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Introduction: Cardiovascular disease and osteoporosis (OP) have been shown to have similar risk factors but studies have demonstrated contradictory results with regards to their associations. This study evaluated relationships between bone characteristics and cardiovascular risk factors among adults in selected urban areas in Malaysia. Methods: A cross-sectional study was performed involving 331 subjects between 45-90 years recruited at a health screening programme. Sociodemographic and clinical characteristics were recorded. Biochemical analyses on fasting blood samples and dual energy X-ray absorptiometry scan to determine bone mineral density (BMD) were performed. Results: Increased waist circumference (WC) was protective for abnormal BMD status (osteopenia and OP). Males with increased high-density lipoprotein cholesterol (HDL) were more likely to be osteoporotic. WC, fasting blood glucose (FBG) and triglyceride (TG) were positively associated with BMD at all sites but was gender specific. In contrast, WC was negatively associated with trabecular bone score (TBS) for females but this association became attenuated when adjusted for fat percentage. HDL and MetS were negatively and positively associated with BMD, respectively in males. Conclusion: The cardiovascular risk factors of raised WC, FBG, TG and low HDL were significantly associated with increased BMD with skeletal site and gender specific differences after adjusting for confounders. However, a higher WC was associated with a weaker skeletal microstructure reflected by lower TBS in females driven by fat percentage. A higher BMD was demonstrated among MetS individuals. These findings suggest that adiposity may have a protective effect on BMD.

Home birth is a widely practised norm among women in most developing countries. Studies continue to evaluate the safety of planned home birth (PHB) for low-risk women in high-income countries. However, such studies are scarce in Africa and other developing countries. The study examined PHB as a safe alternative to planned hospital birth for low-risk women. An electronic search was carried out on databases such as Medline database, Cochrane, Google Scholar, PubMed, and CINAHL to identify studies published in English from January 2007 to December 2017. A Meta-analytic study, systematic reviews, and observational (prospective and retrospective) studies were included in the literature reviews. The studies were analyzed using descriptive and narrative synthesis. The strength and or limitations of each study were assessed. Sixteen eligible articles were finally reviewed. PHB is equally safe in terms of complication (especially postpartum haemorrhage) compared to planned hospital birth. PHB would have a similar outcome in reducing maternal death for low-risk women if compared with planned hospital birth. Although neonatal asphyxia is mixed across studies, PHB is associated with a similarly low rate of neonatal intensive care unit admission. It was also indicated that there was no increase in neonatal mortality for PHB, especially for parous women. PHB compared to the hospital is associated with a similar low risk of maternal complications, maternal deaths, newborn complications, and newborn deaths, especially for parous women. Therefore, PHB is a safe alternative to hospital birth for low-risk women. While studies that are more recent are required to evaluate its feasibility and safety in developing countries, PHB (if properly attended) may reduce maternal and newborn complications and death associated with unplanned home births.

Disaster preparedness is an issue that receives little attention in the community. Communities must take preventative measures to overcome obstacles and improve community preparedness. This review identifies the optimal dose of disaster preparedness intervention in the community. A systematic literature search was conducted to examine a study about the optimal dose of disaster preparedness intervention developed for implementation at a community level. A scoping review based on the PRISMA diagram was conducted from four databases. A combination of keywords was adapted for each database. Inclusion and exclusion criteria were applied. A total of eight articles were synthesized based on the intervention dose of disaster preparedness among community interventions. The summarized studies provided evidence that the optimal dose for disaster preparedness intervention in the community can be prevented with an educational intervention program with a minimal dosage of intervention. The Health Belief Model Theory was the most often cited theory by researchers. The best dose for disaster preparedness intervention in a community can be mitigated with a single dose of education. Nonetheless, we cannot disregard alternative disaster preparedness theories because each has its advantages and disadvantages.

