Barriers and Drivers of Physical Activity Participation Among Older Adults in Malaysia: A Systematic Review

@#Introduction: Ageing is commonly linked with physical inactivity. This review was performed to identify the factors associated with participation in physical activity among older adults in Malaysia. Methods: A systematic review was conducted using five databases; Pubmed, Sagepub, Scopus, Cochrane Library and Science Direct. Observational and intervention studies published between January 2010 and December 2020 were included, with Malaysian older adults aged 55 years and older being the main subject. Results: A total of 9 articles were included in the review. Analysis was guided by the Social Ecological Model for Health Promotion. The review had successfully identified gender, age, education level, health reasons, ethnicity and attitude as intrapersonal factors, social support (friend) and marital status as interpersonal factors, and locality as well as availability of facilities as environmental factors. Conclusions: Physical activity participation among Malaysian older adults were mainly determined by intrapersonal factors, particularly gender, health condition and educational level.

Catastrophic Health Expenditure Among Cancer Patients In National Cancer Institute (NCI), Malaysia And Its Influencing Factors

@#Introduction: This study looks at the patient’s perspective to determine the Catastrophic Health Expenditure (CHE) level and the possible factors which can be associated with CHE in cancer patients. Methods: This cross sectional study was done in National Cancer Institute, Malaysia with 206 patients sampled using the multilevel sampling method and data collected from interview with patients using a validated questionnaire. The CHE definition used in this study is when the monthly health expenditure exceeds more than 10% of the monthly household income. Results: This study showed a CHE level of 26.2%. CHE was higher in Indian ethnicity (P = 0.017), single marital status (P = 0.019), poverty income (P < 0.001), small household size (P = 0.006) and without Guarantee Letter (GL) (P = 0.002) groups. The significant predicting factors were poverty income aOR 5.60 (95% CI: 2.34 – 13.39), home distance near to hospital aOR 4.12 (95% CI: 1.74 – 9.76), small household size aOR 4.59 (95% CI: 1.07 – 19.72) and lack of Guarantee Letter aOR 3.21 (95% CI: 1.24 – 8.30). Conclusion: The information from this paper can be used by policy makers to formulate better strategies in terms of health financing so that high risk for CHE cancer patients groups can be protected under a better health financing system.

Mental Health of University Students in Northern Malaysia

Context/Background: Today, poor mental health is one of the most neglected diseases although it is one of the leading causes of disabilities in both developed and developing countries. This mental health issue be-comes a problem among university students too. This study was aimed to determine the prevalence and asso-ciated factors of depression, anxiety, and stress (DAS) among university students. Methodology: A cross-sectional study was carried out in a private university of northern Malaysia during 2020. A random sample of 161 students were included and DASS-21 was used to determine the prevalence of DAS. Multiple logistic regression analysis was performed to examine the associated factors. Results: The prevalence of DAS among students were 34.8%, 42.2%, and 33.5%, respectively. In contrast to years 2 and 4, the prevalence of all types of mental disorders were lower in years 1 and 3. The students’ living area, residence, academic year, and parental income were significantly associated with anxiety whereas the age group of the students and parent’s income did so for depression. The variables; age group, academic year and parent’s income were identified as significant determinants for the presence of stress among students. Conclusions: The significant extent of the mental health problems was detected among university students in Malaysia. Despite the small sample, this analysis indicates that opportunities exist to improve campus-based mental health education and psychological support among university students.

A Systematic Review on Caregiver’s Burden Among Caregivers of Dementia Patients in Malaysia

@#Introduction: Increasing prevalence of dementia and the associated caregiving burden are expected due to longer life expectancy. This review aimed to critically assess dementia-driven caregiving burden and the associated factors in Malaysia. Methods: A systematic search using several combinations of keywords was conducted in Ovid Medline, PubMed, Science Direct, ProQuest, and Ebscohost databases. The primary outcome was the score or level of caregiver burden, while the secondary outcome was the factors associated with such burden. The quality of the individual articles was assessed using the Newcastle–Ottawa Scale and the Joanna Briggs Institute checklist. Results: The systematic search resulted in seven studies being reviewed, consisting of six cross-sectional studies and one quasi-experimental study. Using the Zarit Burden Interview, two studies reported moderate caregiver burden with mean scores of 35.4 (15.08) and 46.0 (17.0). High levels of burden or strain were reported using the Caregiver Strain Index in other studies. The three main associated factors with burden identified in these studies were the presence of behavioural and psychological symptoms of dementia (BPSD), higher education level, and lack of social support. Conclusion: Moderate to severe caregiving burden level were found to be experienced by dementia caregivers in this country. High education, lack of support, as well as taking care of patient with BPSD being the most prominent factors associated with burden. Therefore, burden should be regularly assessed among the dementia caregivers especially among those with lack of social support and manage family members with BPSD, as to prevent adverse outcome from dementia caregiving.

