Effectiveness of health education module on work safety culture in improving knowledge, attitudes and practices: a cluster randomized controlled trial among public sector administrative workers in Nigeria.

INTRODUCTION: Studies have shown that a workplace safety culture (WSC) is lacking among the general workforce in Nigeria. Poor WSC can adversely impact workers' health and high remedial costs for employers. To improve WSC, workers need to improve related knowledge, attitude, and practices (KAP) towards WSC through effective health interventional programs at the workplace. The main objective of this study is to develop, implement and evaluate the effectiveness of the Work Safety Culture Health Education Module (WSCHEM). The specific goals are to improve KAP related to office ergonomics towards WSC among public sector administrative workers in Abeokuta, Nigeria MATERIALS AND METHODS: The study was a two-armed, singleblinded cluster randomised controlled trial (CRCT) involving 247 public sector administrative workers from clusters of 20 ministries in Abeokuta, Southwestern Nigeria. The intervention group was given WSCHEM, whereas the waitlist group received a seminar on team building and leadership skills and received the WSCHEM after the intervention program ended. The evaluation was done three times using the first formal validated, self-administered Work Safety Culture Questionnaire (WSCQ) among the administrative workers: first at baseline, second at 1 month, and third at 3 months post-intervention. RESULT: The results showed no statistically significant differences between groups regarding the respondents' characteristics (socio-demographic and occupational/officerelated ergonomic factors) and the outcome variables KAP towards WSC at baseline. For practices towards WSC, both intervention (ß 6.8, 95%CI 4.85, 8.72) and time (ß 6.2, 95%CI 4.49, 7.94) significantly improved the respondents' practices towards WSC in the per-protocol analysis. In the secondary outcomes, both knowledge of WSC, intervention (ß 3.5, 95%CI 2.8, 4.2) and time (ß 3.4, 95%CI 2.7, 5.9); and attitudes towards WSC, intervention (ß1.7, 95%CI 1.25, 2.23) and time (ß 2.3, 95%CI 1.92, 2.76) significantly improved the respondents' level of knowledge and attitudes respectively towards WSC. CONCLUSION: The intervention, WSCHEM, was effective in improving the administrative workers' KAP towards WSC, as demonstrated by the significance between and within-group differences.

Incidence and determinants of catastrophic health expenditure among low-income Malaysian households.

INTRODUCTION: Catastrophic health expenditure (CHE) incurs when out-of-pocket health expenditure (OOPHE) exceeds a certain threshold, therefore exposing households to financial hardship, with the low-income population being most vulnerable. Data related to the incidence and determinants of CHE among the low-income population in Malaysia are lacking. This study aims to determine the incidence and determinants of CHE among Malaysian lowincome households. METHODOLOGY: This is a cross-sectional study using data from 6,720 low-income households from the national Household Expenditure Survey (HES) 2016 conducted from May 2016 till February 2017. The data were analysed using IBM SPSS software 25.0. OOPHE in this study included all spending on healthcare products and services by the household. CHE was identified in households with OOPHE of at least 10% of total monthly income. RESULTS: The incidence of CHE at the threshold of 10% household income was 1.7% (n=112). The determinants of CHE were households with any accident or medical insurance (p<0.001), having less than five members in a household (p<0.001), presence of elderly (p=0.024), and hospitalisation (p=0.021). In contrast, employment of the head of household (p=0.003) and having a child aged ≤5 years old (p=0.033) protect households from CHE. CONCLUSION: In the context of this study, the incidence of CHE among the low-income Malaysian population was low, indicating that a majority of the low-income population is protected from financial catastrophe. Regardless, the determinants of CHE among low-income population should be considered in future health policies.