The association between temperature and cause-specific mortality in the Klang Valley, Malaysia

This study aims to examine the relationship between daily temperature and mortality in the Klang Valley, Malaysia, over the period 2006–2015. A quasi-Poisson generalized linear model combined with a distributed lag non-linear model (DLNM) was used to estimate the association between the mean temperature and mortality categories (natural n=69,542, cardiovascular n= 15,581, and respiratory disease n=10,119). Particulate matter with an aerodynamic diameter below 10 μm (PM₁₀) and surface ozone (O₃) was adjusted as a potential confounding factor. The relative risk (RR) of natural mortality associated with extreme cold temperature (1st percentile of temperature, 25.2 °C) over lags 0–28 days was 1.26 (95% confidence interval (CI): 1.00, 1.60), compared with the minimum mortality temperature (28.2 °C). The relative risk associated with extremely hot temperature (99th percentile of temperature, 30.2 °C) over lags 0–3 days was 1.09 (95% CI: 1.02, 1.17). Heat effects were immediate whereas cold effects were delayed and lasted longer. People with respiratory diseases, the elderly, and women were the most vulnerable groups when it came to the effects of extremely high temperatures. Extreme temperatures did not dramatically change the temperature mortality risk estimates made before and after adjustments for air pollutant (PM₁₀ and O₃) levels

Health education module based on information–motivation–behavioural skills (imb) for reducing depression, anxiety, and stress among adolescents in boarding schools: a clustered randomised controlled trial

Depression, anxiety, and stress (DAS) among adolescents have become a public health concern. The aim of this study was to develop, implement, and measure an IMB-based health education intervention module for reducing DAS among adolescents in boarding schools in the state of Negeri Sembilan, Malaysia. A single-blinded cluster randomised control trial (RCT) was conducted among students with abnormal DASS-21 scores. They were divided into an intervention group (three schools, 62 participants) and a control group (three schools, 57 participants). Participants in the intervention group received IMB-based health education, while participants in the control group underwent the standard care session. To determine the effectiveness of the intervention, the Generalised Linear Mixed Model (GLMM) analysis was conducted. A total of 119 students participated in this study, and no loss to follow-up was reported. Both intervention and control groups showed significantly reduced DAS scores (p < 0.005). However, the reduction of these scores was greater in the intervention group. The GLMM analysis revealed that the intervention was effective in reducing depression (ß = −2.400, t = −3.102, SE = 0.7735, p = 0.002, 95% CI = −3.921, −0.878), anxiety (ß = −2.129, t = −2.824, SE = 0.7541, p = 0.005, 95% CI = −3.612, −0.646), and stress (ß = −1.335, t = −2.457, SE = 0.536, p = 0.015, 95% CI = −2.045, −0.266) among adolescents. The IMB-based health education module was effective in reducing DAS among adolescents in boarding schools

The Impact of Air Pollution and Haze on Hospital Admissions for Cardiovascular and Respiratory Diseases

Air pollution has been widely known to have an influence on health of the general population.Air pollution can result from natural causes, human activities and transboundary air pollution. Weather and climate play crucial role in determining the pattern of air quality. In recent years, air pollution and recurrent episodes of haze has become a major concern in Malaysia. Surveillance data on concentrations of main air pollutants such as carbon dioxide, (CO2), Nitrogen Dioxide (NO2), Ozone (O3), sulphur dioxide (SO2) and particulate matter (PM10) were found to be higher during the haze days and this may have an impact on health of the community as reflected by an increase in hospital admissions particularly the respiratory and cardiovascular diseases

Investigation of association between smoke haze and under-five mortality in Malaysia, accounting for time lag, duration and intensity

[Background] Studies on the association between smoke haze (hereafter ‘haze’) and adverse health effects have increased in recent years due to extreme weather conditions and the increased occurrence of vegetation fires. The possible adverse health effects on under-five children (U5Y) is especially worrying due to their vulnerable condition. Despite continuous repetition of serious haze occurrence in Southeast Asia, epidemiological studies in this region remained scarce. Furthermore, no study had examined the association accounting for three important aspects (time lag, duration and intensity) concurrently. [Objective] This study aimed to examine the association between haze and U5Y mortality in Malaysia, considering time lag, duration and intensity of exposure. [Methods] We performed a time-stratified case-crossover study using a generalized additive model to examine the U5Y mortality related to haze in 12 districts in Malaysia, spanning from 2014 to 2016. A ‘haze day’ was characterized by intensity [based on concentrations of particulate matter (PM)] and duration (continuity of haze occurrence, up to 3 days). [Results] We observed the highest but non-significant odds ratios (ORs) of U5Y mortality at lag 4 of Intensity-3. Lag patterns revealed the possibility of higher acuteness at prolonged and intensified haze. Stratifying the districts by the 95th-percentile of PM distribution, the ‘low’ category demonstrated marginal positive association at Intensity-2 Duration-3 [OR: 1.210 (95% confidence interval: 1.000, 1.464)]. [Conclusions] We found a null association between haze and U5Y mortality. The different lag patterns of the association observed over different duration and intensity suggest consideration of these aspects in future studies

