Background: Influenza poses a significant threat to the health of Malaysians, particularly among the elderly population. It results in high levels of illness and mortality, becoming a financial burden on the government. Vaccination is widely recognised as the most effective measure for controlling the spread and impact of influenza. Objectives: This study sought to assess the knowledge, attitudes, and practices (KAP) regarding influenza and influenza vaccination among older adults attending primary healthcare centres in different states of Malaysia. Additionally, the study assessed the level of acceptance for a proposed free annual influenza vaccination program. Methods: A nationwide survey was conducted involving 672 older people aged 60 and above who visited nine primary healthcare centres in Malaysia. These centres were selected using proportionate to population size (PPS) sampling to ensure representation from each zone. Participants completed a validated self-reported questionnaire. Descriptive statistics were used to determine the levels of KAP, and a binomial logistic regression model was used to determine the predictors of acceptance for the proposed free annual vaccination program. Results: Most participants displayed a strong understanding of influenza illness (74.0%) and the vaccine (65.9%). Moreover, 76.4% of respondents exhibited a positive attitude towards influenza vaccination. However, the prevalence of good vaccination practices was relatively low, with only 29.2% of participants having a history of previous vaccination, and just 55.2% of these consistently practicing annual vaccination. The group acceptance rate for the proposed free annual influenza vaccination was 62.3%. Significant predictors of acceptance included a history of previous vaccination (good practice) (OR = 6.438, 95% CI = 1.16-35.71, p < 0.001), a positive attitude towards vaccines (OR = 21.98, 95% CI = 5.44-88.87, p = 0.033), and a good level of knowledge about the influenza vaccine (OR = 0.149, 95% CI = 0.03-0.79, p = 0.026). Conclusions: Increasing the uptake of influenza vaccination among the older population in Malaysia remains a significant challenge. It is recommended that a targeted, free annual influenza vaccination program be implemented for high-risk populations, particularly those with comorbidities and those who have shown greater receptiveness. In addition, health education strategies aimed at raising awareness and understanding of influenza should be prioritised. Strengthening epidemiological data collection and establishing systematic monitoring mechanisms are also essential to support these efforts.

Family planning is a fundamental strategy to enhance the well-being of women, their partners, and children however, disparities among certain groups of women of reproductive age (WR) persist. This study aims to estimate the prevalence of unmet family planning needs among WR in Malaysia and its associated factors. Data from the 2022 national health survey were utilized. Face-to-face interviews were conducted using a standard questionnaire on contraceptive use among the eligible WR who provided written consent. Unmet needs refer to fecund WR who are not using any contraceptive method but wish to either limit childbearing (cease having children) or space pregnancies (delay their next birth). Out of 1,987 eligible WR, 1,877 respondents were interviewed, resulting in an 86.6

Stigma and discrimination against people living with HIV (PLHIV) can seriously affect their mental well-being and overall health. However, limited research has focused on the most economically active age group. This study sought to measure the extent of HIV-related stigma and examine the factors associated with discriminatory attitudes. This study utilized data from a nationwide survey conducted in 2020. The survey employed a cross-sectional design with a complex sampling strategy to ensure national representativeness. Data on HIV stigma were collected through a self-administered questionnaire due to the sensitive nature of the items. A total of 2,818 individuals aged 15 to 49 years who responded to the HIV stigma module, which assessed six stigma domains, were included in the analysis. IBM SPSS Statistics version 29.0 was used to conduct descriptive analyses and multivariable logistic regression. The prevalence of the global indicator for discriminatory attitudes towards PLHIV was 78.7%. Additionally, the prevalence of each six HIV stigma domains was: experienced stigma (70.3%), fear of HIV infection (64.4%), discrimination (60.6%), anticipated stigma (57.6%), social judgment (44.9%), and perceived stigma (42.2%). Multivariable logistic regression analysis identified lower education levels (aOR: 2.42, 95% CI [1.85, 3.15]) and rural residence (aOR: 1.57, 95% CI [1.20, 2.04]) as significant factors associated with discriminatory attitudes towards PLHIV. HIV-related stigma and discrimination remain common among individuals aged 15 to 49 years in Malaysia. Effective and timely action is needed to address these issues and contribute to the global effort to end the AIDS epidemic by 2030.

