Risk factors for low birth weight among rural and urban Malaysian women.

BACKGROUND: Low birth weight prevalence in Malaysia remains high. Socioeconomic background may lead to differences in physical activity and maternal nutritional status, which may play an important role in birth outcomes. METHODS: This prospective cross-sectional study aimed to identify rural-urban differences in risk factors for low birth weight among women in Malaysia. Pregnant women at ≥20 weeks of gestation in urban and rural Malaysia (n = 437) completed questionnaires on sociodemographic characteristics and physical activity. Weight and middle-upper arm circumference were measured. Infant birth outcomes were extracted from medical records. RESULTS: The overall prevalence of low birth weight infants was 6.38%. Rural women had more low birth weight infants than urban women (9.8% vs 2.0%, p = 0.03). Findings showed rural women were less sedentary (p = 0.003) and participated in more household/caregiving activities (p = 0.036), sports activities (p = 0.01) and less occupational activity (p < 0.001) than urban women. Logistic regression revealed that older age (OR = 1.395, 95% Cl = 1.053 to 1.846), low parity (OR = 0.256, 95% Cl = 0.088-0.747) and low middle-upper arm circumference (OR = 0.738, 95% Cl = 0.552 to 0.987) increased the risk of low birth weight infants in rural, but not in urban women. CONCLUSIONS: We observed differences in risk factors for low birth weight between urban and rural pregnant women. Age, malnutrition and low parity were risk factors for low birth weight among rural pregnant women. Our findings suggest that rural pregnant women with low nutritional status should be encouraged to monitor their middle-upper arm circumference consistently throughout pregnancy. Improving nutritional status in rural pregnant women may reduce the risk of low birth weight infants in this population.

Maternal Factors Associated with the Initiation of Exclusive Breastfeeding among Mothers at One Week after Delivery in Two Selected Hospitals in Kelantan, Malaysia.

BACKGROUND: The first week following delivery usually coincides with the initiation of exclusive breastfeeding. This study aimed to determine the prevalence of and the associated factors regarding the initiation of exclusive breastfeeding among mothers at one week after delivery in two selected hospitals in the state of Kelantan, Malaysia. METHODS: A cross-sectional study was conducted from March to August 2015 among post-partum mothers, who were selected through systematic sampling. A newly developed and validated questionnaire on the participants' data, knowledge and attitude items and a breastfeeding practice checklist were used. The mothers were interviewed in the post-natal ward, and their breastfeeding practices were determined through a phone call at one week following delivery. Descriptive statistics and simple and multiple logistic regressions were used for the data analysis. RESULTS: A total of 335 participants were included. The prevalence of exclusive breastfeeding at one week post-partum was 77.9% (95% CI: 73.0%, 82.2%), with significant associated factors being previous exclusive breastfeeding experience [adjusted odds ratio (AOR) 2.48; 95% CI: 1.37, 4.49; P-value = 0.003] and the mean total score of knowledge [AOR 1.06; 95% CI: 1.01, 1.11; P-value = 0.011]. CONCLUSION: Every mother should receive breastfeeding education, with special emphasis on those with no previous experience. The weak areas of knowledge identified herein should be strengthened during health education.

Self-perception and quality of life among overweight and obese rural housewives in Kelantan, Malaysia.

INTRODUCTION: Obesity, in the past was perceived to be the problem of the rich, but recent studies have reported that the problem of obesity is a worldwide problem and rural population is no less affected. Self-perceived health and weight appropriateness is an important component of weight-loss and eating behaviors and may be mediated by local, social and cultural patterning. In addition to the quality of life assessment, it should therefore be an important focal point for the design and implementation of clinical and public health policies. METHODS: The present study was carried out to assess the self-perception of weight appropriateness as well as the quality of life of overweight and obese individual among the rural population particularly among housewives. A total of 421 respondents participated in the study which consisted of 36.6% in the overweight and 63.4% in the obese categories. RESULTS: the analysis of the survey revealed that self-perception regarding obesity among respondents show common similarities, particularly in self reporting on health, dietary habit and also the concept of beauty and a beautiful body. Character and behavior are highly regarded in evaluating a person's self-worth in society. The results on the quality of life using the ORWELL 97 instrument show that the quality of life of respondents was moderate. Most of the respondents were aware of their body weight and indicated an intention to lose weight but also reported themselves as healthy or very healthy. CONCLUSION: The results of the survey indicated that perception on obesity did not differed very much between respondents, in fact there existed a lot of similarities in their perception about health, quality of life, personal health and self-satisfaction with own body. However, their quality of life was within the normal or moderate level based on the ORWELL 97 assessment. Even though most of the respondents were aware of their body weight and indicated an intention to lose weight they also reported themselves as healthy or very healthy, suggesting that public health messages intended for rural housewives need to be more tailored to health-related consequences of fatness.

