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Introduction: Community health workers (CHW) or volunteers are health workers who are trained but do not possess a professional certificate. They are community members who live and work in that particular community. The Ministry of Health Malaysia had initiated a community-based intervention programme, Healthy Community Empowers the Nation or ‘Komuniti Sihat Pembina Negara’ (KOSPEN) in October 2013. In this programme, CHWs main task is to conduct non-communicable diseases (NCD) risk factor screening. Methods: Data from the “Evaluation of the implementation of KOSPEN programme in Malaysia 2016” was used. It is a cross-sectional study which was carried out in randomly selected KOSPEN localities throughout Malaysia. Logistic regression analysis was applied to determine factors associated with not performing KOSPEN screening activities by the volunteers. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 20. Results: A total of 700 volunteers were included in this study. Most of the volunteers were female (65.7%) and were aged 50-59 years (30.9%), followed by those aged 40-49 (27.1%). Majority had secondary education (65.3%), employed (55.7%.) and were married (80.4%). Multivariate logistic regression showed that volunteers who never attended training (aOR 2.79; 95% CI:1.66, 4.67) and who felt the content of the training module was inadequate (aOR 2.693; 95% CI: 1.46, 4.98) were more likely to not perform screening activities in the community. Conclusion: Attendance of the training should be a pre-requisite to qualify as a volunteer. Improvement to the training module should done to increase comprehensibility of the modules among the volunteers. Keywords: KOSPEN-community health workers-NCD screening-community-based intervention Word count (249)

Background Pre-existing comorbidities can predict severe disease requiring intensive care unit (ICU) admission among COVID-19 cases. We compared comorbidities, clinical features and other predictive factors between COVID-19 patients requiring ICU admission for intubation/mechanical ventilation and all other COVID-19 cases in Selangor, Malaysia. Method Field data collected during the COVID-19 outbreak in Selangor, Malaysia, up to 13 April 2020 were used, comprising socio-demographic characteristics, comorbidities and presenting symptoms of COVID-19 cases. ICU admission was determined from medical records. Multiple logistic regression analysis was performed to identify factors associated with ICU admission requiring intubation/mechanical ventilation among COVID-19 cases. Results A total of 1287 COVID-19-positive cases were included for analysis. The most common comorbidities were hypertension (15.5%) and diabetes (11.0%). More than one third of cases presented with fever (43.8%) or cough (37.1%). Of the 25 cases that required intubation/mechanical ventilation, 68.0% had hypertension, 88.0% had fever, 40.0% had dyspnoea and 44.0% were lethargic. Multivariate regression showed that cases that required intubation/mechanical ventilation had significantly higher odds of being older (aged 360 years) [adjusted odds ratio (aOR) = 3.9] and having hypertension (aOR = 5.7), fever (aOR = 9.8), dyspnoea (aOR = 9.6) or lethargy (aOR = 7.9) than cases that did not require intubation/mechanical ventilation. Conclusion The COVID-19 cases in Selangor, Malaysia requiring intubation/mechanical ventilation were significantly older, with a higher proportion of hypertension and symptoms of fever, dyspnoea and lethargy. These risk factors have been reported previously for severe COVID-19 cases, and highlight the role that ageing and underlying comorbidities play in severe outcomes to respiratory disease.

Aim The objective of this study is to determine the prevalence of self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia and their associated factors. Methods The study used data from the National Health and Morbidity Survey in 2018. It was a cross-sectional study with two-staged stratified cluster sampling design. In total, 3977 adults aged ≥60 years were selected for this study. Respondents were interviewed face to face using a structured questionnaire. Self-reported diabetes, hypertension or hypercholesterolemia was defined as having ever been told they have these diseases by a medical doctor or paramedic. Data were analyzed using SPSS version 25. The multiple logistic regression model was used to examine the factors associated with the prevalence of self-reporting. Results The prevalence of self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia were 27.7%, 51.1% and 41.8% respectively. Presence of other comorbidities and being obese showed higher odds for all three diseases. Indians, unemployed, inactive had higher odds for diabetes. Other Bumiputras, unemployed, non-smoker, obese and inactive had higher odds for hypertension. Non-smoker had higher odds for hypercholesterolemia. Conclusions Health promotion, vigilance, attention and services targeting on the associated factors should be strengthened for older persons in Malaysia to ensure healthy aging. Geriatr Gerontol Int 2020; 20: 79-84.

