Immunization of Children under 2 Years Old in the Coastal Hadhramaut Governorate, Yemen, during Public Health Emergencies: A Trend Analysis of 2013-2020.

Although immunization is one of the most successful and cost-effective interventions that prevents millions of infant and child deaths yearly, it has failed to achieve its intended goals in some low-income countries. Yemen is currently experiencing the most extreme humanitarian crisis globally, which has affected health and worsened its economy and political governance instability. There are few reports on Yemeni vaccination statuses. The present study aimed to investigate the effect of the public health emergency crises on childhood immunization in Yemen. A retrospective descriptive study was conducted in the Coastal Hadhramaut Governorate, Yemen. Secondary data from governorate annual reports for 2013-2020 were extracted. The assessment of the annual immunization coverage rate according to each vaccine was tabulated. The analysis revealed that the 2013-2019 vaccination coverage in Coastal Hadhramaut demonstrated an increasing trend. However, vaccination coverage decreased for all vaccines in 2015-2016 and 2020. Although all three doses of the pentavalent vaccine demonstrated >85% coverage in all years, the coverage of the first and second doses decreased in 2016, and the coverage of all doses decreased in 2020 during the COVID-19 pandemic. Public health emergencies negatively affected routine immunization coverage in Yemen. The trend correlated with the humanitarian crisis and other research findings in Yemen. The national response to public health threats during emergency crises must involve strengthening the program for monitoring and evaluating vaccine-preventable diseases.

Personality traits and workplace bullying among contract trainee doctors in Malaysia.

Introduction: Workplace bullying (WPB) among trainee doctors is a concerning problem in Malaysia. However, there is still limited understanding regarding the influence of trainee doctors' personality traits on WPB. Furthermore, the impact of contract employment status on WPB among trainee doctors is not yet well-defined. To address these gaps, this study was aimed to determine the prevalence of WPB among trainee doctors and to examine the association of sociodemographic characteristics, job characteristics, and personality traits with WPB among trainee doctors in Malaysia. Methods: A multi-center cross-sectional study was conducted with 264 trainee doctors in Selangor, Malaysia. Eligible participants were provided with sociodemographic characteristics questionnaire, job characteristics questionnaire, WPB questionnaire, and the Big Five Inventory-10 (BFI-10). Chi-square tests were used to examine the association between: (i) sociodemographic characteristics and WPB, (ii) job characteristics and WPB; and (iii) personality traits and WPB. Multivariate logistic regression was performed to evaluate the association between the significant independent variables (as determined from Chi-square tests) and WPB. Results: The prevalence of WPB was 45.1 %, with verbal abuse being the most common form of bullying (46.2 %). Chi-square test showed that only marital status and low agreeableness were significantly associated with WPB. Subsequently, multiple logistic regression demonstrated that being married (OR: 1.866; 95 % CI: 1.077-3.234) and low agreeableness (OR: 2.287; 95 % CI: 1.169-4.473) were significant predictors of WPB. Conclusion: The high prevalence of WPB among trainee doctors could be attributed by marriage and low agreeableness personality traits in this population. In order to minimise WPB and maximise workforce potential, it is essential for healthcare institutions and medical training programmes to recognise this vulnerabilities and take steps to protect and support trainee doctors who are married and/or with low agreeableness personality trait.

Contemporary evidence of workplace violence against the primary healthcare workforce worldwide: a systematic review.

Violence against healthcare workers recently became a growing public health concern and has been intensively investigated, particularly in the tertiary setting. Nevertheless, little is known of workplace violence against healthcare workers in the primary setting. Given the nature of primary healthcare, which delivers essential healthcare services to the community, many primary healthcare workers are vulnerable to violent events. Since the Alma-Ata Declaration of 1978, the number of epidemiological studies on workplace violence against primary healthcare workers has increased globally. Nevertheless, a comprehensive review summarising the significant results from previous studies has not been published. Thus, this systematic review was conducted to collect and analyse recent evidence from previous workplace violence studies in primary healthcare settings. Eligible articles published in 2013-2023 were searched from the Web of Science, Scopus, and PubMed literature databases. Of 23 included studies, 16 were quantitative, four were qualitative, and three were mixed method. The extracted information was analysed and grouped into four main themes: prevalence and typology, predisposing factors, implications, and coping mechanisms or preventive measures. The prevalence of violence ranged from 45.6% to 90%. The most commonly reported form of violence was verbal abuse (46.9-90.3%), while the least commonly reported was sexual assault (2-17%). Most primary healthcare workers were at higher risk of patient- and family-perpetrated violence (Type II). Three sub-themes of predisposing factors were identified: individual factors (victims' and perpetrators' characteristics), community or geographical factors, and workplace factors. There were considerable negative consequences of violence on both the victims and organisations. Under-reporting remained the key issue, which was mainly due to the negative perception of the effectiveness of existing workplace policies for managing violence. Workplace violence is a complex issue that indicates a need for more serious consideration of a resolution on par with that in other healthcare settings. Several research gaps and limitations require additional rigorous analytical and interventional research. Information pertaining to violent events must be comprehensively collected to delineate the complete scope of the issue and formulate prevention strategies based on potentially modifiable risk factors to minimise the negative implications caused by workplace violence.

