Immunization of Children under 2 Years Old in the Coastal Hadhramaut Governorate, Yemen, during Public Health Emergencies: A Trend Analysis of 2013-2020.

Although immunization is one of the most successful and cost-effective interventions that prevents millions of infant and child deaths yearly, it has failed to achieve its intended goals in some low-income countries. Yemen is currently experiencing the most extreme humanitarian crisis globally, which has affected health and worsened its economy and political governance instability. There are few reports on Yemeni vaccination statuses. The present study aimed to investigate the effect of the public health emergency crises on childhood immunization in Yemen. A retrospective descriptive study was conducted in the Coastal Hadhramaut Governorate, Yemen. Secondary data from governorate annual reports for 2013-2020 were extracted. The assessment of the annual immunization coverage rate according to each vaccine was tabulated. The analysis revealed that the 2013-2019 vaccination coverage in Coastal Hadhramaut demonstrated an increasing trend. However, vaccination coverage decreased for all vaccines in 2015-2016 and 2020. Although all three doses of the pentavalent vaccine demonstrated >85% coverage in all years, the coverage of the first and second doses decreased in 2016, and the coverage of all doses decreased in 2020 during the COVID-19 pandemic. Public health emergencies negatively affected routine immunization coverage in Yemen. The trend correlated with the humanitarian crisis and other research findings in Yemen. The national response to public health threats during emergency crises must involve strengthening the program for monitoring and evaluating vaccine-preventable diseases.

Setting research priorities for global pandemic preparedness: An international consensus and comparison with ChatGPT's output.

Background: In this priority-setting exercise, we sought to identify leading research priorities needed for strengthening future pandemic preparedness and response across countries. Methods: The International Society of Global Health (ISoGH) used the Child Health and Nutrition Research Initiative (CHNRI) method to identify research priorities for future pandemic preparedness. Eighty experts in global health, translational and clinical research identified 163 research ideas, of which 42 experts then scored based on five pre-defined criteria. We calculated intermediate criterion-specific scores and overall research priority scores from the mean of individual scores for each research idea. We used a bootstrap (n = 1000) to compute the 95% confidence intervals. Results: Key priorities included strengthening health systems, rapid vaccine and treatment production, improving international cooperation, and enhancing surveillance efficiency. Other priorities included learning from the coronavirus disease 2019 (COVID-19) pandemic, managing supply chains, identifying planning gaps, and promoting equitable interventions. We compared this CHNRI-based outcome with the 14 research priorities generated and ranked by ChatGPT, encountering both striking similarities and clear differences. Conclusions: Priority setting processes based on human crowdsourcing - such as the CHNRI method - and the output provided by ChatGPT are both valuable, as they complement and strengthen each other. The priorities identified by ChatGPT were more grounded in theory, while those identified by CHNRI were guided by recent practical experiences. Addressing these priorities, along with improvements in health planning, equitable community-based interventions, and the capacity of primary health care, is vital for better pandemic preparedness and response in many settings.

The determinants of maternal perception of antenatal care services during the COVID-19 pandemic critical phase: A systematic review.

INTRODUCTION: The COVID-19 pandemic has exerted devastating effects on healthcare delivery systems, specifically those for pregnant women. The aim of this review was to determine the maternal perception of antenatal health care services during the COVID-19 pandemic critical phase. METHODS: Scopus, Web of Science, SAGE, and Ovid were systematically searched using the keywords "maternal", "COVID-19 pandemic", "maternal health service", and "maternal perception". Articles were eligible for inclusion if they were original articles, written in English, and published between January 1, 2020, and December 12, 2022. This review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible articles were assessed using the Mixed Methods Appraisal Tool. Thematic analysis was used for data synthesis. RESULTS: Of 2683 articles identified, 13 fulfilled the inclusion criteria and were included in the narrative synthesis. Five themes emerged regarding the determinants of maternal perception of antenatal healthcare services during the COVID-19 pandemic critical phase: lack of psychosocial support, poor maternal healthcare quality, poor opinion of virtual consultation, health structure adaptation failure to meet women's needs, and satisfaction with maternal health services. CONCLUSION: Maternal perception, specifically pregnant women's psychosocial and maternal health needs, should be focused on the continuation of maternal care during the COVID-19 pandemic. It is critical to identify the maternal perception of maternal health services during the pandemic to ensure health service equity in the "new normal" future.

