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Introduction: Physical inactivity has been identified as the fourth leading risk factor for worldwide mortality with major implications towards general health. Monitoring the level of physical inactivity may reduce the burden of non-communicable diseases (NCDs) and their risk factors. This study aims to determine the prevalence of physical inactivity and its associated factors among adults aged 18 years and above in Malaysia. Methodology: Data was obtained from the National Health and Morbidity Survey (NHMS) 2019. It was a cross-sectional, population-based survey which employed two- stage stratified random sampling design. A total of 10,356 out of 10,472 respondents were interviewed using a short version of International Physical Activity Questionnaire (IPAQ). Results: Overall, the prevalence of physical inactivity among adults aged 18 years and above in Malaysia was 24.6% (95% CI: 23.2, 26.1). Results from multivariable logistic model showed that Chinese ethnicity (aOR 1.32; 95% CI: 1.04, 1.67), urban dwellers (aOR 1.30; 95% CI: 1.07, 1.57), those who were single (including widow, widower and divorcee) (aOR 1.36; 95% CI: 1.14, 1.61), students (aOR 2.10; 95% CI: 1.30, 3.40), higher household income earners (aOR 1.34; 95% CI: 1.07, 1.68) and those with hypercholesterolaemia (aOR 1.25; 95% CI: 1.03, 1.51) were significantly more likely to be physically inactive. Conclusion: Specific and appropriate intervention towards targeted group is in crucial need to increase the level of physical activity and to promote an active living towards an active and healthy Malaysia.

Introduction: Community health workers (CHW) or volunteers are health workers who are trained but do not possess a professional certificate. They are community members who live and work in that particular community. The Ministry of Health Malaysia had initiated a community-based intervention programme, Healthy Community Empowers the Nation or ‘Komuniti Sihat Pembina Negara’ (KOSPEN) in October 2013. In this programme, CHWs main task is to conduct non-communicable diseases (NCD) risk factor screening. Methods: Data from the “Evaluation of the implementation of KOSPEN programme in Malaysia 2016” was used. It is a cross-sectional study which was carried out in randomly selected KOSPEN localities throughout Malaysia. Logistic regression analysis was applied to determine factors associated with not performing KOSPEN screening activities by the volunteers. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 20. Results: A total of 700 volunteers were included in this study. Most of the volunteers were female (65.7%) and were aged 50-59 years (30.9%), followed by those aged 40-49 (27.1%). Majority had secondary education (65.3%), employed (55.7%.) and were married (80.4%). Multivariate logistic regression showed that volunteers who never attended training (aOR 2.79; 95% CI:1.66, 4.67) and who felt the content of the training module was inadequate (aOR 2.693; 95% CI: 1.46, 4.98) were more likely to not perform screening activities in the community. Conclusion: Attendance of the training should be a pre-requisite to qualify as a volunteer. Improvement to the training module should done to increase comprehensibility of the modules among the volunteers. Keywords: KOSPEN-community health workers-NCD screening-community-based intervention Word count (249)

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.

Employee turnover could affect the organisation’s performance. Job dissatisfaction and burnout have been identified as factors influencing the intention to leave. Thus, this study aimed to determine the level of intent to leave, and predictors associated with intention to leave among medical researchers in Malaysia. A cross-sectional, stratified random sampling study was conducted among researchers in a research organisation under the Ministry of Health. Respondents answered an online questionnaire that included sociodemographic information, job dissatisfaction, burnout, and intention to leave. A total of 133 researchers participated. More than one-third (41.4%) of the researchers had a moderate and high level of intention to leave. Burnout and job dissatisfaction were identified as significant predictors. Burnout was noted to have a positive relationship with the intent to leave (β = 0.289, 95% CI (B): 0.287, 1.096). Meanwhile, job satisfaction was found to have a negative relationship with the intention to leave (β = −0.348, 95% CI (B): −0.768, −0.273). Burnout among researchers is quite worrisome as more than two-thirds of the researchers experienced moderate to high burnout. Reducing burnout and job dissatisfaction would increase work performance and produce high-quality research output, hence decreasing the turnover rate.

Aim The objective of this study is to determine the prevalence of self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia and their associated factors. Methods The study used data from the National Health and Morbidity Survey in 2018. It was a cross-sectional study with two-staged stratified cluster sampling design. In total, 3977 adults aged ≥60 years were selected for this study. Respondents were interviewed face to face using a structured questionnaire. Self-reported diabetes, hypertension or hypercholesterolemia was defined as having ever been told they have these diseases by a medical doctor or paramedic. Data were analyzed using SPSS version 25. The multiple logistic regression model was used to examine the factors associated with the prevalence of self-reporting. Results The prevalence of self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia were 27.7%, 51.1% and 41.8% respectively. Presence of other comorbidities and being obese showed higher odds for all three diseases. Indians, unemployed, inactive had higher odds for diabetes. Other Bumiputras, unemployed, non-smoker, obese and inactive had higher odds for hypertension. Non-smoker had higher odds for hypercholesterolemia. Conclusions Health promotion, vigilance, attention and services targeting on the associated factors should be strengthened for older persons in Malaysia to ensure healthy aging. Geriatr Gerontol Int 2020; 20: 79-84.

