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The outbreak of pandemic disease is catastrophic and caused negative psychological effects among patients, healthcare workers and their surroundings. This study aims to determine the prevalence of depression and suicidal ideation among stable hospitalized COVID-19 patients. This is a cross-sectional study with web-based online survey involving 401 stable hospitalized COVID-19 patients aged 18 years above who were selected via quota sampling technique. The questionnaire consists of socio-demographic profile, Patient Health Questionnaire 9 items (PHQ-9) and Brief COPE (Coping Orientation to Problems Experienced). The identified probable cases of depression and suicidal ideation were subsequently referred to psychiatrists. The prevalence of depression and suicidal ideation were 7.5% and 4.0% respectively. The prediction model revealed that females [aOR=5.29 (95% CI: 1.34, 20.80)], age 35-49 years old [aOR=7.47 (95% CI: 1.78, 31.30)], adopting behavioral disengagement [aOR=1.94 (95% CI: 1.31, 2.87)] and self-blame [(aOR = 1.74, 95% CI: 1.31, 2.30)] as coping strategies, were significant predictors of depression. The findings estimate mental health burden among COVID-19 patients in Malaysia. The establishment of continuous mental health surveillance is essential in managing cases of depression and suicidal ideation.

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: Human Immunodeficiency Virus (HIV) is a retrovirus that targets the CD4+ of human T-lymphocyte cells of the immune system. The weakening immune system causes susceptibility to multiple infective diseases and cancers. This study is aimed to determinant the knowledge regarding HIV/AIDS and to identify the associated factors of the HIV/AIDS knowledge among the urban and rural Malaysian young people. Methods: Data was collected using Computer Assisted Telephone Interviewing (CATI) method. HIV knowledge was assessed using the UNGASS indicators, which contain five questions on HIV prevention and transmission. There were two questions regarding the association between HIV transmission with sexual practice and behaviour. The remainder was one question, each related to insect bite, meal sharing, and knowledge about the physical appearance of someone with HIV infection. Respondents who correctly answer all five questions were considered to have adequate knowledge about HIV/AIDS. Results: The result from a questionnaire revealed the prevalence of the young people HIV/AIDS knowledge in urban area was 14.7% (95% CI: 9.96, 21.28) whereas in rural area was 10.9% (95% CI: 6.83, 16.89) in 2020. The results revealed significant difference of misconceptions on healthy-looking person have HIV where urban was 71.7% (95% CI: 66.46, 76.37) and rural was 59.8% (95% CI: 56.05, 63.41). Furthermore, there are significant difference of misconceptions on person get HIV by sharing food with someone who is infected where as urban was 64.8% (95% CI: 60.48, 68.98) while rural was 52.6% (95% CI: 48.67, 56.50). Conclusion: The findings from this survey have important implications for the development of primary HIV/AIDS prevention programs and HIV educational campaigns to increase knowledge and dispel misconceptions about HIV.

Introduction: The rapid spread of the COVID-19 worldwide has led the World Health Organization (WHO) to declare COVID-19 outbreak as a pandemic on March 11, 2020. This study aims to determine the factors associated with asymptomatic COVID-19 patients in Petaling District, Selangor, Malaysia. Methods: Data on COVID-19 patients were extracted from the database of confirmed cases in Petaling District Health Office, Selangor, Malaysia from 3rd February 2020 to 30th April 2020. An asymptomatic laboratory-confirmed case is a person infected with COVID-19 who does not develop any symptoms. The study included socio-demographic variables, the detailed information on clinical manifestations and co-morbidity of the patients. Descriptive and multivariable logistic regression analyses were conducted to determine the factors associated with asymptomatic patients. Results: The overall COVID-19 patients in Petaling District were 434. Approximately 70% (N = 292) of the patients were symptomatic while 32.7% (N = 142) were asymptomatic. Multivariable logistic regression analyses revealed that factors significantly associated with asymptomatic patients were age below 40 years old (aOR: 1.79, 95% CI 1.11, 2.86), non-Malaysians (aOR: 3.22, 95% CI 1.44, 7.19) and local cases (aOR: 2.51, 95% CI 1.42, 4.42). Gender, ethnicity, co-morbidity and township were not significantly associated with asymptomatic patients. Conclusion: Approximately one-third of COVID-19 patients were asymptomatic and the risk factors identified were younger age, non-Malaysians and local cases. Rigorous epidemiological investigation and laboratory examinations are helpful in identifying COVID-19 cases among these group of people who are asymptomatic. Keywords: COVID-19 - asymptomatic - pandemic - Malaysia