The impacts of climate variability on cholera cases in Malaysia

Introduction: Altered weather patterns and changes in precipitation, temperature and humidity resulting from climate change could affect the distribution and incidence of cholera. This study is to quantify climate-induced increase in morbidity rates of cholera. Material and Methods: Monthly cholera cases and monthly temperature, precipitation, and relative humidity data from 2004 to 2014 were obtained from the Malaysian Ministry of Health and Malaysian Meteorological Department, respectively. Poisson generalized linear models were developed to quantify the relationship between meteorological parameters and the number of reported cholera cases. Results: The findings revealed that the total number of cholera cases in Malaysia during the 11 year study period was 3841 cases with 32 deaths. Out of these, 45.1% of the cases were among children below 12 years old and 75% of the cases were from Sabah. Temperature and precipitation gave significant impact on the cholera cases in Sabah, (p<0.001) while precipitation were significant in Terengganu (p<0.001), and Sarawak (p=0.013). Monthly lag temperature data at Lag 0, 1, and 2 months were associated with the cholera cases in Sabah (p<0.001). The change in odds of having cholera cases were by the factor of 3.5 for every 1ºC increase in temperature. However, the contribution of rainfall was very mild, whereby an increase of 1 mm in precipitation will increase the excess risk of cholera by up to 0.8%. Conclusion: This study concludes that climate does influence the number of cholera cases in Malaysia

Tabiat pengambilan ulam-ulaman di kalangan orang dewasa pelbagai etnik di Selangor

Satu soal selidik telah dijalankan bertujuan untuk menilai tahap pengambilan ulam-ulaman di Negeri Selangor di kalangan 252 orang dewasa (> 17 tahun) (lelaki 28.6%, wanita 71.4%), pelbagai etnik (Melayu-51.6%; Cina-30.5%; India-17.5%) dengan umur purata 42.7 ± 13.9 tahun. Pengumpulan data pengambilan ulam-ulaman dibuat menggunakan kaedah sampel pendua 24 jam dan disertakan dengan soal selidik persepsi. Keputusan kajian ini mendapati bahawa ulam segar digemari oleh hampir semua subjek (82.1%) terutama daripada kalangan etnik Melayu (92.3%). Sebanyak 52% subjek memilih ulam celur/rebus. Faktor utama pengambilan ulam-ulaman adalah kerana khasiat yang baik kepada kesihatan serta rasanya yang enak dan unik. Ulam segar utama yang diambil oleh subjek kajian adalah mentimun (Cucumis sativus) (60.6%), kacang botol (Psophocarpus tetragonolobus) (33%), pegaga (Hydrocotyle asiatica) (31.5%), daun salad (Lactuca sativa) (27.6%), petai (Parkia speciosa) (29%) dan ulam raja (Cosmos caudatus) (21.9%). Sementara ulam celur/rebus pilihan adalah pucuk ubi (Manihot esculenta) (31.5%), bendi (Hibiscus esculentus) (12.5%) dan jantung pisang (Musa sapientum) (20.1%). Tiada perbezaan bererti (P > 0.05) terhadap pengambilan ulam-ulaman di kalangan etnik berbeza di mana nilai median untuk jumlah pengambilan sehari adalah pada julat 30-39 g/hari. Ulam berpotensi menjadi sumber dalam meningkatkan pengambilan sayursayuran bagi memenuhi saranan oleh Badan Kesihatan Sedunia (WHO) iaitu 400 g sehari

Climate change and temperature rise: implications on food poisoning cases in Malaysia

Background/Aim: This study is an attempt to quantify climate-induced increases in morbidity rates of food poisoning cases. Methods: Monthly food poisoning cases and average monthly meteorological data from 2004 to 2014 were obtained from the Malaysian Ministry of Health and Malaysian Meteorological Department, respectively. Population projections in Malaysia, up to the year 2040 were adopted from the Malaysian Department of Statistics and modified to the year 2100. The PRECIS model was used to project future climate up to the year 2100 under the A1B scenario. Poisson generalized linear models were developed to quantify the relationship between climatic parameters and the number of reported food poisoning cases in the future. Results: The findings revealed that the total number of food poisoning cases in Malaysia during the 11 years study period was 134,820 cases with 46 deaths. The mean age of the patients was 20±18 years. Half of the cases were among the ages of 13-24 years old. Among the cases, 98.2% were Malaysians and 55.7% were females. The PRECIS model projection under the A1B scenario showed that the surface temperature in Malaysia has a monotonic increment for all states with slightly higher warming rates over the Southern and Northern regions, with an increase of more than 3.0 °C towards the end of the 21st century. Temperature gave a significant impact on the incidence of food poisoning cases in Selangor (p<0.001), Melaka (p<0.001), and Kelantan (p<0.001). For a 1.0°C increase in temperature, the excess risk of food poisoning in each state will increase up to 56.4%. Conclusion: The study concludes that climate does affect the distribution of food poisoning cases in Selangor, Melaka, and Kelantan. Food poisoning cases in other states are not directly associated with temperature but related to long term trends and seasonality

Risk of concentrations of major air pollutants on the prevalence of cardiovascular and respiratory diseases in urbanized area of Kuala Lumpur, Malaysia