TRADITIONAL CARDIOVASCULAR RISK-FACTORS AMONG HEALTHCARE WORKERS IN KELANTAN, MALAYSIA.

We conducted a cross sectional study of cardiovascular risk factors among healthcare workers at four government hospitals in Kelantan, Malaysia. We randomly selected 330 subjects fulfilling the following study criteria: those who had been working for at least one year at that health facility, Malaysians citizens and those with some form of direct contact with patients. We conducted an interview, obtained physical measurements, a fasting blood sugar and fasting lipid profiles among 308 subjects. The mean age of the subjects was 43.5 years, 82% were female; 30.8%, 14.3%, 10.4%, 1.3% and 1.6% of the subjects had dyslipidemia, hypertension, diabetes mellitus, a history of stroke and a history of ischemic heart disease, respectively. Forty-two percent of subjects had at least one medical condition. The mean body mass index (BMI) was 27.0 kg/M2 (SD=4.8) and 24.3% had a BMI > or =30 kg/M2. The mean systolic and diastolic blood pressures were 121.5 mmHg (SD=14.0) and 76.5 mmHg (SD=9.7), respectively and the mean waist-hip ratio was 0.84 (SD=0.1). The mean fasting blood sugar, total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein were 5.8 mmol/l (SD=2.4), 5.5 mmol/l (SD=1.0), 1.4 mmol/l (SD=0.9), 1.5 mmol/l (SD=0.3) and 3.5 mmol/l (SD=0.9), respectively. Our study population had a smaller proportion of hypertension than that of the general Malaysian population. They had higher fasting total cholesterol, slightly lower fasting blood sugar, with a large proportion of them, obese and had diabetes. Immediate intervention is needed to reduce the traditional cardiovascular risk factors in this population. Keywords: cardiovascular risk factors, health care workers, Malaysia

Validation of the Malaysian Coping Strategy Instrument to measure household food insecurity in Kelantan, Malaysia.

BACKGROUND: Food insecurity occurs whenever people are not able to access enough food at all times for an active and healthy life or when adequate and safe food acquired by socially acceptable ways is not available. OBJECTIVE: To validate the Malaysian Coping Strategy Instrument (MCSI) to measure household food insecurity in Kelantan, Malaysia. METHODS: A cross-sectional study was conducted on 301 nonpregnant, nonlactating Malay women, aged between 19 and 49 years, living in rural and urban areas. The respondents were interviewed with the use of a structured questionnaire to obtain information on their demographic and socioeconomic characteristics, household food security, and dietary intake. RESULTS: Demographic and socioeconomic characteristics (household size, number of children, number of children attending school, household income, and per capita income) were significantly associated with household food-security status in rural and urban areas. Energy intake, fat intake, percentage of energy from fat, and number of servings of meat,fish, or poultry and legumes were significantly associated with household food-security status in rural areas. The dietary diversity score was significantly associated with household food-security status in rural and urban areas. CONCLUSIONS: Validating the MCSI in other areas of Malaysia as well as in similar settings elsewhere in the world before it is used to measure household food insecurity in the population is strongly recommended. In this study, the MCSI was found to be a reliable and valid measure of household food insecurity based on criterion-related validity, particularly in terms of demographic and socioeconomic characteristics and dietary diversity.

Maternal Obesity and Its Associated Factors and Outcomes in Klang Valley, Malaysia: Findings from National Obstetric Registry.

