Stroke Survivors' Dependency Level and Informal Caregivers' Quality of Life in Kelantan, Malaysia: Examining the Mediating Role of Psychological Distress.

BACKGROUND: Caring for stroke survivors can affect the caregiver's life, especially with the increment of patients' dependency level. This led to depression, anxiety, and stress in the caregiver, impacting their quality of life (QoL). This study aims to model relationships between caregivers' factors and stroke survivors' factors with caregivers' QoL and to estimate the mediation effects of caregivers' depression, anxiety, and stress in the relationships between stroke survivors' dependency level and caregivers' QoL.  Methods: Data from a cross-sectional study with a sample size of 250 subjects was analyzed. Linear regression was done to model the relationship between stroke survivors' factors and caregivers' factors with caregivers' QoL. Hayes's PROCESS macro model 4 for bootstrapping indirect effects was used to estimate the mediation effects of depression, anxiety, and stress in the relationship between stroke survivors' dependency level and caregivers' QoL. RESULTS: Stroke survivors' dependency levels that were measured by the Modified Barthel Index score (b=0.14; 95% CI: 0.07, 0.20), caregivers' depression score (b=-0.81; 95% CI: -1.44, -0.20), and caregivers' anxiety score (b=-0.73; 95% CI: -1.34, -0.12) were found to be associated with caregivers' QoL. Caregivers' depression score (effect=0.02; 95% CI for bootstrapping: 0.01, 0.04) and caregivers' anxiety score (effect=0.01; 95% CI for bootstrapping: 0.01, 0.04) were found as partial mediators in the relationship between stroke survivors' dependency level and caregivers' QoL. CONCLUSION:  Stroke survivors' dependency level and caregivers' depression and anxiety significantly impact caregivers' QoL, with the latter factors partially mediating this relationship. Interventions such as providing caregivers with psychological support, stress management programs, and training in caregiving skills could help mitigate these impacts and improve caregivers' QoL.

Individual and contextual factors associated with measles infection in Malaysia: a multilevel analysis.

Objectives: Despite effective vaccination strategies, measles remains a global public health challenge. The study explored individual and contextual factors associated with measles infection in Malaysia from 2018 to 2022, informing the development of targeted public health interventions. Methods: This cross-sectional study utilised data from the Ministry of Health, the Department of Statistics, and the Department of Environment Malaysia. Multilevel logistic regression analysis was employed to examine individual-level factors, including age, sex, ethnicity, nationality, contact history, travel history, and vaccination status. Concurrently, contextual factors were assessed, encompassing district-level determinants such as population density, median household income, urbanisation, the number of health and rural clinics, vaccination rates, PM2.5 levels, relative humidity, and temperature, to determine their impact on measles infection risk. Results: Measles infection was significantly associated with various individual factors. These included age (adjusted odds ratio [aOR], 1.02; 95% confidence interval [CI], 1.02-1.03), ethnicity, non-Malaysian nationality (aOR, 34.53; 95% CI, 8.42-141.51), prior contact with a measles case (aOR, 2.36; 95% CI, 2.07-2.69), travel history (aOR, 2.30; 95% CI, 1.13-4.70), and vaccination status (aOR, 0.76; 95% CI, 0.72-0.79). Among contextual factors, urbanisation (aOR, 1.56; 95% CI, 1.16-2.10) and the number of clinics (aOR, 0.98; 95% CI, 0.97-0.99) were significant determinants. Conclusion: This multilevel logistic regression analysis illuminates the complexities of measles transmission, advocating public health interventions tailored to individual and contextual vulnerabilities. The findings highlight the need for a synergistic approach that combines vaccination campaigns, healthcare accessibility improvements, and socioeconomic interventions to effectively combat measles.

Translation and Validation of the Risk Perception on Safety and Health Questionnaire Among Palm Oil Plantation Workers in Terengganu, Malaysia.

