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Sexting refers to the sharing of sexually explicit digital messages via online platform. This behavior is becoming more prevalent among young people and has been linked to a number of detrimental effects. The current systematic review has aimed to examine the significant intrinsic and extrinsic factors associated with sexting behavior among youths. The relevant studies were found via six electronic databases and the eligible studies include studies that measured intrinsic and extrinsic factors associated with sexting behavior as dependent variables among the mean age group 10 to 24 years old, and cross-sectional, cohort, or case-control studies that reported the odds ratio (OR) or relative risk (RR) value and significant p-value or 95% CI. A total of 14 articles that were produced between years 2014 to 2020 were included in the qualitative synthesis. From these 14 studies, the reported significant factors associated with sexting were age, puberty, sex, sexual orientation, personal characteristics, psychosocial factors, peers, family, relationship status, sexual activity, internet use, and online-related activities. Perception of popular peer’s sexting behavior and female sex were the reported intrinsic factors with the highest odds ratio (OR) value. Participation in risky online activities and a history of sexual activity were reported to have the highest OR value among other extrinsic factors. In contrast to prior reviews on sexting that have mostly focused on the association of sexting with sexual risk behavior and mental health, this review has closely examined both individual and extrinsic factors related with sexting behavior, particularly among youths. The findings from this review can assist in the development of more comprehensive health education and behavioral intervention on sexting behavior among youths, such as using peer-based intervention and limiting the duration of internet use.

Introduction: Increasing prevalence of dementia and the associated caregiving burden are expected due to longer life expectancy. This review aimed to critically assess dementia-driven caregiving burden and the associated factors in Malaysia. Methods: A systematic search using several combinations of keywords was conducted in Ovid Medline, PubMed, Science Direct, ProQuest, and Ebscohost databases. The primary outcome was the score or level of caregiver burden, while the secondary outcome was the factors associated with such burden. The quality of the individual articles was assessed using the Newcastle–Ottawa Scale and the Joanna Briggs Institute checklist. Results: The systematic search resulted in seven studies being reviewed, consisting of six cross-sectional studies and one quasi-experimental study. Using the Zarit Burden Interview, two studies reported moderate caregiver burden with mean scores of 35.4 (15.08) and 46.0 (17.0). High levels of burden or strain were reported using the Caregiver Strain Index in other studies. The three main associated factors with burden identified in these studies were the presence of behavioural and psychological symptoms of dementia (BPSD), higher education level, and lack of social support. Conclusion: Moderate to severe caregiving burden level were found to be experienced by dementia caregivers in this country. High education, lack of support, as well as taking care of patient with BPSD being the most prominent factors associated with burden. Therefore, burden should be regularly assessed among the dementia caregivers especially among those with lack of social support and manage family members with BPSD, as to prevent adverse outcome from dementia caregiving.

Most food poisoning outbreaks are caused by consumers’ poor knowledge, attitude, perception, and behaviour in relation to food safety. A valid and reliable tool is thus needed to measure these factors among the consumers. A total of 79 respondents participated in this pilot survey using convenient sampling, and participants self-completed the questionnaire given. Item analysis was conducted to determine the difficulty and discrimination indices of 40 items involved in knowledge construction. Construct validity and reliability were performed on 33 items which measured attitudes, preventive practices, and perceptions. Item analysis showed that more than 80% of respondents answered 19 items correctly. The discrimination index revealed that 16 items scored below 0.20. The Average Variance Extraction for all latent constructs, namely attitude, practice, and perception met acceptable threshold values of 0.527, 0.517, and 0.535, respectively. The Fornell-Larcker criterion suggested that three latent constructs were acceptable for discriminant validity. The internal consistency and reliability for all scaled items in each construct were good, with Cronbach’s alpha values of more than 0.7 (0.820, 0.809, and 0.799 for attitude, practice, and perception, respectively). In conclusion, the present work indicated that the knowledge, attitude, practice, and perception (KAP2) questionnaire used could be a valid and reliable measure to evaluate consumer’s knowledge, attitude, preventive practice, and perception on food poisoning.

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 face-to-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.