Introduction Many studies have revealed that exposure to secondhand smoke (SHS) substantially increases the risk of smoking related diseases especially among the vulnerable groups, yet data on the location of SHS exposure among youth in Malaysia are still lacking. The study aims to describe the prevalence and factors associated with SHS exposure at home, outside the home, and inside the school among school-going adolescents in Malaysia. Methods We derived the data from the TECMA study, which used a cross-sectional study design and multi-stage sampling method to obtain a representative sample of school-going adolescents aged 11-19 years in Malaysia in 2016. Data were collected through a self-administered approach using a pre-validated standard questionnaire. Descriptive and multivariate analyses were used to analyze the data, and results are presented as adjusted odds ratio (AOR) with 95% confidence interval (95% CI). Results SHS exposure for the past seven days was higher outside the home (51.2%; 95% CI: 49.2-53.2) compared to at home (37.8%; 95% CI: 35.8-39.9) while 27.3% (95% CI: 25.1-29.5) of school-going adolescents reported exposure to SHS inside the school in the past one month. In the regression analyses, older adolescents, those of Malay and Bumiputra Sarawak ethnicities, adolescents from rural areas and current smokers had higher likelihood of exposure to SHS at home, outside home and inside the school. Our study also found that adolescents who were current smokers had higher odds of being exposed to SHS at home (AOR=2.87; 95% CI: 2.57-3.21), outside the home (AOR=3.46; 95% CI: 3.05-3.92) and in the school (AOR=2.25; 95% CI: 2.01-2.51). Conclusions Health promotion measures should target parents/guardians and household members to reduce SHS exposure among adolescents. In addition, smoke-free regulation should be fully enforced in school. Furthermore, more public places should be designated non-smoking areas to reduce SHS exposure and denormalize smoking behavior.

The epidemic of Coronavirus Disease 2019 (Covid-19) in China and a number of countries had led to the Covid-19 pandemic declaration by WHO. The aim of this study is to assess the evidence and to report the effectiveness of Covid-19 containment and mitigation measures among the affected countries. A comprehensive search strategy was performed using the MESH terms of “Novel coronavirus,” “Novel coronavirus 2019”, “2019 nCoV”, “Covid-19”, “Wuhan coronavirus”, “SARS-CoV-2”, “Containment”, “Mitigation” and “Control”. After completion of the initial screening, 922 articles were excluded for the following reasons: the article did not meet the inclusion criteria (N = 862), the article was a duplicate (N = 60). The remaining 72 articles were screened at the full-text level. After full review for relevancy, 41 articles were excluded and a total of 31 articles were selected for scoping review. The two most successful countries that managed to control this pandemic were Hong Kong and South Korea. While, the United States of America (USA) and Brazil are the countries yet unable to significantly reduce the Covid-19 cases. The aggressiveness of government efforts and the compliance among the population are the main factors contributing to the effectiveness of the containment and mitigation measures implemented.

In the early stages of the COVID-19 crisis, there was no specific guideline for handling an outbreak if it occurred in a workplace. This study aimed to describe the first and one of the largest clusters linked to a business corporate in Malaysia. A descriptive analysis was conducted using surveillance data from the Petaling District Health Office notified between 28 Feb and 22 Mar 2020. All cases and contacts were identified through surveillance, epidemiological investigation, and laboratory investigation. The total number of confirmed cases and close contacts were 63 and 1,536, respectively. The respondents were mainly Malay, male, and the mean age was 46 years. Of the 63 positive cases, 48 (76%) were reported to have symptoms during the investigation, while the remaining 15 cases (24%) were asymptomatic. The main clinical manifestations were fever (52%), cough (37%), sore throat (27%) and shortness of breath (27%). The mean incubation period was 3.5 days. Due to the timely prevention and control measures carried out by the Petaling District Health Office, the chain of transmission was interrupted as the last case was reported on 19 Mar 2020.

Smoking is a major contributor to morbidity and mortality worldwide, with Malaysia no exception. Through the Ministry of Health and other ministries in the government of Malaysia, numerous anti-smoking measures have been introduced to prevent and control smoking in the country. Continuous monitoring of smoking prevalence in the community is essential in order to evaluate the effectiveness of anti-smoking policies. This study aims to update the sociodemographic factors associated with smoking in the past decade in Malaysia.The study utilized data from three national household surveys in Malaysia, namely the Global Adult Tobacco Survey (GATS) 2011, the National Health and Morbidity Survey (NHMS) 2015 and the National Health and Morbidity Survey (NHMS) 2019. These surveys adopted a multistage stratified sampling design that represents the population in Malaysia. Smoking status was determined based on the GATS protocol and definitions. Complex sample design estimates and complex multivariable logistic regression were used in the analysis.A total of 4250, 21410 and 11111 respondents aged ≥15 years participated in GATS 2011, NHMS 2015 and NHMS 2019, respectively, with a response rate between 85% and 87%. The prevalence of smoking was 23.1% (95% CI: 21.2-25.2) in 2011, 22.8% (95% CI: 21.9-23.8) in 2015 and 21.3% (95% CI: 19.9-22.8) in 2019. The prevalence was consistently higher in males (40.5-43.9%), adults aged 25-44 years (25.4-29.0%), Malay (22.6-24.7%), other ethnicities (30.0-35.0%), and the self-employed (33.7-44.6%). Multiple logistic regression analysis showed that the adjusted odds ratio (AOR) of smoking was higher in males, in younger and middle age groups, Malays, and those with lower education level.There were slight changes in the sociodemographic factors of smoking in the past decade in Malaysia. Stern measures and more aggressive strategies are needed to address all the risk factors in controlling smoking behavior in the country.

In the original publication [...]