Background: Childhood immunisation coverage is very low in Nigeria (31%) with Zamfara State being amongst the states with the poorest coverage (<10%). Lack of maternal knowledge, attitude, outcome expectations, self-efficacy, cultural beliefs and assumptions of religious regulations of antenatal mothers towards childhood immunisation are the contributory factors to poor childhood immunisation uptake. This study aims is to develop, implement and evaluate the effects of an immunisation health educational intervention with application of Social Cognitive Theory on pregnant women to improve knowledge, attitude, outcome expectations, self-efficacy, cultural beliefs and assumptions on religious regulations regarding childhood immunization uptake in Federal Medical Centre Gusau, Zamfara State, Nigeria. Methodology: The study will be a single-blind parallel-group randomised controlled trial, where baseline data will be collected from 392 estimated antenatal mothers, after that they will be evenly randomised using randomly generated permuted block sizes (each containing two intervention and two control assignments). The study participants will be antenatal mothers of ages 18 years and above who are in third trimesters and attending Federal Medical Centre Gusau, Zamfara State, Nigeria; during the study period and fulfilled all the inclusion and exclusion criteria. The intervention group will undergo five-health education sessions on immunisation, which will be strictly guided by Social Cognitive Theory-based intervention module: while the control group will receive usual care (standard care). Follow-up data will be collected using the same questionnaire at 6-weeks post-delivery, 10-weeks post-delivery and 14-weeks post-delivery. The generalized linear mixed model will be carried-out to determine the overall effect of the intervention after controlling for 14 potential confounding variables. An intention to treat analysis will also be carried-out. Childhood immunisation uptake

Objective: To examine the effectiveness and safety of non-pharmacological interventions to reduce bone loss among post-stroke adult patients. Data sources: Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database for Systematic Reviews, MEDLINE, CINAHL, ScienceDirect, Scopus, PubMed and PeDRO databases were searched from inception up to 31st August 2021. Methods: A systematic review of randomized controlled trials, experimental studies without randomization and prospective cohort studies with concurrent control of non-pharmacological interventions for adult stroke patients compared with placebo or other stroke care. The review outcomes were bone loss, fall and fracture. The Cochrane Risk of Bias Tools were used to assess methodological quality, and Grading of Recommendations, Assessment, Development and Evaluations Framework to assess outcome quality. Synthesis Without Meta-Analysis (SWiM) was used for result synthesis. Results: Seven studies (n = 453) were included. The methodological and outcome qualities varied from low to moderate. There were statistically significant changes between the intervention and parallel/placebo group in bone mineral density, bone mineral content, cortical thickness and bone turnover markers with specific physical and vibration therapies (p<0.05). Falls were higher in the intervention group, but no fracture was reported. Conclusion: There was low to moderate evidence that physical and vibration therapies significantly reduced bone loss in post-stroke patients at the expense of a higher falls rate. The sample size was small, and the interventions were highly heterogeneous with different duration, intensities and frequencies. Despite osteoporosis occurring with ageing and accelerated by stroke, there were no studies on vitamin D or protein supplementation to curb the ongoing loss. Effective, high-quality non-pharmacological intervention to improve post-stroke bone health is required.

Coronavirus disease 2019 (COVID-19) deaths can occur in hospitals or otherwise. In Malaysia, COVID-19 deaths occurring outside of the hospital and subsequently brought to the hospital are known as brought-in-dead (BID) cases. To date, the characteristics of BID COVID-19 cases in Malaysia are not clear. The objectives of this study are 2-fold: to explore the characteristics of 29,155 mortality cases in Malaysia and determine the factors associated with the high probability of BID, using the multilevel logistic regression model. Data on COVID-19 mortality cases from the entire country between March 17, 2020 and November 3, 2021 were retrieved from a national open data source. Of the 29,155 COVID-19 mortality cases, 5,903 (20.2%) were BID. A higher probability of BID (p < 0.05) was seen among individuals aged between 18 and 59 years, non-Malaysians, had no comorbidities, did not receive COVID-19 vaccination, and the interval between the date of death and diagnosis. A high prevalence of BID is an alarming public health issue, as this may signal health system failure at one or several levels and, hence, need urgent attention from relevant stakeholders. Based on the findings of this study, increasing the intensity of the vaccination campaign, addressing any issues faced by noncitizens about to COVID-19 management in- and out-of-hospital, increasing the awareness of signs and symptoms of worsening COVID-19 and, hence, the significance of self-monitoring, and determining the potential gaps in the health system may contribute to their increased risk of deaths.