Physiological and emotional changes during adolescence increases their vulnerability to the adoption of risky behaviour such as substance use. Hence, adolescence has been reported to be a critical risk period for initiating the use of substances [1]. In Nigeria, research has shown a high prevalence of substance use among adolescents [2 & 3]. Empowerment education intervention is a type of empowerment intervention with the potential to prevent and reduce adolescent substance use. This intervention involves a three-step methodology – listen, dialogue, and action to empower participants. This type of intervention has been reported to improve self-esteem, critical thinking, problem solving, community connectedness, and social support of the participants [4]. However, studies using the empowerment education intervention to prevent adolescent substance use are few in developing countries [5]. This study was, therefore, conducted to determine the short-term effect of an empowerment education intervention aimed at preventing adolescent substance use among adolescents living in peri-urban communities in Nigeria. This study involved a quasi-experimental design, conducted in Abuja with communities as the unit of randomization. Using G-power, the total sample size obtained was 300. Two peri-urban communities each were randomly assigned to the intervention and control groups, and adolescents from these communities who expressed interest in the project were enrolled for the study. All adolescents who were enrolled were aged between 11 to 19 years old, in secondary schools, and had basic reading and writing skills. Participants who were involved in similar programme were not included in the current study. The intervention group received weekly sessions for 12 weeks according to the Teen Heroes curriculum; an empowerment education curriculum developed according to Friere’s principles, which required some form of community action from the participants. The curriculum contains sessions on teamwork, alcohol and tobacco use, drug use, and planning a substance use project in the community. The sessions are mainly interactive, using problem posing method of education, interspersed with group activities and presentation. For the control group, monthly sessions on bullying and personal hygiene were conducted. Short-term post-intervention data was collected two weeks after the intervention. Data was collected on quantity of substance use as well as other risk and protective factors (delinquency, self-esteem, self-efficacy, attitude to substance use, peer support, behavioural conduct, social competence, depression and delinquency) identified in the problem behaviour theory. An independent t-test was conducted to determine if there was a significant difference in the mean quantity of substance use, as well as other risk and protective factors among the intervention and control groups. A p-value of less than 0.05 was considered significant. Data was collected from two hundred and fifty-six participants, with 131 in the intervention group and 125 participants in the control group. Majority (62.1%) of the respondents were females, while 37.9% were males. Data analysis showed no significant effect of the intervention on the quantity of substances used by the participants two weeks post intervention. Perhaps, the nature of the substances did not allow for the effect of the intervention to be observed after two weeks. Additionally, the intervention did not address parental and familial factors of substance use which may have had a stronger effect on adolescent substance use. However, there was a significant mean difference in peer support, social competence and self-efficacy between the intervention and control groups. The effect observed on their peer support and social competence could be due to the interactive and social nature of the intervention, as it required lots of teamwork, discussions and project planning, while their self-efficacy could have been improved due to the practical nature of the intervention, as participants were expected to carry out a project for the community. This finding was supported by Thulin et al [6]. Other risk and protective variables were not significantly associated with the intervention. The findings are different from the studies conducted by Zimmerman et al. in 2018 [7], and Thulin et al. in 2022 [6] which found the intervention influenced delinquency, and prosocial behaviour. There is a need to conduct more medium- and longer-term studies to determine any delayed effect of the intervention on substance use, and other risk and protective factors. Conclusively, the intervention had no short-term effect on substance use, however an effect could be seen on social competence, peer support and self-efficacy.

BACKGROUND Allergic diseases affects around 40% of children population worldwide. The coexistence of asthma, allergic rhinitis (AR), eczema, and food allergy (FA) renders allergy treatment and prevention challenging. Infant feeding strategies recommended avoiding allergenic foods to prevent allergy development and anaphylaxis. However, recent evidence suggests that early consumption of food allergens during weaning in infants at age of 4 to 6 months could result in food tolerance hence reduce the risk of developing allergies. OBJECTIVE The aim of this study is to systematically review and meta-analyze evidence on the effect of the early food introduction for prevention childhood allergic diseases. METHODS : We will conduct a systematic review of intervention through comprehensive search of various databases including PubMed, EMBASE, Scopus, CENTRAL, PsycINFO, CINAHL and Google Scholar to identify potential studies. The search will be performed for any eligible articles from the earliest published articles up to the latest available studies in 2023. We will include randomized controlled trials (RCTs), or cluster RCT, non-RCTs and other observational studies that assess the effect of early food introduction to prevent childhood allergic diseases. RESULTS Primary outcomes will include measures related with the effect of childhood allergic diseases (i.e., asthma, allergic rhinitis, eczema and/or food allergy). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be followed for studies selection. All data will be extracted using a standardized data extraction form and quality of the studies will be assessed using the Cochrane Risk-of-Bias Tools. A ‘summary of findings’ will be tabulated for the following outcomes: (1) Total number of allergic disease(s), (2) Rate of sensitization, (3) Total number of adverse events, (4) Improvement of health –related quality of life (HRQoL) and/or (6) All-cause mortality Descriptive and meta-analysis will be performed using a random effect model in Review Manager File. Heterogeneity among selected studies will be assessed using the I2 statistic and explored through meta-regression and subgroup analyses. Data collection is expected to start in June 2023. CONCLUSIONS The results acquired from this study will contribute to existing literature and harmonize recommendation for harmonizing infant feeding guidelines with regards to prevention of childhood allergic diseases. CLINICALTRIAL International Prospective Register for Systematic Reviews (PROSPERO) number CRD42021256776 was registered on 25 June 2021.