Background Small/kiddie cigarette packs consist of less than 20 cigarette sticks. Kiddie packs were recently proposed to be reintroduced by the tobacco industry with an excuse to prevent consumers from buying illicit cigarettes. By reintroducing kiddie packs, cigarettes will inevitably be more affordable and this would appeal to lower-income consumers especially teens. In this systematic review, we aimed to identify the impact of kiddie packs on smoking, specifically on smoking initiation, the urge/tendency to buy cigarettes and attempts to reduce cigarette consumption. Methods This systematic review will be based on the review of original articles on the impact of kiddie packs on smoking. There is no restriction on the publication dates. The Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Web of Science and Scopus will be searched to retrieve potential original articles. Additional records identified through other sources: Google Scholar, as well as Journal of Substance Use and Tobacco Control, are also to be searched. These will include original articles in any language which included all study designs (randomised controlled trials, quasi experimental and experimental studies, observational cross-sectional and cohort studies) comparing kiddie packs with regular cigarette packs. The primary outcomes of interest will be initiation of smoking and urge/tendency to buy cigarettes in the general population and attempts to reduce cigarette consumption among current smokers. Secondary outcomes will be the prevalence of smoking using kiddie packs among the current smokers. Discussion This systematic review will provide evidence to support the impact of kiddie packs on smoking in terms of smoking initiation, smoking prevalence, urge/tendency to purchase cigarettes and attempts to reduce cigarette consumption. The findings from this review could be helpful to policymakers in regulating kiddie packs to control the consumption of tobacco. Systematic review registration PROSPERO CRD42018102325

Smoking is a learned behavior during adolescence, and it is found predominantly among male adolescents in Malaysia. Our study aimed to investigate the prevalence and predictive factors of current cigarette smoking among school-going male adolescents in Malaysia. Data were derived from the National Health and Morbidity Survey: Adolescent Health Survey 2017, a cross-sectional study that utilized a 2-stage stratified cluster sampling to select a nationally representative sample of school-going adolescents in Malaysia (n = 27 497). Multiple logistic regression analysis was performed to identify factors associated with current cigarette smoking among male adolescents in Malaysia. Male adolescents aged 16 to 17 years (adjusted odds ratio [AOR] = 1.55; 95% confidence interval [CI] = 1.41-1.70), current illicit drug users (AOR = 8.14; 95% CI = 6.37-10.41), current alcohol users (AOR = 1.92; 95% CI = 1.65-2.23), those from rural schools (AOR = 1.60; 95% CI = 1.46-1.76), those whose parents were widowed/divorced/separated (AOR = 1.37; 95% CI = 1.21-1.55), and those whose parents/guardians were tobacco product users (AOR = 3.47; 95% CI = 2.33-5.16) were more likely to be current cigarette smokers. Tobacco control strategies should be aimed at both adolescents at risk and at promoting parental smoking cessation.

IntroductionSecond-hand smoke (SHS) contains more than 7,000 chemicals and at least 70 of them can cause cancers . Globally, more than 600,000 deaths are attributable to SHS annually . Our study aims to determine the prevalence and correlates of SHS exposure among adults in Malaysia. MethodologyData was obtained from the National Health and Morbidity Survey (NHMS) 2019, a cross-sectional study which utilized a two-stage stratified cluster sampling design to select a nationally representative sample of adults in Malaysia. Data was collected using a short version of Global Adult Tobacco Surveillance (GATS) questionnaire. Multiple logistic regression analysis was performed to identify correlates of SHS exposure among adults in Malaysia. ResultsOverall, 53.0% of Malaysian adults were exposed to SHS either at home, at work or at restaurant. Our study found that male adults (AOR 1.76; 95% CI: 1.60, 1.93), those aged 15-24 years (AOR 2.53; 95% CI: 2.11, 3.02), those who had no formal education (AOR 1.48; 95% CI: 1.17, 1.88) and those who were working (AOR 1.53; 95% CI: 1.38, 1.69) were more likely to be exposed to SHS. However, Indian (AOR 0.61; 95% CI: 0.51, 0.73) and those who have not noticed information about danger of smoking in newspaper/television/magazine (AOR 0.54; 95% CI: 0.49, 0.59) were less likely to be exposed to SHS as compared with their respective counterparts. DiscussionOur findings that male adults and those of younger age group were at higher risk of SHS exposure were in line with other local studies. Consistent with other studies among adults in India and Vietnam, our study reported that those who had no formal education were more likely to be exposed to SHS compared with those with higher education attainment. Our study found that working adults were at higher risk of SHS exposure while Indian adults were less likely to be exposed to SHS. In contrast, other local study reported higher likelihood of SHS exposure among unemployed adults and lower likelihood of SHS exposure among Chinese adults.Our study reported that those who have not noticed information about the danger of smoking in newspaper/television/magazine were less likely to be exposed to SHS which was similar to other study. ConclusionSHS exposure among Malaysian adults was high. Tobacco control measures should be strengthened to protect Malaysian adults from SHS exposure. Health promotion and educational programmes should be tailored to those at risk of SHS exposure.