Introduction: Over the last decade, tuberculosis (TB) has remained the main cause of death from communicable diseases in Malaysia. This study was aimed to determine the risk factors of unfavourable treatment outcomes (UTO) among new TB cases in Hulu Langat. Methods: A cohort study was prospectively conducted among the new TB cases registered in the government health clinics of Hulu Langat district. The event was defined as any one of the UTO (default, transferred out, treatment failure and death) whichever came first. This data was analysed using SPSS version 25.0. Survival pattern was assessed by Kaplan-Meier plots and Log rank test. Hazard ratios of unfavourable TB treatment outcomes among the new TB cases at 95% confidence interval and level of significance set at 0.05 were calculated using Cox proportional hazard model. Results: Of the 321 patients analysed, 80.4% (n=258) had favourable treatment outcomes and 19.6% (n=63) had UTO with 10.9% (n=35) transferred out, 6.9% (n=22) defaulted and 1.9% (n=6) died. There was no treatment failure. The mean survival time was 5.2 (SD=0.09) months. The risk factors of hazard probability of UTO were male, ethnicity type Others, positive human immunodeficiency virus (HIV) status and not done sputum at 2 months of treatment. Conclusion: Transferred out and default formed the bulk of the UTO in Hulu Langat. New interventions to improve the existing TB prevention and control program should be planned in the first three months of treatment.

Introduction: Dog bite is a global public health concern because it is the main risk factor for human rabies and it particularly affects children. In Nigeria, most dog bites are from stray dogs and their vaccination status remains unknown. Thus, this study aimed to investigate the prevalence and associated factors of dog bite among public primary school children in Madawaki district Gusau, Nigeria. Methods: A cross-sectional study was conducted using an unequal stratified sampling technique among 999 children aged 11 to 13-year-old at seven public primary schools from September 2017 to January 2020. A self-reported history of dog bites, socio-demographic characteristics, knowledge on interaction with dogs, knowledge on the implication of dog bites, risk behaviours of children and dog ownership were collected using a validated questionnaire. Results: The prevalence of dog bites was 54.5%. The predictors of dog bite among the children were being a male (Adjusted Odds Ratio; AOR = 2.252; Confidence Interval; CI = 1.719, 2.949), dog ownership by respondent’s family (AOR = 1.456; Cl = 1.089, 1.946), dog ownership by neighbours of the respondents (AOR = 1.752; Cl =1.334, 2.303), total score for knowledge on interaction with dogs (AOR = 0.884; Cl = 0.858, 0.911), and total score for risk behaviours of children (AOR = 1.020; Cl =1.004, 1.035). Conclusion: Poor knowledge on interaction with dogs, children’s risk behaviours around dogs, dog ownership and being male were the factors associated with a high prevalence of dog bite among primary school children from this study. These factors should be considered in order to develop an effective awareness campaign in schools to reduce the prevalence of dog bites among children.

Objective: This study aimed to determine the prevalence of vertebral fractures (VF) in a selected urban population in Malaysia and to explore possible variables associated with VF in the study population. Methods: A cross-sectional study involving community-living, healthy subjects aged between 45–90 years from the state of Selangor, Malaysia, were invited to attend a bone health check-up. Subjects with diseases known to affect bone metabolism or were on treatment for osteoporosis (OP) were excluded. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DXA). Lateral and antero-posterior view lumbar spine x-rays were performed and VF was determined by the semi-quantitative Genant method. Results: A total of 386 subjects were studied. Asymptomatic morphometric VF were found in 44 (11.4%) subjects. T12 was the most common vertebrae to be fractured. The prevalence of VF was significantly higher in menopausal women (12.4%) compared to non-menopausal women, in those above the age of 60 (18.5%), in those of Chinese ethnicity (16.5%), in those with a low body fat percentage (17.1%) and among those with OP (27.0%). The mean (standard deviation) 25-hydroxyvitamin D [25(OH)D] levels were significantly higher in those with VF compared to those without VF, 67.64 (23.50) and 57.47 (21.71) nmol/L, respectively. However, after multiple regression analysis, age over 60 years and OP on DXA BMD measurement were the only significant associated factors for VF. Conclusion: Overall, 11.4% of a selected Malaysian urban population had asymptomatic morphometric VF. Age over 60 years and OP on DXA BMD measurement, but not 25(OH)D levels, were associated with VF.

