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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

Aims: Children below five years have been the target of screen time guidelines. The adverse health outcomes associated with it require focusing on prime strategies for reducing screen time. The current study reviews parental intervention strategies to reduce screen time among preschool-aged children. Design: Systematic review. Data sources: A total of five databases of the Cochrane register of controlled trials, CINAHL, Medline PubMed, and Scopus databases were searched from May 1 to 31, 2020. Review Methods: The keywords of “screen time”, “television”, “video”, “computer”, “mobile device”, “hand phone”, “media use”, “preschool-aged children”, “interventions”, and “strategies” used for search. The inclusion criteria are limited to specific study populations, intervention, comparison and outcomes (PICOs), language, and published study types. The quality of articles was assessed using the Cochrane Risk of Bias (RoB) tool. Results: A total of six studies that met the inclusion criteria were further analysed. It showed that besides providing knowledge and awareness regarding screen time, restrictive practices, offering alternative activities to parents and removing the screen from the child’s bedroom were the most common strategies used by successful studies. The duration of intervention between 6-8weeks was sufficient to observe screen time reduction, while faceto-face methods dominated the mode of delivery. Increasing parental self-efficacy, listing outcome expectations, and reinforcement strategies targeting both the parents and their home environment were beneficial in reducing screen time. Conclusion: Future screen time reduction studies could benefit from incorporating the above approaches for screen time reduction intervention among preschool children.

Introduction: Men who have sex with men (MSM) living with HIV are more likely to be depressed than MSM without HIV. The AIDS epidemic will not end if the needs of people living with HIV and the determinants of health are not being addressed. Compared to HIV individuals without depression, depressed HIV individuals have worse clinical outcomes and higher mortality risk. Depression is caused by a complex combination of social, psychological, and biological variables. This systematic review, thereby motivated by the need to address this gap in the literature, aims to articulate determinants of depression among MSM living with HIV according to the biopsychosocial approach. Methodology;We systematically searched four databases from 2011 to 2021. We searched for observational studies on determinants of depression among MSM living with HIV. The outcome is depression based on the categorical or numerical outcome. Two reviewers independently extracted data and assessed study risks of bias. Any disagreements are consulted with the third reviewer. Results: We identified 533 articles, of which only eight studies are included. A total of 3,172 MSMs are included in the studies. We found the determinants of depression and categorized them according to biological, psychological, and social approaches. Conclusion: The determinants of depression with the strongest evidence across studies were enacted HIV-related stigma, unemployment, sleep disturbance, current smoker, black ethnicity, born overseas, ART initiation, and access to mental health care. Despite weaker evidence, the other relevant determinants to be included were older age, internalized stigma, self-efficacy, and social support. Efforts to improve or prevent depression among MSM living with HIV could benefit from addressing the determinants of depression based on the biopsychosocial approach immediately after HIV diagnosis. Integrating mental health screening and care into HIV treatment settings would strengthen HIV preven

Determining the level of customer satisfaction in cleanliness regarding a product or service is a significant aspect of businesses. However, the availability of feedback tools for consumers to evaluate the cleanliness of a restaurant is a crucial issue as several aspects of cleanliness need to be evaluated collectively. To overcome this issue, this study designed a survey instrument based on the standard form used for grading the food premises and transformed it into a seven Likert scale questionnaire and consists of seven questions. This study employed fuzzy conjoint analysis to measure the level of satisfaction in cleanliness in food premises. This pilot study recruited 30 students in Universiti Teknologi MARA (UiTM) Seremban 3. The student’s perception was represented by the scores calculated based on their degree of similarities and corresponding levels of satisfaction, whereby, only scores with the highest degree of similarity were selected. Furthermore, this study identified the aspects of hygiene that assessed based on the customers’ satisfaction upon visiting the premises. The results indicated that the fuzzy conjoint analysis produced a similar outcome as the statistical mean, thus, was useful for the evaluation of customer satisfaction on the cleanliness of food premises.

Background: Previous research has documented the benefits of physical activity (PA) for cancer survivors which include improved quality of life, physical, physiological, emotional and social functioning, reduced relapse of cancer and the mitigation of cancer mortality. This study aims to evaluate the effects of an independent PA programme based on PA level, quality of life, self-efficacy, outcome expectations, reinforcement, behavioural capability and observational learning amongst registered National Cancer Society Malaysia’s (NCSM) cancer survivors. Methods: A two-armed, parallel, double-blinded, randomized, controlled trial, intervention and wait-list control groups will be conducted amongst 106 NCSM’s cancer survivors. The programme is developed based on a Social Cognitive Theory that combines both psychoeducation and social media approaches to behavioural intervention. The duration of intervention will be 2 months, in which data will be collected at baseline, 2- month (immediately post-intervention) and 4-month. The primary outcome of the study is to determine the PA level of the participant which will be measured as METminutes/week of PA using the International Physical Activity Questionnaire (IPAQ). There are four measurements of PA that are measured which are moderate and vigorous PA (MVPA) MET-minutes/week, light PA MET-minutes/week, moderate PA MET-minutes/week and vigorous PA METminutes/week. A Generalised Estimating Equation (GEE) analysis will be used to evaluate the effectiveness of the intervention, adjusted for baseline covariates on both continuous and categorical outcomes. This study will utilize a significance level of 0.05 with a confidence interval of 95% for means estimation in rejecting null hypothesis. The trial registered to the Australian New Zealand Clinical Trials (ANZCTR) with the Registration Number, ACTRN12620000039987. Conclusion: The programme will be useful as a supplementary prescription to assist policy makers to strengthen non-ph