INTRODUCTION: Occupational safety and health are of utmost importance in the palm oil industry, particularly in Malaysia where palm oil plantation workers face various hazards. This study aimed to translate and validate a risk perception questionnaire specifically designed to assess the perceptions of safety and health risks among palm oil plantation workers in Terengganu, Malaysia. METHODOLOGY: The original risk perception questionnaire, consisting of 22 items, was translated into the local language and culturally adapted. The translation process involved forward translation, expert panel discussions, and back translation to ensure linguistic equivalence. The translated questionnaire was then administered to a sample of palm oil plantation workers in Terengganu, Malaysia, for validation purposes. Confirmatory factor analysis (CFA) was conducted to assess the model fitness of the questionnaire, and Cronbach's Alpha coefficient was calculated to determine the internal consistency reliability of the final model. RESULTS: The translated risk perception questionnaire demonstrated good model fitness as indicated by CFA results (X2=224, df=79, p-value<0.0001, root mean square error of approximation (RMSEA)=0.07, goodness of fit index (GFI)=0.929, comparative fit index (CFI)=0.902). The questionnaire's final version has one factor comprising 13 items, selected based on factor loadings and theoretical relevance. The internal consistency reliability of the 13-item questionnaire was satisfactory, with a Cronbach's Alpha coefficient of α=0.77. CONCLUSION: The 13-item risk perception questionnaire demonstrated a good model fit and acceptable internal consistency reliability. It shows that the questionnaire is a valid and reliable tool to evaluate the level of risk perception on safety and health among palm oil plantation workers in Malaysia.

Developing a Supplementary Diagnostic Tool for Breast Cancer Risk Estimation Using Ensemble Transfer Learning.

Breast cancer is the most prevalent cancer worldwide. Thus, it is necessary to improve the efficiency of the medical workflow of the disease. Therefore, this study aims to develop a supplementary diagnostic tool for radiologists using ensemble transfer learning and digital mammograms. The digital mammograms and their associated information were collected from the department of radiology and pathology at Hospital Universiti Sains Malaysia. Thirteen pre-trained networks were selected and tested in this study. ResNet101V2 and ResNet152 had the highest mean PR-AUC, MobileNetV3Small and ResNet152 had the highest mean precision, ResNet101 had the highest mean F1 score, and ResNet152 and ResNet152V2 had the highest mean Youden J index. Subsequently, three ensemble models were developed using the top three pre-trained networks whose ranking was based on PR-AUC values, precision, and F1 scores. The final ensemble model, which consisted of Resnet101, Resnet152, and ResNet50V2, had a mean precision value, F1 score, and Youden J index of 0.82, 0.68, and 0.12, respectively. Additionally, the final model demonstrated balanced performance across mammographic density. In conclusion, this study demonstrates the good performance of ensemble transfer learning and digital mammograms in breast cancer risk estimation. This model can be utilised as a supplementary diagnostic tool for radiologists, thus reducing their workloads and further improving the medical workflow in the screening and diagnosis of breast cancer.

Master of Science in Medical Statistics Programme at Universiti Sains Malaysia: 20 Years Ongoing.

Health and medical research are important parts of the curriculum of medical and health programmes in universities and play an important role in the functioning of organisations related to health care. There is a shortage of well-trained health and medical research statisticians. This article describes the courses and structure of the Master of Science in Medical Statistics programme at Universiti Sains Malaysia (USM), as well as the graduates' achievements. It is a 2-year programme that prepares qualified and competent graduates in statistical methods and data analysis for research in health and medical sciences. The Biostatistics and Research Methodology Unit, School of Medical Sciences, USM has been running the programme since 2003. It is currently the only medical statistics programme available in Malaysia. There have been 97 graduates since 2005, with an employment rate of 96.7% and a successful subsequent doctorate rate of 21.1%. Most of the students returned to their previous employments, mainly with the Ministry of Health of Malaysia and several others became lecturers, statisticians or research officers. The employability of graduates from this programme is very high and their professional future is bright. We hope our graduates will impart their knowledge and skills to the nation.

Prevalence and Factors Influencing Smoking Behavior among Female Inmates in Malaysia.

BACKGROUND: Lately, smoking among adolescents is increasing despite various campaigns to address it being carried out. Previously, this habit was common among men, however, nowadays, smoking has become a habit for women as well. The purpose of this study was to determine the prevalence and its associated factors that influence smoking behavior among women inmates in Kelantan. METHODS: A cross-sectional study was carried out among women inmates from Pengkalan Chepa Women's Prison, Kota Bharu, Kelantan. A total of 274 respondents were needed to answer a self-administered questionnaire. The data were analyzed using Multiple Logistic Regression. RESULTS: A total of 183 participants were smokers. Women who were single and divorced had a lower chance of being influenced to smoke compared to married women. Parents with smoking habits were more associated with children who smoked compared to parents who did not smoke. A participant with secondary level education had higher odds of smoking compared to a participant with primary level education. Smoking peers significantly influenced their friends and, therefore, peer practice was a main factor influencing smoking among women inmates. CONCLUSION: The prevalence of smoking among women inmates in Kelantan was found to be quite high. Religion (majority (90.5%) of women in the study were Muslims; it would be inappropriate to draw conclusion that religion is an influencing factor), marital status, parents' practice, peer practice and education significantly influenced women inmates to smoke.