Rapid urbanisation in Malaysian cities poses risks to the health of residents. This study aims to estimate the relative risk (RR) of major air pollutants on cardiovascular and respiratory hospitalisations in Kuala Lumpur. Daily hospitalisations due to cardiovascular and respiratory diseases from 2010 to 2014 were obtained from the Hospital Canselor Tuanku Muhriz (HCTM). The trace gases, PM10 and weather variables were obtained from the Department of Environment (DOE) Malaysia in consistent with the hospitalisation data. The RR was estimated using a Generalised Additive Model (GAM) based on Poisson regression. A “lag” concept was used where the analysis was segregated into risks of immediate exposure (lag 0) until exposure after 5 days (lag 5). The results showed that the gases could pose significant risks towards cardiovascular and respiratory hospitalisations. However, the RR value of PM10 was not significant in this study. Immediate effects on cardiovascular hospitalisations were observed for NO2 and O3 but no immediate effect was found on respiratory hospitalisations. Delayed effects on cardiovascular and respiratory hospitalisations were found with SO2 and NO2. The highest RR value was observed at lag 4 for respiratory admissions with SO2 (RR = 1.123, 95% CI = 1.045–1.207), followed by NO2 at lag 5 for cardiovascular admissions (RR = 1.025, 95% CI = 1.005–1.046). For the multi-pollutant model, NO2 at lag 5 showed the highest risks towards cardiovascular hospitalisations after controlling for O3 8 h mean lag 1 (RR = 1.026, 95% CI = 1.006–1.047), while SO2 at lag 4 showed highest risks towards respiratory hospitalisations after controlling for NO2 lag 3 (RR = 1.132, 95% CI = 1.053–1.216). This study indicated that exposure to trace gases in Kuala Lumpur could lead to both immediate and delayed effects on cardiovascular and respiratory hospitalisations

Health education module based on Information-Motivation-Behavioural Skills (IMB) for reducing depression, anxiety, and stress among adolescents in boarding schools: a clustered randomised controlled trial

Depression, anxiety, and stress (DAS) among adolescents have become a public health concern. The aim of this study was to develop, implement, and measure an IMB-based health education intervention module for reducing DAS among adolescents in boarding schools in the state of Negeri Sembilan, Malaysia. A single-blinded cluster randomised control trial (RCT) was conducted among students with abnormal DASS-21 scores. They were divided into an intervention group (three schools, 62 participants) and a control group (three schools, 57 participants). Participants in the intervention group received IMB-based health education, while participants in the control group underwent the standard care session. To determine the effectiveness of the intervention, the Generalised Linear Mixed Model (GLMM) analysis was conducted. A total of 119 students participated in this study, and no loss to follow-up was reported. Both intervention and control groups showed significantly reduced DAS scores (p < 0.005). However, the reduction of these scores was greater in the intervention group. The GLMM analysis revealed that the intervention was effective in reducing depression (ß = −2.400, t = −3.102, SE = 0.7735, p = 0.002, 95% CI = −3.921, −0.878), anxiety (ß = −2.129, t = −2.824, SE = 0.7541, p = 0.005, 95% CI = −3.612, −0.646), and stress (ß = −1.335, t = −2.457, SE = 0.536, p = 0.015, 95% CI = −2.045, −0.266) among adolescents. The IMB-based health education module was effective in reducing DAS among adolescents in boarding schools

Investigation of the impacts of climate change and rising temperature on food poisoning cases in Malaysia.

This study is an attempt to investigate climate-induced increases in morbidity rates of food poisoning cases. Monthly food poisoning cases, average monthly meteorological data, and population data from 2004 to 2014 were obtained from the Malaysian Ministry of Health, Malaysian Meteorological Department, and Department of Statistics Malaysia, respectively. Poisson generalised linear models were developed to assess the association between climatic parameters and the number of reported food poisoning cases. The findings revealed that the food poisoning incidence in Malaysia during the 11 years study period was 561 cases per 100 000 population for the whole country. Among the cases, females and the ethnic Malays most frequently experienced food poisoning with incidence rates of 313 cases per 100,000 and 438 cases per 100,000 population over the period of 11 years, respectively. Most of the cases occurred within the active age of 13 to 35 years old. Temperature gave a significant impact on the incidence of food poisoning cases in Selangor (95% CI: 1.033-1.479; p = 0.020), Melaka (95% CI: 1.046-2.080; p = 0.027), Kelantan (95% CI: 1.129-1.958; p = 0.005), and Sabah (95% CI: 1.127-2.690; p = 0.012) while rainfall was a protective factor in Terengganu (95% CI: 0.996-0.999; p = 0.034) at lag 0 month. For a 1.0°C increase in temperature, the excess risk of food poisoning in each state can increase up to 74.1%, whereas for every 50 mm increase in rainfall, the risk of getting food poisoning decreased by almost 10%. The study concludes that climate does affect the distribution of food poisoning cases in Selangor, Melaka, Kelantan, Sabah, and Terengganu. Food poisoning cases in other states are not directly associated with temperature but related to monthly trends and seasonality