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ObjectiveWe aimed to explore the views of Malaysian children with asthma and their parents to enhance understanding of early influences on development of self-management skills.DesignThis is a qualitative study conducted among children with asthma and their parents. We used purposive sampling and conducted focus groups and interviews using a semi-structured topic guide in the participants’ preferred language. All interviews were audio-recorded, transcribed verbatim, entered into NVivo and analysed using a grounded theory approach.SettingsWe identified children aged 7–12 years with parent-reported, physician-diagnosed asthma from seven suburban primary schools in Malaysia. Focus groups and interviews were conducted either at schools or a health centre.ResultsNinety-nine participants (46 caregivers, 53 children) contributed to 24 focus groups and 6 individual interviews. Children mirrored their parents’ management of asthma but, in parallel, learnt and gained confidence to independently self-manage asthma from their own experiences and self-experimentation. Increasing independence was more apparent in children aged 10 years and above. Cultural norms and beliefs influenced children’s independence to self-manage asthma either directly or indirectly through their social network. External influences, for example, support from school and healthcare, also played a role in the transition.ConclusionChildren learnt the skills to self-manage asthma as early as 7 years old with growing independence from the age of 10 years. Healthcare professionals should use child-centred approach and involve schools to facilitate asthma self-management and support a smooth transition to independent self-management.Trial registration numberMalaysian National Medical Research Register (NMRR-15-1242-26898).

As global trends in Marine Protected Area (MPA) management shift towards participatory co-governance, the importance of effective stakeholder engagement in its implementation stages warrant greater emphasis. This case study highlights key lessons learned from the employment of a mixture of focus group discussions (FGDs), interviews and reconnaissance surveys in a preliminary study-site visit to Tun Mustapha Park (TMP), Sabah, Malaysia, where our research team is undertaking a 4-year research and capacity-building project. We found that trust building, understanding the local culture and politics, and recognition of complex stakeholder dynamics were key elements to successful engagement, while identifying key decision-makers for follow-ups were crucial for on-going engagement. This paper presents insights into the types of information collected by our team, which would be useful among conservation practitioners who will be conducting similar engagement work in the future.

Background: Self-management of asthma improves asthma control and reduces exacerbations. Children are expected to independently self-manage asthma, as they get older. However, the transition from parental to independent self-management among children remains unclear. Aim: To explore the views of children with asthma and their carers regarding self-management of asthma. Methods: We identified children aged 7-12 years, diagnosed with asthma from seven suburban primary schools in Malaysia. We used purposive sampling and conducted focus groups supplemented by interviews using a semi-structured topic guide in participants’ preferred language. All interviews were audio-recorded, transcribed verbatim, entered into NVivo, and analysed using a grounded theory approach. Results: 99 participants (46 caregivers, 53 children: 34 Malays, 45 Indians, 20 Chinese) contributed to 22 focus groups and 7 interviews. Carers’ view and actions emerged as an important influencer. Children mirrored their carers’ actions and views but in parallel learnt from their own experiences, and gained more confidence to independently self-manage. External influences e.g. support from school and healthcare also played a role in the transition. Cultural norms and beliefs influenced children’s independence to self-manage asthma either directly or indirectly through their social network. Conclusion: Children gain skills to independently self-manage asthma based on their experiences and influences of surrounding people. Thus, interventions to improve self-management of childhood asthma should include childrens’ networks and incorporate elements based on good understanding of cultural beliefs in the community. Funding: NIHR RESPIRE

Several of the coastal zones in Sabah, Malaysia, are isolated and inaccessible. This study aimed to review the published literature on the health status of the coastal communities in Sabah. The following four main health issues were found: (i) malaria, (ii) tuberculosis (TB), (iii) seafood poisoning, and (iv) antenatal problems. Factors associated with the risk of acquiring malarial infection in the studied coastal area were advanced age, male sex, farming as an occupation, history of travel outside the village, and rainy seasons. TB infection was primarily observed in adult men. Seafood poisoning was significantly common in Sabah. Studies have reported that tetrodotoxin and paralytic shellfish poisoning were commonly reported (30–60 cases annually). Several pregnant women in the coastal community had insufficient knowledge of the national antenatal care programme. Nonetheless, 99% of them received antenatal care at public healthcare facilities with 92% of them undergoing safe delivery. Nevertheless, a majority of the pregnant women had iodine deficiency due to low iodised salt intake. Findings from this review highlighted that the coastal communities in Sabah are experiencing significant health problems. Specific attention is required to significantly enhance the health and well-being of the individuals living in the coastal communities in Sabah.

Complementary and alternative medicine (CAM) is widely used especially in Asia including for childhood asthma. The use of CAM could influence adherence to evidence-based (E-B) medicine. We explored the views of carers of Malaysian children with asthma regarding the use of CAM for childhood asthma, and its relationship with self-reported adherence to E-B medicine. We used a screening questionnaire to identify children diagnosed with asthma from seven suburban primary schools in Malaysia. Informed consent was obtained prior to the interviews. We conducted the interviews using a semi-structured topic guide in participants’ preferred language (Malay, Mandarin, or Tamil). All interviews were audio-recorded, transcribed verbatim and coded using Nvivo. Analysis was performed thematically, informed by the Necessity-Concerns Framework. A total of 46 carers (16 Malays, 21 Indians, 9 Chinese) contributed to 12 focus groups and one individual interview. We categorised participants’ as ‘Non-CAM’; ‘CAM’; or ‘combination’ user. Cultural practices and beliefs in the efficacy of CAM resulted in widespread use of CAM. Most carers used CAM as ‘complementary’ to E-B medicine. Concerns about dependence on or side effects of E-B treatment influenced carers’ decisions to rely on CAM as an ‘alternative’, with an important minority of accounts describing potentially harmful CAM-use. Healthcare professionals should discuss beliefs about the necessity for and concerns about use of both E-B medicine and CAM, and provide balanced information about effectiveness and safety. The aim is to improve adherence to regular E-B preventer medication and prevent delays in seeking medical advice and harmful practices associated with CAM.