Background Malaysia has the highest rate of diabetes mellitus (DM) in the Southeast Asian region, and has ongoing air pollution and periodic haze exposure. Methods Diabetes data were derived from the Malaysian National Health and Morbidity Surveys conducted in 2006, 2011 and 2015. The air pollution data (NOx, NO2, SO2, O3 and PM10) were obtained from the Department of Environment Malaysia. Using multiple logistic and linear regression models, the association between long-term exposure to these pollutants and prevalence of diabetes among Malaysian adults was evaluated. Results The PM10 concentration decreased from 2006 to 2014, followed by an increase in 2015. Levels of NOx decreased while O3 increased annually. The air pollutant levels based on individual modelled air pollution exposure as measured by the nearest monitoring station were higher than the annual averages of the five pollutants present in the ambient air. The prevalence of overall diabetes increased from 11.4% in 2006 to 21.2% in 2015. The prevalence of known diabetes, underdiagnosed diabetes, overweight and obesity also increased over these years. There were significant positive effect estimates of known diabetes at 1.125 (95% CI, 1.042, 1.213) for PM10, 1.553 (95% CI, 1.328, 1.816) for O3, 1.271 (95% CI, 1.088, 1.486) for SO2, 1.124 (95% CI, 1.048, 1.207) for NO2, and 1.087 (95% CI, 1.024, 1.153) for NOx for NHMS 2006. The adjusted annual average levels of PM10 [1.187 (95% CI, 1.088, 1.294)], O3 [1.701 (95% CI, 1.387, 2.086)], NO2 [1.120 (95% CI, 1.026, 1.222)] and NOx [1.110 (95% CI, 1.028, 1.199)] increased significantly from NHMS 2006 to NHMS 2011 for overall diabetes. This was followed by a significant decreasing trend from NHMS 2011 to 2015 [0.911 for NO2, and 0.910 for NOx]. Conclusion The findings of this study suggest that long-term exposure to O3 is an important associated factor of underdiagnosed DM risk in Malaysia. PM10, NO2 and NOx may have mixed effect estimates towards the risk of DM, and their roles should be further investigated with other interaction models. Policy and intervention measures should be taken to reduce air pollution in Malaysia.

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 Small/kiddie cigarette packs consist of less than 20 cigarette sticks. Kiddie packs were recently proposed to be reintroduced by the tobacco industry with an excuse to prevent consumers from buying illicit cigarettes. By reintroducing kiddie packs, cigarettes will inevitably be more affordable and this would appeal to lower-income consumers especially teens. In this systematic review, we aimed to identify the impact of kiddie packs on smoking, specifically on smoking initiation, the urge/tendency to buy cigarettes and attempts to reduce cigarette consumption. Methods This systematic review will be based on the review of original articles on the impact of kiddie packs on smoking. There is no restriction on the publication dates. The Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Web of Science and Scopus will be searched to retrieve potential original articles. Additional records identified through other sources: Google Scholar, as well as Journal of Substance Use and Tobacco Control, are also to be searched. These will include original articles in any language which included all study designs (randomised controlled trials, quasi experimental and experimental studies, observational cross-sectional and cohort studies) comparing kiddie packs with regular cigarette packs. The primary outcomes of interest will be initiation of smoking and urge/tendency to buy cigarettes in the general population and attempts to reduce cigarette consumption among current smokers. Secondary outcomes will be the prevalence of smoking using kiddie packs among the current smokers. Discussion This systematic review will provide evidence to support the impact of kiddie packs on smoking in terms of smoking initiation, smoking prevalence, urge/tendency to purchase cigarettes and attempts to reduce cigarette consumption. The findings from this review could be helpful to policymakers in regulating kiddie packs to control the consumption of tobacco. Systematic review registration PROSPERO CRD42018102325

