Treatment intensification and therapeutic inertia of antihypertensive therapy among patients with type 2 diabetes and hypertension with uncontrolled blood pressure.

Treatment intensification is essential to ensure guideline targets are attained in diabetes patients. The failure to intensify treatment when the targets are not achieved is therapeutic inertia. This study aimed to determine the proportions and factors associated with treatment intensification and therapeutic inertia of antihypertensive therapy in type 2 diabetes patients with uncontrolled hypertension in Malaysia. A retrospective cohort analysis was conducted utilising registry data. Diabetes hypertensive patients with uncontrolled baseline systolic or diastolic blood pressure were included. Treatment intensification was the increase in the number of antihypertensive agents from the index treatment. Therapeutic inertia was the absence of treatment intensification when the second blood pressure reading was still uncontrolled. About 6956 patients were followed up over 2.5 ± 1.1 person-years. Treatment intensification was observed in 29.8% of patients, while 38.6% had therapeutic inertia. Chinese, Indian, and 'others' ethnic groups, retinopathy, more antihypertensive agents, and higher systolic blood pressure were associated with therapeutic inertia. Underweight, overweight patients and those with dyslipidaemia had lower risks for therapeutic inertia. The results indicate suboptimal quality of care in public health clinics in Malaysia. Further studies are needed to determine the underlying causes to formulate precise interventions to tackle the problem in Malaysia.

Development and Utility of an Interactive Online Dashboard for Monitoring Data Collection and Data Processing During a School-Based Health Survey.

We built an interactive online dashboard using Google Looker Studio to monitor data collection and data processing activities during the Adolescent Health Survey (AHS) 2022, a large-scale nationwide survey conducted among school-going adolescents in Malaysia. Through user testing and training, refinements were made to the initial dashboard, resulting in a more streamlined and concise dashboard design. The dashboard comprised 2 pages that provided key metrics on the progress of data collection and data processing, respectively. The introduction of the dashboard enhanced the quality and ease of weekly progress reporting during meetings of the survey's central coordinating team, while its drill-down and filtering functionalities helped us detect arising issues early and supported collaborative problem-solving. Research teams coordinating comparable school-based health surveys are invited to duplicate the dashboard using Looker Studio's built-in "Make a copy" function and customize it further based on their country- or survey-specific requirements.

Prevalence of diabetic kidney disease and the associated factors among patients with type 2 diabetes in a multi-ethnic Asian country.

The actual prevalence of diabetic kidney disease (DKD) in patients with type 2 diabetes (T2D) in Malaysia is unknown. We aimed to determine the prevalence of DKD and its associated risk factors among T2D patients in Malaysia. An analytical cross-sectional study was conducted using the year 2022 clinical audit dataset from the National Diabetes Registry. DKD was defined as albuminuria, a decreased glomerular filtration rate, or both. Among 80,360 patients, 62.2% were female, 68.4% were Malay, and the mean age was 61.4 years. A total of 56.7% (95% CI 56.4-57.1%) of patients were found to have DKD. Increasing age, male sex, Malay ethnicity, longer duration of diabetes, overweight, obesity, hypertension, diabetic retinopathy, diabetic foot ulcer, nontraumatic lower-extremity amputation, ischaemic heart disease, stroke, insulin, higher numbers of antihypertensive agents, antiplatelet agents, poorer HbA1c control, higher systolic blood pressure, non-achievement of triglyceride target, and non-attainment of HDL-cholesterol goal were independent risk factors associated with DKD. Clinicians, program managers, and health policymakers should target modifiable factors to manage DKD and prevent its progression to end-stage kidney disease in Malaysia.

Anti-S Antibodies Against SARS-CoV-2 Infection Among Four Types of Vaccines in Malaysia.