Prevalence of Burnout and Its Associated Factors among Medical Students in a Public University in Selangor, Malaysia: a CrossSectional Study

@#Introduction: Burnout is a growing trend among medical students worldwide. The aim of this study was to determine the prevalence and factors associated with burnout among medical students at a public university in Malaysia. Methods: A cross-sectional study was conducted among 1st through 5th year medical students at a public university using a simple random sampling method in recruiting participants. In this study, The Maslach Burnout Inventory-General Survey for Student (MBI-SS) was used and burnout is defined as severely emotionally exhausted and severely depersonalised. Results: A total of 328 medical students were recruited with a with response rate of 88.6%. The burnout prevalence was 10.1%. Based on multivariate logistic regression, presence of smartphone addiction with adjusted (odds ratio (OR) 7.37, 95% confidence interval (CI) = 1.67, 32.49), course choice not based on personal interest or due to family pressure (OR 2.72, 95% CI = 1.08, 6.85) and the presence of family relationship problems (OR = 3.58, 95% CI = 1.27, 10.04) are more likely to be associated with burnout among the medical students. Conclusion: Our study has shown that every tenth medical students suffers from burnout. Medical students who are addicted to smartphone, have chosen medical course against individual interest or because of family pressure and have family relationship problems are at risk of getting burnout. Intervention is required to address this issue for the future well-being of medical students.

First observation of Afromorgus chinensis (boheman, 1858) (Coleoptera: Trogidae) on a rabbit (Oryctolagus cuniculus L., 1758) carcass and its implications in forensic entomology

@#Beetles (Coleoptera) are known to constitute forensic evidence in medico-legal investigations as their presence can be used to date human remains in almost all decomposition stages. Many forensic studies focus on the successional colonization pattern of flies (Diptera); however, beetles have not so far been studied extensively for this aspect. A beetle of the genus Afromorgus Scholtz, 1986, A. chinensis (Boheman, 1858) (Scarabaeoidea: Trogidae), was found beneath a late decaying rabbit carcass at Paya Indah Wetland, Dengkil, Malaysia, for the first time. Both genus and species are already known to occur in Malaysia from literature.

Evaluation of insecticide resistance among Malaysian Aedes albopictus Skuse larvae based on revised diagnostic doses of larvicides

@#The susceptibility levels of Malaysian Aedes albopictus larvae sampled from several agricultural, fogging-free residential and dengue prone residential areas against different larvicides were evaluated using revised diagnostic doses derived from the 2xLC99 values of the reference strain. Upon 24-hour recovery period of WHO larval bioassay, incipient resistance was observed among Ae. albopictus larvae from rubber estates against fenitrothion (96.67% mortality) and permethin (97.00% mortality) while Ae. albopictus larvae from rice cultivation areas were moderately resistant to fenthion (94.33% mortality). Aedes albopictus larvae from dengue prone residential areas developed moderate to high resistance against dichlorodiphenyltrichloroethane (DDT), fenitrothion, fenthion, propoxur and permethrin (79.67% – 97.33% mortality). Moderate to high resistance were also demonstrated among all populations of Ae. albopictus larvae against temephos and chlorpyrifos (63.00% – 97.67% mortality). Except for Ae. albopictus larvae from oil palm plantations, all Ae. albopictus larval populations were also highly resistant to bendiocarb (65.67% – 89.67% mortality). Cross resistance between larvicides from similar and different insecticide classes were also revealed in this study. The use of revised diagnostic doses established from the local reference strain could reduce the possibility of underestimation or overestimation of the insecticide susceptibility status of field strain populations.