INTRODUCTION: Maternal obesity presents significant health risks to mothers and their fetuses. This study aimed to determine the proportion, associated factors and outcomes of maternal obesity among pregnant women in Klang Valley, Malaysia. METHODS: A retrospective cross-sectional study was conducted between January 2018 and March 2018 using secondary data from the Malaysian National Obstetric Registry (NOR) for the year 2015. All pregnant women with first-trimester booking at 12 weeks and below that were registered with the NOR and met the inclusion and exclusion criteria were included in the study. Descriptive statistics and multiple logistic regression analysis were used. Data were analysed using SPSS version 22.0. A total of 2113 respondents were included in this study to determine the proportion, associated factors and outcomes of maternal obesity. Regarding the univariate and multivariate analyses, respondents were classified into two groups: normal and obese. The obese group comprised overweight and obese mothers. The underweight group was excluded in the subsequent analysis. RESULTS: Out of the 2113 respondents, 7.1% were underweight, 41.7% were of normal weight, 28.6% were overweight, 15.9% were in obese class I, 4.6% were in obese class II, and 2.1% were in obese class III according to the WHO (1995) reference. However, when the MOH (2003) cutoff point was used, there was a marked increase in the proportion of respondents in the overweight categories by 2.7% and obesity class I by 12.8%. The Indian (AdjOR 2.06, 95% CI: 1.11, 3.83, p=0.021) and Malay (AdjOR 1.75, 95% CI: 1.02, 3.00, p=0.040) ethnicities, as well as both multiparity (AdjOR 1.46, 95% CI: 1.23, 1.73, p <0.001) and grand multiparity (AdjOR 2.41, 95% CI: 1.78, 3.26, p <0.001), were significantly associated with maternal obesity. There were significant association between maternal obesity with hypertensive disorder in pregnancy (p=0.025), caesarean section delivery (p=0.002) and macrosomic infant (p <0.001). CONCLUSION: The identification of risk factors for maternal obesity is important to facilitate intervention programmes focused on improving the pregnancy outcomes for a high-risk group of women.

Postnatal breastfeeding education at one week after childbirth: What are the effects?

BACKGROUND: The first week after childbirth is a crucial period for exclusive breastfeeding initiation. OBJECTIVE: This study aims to determine the association of postnatal breastfeeding education with knowledge, attitude, and exclusive breastfeeding practice at six months after childbirth among women who delivered at two district hospitals in the northeast part of Peninsular Malaysia. METHODS: This is a quasi-experimental study design. A newly developed and validated questionnaire was used to determine scoring for baseline and six months after childbirth. The intervention consisted of individualized postnatal breastfeeding education delivered by researchers using flipchart one week after childbirth and breastfeeding diary in addition to usual care. The comparison group received the usual postnatal care by health clinics. Repeated measure analysis of variance and multiple logistic regression analysis were used. RESULTS: A total of 116 participants were included in this study (59 in intervention group and 57 in comparison group). Six months after childbirth, the adjusted mean score of knowledge and attitude of the intervention group were significantly higher than that of the comparison group (p<0.001 and p=0.002, respectively). More participants in the intervention group (n=26, 44.1%) exclusively breastfed their infants compared with 15 (26.3%) in the comparison group (p=0.046). Postnatal breastfeeding education was significantly associated with exclusive breastfeeding practice six months after childbirth [adjusted odds ratio 2.31; 95% confidence interval: 1.02, 5.14; p=0.040]. CONCLUSIONS: Postnatal breastfeeding education was significantly associated with an improvement in women's knowledge, attitude and exclusive breastfeeding practice six months after childbirth.

Effect of physical activity on severity of primary angle closure glaucoma.

OBJECTIVE: To determine the association between physical activity and severity of primary angle closure glaucoma in Malay patients. METHODS: A cross-sectional study was conducted involving 150 primary angle closure glaucoma patients between April 2014 and August 2016. Using the International Physical Activity Questionnaire, the physical activity status was assessed and divided into three categories: mild, moderate and heavy physical activity. The duration of physical activity and corresponding minimum energy requirements were calculated. Ocular examination was performed including Humphrey visual field 24-2 analysis assessment. Based on two consecutive reliable Humphrey visual fields, the severity of glaucoma was scored according to modified Advanced Glaucoma Intervention Study and classified as mild (0-5), moderate (6-11) and severe (12-20). Association between physical activity and Advanced Glaucoma Intervention Study score was determined with multiple linear regression analysis. RESULTS: A total of 150 Malay patients with primary angle closure glaucoma were included (50 patients with mild, 50 with moderate and 50 with severe glaucoma). Physical activity showed inverse association with the severity of primary angle closure glaucoma. After calculating adjustments for age, sex, duration of glaucoma, body mass index, systemic co-morbidities, family history of glaucoma, myopia and educational status [adjusted b -3.41, 95% confidence interval (-5.23, -1.59), p < 0.001], there was also an inverse relationship with Advanced Glaucoma Intervention Study score. Every increase in physical activity level reduces the Advanced Glaucoma Intervention Study score by 3.4 point. CONCLUSION: Physical activity is the potential modifiable risk factor in reducing the severity of glaucoma among primary angle closure glaucoma patients. However, there is possibility of the severity of glaucoma restricted the physical activity of primary angle closure glaucoma patients.

Socioeconomic Status and Glycemic Index Among Punjabis in Kuala Lumpur, Malaysia: Possible Association with Metabolic Syndrome.