Monitoring SARS-CoV-2 antibody levels can provide insights into a person's immunity to COVID-19 and inform decisions about vaccination and public health measures. Anti-S may be useful as an indicator of an effective immune response. Thus, we conducted this study that aimed to determine the immune response of anti-S antibodies against SARS-CoV-2 for all the vaccine types over time among adult recipients in Malaysia and to determine the associated factors. This study was a cohort that recruited 2513 respondents aged 18 years and above from June to December 2021. Each participant was followed-up for 1-year period from the initial vaccine dose (baseline). We found that the anti-S antibody generally increased for all vaccine types and peaked at two weeks after the second dose vaccination, with Pfizer recipients having the highest median of 100 (100.00-100.00). During the third-month follow-up, the seropositivity of anti-S antibody and the median level decreased for all vaccines. We found that type of vaccines, comorbid status, infection, and booster status were significantly associated with the anti-S antibody level after one year.

Association of dietary behaviour and depression among adolescents in Malaysia: a cross-sectional study.

BACKGROUND: Depression is on the rise and has become a significant concern for public health. Limited research has explored the connection between dietary patterns and depression. This investigation aimed to examine how dietary behaviours relate to depression among adolescents attending school in Malaysia. METHODS: The study utilized data from the National School-Based Health Survey 2022, a nationwide survey involving school-going adolescents aged 13-17, with a total of 33,523 participants from 239 schools. To assess depression, the study employed the Patient Health Questionnaire (PHQ-9), considering a score of 10 or higher as indicative of depression. Dietary behaviours were assessed using a validated self-administered questionnaire adapted from the World Health Organization's Global School-based Student Health Survey. Descriptive analysis and complex sample logistic regression were carried out using SPSS version 26.0. RESULTS: The study revealed a 26.9% overall prevalence of depression, with higher risks among female adolescents (AOR 2.71, 95% CI 2.51, 2.92) and those in higher grades. Malays (AOR 1.71, 95% CI 1.41, 2.07), Other Bumiputeras (AOR 1.69, 95% CI 1.32, 2.17), and Others (AOR 1.63, 95% CI 1.16, 2.30) had elevated odds of depression compared to Indians. Healthy dietary habits, like consuming less than two servings of fruits daily, correlated with depression (AOR 1.44 95% CI 1.35, 1.54). Additionally, unhealthy dietary behaviours such as fast food consumption (AOR 1.73 [95% CI 1.55, 1.93]) and carbonated soft drink intake (AOR 1.59 [95% CI 1.48, 1.70]) were positively associated with depression. CONCLUSIONS: One out of every four Malaysian adolescents was identified to experience depression. Depression was linked to several factors, such as being female, belonging to higher grade levels, identifying as Malays, Other Bumiputeras, or belonging to other ethnicities, and participating in the consumption of fast food, carbonated soft drinks, and fruits. To address these observations, it is crucial to formulate effective public health programmes that prioritize adolescent mental health and encourage the adoption of healthy eating habits.

Suicide attempt among Malaysian school-going adolescents: relationship with bullying.

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.

Prevalence of metabolic syndrome and metabolic dysfunction-associated fatty liver disease in Malaysia 2023: study protocol for a community-based nationwide cross-sectional survey.

INTRODUCTION: Metabolic syndrome (MetS) is a cluster of cardio-metabolic dysfunctions characterised by increased fasting plasma glucose, waist circumference, blood pressure, triglycerides and reduction in high-density lipoprotein cholesterol. Meanwhile, metabolic dysfunction-associated fatty liver disease (MAFLD) is the new term for fatty liver associated with MetS. People with MetS or MAFLD have higher risks for adverse cardiovascular outcomes and mortalities. However, large-scale data on MetS and MAFLD prevalence in Malaysia is mainly unknown. This study aims to determine the prevalence of MetS and MAFLD among the general adult population in Malaysia. METHODS AND ANALYSIS: This is a community-based nationwide cross-sectional study in Malaysia. The data collection period is from July 2023 until September 2023, with a planned sample size of 1296 participants. We use a two-stage proportionate stratified random sampling method to ensure national representativeness. The definition of MetS follows the Harmonised Joint Interim Statement in 2009. A diagnosis of MAFLD is made if a participant has fatty liver, defined as having a Fatty Liver Index ≥60 and has type 2 diabetes, a body mass index ≥23 kg/m2, or ≥2 metabolic risk abnormalities. Complex sample analysis will be conducted, and the disease prevalence will be reported with 95% CIs, unweighted counts and estimated populations. ETHICS AND DISSEMINATION: The protocol has been approved by the Medical Research and Ethics Committee of the Ministry of Health Malaysia (NMRR ID-22-02845-GUT). The findings will be disseminated through a formal report, policy brief, scientific publications, conference presentations, social media, print media and stakeholder engagement activities.