IntroductionTobacco advertisings and/or promotions are prohibited in Malaysia as stipulated in Part II & III of Control of Tobacco Product Regulations 2004 [CTPR], Food Act 1983 (Act 281) [FA]. However, any packaging or wrapping contains tobacco products on or inside it are not considered to be violating CTPR . This exception was confirmed by WHO Framework Convention on Tobacco Control (FCTC), where in Malaysia all tobacco advertisings, promotions and sponsorships are comprehensively banned except for tobacco product displays at point of sales as well as nor it is covering cross-border advertising originating from Malaysia (for exportation purpose) . Therefore, tobacco advertising or promotion still exists in this country. This study aims to determine the factors associated with the exposure to tobacco advertising or promotion among male population aged 15 years old and above in Malaysia. Materials and MethodsWe’re using secondary data from National Health & Morbidity Survey (NHMS) 2019 conducted between July 14, 2019 until September 30, 2019 using face-to-face interview or self-administered questionnaires. The survey was cross-sectional nationwide population-based with two stages stratified random sampling methods. “Exposure to tobacco advertising” was defined as either the respondents noticed any advertisement or sign promoting cigarettes in stores where cigarettes are sold within the past 30 days from the data collection. “Exposure to one of the tobacco promotions” was defined as either the respondents noticed any tobacco promotions (free samples of cigarettes, cigarettes at sale prices, coupons for cigarettes, free gifts or special discount offers on other products when buying cigarettes, clothing or other items with a cigarette brand name or logo, or cigarette promotions in the mail) within the past 30 days from the data collection. Data were analysed using complex sampling design and multiple logistic regressions. Results[Refer to Poster]. DiscussionAmong all types of exposures to tobacco advertising or promotion of male aged 15+ years in Malaysia, the exposure to any advertisement or signs promoting cigarettes in stores where cigarettes are sold ranked the highest (17.6%). This result was consistent with other survey conducted in Vietnam where the highest type of exposure to tobacco advertising and promotion was points of sale (8.6%). Respondents within younger age group (15-34 years old) are two times more likely to exposed to tobacco advertising or promotion compared to the eldest age group (65 years old and above). Younger age group is major target client for tobacco industry thus more attractive advertising or promotion improvised to tackle this group’s sight especially in the store selling tobacco product. This study found that respondent with higher educational background are more prone to the exposure to tobacco advertising or promotion as compared to those with lower educational background. This is similar to the findings in Vietnam but contradict to the findings in Hong Kong and United States . Based on ethnicity,Malay and other Bumiputra were more likely to be exposed to tobacco adevertising or promotion compared with Chinese ethnic in Malaysia. As strongly agreed by most of the studies, current smokers were more likely to be exposed with tobacco advertising or promotion. Tobacco advertising or promotion contributes to the consumption of cigarettes as it increasing the desire to use the advertised tobacco products and discouraging smoking cessation especially among current smoker. Conclusion and RecommendationAlthough prohibited by CTPR 2004 but with an exception, Malaysian male population aged 15 and above is still exposed with the tobacco advertisements or promotions. An immediate revision of the law is required so that strictly enforcement can be done to bring down this matter to zero exposure to the population.

IntroductionCommunity health workers (CHW) are health workers who are trained but do not possess a formal professional certificate, live and work in the community. The Ministry of Health Malaysia had initiated a community-based intervention programme, known as Healthy Community Empowers the Nation or ‘Komuniti Sihat Pembina Negara’ (KOSPEN) where CHWs main task is to conduct non-communicable diseases (NCD) risk factor screening. MethodsData from the “Evaluation of the implementation of KOSPEN programme in Malaysia 2016” was used. Logistic regression analysis was applied to determine factors associated with not performing KOSPEN screening activities by the volunteers. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 20. Results[Refer to Poster]. Discussion / ConclusionVolunteers and community health workers have been widely recognised to help in reducing the burden of NCDs in their communities. Sufficient training and resources is needed to facilitate their work. Volunteers who were not trained were not likely to perform screening activities maybe be due to lack of confidence as community volunteers are usually lay persons with little or no medical training. Attendance of training should be a pre-requisite to qualify as a volunteer. Improvement to the training module should done to increase comprehensibility of the modules among the volunteers.

IntroductionDiabetes is a major non-communicable health problem in both developed and developing countries, including Malaysia. Person with diabetes are living longer and are vulnerable to microvascular and macrovascular complications thus representing an important public health problem with high morbidity, mortality and significant economic repercussions. ObjectiveTo determine the national prevalence of diabetes and to identify associated factors among adults population in Malaysia. MethodologyA nationwide cross-sectional study was conducted in 2019 involving 10,464 respondents in Malaysia. Two-stage stratified sampling design was used to select a representative sample of Malaysia adults population. Structured validated questionnaire with face-to-face interview were used to obtain data from selected respondents aged ≥ 18 years. Finger pricked fasting blood glucose test by using Accutrend GC machine were performed on respondents who claimed that they were not having diabetes. Chi-square tests and logistic regression were used to determine associations between diabetes and associated factors at the significance level of =0.05. For the purpose of this study, a respondent was classified as having “diabetes” when the respondent had a fasting capillary blood glucose (FBG) of ≥ 7.0 mmol/L (or non-fasting capillary blood glucose of ≥ 11.1 mmol/L). ResultsThe overall prevalence of diabetes among adults respondents was 18.3% (n=2629). The highest prevalence of diabetes were among females (18.4%), aged 60 & above (41.5%) Indian (31.4%), those without formal education (28.7%), widow/widower/divorce (33.2%), not working (24.9%), inactive (22.5%), obese (27.1%), hypertension (36.0%) and high cholesterol level (30.4%). Logistic regression analyses revealed that age group, ethnicity, education level, marital status, physical activity level, obesity, blood pressure status and cholesterol status were associated with diabetes among adults. DiscussionThis study showed the prevalence of diabetes among adults Malaysian population at 18.3%. Our study recorded a relatively higher level of diabetes among adults population as compared to 7.5% in Brazil (Luisa SF and Monica RC) but lower than Majmaah, Arab Saudi at 34.6% (Mohammed Abdullah AM) There were significant associations between diabetes with age groups, ethnicity and education level, marital status, physical activity which concurred with findings from Alemayehu Z et. al. and Meiqin Hu et. al. Our study also showed there were significant associations between diabetes with obesity, hypertension and cholesterol. Similar findings were reported by Wan Nazaimoon WM et al. and Shiferaw BA & Ayalew JZ. However, no significant association was found in gender, residence and occupational status. ConclusionThis study showed that the prevalence of diabetes among adults populations in Malaysia to be high, with one in five persons found to have diabetes. This study also found that established risk factors like age group, ethnicity, education, physical activity, obesity, hypertension and cholesterol were associated with diabetes. Awareness program and interventions on diabetes need to be improved especially related to behavioural charge as a strategy for prevention and control of diabetes and its complications.

