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

Introduction: 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

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

Background: Anaemia continues to be a global public health burden affecting all age groups, particularly children. Indigenous people, including the Orang Asli (OA) population in Malaysia, are at risk of anaemia due to the vast disparities in social determinants of health in their population compared to the non-indigenous population. Objectives: This review aimed to identify the prevalence and risk factors of anaemia among OA children in Malaysia and analyse the knowledge gaps. Methods: A systematic search was conducted in PubMed, Cochrane Library, Scopus and Google Scholar databases. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Results: This review identified six studies involving the participation of OA children from eight subtribes residing in Peninsular Malaysia. The overall prevalence of anaemia among OA children ranged from 21.6 to 80.0%, with iron deficiency anaemia prevalence at 34.0%. The risk factors of anaemia among OA children reported from one study in this review were being younger than ten years old children (AOR 2.11 (95% CI 1.23, 3.63)) and moderate to heavy Ascaris infections (AOR 2.05 (95% CI 1.12, 3.76)). There was no data from OA children from certain age groups and subtribes. Additionally, there is a paucity of data on risk factors for anaemia among OA children from the currently available evidence. Conclusion: The prevalence of anaemia among OA children poses a moderate to severe public health concern. Therefore, more comprehensive studies in the future are needed to address the gaps identified in this review, primarily regarding anaemia risk factors. This data would encourage policymakers in devising effective national prevention strategies to improve morbidity and mortality among OA children in the future.

Objective: This study aims to determine the prevalence of poor self-rated health (SRH) in Malaysia and its association with sociodemographic characteristics, lifestyle behavior, chronic diseases, depression, and functional limitations in activities of daily living (ADLs) among older persons. Design: Cross-sectional. Setting, participants, and outcome measures: We used data from the National Health and Morbidity Survey 2018, a nationwide community-based study. This study was conducted using a two-stage stratified cluster sampling design. Older persons were defined as persons aged 60 years and above. SRH was assessed using the question “How do you rate your general health?” and the answers were “very good”, “good”, “moderate”, “not good”, and “very bad”. SRH was then grouped into two categories; “Good” (very good and good) and “Poor” (moderate, not good, and very bad). Descriptive and logistic regression analyses were conducted using SPSS version 25.0. Results: The prevalence of poor SRH among older persons was 32.6%. Poor SRH was significantly related to physical inactivity, depression, and limitations in activities of daily living (ADLs). Multiple logistic regression revealed that poor SRH was positively associated with those who had depression (aOR 2.92, 95% CI:2.01,4.24), limitations in ADLs (aOR 1.82, 95% CI: 1.31, 2.54), low individual income (aOR 1.66, 95% CI:1.22, 2.26), physical inactivity (aOR 1.40, 95% CI:1.08, 1.82), and hypertension (aOR 1.23, 95% CI:1.02, 1.49). Conclusions: Older persons with depression, limitations in ADLs, low income, physical inactivity, and hypertension were significantly associated with poor SRH. These findings provide information to aid health personnel and policymakers in the development and implementation of health promotion and disease prevention programs, as well as adequate evidence in planning different levels of care for the older population.

This study aims to determine the prevalence of anaemia and factors associated with anaemia among men in Malaysia. Data from the National Health and Morbidity Survey 2019 was utilized. Haemoglobin level for men aged 15 years and above who gave their consent was measured using HemoCue® Hb 201+ System©. Majority of them (87.2%) were men aged 15-59 years referring to the younger age group. The prevalence of anaemia among men was 12.6% (95% confidence interval [CI]: 10.9, 14.5). Prevalence was higher in the older men (30.7%; 95% CI: 26.6, 35.1) than the younger men (10.0%; 95% CI: 8.2, 12.2). The multivariable logistic regression observed that anaemia among men was associated with older age (adjusted odds ratios [aOR] = 3.1; 95% CI: 2.1, 4.4) and those with diabetes (aOR = 1.5; 95% CI: 1.2, 2.1). Older men are more affected by anaemia than younger men. Anaemia among older men in Malaysia is considered at the level of moderate to severe public health significance and the likelihood of developing anaemia increases among older men with diabetes. These often-overlooked issues among men need to be detected and treated early to prevent complications and to improve their quality of life.