Smoking is a learned behavior during adolescence, and it is found predominantly among male adolescents in Malaysia. Our study aimed to investigate the prevalence and predictive factors of current cigarette smoking among school-going male adolescents in Malaysia. Data were derived from the National Health and Morbidity Survey: Adolescent Health Survey 2017, a cross-sectional study that utilized a 2-stage stratified cluster sampling to select a nationally representative sample of school-going adolescents in Malaysia (n = 27 497). Multiple logistic regression analysis was performed to identify factors associated with current cigarette smoking among male adolescents in Malaysia. Male adolescents aged 16 to 17 years (adjusted odds ratio [AOR] = 1.55; 95% confidence interval [CI] = 1.41-1.70), current illicit drug users (AOR = 8.14; 95% CI = 6.37-10.41), current alcohol users (AOR = 1.92; 95% CI = 1.65-2.23), those from rural schools (AOR = 1.60; 95% CI = 1.46-1.76), those whose parents were widowed/divorced/separated (AOR = 1.37; 95% CI = 1.21-1.55), and those whose parents/guardians were tobacco product users (AOR = 3.47; 95% CI = 2.33-5.16) were more likely to be current cigarette smokers. Tobacco control strategies should be aimed at both adolescents at risk and at promoting parental smoking cessation.

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.

IntroductionSecond-hand smoke (SHS) contains more than 7,000 chemicals and at least 70 of them can cause cancers . Globally, more than 600,000 deaths are attributable to SHS annually . Our study aims to determine the prevalence and correlates of SHS exposure among adults in Malaysia. MethodologyData was obtained from the National Health and Morbidity Survey (NHMS) 2019, a cross-sectional study which utilized a two-stage stratified cluster sampling design to select a nationally representative sample of adults in Malaysia. Data was collected using a short version of Global Adult Tobacco Surveillance (GATS) questionnaire. Multiple logistic regression analysis was performed to identify correlates of SHS exposure among adults in Malaysia. ResultsOverall, 53.0% of Malaysian adults were exposed to SHS either at home, at work or at restaurant. Our study found that male adults (AOR 1.76; 95% CI: 1.60, 1.93), those aged 15-24 years (AOR 2.53; 95% CI: 2.11, 3.02), those who had no formal education (AOR 1.48; 95% CI: 1.17, 1.88) and those who were working (AOR 1.53; 95% CI: 1.38, 1.69) were more likely to be exposed to SHS. However, Indian (AOR 0.61; 95% CI: 0.51, 0.73) and those who have not noticed information about danger of smoking in newspaper/television/magazine (AOR 0.54; 95% CI: 0.49, 0.59) were less likely to be exposed to SHS as compared with their respective counterparts. DiscussionOur findings that male adults and those of younger age group were at higher risk of SHS exposure were in line with other local studies. Consistent with other studies among adults in India and Vietnam, our study reported that those who had no formal education were more likely to be exposed to SHS compared with those with higher education attainment. Our study found that working adults were at higher risk of SHS exposure while Indian adults were less likely to be exposed to SHS. In contrast, other local study reported higher likelihood of SHS exposure among unemployed adults and lower likelihood of SHS exposure among Chinese adults.Our study reported that those who have not noticed information about the danger of smoking in newspaper/television/magazine were less likely to be exposed to SHS which was similar to other study. ConclusionSHS exposure among Malaysian adults was high. Tobacco control measures should be strengthened to protect Malaysian adults from SHS exposure. Health promotion and educational programmes should be tailored to those at risk of SHS exposure.