There are only limited reports on Punjabi's health status in Malaysia. This cross-sectional study assessed the prevalence of metabolic syndrome (Mets) and its risk factors among 277 subjects recruited from the Malaysian Punjabi community. Overall prevalence of Mets was 43%, but 61% among females. Subjects classified with Mets had significantly (p < 0.05) higher body mass index, visceral fat and percentage of body fat. Daily carbohydrate and glycemic index (GI) were also higher among Mets subjects (p < 0.05). Logistics regression analysis showed that primary level of education (OR 5.57, CI 1.29-23.97, p = 0.021) was a factor associated with Mets, followed by middle household income (OR 2.30, CI 1.01-5.20, p = 0.046), GI (OR 1.03, CI 1.00-1.06, p = 0.026), and age (OR 1.03, CI 1.00-1.05, p = 0.023). Mets shows high prevalence among the studied Punjabi population, prompting the consideration of adequate preventive measures, primarily among lower socioeconomic groups.

Understanding Dieting and Previous Weight Loss Attempts among Overweight and Obese Participants: Insights into My Body Is Fit and Fabulous at Work Program.

BACKGROUND: A qualitative study providing an in-depth exploration of people's view and the increasing burden of overweight and obesity is required. This study aimed to explore the understanding of dieting and previous experiences on weight loss attempts among overweight and obese government employees in Kelantan, Malaysia, prior to recruitment into the intervention program. METHODS: Thirteen focus group discussions involving 129 participants from a weight-loss intervention program were conducted within the first 1 month of recruitment. These discussions were moderated by two trained researchers in the Malay language and assisted by an interview guide. They were audio-recorded and transcribed verbatim. A thematic analysis was performed, and codes and themes from each discussion were constructed. RESULTS: The participants understood dieting with various meanings, including skipping meals and removing rice from daily diets. They applied numerous methods to lose weight and achieved various outcomes. Health and appearance, social support, and compliance with current trends were the factors motivating these participants to lose weight. Their determination to lose weight was limited by lack of self-control and motivation, experiences of unpleasant effects, influence on weight, and environmental and health factors. CONCLUSION: Real-life weight loss experiences and perceptions provided relevant insights into current weight loss management strategies. Some of these issues and misunderstandings should be emphasized in weight loss strategies during health promotion.

Food insecurity and the metabolic syndrome among women from low income communities in Malaysia.

This cross-sectional study examined the relationship between household food insecurity and the metabolic syndrome (MetS) among reproductive-aged women (n=625) in low income communities. The Radimer/Cornell Hunger and Food Insecurity instrument was utilized to assess food insecurity. Anthropometry, diet diversity, blood pressure and fasting venous blood for lipid and glucose profile were also obtained. MetS was defined as having at least 3 risk factors and is in accordance with the Harmonized criteria. The prevalence of food insecurity and MetS was 78.4% (household food insecure, 26.7%; individual food insecure, 25.3%; child hunger, 26.4%) and 25.6%, respectively. While more food secure than food insecure women had elevated glucose (food secure, 54.8% vs food insecure, 37.3-46.1%), total cholesterol (food secure, 54.1% vs food insecure, 32.1-40.7%) and LDL-cholesterol (food secure, 63.7% vs food insecure, 40.6-48.7%), the percentage of women with overweight/ obesity, abdominal obesity, hypertension, high triglyceride, low HDL-cholesterol and MetS did not vary significantly by food insecurity status. However, after controlling for demographic and socioeconomic covariates, women in food insecure households were less likely to have MetS (individual food insecure and child hunger) (p<0.05), abdominal obesity (individual food insecure and child hunger) (p<0.01), elevated glucose (household food insecure), total cholesterol (child hunger) (p<0.05) and LDL-cholesterol (household food insecure and child hunger) (p<0.05) compared to food secure women. Efforts to improve food insecurity of low income households undergoing nutrition transition should address availability and accessibility to healthy food choices and nutrition education that could reduce the risk of diet-related chronic diseases.

Reduced fibrinogen, fibrinolytic biomarkers, and physical parameters after a weight-loss program in obese subjects.

BACKGROUND: Obese subjects are at risk of multiple comorbidities including stroke and coronary heart disease (CHD), which is partly due to disturbances in the hemostatic system. AIMS: The aims of the present study were to determine the effects of a weight-loss program on fibrinogen and fibrinolytic markers. MATERIALS AND METHODS: Twenty-eight obese subjects were involved in a weight-loss program consisted of exercise and nutritional education for 12-weeks duration. Physical parameters were documented and blood specimen was tested at pre and post-intervention for fibrinogen, tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), and thrombin activatable fibrinolysis inhibitor (TAFI). Paired t-test was used for statistical analysis. RESULTS: There was a significant decline in the levels of t-PA, PAI-I, TAFI and fibrinogen following the weight-loss program (P < 0.01 for each). A significant positive correlation between tPA levels and body weight, body mass index (BMI), waist circumference, and fat-free mass were found. There was also a significant correlation betwen BMI and other blood parameters. CONCLUSION: Reduced fibrinogen, fibrinolytic, and physical parameters were demonstrated in obese subjects following the weight reduction program. These findings suggest the possible beneficial effects of this program on the hemostatic burden particularly on the fibrinolytic biomarkers.

