematic Review

Shortage of nurses and declining interest in becoming a mental health nurse are often attributed to workplacedistress and violence. These have become global issues and believed that shortage of nurses decreases the qualityof health care services. It leads distress among nurses, which is exposure to violence and traumatic experiences.In addition, nurses are also accused of seizing the rights of patients and committing violence against a patient.This paper focuses on the violence that occurred in mental health nurses during working in unpredictablesituation. A literature search of systematic review through the CINAHL, Medline, Google scholars and PsycInfodatabases, the empirical report using a nursing sample includes data on rates of violence exposure includingviolence, aggressive behavior, bullying, and sexual harassment. The result, a total of 400 articles provide dataon 2742 publications indicates near all of nurses in mental health experienced verbal abuse in the past month,furthermore, most of respondents' ever experienced psychological abuse, and less of respondents experiencedphysical violence and sexual harassment. Rates of exposure vary by world region (Developed countries, Asia,Europe and Middle East), with the highest rates for physical violence and sexual harassment in the USA,Australia, United Kingdom, New Zealand region, and the highest rates of psychological violence and bullyingin the Middle East. The presence of violence signals an "alarm" that violence against nurses calls for specialattention in many countries. Essentially, the world must give a "priority" to handling violence against nurses

Physical Activity and Fundamental Motor Skill Outcome: A Quasi‑Experimental Study Among Rural Pre‑schoolers in Kuching, Sarawak

Fundamental movement skills (FMS)-oriented school-based intervention allows children to be more competent and interested to participate in a wider range of physical activities. This study aimed to determine the physical activity and fundamental motor skills outcome from a school-based intervention programme among rural preschoolers in Kuching. It used a quasi-experimental non-randomised design with a total of 153 children from 9 government indergartens. For physical activity level, there was a signifcant diference between the intervention and control group at the 3 months, F (1, 151)=3.90, p=0.05, with a ŋ2=0.025 and 6 months-time duration, F (1, 151)=55.70, p<0.001, with a ŋ2=0.27. The same pattern of interaction effect (time * group) was also found in gross motor skill, F (2, 150)=80.9, p<0.001, ŋ2=0.52, where the mean score in intervention group was greater than in control group. It is important to understand in depth each of the skills components involved in locomotor and object control and also its diferences between the boys and girls, as it can help in planning of the module of an intervention programme. Object control skills have higher predictive value in engaging in wider range of PA which could be the possible reason why boys are more active than girls

EFFECTS OF AN EDUCATIONAL INTERVENTION ON KNOWLEDGE AND SAFETY PRACTICES IN PESTICIDE HANDLING AMONG FARMERS IN SAMARAHAN, SARAWAK

Poor safety practices in pesticide handling contribute to the severe consequences of cases of pesticide poisoning globally. The objective of this study was to determine the effectiveness of an educational intervention to improve the knowledge and safety practices in pesticide handling among farmers in Samarahan, Sarawak. A quasi-experimental study was conducted involving an interventional (n= 50) and a control group (n = 50). A self-administered questionnaire was used to collect baseline information on participants’ knowledge and practices in pesticide handling. Participants in the interventional group underwent a five-month interventional programme consisting of four modules on the importance of understanding pesticides label, short and long-term effects of pesticides, routes of entry into the body and symptoms manifested upon exposure, safety usage, storage and disposal methods and practices. The control group were not exposed to any intervention. All the participants were reassessed at one- and fifth-month post-intervention using a validated self-administered questionnaire. Data were analysed using repeated measure analysis of variance to measure the effect of intervention between the groups. No significant difference was observed in the baseline based on gender and age distribution between both groups. Participants from the interventional group recorded a significant improvement in the mean knowledge and safety practices scores in the first month and fifth months compared to the baseline values. Meanwhile, no significant improvement in both outcomes was detected in the control group throughout the three assessments. These findings revealed that locally tailored educational intervention is effective in improving the knowledge level and safety practices of farmers in pesticide handling. Hence, these findings can be used by local authorities to develop an effective intervention for pesticide users in Sarawak and other states in Malaysia in reducing the risk of pesticide exposure. Keywords: Farmers, pesticide poisoning, educational intervention, safety practices, knowledg

Prevalence and associated factors of hypertension among primary school children: a cross-sectional study in Kuching, Sarawak

Introduction: Hypertension is an emerging health concern among children owing to its increasing prevalence and association with obesity. However, hypertension screening is uncommon, and childhood hypertension-related data are limited. This cross-sectional study determined the prevalence and associated factors of hypertension among primary school children in Kuching, Sarawak. Methods: Standard procedures and validated equipment were used to measure blood pressure and anthropometric indicators. The body mass index (BMI)-for-age and waist-to-height ratio (WHtR) were calculated. Questionnaires were used to obtain family sociodemographic data and health history. Results: A total of 1,314 children aged 6–12 years were enrolled, of whom 107 (8.1%) and 178 (13.5%) were hypertensive and pre-hypertensive, respectively. The chi-squared test indicated that hypertension was significantly associated with male sex (P<0.05), ≥1 standard deviation BMI-for-age (P<0.001), percentage of excess body fat (BF)(P<0.001), 5th to 95th height percentile (P<0.001), >90th excess waist circumference (WC) percentile (P90th WHtR percentile (P<0.001), clerical, service, sales and skilled parental work (P<0.05), excess weight (P<0.05) and cardiovascular disease (P<0.01). Multivariate logistic regression analysis showed that the percentage of excess BF [odds ratio (OR): 4.84, 95% confidence interval (CI): 2.01–11.66] and excess WC (OR: 2.33, 95% CI: 1.15–4.72) were significantly related to hypertension after adjusting for sex and age. Conclusion: The prevalence of hypertension among the study population is higher than that among children worldwide. Childhood hypertension-related factors must be identified to aid in routine blood pressure screening, which is crucial for early detection and intervention to reduce future morbidity burden