Effectiveness of a Theory-Based Digital Animated Video Intervention to Reduce Intention and Willingness to Sext Among Diploma Students: Cluster Randomized Controlled Trial.

BACKGROUND: Sexting refers to the exchange of sexually explicit digital content in the form of texts, photos, or videos. In recent years, sexting has become a public health concern. Surveys in Malaysia show a high prevalence of young adults engaged in sexting. Given that sexting is associated with sexual risk behavior, cyberbullying, and mental health issues, this behavior needs intervention to alleviate the resulting public health burden. However, there is a scarcity of theory-based intervention programs on the prevention of intention and willingness to sext among young adults. OBJECTIVE: This study aimed to develop and implement a sexting intervention module guided by the prototype willingness model (PWM), delivered using web-based animated video, and evaluate its effectiveness among diploma students from a public higher educational institution. The primary outcomes were intention and willingness to sext, while the secondary outcomes were knowledge, attitude, perceived norms, and prototype perceptions of sexting. METHODS: This 2-armed, parallel, single-blinded cluster randomized controlled trial was conducted in a public higher educational institution in the state of Melaka, Malaysia. Diploma students from 12 programs were randomly allocated into intervention and control groups. Both groups answered a self-administered web-based questionnaire assessing the outcomes at the baseline. The intervention group received a newly developed intervention module based on the PWM in the form of 5 animated videos posted on a private YouTube platform, while the control group was put on the waitlist. The intervention group was encouraged to discuss any issues raised with the researchers via WhatsApp private chat after viewing the videos. All participants were observed immediately and 3 months postintervention. Data analysis was performed with SPSS (version 26; IBM Corp). A generalized linear mixed model was used to determine the effectiveness of the intervention. RESULTS: There were a total of 300 participants with an attrition rate of 8.3% (n=25). After adjusting for age, sex, relationship status, and the amount of time spent on the web, there were significant differences in the intention to sext (ß=-.12; P=.002; Cohen d=0.23), willingness to sext (ß=-.16; P<.001; Cohen d=0.40), knowledge (ß=.12; P<.001; Cohen d=0.39), attitude (ß=-.11; P=.001; Cohen d=0.31), perceived norms (ß=-.06; P=.04; Cohen d=0.18), and prototype perceptions (ß=-.11; P<.001; Cohen d=0.35) between the intervention and control groups over 3 months. CONCLUSIONS: In this study, the sexting intervention module using the PWM that was delivered via web-based animated videos was effective in reducing intention and willingness to sext as well as in improving knowledge of sexting, attitudes, perceived norms, and prototype perceptions. Therefore, relevant agencies involved in the promotion of sexual and reproductive health among young adults in Malaysia can consider the implementation of this module. TRIAL REGISTRATION: Thai Clinical Trial Registry TCTR20201010002; https://www.thaiclinicaltrials.org/show/TCTR20201002001.

Decoding the Clinical Significance of Immunoglobulin G4 in Rheumatoid Arthritis.