A cross-sectional study was conducted among mothers visiting clinic in UKMMC from 1st to 19th August 2016 to acquire opinions on unassisted childbirth and the determinant factors among mothers at a teaching hospital. Structured questionnaires were used in assessing their opinions on unassisted childbirth. A total of 259 respondents were recruited, 229 of them who met the inclusion criteria were included for analysis. Majority (87.3%) was Malay and 98.7% of respondents were more than 25 years old. The prevalence for mothers who agreed with unassisted childbirth was 6.6%. Bivariate analysis showed Malay (p=0.013) and non-working mothers (p=0.000) are the significant factors. There was no significant association between opinions on unassisted childbirth and quality of government healthcare services. Multivariate analysis showed middle income and non-working mothers were the significant factors contributing to opinions on unassisted childbirth. The outcome showed minority of mothers agreed with unassisted childbirth, middle income group and non-working mothers agreed on unassisted childbirth. Dissatisfaction to the quality of care at government healthcare services was not found to be the reason for unassisted childbirth. However, there could be other factors contributing to opinions on unassisted childbirth delivery which were not studied. Community-based study should be conducted to determine the other factors.

Substance use is a global health issue that may lead to engagement in other risky behaviours, addiction, accidents and non-communicable diseases. In Nigeria, this risky behaviour is becoming an emerging trend among secondary school students. This review was thus carried out to gain an overview of the prevalence and risk factors of substance use among secondary school students in Nigeria. A literature search of articles in Scopus, PubMed and other online databases was conducted for articles published between 2009 to 2019. Sixteen studies met the inclusion criteria. Overall, psychoactive substance ranged from 21% to 87%. Alcohol consumption was the highest, while the use of tobacco, cannabis, and cocaine was low. The mean age at initiation ranged from 11 to 15 years. Male gender, peer influence, parental factors, individual factors and knowledge on the dangers of psychoactive substance use were common factors associated with substance use among Nigerian secondary school students. School-based interventions should be multifaceted and holistic. More research should be theory-based and conducted in the Northern parts of Nigeria. Future studies should measure other psychological factors that may influence these behaviours to provide more insight into interventions.

Introduction: Hypertension treatment aims to reduce morbidity and mortality from cardiovascular and renal complications. In Malaysia, there is a high prevalence of uncontrolled hypertension among patients on treatment. This study aimed to identify the predictors of uncontrolled hypertension among patients receiving treatment from public primary care clinics in Pulau Pinang, Malaysia. Methods: An unmatched case-control study with 1:1 ratio was conducted among 334 hypertensive patients receiving treatment from selected public primary care clinics. Mean blood pressure measurements from the last two clinical visits were used to determine the hypertension status, and uncontrolled hypertension was defined as 140/90 mm Hg or higher. The cases were those with uncontrolled hypertension, while the controls were those with controlled hypertension. Participants were recruited by simple random sampling. Independent variables were sociodemographic factors, clinical and psychosocial factors, medication adherence, lifestyle modification, and clinical inertia. Data were collected using validated questionnaires and review of medical records. Multiple logistic regression analysis was performed by using IBM SPSS Statistics 25. Results: The mean age of respondents was 59 years (SD=11). Patients with medication non-adherence had 11.36 times higher odds of uncontrolled hypertension (aOR=11.36, 95% CI=6.59, 19.56, p <0.001). Clinical inertia increased 7.82 times the odds of uncontrolled hypertension (aOR=7.82, 95% CI=2.65, 23.09, p<0.001). Conclusion: Addressing medication adherence and clinical inertia are vital in reducing uncontrolled hypertension. The findings would help to prioritise interventions to improve the clinical management of hypertension and patient outcomes.

Background: Intimate partner violence (IPV) is any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship. IPV is an important public health problem with substantial consequences on physical, mental, sexual, and reproductive health. Data on the systematic review of IPV are vital as basis for policy and program recommendations. The purpose of this systematic review was to ascertain the prevalence of IPV and its associated factors in Malaysia. Materials and methods: A systematic review was conducted on published research studies from four databases which included Scopus, Medline, Sage and Google Scholar using keywords of intimate partner violence OR IPV AND associated factors OR risk factors OR protective factors AND Malaysia. Articles included were either cross-sectional, cohort or case-control studies which were published between the year 2005 till present. Excluded articles were the non-Malaysian origin, irrelevant topics being studied and articles not written in English. Results and discussion: Out of 1983 records identified and screened, five were included for the analysis and interpretation of the data. All of the included studies were of cross-sectional design in which one of the studies was secondary data. IPV prevalence in Malaysia has a wide range between 4.94 and 35.9%. Two studies reported emotional or psychological abuse as the most common form of IPV (13% out of 22%) and (29.8%; CI = [0.27, 0.32]). Significant factors associated with IPV were lower education background, lower socio-economic status, history/ current substance abuse, exposure to prior abuse or violence, violence-condoning attitude; husbands or partners controlling behaviour, substance abuse and involvement in fights and lack of social support. Conclusion: Specific IPV intervention should focus on lower socio-economic groups, high-risk institutionalised groups, the involvement of partners or husband and addressing issues of

