Iodine Deficiency Disorder and Goitre among School Children in Sarawak -A Nationwide Study.

Iodine deficiency disorders (IDD), is one of the most important micronutrient deficiencies which has multiple adverse effects on growth and development. The aim of this study was to determine the prevalence of IDD among school children and to elucidate the distribution of iodized salt at household level in Sarawak, East Malaysia. This cross-sectional study was conducted among school children aged 8 to 10 years in 2008. A multi-stage probability proportionate to population size(PPS) cluster sampling method was used to obtain a representative state sample of 1200 school children. Spot urine samples were collected for the determination of urinary iodine concentration while the iodine content in salt was determined using field rapid test kits. The thyroid status was determined by palpation. Response rate was 92.0% (n=1104/1200). The prevalence of goitre among school children in Sarawak was 2.9% (5.2% in urban, 0.7% in rural). The median urinary iodine concentration (UIC) among the school children was 102.1 μg/L (IQR, 62.3-146.5 μg/L). Urban children had significantly higher median UIC of 109.3 μg/L (IQR, 72.4-159.0 μg/L) than their rural counterparts [91.9 μg/L (IQR, 55.7-140.2 μg/L)]. The salt samples tested by rapid test kit (RTK) showed only 46.0% of household salt contained iodine. The present study revealed that the population in Sarawak were of borderline iodine sufficient with mild IDD seen in rural areas. Hence, the state IDD control programmes need to encourage and advocate the consumption of iodized salt in order to eliminate IDD-related health problems in Sarawak

Awareness, knowledge and acceptance of community on a non-communicable disease intervention – findings from the “Healthy Community, Developed Nation” (KOSPEN) in the Southern Zone of Peninsular Malaysia

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). Methods 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. Results 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. Conclusions 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

Factors associated with non-participation in a health screening programme and its barriers: findings from the community empowers the nation programme (KOSPEN), Malaysia 2016

Introduction The Ministry of Health, Malaysia had introduced the community based action programme (KOSPEN) to improve the early detection of non-communicable diseases (NCDs) in the population. This study aims to identify factors associated with non-participation in screening activities and its barriers. Methods This cross sectional study was conducted from May to June 2016 in KOSPEN localities. A total of 2354 adults aged 18 years and above were selected using a two-stage stratified cluster sampling design. The data were obtained through face-to-face interviews using validated questionnaires. Multiple logistic regression analysis was used to determine the sociodemographic factors associated with non-participation in health screening. Results Out of 2156 respondents interviewed (response rate of 91.6%), approximately 75% (n=1624) of the respondents did not participate in the KOSPEN health screening programme. Multivariable logistic regression analyses revealed that, males (aOR: 2.35, 95% CI 1.21, 4.55) and those working in private sector (aOR: 2.11, 95% CI 1.21, 3.67) were more likely to not participate in health screening. While, age, ethnicity, level of education, marital status and household income were not significantly associated with non-participation in health screening. The barrier for not participated were “did not know health screening was conducted in their localities” (39.3%) and had no time to attend the programme (18.2%). Conclusions The study findings are of public health concern as about three quarters of the respondents failed to participate in this programme because they didn’t know that there were health screening activities conducted in their localities beside the time constraint problems. Thus, KOSPEN health screening activities should be made known to the community especially males who are mostly working in the private sector

Undiagnosed Type 2 Diabetes Mellitus and Its Risk Factors among Malaysians: Findings of a Nationwide Study

Introduction: The prevalence of Type 2 diabetes mellitus (T2DM) is increasing worldwide and many of these affected individuals remain unidentified. Undiagnosed T2DM may impose substantial public health implications because these individuals remain untreated and at risk for complications. The objective of this study was to determine the national prevalence of undiagnosed T2DM and to identify the associated risk factors. Methods: A nationwide cross-sectional study was conducted involving 17,783 respondents. Two-stage stratified sampling design was used to select a representative sample of the Malaysian adult population. Structured validated questionnaires with face to face interviews were used to obtain data. Respondents, who claimed that they were not having diabetes, were then asked to perform a fasting blood glucose finger-prick test by Accutrend GC machine. Results: The prevalence of undiagnosed T2DM was 8.9% (n=1587). The highest percentage of undiagnosed T2DM was found among males (10.2%), 55-59 years old (13.4%), highest education attainers of primary school (11.1%), Indians (10.3%), married (10.3%), working (8.9%) and living in the urban areas (9.2%). Multivariate analyses showed that factors associated with undiagnosed T2DM were gender, age group, ethnicity, marital status, obesity and hypertension. Conclusion: This study found an increasing trend of undiagnosed T2DM in Malaysia compared to 2006. This finding is alarming as risk factors associated with undiagnosed diabetes were related to most of the socio-demographic factors studied. Therefore, early diabetic screening is crucial especially among adults aged 30 and above to prevent more serious complications of this disease