IntroductionHypertension is a global public health issue. In 2010, a total of 1.38 billion people (31.1%) of the global adult population had hypertension. It is estimated that the number of hypertensive patients will raise to 1.56 billion worldwide by 2025. If left uncontrolled, hypertension causes stroke, heart disease, cognitive impairment, chronic kidney disease (CKD), and renal failure. Hypertension responsible for at least 45% of CVD death and 51% stroke death. CVD accounted for 17.3 million death in 2013 which represent 31% of all global deaths and made it the world’s leading cause of death and disability. The objective for this study is to determine the prevalence of hypertension and its factors associated among adults aged 18 years and above in Malaysia. MethodologyThe study used data from the National Health and Morbidity Survey in 2019. • It was a cross sectional study with two-stage stratified random sampling design. Respondents were given structured questionnaire via face to face interview using mobile device for data collection. Blood pressure was recorded as the average reading from two electronic pressure monitoring measurements. Hypertension was defined as systolic BP≥ 140mmHg or diastolic BP≥ 90mmHg. • Data was analysed using the complex sample design analysis. • Multiple logistic regression was used to determine the factors associated with prevalence of hypertension. ResultsThe prevalence of hypertension in Malaysia was 30.0% (95%CI: 28.57,31.50). The prevalence among male and female was 30.3% (95%CI: 28.22,32.50) and 29.7% (95%CI: 27.98,31.46) respectively. DiscussionOne third of Malaysian population have hypertension. It is higher than Iran (17.3%) [men: 18.9% women: 15.5%] and Laos (20.0%) [men: 18.5%, women: 21.1%]. • Increasing in age and BMI showed higher likelihood to get hypertension. It is similar to many previous studies which showed that increasing in age and higher BMI as an independent risk factor for hypertension. • Divorcee, unemployed, Other Bumiputras, presence of diabetes and hypercholesterolemia showed higher odds to have hypertension for both genders. • Among male, those from M40 household income group, current smokers and non-drinker showed lower likelihood to have hypertension compared to B40 household income group, non-smokers, and current drinker. Our findings on smoking was inconsistent with a study done in Nepal [9] but similar with a study in Korea • Among female, higher education and physically active showed lower likelihood to have hypertension compared to lower educational group and physically inactive female. • Systematic approaches are needed for better detection and risk factor modification among the targeted group.&nbsp

IntroductionIn December 2019, an epidemic of Coronavirus Disease 2019 (Covid-19) began in China and the number of countries infected by the virus has continued to rise. This phenomenon has led WHO to declare Covid-19 as pandemic on March 11, 2020, and has urged all affected countries to take urgent and aggressive action to control this pandemic. Most of the countries affected by the Covid-19 pandemic were recommended to adopt the containment and mitigation measures in order to control the disease from spreading. Briefly, the containment measures aimed at preventing the disease from taking hold, encompassing early detection, isolation, and care of people already infected, with careful tracing and screening of their contacts. While, mitigation measures aimed at reducing the impact and its incidence, as well as disruptions to economic, political, and social systems, encompassing social distancing strategies such as the cancellation of conferences and other large gatherings, reducing non-essential use of public transport, and closure of schools. ObjectiveThe aim of this study is to determine the control methods used in containment and mitigation of the Covid-19 virus from the affected countries and to ascertain what are the best methods in Covid-19 transmission control. MethodologyIn our study, a scoping review approach in searching, screening, reviewing and data extraction was applied based on framework by Arksey and O’Malley. A comprehensive search strategy was performed, which included published scientific journals, unpublished work, grey literature using the MESH terms of “Novel coronavirus,” “Novel coronavirus 2019”, “2019 nCoV”, “Covid-19”, “Wuhan coronavirus”, “SARS-CoV-2”, “Containment”, “Mitigation” and “Control”. Two reviewers independently screened all references from the articles search and then reached consensus on which met the eligibility criteria. Two reviewers independently screened all references from the articles search and then reached consensus on which met the eligibility criteria. Non-English language articles were excluded as the translation was not practical. Data from the articles were extracted and summarized on a standardized form with the data reviewed by both authors. ResultsA total of 996 sources of evidence identified from the literature search and grey literature hand search were included in the review, representing the types of containment and mitigation from four regions; i. Western Pacific and South East Asia, ii. European, iii. Eastern Mediterranean, and iv. The Americas. After completion of the initial screening, 922 articles were excluded for the following reasons: the article did not meet the inclusion criteria (N = 862), the article was a duplicate (N = 60). The remaining 72 articles were screened at the full-text level. After full review for relevancy, 41 articles were excluded and a total of 31 articles were selected for scoping review (Figure 1;).After more than one month of the containment and mitigation control measures taken, most of the countries managed to reduce the Covid-19 cases from spreading in the communities [45]. However, the two most successful countries that managed to control this pandemic were Hong Kong and South Korea. While, the United States of America (USA) and Brazil are the countries yet unable to significantly reduce the Covid-19 cases (Table 1). ConclusionThis review revealed all countries affected by the Covid-19 had implemented multiple containment and mitigation measures to reduce the impact of the disease. Thus, making it difficult to measure the effectiveness of each individual method. A combination of multiple control measures is necessary, since this could increase the success in reducing the transmission of the Covid-19 disease. In addition, the aggressiveness of government efforts and the compliance among the population are the main factors for the effectiveness of the containment and mitigation measures implemented. Lastly, the efforts should be directed at the creation of standard guidelines to improve the containment and mitigation efforts, considering the characteristics of the virus and community acceptance.