Background: The aim of this study is to determine the current practice level of family planning and the associated factors among public secondary school teachers in Enugu East Senatorial District. Method: A cross-sectional study was carried out among public secondary school teachers, aged 18 - 60 years, in Enugu East Senatorial District, using probability proportional to size sampling and systematic random sampling to select 1000 participants. Binary and multiple logistic regression analyses were used to determine association. An odds ratio with a 95% confidence interval (CI) was computed to determine the level of significance. Results: The current practice level of family planning is 26.5%. Respondents with bachelor in education were 2 times more likely to be a current user of family planning (AOR=2.39; 95% CI: 1.25-4.55). However, respondents in age group 38 years and above were less likely to be a current user of family planning (AOR=0.64; 95% CI: 0.43-0.95), likewise female respondents (AOR=0.66; 95% CI: 0.44-0.98). Additionally, respondents who mentioned radio (AOR=0.64; 95%CI: 0.44-0.93), social media (AOR=0.73; 95% CI: 0.53-0.99) and healthcare (AOR=0.61; 95%CI: 0.43-0.88) as source of information were less likely to be current user of family planning. Whereas, partner who encouraged the use of family planning (AOR=2.54; 95% CI: 1.71-3.78) span style="font-family:'Times New Roman'; font-weight:bold">, partner who allow each other to decide on family planning methods (AOR=4.47; 95% CI: 2.67-7.48) and those who had good knowledge of family planning (AOR=1.96; 95% CI: 1.40-2.67) were more likely to be current user of family planning. Conclusion: The level of current practice of family planning is low and a significant number of factors predict the current practice of family planning. A family planning educational workshop among teachers is needed to improve teacher’s knowledgeon family planning to address the issue of adolescent sexual reproduction as teachers are vessels of knowledge impartation to students. Keywords: Teachers; Family Planning; Current Practice; Predictors; Nigeria.

Malnutrition is a significant cause of morbidity and mortality among under-five children, especially in low- and middle-income countries (LMICs). This study aimed to assess the predictors of malnutrition among children less than five years in IDP camps of Adamawa and Yobe states, Nigeria. It was a cross-sectional study conducted from September 2018 to January 2019. A sample of 807 children aged 6 to 59 months was selected using the probability proportionate to size sampling (PPSS) technique. A structured questionnaire was administered to collect information on the children and their caregivers. The overall prevalence of stunting, wasting, and underweight were 17.1%, 40.9%, and 29.7%, respectively. The predictors of stunting were the mother's level of education and family planning usage. For wasting, identified predictors include the mother's level of education, family planning usage, family planning interest, mother's visit to the antenatal clinic, and the number of mother's visits to the antenatal clinic. In contrast, the predictors of underweight consisted of mother's level of education, family planning usage, family planning interest, mother's visit to antenatal clinic, and household income. In conclusion, it is evident from these findings that malnutrition, especially the acute form (wasting), is not only disproportionally high among under-five children but is a public health emergency that calls for urgent attention from concerned authorities. Collaborative efforts among sectors like health, agriculture, education, environment and finance; are very critical.