IntroductionDiabetes is a major non-communicable health problem in both developed and developing countries, including Malaysia. Person with diabetes are living longer and are vulnerable to microvascular and macrovascular complications thus representing an important public health problem with high morbidity, mortality and significant economic repercussions. ObjectiveTo determine the national prevalence of diabetes and to identify associated factors among adults population in Malaysia. MethodologyA nationwide cross-sectional study was conducted in 2019 involving 10,464 respondents in Malaysia. Two-stage stratified sampling design was used to select a representative sample of Malaysia adults population. Structured validated questionnaire with face-to-face interview were used to obtain data from selected respondents aged ≥ 18 years. Finger pricked fasting blood glucose test by using Accutrend GC machine were performed on respondents who claimed that they were not having diabetes. Chi-square tests and logistic regression were used to determine associations between diabetes and associated factors at the significance level of =0.05. For the purpose of this study, a respondent was classified as having “diabetes” when the respondent had a fasting capillary blood glucose (FBG) of ≥ 7.0 mmol/L (or non-fasting capillary blood glucose of ≥ 11.1 mmol/L). ResultsThe overall prevalence of diabetes among adults respondents was 18.3% (n=2629). The highest prevalence of diabetes were among females (18.4%), aged 60 & above (41.5%) Indian (31.4%), those without formal education (28.7%), widow/widower/divorce (33.2%), not working (24.9%), inactive (22.5%), obese (27.1%), hypertension (36.0%) and high cholesterol level (30.4%). Logistic regression analyses revealed that age group, ethnicity, education level, marital status, physical activity level, obesity, blood pressure status and cholesterol status were associated with diabetes among adults. DiscussionThis study showed the prevalence of diabetes among adults Malaysian population at 18.3%. Our study recorded a relatively higher level of diabetes among adults population as compared to 7.5% in Brazil (Luisa SF and Monica RC) but lower than Majmaah, Arab Saudi at 34.6% (Mohammed Abdullah AM) There were significant associations between diabetes with age groups, ethnicity and education level, marital status, physical activity which concurred with findings from Alemayehu Z et. al. and Meiqin Hu et. al. Our study also showed there were significant associations between diabetes with obesity, hypertension and cholesterol. Similar findings were reported by Wan Nazaimoon WM et al. and Shiferaw BA & Ayalew JZ. However, no significant association was found in gender, residence and occupational status. ConclusionThis study showed that the prevalence of diabetes among adults populations in Malaysia to be high, with one in five persons found to have diabetes. This study also found that established risk factors like age group, ethnicity, education, physical activity, obesity, hypertension and cholesterol were associated with diabetes. Awareness program and interventions on diabetes need to be improved especially related to behavioural charge as a strategy for prevention and control of diabetes and its complications.