Physical inactivity and its associated factors among adults in Malaysia : findings from National Health and Morbidity Survey (NHMS) 2019

Physical inactivity has been identified as the fourth leading risk factor for worldwide mortality with major implications towards general health. Monitoring the level of physical inactivity may reduce the burden of non-communicable diseases (NCDs) and their risk factors. This study aims to determine the prevalence of physical inactivity and its associated factors among adults aged 18 years and above in Malaysia. Data was obtained from the National Health and Morbidity Survey (NHMS) 2019. It was a cross-sectional, population-based survey which employed two- stage stratified random sampling design. A total of 10,356 out of 10,472 respondents were interviewed using a short version of International Physical Activity Questionnaire (IPAQ). Overall, the prevalence of physical inactivity among adults aged 18 years and above in Malaysia was 24.6% (95% CI: 23.2, 26.1). Results from multivariable logistic model showed that Chinese ethnicity (aOR 1.32; 95% CI: 1.04, 1.67), urban dwellers (aOR 1.30; 95% CI: 1.07, 1.57), those who were single (including widow, widower and divorcee) (aOR 1.36; 95% CI: 1.14, 1.61), students (aOR 2.10; 95% CI: 1.30, 3.40), higher household income earners (aOR 1.34; 95% CI: 1.07, 1.68) and those with hypercholesterolaemia (aOR 1.25; 95% CI: 1.03, 1.51) were significantly more likely to be physically inactive. Specific and appropriate intervention towards targeted group is in crucial need to increase the level of physical activity and to promote an active living towards an active and healthy Malaysia

An assessment of risk of iodine deficiency among pregnant women in Sarawak, Malaysia

Previous findings from a state-wide Iodine Deficiency Disorders (IDD) study among pregnant women (PW) in Sarawak indicated that PW are at risk of IDD and further assessment is needed. This paper describes the methodology used in conducting this study for an assessment of risk of iodine deficiency among pregnant women in Sarawak, Malaysia. A total of 30 maternal child health care clinics (MCHCs) were selected using probability proportional to population size (PPS) sampling technique.  The PW sample size was calculated based on 95% confidence interval (CI), relative precision of 5%, design effect of 2, anticipated IDD prevalence of  65.0% and non-response rate of 20%. Thus, the total sample size required was 750 (25 respondents per selected MCHC). The WHO Expanded Programme on Immunization (EPI) surveys approach was used to randomly select the first respondent and subsequent respondents were chosen until the required number of PW was met. The required data were obtained through: face-to-face interviews (socio-demographic and food frequency questionnaire), clinical assessments (thyroid size, and hyper/hypothyroidism) and biochemical analysis (urine and blood serum). A total of 677 PW responded in the study with a response rate of 90.2%. Majority of the PW were at second gravida, aged 25-29 years old and of Malay ethnicity. The methodology used in this study was based on international guidelines which may provide state’s estimates. All the necessary steps were taken into consideration to ensure valid and reliable findings on current iodine status among PW