Objective: To determine the level of dengue prevention practices among wet market traders in a Malaysian district and their associated socio-ecological factors including individual, relationships, community and societal factors. Methods: A cross-sectional study involving 246 wet market traders was conducted in a district in Perak state in northwest Malaysia between September 2018 to June 2019. Participants were selected through stratified sampling from four wet markets in Hilir Perak district. Data on dengue prevention practices and associated socioecological characteristics were collected using a validated interviewbased questionnaire. The data were analyzed using SPSS version 25. Multiple logistic regression was performed to identify socioecological determinants of dengue prevention practices among wet market traders in Hilir Perak District. Results: From the total number of respondents, 78% had high dengue prevention practices. Higher dengue prevention practices were associated with owners of wet market shoplots compared to employed workers (adjusted OR 4.18, 95% CI 1.78, 9.85), high perceived susceptibility (adjusted OR 6.93, 95% CI 3.02, 15.92), high familial support (adjusted OR 3.65, 95% CI 1.25, 10.64), and high perceived dengue prevention and control laws and regulations (adjusted OR 3.24, 95% CI 1.44, 7.32). Conclusions: Dengue prevention practices were associated not only with individual determinants but also with other determinants fromrelationships to societal level which must be considered in planning or evaluating current dengue control programs.

Introduction: Hedgehog (HH) pathway is an important signalling cascade for growth and patterning during embryonic development. Constitutive activation of Hedgehog pathway can be found in various types of malignancies including medulloblastoma, basal cell carcinoma, gastrointestinal, breast, pancreatic, prostate cancer and leukaemia. Little is known about the expression and role of Hedgehog signalling in bladder cancer. Materials and methods: The purpose of this study was to investigate the immunohistochemical expression of SMO in 112 bladder cancer cases and determine their association with demographic and clinicopathological parameters. Bladder cancer tissues were obtained from the Hospital Kuala Lumpur. Results: SMO was expressed in the cytoplasm of all cases of bladder cancer. 6 cases (5.4%) showed low expression, while 106 cases (94.6%) showed high expression. Positive expression of SMO protein was correlated with a few variables which include grade and stage of tumour, lymph node metastasis and distant metastasis. SMO expression showed statistically significant association with higher grade (p=0.001) and higher stage (p=0.042) of bladder cancer. SMO expression also showed borderline association with lymph node metastasis (p=0.056). Conclusion: These findings indicate that SMO expression may be a poor prognostic marker in bladder cancer.

We developed and psychometrically tested a Theory of Planned Behavior (TPB) questionnaire which focused on assessing the midwives’ intention to provide planned home birth (PHB) services. This is a quantitative, cross-sectional survey, conducted among 226 midwives working in ten participating health facilities. The reliability and validity of the theoretical constructs were assessed. The Cronbach’s alpha values were >0.8 for all scales, suggesting satisfactory internal consistency. Confirmatory factor analysis revealed sufficient convergent validity (the average variance extracted was >0.5 for each construct) and discriminant validity. The study gathered an evidence of the usefulness of TPB in the specific context of PHB.

Background: Studies on uptake of first dose of intermittent preventive treatment in pregnancy (IPTp) are lacking, despite it being a predictor of subsequent doses. This study aimed at assessing the determinants of uptake of first dose of IPTp among pregnant women at the State Specialist Hospital, Maiduguri. Methods: A cross-sectional study was conducted, in which respondents were selected using a systematic random sampling method, and structured questionnaires were used to obtain information from them. Chi-squared test was used to determine factors associated with uptake of first IPTp dose, while a further multivariate logistic regression was performed to determine its predictors. Results: Three hundred and eighty respondents answered the survey, whose ages ranged from 15 to 45 years, and 86.8% were multigravid. Sixty five percent of them were aware of IPTp, and 34.7% believed that IPTp could be harmful to their pregnancies. Over a half of the respondents (52.9%) believed that taking all their IPTp medicines was very good for their pregnancies, while 45.0% felt that taking their IPTp medicines was very pleasant. Only two respondents (0.5%) stated that it was very untrue that their significant others thought that they should take all their IPTp medicines. Half of the respondents said it was very easy for them to take all their IPTp medicines even if they were experiencing mild discomforts while taking them. Less than a half (42.37%) had received their first dose of IPTp. In bivariate as well as multivariate analysis, only higher level of knowledge was significantly associated with uptake of first IPTp dose. Those with better knowledge of IPTp were about twice more likely to have taken their first dose of IPTp, compared to those with lower knowledge of IPTp (AOR = 1.85; 95% CI: 1.17–2.92). Conclusions: Knowledge of IPTp as well as its uptake, were sub-optimal in this study. Since knowledge of IPTp significantly predicts uptake of the first dose of IPTp, there is the n