Poor Self-Rated Health and Associated Factors among Older Persons in Malaysia: A Population-Based Study.

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.

Factors Influencing the Levels of Awareness on Malaysian Healthy Plate Concept among Rural Adults in Malaysia.

Malaysian Healthy Plate was launched in 2017 as a vital component of the Malaysian Ministry of Health's "Quarter-Quarter-Half" program. It is predicted that this concept will bring positive change to the citizen's dietary habits; however, the residents in rural areas may experience less exposure to this campaign, or lack of understanding to the concept of Malaysian Healthy Plate. Hence, this study aims to assess factors affecting the campaign's awareness among the rural population in Malaysia. The National Health and Morbidity Survey (NHMS) 2019 focused on Non-Communicable Diseases (NCDs). Data collection was carried out from July to September 2019. Questionnaires that pertained to awareness, knowledge, and practice were included in this nationwide survey. Data collected from adults in rural areas aged 18 years old and above were used as respondents for the statistical analysis. Complex sample multiple logistic regression analysis was conducted to determine the association between the independent variables and awareness of the Malaysian Healthy Plate concept. About four fifths (83.2%) of rural adults in Malaysia were unaware of the Malaysian Healthy Plate concept after three years of implementation. The unawareness was significantly higher in males (91.3%), adults aged above 60 years old (91.8%), adults of others ethnicity (88.5%), those without formal education (95.2%), widows/widowers/divorcees (88.1%), retirees/adults who were not working (88.4%), and household income at the bottom 40% (B40) (85.0%). Unawareness of this concept was significantly associated with male gender (aOR = 4.12; 95% CI: 3.06-5.56); age, 40-59 years (aOR = 1.46; 95% CI:1.08-1.97); without formal education (aOR = 3.47; 95% CI:1.34-9.01); working in private sector (aOR = 2.75; 95% CI: 1.59-4.77); self-employed (aOR = 2.78; 95% CI: 1.58-4.87); retirees (aOR = 2.32; 95% CI: 1.23-4.36); and unpaid workers (aOR = 2.61; 95% CI: 1.51-4.51). Awareness of the Malaysian Healthy Plate concept is associated with rural adults being males, with older age, with lower socio-economic status, without partner, and without job. This study suggests that a more effective strategy is needed to increase the awareness of the Malaysian Healthy Plate concept among rural adults.

A 10-Year Impact Evaluation of the Universal Salt Iodization (USI) Intervention in Sarawak, Malaysia, 2008-2018.

A universal salt iodization (USI) was introduced in Sarawak, Malaysia in 2008 to control the iodine deficiency disorders (IDD) among its population. The purpose of this study is to evaluate the impact of the USI among school children in Sarawak after 10 years of implementation. The data were extracted from 2008 and 2018 Sarawak state-wide IDD surveys. Briefly, both surveys were cross-sectional surveys covering information on the socio-demographic, status of goitre, urinary iodine, and the amount of iodine in the salt samples. A total of 1104 and 988 between the ages of 8 and 10 were involved in the 2008 and 2018 surveys, respectively. The overall prevalence of goitre among the school children in Sarawak was significantly lower in 2018 (0.1%) compared to 2008 (2.9%). The median urinary iodine concentration (UIC) in urine samples had risen significantly from 102.1 µg/L in 2008 to 126.0 µg/L in 2018. In terms of iodine content in salt samples, the median concentration improved significantly in 2018 (35.5 µg/L) compared to 2008 (14.7 µg/L). After 10 years of USI implementation in Sarawak, the results from both surveys confirmed the effectiveness of mandatory USI in increasing the nutritional iodine status of school children in Sarawak.