Abstract Introduction Data on child functioning and disability are important for public policy development which aimed at reducing child disability prevalence and strengthening the provision of appropriate and timely health care services. This study reports the prevalence of functional difficulty in Malaysian children aged 2–17 years and its associated sociodemographic factors and epilepsy. Methods Data on children aged 2–17 years (n = 4576) were generated from the National Health and Morbidity Survey (NHMS) 2019, a population-based cross-sectional survey. Functional difficulty in children was assessed using the United Nations Children’s Fund (UNICEF)/Washington Group on Disability Statistics (WG) Child Functioning Module (CFM). The questionnaires were administered to the parents or guardians of the children via face-to-face interviews. Functional difficulty, defined as having difficulty in at least one domain, was examined for its prevalence and associations with sociodemographic variables and the epilepsy variable in children using descriptive analysis and multiple logistic regression. Results The overall prevalence of functional difficulty among children aged 2–17 years was 4.7%. Multiple logistic regression analysis revealed that older children, children from households whose heads of household had a lower education level and children who have epilepsy were significantly more likely to experience functional difficulty (p < 0.05). Children of Chinese ethnicity were less likely to experience functional difficulty compared to children of Malay ethnicity. Conclusions This study provides baseline findings on the prevalence of functional difficulty among children in Malaysia using nationally representative data. Although the prevalence was relatively low, the information is important for the planning of strategies to improve the development and well-being of children in Malaysia and for achieving the Sustainable Development Goals (SDGs).

Erectile dysfunction (ED) is a pervasive problem among men, often shrouded in silence and stigma. This manuscript analysed the National Health and Morbidity Survey 2019 data to identify the prevalence of moderate to severe ED among men aged 18 and above in Malaysia and describe its associated factors. Self-administered questionnaire on ED utilised a locally validated International Index of Erectile Function. Variables on sociodemographics, risky lifestyles and comorbidities were obtained via an interviewer-administered questionnaire. The prevalence was determined using complex sampling analysis, and logistic regression was used to determine the associated factors of ED. A sample of 2403 men aged ≥ 18 participated, with a moderate to severe ED prevalence was 31.6% (95% CI 28.8, 34.6). The mean (± SD) of the total score of IIEF-5 for overall respondents was 18.16 (± 4.13). Multiple logistic regression analysis revealed a significant association between moderate to severe ED among men aged 60 years and above, single or divorcee, men without formal, primary, and secondary education, non-government employees, unemployed, and retiree, as well as physically inactive men. Focused public health interventions are necessary to improve education in sexual health, increase health promotion programs, and promote healthy ageing across the population.

BACKGROUND:Anaemia continues to be a global public health burden affecting all age groups, particularly children. Indigenous people, including the Orang Asli (OA) population in Malaysia, are at risk of anaemia due to the vast disparities in social determinants of health in their population compared to the non-indigenous population. OBJECTIVES:This review aimed to identify the prevalence and risk factors of anaemia among OA children in Malaysia and analyse the knowledge gaps. METHODS:A systematic search was conducted in PubMed, Cochrane Library, Scopus and Google Scholar databases. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. RESULTS:This review identified six studies involving the participation of OA children from eight subtribes residing in Peninsular Malaysia. The overall prevalence of anaemia among OA children ranged from 21.6 to 80.0%, with iron deficiency anaemia prevalence at 34.0%. The risk factors of anaemia among OA children reported from one study in this review were being younger than ten years old children (AOR 2.11 (95% CI 1.23, 3.63)) and moderate to heavy Ascaris infections (AOR 2.05 (95% CI 1.12, 3.76)). There was no data from OA children from certain age groups and subtribes. Additionally, there is a paucity of data on risk factors for anaemia among OA children from the currently available evidence. CONCLUSION:The prevalence of anaemia among OA children poses a moderate to severe public health concern. Therefore, more comprehensive studies in the future are needed to address the gaps identified in this review, primarily regarding anaemia risk factors. This data would encourage policymakers in devising effective national prevention strategies to improve morbidity and mortality among OA children in the future.

