Cause-specific mortality estimates for Malaysia in 2013: Results from a national sample verification study using medical record review and verbal autopsy

Mortality indicators are essential for monitoring population health. Although Malaysia has a functional death registration system, the quality of information on causes of death still needs improvement, since approximately 30% of deaths are classified to poorly defined causes. This study was conducted to verify registered causes in a sample of deaths in 2013 and utilise the findings to estimate cause-specific mortality indicators for Malaysia in 2013.This study was funded by the Ministry of Health, Malaysi

Cross-cultural adaptation and validity of the patient rated michigan hand uutcome questionnaire in Bahasa Melayu for Malaysian patients

Background: The Michigan Hand Outcomes Questionnaire (MHQ) was designed in 1998 by Chung and colleagues at the University of Michigan in 1998. It is a hand-specific patient-rated outcome (PRO) instrument used to measure patients' outcome with conditions of, or injury to, the hand and/or wrist. This study is aimed at translating and cross-culturally adapting the MHQ into Bahasa Melayu (BM), examining the validity and reliability of the MHQ-BM version for our local population to be used as a patient-rated outcome measurement in Malaysian patients with hand injuries. Methods: This study was performed in two phases. Phase 1 involved the translation of the MHQ into BM using Beaton Protocol. In Phase 2, we administered the final version of the MHQ-BM in patients with hand and/or wrist injuries to test its stability (n = 50) and validity (n = 185). Results: The MHQ-BM showed good content and face validity. Cronbach α totalled 0.821 for the MHQ-BM. The Intra-class Correlation Coefficient (ICC) of the test-retest reliability for the six domains ranged from 0.960 to 0.984 with excellent correlation (ICC = 0.984) for the total score. The BM version of MHQ-BM showed excellent test-retest reliability. Conclusions: The MHQ-BM is well-translated and culturally well-adapted to maintain the reliability and content validity of the instrument (MHQ) at a conceptual level across Malaysia. We found the application and evaluation of the instrument to be feasible and understandable among patients with hand and/or wrist injuries in Malaysia

Validation of verbal autopsy: determination of cause of deaths in Malaysia 2013

Background Mortality statistics by age, sex and cause are the foundation of basic health data required for health status assessment, epidemiological research and formation of health policy. Close to half the deaths in Malaysia occur outside a health facility, are not attended by medical personnel, and are given a lay opinion as to the cause of death, leading to poor quality of data from vital registration. Verbal autopsy (VA) is a very useful tool in diagnosing broad causes of deaths for events that occur outside health facilities. This article reports the development of the VA methods and our principal finding from a validation study. Methods A cross sectional study on nationally representative sample deaths that occurred in Malaysia during 2013 was used. A VA questionnaire suitable for local use was developed. Trained field interviewers visited the family members of the deceased at their homes and conducted face to face interviews with the next of kin. Completed questionnaires were reviewed by trained physicians who assigned multiple and underlying causes. Reference diagnoses for validation were obtained from review of medical records (MR) available for a sample of the overall study deaths. Results Corresponding MR diagnosis with matched sample of the VA diagnosis were available in 2172 cases for the validation study. Sensitivity scores were good (>75%) for transport accidents and certain cancers. Moderate sensitivity (50% - 75%) was obtained for ischaemic heart disease (64%) and cerebrovascular disease (72%). The validation sample for deaths due to major causes such as ischaemic heart disease, pneumonia, breast cancer and transport accidents show low cause-specific mortality fraction (CSMF) changes. The scores obtained for the top 10 leading site-specific cancers ranged from average to good. Conclusion We can conclude that VA is suitable for implementation for deaths outside the health facilities in Malaysia. This would reduce ill-defined mortality causes in vital registration data, and yield more accurate national mortality statistics.This study was funded by the Ministry of Health, Malaysia

Factors associated with attendance to early childhood education programs in Malaysia: results from the national health and morbidity survey (Maternal and child health) 2016

The National Health and Morbidity Survey (NHMS) 2016 was a nationwide cross-sectional survey focusing on maternal and child health. This study aimed to identify the prevalence of, and factors associated with early childhood educational program (ECE) attendance among children aged three to five years in Malaysia. Attendance to ECE has been shown to enhance children’s development, yet there is no national information on ECE attendance in Malaysia, where attendance is not compulsory for children below five years. Parents were interviewed face-to-face utilising a validated questionnaire from the UNICEF Multiple Indicator Cluster Survey using mobile devices. Multivariate logistic regression analysis was performed to identify factors associated with ECE attendance. Half (53.4%) of children aged three to five years in Malaysia attend ECE. Older children aged four to five were six times more likely to attend ECE than children three to four years. Malaysian children of Chinese ethnicity were thrice as likely than ethnic Malays to attend ECE. Children with access to >3 children’s books were twice more likely to attend ECE than those who had access to <3 books. Unemployed mothers were less likely to send their children to ECE than mothers employed in civil service. More awareness on the importance and benefits of ECE attendance on children’s development is necessary so that younger children benefit from ECE