Introduction: Tuberculosis (TB) is a major global concern as it continues to kill million people annually despite the availability of effective treatment. One of the social factors affecting the spread of tuberculosis is urbanization. Tuberculosis remains as the leading cause of death from communicable diseases in Malaysia for more than a decade. Geographic information system (GIS) has been used to understand the epidemiology of infectious diseases, to identify hot spots/ clusters of areas/ populations at high risk. The aim of this study was to determine the correlation between urbanization and TB in the Peninsular of Malaysia during 2011-2015 and develop TB incidence risk map using GIS. Methods: A cross-sectional study was conducted using TB cases data on tuberculosis incidence, tuberculosis deaths, urban population, population and population density from the Ministry of Health, Malaysia for the period 2011 to 2015. This data was analysed using SPSS version 23.0 and Arc GIS. Results: The number of TB cases and urbanization varied in the Peninsular. There was a statistically significant strong positive correlation between the number of TB cases and urban population (r=.884,p<.001). The highest mean of TB cases was recorded in Selangor (3922) while the lowest mean was in Perlis (146). Selangor state was noted to have the highest number of urban population and TB cases. Conclusion: The areas with higher urban population are at a higher risk of TB compared to those with low urban population.

This book provides details on what constitutes an ideal planned home birth practice among midwives and maternity providers—during antenatal, intrapartum, and postpartum. One unique feature of this book is that we included clinical vignettes in each session to facilitate active learning and experience sharing regarding planned home birth practice among midwives. We believe that this book will be useful to midwives, maternity care providers, and educators in teaching the planned home birth practice.

Introduction: Despite advancement of treatment modalities, Tuberculosis (TB) treatment interruption rate has globally accelerating, calling for greater framework shifting towards psychosocial intervention. Similarly, Selangor state had reported the perturbing TB treatment interruption rate, which was figured persistently above 10% in the interval year of 2014 to 2018, thus signifies an empirical assessment on Information-Motivation-Behavioural skills (IMB) determinants of TB intensive phase treatment. This study aims to determine the time to intensive phase TB treatment interruption and its prognostic factors among newly diagnosed pulmonary Tuberculosis (PTB) smear positive patients in urban district Selangor. Methods: A multi-centric prospective cohort study will recruit 695 newly diagnosed PTB smear positive patients at treatment centres in urban districts, Selangor. This study will utilize validated self-administered questionnaire and standardised data collection form (PROFORMA). At baseline, we will elicit information on IMB models constructs, additionally on socio-demographics, health service factors and clinical characteristics. Meanwhile, four points follow up will be executed to retrieve information on treatment status and time varying effects of body weight, treatment side effects, symptoms improvement and internalised stigma. Finally, survival analysis will be computed to identify the time to intensive phase treatment interruption and its prognostic factors. Conclusion: This study will enlighten IMB model determinants of intensive phase treatment interruption, hence to endeavour psychosocial elements in designing time relevant public health strategies in TB case management.

Objective: Planned home birth may increase women’s access to skilled midwives in all settings. Using theory to understand and predict midwives’ intention regarding planned home birth services is rare. Therefore, using the theory of planned behaviour, we determined the factors associated with midwives’ intention to provide planned home birth services to low-risk women. Design: This cross-sectional study adopted a quantitative approach and a survey. Stratified random sam- pling was used to recruit 226 midwives in Sokoto, Nigeria. Data—including descriptive statistic and mul- tiple linear regression analyses—were analysed using SPSS 23 and significant was set at 0.05. Setting: Ten public health facilities in Sokoto, northwestern Nigeria. Participants: Among all 460 midwives (women aged 20–60 years), working in the maternity wards of health facilities in Sokoto, a sample of 226 midwives was calculated using a power of 0.80 and a 95% confidence interval. Findings: The multiple linear regression analyses confirmed that the major factors associated with mid- wives’ intention to provide planned home birth services were midwives’ attitude towards planned home birth (p < .001) and midwives’ previous experience with planned home birth practice (p = .008). Conclusions and implications: The theory of planned behaviour is a useful framework for identifying fac- tors that affect midwives’ intention to provide planned home birth services. While future research may employ a qualitative approach to explore other factors, planned home birth education campaigns should target information that enhances positive attitude and encourages midwives to provide planned home birth services.