IntroductionSmoking has been a major contributor to morbidity and mortality worldwide including in Malaysia. Every year, more than 8 million people die from tobacco use worldwide1 . In Malaysia, smoking related-diseases have been identified as the major contributor to disability-adjusted life years and lost of years of life among the Malaysian population. The government of Malaysia through the Ministry of Health and other ministries have introduced numerous anti-smoking measures to prevent and control smoking behaviour in the country. Continuous monitoring of smoking status is essential in evaluating the effectiveness of anti-smoking policies. Objectives This paper aimed to study the trend in prevalence and sociodemographic factors of smoking in Malaysia. MethodologyThe study utilised data from three national household surveys in Malaysia namely the Global Adult Tobacco Survey (GATS) 2011, the National Health and Morbidity Survey (NHMS) 2015 and the National Health and Morbidity Survey (NHMS) 2019. The surveys adopted a multistage stratified sampling design that could represent population in Malaysia. All the three surveys had the same target population (population aged 15 years and above) and smoking questionnaires. Smoking status was measured based on GATS protocol and definitions5 . Complex sample design analysis was used to estimate the prevalence and complex multivariable logistic regression was used to identify sociodemographic factors of smoking for all the three surveys. ResultsA total of 4250, 21,410 and 11,111 respondents aged 15 years and above participated in GATS 2011, NHMS 2015 and NHMS 2019 respectively with the response rate of 85% to 87%. The prevalence of smoking was 23.1% (95% CI; 21.2, 25.2) in 2011, 22.8% (95% CI; 21.9, 23.8) in 2015 and 21.3% (95% CI; 19.9, 22.8) in 2019. The prevalence was consistently higher in males (40.5% - 43.9%), adults aged 25-44 years (25.4% - 29.0%), Malay (22.6% - 24.7%), other ethnics (30.0% - 35.0%), and among the self-employed (33.7% - 44.6%) (Table 1). Multiple logistic regression analysis of the three surveys showed that the adjusted odds ratio (aOR) of smoking was markedly higher in males, higher in younger and middle age groups, Malays and those with lower education attainment (Table 2). Discussion / ConclusionAlmost 5 million population aged 15 years and above were smokers in Malaysia. A reduction trend was seen in the prevalence of smoking across almost all sociodemographic characteristics from 2011 to 2019 although the reduction was not statistically significant. Based on the trend, it is still far from achieving the target set by WHO which is 30% reduction in the prevalence of smoking by 2025 from the 2010 baseline. The smoking prevalence in Malaysia is also high compared to in developed countries such as Singapore (14.1%) 6 and Australia (12.8%) 7 . Although there were slight changes in the aOR of the associated factors, the sociodemographic factors associated with smoking were almost consistent in the three surveys. These findings indicate there is a need to strengthen the current anti-smoking policies in terms of their planning, implementation and evaluation.

IntroductionThe first case of Coronavirus Disease (COVID-19) in Malaysia was reported on the 25th of January 20201. Basic epidemiology remains the cornerstone of identifying the distribution of diseases, and the source of an infection. This study aims to describe the epidemiological characteristics of the first 1,375 positive cases of COVID-19 reported in the state of Selangor, Malaysia. Materials and MethodsAll laboratory confirmed positive cases of COVID-19, based on RT-PCR testing from Nasopharyngeal Swabs reported in Selangor up to 25th of April 2020 were included. The epidemic curve was based on the date of onset of symptoms, or their date of exposure for asymptomatic patients. A second plot was done based on the date of onset, asymptomatic cases based on date of exposure plus median incubation period. Results1375 positive COVID-19 cases were reported in Selangor. The mean age was 38•6 ± 18•3 years. • 36•4% of patients were asymptomatic. Fever (66•1%), and cough (56•0%) being the most common symptoms. The median incubation period was 6 (IQR: 3 – 10) days. DiscussionScreening based on symptoms is inadequate in capturing all cases in the community. • Limiting human-to-human transmission remains crucial in containing this disease. This supports the findings of modelling studies which predicted a decline to occur two weeks after travel restrictions.

Background:Kiddie/small packs contain less than 20 cigarette sticks in a pack.Kiddie packs were introduced by the tobacco industry to support moderation and encourage quit smoking among heavy smokers although this may in turn encourage underage smoking. Smaller packs may suggest lower costs and this may increase affordability among the younger generation. This concern has causedmany countries to ban the sale of single cigarette sticks or kiddie packs. Hence, a systematic review was conducted to identify the impact of kiddie packs on smoking as compared to regular cigarette packaging in the general population.Methods:A database search was conductedin PubMed, EMBASE, CENTRAL, Web of Science and Scopus up to31stJanuary 2020. Other sources namely Google Scholar, as well as Journal of Substance Use and Tobacco Control were also searched.The results were analysed qualitatively, under four groups: initiation of smoking;urge /tendency to buy cigarettes; prevalence of smoking and attempt to reduce cigarette consumption. The methodological quality of all articles that were includedwas determined using a validated 16-item quality assessment tool (QATSDD). The literature search identified 2253 articles, of which20articles had met theinclusion criteria. Discussion:Articles that we reviewed had some evidence that kiddie packs increase the urge/tendency to buy cigarettes and also increase the attempt to reduce cigarette consumption. However, we found no evidence on theimpact of kiddie packs on the initiation of smoking and the prevalence of smoking. The average quality score for all papers was 34.1%.Given the diverse study settings of the articles and despite the challenges of the methodological quality of some papers, this review will provideevidence that kiddie packs increase urge/tendency to buy cigarettes and also increase the attempt to reduce cigarette consumption. However, since most studies were of low quality, further high-quality studies are needed to come to a firm conclusion of the impact of kiddie packs on smoking.Systematic review registration: PROSPEROCRD42018102325