Assessing Gender Identity and Sex in Diverse Low-, Middle-, and High-Income Settings: Findings from a WHO/HRP Consultative Process.

ABSTRACT: Obtaining detailed data on gender identity and sex in population-based sexual health studies is important. We convened a group to develop consensus survey items. We identified 2 items to capture data on gender identity and sex that can be used in diverse settings.

Anemia among Men in Malaysia: A Population-Based Survey in 2019.

This study aimed to determine the prevalence of anemia and factors associated with anemia among men in Malaysia. The researchers used data from the 2019 National Health and Morbidity Survey (NHMS). The hemoglobin levels of men aged 15 years and above who gave their consent was measured using the HemoCue® Hb 201+ System©. The majority of them (87.2%) were men aged 15-59 years, referred to as the younger age group in this study. The prevalence of anemia among men was 12.6% (95% confidence interval (CI): 10.9, 14.5). The prevalence was higher among older men (30.7%; 95% CI: 26.6, 35.1) than younger men (10.0%; 95% CI: 8.2, 12.2). Anemia among men was associated with older age (adjusted odds ratios (aOR) = 3.1; 95% CI: 2.1, 4.4) and those with diabetes (aOR = 1.5; 95% CI: 1.2, 2.1) via a logistic regression analysis. In conclusion, older men were more affected by anemia than younger men in this study. Anemia among older men in Malaysia is at the level of moderate to severe public health significance. The likelihood of developing anemia is increased among older men with diabetes compared to older men without diabetes. These often-overlooked issues among men need to be detected and treated early in order to prevent complications and improve their quality of life.

Preparing for and conducting the National Health and Morbidity Survey in Malaysia amid the COVID-19 pandemic: balancing risks and benefits to participants and society.

PROBLEM: The novel coronavirus disease 2019 (COVID-19) pandemic adversely affected the preparation of Malaysia's National Health and Morbidity Survey for 2020 because conducting it would expose data collectors and participants to an increased risk of infection. CONTEXT: The survey is nationally representative and community based and is conducted by the Institute for Public Health, part of the National Institutes of Health, to generate health-related evidence and to support the Malaysian Ministry of Health in policy-making. Its planned scope for 2020 was the seroprevalence of communicable diseases such as hepatitis B and C. ACTION: Additional components were added to the survey to increase its usefulness, including COVID-19 seroprevalence and facial anthropometric studies to ensure respirator fit. The survey's scale was reduced, and data collection was changed from including only face-to-face interviews to mainly self-administered and telephone interviews. The transmission risk to participants was reduced by screening data collectors before the survey and fortnightly thereafter, using standard droplet and contact precautions, ensuring proper training and monitoring of data collectors, and implementing other administrative infection prevention measures. OUTCOME: Data were collected from 7 August to 11 October 2020, with 5957 participants recruited. Only 4 out of 12 components of the survey were conducted via face-to-face interview. No COVID-19 cases were reported among data collectors and participants. All participants were given their hepatitis and COVID-19 laboratory test results; 73 participants with hepatitis B and 14 with hepatitis C who had been previously undiagnosed were referred for further case management. DISCUSSION: Preparing and conducting the National Health and Morbidity Survey during the COVID-19 pandemic required careful consideration of the risks and benefits, multiple infection prevention measures, strong leadership and strong stakeholder support to ensure there were no adverse events.

Self-Reported Modifiable Risk Factors of Cardiovascular Disease among Older Adults in Malaysia: A Cross-Sectional Study of Prevalence and Clustering.

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.

Comorbidities and clinical features related to severe outcomes among COVID-19 cases in Selangor, Malaysia.