Impact of a Health Education Intervention on the Incidence of Influenza-Like Illnesses (ILI) During Hajj via Smartphone Application.

This study was aimed at demonstrating the impact of a health education intervention on reducing the incidence of influenza-like illnesses symptoms among Malaysian Hajj pilgrims. This study utilizes a quasi-experimental study in the evaluation of the impact of the intervention. Participants were recruited during Hajj orientation courses organized by private Hajj companies. Participants from two companies were assigned to an intervention group and control group, respectively. The intervention group received a smartphone-based health education intervention guided by the Health Belief Model (HBM), while the control group received a regular Hajj guide intervention smartphone application before departure to Hajj. Data on the incidence of influenza-like illnesses (ILI) were collected from participants from two Hajj companies before and after returning from Hajj. Data analysis was conducted using SPSS with descriptive analysis, and analytical tests were conducted at 5% significance level. A total of 102 pilgrims completed the study in both intervention and control groups. The incidence of ILI and Non-ILI symptoms were statistically significant when the intervention and control groups (p = 0.049) were compared. In conclusion, health education has an impact on reducing the incidence of ILI and non-ILI among Hajj pilgrims.

A scoping review on the relationship between mental wellbeing and medical professionalism.

BACKGROUND: Mental wellbeing issues among medical students are common, and their relationship to medical professionalism is debated. Few studies have attempted to link such issues with undergraduate medical education. This review aimed to advance the knowledge on this matter by exploring the relationship between mental wellbeing and medical professionalism in undergraduate medical education. METHODS: We collected the literature about mental wellbeing and medical professionalism (published from 1 January 1986 to 31 March 2021) from the Web of Science, PubMed, Scopus and ScienceDirect databases using the search terms 'mental wellbeing' and 'medical professionalism'.We included all peer-reviewed articles in which mental wellbeing and medical professionalism in the undergraduate medical education context were the central topics regardless of the age range, nationality, race and gender of the participants. RESULTS: From the 13,076 Iinitially found articles, 16 were included. These 16 articles were from nine countries in four different continents, which all together helped us find answer to our research question using extracted points relating to the main study themes (mental wellbeing and medical professionalism). Under theme 1 (mental wellbeing), six subthemes emerged: burnout, stress, depression, disappointment, depersonalisation and conscientiousness. Theme 2 (medical professionalism), on the other hand, had five subthemes: empathy, academic performance, compassion, unprofessional behaviour and professionalism. A significant inverse association was found between empathy and burnout. Academic performance was also related to burnout. At the same time, empathy was found to have a varied association with stress. Moreover, compassion was found to alleviate burnout and nurture professional gratification. CONCLUSION: The medical professionalism attributes were found to deteriorate as the mental wellbeing issues grow. This can harm medical students' overall health, current learning abilities and future attitudes towards their patients. Explicit primary research is thus required to examine and intervene in the cause-effect relationship between medical professionalism and mental wellbeing.

Over-the-Counter Breast Cancer Classification Using Machine Learning and Patient Registration Records.

This study aims to determine the feasibility of machine learning (ML) and patient registration record to be utilised to develop an over-the-counter (OTC) screening model for breast cancer risk estimation. Data were retrospectively collected from women who came to the Hospital Universiti Sains Malaysia, Malaysia for breast-related problems. Eight ML models were used: k-nearest neighbour (kNN), elastic-net logistic regression, multivariate adaptive regression splines, artificial neural network, partial least square, random forest, support vector machine (SVM), and extreme gradient boosting. Features utilised for the development of the screening models were limited to information in the patient registration form. The final model was evaluated in terms of performance across a mammographic density. Additionally, the feature importance of the final model was assessed using the model agnostic approach. kNN had the highest Youden J index, precision, and PR-AUC, while SVM had the highest F2 score. The kNN model was selected as the final model. The model had a balanced performance in terms of sensitivity, specificity, and PR-AUC across the mammographic density groups. The most important feature was the age at examination. In conclusion, this study showed that ML and patient registration information are feasible to be used as the OTC screening model for breast cancer.

Partial Verification Bias Correction Using Inverse Probability Bootstrap Sampling for Binary Diagnostic Tests.

