A brief analysis of the COVID-19 death data in Malaysia

In December 2019, the first cases of Coronavirus Disease 2019 (COVID-19) were detected in Wuhan, China. Since then, COVID-19 begun to spread rapidly all over the world. On March 11, 2020, the World Health Organisation declared COVID-19 a pandemic. As of September 7, 2021, there were over 220 million confirmed COVID-19 cases globally, with more than 4.6 million deaths. Malaysia reported 2,067,327 confirmed cases with 22,743 deaths. Given the severity of the pandemic, the Ministry of Health Malaysia has stepped up in its efforts in handling the pandemic locally by sharing the COVID-19 related data on the GitHub, enabling transparent data sharing. This enables timely data analysis and quick decision to better understand the COVID-19 situation in this country. This article aims to provide a quick analysis of the death and vaccination data provided by the Malaysian Ministry of Health and to provide useful insight into the analysis.

A Susceptible-Infected-Removed (SIR) model of COVID-19 epidemic trend in Malaysia under Movement Control Order (MCO) using a data fitting approach

BackgroundIn this work, we presented a Susceptible-Infected-Removed (SIR) epidemiological model of COVID-19 epidemic in Malaysia post- and pre-Movement Control Order (MCO). The proposed SIR model was fitted to confirmed COVID-19 cases from the official press statements to closely reflect the observed epidemic trend in Malaysia. The proposed model is aimed to provide an accurate predictive information for decision makers in assessing the public health and social measures related to COVID-19 epidemic. MethodsThe SIR model was fitted to the data by minimizing a weighted loss function; the sum of the residual sum of squares (RSS) of infected, removed and total cases. Optimized beta ({beta}),), gamma ({gamma}) parameter values) parameter values and the starting value of susceptible individuals (N) were obtained. ResultsThe SIR model post-MCO indicates the peak of infection on 10 April 2020, less than 100 active cases by 8 July 2020, less than 10 active cases by 29 August 2020, and close to zero daily new case by 22 July 2020, with a total of 6562 infected cases. In the absence of MCO, the model predicts the peak of infection on 1 May 2020, less than 100 active cases by 14 February 2021, less than 10 active cases by 26 April 2021 and close to zero daily new case by 6 October 2020, with a total of 1.6 million infected cases. Conclusion: The results suggest that the present MCO has significantly reduced the number of susceptible population and the total number of infected cases. The method to fit the SIR model used in this study was found to be accurate in reflecting the observed data. The method can be used to predict the epidemic trend of COVID-19 in other countries.

Effectiveness Of Community-Based Health Education On Preparedness For Flood-Related Communicable Diseases In Kelantan

@#The flood disaster in Kelantan in 2014 had resulted in substantial health implications including increased cases of communicable diseases. There was a lack of community preparedness including customized health educations in the prevention and control of flood-related communicable diseases in the affected areas. The research was aimed to evaluate the effectiveness of community-based health education modules on flood-related communicable diseases among communities in Kelantan. Health education modules focusing on major food-related diseases were developed. A non-randomized community-controlled trial using the modules were conducted. Outcomes were assessed on knowledge, attitude and preventive practice scores to flood-related communicable diseases using a pre-validated questionnaire. Independent t test was used to compare mean scores between the intervention community (Tumpat) and the control community (Bachok) at 1-month post intervention. One-way independent ANOVA test was done to compare score differences at baseline (pre), post 1-month and post 2-month from repeated surveys among random samples within the intervention community. There were significant improvements in all knowledge components from 9.4% to 52.6% with 10% increment in attitude scores toward preventing behaviours on flood-related communicable diseases. When compared against the control community at one-month post-intervention, there were significantly higher knowledge on types of diseases, symptoms and risk factors as well as practice scores of drinking safe water and protective habits. This research demonstrated that community-based health education is effective in improving relevant knowledge, attitude and preventive practices among affected communities as part of their preparedness toward communicable diseases related to flood.