IntroductionSmoking has been a major contributor to morbidity and mortality worldwide including in Malaysia. Every year, more than 8 million people die from tobacco use worldwide1 . In Malaysia, smoking related-diseases have been identified as the major contributor to disability-adjusted life years and lost of years of life among the Malaysian population. The government of Malaysia through the Ministry of Health and other ministries have introduced numerous anti-smoking measures to prevent and control smoking behaviour in the country. Continuous monitoring of smoking status is essential in evaluating the effectiveness of anti-smoking policies. Objectives This paper aimed to study the trend in prevalence and sociodemographic factors of smoking in Malaysia. MethodologyThe study utilised data from three national household surveys in Malaysia namely the Global Adult Tobacco Survey (GATS) 2011, the National Health and Morbidity Survey (NHMS) 2015 and the National Health and Morbidity Survey (NHMS) 2019. The surveys adopted a multistage stratified sampling design that could represent population in Malaysia. All the three surveys had the same target population (population aged 15 years and above) and smoking questionnaires. Smoking status was measured based on GATS protocol and definitions5 . Complex sample design analysis was used to estimate the prevalence and complex multivariable logistic regression was used to identify sociodemographic factors of smoking for all the three surveys. ResultsA total of 4250, 21,410 and 11,111 respondents aged 15 years and above participated in GATS 2011, NHMS 2015 and NHMS 2019 respectively with the response rate of 85% to 87%. The prevalence of smoking was 23.1% (95% CI; 21.2, 25.2) in 2011, 22.8% (95% CI; 21.9, 23.8) in 2015 and 21.3% (95% CI; 19.9, 22.8) in 2019. The prevalence was consistently higher in males (40.5% - 43.9%), adults aged 25-44 years (25.4% - 29.0%), Malay (22.6% - 24.7%), other ethnics (30.0% - 35.0%), and among the self-employed (33.7% - 44.6%) (Table 1). Multiple logistic regression analysis of the three surveys showed that the adjusted odds ratio (aOR) of smoking was markedly higher in males, higher in younger and middle age groups, Malays and those with lower education attainment (Table 2). Discussion / ConclusionAlmost 5 million population aged 15 years and above were smokers in Malaysia. A reduction trend was seen in the prevalence of smoking across almost all sociodemographic characteristics from 2011 to 2019 although the reduction was not statistically significant. Based on the trend, it is still far from achieving the target set by WHO which is 30% reduction in the prevalence of smoking by 2025 from the 2010 baseline. The smoking prevalence in Malaysia is also high compared to in developed countries such as Singapore (14.1%) 6 and Australia (12.8%) 7 . Although there were slight changes in the aOR of the associated factors, the sociodemographic factors associated with smoking were almost consistent in the three surveys. These findings indicate there is a need to strengthen the current anti-smoking policies in terms of their planning, implementation and evaluation.

Hypertension is strongly associated with chronic diseases such as myocardial infarction, stroke, heart failure, and renal failure. The objective of this study is to determine the trend of prevalence, awareness, treatment, and control of hypertension among Malaysian population since 2006 to 2015. The study used the data from National Health and Morbidity Survey (NHMS) 2006, 2011, and 2015. It was a cross-sectional with two-stage stratified random sampling throughout Malaysia for eligible respondents 18 years old and above. Respondents were interviewed face to face and blood pressure was recorded as the average reading from two electronic pressure monitoring measurements. Data was analyzed using the Complex sample module in SPSS Version 20. The prevalence of hypertension in Malaysia was 34.6% (95% CI: 33.9, 35.3) in 2006, 33.6% (95% CI: 32.6, 34.6) in 2011 and 35.3% (95% CI: 34.5, 36.3) in 2015. Awareness of hypertension in 2006, 2011, and 2015 was 35.6% (95% CI: 34.6, 36.6), 40.7% (95% CI: 39.3, 42.1), and 37.5% (95% CI: 36.1, 38.9) respectively. The trend of receiving treatment from 2006 to 2015 was 78.9% (95% CI: 77.5, 80.2) to 83.2% (95% CI: 81.3, 84.8). The control of hypertension increased significantly from 27.5% (95% CI: 25.9, 29.2) in 2006 to 37.4% (95% CI: 35.3, 39.5) in 2015. Despite higher proportions receiving treatment over time, the control of hypertension remained below 40% since NHMS 2006 until 2015. The strategies to further reduce the prevalence and increase awareness of hypertension should be enhanced particularly among the targeted age group to ensure early detection, treatment, and control thus preventing from long-term complications.

In the article “Hypercholesterolemia Prevalence, Awareness, Treatment and Control Among Adults in Malaysia: The 2015 National Health and Morbidity Survey, Malaysia” which appeared in Volume 10, No. 7(2018), a sentence in the abstract under results section, “Only a mere 12.7% (95% CI:12.4 -13.1) among those who were aware were on treatment and out of which only 53.7% (95% CI: 50.1-57.2) had their cholesterol levels controlled” appeared incorrect and should have appeared as “Only a mere 12.7% (95% CI:12.4 -13.1) were on treatment and out of which only 53.7% (95% CI: 50.1-57.2) had their cholesterol levels controlled”. We apologise to the readers of Global Journal of Health Science for this error.