In medical care, it is important to evaluate any new diagnostic test in the form of diagnostic accuracy studies. These new tests are compared to gold standard tests, where the performance of binary diagnostic tests is usually measured by sensitivity (Sn) and specificity (Sp). However, these accuracy measures are often biased owing to selective verification of the patients, known as partial verification bias (PVB). Inverse probability bootstrap (IPB) sampling is a general method to correct sampling bias in model-based analysis and produces debiased data for analysis. However, its utility in PVB correction has not been investigated before. The objective of this study was to investigate IPB in the context of PVB correction under the missing-at-random assumption for binary diagnostic tests. IPB was adapted for PVB correction, and tested and compared with existing methods using simulated and clinical data sets. The results indicated that IPB is accurate for Sn and Sp estimation as it showed low bias. However, IPB was less precise than existing methods as indicated by the higher standard error (SE). Despite this issue, it is recommended to use IPB when subsequent analysis with full data analytic methods is expected. Further studies must be conducted to reduce the SE.

Factors Influencing Mammographic Density in Asian Women: A Retrospective Cohort Study in the Northeast Region of Peninsular Malaysia.

Mammographic density is a significant risk factor for breast cancer. In this study, we identified the risk factors of mammographic density in Asian women and quantified the impact of breast density on the severity of breast cancer. We collected data from Hospital Universiti Sains Malaysia, a research- and university-based hospital located in Kelantan, Malaysia. Multivariable logistic regression was performed to analyse the data. Five significant factors were found to be associated with mammographic density: age (OR: 0.94; 95% CI: 0.92, 0.96), number of children (OR: 0.88; 95% CI: 0.81, 0.96), body mass index (OR: 0.88; 95% CI: 0.85, 0.92), menopause status (yes vs. no, OR: 0.59; 95% CI: 0.42, 0.82), and BI-RADS classification (2 vs. 1, OR: 1.87; 95% CI: 1.22, 2.84; 3 vs. 1, OR: 3.25; 95% CI: 1.86, 5.66; 4 vs. 1, OR: 3.75; 95% CI: 1.88, 7.46; 5 vs. 1, OR: 2.46; 95% CI: 1.21, 5.02; 6 vs. 1, OR: 2.50; 95% CI: 0.65, 9.56). Similarly, the average predicted probabilities were higher among BI-RADS 3 and 4 classified women. Understanding mammographic density and its influencing factors aids in accurately assessing and screening dense breast women.

Motion characteristics of subclinical tremors in Parkinson's disease and normal subjects.

The characteristics of the Parkinson's disease tremor reported previously are not applicable to the full spectrum of severity. The characteristics of high- and low-amplitude tremors differ in signal regularity and frequency dispersion, a phenomenon that indicates characterisation should be studied separately based on the severity. The subclinical tremor of Parkinson's disease is close to physiological tremor in terms of amplitude and frequency, and their distinctive features are still undetermined. We aimed to determine joint motion characteristics that are unique to subclinical Parkinson's disease tremors. The tremors were characterised by four hand-arm motions based on displacement and peak frequencies. The rest and postural tremors of 63 patients with Parkinson's disease and 62 normal subjects were measured with inertial sensors. The baseline was established from normal tremors, and the joint motions were compared within and between the two subject groups. Displacement analysis showed that pronation-supination and wrist abduction-adduction are the most and least predominant tremor motions for both Parkinson's disease and normal tremors, respectively. However, the subclinical Parkinson's disease tremor has significant greater amplitude and peak frequency in specific predominant motions compared with the normal tremor. The flexion-extension of normal postural tremor increases in frequency from the proximal to distal segment, a phenomenon that is explainable by mechanical oscillation. This characteristic is also observed in patients with Parkinson's disease but with amplification in wrist and elbow joints. The contributed distinctive characteristics of subclinical tremors provide clues on the physiological manifestation that is a result of the neuromuscular mechanism of Parkinson's disease.

Effective coping strategies utilised by medical students for mental health disorders during undergraduate medical education-a scoping review.