First molecular detection of porcine circovirus type 4 (PCV4) in Malaysia

@#Porcine circovirus type 4 (PCV4) is the newest member in the porcine circovirus family, first reported in 2020. To date, the presence of PCV4 has only been reported in China, South Korea and most recently in Thailand. Detection of PCV4 have been reported in various production stages of pigs from piglets, finishers to sows; associated with a myriad of clinical manifestations including porcine dermatitis and nephropathy syndrome (PDNS), postweaning multisystemic wasting syndrome (PMWS), respiratory, enteric and neurological diseases. While successful virus isolation and culture has yet to be reported, pathogenicity of PCV4 has been demonstrated through infectious clone studies. The objective of this study is to investigate the presence of PCV4 in Malaysian porcine population to update the epidemiology of porcine circoviruses in Malaysia. A total of 49 samples from commercial intensive pig farms, abattoir and wild boar population were subjected to conventional polymerase chain reaction assay to detect PCV4 capsid (cap) genome. Resulting cap nucleotide sequences were analyzed for maximum likelihood phylogeny relationship. Results revealed that PCV4 is present in Peninsular Malaysia at a molecular prevalence of 4.08% (2 / 49 samples). Both PCV4 positive samples originated from clinically healthy finishers. Malaysian PCV4 strains were classified as genotype PCV4b, and were found to be phylogenetically distinct from the China, South Korea and Thailand strains. With this latest update of the novel PCV4 in Malaysia, it is clear that more attention needs to be given to the investigation of novel porcine circoviruses (PCV) and management of PCV diseases.

Presence of SARS-CoV-2-like coronaviruses in bats from east coast Malaysia

@#Most of the public health importance coronaviruses, such as Severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS-CoV-2 are likely originated from bats and spread to humans through intermediate hosts; civet cats, dromedary camel and Malayan pangolin, respectively. SARS-CoV-2-like coronaviruses were detected in Thailand, which is neighbouring with Kelantan in East Coast Malaysia. To date, there is no report on the presence of public health concerns (SARS-CoV, SARS-CoV-2 and MERS-CoV) coronaviruses in bats from Malaysia. This study was aimed to elucidate the presence of these coronaviruses in bat samples from East Coast, Malaysia. A total of hundred seventy oropharyngeal swab samples were collected from three states of East Coast Malaysia. Reverse Transcription-Polymerase Chain Reaction (RT-PCR) was conducted based on partial 3’ Untranslated region (3’UTR) or ORF10 gene and the products were sequenced. The sequences were compared with all coronavirus sequences from the National Center for Biotechnology Information-GenBank (NCBI-GenBank) using NCBI-Basic Local Alignment Search Tool (NCBI-BLAST) software. A phylogenetic tree was constructed to determine the genetic relationship among the detected coronaviruses with the reference coronaviruses from the NCBI-GenBank. Our results showed that SARSCoV-2-like viruses were present in 3% (5/170) of the bats from East Coast Malaysia that have 98-99% sequence identities and are genetically related to SARS-CoV-2 from humans. This finding indicates the presence of SARS-CoV-2-like viruses in bats from East Coast Malaysia that may become a public health concern in the future.

Molecular characterization and phylogenetic analysis of avian influenza H3N8 virus isolated from imported waterfowl in Malaysia

@#Wild aquatic birds are natural reservoirs of influenza A viruses and H3 subtype is one of the most prevalent subtypes in waterfowl. Two H3N8 viruses of low pathogenic avian influenza (LPAI) were isolated via egg inoculation technique from the fecal swab specimens from imported barnacle goose and paradise shelduck in Veterinary Research Institute Ipoh, Malaysia. The full length of eight gene segments of the two viruses were amplified and sequenced with specific primers. The sequences were molecularly characterized, and the sequence identity were assessed with other published sequences. The two viruses are identical and they possess the same amino acid sequences for all the eight gene segments. The viruses were highly similar to the H3 virus from Netherlands and N8 virus from Belgium respectively. Phylogenetic analysis revealed that all the eight gene segments were grouped in the Eurasian lineage, and genetic reassortment may occur between the internal genes of the H3 viruses and other AI subtypes. Though four amino acid substitutions were identified in the hemagglutinin gene, the viruses retained most of the avian-type receptor binding preference. Few amino acid substitutions were observed in all internal genes. Most of the neuraminidase inhibitors and adamantine resistance related mutation were not seen in the viruses. The replicative capacity, cross species transmissibility, and potential zoonotic risk of the viruses are worth further investigation. As H3 virus poses potential threats to both human and animals, and with the increase in the international trade of birds; strict quarantine practice at the entry point and good laboratory diagnostic capabilities is crucial to prevent the introduction of new AI virus into our country.