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school&#x2;aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Worldwide trends in underweight and obesity from 1990 to 2022 : a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

A list of authors and their affiliations appears online. A supplementary appendix is herewith attached.Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.peer-reviewe

Practice of disciplinary methods and factors associated with belief for physical punishment among Malaysian parents: findings from NHMS 2016

The belief in the effectiveness of physical punishment is an important predictor for its use. The objectives of this study was to describe the factors associated with the belief for physical punishment toward children 1 to 5 years of age among Malaysian parents. Data was collected as part of the Malaysian National Health and Morbidity Survey (NHMS) 2016. The respondents were asked if they believed that physical punishment is needed to raise a child properly. A total of 60.0% of Malaysian parents believed in the need for physical punishment, with 54.3% practising it. Parents who believed in physical punishment had more than 2 times a higher likelihood of practising it (odds ratio 2.57) than those who did not. Parents need to be taught to respond positively to children’s behavior and anger management strategies in difficult parenting situations

Double burden of malnutrition and its socio-demographic determinants among children and adolescents in Malaysia: National Health And Morbidity Survey 2019

Abstract Introduction Malaysia faces the threat of a double burden of malnutrition where undernutrition and overweight (including obesity) coexist in the same population. This study aimed to determine the anthropometric assessment among children and adolescents aged 5 to 17 years and its association with socio-demographic factors. Methods Data were extracted from the National Health and Morbidity Survey conducted in 2019. This cross-sectional survey applied a two-stage stratified sampling design. Socio-demographic characteristics were obtained. Weight and height were measured, age- and sex-specific standard scores for height and BMI were calculated to establish individual’s anthropometric assessment. Having either stunting or thinness was considered undernutrition, while being overweight (including obesity) was considered overnutrition. If someone had undernutrition and/or overnutrition, they were classified as having malnutrition. The prevalence was determined using complex sampling analysis, while the association was assessed through logistic regression. The analysis included a total of 3,185 respondents. Results The prevalence of stunting, thinness, overweight and obesity among the respondents aged 5 to 17 years was 12.7%, 10.0%, 15.0% and 14.8%, respectively. The overall prevalence of malnutrition was 48.3%. Respondents residing in rural had 1.35 times more likelihood of experiencing undernutrition [AOR = 1.35, 95% CI (1.04, 1.77)] compared to their urban counterparts. Boys exhibited a greater likelihood of being overweight and obese than girls [AOR = 1.40, 95% CI (1.13, 1.73)]. Respondents aged 10 to 14 years were 1.37 times more likely to be overnutrition than those aged 5 to 9 years old [AOR = 1.37, 95% CI (1.09, 1.73)]. Conclusion There is growing evidence of the increasing prevalence of coexistence of undernutrition along with overweight and obesity among children and adolescents in Malaysia. Moving forward, greater initiatives and efforts are required to formulate strategies for planning and implementing programs and policies to expedite progress in improving nutrition

Malaysian burden of disease: years of life lost due to premature deaths

Abstract Background In Malaysia, the previous mortality burden has been a significant concern, particularly due to the high prevalence of noncommunicable diseases (NCDs) as the leading cause of death. Estimates of mortality are key indicators for monitoring population health and determining priorities in health policies and health planning. The aim of this study was to estimate the disease burden attributed to 113 major diseases and injuries in Malaysia in 2018 using years of life lost (YLL) method. Methods This study included all deaths that occurred in Malaysia in 2018. The YLL was derived by adding the number of deaths from 113 specific diseases and multiplying it by the remaining life expectancy for that age and sex group. Data on life expectancy and mortality were collected from the Department of Statistics Malaysia. Results In 2018, there were 3.5 million YLL in Malaysia. Group II (NCDs) caused 72.2% of total YLL. Ischaemic heart disease was the leading cause of premature mortality among Malaysians (17.7%), followed by lower respiratory infections (9.7%), road traffic injuries (8.7%), cerebrovascular disease (stroke) (8.0%), and diabetes mellitus (3.9%). Conclusions NCDs are a significant health concern in Malaysia and are the primary contributor to the overall burden of disease. These results are important in guiding the national health systems on how to design and implement effective interventions for NCDs, as well as how to prioritise and allocate healthcare resources. Key strategies to consider include implementing health promotion campaigns, adopting integrated care models, and implementing policy and regulatory measures. These approaches aim to enhance health outcomes and the managements of NCDs in Malaysia