Introduction: Internet usage has changed the way adolescents socialize. This study aims to determine the determinants of internet addiction among school-going adolescents in Malaysia. Methodology: This study was a cross-sectional study involving 27,455 school-going adolescents from 212 selected schools in Malaysia, as part of the 2017 National Health and Morbidity Survey that implemented a two-stage stratified cluster sampling design. Data collection via a self-administered questionnaire was conducted from March till May 2017. Results: Overall, 8,049 (29.0%) school-going adolescents had internet addiction. Internet addiction was positively associated with male (odds ratio, OR [95% confidence interval, CI] = 1.20 [1.08,1.34]) compared to female, Chinese ethnicity (1.67 [1.12,2.48]) compared to other ethnicity, feeling loneliness (1.37 [1.20,1.57]) compared to never feel lonely, unable to sleep due to worrying of something (1.40 [1.17,1.67]) compared to able to sleep, insufficient parental supervision (1.30 [1.14,1.48]) compared to sufficient parental supervision, depression (1.67 [1.48,1.89]) compared to no depression, anxiety (2.12 [1.95,2.30]) compared to no anxiety and stress (2.26 [1.96,2.61]) compared to no stress. The odds of having internet addiction increase from Form 2 (1.51 [1.28,1.78]), Form 3 (2.37 [2.01,2.80]), Form 4 (2.60 [1.76,3.85]) to Form 5 adolescents (2.96 [1.98,4.41]) compared to Form 1 adolescents. Conclusion: Our results suggest that being a male, of Chinese ethnicity, higher form level, feeling loneliness, unable to sleep due to worrying of something, insufficient parental supervision, depression, anxiety and stress were positively associated with internet addiction among school-going adolescents. Keywords: Internet addiction – public health – adolescents – NHMS - Malaysia

Background Fast-food consumption is an unhealthy dietary behaviour because it increases the risk of diet-related chronic diseases. We aimed to investigate factors associated with fast-food consumption, namely sociodemographic characteristics, body mass index-for-age, meal away from home habit, and intake of various food groups among adolescents in Malaysia. Methods We analysed data from the National School-Based Nutrition Survey (NSNS). The NSNS was a nationwide, cross-sectional survey. Multiple-stage stratified cluster random sampling method was applied to obtain a representative sample of adolescents’ population. This study recruited adolescents aged 10–18 years who were attending schools. Pre-tested self-administered questionnaires in Malay language were used to obtain relevant information. Frequency of fast-food consumption per week was classified into three groups: “consumed fast-food four to seven days”, “consumed fast-food one to three days”, and “did not consume fast-food”. Intake of food groups was assessed by self-administered food frequency questionnaire. Descriptive and complex sample multinomial logistic regression analyses were performed in data analysis. Results A total of 26,383 from 40,012 selected adolescents completed all the relevant questions for this study. Of those surveyed, 13.5% of the respondents consumed fast-food 4 to 7 days, 69.3% of the respondents consumed fast food 1 to 3 days, and 17.2% of them did not consume fast-food in a typical week. Frequency of fast-food consumptions (4 to 7 days and 1 to 3 days per week) was significantly associated with age; sex; ethnicity; locality of schools; frequency of eating out; and not consuming recommended intake of cereals or grains, vegetables, and meat or poultry or eggs. Conclusion In conclusion, age; sex; ethnicity; locality of schools; frequency of eating out per week; imbalanced intake of cereals or grains, meat, or poultry or eggs; and inadequate vegetable intake were significantly associated with fast-food consumption among adolescents in Malaysia. The findings of this study will be useful for policy makers in promoting healthy food choices among adolescents in Malaysia.

Background: A mandatory universal salt iodization (USI) has been implemented in Sarawak, Malaysia since 2008. Objectives: The aim of this study is to assess the current iodine status among school-aged children (SAC) and pregnant women (PW) after 10 years of USI implementation in Sarawak. Methods: This cross-sectional survey among school-aged children and pregnant women was conducted between July and October 2018 in Sarawak. The multistage proportionate to population size sampling technique was used to select 30 schools and 30 maternal and child health care clinics. A total of 1200 children aged 8 to 10 years and 750 first-trimester pregnant women were randomly selected to participate in the study. Iodine excretion level in urine was determined according to the World Health Organization classification. Results: A total of 988 children and 677 PW participated in the study with a response rate of 82.3% and 90.2%, respectively. The overall median urinary iodine concentration (UIC) level among the children was 126.0 μg/L (interquartile range [IQR], 71.0-200.9 μg/L) and classified as adequate iodine status. The median UIC among PW was 123.9 μg/L (IQR, 56.5-192.1μg/L) indicating inadequate iodine status. Conclusion: The present findings indicate that despite adequate iodine status in children, the majority of PW still showed inadequate iodine status. Thus, comprehensive monitoring of the iodine deficiency disorder problem among PW is warranted.

