Factors affecting implementation of tuberculosis contact investigation and tuberculosis preventive therapy among children in Sabah, East Malaysia: A qualitative study.

Contact investigation and TB preventive treatment of children under five years of age who are close contacts of a TB case is a key component of TB prevention. However, the uptake of TB preventive treatment is low in many high-TB burden settings. This study explores factors affecting the implementation of TB contact investigation and preventive treatment among children in Malaysia's city of Kota Kinabalu, Sabah State. This study was conducted in three primary health clinics between 2019 and 2020. We purposively sampled 34 parents and guardians of child contacts eligible for TB preventive treatment, and 25 healthcare providers involved in the management of child contacts. We conducted thematic analysis of semi-structured interviews and focus group discussions to illicit factors affecting implementation and uptake of TB contact investigation and TB preventive therapy. Six main themes emerged from the analyses-four of these relating to contact investigation and two relating to TB preventive therapy. Factors affecting TB contact investigation were addressed under system related factors (external factors, stakeholder collaboration, healthcare workers' and clients' concerns), clinic related factors (perceived performance, clinic schedule, and space), healthcare worker related factors (cooperation, commitment, knowledge, misconception, counselling and communication) and patient and contact related factors (cooperation and commitment). Factors affecting TB preventive treatment delivery were addressed under guardian related factors (cooperation, commitment, knowledge and misconception) and treatment related factors (child-friendly form and adverse effects). To address gaps and barriers identified in our study, we recommend developing system capacity to maintain routine contact investigation and preventive treatment in the context of external program risks, providing training to healthcare workers to address misconceptions, safeguarding vulnerable clients against the risk of detention and deportation while accessing care, ensuring public and private services are provided regardless of migration status, and improving processes and resources for contact investigation and preventive treatment.

Socioecological Challenges of Polio Supplementary Immunization Activities (SIAs) in the Asia-Pacific Region: A Systematic Review.

Background: Polio supplementary immunization activities (SIAs) are one of the polio eradication pillars in the Global Polio Eradication Initiative (GPEI) that increased the immunization coverage and made progress towards polio eradication. However, socioecological challenges faced during SIAs contribute to suboptimal campaign quality. The aim of this review is to identify the reported challenges during polio supplementary immunization activities (SIAs) and associated improvement strategies based on the socioecological model (SEM). Methods: Articles were searched from three databases which were WOS, Scopus, and PubMed. The systemic review identified the primary articles related to SIA that focused on the impact of immunization coverage, challenges, and improvement strategies. The inclusion criteria were open access English articles that were published between 2012 and 2021 and conducted in the Asia region. Results: There are nine articles described and explained regarding some form of supplementary immunization activities (SIAs) in their findings across Asia region. The majority of studies selected reported on post vaccination coverage and revealed a multifaceted challenge faced during SIAs which are widely diverse range from the microlevel of interpersonal aspects up to the macrolevel of government policy. Upon further analysis, the intervention at community level was the most dominant strategies reported during the SIA program. Conclusions: An effective SIAs program provides the opportunity to increase the national capacity of the polio immunization program, reducing inequities in service delivery and offering additional public health benefits in controlling polio outbreaks in both endemic and nonendemic countries. Strengthening routine immunization (RI) programmes is also important for the sustainability of SIA's programs. Despite the challenges and hurdles, many Asian countries exhibited great political willingness to boost polio immunization coverage through SIA efforts.

Translation and cross-cultural adaptation of heat strain score index (HSSI) into the Malay language.