IntroductionThe first Malaysian case of covid-19 was the ninth case reported at the beginning of February 2020 . This 42-year-old businessman had a travel history to Singapore from 16th to 23rd January 2020 for an International Conference. He was also the index case of the first local transmission cluster in Malaysia . Malaysia was free of COVID-19 cases for 11 days before the second wave of the disease arrived late February 2020 . Most of the early cases in the second wave were initially imported and sporadic . However, a case notified on 28th February 2020 to Petaling District Health Office (DHO) in the Selangor State, Malaysia, was later found to link to a cluster from a business corporate in Malaysia . During this time, there was no specific guidelines from the Ministry of Health Malaysia for the corporate companies on handling the outbreak. Here, we reported the detection and management of this COVID-19 first business cluster in Malaysia by Petaling DHO. ObjectiveThis study aimed to report the detection and management of COVID-19 from the first and one of the largest clusters linked to a business corporate in Malaysia from Petaling District, Selangor Material and MethodsThis is a descriptive study analysis that was conducted from the surveillance data of Petaling district health office (DHO) notified on 28th February 2020 until 22nd of March 2020. All cases and contacts were identified through surveillance, epidemiological investigation, and laboratory investigation. The network graph was done using the software R and the epidemiology curve was done using Microsoft Excel. Results and DiscussionFrom 28th February to 22nd March 2020, a total of 1536 people were traced by Petaling DHO linked to the cluster. The total number of positive COVID-19 cases from this cluster was 126 out of 1536 which come to an attack rate of 8.2% 63 of them, which was 50% of the total number in the cluster, lived in Petaling District. Other positive cases were transferred to the respective districts according to their house addresses. ConclusionCluster of COVID-19 in this workplace setting was curbed quickly, within three weeks, due to the efficient control efforts by the Petaling DHO with mutual co-operation with the employer and other related DHO. They did all the necessary measures to prevent the outbreak from getting worse and bigger.

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.

IntroductionFalls are a common problem among older people, leading to major morbidity and increased mortality. It has been estimated that 30-40% of older persons will fall at least once over a 12-month period . Among those who have fallen, one in five will sustain two or more injuries . The aim of this study is to determine the prevalence of falls among older persons in Malaysia and its associated factors. MethodologyData were obtained from the National Health and Morbidity Survey 2018, a cross-sectional study using stratified cluster sampling design. Older persons were defined as aged 60 years and above in this study. Fall was defined as a situation where a person accidentally falls to a lower level usually the floor other than as a result of having a strong blow. Descriptive and logistic regression analyses were conducted using SPSS version 25.0 (IBM, USA) taking into account the complex survey design. Results 1. Overall, 14.1% (95% CI: 12.46,15.84) of older persons reported having experienced at least one fall in the past 12 months. 2. Falls were more likely to occur among individuals who were not employed, [OR=1.35 (95%CI:1.03, 1.77)], and with self-reported medically diagnosed diabetes mellitus, [OR=1.65 (95%CI: 1.33, 2.040] and among those with limitations in ADL, [OR=1.90 (95%CI: 1.43, 2.54)] or IADL, [OR=1.47 (95%CI: 1.16, 1.84)]. 3. Multiple logistic regression revealed that falls were positively associated with those who had diabetes mellitus [aOR:1.55 (95% CI: 1.23,1.94)] and limitation in ADL [aOR:1.56 (95% CI: 1.14, 2.15)]. DiscussionIn comparison to other Asian countries, the fall prevalence of our population approximated most to Japan 15.9% and Taiwan 19.1% , but appears to be lower than the prevalence reported by Thailand 26.1% . Diabetes mellitus was a prominent risk factor of falls among the population included in the NHMS 2018 confirming the findings of previous local studies . A meta-analysis found that older persons with diabetes mellitus had a 64% greater risk of falls with an overall increased risk of 94% and 27% among those who are insulin and non-insulin treated respectively . The relationship between falls and impaired ADLs has also been established in numerous previous studies. ConclusionOne in six older Malaysians experienced at least one fall over a 12 months period. Diabetes mellitus and limitation in ADL were the factors significantly associated with falls among older persons. A comprehensive and targeted program designed to reduce risk of falls is urgently needed. Future research should identify suitable programs for our setting to reduce the potential societal burden of falls in older Malaysians. &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.