The National Health and Morbidity Survey (NHMS) 2016 was a nationwide cross-sectional survey focusing on maternal and child health. This study aimed to identify the prevalence of, and factors associated with early childhood educational program (ECE) attendance among children aged three to five years in Malaysia. Attendance to ECE has been shown to enhance children’s development, yet there is no national information on ECE attendance in Malaysia, where attendance is not compulsory for children below five years. Parents were interviewed face-to-face utilising a validated questionnaire from the UNICEF Multiple Indicator Cluster Survey using mobile devices. Multivariate logistic regression analysis was performed to identify factors associated with ECE attendance. Half (53.4%) of children aged three to five years in Malaysia attend ECE. Older children aged four to five were six times more likely to attend ECE than children three to four years. Malaysian children of Chinese ethnicity were thrice as likely than ethnic Malays to attend ECE. Children with access to >3 children’s books were twice more likely to attend ECE than those who had access to

In 2016, the Ministry of Health (MOH) Malaysia has introduced a new programme to prevent and reduce the occurrence of non-communicable diseases (NCDs) as well as related risk factors in the work place environment known as KOSPEN Plus. This study aims to evaluate the awareness and perception of KOSPEN Plus programme after 3 years of implementation in MOH health facilities, government and private agencies in Malaysia. A cross sectional study design was employed in the study. All health facilities, government and private agencies which had implemented KOSPEN Plus programme between 2016 and 31 December 2018 in all states in Malaysia were invited to participate in the study. The computer assisted self-interview (CASI) using the pre-tested self-administered questionnaire in the electronic form was used. A total of 362 health facilities, government and private agencies which had implemented KOSPEN Plus programme was involved in this study. Overall, more than 80% of facilities/agencies in this study implemented six out of the eight scopes of KOSPEN Plus. The survey was planned with the goal of obtaining data to support the Ministry of Health in reviewing the present health activities related to workers health in Malaysia and make necessary improvement to the programme.

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

Internet addiction (IA) among adolescents is an issue of growing concern with adverse effects on adolescents&rsquo, health and social functioning. This study aims to determine the prevalence of IA among school-going adolescents in Malaysia and its associated factors&mdash, specifically, lifestyle factors. A nationwide cross-sectional school-based health survey was conducted in 2017 among 27,497 students from 212 randomly selected secondary schools. Information regarding sociodemography, lifestyle, and internet use was obtained using a self-administered questionnaire. IA was measured using the Malay Version of Internet Addiction Test (MVIAT). The prevalence of internet addiction was 29.0%. A multivariable logistic analysis revealed that inadequate fruit and vegetable intakes, consumed carbonated soft drinks at least once a day, consumed fast food at least three days/week, sedentary behavior, current E-cigarette users, and ever/current alcohol drinkers were lifestyle factors significantly associated with IA. Adolescents from urban schools, of higher school grade, and those whose parents are married but living apart were also found to have a greater risk for internet addiction. A positive association was found between IA with unhealthy dietary and lifestyle behaviors among adolescents. The modification of lifestyle factors needs to be considered while developing strategies and interventions for awareness-raising and prevention of IA among adolescents.