Concerns about the health and safety of working populations as well as preventive actions to reduce heat-related illnesses and fatalities have intensified as global warming and heatwaves continue to rise as a result of climate change. This study aimed to translate and culturally-adapted the translated Malay version of the Heat Strain Score Index (HSSI) questionnaire so that it can be utilized as a screening tool for heat stress among the Malay-speaking outdoor workers. The original English version of HSSI underwent forward-backward translation and was cross-culturally adapted into the Malay language by bilingual translators based on established guidelines. The content validation was reviewed by a six-member expert committee including the representative of outdoor workers. Face validation was carried out among 10 outdoor workers involved with various work tasks. Psychometric analysis was conducted based on a cross-sectional study among 188 workers who were eligible. Exploratory Factor Analysis (EFA) was used for construct validity while internal consistency reliability was performed using Cronbach's alpha. The interclass correlation coefficient (ICC) was used to calculate the test-retest reliability. Both content and face validity were acceptable with the overall content validity index being 1.00, while the universal face validity index was 0.83. The factor analysis using varimax rotation extracted four factors which explained 56.32% of the cumulative percentage of variance and factor loading ranging from 0.415 to 0.804. The internal consistency reliability was acceptable with Cronbach's alpha ranging from 0.705 to 0.758 for all the factors. The overall ICC value was 0.792 (95% CI; 0.764-0.801) which signifies good reliability. The findings from this study indicate that the Malay version of HSSI is a reliable and culturally-adapted instrument. Further validation is needed so that it can be used extensively assess the heat stress among susceptible Malay-speaking outdoor workers in Malaysia who are exposed to hot humid environments.

Workplace violence in healthcare settings: The risk factors, implications and collaborative preventive measures.

Violence at work refers to acts or threats of violence directed against employees, either inside or outside the workplace, from verbal abuse, bullying, harassment, and physical assaults to homicide. Even though workplace violence has become a worrying trend worldwide, the true magnitude of the problem is uncertain, owing to limited surveillance and lack of awareness of the issue. As a result, if workplace violence, particularly in healthcare settings, is not adequately addressed, it will become a global phenomenon, undermining the peace and stability among the active communities while also posing a risk to the population's health and well-being. Hence, this review intends to identify the risk factors and the implications of workplace violence in healthcare settings and highlight the collaborative efforts needed in sustaining control and prevention measures against workplace violence.

The Association of Eating Behaviour on the Growth of Children from the Interior Districts of Sabah, Malaysia.

Background: The double burden of malnutrition among children is an emerging public health problem, especially in developing countries. Eating behaviours have been hypothesised to contribute to both being underweight and overweight in children and adults. The objective of this study was to examine the association between the Child Eating Behaviour Questionnaire (CEBQ) subscale scores and body mass index (BMI) z-scores among Malaysian children under-5 years. Methods: This was a cross-sectional study conducted in 2020 by recruiting a sample of 500 children aged 24-59 months old from clinics located in the interior districts of Sabah, Malaysia. The CEBQ was completed by the mothers on behalf of the child to assess their eating behaviour traits. The height and weight of the child were measured using standardised instrument. The BMI-for-age percentile, z-scores for BMI-for-age, height-for-age and weight-for-age were determined and classified using World Health Organization AnthroPlus software. The relationship between the CEBQ subscale scores and BMI z-scores were evaluated using multiple linear regression models adjusting for potential confounders. Results: The prevalence of underweight, stunting and wasting were 20.2%, 29.2% and 5.6%, respectively, whereas the prevalence of overweight and obese was 5.0%. There were significant positive association between Food responsiveness, Emotional overeating, Enjoyment of food with BMI z-scores (p<0.05; unstandardised regression coefficient: 0.17 to 0.38). In contrast, there were significant negative association between Satiety responsiveness, Slowness of eating, Food fussiness with BMI z-scores (p<0.01; unstandardised regression coefficient: -0.35 to -0.36). Conclusion: These findings show that specific eating behaviours can influence the growth of children under-5 years. Therefore, policymakers should formulate a nutrition policy that incorporates behavioural assessment and behavioural intervention in the prevention and management of malnutrition among children in Malaysia.

Prevalence of upper limb musculoskeletal disorders and its associated risk factors among janitorial workers: A cross-sectional study.