Molecular identification and in vitro assessment of zoonotic-potential of a novel Orthobunyavirus isolated from broiler chicken in Malaysia

@#We have previously isolated a novel avian Orthobunyavirus, Kedah Fatal Kidney Syndrome (KFKS) virus from a broiler farm in Kedah, Malaysia in 2020 with a severe kidney lesion in chickens. The virus was designated as KFKS2_CS virus. Sequence analysis of partial nucleocapsid (N) and nonstructural (NSs) sequence of this virus showed the highest sequence identity with previous KFKS1 from Malaysia (100%) and 97% with a zoonotic Umbre (UMB) virus, which was reported to cause encephalitis in immunocompromised humans in India. Phylogenetic analysis revealed that this virus was clustered together with previous KFKS1 virus from Malaysia, UMB and Cristoli viruses. This study aimed to assess the zoonotic potential of this KFKS2_CS virus in vitro by determining its ability to inhibit the production of interferon (IFN) in human glioblastoma multiforme (GBM) brain cells using reverse-transcriptase polymerase reaction (RT-PCR). This virus blocked the production of interferon-a in this human brain cells. In conclusion, this KFKS2_CS virus may have a zoonotic potential and become a public health concern in the future.

Current status of infectious diseases among migrants and non-citizens in Malaysia

@#The mass movement of migrants to Malaysia for employment is one of the factors contributing to the emergence and re-emergence of infectious diseases in this country. Despite mandatory health screening for migrants seeking employment, prevalence records of infectious diseases amongst migrant populations in Malaysia are still within negligible proportions. Therefore, the present review highlights the incidence, mortality and overall status of infectious diseases amongst migrants’ populations in Malaysia, which maybe be useful for impeding exacerbation of inequalities among them and improving our national health system thru robust and effective emergency responses in controlling the prevalent diseases found among these populations and maybe, Malaysian citizens too. Peer-reviewed articles from January 2016 to December 2020 were searched through online platform including SCOPUS, PubMed, Science Direct, and Google Scholar. Non-peer-reviewed reports and publications from ministry and government websites including data from related agencies were also scoured from in order to ensure that there are no cases being overlooked, as most published articles did not have migrants as the research subjects. A total of 29 studies had been selected in the final analysis. Migrants in Malaysia were at higher risk for tuberculosis, malaria, lymphatic filariasis, cholera, leprosy and leptospirosis. Lymphatic filariasis was still endemic among this population while thousand cases of TB and cholera had been reported among them due to cramp living conditions and poor sanitation in their settlements respectively. While malaria had gradually decreased and become sporadic, the influx of migrant workers had led to the rising of imported malaria cases. Low cases of leprosy had been recorded in Malaysia but a significant proportion of it was contributed by migrant workers. As for leptospirosis, studies found that there are prominent cases among migrant workers, which particularly highest within workers with lower educational attainment. Infectious diseases are still prevalent among migrants in Malaysia due to various interplay factors including their working sectors, country of origin, immunization status, type of settlement, impoverished living conditions, and language and cultural barriers that impeding access to health facilities.

Poverty related diseases amongst Malaysia’s low-income community: a review

@#Poverty, as proven by several studies, is a driving force behind poor health and hygiene practices. This review attempts to outline common communicable and non-communicable diseases that disproportionately affect Malaysia’s 2.91 million low-income households. The current study also looks into the government’s housing and healthcare programmes for this demographic to improve their health and well-being. The initial examination yielded incredibly little research on this marginalised community, with event reporting typically generalised to the Malaysian community as a whole rather than analysing disease incidences based on household income, which would better reflect povertydriven diseases. As a result, there is an acute need for more accurate information on the epidemiology of diseases among the poor in order to address this public health issue and provide conclusions that can drive policy designs.