Immunoglobulin (Ig) G4 accounts for 4-6% of the total IgG in a healthy human. Several evidence-based studies have suggested that the level of IgG4 is significantly elevated in autoimmune diseases, including rheumatoid arthritis (RA). The clinical significance of IgG4 in RA with regard to disease activity, severity, and treatment response remains elusive. We consecutively recruited 174 patients with RA from our rheumatology clinic. All subjects were assessed for their disease activity based on DAS28, radiographic joint damage based on the Modified Sharp Score (MSS), the functional capacity based on the Health Assessment Questionnaire -Disability Index (HAQ-DI), and treatment responsiveness using the European League Against Rheumatism (EULAR) response criteria. The serum IgG4 of the recruited subjects was measured via the ELISA test. The mean serum IgG4 level was 60.23 ± 30.08 mg/dL. We found that serum IgG4 had significant positive correlations with disease activity (r = 0.406; p < 0.001), ESR (r = 0.155; p = 0.041), CRP (r = 0.269; p < 0.001), joint damage (r = 0.195; p = 0.012) and functional disability (r = 0.909; p < 0.001). Subjects with elevated IgG4 (IgG4 > 86 mg/dL) had significantly higher ESR, CRP, HAQ-DI, and DAS 28 and a poorer treatment response compared to the group with non-elevated IgG4. After multivariate analysis, only HAQ-DI (OR = 4.229, 95% CI 1.302, 15.751, p = 0.018) and DAS28 (OR = 3.743, 95% CI 1.062, 13.193, p = 0.040) remained significantly associated with elevated serum IgG4. The preliminary findings of this study could suggest serum IgG4 to be a potential biomarker of disease activity and functional disability in RA.

Psychometric evaluation of the Malay version of the Individual Community-Related Empowerment scale among older adults in Malaysia.

Background: Malaysia is projected to become an aged country by 2030, with the older age group comprising 10 percent of the total population. To address this demographic shift, comprehensive plans and initiatives are being implemented at various levels, ranging from the government to local communities. A crucial aspect of these efforts is community empowerment, which requires a reliable and validated tool for measurement. Objective: This study aimed to validate the Individual Community Related Empowerment (ICRE) scale in alignment with the national language of Malaysia. Methods: This cross-sectional study was conducted from May to December 2019. Back-to-back translation from the English to Malay version of the ICRE scale was done. A total of 328 older persons aged 60 years old and above who attended clinics and understood Malay had been randomly selected. Exploratory factor analysis (EFA), particularly Principal Component Analysis (PCA) with Varimax rotation and Kaiser Normalization, was performed in this study using IBM SPSS version 27 Amos graphic. Results: The findings revealed that the Malay version of the Individual Community Related Empowerment (ICRE-m) scale consists of five components: self-efficacy, intention, participation, motivation, and critical awareness, which collectively accounted for 92.3% of total variance. All five components demonstrated Cronbach's alpha values greater than 0.7, indicating the reliability of the selected items for field studies. Conclusion: The ICRE-m scale is acceptable for field studies and valid for measuring individual-related community empowerment. Nurses and other healthcare professionals can employ this scale specifically within the Malay-speaking population, particularly in the Asian region. Future studies on community empowerment among older individuals can utilize this tool to assess community readiness for participating in community health interventions.

Self-care educational guide for mothers with gestational diabetes mellitus: A systematic review on identifying self-care domains, approaches, and their effectiveness.

Background: Gestational Diabetes Mellitus (GDM) is a common form of poor carbohydrate intolerance, prevalent among pregnant women and associated with unhealthy lifestyle behaviors. Given the dearth of information on self-empowerment among mothers with GDM, a self-care health education package needs to be developed to prevent related complications. Objective: This review aimed to identify self-care approaches, domains, and their effectiveness for a proper self-care educational guide package for women with GDM. Design: A systematic review using electronic literature databases published between January 2016 and December 2022 was conducted. Data Sources: Web of Science, Scopus, and Ovid databases were used. Review Methods: This review utilized the PICO (Population, Intervention, Comparison, and Outcomes) framework to screen the retrieved articles for eligibility in which mothers with GDM, educational materials, standard practice or intervention, and effectiveness were considered the PICO, respectively. The CIPP (Context, Input, Process, Product) model served as a framework for adopting the education development model. Mixed methods appraisal tool was used for quality assessment. Data extraction and synthesis without meta-analysis were presented as evidence tables. Results: A total of 19 articles on GDM were included in the final analysis (16 Intervention studies, two qualitative studies, and one mixed-methods study). Four broad domains emerged from the analysis: 1) information or knowledge of GDM, 2) monitoring of blood glucose levels, 3) practice of healthy lifestyles, and 4) other non-specific activities. The majority of the articles employed a face-to-face approach in executing the educational group sessions, and most studies disclosed their positive effects on GDM management. Other methods of evaluating intervention effectiveness were described as improved self-care behavior, increased satisfaction score, enhanced self-efficacy, good glucose control, and better pregnancy outcome. Conclusion: Knowledge or information about GDM, healthy diet, and exercise or physical activity was found to be the most applied domains of intervention. Framework domains based on the present review can be used in the future development of any interventional program for GDM women in enhancing health information reaching the targeted group in promoting self-efficacy. PROSPERO registration number: CRD42021229610.

