Development of the Malay Language of understanding, attitude, practice and health literacy questionnaire on COVID-19 (MUAPHQ C-19): content validity & face validity analysis.

OBJECTIVE: This study aimed to assess the content and face validity index of the development of the understanding, attitude, practice and health literacy questionnaire on COVID-19 (MUAPHQ C-19) in the Malay language. METHODS: The development of the MUAPHQ C-19 was conducted in two stages. Stage I resulted in the generation of the instrument's items (development), and stage II resulted in the performance of the instrument's items (judgement and quantification). Six-panel experts related to the study field and ten general public participated to evaluate the validity of the MUAPHQ C-19. The content validity index (CVI), content validity ratio (CVR) and face validity index (FVI) were analysed using Microsoft Excel. RESULTS: There were 54 items and four domains, namely the understanding, attitude, practice and health literacy towards COVID-19, identified in the MUAPHQ C-19 (Version 1.0). The scale-level CVI (S-CVI/Ave) for every domain was above 0.9, which is considered acceptable. The CVR for all items was above 0.7, except for one item in the health literacy domain. Ten items were revised to improve the item's clarity, and two items were deleted due to the low CVR value and redundancy, respectively. The I-FVI exceeded the cut-off value of 0.83 except for five items from the attitude domain and four from the practice domains. Thus, seven of these items were revised to increase the clarity of items, while another two were deleted due to low I-FVI scores. Otherwise, the S-FVI/Ave for every domain exceeded the cut-off point of 0.9, which is considered acceptable. Thus, 50-item MUAPHQ C-19 (Version 3.0) was generated following the content and face validity analysis. CONCLUSIONS: The questionnaire development, content validity, and face validity process are lengthy and iterative. The assessment of the instruments' items by the content experts and the respondents is essential to guarantee the instrument's validity. Our content and face validity study has finalised the MUAPHQ C-19 version that is ready for the next phase of questionnaire validation, using Exploratory and Confirmatory Factor Analysis.

Risk Factors for COVID-19 Mortality in Malaysia.

Background: Understanding the risks of COVID-19 mortality helps in the planning and prevention of the disease. This study aimed to determine the risk factors for COVID-19 mortality in Malaysia. Methods: Secondary online data provided by the Ministry of Health, Malaysia and Malaysia's national COVID-19 immunisation programme were used: i) COVID-19 deaths data; ii) vaccination coverage data and iii) population estimate data. Quasi-Poisson regression was performed to determine the risk factors for COVID-19 mortality. Results: Four risk factors were identified: i) vaccination status (partial versus unvaccinated, incidence rate ratio [IRR]: 0.59; 95% CI: 0.54, 0.64; complete versus unvaccinated, IRR: 0.50; 95% CI: 0.45, 0.56; booster versus unvaccinated, IRR: 0.13; 95% CI: 0.05, 0.26); ii) age group (19 years old-59 years old versus above 60 years old, IRR: 0.90; 95% CI: 0.84, 0.97; 13 years old-18 years old versus above 60 years old, IRR: 0.09; 95% CI: 0.04, 0.19; 6 years old-12 years old versus above 60 years old, IRR: 0.09; 95% CI: 0.03, 0.22; below 5 years old versus above 60 years old, IRR: 0.11; 95% CI: 0.04, 0.23); iii) gender (male versus female, IRR: 1.23; 95% CI: 1.14, 1.32) and iv) comorbidity (yes versus no, IRR: 2.13; 95% CI: 1.96, 2.32). Conclusion: This study highlighted the risk factors for COVID-19 mortality and the benefit of COVID-19 vaccination, especially of booster vaccination, in reducing the risk of COVID-19 mortality in Malaysia.

The Prevalence and Work-Related Factors of Burnout Among Public Health Workforce During the COVID-19 Pandemic.

OBJECTIVE: To examine the prevalence of burnout and its work-related factors among public health providers (PHP) during the COVID-19 pandemic. METHODS: We surveyed 366 PHP in May 2021 on their burnout, demographic, and work-related characteristics. Logistic regression analyses were conducted to identify associated factors. RESULTS: 45% PHP reported burnout. Higher PHP burnout was associated with younger age (AOR 0.96, 95% CI 0.93-0.99), prolonged COVID-19 involvement (AOR 2.35, 95% CI 1.16-4.72), as well as perceiving medium (AOR 2.10, 95% CI 1.27-3.48) and high emotional demand (AOR 4.45, 95% CI 1.67-11.77), low (AOR 2.10, 95% CI 1.27-3.48) and medium (AOR 4.18, 95% CI 1.64-10.59) role clarity, medium job satisfaction (AOR 3.21, 95% CI: 1.11-9.29), and low organisational justice (AOR 3.32, 95% CI 1.51-7.27). CONCLUSIONS: Improving job content and organisational characteristics may be key to reducing PHP burnout.

Promoting Mental Health During the COVID-19 Pandemic: A Hybrid, Innovative Approach in Malaysia.

Background: The COVID-19 pandemic has had monumental effects on the mental health of populations worldwide. Previous research indicated that programs and interventions using social networks can play a positive role in promoting mental health. Nevertheless, current evidence is largely derived from high-income regions, reflecting an urgent need for more studies in low- and middle-income settings. Objectives: This paper aims to (a) describe the potential value of a hybrid health carnival in promoting mental health and increasing access to screening services; (b) assess the level of community engagement with the digital platform. Methods: A mental health carnival was conducted with the theme of "Mind Your Mental Health" (Cakna Kesihatan Mental) in conjunction with the World Mental Health Day in Malaysia. This was a hybrid carnival that combined elements of face-to-face interactions and virtual learning. Free online therapy sessions were offered to high-risk groups identified during the screening process. Social media metrics were utilized to report the levels of community engagement and participants completed pre-and post-assessments to measure the program's impact on their knowledge. Results: The carnival was attended by 515 participants (78.8% virtual participants). Social media metrics reported more than 5,585 reaches on Facebook for all the activities held throughout the event. Results from pre-and post-assessments showed significant improvement in the mean knowledge scores (p < 0.05). Conclusion: This digital approach will continue to evolve by releasing new features and tools as a new frontier for high-risk populations and all individuals seeking mental health support and treatment.