IntroductionMental health problem affected 20% of adolescents worldwide, most commonly depression or anxiety . This study aims to compare the prevalence of depression and factors related to depression among adolescents in Malaysia from two surveys. MethodologyA sub-analysis of data from two nationwide surveys using multistage cluster random sampling design was done among secondary school students aged 13-17 years in Malaysia from 234 (NHMS 2012) and 212 (NHMS 2017) randomly selected schools. We used a validated self-administrated bilingual Depression, Anxiety, Stress Scale (DASS-21) questionnaire to evaluate for depression. Descriptive analysis was applied using SPSS. ResultsThe prevalence of depression among adolescents was 17.7% (95% CI:16.71,18.67) in 2012 and slightly increased to 18.3% (95% CI:17.20,19.38) in 2017. The state with the highest prevalence of depression was Sarawak (20.9%) in the NHMS 2012 and Selangor (22.6%) in NHMS 2017. In 2012, the prevalence of depression was higher among females (18.5%) whereas in 2017, the prevalence was higher among males (18.9%). Table 1: Prevalence of Depression among adolescents by Sociodemographic in Malaysia. Discussion 1. The increasing number of ‘ever used drugs’ among adolescents from the two studies supported by Junette & Trishna (2011) found that the risk for depression may also increase by two - to threefold in the presence of comorbidities such as substance abuse and anxiety disorders. 2. This comparison of two studies showed quite similar findings as increasing trend of the prevalence of psychiatric morbidity among adolescents was from 13.0% in NHMS 1996, to 19.4% in 2006 and 20.0% in 2011. 3. A trend study in United States also reported that the prevalence rate of severe adolescent depression varied from 8.7% in 2005 to 11.3% in 2014. The trends remained significant after adjustment for substance use disorders and sociodemographic factors. 4.This comparison also showed the rates of prepubertal depression are similar for boys and girls; however, depression rates double in females after puberty. ConclusionThere was an increase in the prevalence of depression among adolescents in NHMS 2017 compared to the NHMS 2012. Depression remains a problem among adolescents especially those with risky behaviours. Intervention strategies should be targetted on adolescents with risky behaviours and those from broken family.

IntroductionPhysical inactivity was identified as the fourth leading risk factor for worldwide mortality with major implications towards general health including prevalence of noncommunicable diseases (NCDs) such as cardiovascular disease, diabetes, cancer and NCDs risk factor such as raised blood pressure, raised blood sugar and overweight . Monitoring the level of physical inactivity may reduce the disease burden, evaluate the effectiveness of current programme and as a guide for future planning. ObjectiveThis study aimed to determine the prevalence of physical inactivity among adults aged 16 years and above in Malaysia. MethodologyData was obtained from adults aged 16 years (n= 10,767) and above from the National Health and Morbidity Survey (NHMS) 2019, a cross sectional, population-based survey using a two- stage stratified random sampling design. Respondents were interviewed using a short version of International Physical Activity Questionnaire (IPAQ) . An individual with any combination total score of Metabolic Equivalents score (MET-minutes/week) from walking, moderate-intensity physical activity or vigorous-intensity physical activity which is lower than 600 METs minute a week were considered as physically inactive. Data were analysed by complex sampling descriptive analysis using SPSS version 26. Results[Refer to Poster]. ConclusionIt is important to encourage younger generations to be physically active during adolescence and young adulthood, as this may be predictive for their cardiovascular risk profile and lipid related risk later in life. Specific and appropriate intervention programmes towards specific targeted group should be establish to increase the level of physical activity and to promote an active living towards an active and healthy Malaysia as vision in National Strategic Plan for Active Living (NASPAL) 2017 – 2025 &nbsp

IntroductionIn an ageing society, falls is a serious issue that contributes to morbidity and mortality. Additional health problem such as urinary incontinence could further increase risks. Urinary incontinence could present in the form of stress, urge incontinence or mixed. Previous studies have demonstrated the link between urinary incontinence and falls. This sub-study aims to demonstrate the prevalence of falls among older women in Malaysia and its association with urinary incontinence. MethodologyData was obtained from the National Health and Morbidity Survey (NHMS) 2018, a cross-sectional survey focusing on elderly health in the population. Secondary data obtained were for women aged ≧60 years old (n=). Information on socio-demography and falls history were obtained from face-to-face interview. Urinary incontinence was measured using a validated tool, Questionnaire for Urinary Incontinence Diagnosis (QUID) which could assess stress and urge incontinence. Descriptive and logistic regression complex sampling analysis was done using SPSS version 22. ResultsThe prevalence of having at least 1 fall episode in the past 12 months at the date of interview among women aged 60 and above was 14.7% in Malaysia. Those aged >80 years old, from urban area, unemployed and with a spouse have higher prevalence of falls compared to their counterparts. The prevalence of falls among women with urinary incontinence was 24.3%; higher for stress incontinence (33.5%) compared to urge incontinence (20.1%). Older women with urinary incontinence have almost 2 times odds of falling [OR 1.98 (95% CI: 1.3, 3.0). Those with stress incontinence 3 times odds of falling [OR 3.09 (95% CI: 2.0,5.0)] as to urge incontinence [OR 1.48(95% CI: 0.52,4.19)]. Multiple logistic regression revealed that urinary incontinence were positively associated with those who had stress urinary incontinence [aOR 1.51 (95%CI: 1.03,2.04)] Discussion / ConclusionPrevalence of falls increases with age which is consistent with previous studies. The finding that urinary incontinence is associated with falls was similar to studies done in England, Australia, Japan and the United States. This could be due to the need to rush to the bathroom due to incontinence. Another study suggested that the discomfort and anxiety associated with it which could interfere with balance leading to falls. Urinary incontinence should be considered as a risk factor for falls especially in women. Likely due to the small sample size, significant associations when multiple factors were considered were unable to be demonstrated. Further studies should be done in the future with larger sample size to explore the association in order to determine the necessity and suitable early preventive strategies.