Insights into frontline healthcare workers' mental health amidst COVID-19 - Sources of workplace worries and coping strategies.

Introduction: This study was aimed to measure the prevalence of depression, anxiety, and stress as well as to evaluate the associations of these mental disorders with sociodemographic factors, workplace worries, and coping strategies among frontline HCWs in Kuala Lumpur, Malaysia during the COVID-19 pandemic. Methods: A cross-sectional study was conducted in a tertiary teaching hospital in Kuala Lumpur, Malaysia. Sociodemographic data questionnaire, Depression, Anxiety, and Stress Scale 21, sources of workplace worries questionnaire, and Brief-COPE inventory were randomly distributed to frontline HCWs who worked at the medical, emergency, and anaesthesiology departments. Data were analyzed using Chi-square tests and multivariable linear regression analysis. Results: A total of 137 frontline HCWs responded to the questionnaires. The prevalence of depression, anxiety, and stress was 69.3%, 77.4%, and 57.7%, respectively. None of the sociodemographic characteristics was associated with depression, anxiety, and stress. Depression was associated to all sources of workplace worries, except "fear of getting infected" (p = 0.089), while anxiety and stress were associated with all sources of workplace worries. Humour (ß = 0.821), self-blame (ß = 0.686), denial (ß = 0.676), substance use (ß = 0.835), and behavioural disengagement (ß = 0.583) were positively correlated to depression. However, active coping (ß = -0.648) and acceptance (ß = -0.602) were negatively correlated to depression. On the other hand, active coping (ß = 0.913), planning (ß = 0.879), acceptance (ß = 0.831), religion (ß = 0.704), and self-distraction (ß = 0.929) were positively correlated to stress. Only substance use (ß = -0.417) was negatively correlated to stress. All coping strategies did not correlate to anxiety. Conclusion: The high prevalence of depression, anxiety and stress is attributed by the various sources of workplace worries and the inappropriate coping strategies among the frontline HCWs. Measures that minimise workplace worries and inappropriate coping strategies must be implemented promptly.

The rising threat of illicit amphetamine-type stimulant use among methadone maintenance treatment patients in East Coast Malaysia: a retrospective observational study.

Background: In recent years, amphetamine-type-stimulants (ATS) have been extensively misused in South-East Asia, inducing major problems among methadone-maintenance-treatment (MMT) patients.Objective: We examine ATS-misuse prevalence and its determinants among MMT patients in East-Coast-Malaysia.Methods: A retrospective-observational study was conducted on government-subsidized medication for opioid-use-disorder (MOUD) treatment clinics involving 292 MMT-patients (98% males) who were selected using a multilevel-proportional-stratified random sampling technique. Information obtained during the mandatory monitoring procedure from January 1 to December 31 2019, was utilized to determine ATS misuse prevalence from consecutive random urine drug screening. The determinants associated with its use, namely sociodemographics, social networks, comorbidities, and pharmacological assessments were analyzed via a logistic model.Results: Overall, 52.2% of the MMT-patients (95% CI: 0.42-0.54) had misused ATS at least once during their methadone treatment. These misusing patients were active smokers, hepatitis B and C seronegative, concurrently misused opioids, and had received suboptimum prescribed doses of methadone. Multiple logistic regression analysis demonstrated that the odds of misusing ATS during methadone treatment were 37 times higher among those who concurrently misused opioids (AOR: 37.60, 95% CI: 14.03-100.74) and 12 times higher among those who received suboptimal methadone doses (<60 mg/day) (AOR: 12.24, 95% CI: 5.58-25.43).Conclusion: This study demonstrated the significant prevalence of ATS misuse among MMT-patients in East-Coast-Malaysia, especially among patients who were prescribed suboptimal doses of methadone and/or demonstrated concomitant opioid-misuse. Stringent urine-monitoring is crucial to prevent diversion to ATS misuse. Nonetheless, to avoid negligence and improve physician engagement, the relevant authorities should immediately plan a comprehensive national-standard training module comprising support activities for professional methadone-prescribers.

Association between lung function impairment with urinary heavy metals in a community in Klang Valley, Malaysia.