INTRODUCTION: Janitorial workers are considered a high-risk group to develop WRMSDs based on their numerous hazardous job tasks and frequent non-fatal injuries being reported. This study aimed to determine the prevalence of upper limb musculoskeletal disorders (ULMSDs) and its associated risk factors among janitorial workers. METHODS: This cross-sectional study involved janitorial workers in a university in Sabah, Malaysia. The participants, who included supervisors, cleaners, and landscape workers, were recruited via universal sampling. Those with at least 12-months of experience in their present employment were included, while those with prior musculoskeletal injuries were excluded. Data were collected through interviews using the Malay version of Standardized Nordic Musculoskeletal Questionnaire (SNMQ), and Job Content Questionnaire (JCQ), followed by Ergonomic Risk Assessment (ERA). Data were analyzed and produced using SPSSv.26, encompassing descriptive statistics, Pearson's Chi-Square, and Multiple Logistic Regression analysis. Ethical approval and respondents' informed consents were obtained prior to the study. RESULTS: Among 142 respondents, ULMSDs were found to be prevalent in 76.8% of janitorial workers, with the highest prevalence (71.6%) reported in the shoulder regions. None was at negligible risk, with 95.1% in the medium or high-risk categories for RULA assessment. The significant associated factors were landscape workers [aOR = 3.07,95% CI = 1.04, 9.91], more than three years of employment [aOR = 2.47,95% CI = 1.06, 5.79], and low job control [aOR = 2.69,95% CI = 1.16, 6.23]. CONCLUSIONS: Given the high prevalence of ULMSDs, risky awkward postures, and low job control, amendments in working apparatuses and improvements in administrative procedures, are highly recommended to prevent the occurrence of ULMSDs.

Hearing Loss and Associated Factors Among Noise-Exposed Workers in Palm Oil Mills.

INTRODUCTION: Almost 90% of the reported occupational diseases in Sabah, Malaysian Borneo were due to hearing loss. The manufacturing industry was the main contributor to this problem. This study aims to identify the prevalence and associated factors for hearing loss among workers in the palm oil manufacturing industry in Sabah. MATERIAL AND METHODS: A cross-sectional study was done among 312 respondents from five palm oil mills in Sabah from January to April 2019. Audiometric tests, validated questionnaires and sound level meters were used. Chi-square test and independent t-test were conducted to determine the associated factors for hearing loss. RESULTS: 75% (n = 234) of the respondents were diagnosed with hearing loss. Most of them were male (96.2%) with a mean age of 44.4 (SD 9.8) years, mean duration of employment of 16.2 (SD 9.7) years and mean noise exposure of 96.1 (SD 4.8) dB(A). The significant factors associated with hearing loss were older age (p = 0.001), married (p = 0.001), blue-collar jobs (p = 0.003), smoking (p = 0.001), works with noisy machinery (p = 0.005), lower level of noise exposed (p = 0.015), longer duration of employment (p = 0.001), and longer overtime hours per week (p = 0.001). CONCLUSION: The prevalence of hearing loss among workers in the noise-exposed palm oil industries was high. Annual audiometry testing and job rotation from noise-exposed workstations were recommended. A smoking cessation program may help but reduction of noise from the source by engineering control is still the best method.

High incidence of asymptomatic leptospirosis among urban sanitation workers from Kota Kinabalu, Sabah, Malaysian Borneo.

Leptospirosis is a public health challenge in Sabah State of Malaysian Borneo. Rapid urbanization, rural-to-urban migration, and undocumented immigration in Sabah have increased the pressure on the urban garbage disposal system. Rodents and other small animals thrive under these conditions. We hypothesized that urban sanitation workers would be at risk of developing leptospirosis. In total, 303 urban sanitation workers with a mean age of 42.6 years were enrolled in this study. The serum samples collected from these workers were subjected to the microscopic agglutination test (MAT), PCR and nucleotide sequencing of the amplicons to confirm the presence of Leptospira. The phylogenetic analysis using the neighbor joining method was performed to assess whether they were pathogenic. In this study 43.8% (133/303) of the samples were MAT-seropositive and among them, 29 (21.8%) were positive by PCR. Nucleotide sequencing of the amplicons confirmed the presence of Leptospira. Phylogenetic analysis showed that our strains belonged to the pathogenic group of Leptospira. A high proportion of urban sanitation workers were seropositive for leptospirosis, and a considerable number were PCR positive for Leptospira, thereby indicating asymptomatic infections. Further research is needed to confirm whether this is a transient phenomenon or antibiotic therapy is required.