Aims As the Malaysian population is aging rapidly, there is an urgent need for an effective management plan for healthy aging, to extend life expectancy and to improve quality of life (QoL). Urinary incontinence (UI), which is common in older persons, is often linked to reduced QoL. This study aimed to determine the effects of UI on QoL among older persons in Malaysia. Methods This study was based on data obtained from 3716 Malaysians aged ≥60 years as part of the National Health and Morbidity Survey (NHMS) 2018. QoL was measured using the Control, Autonomy, Self-realization and Pleasure 19-item (CASP-19) questionnaire. UI was measured using the Questionnaire Urinary Incontinence Diagnosis (QUID) score. Association between UI and QoL were examined using linear regression analysis, after controlling socio-demographic variables and comorbidities. Results Overall, the prevalence of UI was 5.2%. By subtypes, the prevalence of stress UI and urge UI were both 2.0%, while that of mixed UI was 1.3%. The UI group rated their lives more negatively in all four domains of QoL compared with non-UI group. Those who were incontinent had lower standardized scores on control and autonomy domains of CASP-19 as well as total score. Results from linear regression analysis indicated that UI had a significantly negative impact on control and autonomy domains of QoL after controlling for socio-demographic factors and comorbidities. Conclusion UI contributes to a significant reduction on QoL of older persons. Healthcare providers need to be sensitive in evaluating and discussing UI, particularly with their older patients. Geriatr Gerontol Int 2020; 20: 38-42.

Hypertension is strongly associated with chronic diseases such as myocardial infarction, stroke, heart failure, and renal failure. The objective of this study is to determine the trend of prevalence, awareness, treatment, and control of hypertension among Malaysian population since 2006 to 2015. The study used the data from National Health and Morbidity Survey (NHMS) 2006, 2011, and 2015. It was a cross-sectional with two-stage stratified random sampling throughout Malaysia for eligible respondents 18 years old and above. Respondents were interviewed face to face and blood pressure was recorded as the average reading from two electronic pressure monitoring measurements. Data was analyzed using the Complex sample module in SPSS Version 20. The prevalence of hypertension in Malaysia was 34.6% (95% CI: 33.9, 35.3) in 2006, 33.6% (95% CI: 32.6, 34.6) in 2011 and 35.3% (95% CI: 34.5, 36.3) in 2015. Awareness of hypertension in 2006, 2011, and 2015 was 35.6% (95% CI: 34.6, 36.6), 40.7% (95% CI: 39.3, 42.1), and 37.5% (95% CI: 36.1, 38.9) respectively. The trend of receiving treatment from 2006 to 2015 was 78.9% (95% CI: 77.5, 80.2) to 83.2% (95% CI: 81.3, 84.8). The control of hypertension increased significantly from 27.5% (95% CI: 25.9, 29.2) in 2006 to 37.4% (95% CI: 35.3, 39.5) in 2015. Despite higher proportions receiving treatment over time, the control of hypertension remained below 40% since NHMS 2006 until 2015. The strategies to further reduce the prevalence and increase awareness of hypertension should be enhanced particularly among the targeted age group to ensure early detection, treatment, and control thus preventing from long-term complications.

In the article “Hypercholesterolemia Prevalence, Awareness, Treatment and Control Among Adults in Malaysia: The 2015 National Health and Morbidity Survey, Malaysia” which appeared in Volume 10, No. 7(2018), a sentence in the abstract under results section, “Only a mere 12.7% (95% CI:12.4 -13.1) among those who were aware were on treatment and out of which only 53.7% (95% CI: 50.1-57.2) had their cholesterol levels controlled” appeared incorrect and should have appeared as “Only a mere 12.7% (95% CI:12.4 -13.1) were on treatment and out of which only 53.7% (95% CI: 50.1-57.2) had their cholesterol levels controlled”. We apologise to the readers of Global Journal of Health Science for this error.

Additional file 1. PRISMA-P checklist.

Additional file 2: Table S1. Key search strategy.

Additional file 4: Table S3. Study/risk of bias for individual included Randomised Controlled Trial studies.

Background: Coronavirus Disease (COVID-19) has spread rapidly across the globe, since it was first discovered in late December 2019 We are still learning about

Additional file 3: Table S2. Data extraction sheet.