Lung function status can be directly or indirectly affected by exposure to pollutants in the environment. Urinary heavy metals may be an indirect indicator of lung function impairment that leads to various diseases such as chronic obstructive pulmonary disease (COPD). This study aimed to explore the prevalence of lung function impairment as well as its association with urinary heavy metal levels and other influencing factors among the community in Klang Valley, Malaysia. Urinary sampling was done during various community events in the housing areas of Klang Valley between March and October 2019. Only respondents who consented would undergo a lung function test. Urine samples were obtained and sent for Inductively Coupled Plasma Mass Spectrometry (ICP-MS) analysis for heavy metal cadmium (Cd) and lead (Pb) concentration. Of the 200 recruited respondents, 52% were male and their ages ranged from 18 years old to 74 years old with a mean age of 38.4 ± 14.05 years. Urinary samples show high urinary Cd level in 12% of the respondents (n = 24) whereas none recorded a high urinary Pb level. There was a positive correlation between the levels of urinary Cd and urinary Pb (r = 0.303; p = 0.001). Furthermore, a negative correlation was detected between urinary Cd level and forced vital capacity (FVC) (r =  - 0.202, p = 0.004), force expiratory volume at the first second (FEV1) (r =  - 0.225, p = 0.001), and also force expiratory flow between 25-75% of FVC (FEF 25-75%) (r =  - 0.187, p = 0.008). However, urinary Pb did not show any correlation with lung function parameters. Multiple linear regression analysis showed that urinary Cd had a significant negative effect on FVC (p = 0.025) and FEV1 (p = 0.004) based on the predicted value. Additionally, other factors such as education level (p = 0.013) also influenced lung function. However, no interaction was detected between heavy metals or other factors. In short, there was a significant negative linear relationship between urinary Cd and lung function, whereas urinary Pb was not associated with lung function. Beside acting as a biomarker for cadmium exposure level, urinary Cd may also be applied as indirect biomarker for asymptomatic chronic lung function deterioration among the healthy population.

Vaccine hesitancy from parents and healthcare providers perspectives in Hadhramout Governorate, Yemen: a mixed-method study protocol.

INTRODUCTION: Although immunisation prevents the death of millions of infants and children each year, the vaccination coverage of routine childhood vaccination does not reach its target. The reasons for low vaccination uptake can be related to both demand and supply side determinants. The prevalence of vaccine hesitancy is increasing globally. However, data on vaccine hesitancy in low-income Arabic countries are scarce. To investigate this issue in Yemen, an Arabic low-income country, we aim to examine the link between vaccine hesitancy and the immunisation status of children living in Costal Hadhramout, Yemen, from the perspective of their parents and healthcare providers. METHODS AND ANALYSIS: We will use a mixed-method research design. The study will be conducted in Costal Hadhramout in three phases. Phase 1 will involve a situational analysis using secondary data from records of the national expanded immunisation programme in Costal Hadhramout to examine the trend for previous years. Phase 2 will be a quantitative study aimed at assessing the prevalence of vaccination status of children aged <2 years and the determinants of parental vaccine hesitancy perception through a validated questionnaire. Lastly, phase 3 will be a qualitative study that explores vaccine hesitancy in Yemen using in-depth interviews and focus group discussions with parents and healthcare providers, respectively. ETHICS AND DISSEMINATION: The study has been approved by the Research Committee of the Faculty of Medicine, University Kebangsaan Malaysia. The findings will be disseminated via publication in peer-reviewed academic journals, academic conferences and public presentations.

Compliance of Healthcare Worker's toward Tuberculosis Preventive Measures in Workplace: A Systematic Literature Review.

Despite several guidelines published by the World Health Organization (WHO) and national authorities, there is a general increase in the number of healthcare workers (HCWs) contracting tuberculosis. This review sought to evaluate the compliance of the HCWs toward tuberculosis preventive measures (TPMs) in their workplace. Both electronic databases and manual searches were conducted to retrieve articles regarding the compliance of HCWs in the workplace published from 2010 onwards. Independent reviewers extracted, reviewed, and analyzed the data using the mixed methods appraisal tool (MMAT) 2018, comprising 15 studies, 1572 HCWs, and 249 health facilities. The results showed there was low compliance toward TPMs in the workplace among HCWs and health facilities from mostly high-burden tuberculosis countries. The failure to comply with control measures against tuberculosis was mainly reported at administrative levels, followed by engineering and personnel protective control measures. In addition, low managerial support and negative attitudes of the HCWs influenced the compliance. Further studies are needed to elucidate how to improve the compliance of HCWs toward the preventive measures against tuberculosis in order to reduce the disease burden among HCWs worldwide.

Bullying and Its Associated Individual, Peer, Family and School Factors: Evidence from Malaysian National Secondary School Students.