Background Vaccine preventable diseases are still the most common cause of childhood mortality, with an estimated 3 million deaths every year, mainly in Africa and Asia. An estimate of 29% deaths among children aged 1–59 months were due to vaccine preventable diseases. Despite the benefits of childhood immunisation, routine vaccination coverage for all recommended Expanded Programme on Immunization vaccines has remained poor in some African countries, such as Nigeria (31%), Ethiopia (43%), Uganda (55%) and Ghana (57%). The aim of this study is to collate evidence on the factors that influence childhood immunisation uptake in Africa, as well as to provide evidence for future researchers in developing, implementing and evaluating intervention among African populations which will improve childhood immunisation uptake. Methods We conducted a systematic review of articles on the factors influencing under-five childhood immunisation uptake in Africa. This was achieved by using various keywords and searching multiple databases (Medline, PubMed, CINAHL and Psychology & Behavioral Sciences Collection) dating back from inception to 2020. Results Out of 18,708 recorded citations retrieved, 10,396 titles were filtered and 324 titles remained. These 324 abstracts were screened leading to 51 included studies. Statistically significant factors found to influence childhood immunisation uptake were classified into modifiable and non-modifiable factors and were further categorised into different groups based on relevance. The modifiable factors include obstetric factors, maternal knowledge, maternal attitude, self-efficacy and maternal outcome expectation, whereas non-modifiable factors were sociodemographic factors of parent and child, logistic and administration factors. Conclusion Different factors were found to influence under-five childhood immunisation uptake among parents in Africa. Immunisation health education intervention among pregnant women, focusing on the significant findings from this systematic review, would hopefully improve childhood immunisation uptake in African countries with poor coverage rates.

BACKGROUND High prevalence of excessive screen time among preschool children is attributable to certain parental factors such as lack of knowledge, false perception about screen time, and inadequate skills. Lack of strategies to implement screen time guidelines, in addition to multiple commitments that may hinder parents from face-to-face interventions, demands the need to develop a technology-based parent-friendly screen time reduction intervention. OBJECTIVE This study aims to develop, implement, and evaluate the effectiveness of Stop and Play, a digital parental health education intervention to reduce excessive screen time among preschoolers from low socioeconomic families in Malaysia. METHODS A single-blind, 2-arm cluster randomized controlled trial was conducted among 360 mother-child dyads attending government preschools in the Petaling district, who were randomly allocated into the intervention and waitlist control groups between March 2021 and December 2021. This 4-week intervention, developed using whiteboard animation videos, infographics, and a problem-solving session, was delivered via WhatsApp (WhatsApp Inc). Primary outcome was the child’s screen time, whereas secondary outcomes included mother’s screen time knowledge, perception about the influence of screen time on the child’s well-being, self-efficacy to reduce the child’s screen time and increase physical activity, mother’s screen time, and presence of screen device in the child’s bedroom. Validated self-administered questionnaires were administered at baseline, immediately after the intervention, and 3 months after the intervention. The intervention’s effectiveness was evaluated using generalized linear mixed models. RESULTS A total of 352 dyads completed the study, giving an attrition rate of 2.2% (8/360). At 3 months after the intervention, the intervention group showed significantly reduced child’s screen time compared with the control group (β=−202.29, 95% CI −224.48 to −180.10; PPPPPP CONCLUSIONS The Stop and Play intervention was effective in reducing screen time among preschool children from low socioeconomic families, while improving the associated parental factors. Therefore, integration into primary health care and preschool education programs is recommended. Mediation analysis is suggested to investigate the extent to which secondary outcomes are attributable to the child’s screen time, and long follow-up could evaluate the sustainability of this digital intervention. CLINICALTRIAL Thai Clinical Trial Registry (TCTR) TCTR20201010002; https://tinyurl.com/5frpma4b

A cross-sectional study was conducted among mothers visiting antenatal 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.

Background Use of a child health record book has long been established in Malaysia. The objective of the study was to determine the proportion of optimum child health record book utilization and its associated factors among parents attending government child health clinics in Putrajaya, the administrative capital of Malaysia. Methods A cross-sectional study was conducted among randomly selected group of 450 parents using a self-administered questionnaire. Optimum utilization of the book was defined as respondents reading all sections and recording comments in the book. Independent variables studied were sociodemographic characteristics; antenatal and breastfeeding history; child health and immunization status; perceptions and level of knowledge on the book and child health; and healthcare providers' performance. A multiple logistic regression analysis was used to identify the associated factors of optimum utilization. Results Out of 450 study participants, 415 completed the questionnaire and 150 (36.1%) were found to optimally utilized the book. Participants who read all sections totalled 245 (59.0%), and 242 (58.3%) respondents reported to record some comments in the book. Optimum utilization of the book was associated with older parents' age (adjusted odds ratio [AOR]: 1.06, 95% confidence interval [CI] 1.01-1.11) and higher education attainment (AOR: 2.21, 95% CI 1.24-3.91), with a good level of knowledge on child health record books and general child health (AOR: 3.87, 95% CI 2.27-6.61; AOR: 2.05, 95% CI 1.25-3.36) and among parents who delivered their children in government hospitals (AOR: 2.93, 95% CI 1.11-7.73). Conclusions The prevalence of child health record book utilization was low at 36.1% but difficult to compare with other studies. Based on the findings, improving the parents' knowledge of the book and general child health, particularly among younger parents with lower educational levels, and delivering the book to institutions outside government hospitals might be useful to increase the utilization.