BACKGROUND: Coping denotes cognitive, emotional and behavioural struggles to tackle a troubled person-environment association. Therefore, coping strategies (CSs) are vital for mental well-being. Widespread research studies have explored this domain, targeting caregivers, nurses, physicians and medical teachers, but limited research has been done to explore the common CSs utilised by medical students at the undergraduate medical education level. Therefore, we aimed to identify the frequently occurring CSs and their effects on mental health disorders (MHDs) through the evidence available in the existing literature. METHODS: For this scoping review, we searched the available literature (articles published from January 1, 1986, to March 31, 2021) on CSs at Google Scholar, PubMed and Scopus using the terms coping, medical students and undergraduate medical education. We included in our search all peer-reviewed journal articles whose central topics were the CSs employed by undergraduate medical students of any age, nationality, race and gender. RESULTS: From among the 2,134 articles that were found, 24 were ultimately included in the study. The articles were authored in 14 countries, allowing us to gather broader data to answer our research question. The first identified theme (MHDs) had four subthemes: stress (55% of the articles), depression (30%), anxiety (25%) and burnout (15%). The second theme (CSs), on the other hand, had eight subthemes: support seeking (60%), active coping (40%), acceptance (40%), avoidance/denial (40%), substance abuse (35%), faith/religion (25%), sports (25%) and miscellaneous (40%). CONCLUSIONS: Themes and subthemes were identified about the most common CSs utilised by undergraduate medical students to tackle common MHDs in the context of medical education. Among the most used CSs was support (social and emotional) seeking. Teaching medical students how to cope with challenging times is essential.

Correcting for partial verification bias in diagnostic accuracy studies: A tutorial using R.

Diagnostic tests play a crucial role in medical care. Thus any new diagnostic tests must undergo a thorough evaluation. New diagnostic tests are evaluated in comparison with the respective gold standard tests. The performance of binary diagnostic tests is quantified by accuracy measures, with sensitivity and specificity being the most important measures. In any diagnostic accuracy study, the estimates of these measures are often biased owing to selective verification of the patients, which is referred to as partial verification bias. Several methods for correcting partial verification bias are available depending on the scale of the index test, target outcome, and missing data mechanism. However, these are not easily accessible to the researchers due to the complexity of the methods. This article aims to provide a brief overview of the methods available to correct for partial verification bias involving a binary diagnostic test and provide a practical tutorial on how to implement the methods using the statistical programming language R.

Risk Factors for COVID-19 Mortality in Malaysia.

Background: Understanding the risks of COVID-19 mortality helps in the planning and prevention of the disease. This study aimed to determine the risk factors for COVID-19 mortality in Malaysia. Methods: Secondary online data provided by the Ministry of Health, Malaysia and Malaysia's national COVID-19 immunisation programme were used: i) COVID-19 deaths data; ii) vaccination coverage data and iii) population estimate data. Quasi-Poisson regression was performed to determine the risk factors for COVID-19 mortality. Results: Four risk factors were identified: i) vaccination status (partial versus unvaccinated, incidence rate ratio [IRR]: 0.59; 95% CI: 0.54, 0.64; complete versus unvaccinated, IRR: 0.50; 95% CI: 0.45, 0.56; booster versus unvaccinated, IRR: 0.13; 95% CI: 0.05, 0.26); ii) age group (19 years old-59 years old versus above 60 years old, IRR: 0.90; 95% CI: 0.84, 0.97; 13 years old-18 years old versus above 60 years old, IRR: 0.09; 95% CI: 0.04, 0.19; 6 years old-12 years old versus above 60 years old, IRR: 0.09; 95% CI: 0.03, 0.22; below 5 years old versus above 60 years old, IRR: 0.11; 95% CI: 0.04, 0.23); iii) gender (male versus female, IRR: 1.23; 95% CI: 1.14, 1.32) and iv) comorbidity (yes versus no, IRR: 2.13; 95% CI: 1.96, 2.32). Conclusion: This study highlighted the risk factors for COVID-19 mortality and the benefit of COVID-19 vaccination, especially of booster vaccination, in reducing the risk of COVID-19 mortality in Malaysia.

Effectiveness of a Novel Smartphone Health Education Intervention in Enhancing Knowledge, Attitudes, and Practices for the Prevention of Respiratory Tract Infections Among Private Hajj Pilgrims From Malaysia.

This study was aimed to develop and evaluate the efficacy of a health education program for increasing knowledge, changing attitudes, and promoting prevention practices to reduce the incidence of RTIs among Malaysian Hajj pilgrims. A quasi-experimental study was done among 130 Hajj pilgrims attending Hajj orientation course organized by a private Hajj tour companies. Hajj pilgrims assigned to intervention group (n = 65) and control group (n = 65). Data were collected baseline and after return from Hajj using a validated questionnaire. Mixed design repeated measure ANOVA was used to analyse the effect of group, time, and group-time interaction on the dependent variables. There was a significant improvement in knowledge, attitude and practice scores in the intervention group compared to the control group. Based on the findings of the interaction of time and group, there was a significant statistical difference for post intervention for knowledge (p = 0.005), attitude (p = 0.041), and practice (p = 0.002). The newly-established health education intervention smartphone application was effective in improving KAP toward RTIs prevention among pilgrims.