AIM Studies on the influence of social support on activity limitation among older persons remain limited. A better understanding of this relationship will help with resource planning and policy making aimed to reduce burden of care. The objective of this study was to assess the influence of social support on limitation in daily living among older persons in Malaysia. METHODS Data from the National Health and Morbidity Survey 2018, a nation-wide, cross-sectional survey using a two-stage stratified sampling design, were analyzed. A representative sample of individuals aged ≥60 years identified through national sampling frames throughout Malaysia was included. Face-to-face interviews were conducted using validated questionnaires on activities of daily living (ADL) and instrumental ADL (IADL). Social support was measured using the Duke Social Support Index. RESULTS The overall prevalence of the presence of any limitations in ADL and IADL was 17.0% and 42.9% respectively. Overall prevalence of the older persons with low to fair social support was 30.8% and high to very high social support was 69.2%. Logistic regression analysis identified the following factors as being associated with limitations in ADL and IADL: being female, of older age, having a monthly income

Aim Falls are a common problem among older people, leading to major morbidity and increased mortality. The study aimed to determine the prevalence of falls among older persons in Malaysia and its associated factors. Methods Data were obtained from the National Health and Morbidity Survey 2018 (NHMS 2018), a cross-sectional study using stratified cluster sampling design. Older persons were defined as aged ≥60 years in this study. Descriptive and logistic regression analyses were conducted using SPSS version 25.0. Results Overall, 14.1% (95% confidence interval [CI]: 12.46, 15.84) of older persons reported having experienced at least one fall during the past 12 months. Univariate analyses revealed an association between the history of falls with not being employed (odds ratio [OR]: 1.35 [95% CI: 1.03, 1.77]), diabetes mellitus (OR: 1.65 [95% CI: 1.33, 2.04]), limitation in activities of daily living (ADL) (OR: 1.90 [95% CI: 1.43, 2.54]) or instrumental ADL (OR: 1.47 [95% CI: 1.16, 1.84]). Multiple logistic regression revealed that falls were positively associated with those who had diabetes mellitus (OR: 1.55 [95% CI: 1.23, 1.94]) and limitation in ADL (OR: 1.56 [95% CI: 1.14, 2.15]); 43.9% of falls occurred outdoors. Conclusion One in six older Malaysian people experience at least one fall over a 12-month period. Diabetes mellitus and limitation in ADL were the factors associated with falls among older persons. A comprehensive and targeted program designed to reduce risk of falls is urgently needed. Future research should identify suitable programs for our setting to reduce the potential society burden of falls in older Malaysians. Geriatr Gerontol Int 2020; 20: 33-37.

This study aimed to determine the prevalence of anemia and factors associated with anemia among men in Malaysia. The researchers used data from the 2019 National Health and Morbidity Survey (NHMS). The hemoglobin levels of men aged 15 years and above who gave their consent was measured using the HemoCue® Hb 201+ System©. The majority of them (87.2%) were men aged 15–59 years, referred to as the younger age group in this study. The prevalence of anemia among men was 12.6% (95% confidence interval (CI): 10.9, 14.5). The prevalence was higher among older men (30.7%, 95% CI: 26.6, 35.1) than younger men (10.0%, 95% CI: 8.2, 12.2). Anemia among men was associated with older age (adjusted odds ratios (aOR) = 3.1, 95% CI: 2.1, 4.4) and those with diabetes (aOR = 1.5, 95% CI: 1.2, 2.1) via a logistic regression analysis. In conclusion, older men were more affected by anemia than younger men in this study. Anemia among older men in Malaysia is at the level of moderate to severe public health significance. The likelihood of developing anemia is increased among older men with diabetes compared to older men without diabetes. These often-overlooked issues among men need to be detected and treated early in order to prevent complications and improve their quality of life.

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

Various factors contribute to suicidal attempt. This study aims to determine the relationship between suicidal attempt and its associated factors among school-going adolescents in Malaysia. Data from the National Health and Morbidity 2017 survey were analyzed. This survey was implemented as a nationwide school-based survey targeting adolescents 13 to 17 years old. Descriptive and multiple logistic regression analysis was done using SPSS version 20. A total of 27 399 adolescents participated in this survey. The prevalence of suicidal attempt was 6.9% (95% confidence interval = 6.2-7.7). Multivariate analysis found that the odds of suicidal attempt among adolescent with depression is 4.3 (adjusted odds ratio = 4.3; 95% confidence interval = 3.9-4.8). Other significant factors are young adolescent, non-Malay ethnicities especially Indian, adolescent with parents living apart, and those without peer support and parental connectedness. A holistic approach for the planning of preventative strategies and public health policies should be made according to these risk factors.