Factors Affecting Continued Participation in Tuberculosis Contact Investigation in a Low-Income, High-Burden Setting.

SETTING: Outpatient clinics, Kota Kinabalu, Malaysia; January-April 2018. OBJECTIVES: To identify barriers to full participation in tuberculosis (TB) contact investigation. METHODS: Cross-sectional study of knowledge, perceptions, and behaviours among TB contacts. This study was conducted among contacts who attended an initial clinic visit to explore retention in care. During this first visit, contacts were approached for participation in a questionnaire at a follow-up visit. Contacts who consented but did not subsequently attend were interviewed at home. Associations between questionnaire findings and attendance were tested using logistic regression. RESULTS: Of the total 1436 identified contacts, 800 (56%) attended an initial clinic visit. Of 237 consenting TB contacts, 207 (87%) attended their follow-up appointment. In univariable analyses, the odds of attendance were highest for people notified to attend the TB clinic directly by a health inspector; close relatives of TB patients; non-students; people with higher incomes and smaller households; older individuals; males; and people not perceiving TB as stigmatising. In multivariable analysis, mode of notification to attend and having a close relative with TB remained significant. CONCLUSIONS: Health inspectors provide an effective role in TB contact investigation through direct personal communication to encourage the completion of the TB screening process, but this requires further integration with clinical processes, and with workplace and school-based investigations.

A University-Wide Preparedness Effort in the Alert Phase of COVID-19 Incorporating Community Mental Health and Task-Shifting Strategies: Experience from a Bornean Institute of Higher Learning.

The COVID-19 pandemic caught the world by surprise, causing millions of confirmed cases and hundreds of thousands of deaths. Hence, the Malaysian government announced a Movement Control Order at the start of the containment phase to flatten the epidemiological curve. Universiti Malaysia Sabah (UMS), a public university in Borneo, was accelerated into alert phase because of high risk of case importation from more than 400 China incoming undergraduates. Measures to mitigate the potential COVID-19 outbreaks in its population were taken by using conventional public health measures with special attention to task-shifting and widespread community mental health interventions. A Preparedness and Response Centre was established to overseer the mitigating measures happening inside the university. Measures taken included empowerment of frontline staff, strengthening of restrictions, strengthening university health center, vigorous contact tracing, widespread health education, maintaining cultural sensitivity, and establishment of early standard operating procedures and university continuity plans. Hence, UMS was able to ensure no importation of cases into its campus during both acute and containment phases at the nationwide level.

Occupational Determinants of Leptospirosis among Urban Service Workers.

This study was carried out to determine the risk factors of leptospirosis infection among local urban service workers in Sabah. This is a cross-sectional study involving 394 workers in Kota Kinabalu City, Sabah, conducted from February to March 2017. Information on demography, occupational exposures and environmental factors was obtained by a modified validated questionnaire. Polymerase Chain Reaction (PCR) was used to determine the prevalence of positive leptospirae. The overall figure for positive leptospirae was 9.4% (95% CI: 6.8-12.8). Urban sweepers and lorry drivers made up the highest proportion of positive leptospirae respondents, contributing 15.5% and 9.4%, respectively. The significant risk factors for positive leptospirae were older age (p-value = 0.001), higher monthly salary (p-value = 0.039), longer duration of employment (p-value = 0.011) and working as an urban sweeper (p-value = 0.021). Leptospirae was prevalent among healthy urban service workers and relates to their working activities.

Respiratory Symptoms Among Domestic Waste Collectors.