Aligning theory with practice: Child health programmes in Malaysia, a Narrative Review.

Introduction: The Malaysian healthcare system, particularly for maternal and child health, has been well recognised to provide high-quality services and be at par with systems in other developed countries. Current health programmes and technological advancements effectively detect vulnerable groups of children, such as small-for-gestational-age (SGA) infants, antenatally. However, the postnatal care for SGA infants is not clearly evaluated, as this group of children is mostly classified as healthy in many medical contexts, especially in primary care settings. Available health programmes and healthcare service delivery must be continuously evaluated by implementing beneficial and relevant evidence-based theories. Method: Articles, reports and guidelines used in providing mother and child health services in Malaysia published since 2000 were reviewed. Results: There was no specific monitoring strategy used for SGA infants without critical health issues in early childhood, as they were commonly treated as healthy infants. Several challenges in aligning theory with the current practice of healthcare service delivery and recommendations for dealing with such challenges were identified. Conclusion: The alignment of theory with the current practice of service delivery should be tailored to the needs and demands parallel to the dynamic change in populations in the urbanisation era.

Development and Validation of the Adolescent Sexual and Reproductive Competency Assessment Tool (ASRH-CAT) for Healthcare Providers.

OBJECTIVES: This study aimed to validate a competency assessment tool for adolescent sexual and reproductive health (ASRH) services for healthcare providers (HCP) at primary healthcare (PHC) facilities that require a specific set of competency skills to address ASRH problems. METHODS: The tool development process used the nine steps of scale development and validation. Fifty-four items were yielded through the expert panel discussion. Two hundred and forty respondents were recruited for an online questionnaire using non-probability sampling. The item content validity index (I-CVI) and exploratory factor analysis (EFA) were used for construct validity. RESULTS: Fourteen items were removed based on the I-CVI (scores < 0.8) and two items were removed in the EFA (factor loadings < 0.4). The reliability analysis, according to the latent factor, yielded a good item-total correlation (ITC) and a good internal consistency value, with Cronbach's alpha values of 0.905-0.949. CONCLUSIONS: The final ASRH competency assessment tool (ASRH_CAT) contains 40 items and is reliable and suitable for use in studies related to the ASRH competency assessment of HCPs at the PHC level.

Youth perceptions toward managing elderly care among low-income household families using the My-Elderly-Care-Skills Module.

Background: Caregivers of elderly people need the right education and empowering skills to manage their own health needs and the elderly people they care for. Objective: The study aimed to explore youth perceptions of the My-Elderly-Care-Skills Module intervention and its perceived feasibility. Methods: This study involved youth respondents (18-30 years old) from low-income households who are accountable to providing care for independent older people (60 years or above) living in the same house. A qualitative study using a case study design was used to assess youth perceptions based on the content of the My-Elderly-Care-Skills module, by focusing on its implementation usage and usefulness for the care of the elderly. A total of 30 youths voluntarily participated in the online training workshop during the COVID-19 pandemic movement restriction order period. There were multiple sources of data, such as video recorded on reflection of care given at home, text messages in a WhatsApp group, and in-depth interviews during small group online meetings. Data were recorded and transcribed verbatim for common themes before a theme analysis was conducted. Inductive content analysis was performed after the saturation point was met. Results: Thematic analysis derived two domains of feasibility: operational and technical feasibility. There were three themes under operational practicality (improving awareness, addressing the caregiving skills needs, and seeking resources for knowledge) and three themes for technical practicality (easily used and informative, skill in effective communication, and program fulfillment). Conclusion: It was verified that it is feasible for young caregivers of the elderly to participate in the My-Elderly-Care-Skills training intervention as it helps in improving knowledge and skills performance in managing and caring for the elderly.