Scoping Review of frequently highlighted attributes of Medical Professionalism in an Undergraduate Medical Education Context.

BACKGROUND AND OBJECTIVES: Medical Professionalism (MP) establishes the trust between society and doctors. We aimed at finding frequently highlighted qualities of MP in the literature. METHODS: We searched PubMed and Scopus for attributes of MP, using terms, "Professionalism," "Medical Students," and "Undergraduate Medical Education". We included English language, original research articles with MP attributes from the perspective of undergraduate medical education, any nationality, race, gender, and age range, as the central topic of the article. Papers published from January 1st 1986 to 29th February 2020 were included. RESULTS: From 1349 identified articles, finally, 18 were included, authored in 10 countries, collectively contributing to answering the scoping review question. Two themes were identified: (1) Nurturing of MP, 11 (61.11%) out of 18 included articles, highlighted "respect" as the most dominant attribute as it appeared in 6 (54.55%) out of 11 reviews, "communication" 5 (45.45 %) studies and "honesty" and "integrity" 4 (36.36%). (2) Assessment of MP, 7 (38.89%) studies, and majority, 4 (57.14 %) assessed MP using American Board of Internal Medicine's elements of MP, viz, "altruism, accountability, excellence, duty, honor and integrity, respect for others." CONCLUSIONS: Themes exemplified MP's most discoursed issues. The attributes are frequently used worldwide. MP deliberates as a commitment toward the individual patient, society, and necessitates transforming from its present generic form to more explicit details.

Modelling knowledge, health beliefs, and health-promoting behaviours related to cardiovascular disease prevention among Malaysian university students.

BACKGROUND: Healthy lifestyle habits formed during young adulthood may have a sustaining impact on health across later life. The current study aimed to test the theoretical model of factors (selected demographic variables, knowledge of heart disease, health belief related to cardiovascular disease (CVD), self-efficacy, cues to action, and screening intention) influencing health-promoting behaviours among Malaysian university students. METHODS: In a cross-sectional survey, the undergraduate students in Universiti Sains Malaysia were invited to complete the self-administered questionnaires. Participants were selected using a purposive sampling method. The proposed hypothesised model was analysed using a structural equation modelling with Mplus 7.3 program. A total of 788 (70.7% female) undergraduate students with a mean age of 20.2 (SD = 1.02) participated in the study. The primary outcome of knowledge, health beliefs, and health-promoting behaviours related to CVD were measured by questionnaires namely: Knowledge of Heart Disease, Health Beliefs Related to CVD, and Health Promoting Lifestyle Profiles-II. RESULTS: The final hypothetical structural model showed a good fit to the data based on several fit indices: with comparative fit index (CFI) at .921, standardised root mean square residual (SRMR) at .037, and root mean square error of approximation (RMSEA) at .044 (90% CI: .032, .054). The final structural model supported 13 significant path estimates. These variables explained 12% of the total variance in health-promoting behaviours. Through perceived benefits, total knowledge had an indirect effect on health-promoting behaviours. CONCLUSION: The results suggest that perceived barriers, perceived benefits, family history of CVD, and screening intention enable young adults to engage in health-promoting behaviours.

Measuring Time-Varying Effective Reproduction Numbers for COVID-19 and Their Relationship with Movement Control Order in Malaysia.

To curb the spread of SARS-CoV-2 virus (COVID-19) in Malaysia, the government imposed a nationwide movement control order (MCO) from 18 March 2020 to 3 May 2020. It was enforced in four phases (i.e., MCO 1, MCO 2, MCO 3 and MCO 4). In this paper, we propose an initiative to assess the impact of MCO by using time-varying reproduction number (Rt). We used data from the Johns Hopkins University Centre for Systems Science and Engineering Coronavirus repository. Day 1 was taken from the first assumed local transmission of COVID-19. We estimated Rt by using the EpiEstim package and plotted the epidemic curve and Rt. Then, we extracted the mean Rt at day 1, day 5 and day 10 for all MCO phases and compared the differences. The Rt values peaked around day 43, which was shortly before the start of MCO 1. The means for Rt at day 1, day 5, and day 10 for all MCOs ranged between 0.665 and 1.147. The average Rt gradually decreased in MCO 1 and MCO 2. Although spikes in the number of confirmed cases were observed when restrictions were gradually relaxed in the later MCO phases, the situation remained under control with Rt values being stabilised to below unity level (Rt value less than one).