Electronic cigarettes (e-cigarettes) are handheld devices that deliver an aerosol by heating a solution made up of propylene glycol and/or glycerol with or without flavoring agents and nicotine. This nationwide cross-sectional survey examined factors associated with e-cigarette usage and reasons for its initiation among 13 162 Malaysian adolescents. Data from TECMA (Tobacco and E-Cigarette Survey among Malaysian Adolescents) were used. Nine percent of adolescents had used e-cigarettes in the past month. Males (adjusted odds ratio [aOR] = 4.08; 95% confidence interval [CI] = 3.36-4.95), 16 to 19 year olds (aOR = 2.64; 95% CI = 2.13-3.26), Malays (aOR = 2.25; 95% CI = 1.79-2.83), Sabah and Sarawak Bumiputeras (aOR = 2.25; 95% CI = 1.61-3.15), and cigarette smokers (aOR = 13.16; 95% CI = 11.14-15.54) were more likely to use e-cigarettes. Three main reasons for e-cigarette initiation among adolescents were its taste and smell, experimentation, and popularity. Sale of e-cigarettes with or without nicotine to people aged younger than 18 years should be banned. Flavored e-cigarettes should also be banned since there is evidence suggesting increased appeal among the younger generation.

We assessed the prevalence of cessation of e-cigarette and its associated factors among adolescents in Malaysia. This study analyzed data from the Tobacco and E-Cigarette Survey among Malaysian Adolescent (TECMA) in 2016, a cross-sectional study with 2-stage stratification cluster sampling. A total of 14 832 school-going adolescents aged 10 to 19 years participated in this survey. A complex sampling design and multiple logistic regression analysis were applied. Nearly half of the adolescents (49.9%; 95% confidence interval [CI] = 44.9-55.0) who had ever used e-cigarette ceased the usage. Based on multivariate analysis, adolescents were more likely to quit e-cigarette because they could not afford the e-cigarette (adjusted odds ratio [aOR] = 2.39, 95% CI = 1.78-3.20), if they are aged 13 year and older (aOR = 1.80, 95% CI = 1.25-2.61), and those who claimed their e-cigarette does not contain nicotine (aOR = 1.35, 95% CI = 1.03-1.78). E-cigarette prevention efforts among adolescents could consider the cessation factors described in this study.

Unintentional injuries are a growing problem hindering progress towards the SDGs, especially among children in low- and middle-income countries (LMICs). Each year, approximately 8 75 000 children die of unintentional injuries and tens of millions more are hospitalized or disabled. Most childhood injuries occur within the home and can be prevented. Proven-effective interventions exist; however, scale up has been limited mainly due to insufficient resources. Thus, the problem of child injuries remains unaddressed. Mobile phones are increasingly recognized as a means of improving reach in low-resource settings. We developed and pilot-tested a smartphone application with the aim of reducing childhood injuries in Malaysia. This application presents an innovative, evidence-informed, and cost-effective strategy to deliver injury prevention interventions. However, there is minimal evidence on the effectiveness and implementation of smartphone applications, especially when scaled up within broader health systems. The aim of this study is to explore the implementation and dissemination of a smartphone application to prevent child injuries in Malaysia. We will conduct 15 in-depth interviews with decision-makers who are purposefully selected for their role in child health and safety interventions including program managers, health and day care providers, and community leaders. We will explore child health and safety interventions, perceptions on the use of smartphone applications, and strategies for dissemination. Transcripts will be uploaded to Nvivo 11 and thematic content analysis will be applied to identify relevant themes. From this study, we hope to gain an understanding of the implementation characteristics and dissemination strategies for a smartphone application to prevent child injuries in Malaysia. This knowledge will be used to inform a strategy for scale up as part of a future study, as well as contribute to the evidence base on the use of smartphone applications to deliver injury prevention and other interventions in low resource settings.