Prevalence, maternal characteristics, and birth outcomes of preeclampsia: A cross-sectional study in a single tertiary healthcare center in greater Kuala Lumpur Malaysia.

Background: Preeclampsia is associated with an increased risk of adverse maternal and perinatal outcomes. This study aimed to assess preeclampsia prevalence in a Malaysian referral maternity hospital and the association between preeclampsia and maternal characteristics and outcomes. Methods: A cross-sectional study was conducted between January 2010 and December 2020 using secondary data from a single tertiary healthcare center in Greater Kuala Lumpur, Malaysia. A total of 40,212 deliveries were included for analysis to investigate the association between conditions (maternal characteristics and adverse birth outcomes) and preeclampsia. Multivariable logistic regression was conducted to assess the association between multiple independent variables and the outcome variable (preeclampsia). Results: The reported prevalence of preeclampsia was 1.6%. Pregnant women with preeclampsia had a higher risk of preterm delivery (67.7%), instrumental and cesarean delivery (74.7%), neonatal low birth weight (48.5%), neonatal 5-min Apgar score <7 (18.1%), and neonatal intensive care unit (NICU) admission (19.8%). There were significantly higher odds of developing preeclampsia among nullipara [adjusted odd ratio (adjOR) 1.792, 95% CI: 1.518-2.115], women with a previous history of preeclampsia (adjOR 5.345, 95% CI: 2.670-10.698) and women with multiple pregnancies (adjOR 1.658, 95% CI: 1.071-2.566). However, there is a significant association between maternal characteristic variables. There was a significant association when a combination of variables for risk assessment: the presence of anemia and gestational hypertension effect on preeclampsia (OR 26.344, 95% CI: 9.775-70.993, p < 0.002) and gestational hypertension without anemia on preeclampsia (OR 3.084, 95% CI: 2.240-4.245, p < 0.001). Similarly, an association was seen between chronic hypertension and younger age (<35 years old) on preeclampsia (OR 14.490, 95% CI: 9.988-21.021, p < 0.001), and having chronic hypertension with advanced maternal age (≥35 years old) on preeclampsia (OR 5.174, 95% CI: 3.267-8.195, p < 0.001). Both conditions had increased odds of preeclampsia, in varying magnitudes. Overall, the significant interaction effects suggest that a history of chronic or gestational hypertension has a different relationship to the incidence of preeclampsia depending on the maternal age and anemia status. Pregnant women with preeclampsia had significantly higher odds for preterm delivery (adjOR 6.214, 95% CI: 5.244-7.364), instrumental and cesarean delivery (adjOR 4.320, 95% CI: 3.587-5.202), neonatal low birth weight (adjOR 7.873, 95% CI: 6.687-9.271), 5-min Apgar score <7 (adjOR 3.158, 95% CI: 2.130-4.683), and NICU admission (adjOR 8.778, 95% CI: 7.115-10.830). Conclusions: Nulliparity, previous history of preeclampsia, and multiple pregnancies were associated with an increased risk of preeclampsia. The presence of different underlying conditions, such as chronic hypertension, anemia, and extremes of maternal age played an important role in increasing preeclampsia risk in the considered study. Larger samples are needed to validate such findings.

Reproductive health practices and use of health services among immigrant Indonesian women working in Malaysia.