Iodine deficiency disorders among pregnant women in Sarawak, Malaysia

Introduction Iodine deficiency disorders (IDD) during pregnancy may impair the neurological development of the fetus. The aim of this study is to determine the iodine status among pregnant women (PW) in Sarawak after introduction of mandatory universal salt iodisation (USI) for seven years. Methods A total of 508 first trimester PW attending government Maternal and Child Health Care clinics in all 11 divisions in Sarawak between 1st April and 15th June 2015 were recruited. Urine samples were obtained and analysed for urinary iodine concentration (UIC) using the modified Sandell-Kolthoff reaction method. For pregnant women, an adequate iodine intake was defined as a median UIC between 150-249 μg/L according to the WHO/UNICEF/ICCIDD’s criterion. For further analyses, the 11 divisions were then combined into 3 regions, namely Northern (Miri, Bintulu, Limbang), Central (Kapit, Mukah, Sibu, Sarikei, Betong) and Southern (Kota Samarahan, Kuching, Sri Aman). Results The median UIC of the PW in Sarawak was 105.6 μg/L, indicating iodine deficiency. A total of 330 (65.0%) PW had UIC<150 μg/L. In terms of urinary iodine levels by region, the median UIC in Northern, Central and Southern regions were 136.3 μg/L, 85.5 μg/L and 97.4 μg/L respectively. The differences in median UIC between regions were significant. In addition, the Northern region (p = 0.001), Malay/Melanau ethnicity (p = 0.015) and parous parity (p = 0.014) were significantly associated with higher median UIC. No significant association was found for locality, age nor gravida. Conclusions This study indicates inadequate iodine status among PW in Sarawak despite seven years of mandatory USI. In fact, the majority of PW appear not to be protected against IDD and its consequences. In future, a comprehensive study should be carried out to determine the levels of iodine in salt at the retail outlets, villages and households in Sarawak

Methodology of National Health and Morbidity Survey (NHMS): adolescent health, Malaysia 2022

In Malaysia, the adolescent health surveys conducted in 2012 and 2017 revealed an increasing trend of adolescent health risk behaviours and protective factors. This current article aims to describe the methodology of the National Health and Morbidity Survey (NHMS) 2022: Adolescent Health in Malaysia. The current nationwide cross-sectional survey of Malaysian secondary school students used multistage stratified sampling to select 240 nationally representative schools. This survey is conducted from June to July 2022 among the students in forms 1, 2, 3, 4, and 5 in all Malaysian states by 34 data collection teams. A validated self-administered questionnaire is used, similar to those used in the NHMS 2012 and NHMS 2017. The quality control is done twice, once at the field level and once at the central level. Sample weighting and analysis are conducted using SPSS statistical software version 28.0. A total of 239 out of 240 randomly selected schools with 33,523 adolescents are involved in this study (overall response rate is 89.0%). The distribution of state, sex, and form among adolescents is almost equal. Compared to both previous adolescent health surveys using the same methodology and approaches, the overall response rates for NHMS 2017 and NHMS 2012 are 89.2% and 88.8%, respectively. The implementation of NHMS 2022 has employed an acceptable methodology for a survey of the adolescent population. This reliable data provides national estimates for adolescent health risk behaviours and protective factors. The survey allows the relevant authorities to carried out further improve the health status of adolescents in Malaysia

Factors associated with asymptomatic COVID-19 patients in Petaling District, Selangor, Malaysia

The rapid spread of the Coronavirus disease 2019 (COVID-19) worldwide has led the World Health Organization to declare COVID-19 outbreak as a pandemic on March 11, 2020. As the local studies on factors leading to the absence or presence of clinical illness among the COVID-19 cases are sparse, the study aims to determine the factors associated with asymptomatic COVID-19 patients in Petaling District, Selangor, Malaysia. Data on COVID-19 patients were extracted from the database of confirmed cases in Petaling District Health Office, Selangor, Malaysia from 3rd February 2020 to 30th April 2020. An asymptomatic laboratory-confirmed case is a person infected with COVID-19 who does not develop any symptoms. The study included socio-demographic variables, the detailed information on clinical manifestations and co-morbidity of the patients. Descriptive and multiple logistic regression analyses were conducted to determine the factors associated with asymptomatic patients. The overall COVID-19 patients in Petaling District were 434. Approximately 70% (n= 292) of the patients were symptomatic while 32.7% (n= 142) were asymptomatic. Multivple logistic regression analyses revealed that factors significantly associated with asymptomatic patients were age below 40 years old (aOR: 1.79, 95% CI 1.11, 2.86), non-Malaysians (aOR: 3.22, 95% CI 1.44, 7.19) and local cases (aOR: 2.51, 95% CI 1.42, 4.42). Gender, ethnicity, co-morbidity and township were not significantly associated with asymptomatic patients. Approximately one-third of COVID-19 patients were asymptomatic and the risk factors identified were younger age, non-Malaysians and local cases. Rigorous epidemiological investigation is helpful in identifying COVID-19 cases among these group of people who are asymptomatic