Development of a new questionnaire to assess childcare providers’ KAP regarding infant and young child feeding

@#Introduction: The integration of infant and young child feeding into childcare settings is important to the overall wellbeing of a community. To our knowledge, there is no questionnaire at the national context specifically on the knowledge, attitude and practice (KAP) of infant and young child feeding among childcare providers. Preexisting questionnaires are unsatisfactory due to different target populations and validation approaches. This study aims to develop a new questionnaire for assessing the KAP regarding infant and young child feeding among childcare providers in Malaysia. Methods: A new questionnaire on childcare providers’ KAP was developed using literature review, expert opinions, and a theoretical framework. It was developed using a modified Delphi technique in five phases: 1. Identification of the domains, 2. Verification of the identified domains, 3. Definition of the domains, 4. Identification of relevant and representative items for each domain, and 5. Final verification of the domains and items, followed by a pre-survey evaluation. Results: The final items were verified by experts with references to relevant literatures, other questionnaires, and experts’ experiences. A total of 236 items were selected after consideration of their relevancy and representativeness: 104, 90, 42 items addressing knowledge, attitude, and practice, respectively. The questionnaire was named Borang Kaji Selidik Pemakanan Bayi dan Kanak-kanak dalam kalangan Pengasuh, or IYCFCCPQ. Conclusion: The IYCF-CCPQ is a newly developed questionnaire to measure childcare providers’ KAP regarding infant and young child feeding.

Validation of Infant and Young Child Feeding Questionnaire for the Assessment of Knowledge, Attitudes and Practices among Child Care Providers: The IYCF-CCPQ.

The validation of a new questionnaire is essential to improving its credibility in the assessment and collection of evidence. This study aimed to validate a newly developed infant and young child feeding questionnaire for child care providers (IYCF-CCPQ) to measure the knowledge, attitudes, and practices regarding infant and young child feeding among them. A cross-sectional study was conducted with 200 child care providers who were involved in handling children less than two years old in child care centers in the northeastern part of Peninsular Malaysia. The IYCF-CCPQ was self-administered and consists of three domains: Knowledge (104 items), attitude (90 items), and practice (42 items). The dichotomous-scale items in the knowledge domain were analyzed using a two-parameter logistic model of item response theory (2-PL IRT). The Likert-type-scale items in the attitude section were assessed using exploratory factor analysis (EFA). The items in the practice section were assessed descriptively. Internal consistency by marginal reliability was assessed in the knowledge domain, and Cronbach's alpha coefficient was used for the attitude domain. The marginal reliability values were 0.91 and 0.74 for the knowledge domains related to breastfeeding/formula feeding and complementary feeding, respectively, and the Cronbach's alpha values were 0.89 and 0.90 for the attitude domains related to breastfeeding/formula feeding and complementary feeding, respectively. The analysis showed good psychometric properties (discrimination, difficulty index, factor loading, and communalities) and good reliability. The IYCF-CCPQ is valid for use assessing the knowledge, attitudes, and practices among Malaysian child care providers regarding infant and young child feeding.

Translation, Cross-Cultural Adaptation, and Validation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) into the Malay Language.

BACKGROUND: Patient feedback is an important tool in assessing health system quality. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was developed in 2006 as a standardized instrument to assess patient perceptions in the United States of America. This study aimed to translate and validate the HCAHPS questionnaire into the Malay language in order to assess patient perceptions of health services in Malaysia. METHODS: The original HCAPHS in English was translated into Malay based on the established guideline. The content validation involved an expert panel of 10 members, including patients. The face validation pilot testing of the HCAHPS-Malay version was conducted among 10 discharged patients. The exploratory factor analysis (EFA) used principal axis factor, and varimax rotation was established based on a cross-sectional study conducted among 200 discharged patients from Hospital Universiti Sains Malaysia (Hospital USM). RESULTS: The overall content validity index was 0.87, and the universal face validity index was 0.82. From the EFA, the factor loading value ranged from 0.652 to 0.961 within nine domains. The internal consistency reliability with Cronbach's alpha was 0.844. CONCLUSION: The HCAHPS-Malay is a reliable and valid tool to determine patients' perception of healthcare services among inpatients in Hospital USM based on the content and face validation result together with a good construct validity and excellent absolute reliability. Further testing on HCAHPS-Malay version in other settings in Malaysia needs to be done for cross-validation.

Predictors of Caregivers' Satisfaction with the Management of Children with Autism Spectrum Disorder: A Study at Multiple Levels of Health Care.