Background According to World Health Organization (WHO), the fourth leading cause of death among adolescents aged 15 -19 years is suicide. The National Health and Morbidity Survey (NHMS) 2017 reported that suicidal attempts among school adolescents increased from 6.8%—6.9% as compared to NHMS 2012. Suicide attempts can cause significant negative impacts on health, social and economic status. Bullying is one of the factors for adolescent suicide attempts, and its relationship to suicidality in adolescents has been shown in numerous research. Objectives This study examined the relationship between suicide attempts and bullying among school adolescents in Malaysia. Methods Data from the Malaysia NHMS 2017, a nationwide study that adopted a two-stage cluster sampling design, were analysed. The survey used a self-administered questionnaire in bilingual language adapted from GSHS developed by WHO. Participants were secondary school students aged 13 -17 in all states. Descriptive and multiple logistic regression analyses were performed using IBM SPSS version 28. Results A total of 27,497 school adolescents participated in the study. Results showed that 6.9% of school adolescents had attempted suicide. There was 16.2% of adolescents being bullied. Multiple logistic regression revealed that students who were bullied were more likely to have suicide attempts (aOR 4.827, 95% CI: 4.143, 5.624) P < 0.001. Discussion/conclusion This study revealed that bullying is associated with suicide attempts among school adolescents in Malaysia. The respective authority should consider and plan effective measures to curb bullying among school adolescents.

Objective: This study aims to determine the prevalence of poor self-rated health (SRH) in Malaysia and its association with sociodemographic characteristics, lifestyle behavior, chronic diseases, depression, and functional limitations in activities of daily living (ADLs) among older persons. Design: Cross-sectional. Setting, participants, and outcome measures: We used data from the National Health and Morbidity Survey 2018, a nationwide community-based study. This study was conducted using a two-stage stratified cluster sampling design. Older persons were defined as persons aged 60 years and above. SRH was assessed using the question “How do you rate your general health?” and the answers were “very good”, “good”, “moderate”, “not good”, and “very bad”. SRH was then grouped into two categories; “Good” (very good and good) and “Poor” (moderate, not good, and very bad). Descriptive and logistic regression analyses were conducted using SPSS version 25.0. Results: The prevalence of poor SRH among older persons was 32.6%. Poor SRH was significantly related to physical inactivity, depression, and limitations in activities of daily living (ADLs). Multiple logistic regression revealed that poor SRH was positively associated with those who had depression (aOR 2.92, 95% CI:2.01,4.24), limitations in ADLs (aOR 1.82, 95% CI: 1.31, 2.54), low individual income (aOR 1.66, 95% CI:1.22, 2.26), physical inactivity (aOR 1.40, 95% CI:1.08, 1.82), and hypertension (aOR 1.23, 95% CI:1.02, 1.49). Conclusions: Older persons with depression, limitations in ADLs, low income, physical inactivity, and hypertension were significantly associated with poor SRH. These findings provide information to aid health personnel and policymakers in the development and implementation of health promotion and disease prevention programs, as well as adequate evidence in planning different levels of care for the older population.