Electronic cigarettes (e-cigarettes) are handheld devices that deliver an aerosol by heating a solution made up of propylene glycol and/or glycerol with or without flavoring agents and nicotine. This nationwide cross-sectional survey examined factors associated with e-cigarette usage and reasons for its initiation among 13 162 Malaysian adolescents. Data from TECMA (Tobacco and E-Cigarette Survey among Malaysian Adolescents) were used. Nine percent of adolescents had used e-cigarettes in the past month. Males (adjusted odds ratio [aOR] = 4.08; 95% confidence interval [CI] = 3.36-4.95), 16 to 19 year olds (aOR = 2.64; 95% CI = 2.13-3.26), Malays (aOR = 2.25; 95% CI = 1.79-2.83), Sabah and Sarawak Bumiputeras (aOR = 2.25; 95% CI = 1.61-3.15), and cigarette smokers (aOR = 13.16; 95% CI = 11.14-15.54) were more likely to use e-cigarettes. Three main reasons for e-cigarette initiation among adolescents were its taste and smell, experimentation, and popularity. Sale of e-cigarettes with or without nicotine to people aged younger than 18 years should be banned. Flavored e-cigarettes should also be banned since there is evidence suggesting increased appeal among the younger generation.

This study was carried out to determine the prevalence of illicit drug use and its associated factors among male adolescents in Malaysia. Data of 13 135 adolescents were extracted from the National Health and Morbidity Survey 2017, a cross-sectional survey among school-going adolescents in Malaysia aged between 13 and 17 years, using a 2-stage stratified cluster sampling. A complex sample design analysis and multiple logistic regression analysis were applied. The overall prevalence of lifetime illicit drug use among male adolescents was 6.6%. The multivariable model showed that illicit drug use among male adolescents were associated with younger age, rural school area, marital status of parent, current smoker, ever having sex, truancy, involved in physical fight, and lack of peer support. The findings from this study can assist community and relevant authorities in their efforts to combat illicit drug usage among adolescents using intervention programs that diminishes risk factors and enhances the protective factors.

We assessed the prevalence of cessation of e-cigarette and its associated factors among adolescents in Malaysia. This study analyzed data from the Tobacco and E-Cigarette Survey among Malaysian Adolescent (TECMA) in 2016, a cross-sectional study with 2-stage stratification cluster sampling. A total of 14 832 school-going adolescents aged 10 to 19 years participated in this survey. A complex sampling design and multiple logistic regression analysis were applied. Nearly half of the adolescents (49.9%; 95% confidence interval [CI] = 44.9-55.0) who had ever used e-cigarette ceased the usage. Based on multivariate analysis, adolescents were more likely to quit e-cigarette because they could not afford the e-cigarette (adjusted odds ratio [aOR] = 2.39, 95% CI = 1.78-3.20), if they are aged 13 year and older (aOR = 1.80, 95% CI = 1.25-2.61), and those who claimed their e-cigarette does not contain nicotine (aOR = 1.35, 95% CI = 1.03-1.78). E-cigarette prevention efforts among adolescents could consider the cessation factors described in this study.

Background Polysubstance use is defined as the use of more than one non-prescribed licit or illicit substance either concurrently or simultaneously. This study aimed to determine the prevalence of single substance users and polysubstance users and 'their associated factors among adolescents in Malaysia. Methods This study was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2017, a cross-sectional survey conducted among Malaysian school-going adolescents aged 13 to 17. The NHMS utilised a two-stage stratified cluster sampling. Multivariate Multinomial Logistic Regression analysis was applied. Results The overall prevalence of single substance use and polysubstance use among adolescents were 17.2% and 5.1% respectively. The multinomial model showed a higher likelihood of being single or polysubstance user among male (single user OR = 3.0, poly user OR = 4.6), others Bumiputeras vs Malay (single user OR = 1.7, poly user OR = 5.3), those who live with a single parent (single user OR = 1.2, poly user OR = 1.4), involved in truancy (single user OR = 1.7, poly user OR = 3.6) and being bullied (single user OR = 1.3, poly user OR = 3.4), those who had lack of peer support (single user OR = 1.3, poly user OR = 1.4), poor parental bonding (single user OR = 1.4, poly user OR = 1.8), depression (single user OR = 1.4, poly user OR = 3.2) and those who had no close friend (single user OR = 1.3, poly user OR = 2.7). Conclusion Our study highlighted multiple significant associated factors of single and polysubstance use among adolescents in Malaysia. This result can assist in the development of specific intervention and prevention programs targeting high-risk groups.

BACKGROUND & OBJECTIVE: Dyslipidaemia is one of the main modifiable risk factors for cardiovascular disease (CVD). Therefore, it is crucial to examine the prevalence, awareness, treatment and control of hypercholesterolemia and its associated factors among adults in Malaysia.METHODS: We used data from 19,935 respondents aged 18 years and above who responded to the cholesterol module in the National Health and Morbidity Survey (NHMS) 2015. The survey employed a two-stage stratified sampling to select a representative sample of Malaysian adults. Descriptive statistics and multivariate logistic regression were used to analyse the data.RESULTS: The overall prevalence of hypercholesterolemia was 47.7%. Among those who were diagnosed to have hypercholesterolemia, only 19.2% were aware of their hypercholesterolemia status. Only a mere 12.7% (95% CI: 12.4 -13.1) among those who were aware were on treatment and out of which only 53.7% (95% CI: 50.1-57.2) had their cholesterol levels controlled. The prevalence of hypercholesterolemia was associated with gender, age, ethnicity, education level, occupation, marital status, obesity, hypertension and diabetes. Awareness and treatment of hypercholesterolemia saw a similar pattern (except for gender and locality). For control of hypercholesterolemia, the female gender and secondary education levels were the only significant associated factors.CONCLUSION: The overall high prevalence of hypercholesterolemia in addition to poor awareness, treatment and control are significant public health problems. Intensified health campaigns and programmes especially among high-risk groups should be implemented in order to reduce or prevent complications of hypercholesterolemia in the near future.