The global Tuberculosis epidemic (TB) poses a significant public health threat. While the consequences of TB treatment interruption are indisputable, the knowledge about the timing and prognostic factors of TB treatment interruption is fundamental. Despite a considerable amount of evaluation, the timing and prognostic factors of TB treatment interruption have been inconsistently identified from one study to another. Therefore, this study aimed to examine the evidence obtained from published literature on the timing and prognostic factors of TB treatment interruption at different points of the treatment course. In this review, three databases namely Pubmed, Scopus, and Science Direct were used to identify articles published from January 2003 to February 2018. This was based on the inclusion criteria and keywords including ‘default’, ‘survival time’, ‘tuberculosis’, and ‘treatment interruption’. The nine selected studies were prospective and retrospective cohort studies conducted in developing countries. The diversity of the study’s participants and TB treatment interruption definition were allowed, thus delineating a heterogeneous finding. This review suggests that the interruption predominantly occurred during the maintenance phase of treatment course. Despite the finding, a considerable gap in understanding the prognostic factors at different time points of TB treatment interruption was elicited. The heterogeneity across the studies may limit the inferences and warrant further evaluation. In essence,the time-related information should be integrated into framing impactful public health strategy, while a vigorous attempt on the evaluation of the cognitive, behavioural and psychosocial aspects may be beneficial.

Hepatitis C infection is a global public health problem. This study was designed to identify the risk factors associated with hepatitis C infection among adult patients in Kedah state, Malaysia. A matched, hospital-based, case–control study was conducted at a tertiary hospital. Cases were adult (aged ≥ 18 years) patients with positive serology test results for hepatitis C virus antibody and detectable hepatitis C virus RNA from January 2015 to December 2018, and controls were age-, sex- and ethnicity-matched patients who were not infected with hepatitis C virus. Self-administered questionnaires were used to collect data on demographic characteristics and previous exposure to selected risk factors among the study participants. Associations between hepatitis C and demographic and risk factors were assessed using univariable and multivariable logistic regression analyses. A total of 255 case–control patient pairs were enrolled. The multivariable analysis indicated that having a history of blood or blood product transfusion before 1992 (adjusted odds ratio [AOR] = 6.99, 95% confidence interval [CI]: 3.73–13.81), injection drug use (AOR = 6.60, 95% CI: 3.66–12.43), imprisonment (AOR = 4.58, 95% CI: 1.62–16.40), tattooing (AOR = 3.73, 95% CI: 1.37–12.00), having more than one sexual partner (AOR = 2.06, 95% CI: 1.16–3.69), piercing (AOR = 1.71, 95% CI: 1.04–2.80), and having only secondary education (AOR = 1.92, 95% CI: 1.06–3.57) were independently associated with hepatitis C. No associations were found between health care occupation, needle-prick injury, surgical procedures, haemodialysis, acupuncture, cupping, or contact sports and hepatitis C infection. These findings demonstrate that hepatitis C risk is multifactorial. Having a history of blood or blood product transfusion before 1992, injection drug use, imprisonment, tattooing, having more than one sexual partner, piercing, and having only secondary education were associated with increased odds of hepatitis C.

Background: Health-related quality of life (HRQoL) is an important clinical outcome assessment in hypertension management, given the lifelong (chronicity) nature and the need for daily self-management for hypertensive patents. Of some of the studies that implemented home-based interventions on hypertension globally, the HRQoL is rarely used as a primary outcome measure. This study developed, implemented, and assessed the impact of home-based follow-up care (HBFC) on HRQoL of hypertensive patients attending outpatients' clinics in Ilorin, Nigeria. Materials and methods: A total of 149 and 150 patients were randomized to intervention and usual care (control) groups, respectively. A 12-month task-shifting (nurse-driven) HBFC intervention was administered to intervention group. The mid-term impact of intervention on HRQoL was assessed after 6 months intervention. Data were analyzed with intention-to-treat principle. Treatment effects were measured with the t-tests, analysis of covariance, and multivariate analysis of covariance analysis. Significant levels were set at P < 0.05 and 95% confidence interval. Results: The between-group treatment effect was not statistically significant (P > 0.05), whereas the within-group treatment effects were statistically significant for both the intervention and control arms (P < 0.05) at 6 months. After controlling for age and baseline HRQoL, the intervention group had an improved physical component of HRQoL than the control group. The intervention group also had statistically significant improvement in blood pressure control, medication adherence, and symptom counts (P < 0.05). Conclusion: The HBFC intervention for hypertensive patients impacted positively on physical component of HRQoL after controlling for baseline HRQoL and age of the patients at 6 months post-intervention.