Adolescents involved in bullying can be at risk of developing behavioural problems, physical health problems and suicidal ideation. In view of this, a quantitative research design using a cross-sectional study was conducted to determine the prevalence of bullying and associated individual, peer, family and school factors. The study involved 4469 Malaysian public-school students who made up the response rate of 89.4%. The students were selected using a randomized multilevel sampling method. The study found that 79.1% of student respondents were involved in bullying as perpetrators (14.4%), victims (16.3%), or bully-victims (48.4%). In a multivariate analysis, the individual domain showed a significant association between students' bullying involvement and age (OR = 1.38; 95% CI 1.12-1.70), gender (OR = 1.73; 95% CI 1.47-0.91), ethnicity (OR = 0.66; 95% CI 0.47-0.91), duration of time spent on social media during the weekends (OR = 1.43; 95% CI 1.09-1.87) and psychological distress level (OR = 2.55; 95% CI 1.94-3.34). In the peer domain, the significantly associated factors were the number of peers (OR = 0.69; 95% CI 0.56-0.86) and frequency of quarrels or fights with peers (OR = 2.12; 95% CI 1.24-3.26). Among the items in the school domain, the significantly associated factors were students being mischievous in classrooms (OR = 1.52; 95% CI 1.06-2.06), student's affection towards their teachers (OR = 1.53; 95% CI 1.06-2.20), frequency of appraisal from teachers (OR = 1.49; 95% CI 1.16-1.94), frequency of friends being helpful in classrooms (OR = 1.92; 95% CI 1.09-3.38) and frequency of deliberately skipping class (OR = 2.91; 95% CI 2.90-1.72). As a conclusion, the study revealed high levels and widespread bullying involvement among students in Malaysia. As such, timely bullying preventions and interventions are essential, especially in terms of enhancing their mental health capacity, which substantially influences the reduction in the prevalence rates of bullying involvement among students in Malaysia.

The Predictive Factors for Severe Leptospirosis Cases in Kedah.

Over the past decade, increased awareness about leptospirosis disease in developing and industrialized countries has resulted in increased numbers of leptospirosis cases being reported worldwide. About 5% to 15% of leptospirosis patients end up with severe forms of the disease. Complication due to leptospirosis requires monitoring, specific treatments, and intensive care admission, thus increasing the cost of treating severe leptospirosis cases. Currently, we have data on incident and mortality rates, but we do not have data on the number of patients with severe form of leptospirosis or how many patients have complications, and whether or not these complications were resolved. Therefore, we carried out this study to determine the predictive factors for severe leptospirosis cases in Kedah. We conducted a cross-sectional study. The data of patients diagnosed with leptospirosis were obtained from the surveillance unit, Kedah Health Department, through the e-notification system. These data were then sorted according to the hospitals where the patients were admitted. The patients' medical records were collected, and their information was obtained using a checklist. A total of 456 confirmed leptospirosis cases were included in the study, with 199 patients classified as severe cases and 257 patients as mild cases, based on the Malaysian leptospirosis guidelines. Most patients were male (71.5%) with a mean SD age of 36.62 ± 20.75 years. The predictive factors for severe leptospirosis include abnormal lung sounds (OR: 3.07 [CI 1.58-6.00]), hepatomegaly (OR: 7.14 [1.10-45.98]), hypotension (OR: 2.16 [1.08-4.34]), leukocytosis (OR: 2.12 [1.37-3.29]), low hematocrit (OR: 2.33 [1.43-3.81]), and increased alanine aminotransferase (SGPT ALT) (OR: 2.12 [1.36-3.30]). In conclusion, knowing these predictive factors will help clinicians identify severe leptospirosis cases earlier and develop their treatment plans accordingly, to reduce the complications and death from severe leptospirosis.

Application of Fuzzy Delphi in the Selection of COPD Risk Factors among Steel Industry Workers.

BACKGROUND: The Delphi method has been widely applied in many study areas to systematically gather experts' input on particular topic. Recently, it has become increasingly well known in health related research. This paper applied the Fuzzy Delphi method to enhance the validation of a questionnaire pertaining chronic obstructive pulmonary disease (COPD) risk factors among metal industry workers. MATERIALS AND METHODS: A detailed, predefined list of possible risk factors for COPD among metal industry workers was created through a comprehensive and exhaustive review of literature from 1995 to 2015. The COPD questionnaire were distributed among people identified as occupational, environmental, and hygiene experts. Linguistic variable using Likert scale was used by the expert to indicate their expert judgment of each item. Subsequently, the linguistic variable was converted into a triangular fuzzy number. The average score of the fuzzy number will be used to determine whether the item will be removed or retained. RESULTS: Ten experts were involved in evaluating 26 items. The experts were in agreement with most of the items, with an average fuzzy number range between 0.429 and 0.800. Two items were removed and three items were added, leaving a total 26 items selected for the COPD risk factors questionnaire. The experts were in disagreement with each other for items F10 and F11 where most of the experts claimed that the question is too subjective and based on self-perception only. CONCLUSION: The fuzzy Delphi method enhanced the accuracy of the questionnaire pertaining to COPD risk factors, and decreased the length of the established tools.