Postpartum depression is a depressive episode that can start at any point during the first year after childbirth. There are several tools that can be used for PPD screening. The need to define a predictive tool that is clinically useful and has acceptable sensitivity and sensitivity is important especially to be used in the primary care setting. This systematic review investigates the evidence of the sensitivity and specificity of screening tools used for PPD screening. The Standard for Reporting of Diagnostic Accuracies (STARD) guidelines were used to conduct the review as a basis for our methodology. PubMed, ScienceDirect and Springerlink databases between 2007 until 2017 were comprehensively searched EPDS and BDI instrument has sensitivity of more than 80% but findings for specificity was inconclusive. The heterogeneity across studies could be the result of methodological differences in validation of the instruments. In addition, these studies were conducted across continents and settings with different cultures, languages and resources. We have identified 5 different instruments used to screen for postpartum depression. The EPDS was the most validated instrument in the review and we found that EPDS and BDI have higher accuracy to screen postpartum depression because the sensitivity reported were more than 80%.

The 10th National Public Health Conference on Managing Pandemic, Controlling Endemic, and Preventing Future Endemics Through Public Health Approach

TB treatment interruption has resulted in delayed sputum conversion, drug resistance, and a high mortality rate and a prolonged treatment course, hence leading to economic and psychosocial affliction. To date, there are limited studies investigating the physico-social risk factors for early treatment interruptions. This prospective multicenter cohort study aimed to investigate the risk factors for early treatment interruption among new pulmonary tuberculosis (TB) smear-positive patients in Selangor, Malaysia. A total of 439 participants were recruited from 39 public treatment centres, 2018–2019. Multivariate Cox proportional hazard analyses were performed to analyse the risk factors for early treatment interruption. Of 439 participants, 104 (23.7%) had early treatment interruption, with 67.3% of early treatment interruption occurring in the first month of treatment. Being a current smoker and having a history of hospitalization, internalized stigma, low TB symptoms score, and waiting time spent at Directly Observed Treatment, Short-course centre were risk factors for early treatment interruption. An appropriate treatment adherence strategy is suggested to prioritize the high-risk group with high early treatment interruption. Efforts to quit smoking cessation programs and to promote stigma reduction interventions are crucial to reduce the probability of early treatment interruption.

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 prevention and care outcomes and improve access to mental healthcare.

Background: It is a major public health concern when 52% of adults worldwide were overweight and obese. Military institutions worldwide were included, which led to negative impacts on the overall combat readiness due to the obesity-associated-diseases. This study determined the prevalence and predictors of overweight and obesity among the low socioeconomic status (SES) army personnel in Kuala Lumpur. Methods: A cross-sectional study involving 772 low SES army personnel in Kuala Lumpur was conducted. Online questionnaires were distributed while anthropometric measurements’ data were obtained from Military Lifetime Health Record (MLHR) system with BMI of > 25kg/m2 as the outcome. Data analysed using SPSS version 23.0 (descriptive and inferential statistics). Results: The median age of the respondents was 30 (IQR=7) years. The prevalence of overweight and obese army personnel was 41.1% (95%CI:37.6-44.6). The predictors found were being married (AOR:2.026,95%CI:1.318-3.113), secondary education (AOR:2.545,95%CI:1.245-5.203), Lance Corporal (AOR:1.994,95%CI:1.061-3.748), Corporal (AOR:2.814,95%CI:1.578-5.020), Sergeant (AOR:4.174,95%CI:2.076-8.390), past injury (AOR:1.879,95%CI: 1.191-2.965), history of obese sibling (AOR:1.737,95%CI:1.013-2.973), history of obese parent (AOR:3.344,95%CI:1.965-5.688), history of obese grandparent (AOR:11.321,95%CI:2.207-58.072), poor knowledge on dietary intake (AOR:1.524,95%CI:1.077-2.157), less than 2 litres daily plain water intake (AOR:1.606,95%CI:1.166-2.210). Conclusions: Knowledge on dietary intake and plain water intake are the two modifiable predictors for overweight and obesity found in this study, while the other nine predictors are non-modifiable. Understanding on issues surrounding the low SES group will help the strategic level in planning for future comprehensive interventions on overweight and obesity, specifically targeting on those predictors.