Mental health problems are major public health concerns during the COVID-19 pandemic due to uncertainties of the disease, public fears and movement control orders which interrupt economic activities. Uncertainties about the diseases could trigger anxiety, particularly among healthcare workers (HCWs) who are directly involved in handling COVID-19 patients and specimens. This study aims to determine the prevalence and factors associated with a probable generalized anxiety disorder (GAD) among public laboratory HCWs in Central Peninsular Malaysia. A cross-sectional study was conducted from October to December 2021 with a total of 406 respondents participating in this study. Anxiety symptoms were assessed using the Malay-validated 7-items GAD questionnaire. The cut-off points to define probable GAD were scores of eight and above. A descriptive analysis and multiple logistic regression were conducted to calculate the prevalence of probable GAD and its associated factors. The prevalence of probable GAD among laboratory HCWs was 20.7%. Factors associated with probable GAD among laboratory HCWs during the COVID-19 pandemic were younger age group (aOR=3.23; 95% CI:1.22, 8.57), excessive working time of more than 50 hours per week (aOR=3.09; 95% CI: 1.76, 5.42) and working with COVID-19 specimens (aOR=1.83; 95% CI:1.07, 3.14). HCWs in the national laboratory were at risk of having probable GAD during the COVID-19 pandemic, especially among the younger age group, those exposed to excessive working time and those who handled COVID-19 specimens. Thus, stakeholders should improve the existing psychological support and provide supportive working environments including a regular mental health screening and early intervention among those who were screened positive for probable GAD.

The COVID-19 pandemic has created anxiety among hospitalized SARS-CoV-2 patients. Therefore, this study aimed to determine the prevalence of anxiety and its associated factors among stable inpatient COVID-19 patients in Malaysia. Method: A cross-sectional study was conducted using a web-based online survey involving 401 patients from Malaysia’s leading COVID-19 hospitals from 15th April until 30th June 2020, who were chosen using quota sampling. The General Anxiety Disorders 7 items (GAD-7) scale, the Coping Orientation to Problems Experienced Inventory (Brief-COPE) and a socio-demographic profile questionnaire were used. Descriptive analysis and multiple logistic regression were performed using SPSS v23 to determine the prevalence of anxiety and its associated factors. Result: The results showed that the prevalence of anxiety was 7.0%. Multiple logistic regression analysis revealed that female gender (p < 0.05), a fear of infection (p < 0.05), a lack of information (p < 0.05), a maladaptive coping mechanism of behavioral disengagement (p < 0.001) and self-blame (p < 0.001) were significantly associated with anxiety. Meanwhile, adaptive coping mechanisms via instrumental support (p < 0.001) were a significant protective predictor of anxiety. Conclusions: COVID-19 infection has had a significant influence on the mental health of patients. Findings in our study provide baseline data on the prevalence of anxiety among stabilized COVID-19 inpatients in Malaysia. Despite the relatively low prevalence, the data have the potential to improve the present mental health monitoring system and the deployment of suitable treatments in dealing with similar circumstances.

The outbreak of pandemic disease is catastrophic and caused negative psychological effects among patients, healthcare workers and their surroundings. This study aims to determine the prevalence of depression and suicidal ideation among stable hospitalized COVID-19 patients. This is a cross-sectional study with web-based online survey involving 401 stable hospitalized COVID-19 patients aged 18 years above who were selected via quota sampling technique. The questionnaire consists of socio-demographic profile, Patient Health Questionnaire 9 items (PHQ-9) and Brief COPE (Coping Orientation to Problems Experienced). The identified probable cases of depression and suicidal ideation were subsequently referred to psychiatrists. The prevalence of depression and suicidal ideation were 7.5% and 4.0% respectively. The prediction model revealed that females [aOR=5.29 (95% CI: 1.34, 20.80)], age 35-49 years old [aOR=7.47 (95% CI: 1.78, 31.30)], adopting behavioral disengagement [aOR=1.94 (95% CI: 1.31, 2.87)] and self-blame [(aOR = 1.74, 95% CI: 1.31, 2.30)] as coping strategies, were significant predictors of depression. The findings estimate mental health burden among COVID-19 patients in Malaysia. The establishment of continuous mental health surveillance is essential in managing cases of depression and suicidal ideation.