BACKGROUND: Pre-existing comorbidities can predict severe disease requiring intensive care unit (ICU) admission among COVID-19 cases. We compared comorbidities, clinical features and other predictive factors between COVID-19 patients requiring ICU admission for intubation/mechanical ventilation and all other COVID-19 cases in Selangor, Malaysia. METHOD: Field data collected during the COVID-19 outbreak in Selangor, Malaysia, up to 13 April 2020 were used, comprising socio-demographic characteristics, comorbidities and presenting symptoms of COVID-19 cases. ICU admission was determined from medical records. Multiple logistic regression analysis was performed to identify factors associated with ICU admission requiring intubation/mechanical ventilation among COVID-19 cases. RESULTS: A total of 1287 COVID-19-positive cases were included for analysis. The most common comorbidities were hypertension (15.5%) and diabetes (11.0%). More than one third of cases presented with fever (43.8%) or cough (37.1%). Of the 25 cases that required intubation/mechanical ventilation, 68.0% had hypertension, 88.0% had fever, 40.0% had dyspnoea and 44.0% were lethargic. Multivariate regression showed that cases that required intubation/mechanical ventilation had significantly higher odds of being older (aged 360 years) [adjusted odds ratio (aOR) = 3.9] and having hypertension (aOR = 5.7), fever (aOR = 9.8), dyspnoea (aOR = 9.6) or lethargy (aOR = 7.9) than cases that did not require intubation/mechanical ventilation. CONCLUSION: The COVID-19 cases in Selangor, Malaysia requiring intubation/mechanical ventilation were significantly older, with a higher proportion of hypertension and symptoms of fever, dyspnoea and lethargy. These risk factors have been reported previously for severe COVID-19 cases, and highlight the role that ageing and underlying comorbidities play in severe outcomes to respiratory disease.

Malnutrition among the Elderly in Malaysia and Its Associated Factors: Findings from the National Health and Morbidity Survey 2018.

BACKGROUND: Malaysia is predicted to become an ageing population by 2035. Malnutrition among the elderly is one of growing concern. This study aims to identify the prevalence of malnutrition and its associated factors among the elderly in Malaysia. METHODS: Data from the National Health and Morbidity Survey (NHMS) 2018 was analysed. This survey applied a multistage stratified cluster sampling design to ensure national representativeness. Malnutrition was identified using a validated Mini Nutrition Assessment-Short Form (MNA-SF). Variables on sociodemographic, health status, and dietary practices were also obtained. The complex sampling analysis was used to determine the prevalence and associated factors of at-risk or malnutrition among the elderly. RESULT: A total of 3,977 elderly completed the MNA-SF. The prevalence of malnutrition and at-risk of malnutrition was 7.3% and 23.5%, respectively. Complex sample multiple logistic regression found that the elderly who lived in a rural area, with no formal or primary level of education, had depression, Instrumental Activity of Daily Living (IADL) dependency, and low quality of life (QoL), were underweight, and had food insecurity and inadequate plain water intake were at a significant risk of malnutrition (malnutrition and at-risk), while Chinese, Bumiputra Sarawak, and BMI more than 25 kgm-2 were found to be protective. CONCLUSIONS: Currently, three out of ten elderly in Malaysia were at-risk or malnutrition. The elderly in a rural area, low education level, depression, IADL dependency, low QoL, underweight, food insecurity, and inadequate plain water intake were at risk of malnutrition in Malaysia. The multiagency approach is needed to tackle the issue of malnutrition among the elderly by considering all predictors identified from this study.

Factors Associated with Mental Health Problems among Malaysian Children: A Large Population-Based Study.

Mental health problems are a major public health issue, particularly among children. They impair children's development, academic achievement, and ability to live a productive life. The present study aimed to determine the prevalence and factors associated with mental health problems among children aged 5 to 15 years old in Malaysia. Data from the National Health and Morbidity Survey (NHMS) 2015 were analyzed. A validated Strengths and Difficulties Questionnaire (SDQ) was used. The overall prevalence of mental health problems among children in Malaysia was 11.1%. Multiple logistic regression analysis revealed that for every year increment in age, mental health problems decreased by 5%. Further analysis found that children who had fathers with a non-formal education and worked in the private sector, had parents who were widowed or divorced, and had either parent with mental health problems were more likely to have mental health problems themselves. Children from the lower socioeconomic group and who had either parent with mental health problems had higher odds of having mental health problems in Malaysia.