Predictors of exclusive breastfeeding among mothers attending rural health clinics in Hulu Langat district

Introduction: Even though exclusive breastfeeding prevalence has increased from 19.3% in 2006 to 47.1% in 2016, this practice was slightly higher in urban areas (48.3%) compared to rural area (45.1%) in Malaysia. National Plan of Action for Nutrition of Malaysia III has set an indicator to achieve at least 70% exclusive breastfeeding by 2025. Therefore this study is to identify predictors that influenced exclusive breastfeeding practice in rural areas. Methods: This cross-sectional study was conducted in six rural health clinics in Hulu Langat District, Selangor among mothers with youngest child aged 6-48 months old. Respondents were selected through systematic random sampling. Validated self-administered questionnaire was used to assess sociodemographic factors, maternal factors, external factors and child’s factors. Mother’s height and weight was measured and body mass index was calculated. Data were analyzed using SPSS version 23. Multivariate logistic regression was used to determine the predictors for exclusive breastfeeding practice. Results: Response rate was 96% with a total of 311 mothers participated in this study. More than half of the mothers exclusively breastfed (52.4%). The predictors for exclusive breastfeeding were Malay ethnicity (AOR=3.951, 95% CI: 1.374-11.358), having tertiary education (AOR=2.401, 95% CI: 1.100-5.241) and positive attitude toward breastfeeding (AOR=7.755, 95% CI: 1.382-43.502). Conclusion: Prevalence of exclusive breastfeeding was higher in this study than the national level. Programme planners should pay special attention to Chinese and Indian ethnicities, mothers with lower level of education and negative attitude in order to improve breastfeeding practice among rural mothers

A qualitative study on ageing related anxiety among middle aged women in Malaysia

Ageing anxiety is commoner among women compared to men. However, little is known on the possible contributing factors towards the development of ageing related anxiety among Malaysian women. This study aimed to explore ageing anxiety among the middle-aged women in Malaysia in facing the ageing process. Series of 6 focus group discussions (FGD) were conducted involving a total of 36 women aged between 35 and 59 years old. Each FGD consisted of 5 to 7 respondents and was conducted for an average of 1 to 2 hours. The respondents were selected using the maximum variation sampling method focussing on five age categories, between 35 to 39, 40 to 44, 45 to 49, 50 to 54 and 55 to 59 years old. Representative from several residential areas in the area of Putrajaya Federal Territory and Seri Kembangan, Selangor were involved in the selection of respondents. The interviews revealed that, majority of the respondents were seriously thinking of the possible negative experiences associated with ageing and being old, but very few experiencing ageing anxiety. Three main themes that were identified to contribute to the ageing anxiety were issues related to caregiving at old age and fear of loneliness, the welfare and care of their children when they are old and eventually die and also physical changes that occurred with ageing process. These themes were not specifically associated with any particular age groups, marital or income status. However, the development of the ageing anxiety was found to be related to their personal experiences and observations from the surrounding community. The findings show that women in Malaysia are still emphasizing on the importance of traditional caregiving system, where elderly parents are looked after by the children or extended family members rather than living in formal institutions. Despite the important role of formal institutions in the care of elderly people in the future, it is still negatively perceived. With the shrinking of the size of nuclear family and massive involvement of women in employment sector, more elderly will be expected to reside in formal institutions in the near future. Relevant authorities should be made aware on the importance to maintain the quality of care in the formal institution for elderly, in order to tackle the negative perceptions

Knowledge, attitude and practice regarding healthy diet and physical activity among overweight or obese children

Background: Inculcating healthy life style such as the habit of consuming balanced diet and performing physical activity among children could prevent them from becoming overweight or obese and thus avoid the risk of chronic diseases related with obesity. Such efforts are challenging yet crucial. This study assessed the immediate effect on children's knowledge, attitude and practices regarding healthy diet and physical activity following an awareness programme. Materials and Methods: A half-day childhood obesity awareness programme was conducted to encourage the practise of healthy diet and physical activity, and persuade against unhealthy food consumption and sedentary life style. The programme was carried out among 30 children aged 8-11year old in an international school in Putrajaya who were overweight or obese. A pre-and post-test design was carried out to evaluate their knowledge, attitude, and practice toward healthy diet and physical activity using pretested questionnaire. Comparison of pre-and post-test' scores were carried out using paired t test. Result: Over half of the respondents were female (63.3%) and obese (70.0%). The mean(sd) knowledge and attitude scores for healthy diet were 2.00(0.91) and 2.33(0.84). The mean knowledge score for physical activity was better i.e., 3.10(1.32) but the attitude scores was very low 0.87(1.07). After the programme, although not statistically significant there were slight increases in all scores, except 'intend to practise' physical activity after the programme. Conclusion: The knowledge, attitude and practices regarding healthy diet and physical exercise among these children were low. A series of improved and validated programmes are recommended for greater impact