BACKGROUND: Caregivers are the initial gatekeepers in the health care management of children with autism spectrum disorder (ASD). METHODS: This cross-sectional study aimed to determine the factors associated with caregivers' satisfaction with different levels of health care services in managing children with ASD in Kelantan. The satisfaction scores of 227 main caregivers of confirmed ASD children were assessed with a modified Parent Satisfaction Scale (PSS) questionnaire. RESULTS: The analysis showed that caregivers who waited longer for a doctor's consultation in primary care had a reduced PSS score, whereas caregivers who were satisfied with the waiting time in primary care had higher PSS scores. At the secondary care level, caregivers who possessed at least a diploma had reduced PSS scores, whereas caregivers who were satisfied with both doctors' consultation times and occupational therapy appointments had higher PSS scores. At the tertiary care level, caregivers with an underlying medical problem and who had children undergoing occupational therapy for two months or more had reduced PSS scores. Nevertheless, the analysis showed that caregivers who were concerned with their children's sleeping problems, who had been informed about parental support, who were satisfied with speech and occupational therapy appointments, who were satisfied with waiting times at tertiary care clinics, and who were satisfied with their doctor's knowledge and experience had higher PSS scores. CONCLUSIONS: This study elucidated the importance of understanding caregivers' satisfaction in attaining care for their ASD children and highlighted the need to promote factors that would increase caregivers' satisfaction with current ASD services.

Perceived Stress among Caregivers of Children with Autism Spectrum Disorder: A State-Wide Study.

BACKGROUND: Caregivers of children with autism spectrum disorder (ASD) experience increased stress and more significant negative caregiving consequences than those with typically developing children. There is a lack of studies specifically focusing on stress among caregivers with ASD children in Asian countries. The current study examines levels of perceived stress and factors associated with it among caregivers in Kelantan, Malaysia. METHODS: In a cross-sectional study, the Malay version of the Perceived Stress Scale (PSS) was administered to 227 caregivers of children with ASD. The caregivers were recruited from ASD databases in four tertiary hospitals in Kelantan and a meeting was set up during the child's follow-up in the clinic. Multiple linear regression analyses were applied to determine the predictors of perceived stress. RESULTS: The mean total perceived stress score was 20.84 (4.72). This was considered higher than average. Higher perceived stress was significantly predicted among caregivers who live far from the health institution, caregivers who do not own transportation to bring the child to the treatment center, and caregivers who have an ASD child with a learning disability. CONCLUSION: Caregivers of an ASD child perceived significant stress while taking care of their children. Institutions should alleviate the factors that were predicted to increase the caregivers' perceived stress to improve the quality of the lives of children and ASD families as a whole.

Psychometric Properties of the Self-Efficacy Scale among Undergraduate Students in Malaysia

@#Background: Self-efficacy (SE) is a person’s belief in his or her own capability to perform and accomplish a task that could produce a favourable outcome, despite facing obstacles. This study aimed to confirm the validity and reliability of an SE scale among undergraduate students at the Health Campus of the Universiti Sains Malaysia. Methods: A cross-sectional study was conducted among the undergraduate students using a self-administered questionnaire. After using a purposive sampling method, 562 students completed the questionnaire. Mplus 8 was employed to conduct the confirmatory factor analysis on the psychometric properties of Bandura’s 18-item SE scale with three factors (internal feeling, competing demands and situational). Then, the composite reliability was calculated for each factor. Results: Most of the students were Malay (73.3%) females (79.0%) who exercised 2.62 times a week for an average of 43.37 min per session. The final measurement model was obtained after removing six problematic items, and the model was deemed fit based on several indices [Root Mean Square Error of Approximation (RMSEA) = 0.067, Standardised Root Mean Square Residual (SRMR) = 0.004, Comparative Fit Index (CFI) = 0.924]. The composite reliability values of the three factors were acceptable (0.65 to 0.84). Conclusion: The simplified 12-item SE scale with three factors displayed good fit indices with regard to the data, and they were considered to be acceptable for the current sampl

Adaptation and Validation of the Malay Version of the Index of Dental Anxiety and Fear (IDAF-4C+) for Malaysian Secondary School Children

Background: Many questionnaires have been developed to measure dental anxiety andfear. Among them is the Index of Dental Anxiety and Fear Scale (IDAF-4C+), which consists of adental anxiety and fear module (IDAF-4C), a phobia module (IDAF-P) and a stimulus module(IDAF-S). The objective of this research was to report the adaptation and validation of the IDAF-4C+ for Malaysian secondary school children.Methods: This was a cross‑sectional validation study. The original English version of theIDAF-4C+ was translated into Malay, back-translated, and then sent for content validation via anexpert validation and face validation by the target student population. Three hundred and seventyquestionnaires were then distributed among 16-year-old school children. Confirmatory factoranalysis (CFA) was conducted for the IDAF-4C module using a bootstrapped maximum likelihoodestimator. Spearman’s rank correlation was used to assess the relationship between the IDAF‑Sand IDAF-4C modules. Intraclass correlation (ICC) was used to determine the stability of theIDAF-S and IDAF-4C modules, while kappa values were used for the IDAF-P module.Results: The response rate was 86.5% for CFA and 76.9% for stability. CFA showed theexistence of only one factor with a reliability estimate of 0.921, obtained via Raykov’s procedure.All items in the IDAF-S module were significantly correlated with the IDAF-4C module (P <0.001). The IDAF-S and IDAF-4C modules were stable, as determined via a two-way mixed modelwith absolute agreement, a single measure and a Case 3 ICC (A, 1). The IDAF-P module showedsatisfactory stability, as assessed via kappa values.Conclusion: The Malay version of the IDAF-4C+ is valid and reliable in measuring dentalanxiety and fear among Malaysian secondary school children.