The co-occurrence of multiple modifiable risk factors increases the risk of cardiovascular disease (CVD) morbidity or mortality. This study examines the prevalence and clustering of self-reported modifiable CVD risk factors among older adults in Malaysia. A total of 7117 adults aged ≥50 years participated in the National Health and Morbidity Survey (NHMS) 2018: Elderly Health, a community-based cross-sectional survey. Data were collected using a standardized structured questionnaire. Multivariable logistic regression was used to determine the factors associated with the clustering of self-reported modifiable CVD risk factors. The prevalence of self-reported diabetes, hypertension, hypercholesterolemia, overweight/obesity, and current smoking was 23.3%, 42.2%, 35.6%, 58.4%, and 17.5%, respectively. Overall, the prevalence of clustering of ≥1, ≥2, and ≥3 modifiable CVD risk factors was 83.3%, 75.4%, and 62.6%, respectively. Multivariable logistic regression analysis showed that men, 60–69 age group, urban dwellers, having no formal education, unemployed/retirees/homemakers, and being physically inactive were independently associated with self-reported modifiable CVD risk factors clustering. There are also ethnic differences in self-reported modifiable CVD risk factors clustering. Our findings underscore the necessity of targeted interventions and integrated strategies for early detection and treatment of modifiable CVD risk factors among older adults, considering age, sex, ethnicity, and socioeconomic status.

INTRODUCTION:Disability has adverse effects on health, wellbeing, and life quality. Vision disorder is one of the top-ranked causes of disability in the elderly population. This study aims to determine the prevalence and factors associated with vision disability among the elderly in Malaysia. Methodology. Data collection from National Health and Morbidity Survey (NHMS) 2018 was obtained. This survey focused on elderly health by using two-stage stratified cluster sampling design. The Washington Group Extended Question Set on Functioning (WG ES-F) was used to determine the vision disability. The data were analyzed using SPSS version 21.0 utilizing a complex sample design with multivariable logistic regression analysis to determine the prevalence and associated factors to vision disability.RESULTS:A total of 3,977 elderly completed the vision disability questionnaire. The overall prevalence of vision disability among those who were 60 years old and above was 4.5%. Multiple logistic regression revealed that no formal education (AOR: 6.69, 95% CI: 1.52, 29.49), only primary education (AOR: 4.26, 95% CI: 1.01, 18.03), unemployed/retiree or homemaker (AOR: 3.25, 95% CI: 1.79, 5.89), hypertension (AOR: 1.45, 95% CI: 1.00, 2.09), and malnourished elderly (AOR: 2.84, 95% CI: 1.76, 461) had higher odds for having vision disability.CONCLUSION:The findings suggest that a low education level, unemployment, hypertension, and malnourishment are significant risk factors for VD among Malaysia's elderly. Strengthening awareness campaigns to increase VD awareness and provide high-quality rehabilitation services must target specific groups, such as the elderly with a low level of education and the unemployed. Empower primary healthcare providers with the knowledge and skills necessary to improve the quality of eye care delivery and expand eye screening in settling VD issues nationally.

BACKGROUND:A mandatory universal salt iodization (USI) has been implemented in Sarawak, Malaysia since 2008.OBJECTIVES:The aim of this study is to assess the current iodine status among school-aged children (SAC) and pregnant women (PW) after 10 years of USI implementation in Sarawak.METHODS:This cross-sectional survey among school-aged children and pregnant women was conducted between July and October 2018 in Sarawak. The multistage proportionate to population size sampling technique was used to select 30 schools and 30 maternal and child health care clinics. A total of 1200 children aged 8 to 10 years and 750 first-trimester pregnant women were randomly selected to participate in the study. Iodine excretion level in urine was determined according to the World Health Organization classification.RESULTS:A total of 988 children and 677 PW participated in the study with a response rate of 82.3% and 90.2%, respectively. The overall median urinary iodine concentration (UIC) level among the children was 126.0 μg/L (interquartile range [IQR], 71.0-200.9 μg/L) and classified as adequate iodine status. The median UIC among PW was 123.9 μg/L (IQR, 56.5-192.1μg/L) indicating inadequate iodine status.CONCLUSION:The present findings indicate that despite adequate iodine status in children, the majority of PW still showed inadequate iodine status. Thus, comprehensive monitoring of the iodine deficiency disorder problem among PW is warranted.