OBJECTIVE: Increasing amount of waste concurrently increases the risk of exposure to hazardous materials among waste collectors. Vigorous exertion in the field intensifies the abundance of contaminated inspirable droplets. If left undetected and untreated, it may provoke significant pernicious health effects and redundant burdens to employees and employers. The purpose of this study is to determine the prevalence of respiratory symptoms and their associated factors among domestic waste collectors. METHOD: A cross-sectional study was conducted in Kota Kinabalu, Sabah between January and April 2020. Data were collected using a validated questionnaire which encompasses details about sociodemographic, health status, environment, and employment characteristics. RESULTS: A total of 290 waste collectors with a mean age of 40 (±9) years old were participated in the study. Most of them were from Kadazan-Dusun-Murut ethnic origin with educational background till secondary school. The average monthly income of the workers was USD 298.45 (±171.9) per month, and they had been in service for 11 (±9.04) years. Respiratory symptoms were seen in 21% of the workers. The identified significant risk factors were determined as underlying chronic diseases (OR=2.34; 95% CI=1.054, 5.219) and contact with pets (OR=1.87; 95% CI=1.004, 3.288). CONCLUSION: Respiratory symptoms are prevalent amidst domestic waste collectors and related to their health and field activities.

Falciparum Malaria Outbreak in Sabah Linked to an Immigrant Rubber Tapper.

Sabah is a Malaysian state situated in the northern part of Borneo, and it is endemic for malaria. The incidence of malaria is the lowest (0.05/1,000 population) in Penampang districts of Sabah. In June 26, 2012, two Plasmodium falciparum malaria cases were notified to public health department from a village in Penampang. Immediate investigation was initiated to identify the risk factors and to institute control measures. We performed active case finding by asking household members of all houses in the village regarding malaria symptoms and by examining blood smears. Environmental investigation was performed by collecting samples to detect mosquito breeding sites and to identify malaria transmitting vector mosquitoes. A case-control study with a ratio of 1:4 (11 cases and 44 controls) was conducted using self-administered questionnaire. The microscopic examination of blood smear for malarial parasite and entomology sampling was carried out. The malarial attack rate was 2.3%, 6/11 smears have gametocyte, and the case fatality rate was 9.1%. One case was a migrant rubber tapper from Indonesia which happened to be the first case with gametocyte positive. Overall, the incidence of malaria was higher (6/11) among rubber tappers. The odds of cases for those living nearby stagnant water were 7.3 [95% confidence interval: 1.2-43.5] times higher. In conclusion, an outbreak of P. falciparum malaria was introduced into a malaria-free village by a migrant rubber tapper, by whom the imported parasite was introduced to the community via vector Anopheles balabacensis. Living near stagnant water bodies was the risk factor in this outbreak.

Surveillance Evaluation of the National Cancer Registry in Sabah, Malaysia.

BACKGROUND: Cancer is the fourth leading cause of death in Sabah Malaysia with a reported agestandardized incidence rate was 104.9 per 100,000 in 2007. The incidence rate depends on nonmandatory notification in the registry. Underreporting will provide the false picture of cancer control program effectiveness. The present study was to evaluate the performance of the cancer registry system in terms of representativeness, data quality, simplicity, acceptability and timeliness and provision of recommendations for improvement. MATERIALS AND METHODS: The evaluation was conducted among key informants in the National Cancer Registry (NCR) and reporting facilities from FebMay 2012 and was based on US CDC guidelines. Representativeness was assessed by matching cancer case in the Health Information System (HIS) and state pathology records with those in NCR. Data quality was measured through case finding and reabstracting of medical records by independent auditors. The reabstracting portion comprised 15 data items. Selfadministered questionnaires were used to assess simplicity and acceptability. Timeliness was measured from date of diagnosis to date of notification received and data dissemination. RESULTS: Of 4613 cancer cases reported in HIS, 83.3% were matched with cancer registry. In the state pathology centre, 99.8% was notified to registry. Duplication of notification was 3%. Data completeness calculated for 104 samples was 63.4%. Registrars perceived simplicity in coding diagnosis as moderate. Notification process was moderately acceptable. Median duration of interval 1 was 5.7 months. CONCLUSIONS: The performances of registry's attributes are fairly positive in terms of simplicity, case reporting sensitivity, and predictive value positive. It is moderately acceptable, data completeness and inflexible. The usefulness of registry is the area of concern to achieve registry objectives. Timeliness of reporting is within international standard, whereas timeliness to data dissemination was longer up to 4 years. Integration between existing HIS and national registration department will improve data quality.