Association between household food insecurity and nutritional outcomes among children in Northeastern of Peninsular Malaysia.

BACKGROUND/OBJECTIVES: The purpose of the study was to investigate the relationship between household food insecurity and nutritional status of children in low-income households. A cross sectional study involved a survey of households (n = 223) receiving the financial assistance. SUBJECTS/METHODS: Eligible mothers that fulfilled the inclusion criteria such as non-pregnant, non-lactating mothers, aged 18 to 55 years with their youngest children aged 2 to 12 years, were purposively selected. The Radimer/Cornell hunger and food-insecurity instrument was administered and children's height and weight were measured. RESULTS: About 16.1% of the households were food secure, while 83.9% experienced some kind of food insecurity. Out of food insecure category, 29.6% households were food insecure, 19.3% women were individual food insecure and 35.0% fell into the child hunger category. Education of the mother (P = 0.047), household size (P = 0.024), number of children (P = 0.024), number of children going to school (P = 0.048), total monthly income (P < 0.001), income per capital (P < 0.001), number of household members contributing to the income (P = 0.018) and food expenditure (P = 0.006) were significant risk factors for household food insecurity. The prevalence of underweight, stunting and wasting in children were 61.0%, 61.4% and 30.6% respectively. Based on multinomial logistic regression, children in food-insecure households were 2.15 times more likely to be underweight and three times to be stunted than children in the food-secure households. CONCLUSIONS: The findings suggest that household food insecurity is associated with the nutritional status of the children in the rural area of Northeastern Peninsular Malaysia.

Validity and reliability of the Malay version of WHO Women's Health and Life Experiences Questionnaire.

The Women's Health and Life Experiences questionnaire measures the prevalence, health implications, and risk factors for domestic violence. This cross-sectional study was conducted to determine the validity and reliability of the Malay version of World Health Organization (WHO) Women's Health and Life Experiences Questionnaire. Construct validity and reliability assessment of the Malay version of the questionnaire was done on 20 specific items that measure four types of intimate partner violence (IPV) act; controlling behaviors (CB), emotional violence (EV), physical violence (PV), and sexual violence (SV), which were considered as the domains of interest. Face-to-face interviewing method was used for data collection. A total of 922 women completed the interviews. The results showed that exploratory factor analysis of four factors with eigenvalues above 1 accounted for 63.83% of the variance. Exploratory factor analysis revealed that all items loaded above 0.40 and the majority of items loaded on factors that were generally consistent with the proposed construct. The internal consistency reliability was good. The Cronbach's α values ranged from 0.767 to 0.858 across domains. The Malay version of WHO Women's Health and Life Experiences Questionnaire is a valid and reliable measure of women's health and experiences of IPV in Malaysia.

Breast milk expression among formally employed women in urban and rural Malaysia: A qualitative study.

BACKGROUND: Many women are unable to practice exclusive breastfeeding because they are separated from their infants while working. Expressing their breast milk helps them to continue breastfeeding. This study explores the perception and experiences related to the feasibility, acceptability and safety of breast milk expression among formally employed women in Kelantan, Malaysia. METHODS: A qualitative method using in-depth interviews was conducted from December 2008 to December 2009 among Malay women from urban and rural areas. A snowball sampling method was used to recruit the informants, and the interviews, which were facilitated by an interview guide, were audio-recorded and transcribed verbatim. Thematic analysis was conducted, with construction of codes and themes from each interview. RESULTS: Analysis of the interviews with 20 informants identified three themes related to breast milk expression. The themes were as follows: (i) lack of feasibility of expressing breast milk, (ii) negative feelings about expressing breast milk, and (iii) doubts about the safety and hygiene of expressed breast milk. The informants who did not practice exclusive breastfeeding believed that expressing their breast milk was not feasible, commonly because they felt there were not enough facilities for them. They also had negative feelings such as embarrassment. The safety and hygiene of the expressed breast milk was also their main concern. CONCLUSION: More practical and focused education, as well as provision of facilities, is needed for women to effectively and safely express and store their breast milk. The issue of inadequate milk production should be emphasized, especially by encouraging them to express their breast milk as a way to improve milk production.