Introduction: Internet usage has changed the way adolescents socialize. This study aims to determine the determinants of internet addiction among school-going adolescents in Malaysia. Methodology: This study was a cross-sectional study involving 27,455 school-going adolescents from 212 selected schools in Malaysia, as part of the 2017 National Health and Morbidity Survey that implemented a two-stage stratified cluster sampling design. Data collection via a self-administered questionnaire was conducted from March till May 2017. Results: Overall, 8,049 (29.0%) school-going adolescents had internet addiction. Internet addiction was positively associated with male (odds ratio, OR [95% confidence interval, CI] = 1.20 [1.08,1.34]) compared to female, Chinese ethnicity (1.67 [1.12,2.48]) compared to other ethnicity, feeling loneliness (1.37 [1.20,1.57]) compared to never feel lonely, unable to sleep due to worrying of something (1.40 [1.17,1.67]) compared to able to sleep, insufficient parental supervision (1.30 [1.14,1.48]) compared to sufficient parental supervision, depression (1.67 [1.48,1.89]) compared to no depression, anxiety (2.12 [1.95,2.30]) compared to no anxiety and stress (2.26 [1.96,2.61]) compared to no stress. The odds of having internet addiction increase from Form 2 (1.51 [1.28,1.78]), Form 3 (2.37 [2.01,2.80]), Form 4 (2.60 [1.76,3.85]) to Form 5 adolescents (2.96 [1.98,4.41]) compared to Form 1 adolescents. Conclusion: Our results suggest that being a male, of Chinese ethnicity, higher form level, feeling loneliness, unable to sleep due to worrying of something, insufficient parental supervision, depression, anxiety and stress were positively associated with internet addiction among school-going adolescents. Keywords: Internet addiction – public health – adolescents – NHMS - Malaysia

In 2016, the Ministry of Health (MOH) Malaysia has introduced a new programme to prevent and reduce the occurrence of non-communicable diseases (NCDs) as well as related risk factors in the work place environment known as KOSPEN Plus. This study aims to evaluate the awareness and perception of KOSPEN Plus programme after 3 years of implementation in MOH health facilities, government and private agencies in Malaysia. A cross sectional study design was employed in the study. All health facilities, government and private agencies which had implemented KOSPEN Plus programme between 2016 and 31 December 2018 in all states in Malaysia were invited to participate in the study. The computer assisted self-interview (CASI) using the pre-tested self-administered questionnaire in the electronic form was used. A total of 362 health facilities, government and private agencies which had implemented KOSPEN Plus programme was involved in this study. Overall, more than 80% of facilities/agencies in this study implemented six out of the eight scopes of KOSPEN Plus. The survey was planned with the goal of obtaining data to support the Ministry of Health in reviewing the present health activities related to workers health in Malaysia and make necessary improvement to the programme.

SUMMARY This research article highlights the first cluster of COVID-19 cases in Malaysia which originated from a group of foreign tourists. The cluster involved 3 cases from 8 close contacts of a COVID-19 case, who was visiting Singapore for holidays. The public health responses and challenges in containing the outbreak we also underlined with the focus on rapid and effective risk communication between relevant authorities in different countries. Keywords: COVID-19, first cluster, Malaysia, public health response

Introduction: The rapid spread of the COVID-19 worldwide has led the World Health Organization (WHO) to declare COVID-19 outbreak as a pandemic on March 11, 2020. This study aims to determine the factors associated with asymptomatic COVID-19 patients in Petaling District, Selangor, Malaysia. Methods: 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 multivariable logistic regression analyses were conducted to determine the factors associated with asymptomatic patients. Results: 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. Multivariable 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. Conclusion: 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 and laboratory examinations are helpful in identifying COVID-19 cases among these group of people who are asymptomatic. Keywords: COVID-19 - asymptomatic - pandemic - Malaysia