Prediction and explanation on adolescent aggression: a study protocol

Introduction: Adolescent aggression is an important public health concern with escalating prevalence of juvenile cases and violence among these age groups including robbery, homicide, and gang fights. The objectives of this study protocol are to determine the biopsychosocial predictors and explore the contextual factors of adolescent aggression among secondary school students in Hulu Langat. Methods: Explanatory mixed method study design will be used, consist of quantitative cross-sectional study followed by basic qualitative study. Proportionate population sampling among Form 4 secondary school students from selected public secondary schools in Hulu Langat will be executed. Questionnaires will be distributed to 481 students on aggression as the dependent variable, and several independent variables: demographic (ethnicity, family income), biological (sex, head injury, nutritional deficiency, breakfast skipping), psychological (attitude and normative beliefs, personality trait, emotional intelligence), and social factors (family environment, single parent status, domestic violence, peer deviant affiliation, alcohol, smoking, substance abuse). Subsequently, participants with moderate to high aggression scores will be further explored on the contextual factors of adolescent aggression by in-depth interview. Multiple linear regression will be executed using SPSS to determine significant predictors whereas thematic analysis will be applied for qualitative data analysis on the context of adolescent aggression. Both findings will be further integrated and discussed to give comprehensive description on the phenomena. Conclusion: Better knowledge and understanding on adolescent aggression may generate new framework to drive more effective preventive strategies and unravel adolescent aggressive related Public Health problems

Research design

Research design is a systematic study plan used to turn a research question (research questions) into a “experimental” or research project, it is specify the methods and procedures for collecting and analyzing the needed information. There are two basic types of a research methodologies, which are then further sub-categorized into various types of research designs; quantitative research method and qualitative research method. Quantitative research method is a formal, objective, systematic process in which numerical data are obtained and used to make conclusion about the subject or subjects of study. Quantitative research will answer questions on what, when and where of the research questions. On the other hand qualitative research method used a systematic subjective approach to describe life experiences, and qualitative research will answer questions on how and why of research questions. Both of the research methodologies have their own strengths and weaknesses, and for certain circumstances each the methods may complement each others

Predictors of knowledge, attitude and practice of noise induced hearing loss among workers in an automotive industry in Malaysia

Introduction: Automotive workers are exposed to high level of noise as part of their daily work routine. Determining the predictors of knowledge, attitude and practice of noise induced hearing loss (NIHL) among automotive is important because it may help prevent a serious irreversible disease known as noise induced hearing loss. Methods: A cross sectional study in an automotive plant in Shah Alam, Selangor was conducted from January 2015 to May 2015 among 550 workers with response rate of 83%. Respondents were workers from the operational divisions, selected based on simple random sampling using validated, published (1) and reliable self-administered questionnaire that focused on knowledge, attitude and practice towards NIHL. Results: Logistic Regression was used to determine predictors and the predictors for satisfactory knowledge on noise induced hearing loss were perceived noise exposure as harmful noise (AOR=0.54, 95%CI = 1.02 - 3.41), years in service for more than 10 years (AOR=2.79, 95%CI = 1.71 – 4.56) and had received training on safety (AOR=1.94, 95%CI = 1.12 – 3.36). For satisfactory attitude the predictors were perceived noise exposure as harmful noise (AOR=3.79, 95%CI = 2.36 – 6.10), years in service for more than 10 years (AOR=0.56, 95%CI = 0.34 – 0.83) and tertiary level of education (AOR=3.61, 95%CI = 1.67 - 7.81). As for satisfactory practice the predictors were more than 10 years in service (AOR=2.16, 95%CI = 1.24 – 3.75) and had received training on safety (AOR=1.94, 95%CI = 1.26 – 2.99). Conclusions: The results from this study may be used to set appropriate measures and identify workers who are at risk of developing noise induced hearing loss

Biosocial background in the development of child overweight and obesity among preschoolers in Putrajaya: an observational study

Introduction: Childhood obesity becomes a global epidemic with the majority are living in developing countries. Obese children are at risk of becoming obese adults with non-communicable diseases, which may further lead to huge economic burden for the affected countries. The study objectives were to determine the biosocial background contributing overweight and obesity among preschoolers in Putrajaya (2017) - sociodemographic, pre-and perinatal factors, feeding and weaning practices. Methods: Cross-sectional study was performed using cluster random sampling among 897 preschoolers, whose anthropometric body weights and heights were measured. The calculated BMI was used to determine their obese status based on WHO Growth Standards 2006 and Reference 2007. Their mothers were distributed with self-administered, validated, and pre-tested questionnaires regarding their children’s first two-years-of-life experience. Chi Square test was used for bivariate categorical analysis, Independent T-test and Mann Whitney U test for continuous data analysis. Multivariate binary logistic regression was executed to determine predictors of child obesity. Results: The prevalence of obese children was 7.4%, which can be predicted by the increase in child’s age (Adjusted Odd Ratio: 2.619; 95%CI: 1.435 – 4.780), mothers with higher level of education (AOR: 3.896; 95%CI: 1.127 – 13.470), and higher maternal BMI (AOR: 1.132; 95%CI: 1.057 – 1.213). Conclusion: Three predictors of child obesity can be derived from sociodemographic and pre-and perinatal factors. Further application on these predictors in more targeted interventions and policies need to be considered to reduce the prevalence of obesity and related non-communicable diseases in the country