Understanding Dieting and Previous Weight Loss Attempts among Overweight and Obese Participants: Insights into My Body Is Fit and Fabulous at Work Program / 가정의학회지

BACKGROUND: A qualitative study providing an in-depth exploration of people's view and the increasing burden of overweight and obesity is required. This study aimed to explore the understanding of dieting and previous experiences on weight loss attempts among overweight and obese government employees in Kelantan, Malaysia, prior to recruitment into the intervention program. METHODS: Thirteen focus group discussions involving 129 participants from a weight-loss intervention program were conducted within the first 1 month of recruitment. These discussions were moderated by two trained researchers in the Malay language and assisted by an interview guide. They were audio-recorded and transcribed verbatim. A thematic analysis was performed, and codes and themes from each discussion were constructed. RESULTS: The participants understood dieting with various meanings, including skipping meals and removing rice from daily diets. They applied numerous methods to lose weight and achieved various outcomes. Health and appearance, social support, and compliance with current trends were the factors motivating these participants to lose weight. Their determination to lose weight was limited by lack of self-control and motivation, experiences of unpleasant effects, influence on weight, and environmental and health factors. CONCLUSION: Real-life weight loss experiences and perceptions provided relevant insights into current weight loss management strategies. Some of these issues and misunderstandings should be emphasized in weight loss strategies during health promotion.

Sample Size Calculation in Animal Studies Using Resource Equation Approach

Animal research plays an important role in the pre-clinical phase of clinical trials. In animal studies, the power analysis approach to sample size calculation is recommended. Whenever it is not possible to assume the standard deviation and the effect size, an alternative to the power analysis approach is the ‘resource equation’ approach, which sets the acceptable range of the error degrees of freedom (DF) in an analysis of variance (ANOVA). The aim of this article is to guide researchers in calculating the minimum and maximum numbers of animals required in animal research by reformulating the error DF formulas.

Psychometric Properties of the Heart Disease Knowledge Scale: Evidence from Item and Confirmatory Factor Analyses

Background: Heart disease knowledge is an important concept for health education, yet there is lack of evidence on proper validated instruments used to measure levels of heart disease knowledge in the Malaysian context. Methods: A cross-sectional, survey design was conducted to examine the psychometric properties of the adapted English version of the Heart Disease Knowledge Questionnaire (HDKQ). Using proportionate cluster sampling, 788 undergraduate students at Universiti Sains Malaysia, Malaysia, were recruited and completed the HDKQ. Item analysis and confirmatory factor analysis (CFA) were used for the psychometric evaluation. Construct validity of the measurement model was included. Results: Most of the students were Malay (48%), female (71%), and from the field of science (51%). An acceptable range was obtained with respect to both the difficulty and discrimination indices in the item analysis results. The difficulty index ranged from 0.12.0.91 and a discrimination index of . 0.20 were reported for the final retained 23 items. The final CFA model showed an adequate fit to the data, yielding a 23-item, one-factor model [weighted least squares mean and variance adjusted scaled chi-square difference = 1.22, degrees of freedom = 2, P-value = 0.544, the root mean square error of approximation = 0.03 (90% confidence interval = 0.03, 0.04); close-fit P-value = > 0.950]. Conclusion: Adequate psychometric values were obtained for Malaysian undergraduate university students using the 23-item, one-factor model of the adapted HDKQ.

Reporting Statistical Results in Medical Journals

Statistical editors of the Malaysian Journal of Medical Sciences (MJMS) must go through many submitted manuscripts, focusing on the statistical aspect of the manuscripts. However, the editors notice myriad styles of reporting the statistical results, which are not standardised among the authors. This could be due to the lack of clear written instructions on reporting statistics in the guidelines for authors. The aim of this editorial is to briefly outline reporting methods for several important and common statistical results. It will also address a number of common mistakes made by the authors. The editorial will serve as a guideline for authors aiming to publish in the MJMS as well as in other medical journals.