Knowledge, Attitude and Practice Assessment on COVID-19 Infection: A Systematic Review Protocol (preprint)

Background: The coronavirus disease 2019 (COVID-19) is an emerging respiratory disease caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has been declared a public health emergency of international concern (PHEIC) by the World Health Organisation (WHO) on 30 January 2020. We aim to systematically review the tool used for the assessment of the knowledge, attitude, and practice (KAP) on Covid-19 infection. Methods: We will conduct a systematic review of knowledge, attitude, and practice assessment on COVID-19 infection. The search will cover the period December 2019 to January 2021. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality will be assessed using the STROBE checklist for a cross-sectional study. Data will be analysed using descriptive statistics. The numerical outcome will be analysed using mean and standard deviation. The categorical outcome will be analysed using absolute number and percentage. The range number of items, reliability, and validity of each domain will be assessed descriptively. Discussion: This systematic review of KAP measurement tools will provide a detailed summary of the existing tools used to assess the KAP levels towards COVID-19 and its’ reliability and validity in different settings and populations. Also, the review will provide evidence on the importance of the reliability and validity of the assessment tools in ensuring quality data from future research. Systematic Review Registration: International Platform of Registered Systematic Reviews and Meta-analysis Protocols (INPLASY), number INPLASY202150039

Measuring Time-Varying Effective Reproduction Numbers for COVID-19 and Their Relationship with Movement Control Order in Malaysia.

To curb the spread of SARS-CoV-2 virus (COVID-19) in Malaysia, the government imposed a nationwide movement control order (MCO) from 18 March 2020 to 3 May 2020. It was enforced in four phases (i.e., MCO 1, MCO 2, MCO 3 and MCO 4). In this paper, we propose an initiative to assess the impact of MCO by using time-varying reproduction number (Rt). We used data from the Johns Hopkins University Centre for Systems Science and Engineering Coronavirus repository. Day 1 was taken from the first assumed local transmission of COVID-19. We estimated Rt by using the EpiEstim package and plotted the epidemic curve and Rt. Then, we extracted the mean Rt at day 1, day 5 and day 10 for all MCO phases and compared the differences. The Rt values peaked around day 43, which was shortly before the start of MCO 1. The means for Rt at day 1, day 5, and day 10 for all MCOs ranged between 0.665 and 1.147. The average Rt gradually decreased in MCO 1 and MCO 2. Although spikes in the number of confirmed cases were observed when restrictions were gradually relaxed in the later MCO phases, the situation remained under control with Rt values being stabilised to below unity level (Rt value less than one).

Measuring Time-Varying Effective Reproduction (Rt) Numbers for COVID-19 and Their Relationship with Movement Control Order (MCO) in Malaysia (preprint)

To quantify the time-varying reproduction number (Rt) for Malaysia using the COVID-19 incidence data., we used data the from the Johns Hopkins University Center for Systems Science and Engineering (JHU CCSE) Coronavirus repository. Day 1 was taken from the first assumed local transmission of COVID-19. Data was split into four intervals: a) Interval 1: from Day 1 to Day 10 MCO 1, b) Interval 2: from Day 1 to Day 10 MCO 2, c) Interval 3: from Day 1 to Day 10 MCO 3 and d) Interval 4: from Day 1 to Day 10 MCO 4. We estimated the Rt using the EpiEstim package. The means for Rt at Day 1, Day 5 and Day 10 for all MCOs ranged between 0.665 to 1.147. The average Rt gradually decreased in MCO 1 and MCO 2. However, Rt increased in MCO 3 before stabilized around 0.8 in MCO 4. MCO 1 and MCO 2 which were stricter coincide with the gradual reduction of Rt. However, the more relaxed MCO 3 and MCO 4 correspond to a slight increase in the Rt before it stabilized.

COVID-19 review: an epidemiological perspective and Malaysian scenario in handling the pandemic (January - May 2020)

The pandemic of Coronavirus Disease 2019 (COVID-19) has brought much fear and anxiety worldwide due to the rapid transmission rate and mortality. The exponential surge of COVID- 19 cases need to be addressed aggressively to flatten the epidemic curve. This review aims to describe the COVID-19 disease epidemiology and disease transmission, response actions taken by the authorities to control this pandemic and risk communication strategies in Malaysia. A literature search via the ScienceDirect and Google Scholar databases of published articles and official statements from the Ministry of Health, Malaysia from December 2019 to May 2020 was conducted. The first wave of COVID-19 outbreak in Malaysia started in late January involving 22 cases but the second wave involved more cases due to the massive religious gathering that occurred in late February. Malaysia implemented the Movement Control Order (MCO) on 18^th March 2020 and other well-coordinated response action plans to prevent community transmission. The reproduction number (R₀) was successfully reduced from 3.6 to 0.3 due to the MCO. Malaysia's risk communication strategies that include daily press conference by the Director General of Health and dissemination of information through national television and social media, played a crucial role in dealing with the COVID-19 outbreak. In conclusion, effective response actions and mitigation plans, should be the main priorities to combat this pandemic. The immediate direction will need to be focused on development of vaccines for COVID-19. Future research should study the origin of the virus in animals and the role of comorbidities contributing to poorer prognosis.