Parental protective factors do play an important role in preventing Internet addiction. A self-administered questionnaire was used to measure health risk behaviors among Malaysian adolescents. The prevalence of Internet addiction was significantly higher among adolescents with perceived lack of parental supervision (30.1% [95% confidence interval (CI) = 28.7-31.4]) and lack of parental connectedness (30.1% [95% CI = 28.5-31.7]), compared with their counterparts. Adolescents who perceived a lack of parental supervision, respect for privacy, connectedness, and bonding were more likely to have Internet addiction: (adjusted odds ratio [aOR] = 1.39; 95% CI = 1.27-1.52), (aOR = 1.23; 95% CI = 1.16-1.31), (aOR = 1.09; 95% CI = 1.02-1.16), (aOR = 1.06; 95% CI = 1.00-1.12), respectively. Among girls, Internet addiction was associated with those who perceived lack in all 4 parental factors, while among boys, those who perceived lack of parental supervision and respect for privacy were more prone to Internet addiction.

Previous findings from a state-wide Iodine Deficiency Disorders (IDD) study among pregnant women (PW) in Sarawak indicated that PW are at risk of IDD and further study is needed. This paper describes the methodology used in conducting this study on assessment of risk of iodine deficiency among pregnant women in Sarawak, Malaysia. Thirty maternal child health care clinics (MCHCs) were selected using probability proportional to population size (PPS) sampling technique. The PW sample size was calculated based on 95% confidence interval (CI), relative precision of 5%, design effect of 2, anticipated IDD prevalence of 65.0% and non-response rate of 20%. Thus, the total sample size required was 750 (25 respondents per selected MCHC). The WHO Expanded Programme on Immunization (EPI) surveys approach was used to randomly select the first respondent and subsequent respondents were chosen until the required number of PW was met. The required data were obtained through: face-to-face interviews (socio-demographic and food frequency questionnaire), clinical assessments (thyroid size, and hyper/hypothyroidism) and biochemical analysis (urine and blood serum). A total of 677 PW responded in the study with a response rate of 90.2%. Majority of the PW were at second gravida, aged 25-29 years old and of Malay ethnicity. The methodology used in this study was based on international guidelines which may provide state’s estimates. All the necessary steps were taken into consideration to ensure valid and reliable findings on current iodine status among PW.

Background Globally, diarrhoea is one of the major causes of morbidity and mortality among children under than 5 years of age. There is a scarcity of published data on acute gastroenteritis (AGE) prevalence in Malaysia among children. This study aims to determine factors associated with diarrhoea in children aged less than 5 years in Malaysia. Method Data from the National Health and Morbidity Survey 2016 conducted by Ministry of Health was analysed. This nationwide survey involved 15,188 children below five years old. The survey was carried out using a two-stage stratified sampling design to ensure national representativeness. The Questionnaire from UNICEF’s Multiple Indicator Cluster Survey (MCIS) was adapted to suit local requirements. Analysis was done using SPSS Version 23. Descriptive followed by multiple logistic regression were done to identify relevant factors. Result The prevalence of diarrhoea among children under five in Malaysia was 4.4% (95% CI: 3.8,5.2). Analysis using logistic regression indicated that only ethnicity and usage of untreated water were significantly associated with diarrhoea among children after controlling for relevant factors. By ethnicity, children in the ‘Other Bumiputera’ group had 2.5 times the odds of having diarrhoea compared to children of Malay ethnicity. Children of Indian ethnicity were also at higher risk, at almost double the odds, as well as other ethnic groups (1.5 times). Children who used untreated water supply were two times more likely to develop diarrhoea. Conclusion There is a higher risk of diarrhoea among children of ‘Other Bumiputera’ ethnicity, Indian ethnicities, and other ethnic groups and those who consume untreated water. Strategies to reduce diarrhoea among children should be targeted towards these at-risk populations. In addition, the Government must strive to ensure universal access to treated clean water in Malaysia and the Ministry of Health must focus on raising awareness on how to prevent diarrhoea.