The American College of Obstetricians and Gynaecologists (ACOG), US Department of Health and Human Services (HHS), and American College of Sports Medicine (ACSM) recommend that all pregnancies with medical clearance should engage in moderate-intensity physical activity (PA) at least 150 minutes per week. However, most of them are physically inactive. Thus, this article aims to identify predictors of physical inactivity among antenatal women. Four databases were used to search relevant articles using PICO strategy systematically. The screening began with examining titles, abstracts, and keywords, followed by scrutinizing and assessing full articles. Finally, a total of five studies were included for the data extraction, and the predictors are sociodemographic (trimesters, parity, marital status, and pre-pregnancy PA status), socioeconomic (household income), lifestyle (smoking and eating unhealthy diet) and health-related factors (multiple pregnancies, received fertility treatment, being unwell, musculoskeletal pain, symptom of early pregnancy and uterine contraction). All these predictors provide crucial information for the success of future physical activity intervention.

Introduction: Adolescent aggression is an important public health concern with escalating prevalence of juvenile cases and violence among these age groups including robbery, homicide, and gang fights. The objectives of this study protocol are to determine the biopsychosocial predictors and explore the contextual factors of adolescent aggression among secondary school students in Hulu Langat. Methods: Explanatory mixed method study design will be used, consist of quantitative cross-sectional study followed by basic qualitative study. Proportionate population sampling among Form 4 secondary school students from selected public secondary schools in Hulu Langat will be executed. Questionnaires will be distributed to 481 students on aggression as the dependent variable, and several independent variables: demographic (ethnicity, family income), biological (sex, head injury, nutritional deficiency, breakfast skipping), psychological (attitude and normative beliefs, personality trait, emotional intelligence), and social factors (family environment, single parent status, domestic violence, peer deviant affiliation, alcohol, smoking, substance abuse). Subsequently, participants with moderate to high aggression scores will be further explored on the contextual factors of adolescent aggression by in-depth interview. Multiple linear regression will be executed using SPSS to determine significant predictors whereas thematic analysis will be applied for qualitative data analysis on the context of adolescent aggression. Both findings will be further integrated and discussed to give comprehensive description on the phenomena. Conclusion: Better knowledge and understanding on adolescent aggression may generate new framework to drive more effective preventive strategies and unravel adolescent aggressive related Public Health problems.

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.

Objectives: To identify and synthesize the evidences regarding factors contributing towards malnutrition among fewer than five indigenous children. Methodology: A systematic review was conducted using electronic databases by searching published articles earliest from January 2000 to April 2017 using five different data bases including MEDLINE, PubMed, Scopus, Proquest and CINAHL. Literatures that provide information on factors contributing towards malnutrition among fewer than five indigenous children according to type of malnutrition (stunting, wasting and underweight) were included. A narrative synthesis was used. Findings: Nine studies were assessed and reviewed in the final stage. This review found that malnutrition among fewer than five indigenous populations is a multifactorial problem and that different domain play in the pathway. These mainly include socioeconomic status, parental factor, and child factor, hygiene and child morbidity as the most common and significant factors contributing towards malnutrition among under five indigenous children. Novelty/ Improvement: Identification of appropriate and relevant factors contributing towards malnutrition problem among fewer than five indigenous populations is important to develop a well-planned and ensuring the effectiveness of health intervention.

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.

Health promotional campaign as the practice of encouraging people to improve health has increased over the last decades in response to various health problems. This paper highlights strategies used by students to develop persuasive promotional campaign posters regarding the dengue health problem. Communication and media studies students were involved to show the combined results between the knowledge of health communication and the effective use of media in constructing an effective and persuasive health messages. A total of 56 students from two cohorts, i.e. twenty-five master’s students and thirty-one undergraduates were selected. Kurt Lewin’s model of action research was used to set the tasks: campaign objectives, information on dengue, themes/slogans to write the posters either by drawing or designing using a computer. The students were divided into groups where each group was monitored to record, check and evaluate their message writing performances. This study uses the Health Message Review Tool for data analysis which is grounded in the theories of Extended Parallel Process Model and Persuasion Hierarchy Effect. The findings revealed that the participants were able to construct, identify and evaluate major multi modal features in the dengue posters and persuasive elements which included: verbal texts, images, colours, graphic designs, metaphors, 1-sided and 2-sided message, firm conclusion and frames with more effective appeals. It was concluded that similar strategies may well be used in producing other campaign materials such as brochures, pamphlets, and billboards. The linguistic and pedagogic implications are also discussed at the end.