Background: Diabetes education and self-care are the cornerstones of diabetes management. There are few nurse-led structured diabetes management programs available in Iran.Objectives: This paper aims to develop and validate a nurse-led diabetes self-management intervention for patients with type 2 diabetes. Method: The theoretical framework underpinning the intervention was the Bandura’s selfefficacy theory. The seven basic steps of the Taba model were used to develop and validate the study intervention. Results: The preliminary results from this study suggest that the study intervention was carefully contextualized and linked to the existing diabetes care. Overall, the intervention was very well received and appreciated by the respondents.Conclusion: This was the first known validated nurse-led diabetes self-management intervention available in the Persian Language.

Background: The levels of insecticide-treated net use among pregnant women and uptake of intermittent preventive treatment in pregnancy, have been sub-optimal in Nigeria. Previous studies have reported positive correlations between knowledge, attitude and practice of malaria preventive measures. It has also been reported that information and motivation, act through a mediator (behavioural skills), to cause a health behaviour change. The aim of this study was as such to develop, implement, and assess the effects of a health educational intervention based on the information–motivation–behavioural skills (IMB) model on the levels of knowledge, motivation, and behavioural skills for ITN use and IPTp uptake among pregnant women in a hospital in north-eastern Nigeria. Methods: This was a randomized controlled parallel-group trial in which 372 antenatal care attendees were randomly assigned to either an intervention or control group after collecting baseline data using a structured questionnaire. The intervention group received a 4-h health education on malaria, guided by a module developed based on the IMB theory, while the control group received health education on breastfeeding for a similar duration and by the same facilitator. Follow-up data were subsequently collected at 2 months and at 4 months post-intervention using the same questionnaire. The generalized linear mixed models analysis was used to determine the between-group and within-group effects of the intervention. The intention-to-treat analysis was used after missing data had been replaced. This was followed by a sensitivity analysis, where the analyses were repeated without replacing the missing values. Results: The intervention was significant in achieving a 12.75% (p < 0.001), 8.55% (p < 0.001), and 6.350% (p < 0.001) higher total knowledge, motivation, and behavioural skills scores respectively, for the intervention group over the control group. The sensitivity analysis revealed no great differences in th

Background: Health care worker are susceptible to develop musculoskeletal disorder (MSD). Nurses in nursing home setting exposed with physical and psychological stressors and they are prone to develop MSD due to these conditions (Simon et al., 2008). Manual handling while handling elderly patient involved awkward posture which lead to MSD among nurses. Therefore safe patient handling intervention is important in reducing prevalence of MSD among nurses. Materials and Methods: The cluster pre-test and post-test with control group quasi experimental study will be done involving 8 government elderly care homes in West Coast Malaysia. Total 256 nurses and assistant nurses will be involved in this study. Four home care will be in the intervention group. While another 4 home care will be in the control group. Safe patient handling intervention program will be conducted. During health education, health belief model theory will be used to increase the knowledge and subsequently change the practice to safe patient handling. Result: Prior to intervention program, module intervention and health education material will be developed. The health education and training will be given according to module provided. Outcome measurements are musculoskeletal disorder, knowledge and practice of safe patient handling. These outcomes will be measured through self- administered questionnaires. Data will be analysed using SPSS version 22. To measure the association, Chi-square test, Mann Whitney U test, independent t test, dependent t test and Wilcoxon signed rank test will be used and for multivariate analysis, the Generalized Estimating Equation (GEE) will be used. Conclusion: Health education on safe patient handling is important in order to reduce the MSD among nurses in elderly care homes.