Growth patterns of urban Malaysian children under 24 months of age in Selangor, Malaysia

@#Introduction: To identify the growth patterns of young children during the first two years of life according to gestational age, birth weight, and growth status at 24 months of age. Methods: This was a retrospective cohort study of 4,570 young children in Selangor. Data were extracted from children’s health records in government health clinics. Growth data were analysed using the Anthro Plus software that utilises the World Health Organization growth standards. Results: Generally, wasting prevalence was the highest at birth and 24 months, but stunting was more predominant from 1 to 21 months. Weight-for-age z-scores (WAZ), lengthfor-age z-scores (LAZ), and weight-for-length z-scores (WLZ) from birth to 24 months were within -3.00 to 0.00 standard deviation (SD) for pre-term low birth weight children, –1.50 to 0.00 SD for pre-term normal birth weight children, and –2.50 to 0.50 SD for full-term low birth weight children. While WAZ, LAZ, and WLZ from birth to 24 months for underweight/stunted/wasted children were within –2.50 to 0.50 SD, the values for overweight/obese (OV/OB) children were within –1.00 to 2.00 SD. For normal children, WAZ, LAZ, and WLZ exhibited comparable trends, with values within –1.00 to 0.00 SD from birth to 24 months. Conclusion: While stunting and wasting persisted as the most common forms of malnutrition in this sample of young children, the prevalence of OV/OB increased by 24 months. Interventions to promote child growth should focus not only on the prevention of undernutrition, but also on OV/OB.

Assessment of Daytime and Nighttime Ground Level Ozone Pollution in Malaysian Urban Areas

@#Introduction: Ozone (O3 ) is a significant component of photochemical smog as a typical secondary which is formed via nitrogen oxide photochemical interactions with volatile organic compounds (VOCs). This research discerns the complex influence of meteorological parameters and air pollutants influencing O3 concentrations. Methods: Data were acquired from 1 January 2018 until 31 December 2020 that including ozone (O3 ), nitrogen oxide (NOx), nitric oxide (NO), sulphur dioxide (SO2 ), nitrogen dioxide (NO2 ), carbon monoxide (CO), particulate matter (PM10, PM2.5), wind speed, solar radiation, temperature, and relative humidity (RH). Data were analysed using descriptive statistics in terms of line graphs. Results: The results demonstrate that the O3 concentration peaked around 14:00 hours and dropped at night (20:00 hours) owing to the lack of sunshine and redox processes. Conclusion: In conclusion, ozone precursors played an important role in ozone formation and the findings of this research are valuable for policymakers and other interested parties

Profiling of Aedes Mosquito Breeding Sites at Residential Construction Sites in Malaysia

@#Introduction: Poor waste management led to mosquito breeding grounds. Previous research found that construction sites are the mosquito breeding area thus it’s important to understand how construction sites affect mosquito breeding. Methods: This study utilized a prospective study to determine the characteristic of breeding preference in residential construction sites. On-field breeding preference survey was conduct in the selected project site in 12 weeks (1st October 2021 until 31st December 2021). Wet container inspection was carried out according to types of the residential construction building and progress of the site. All possible wet materials and containers was inspected and record accordingly in the form during the surveillance. Results: Result shows that the most preferred containers found was building floor (41.68%), others such as planter box that use for landscape purpose, drainage system, building mould and lift wells. The results of the research indicate that prospective containers with water and breeding sites at high rise construction sites were found to be more than those at low rise construction sites. Conclusion: Overall, substantially fewer water containers were discovered in low rise projects compared to high rise projects. Construction management need encourage all the workers to do best management practice such as proper waste disposal and removal of the water and possible wet container and conduct awareness among the workers.

Prevalence of Sleep Quality among Academic Staff of a Private University in Malaysia

@#Introduction: Poor sleep quality is frequently related to poor mental health and is a common medical disorder. It may differ by population, but limited studies have been done in Malaysia. This study was conducted to measure the prevalence of poor sleep quality among academic staff at Universiti Tunku Abdul Rahman (UTAR) Kampar Campus. Methods: In total, 344 randomly selected academic staff were approached to answer the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Results: Unexpectedly, 42.7 % of them were affected by poor sleep quality (global PSQI score >5). The average actual sleep duration was recorded at 6.68 hours. Age and global PSQI scores were not significantly correlated. Female staff had poorer subjective sleep quality (P= 0.027). The elder age group (P= 0.012) and associate professors and professors (P= 0.006) consumed more sleep medications. Non-Ph.D. holders had poorer subjective sleep quality (P= 0.008) and sleep latency (P= 0.032) as well as global PSQI score (P= 0.045) compared to Ph.D. holders. Conclusion: Prevalence of poor sleep quality was higher than expected among academic staff. This may affect workplace functioning and burden the staff with more health issues related to poor sleep quality.