Background The exclusive breastfeeding rate in Malaysia is still not satisfactory. Previous studies have shown that breastfeeding self-efficacy is one of the determinants of exclusive breastfeeding, and it can be improved using social cognitive theory. WhatsApp, which is widely used among Malaysians, could be leveraged as a platform to deliver health education interventions. Objective This study aimed to develop, implement, and evaluate the effect of using a face-to-face and WhatsApp-based health education intervention based on social cognitive theory, namely the Self-Efficacy in Breastfeeding (SeBF) module, on mothers' self-efficacy, knowledge, and attitudes in a district in Selangor state. Methods This study was a 2-arm, parallel, single-blind, cluster randomized controlled field trial with an intervention and a control group involving primigravida or multigravida mothers who reside in a district in Selangor state and did not exclusively breastfeed during their previous pregnancy. All 12 maternity and pediatric clinics in this district were randomly divided into 6 intervention and 6 control groups. A total of 172 pregnant mothers were randomly assigned to the intervention group (n=86) or the control group (n=86). The control group received usual routine care. The primary outcome was breastfeeding self-efficacy, while secondary outcomes were knowledge and attitude toward breastfeeding. Each subject was assessed at 4 time points: at baseline, immediately after the intervention, 4 weeks post partum, and 8 weeks post partum. Generalized mixed model analysis was applied to measure the effect of health education on breastfeeding self-efficacy, knowledge, and attitude after the intervention. Results The response rate was 81% (139/172), with the dropout rate being 7% (6/86) in the intervention group and 31% (27/86) in the control group. In the intent-to-treat analysis, the intervention group showed a significant increase in the mean total breastfeeding self-efficacy score 8 weeks after delivery compared with the control group (F21,601=111.73, P Conclusions Face-to-face and WhatsApp-based participation in the SeBF program, designed on the basis of social cognitive theory, contributed to improved self-efficacy and knowledge about breastfeeding. Further studies need to be conducted with a longer duration (until 6 months post partum) to evaluate its effectiveness in increasing exclusive breastfeeding. Furthermore, new strategies in health education need to be developed to improve breastfeeding attitudes. Trial Registration Thaiclinicaltrials.org TCTR20200213004; https://www.thaiclinicaltrials.org/show/TCTR20200213004

Background: Studies have reported on positive health outcomes from physical activity (PA) for cancer survivorship. Systematic reviews, meta-analysis and trial studies have concluded that PA intervention improves quality of life and physical function, reduces the relapse of cancer and mitigates cancer mortality. Despite these important gains, cancer survivors’ PA level is still not satisfactory. Across all cancer types, home is the most preferred location of PA. This study aims to evaluate the effectiveness of remote feedback delivery strategy for home-based PA among cancer survivors. Methods: A systematic review was conducted by retrieving relevant articles published from the year 2009 to 2019 from the database aggregator EBSCOhost (databases used were Medline, CINAHL, SPORT Discuss and Cochrane trials). Results: Both frequent remote contact and direct remote contact are equally effective and have a larger effect than programmes with usual care, no intervention, participants placed in waiting list for intervention or participants given basic guidelines on PA. Direct remote contact reported strong evidence of moderate effect while frequent telephone contact reported conflicting findings of varied effect sizes. Conclusion: Opting for remote feedback strategies with supervised exercise provide an easier approach for the cancer survivors to keep up with exercise for a longer period of time and can be integrated in a cancer survivor’s lifestyle.