Adherence among parents on under-five childhood immunization schedule: a review

Background: Adherence on under-five childhood immunization schedule has been an area of study that has seldom been explored. Adherence has been the subject of focus in determine if the results of outbreaks and vaccine preventable disease is related to the adherence of the parents to the vaccine schedule. Materials and Methods: A systematic review of articles on the factors of adherence on under-five childhood immunization schedule was performed using various keywords utilizing multiple databases (Medline, PubMed, Science Direct and CINAHL). Studies conducted between 2000 to present, English language and were either observational or qualitative designs were included. Result: Of 45 articles identified, 13 studies were eligible for inclusion. The studies showed that the majority of factors were divided into modifiable and non-modifiable factors. These factors were then further classified into various groups according to its relevance. The modifiable factors were identified as knowledge, vaccine, awareness and perception towards childhood immunization. Whereas non-modifiable factors were sociodemographic factors of parent and child, logistic factors and administration factors. Conclusion: There were many factors identified significantly to be associated with adherence among parents on under-five childhood immunization schedule

Predictors for inadequate knowledge and negative attitude towards childhood immunization among parents in Hulu Langat, Selangor, Malaysia

Vaccine hesitancy among parents has led to re-emergence of vaccine preventable diseases. In Malaysia, measles cases had increased by three times in 2015 compared to previous year. Immunization coverage has always been above 95% since 2009. However, in 2014, Mumps-Measles-Rubella (MMR) coverage has a significant drop to 93.4%. The aim of the study was to identify predictors for inadequate knowledge and negative attitude towards childhood immunization among parents in Hulu Langat, Selangor. A cross sectional study design was conducted from January to July 2016 with760 respondents. Respondents were selected by cluster random sampling and a validated self-administered questionnaire was used. The majority of respondents were female (70%), Malay (87%), employed (92%) and parents with tertiary education (99.7%). In this study, 12.8% parents have an inadequate knowledge on childhood immunization and 47.6% parents have a negative attitude towards childhood immunization. The predictors for inadequate knowledge on childhood immunizations were last child’s age of 2 years old or more (AOR=1.413 95% CI 0.28-0.69); parents without tertiary education (AOR=2.02 95% CI 1.15-3.54); parents withouteducational exposure on childhood immunization (AOR=2.87 95% CI 1.59-5.18) and parents who obtained information on childhood immunization from non-healthcare provider (AOR=2.66 95% CI 1.50-4.70). Predictors for negative attitude on childhood immunizations were being male (AOR=1.44 95% CI 1.04-2.01); parents without tertiary education (AOR=1.67 95% CI 1.04-2.68); household income of less than RM5000 (AOR=1.85 95% CI 1.28-2.67) and unsatisfactory religious belief (AOR=2.76 95% CI 2.03-3.75). Therefore, these predictors should be considered in any health intervention on childhood immunizations for parents in Malaysia

Systematic review on effectiveness of methods of delivery and reminder of health education module to improve adherence on childhood immunization schedule

Background: There are currently various methods of delivery that can improve adherence on under-five childhood immunization schedule. The methods differ significantly and there is the conventional method of providing a health education module, reminders and recalls to improve adherence and some other non-conventional methods to improve adherence. A systematic review was conducted on the effectiveness of methods of delivery and reminder of health education module to improve adherence on childhood immunization schedule. Materials and Methods: The systematic review performed utilized searched on available electronic databases and bibliographies of studies and also previous reviews. The databases were broad search and began with the use of generic terms to identify search terms that were relevant. The PRISMA (Preferred Reporting Items for Systematic Review and MetaAnalysis) by Moher et al (2009) was used. Databases including PubMed, Science Direct, Medline and CINAHL were utilized for this systematic review. Results: The studies in the review conducted was conducted in various countries with the United States of America (USA) contributing 7 studies, followed by the United Kingdom and Pakistan with 3 studies each and Kenya, Australia, New Zealand and India with 1 study respectively. The lowest number of respondents was 12 while the most was 9213 respondents. All studies were Randomized Control Trial’s (RCT’s) and 1 Quasi Experimental study. Conclusion: The studies showed multiple factor and effective methods of delivery with reminders for health education. Utilizing technology showed to be one of the most effective methods