Impact of Coronavirus Disease 2019 Lockdown on Back Pain Intensity, Prevalence and Associated Risk Factor Among Adults in Malaysia

@#Introduction: Low back pain (LBP) is a common musculoskeletal disorder (MSD) that leads to a variety of negative consequences. The prevalence of LBP was found to be high worldwide. Individuals have been forced to remote studying or working conditions during the coronavirus disease 2019 (COVID-19) pandemic, exposing them to the risk factors of LBP to a greater extent. This is a cross-sectional study conducted among 623 adults and aimed to assess LBP intensity and prevalence among adults in Malaysia before and during the COVID-19 lockdown and to identify the association between demographic, physical and psychological factors with LBP. Methods: A self-administered questionnaire composed of 36 questions regarding demographic characteristics, physical activities and psychological aspects was distributed to the public. Pearson’s Chi-square and Fisher Exact tests were performed using collected data to assess the association between LBP intensity and various risk factors. Results: The prevalence of LBP increased from 64.4% before the lockdown to 83.5% during the lockdown. LBP intensity significantly increased during the lockdown. Before lockdown, factors associated with LBP intensity included gender and stress level. While during the lockdown, age, gender, occupation, time spent on computer use, ergonomics as well as stress level affected the intensity of LBP. Conclusion: The present study showed that the COVID-19 lockdown has contributed to the increase in both the prevalence and intensity of LBP among Malaysians. The identified risk factors include age, gender, occupation, duration of sitting and computer use, adherence to ergonomic recommendations, and stress level.

Naja species Bite Injury- Pathophysiology of Envenomation and Multidisciplinary Approach in Management

@#Cobra bite envenomation is one of the commonest causes of snake related injuries in Malaysia. Local tissue injury following a cobra bite is a complex sequalae of envenomation that is attributed to various peptides and enzymes including cytotoxin, metalloproteases, phospholipase A2 and hyaluronidase. This case involves a young construction worker who was bitten by an unidentified snake on the dorsum of his left foot. He presented with typical features of local and systemic envenomation of a Naja species. Remote Envenomation Consultancy Services was consulted and the appropriate antivenom was administered. The patient underwent wound debridement and subsequent skin grafting. Follow up at outpatient clinic showed good skin graft uptake and recovery. Managing a significant Naja species bite envenomation can be a lengthy process requiring expertise from various subspecialties. Timely and seamless multidisciplinary approach in managing a Naja species envenomation ensures a favorable outcome with minimal complication..

Testing Occupational Hazard Self-Evaluation Module (OHSEM) Intervention among Workers of SME (Manufacturing) in Northern Malaysia

@#Introduction: Workplace accidents have been a persistent problem in Malaysia’s manufacturing industry, particularly for small and medium-sized enterprises (SMEs). Employee behavior has been identified as a significant contributing factor to these accidents, and research has suggested that improving safety knowledge and attitudes can enhance safety behavior. Despite this, there have been no empirical intervention studies in Malaysia to investigate the effectiveness of safety intervention programs aimed at improving SME worker safety behavior. Therefore, this study aimed to assess the efficacy of the Occupational Hazard Self-Evaluation Module (OHSEM) intervention in enhancing safety knowledge, attitudes, and behavior (KAB) among SME workers in the manufacturing sector. Methods: A quasi-experimental design with control group was utilized to evaluate the effectiveness of the OHSEM intervention. The intervention was implemented over a 12-week period on production workers in the experimental group, while the control group received no intervention. A self-administered questionnaire was distributed to 88 production workers in both groups before and after the intervention to measure the improvement of safety KAB. Descriptive analysis and an independent t-test were used to analyse the data. Results: The post-test results showed that safety KAB for the control group was moderate (mean = 2.11), while the mean score in the experimental group was high (m=4.17). Furthermore, the t-test result revealed a significant difference in safety KAB mean scores between the experimental and control groups. Conclusion: This study provides empirical evidence on the effectiveness of the OHSEM intervention in enhancing safety KAB in SMEs in the Malaysian SME (manufacturing) sector.