Regular physical activity provides important health benefits. However, adolescents reduced their physical activity level as they grown up and eventually may develop chronic diseases. Psychological factors and sedentary activities influence physical activity level. A cross-sectional study using a clustered random sampling method was conducted to identify the association between sedentary activities and psychological factors on physical activity level among 1158 Malaysian adolescents (aged 16–17 years) in Selangor. Participants completed a self-administered questionnaire. The prevalence of physical activity level was 47.40%, 39.40% and 13.20% for high, moderate and low levels, respectively. The psychological factors of self-esteem (χ2 = 17.927, df = 2, p < 0.001) and physical activity self-efficacy (F (2, 1155) = 43.570, p < 0.001) were significantly related to physical activity level but not for sedentary activities. The predictor variables for physical activity are suggesting that physical activity self-efficacy may take into consideration for future health programme implementation.

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. Keywords: Aborigin, Child, Factors, Indigenous, Malnutrition, Under Five, Under Nutrition

Background Despite the high prevalence of malaria among pregnant women and its associated complications, the level of compliance with insecticide-treated nets (ITN) remains very low. Motivation and self-efficacy have been reported as important determinants of health behaviour, and may be important factors to consider in developing health intervention programmes. The aim of this study was to determine the knowledge, motivation and self-efficacy of ITN use, and their association with its practice, among pregnant women in a secondary health centre in Maiduguri. Methods The study utilized a cross-sectional study design, using a structured and pre-tested questionnaire to obtain information from 380 respondents. Respondents were classified as ITN users if they slept under an ITN for at least 3 days in a week, while those who did not at all, or slept under it less frequently were classified as ITN non-users. Chi squared test was performed to test the bivariate association between ITN use and each of the items of the questionnaire. A further multivariate logistic regression was performed to determine the predictors of ITN use. Results The respondents’ ages ranged from 15 to 45 years, with median (interquartile range) age of 25 (8) years. Eighty percent of them were aware of ITN, but 50.5% believed ITNs could be dangerous. Only 5.5% and 0.8% respectively felt that sleeping under and ITN was either just bad or very bad for their health. Thirty-five percent of the respondents were ITN users. Not having a previous miscarriage (OR = 2.38; 95% CI 1.41–4.03, p = 0.001), knowledge that ITNs were not to be washed after every 1 month (OR = 3.60; 95% CI 1.18–11.06), significant others thinking they should sleep under an ITN (OR = 3.06; 95% CI 1.35–6.96), ability to effectively persuade others to sleep under an ITN (OR = 2.37; 95% CI 1.14–4.94) were significantly associated with ITN use. Conclusions A large proportion of pregnant women in this study were not sleeping under ITNs. The development of health promotion interventions aimed at boosting their self-efficacies for ITN use, and improving social support from their spouses are, therefore, recommended. Health education on ITN use should also be incorporated into post-abortal management.

Background: Premarital sexual behaviours among adolescents and the associated negative consequences of teenage pregnancy is an increasing public health concerns in Malaysia. Despite the extensive research related to sexual and reproductive health of adolescents, the problems remain reflecting the possible poor understanding of the underlying causes contribute to the problem. This systematic review is aimed at critically evaluating the available evidence on the contributing factors related to premarital sexual behaviours among adolescents in Malaysia. Methods: Five databases; Scopus, MEDLINE/ PubMed, CINAHL, Science Direct and Google Scholar were utilized to systematically searched related articles up to July 2018. Searching involved local quantitative, qualitative and mixed methods studies with premarital sexual behaviours among adolescents in Malaysia being the primary outcome. Two reviewers independently extracted data and assessed study risks of bias.Results: We identified 1762 articles, of which only nine articles were included, which was dominated by six cross sectional studies. A total of 41 939 adolescents aged between 12 to 19 years old were included in this review. The prevalence of premarital sexual behaviours among adolescents was ranging between 2.9% to 8.3%, reported by history of ever had sex. Religiosity, attitude towards sexual urge (pornography and masturbation), high-risk behaviours (bullying, smoking and substance intake – alcohol and drugs) and parents-peers influence were main contributing factors identified to associate with premarital sexual behaviours.Conclusion: Negative attitude towards sexual urge and involvement in high risk behaviours put adolescents at higher risk of premarital sexual behaviour, while religious beliefs and reciprocal relationship between parents and peers influence may act as protective factors. However, more qualitative, and mixed methods studies needed to get in-depth understanding on the relationship between these factors and premarital sexual behaviours.

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.

Additional file 2: Tables. Tables of the results of further statistical tests (GLMM and sensitivity analysis).

Additional file 3: Figures. Figures of group and time interaction plots for the outcome variables.