OBJECTIVE: To describe the reproductive health practices of immigrant Indonesian women working in Malaysia and their accessibility to health services. METHODS: A cross-sectional study using a validated self-administered questionnaire was conducted with 593 immigrant Indonesian workers who stayed in Malaysia for at least six months and within the reproductive age group. RESULTS: About 13.5% of the respondents have used health facilities for reproductive health-related problems. Less than half of the respondents preferred to use public health facilities. Only 15% used treatment available in health facilities related to irregular menstrual cycles (34.6%), severe dysmenorrhea (58.7%) and nonspecific symptoms related to menstruation (31.7%). Family planning services were the most required health service. However, only 31.5% met the needs for family planning services. One-third of the respondents had sexual reproductive health problems and required treatment, but only 9.9% sought reproductive health services when needed. CONCLUSIONS: Strategies to improve the accessibility to sexual reproductive health services requires a collaboration between the Indonesian government representatives in Malaysia and non-governmental organizations to address the reproductive health issues among immigrant Indonesian women in Malaysia. Health policy related to immigrant workers is needed in order to enhance the accessibility to women's health needs for universal health coverage.

The feasibility of soluble Fms-Like Tyrosine kinase-1 (sFLT-1) and Placental Growth Factor (PlGF) ratio biomarker in predicting preeclampsia and adverse pregnancy outcomes among medium to high risk mothers in Kuala Lumpur, Malaysia.

BACKGROUND: Preeclampsia significantly contributes to maternal and perinatal morbidity and mortality. It is imperative to identify women at risk of developing preeclampsia in the effort to prevent adverse pregnancy outcomes through early intervention. Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) level changes are noticeable several weeks before the onset of preeclampsia and its related complications. This study evaluated the feasibility of the sFlt-1/PlGF biomarker ratio in predicting preeclampsia and adverse pregnancy outcomes using a single cut-off point of >38. METHODS: This is a prospective cohort study conducted at a single tertiary centre, in an urban setting in Kuala Lumpur, Malaysia, between December 2019 and April 2021. A total of 140 medium to high risk mothers with singleton pregnancies were recruited at ≥20 weeks' gestation. sFlt-1/PlGF ratio was measured and the participant monitored according to a research algorithm until delivery. The primary outcome measure was incidence of preeclampsia and the secondary outcome measure was incidence of other adverse pregnancy outcomes. RESULTS: The overall incidence of preeclampsia was 20.7% (29/140). The mean sFlt-1/PlGF ratio was significantly higher in preeclampsia (73.58 ± 93.49) compared to no preeclampsia (13.41 ± 21.63) (p = 0.002). The risk of preeclampsia (adjusted OR 28.996; 95% CI 7.920-106.164; p<0.001) and low Apgar score (adjusted OR 17.387; 95% CI 3.069-98.517; p = 0.028) were significantly higher among women with sFlt-1/PlGF ratio >38 compared with sFLT-1/PlGF ratio ≤38. The area under the receiver-operator characteristic curve (AUC) for a combined approach (maternal clinical characteristics and biomarker) was 86.9% (p<0.001, 95% CI 78.7-95.0) compared with AUC biomarker alone, which was 74.8% (p<0.001, 95% CI 63.3-86.3) in predicting preeclampsia. The test sensitivity(SEN) was 58.6%, specificity (SPEC) 91%,positive predictive value (PPV) 63% and negative predictive value (NPV) 89.3% for prediction of preeclampsia. For predicting a low Apgar score at 5 minutes, the SEN was 84.6%, SPEC 87.4%, PPV 40.7%, and NPV 98.2%; low birth weight with SEN 52.6%,SPEC 86.0%, PPV 37.0%, NPV 92.0%; premature delivery with SEN 48.5%, SPEC 89.5%, PPV 59.3%, NPV 84.7% and NICU admission with SEN 50.0%, SPEC 85.8%, PPV 37.0% and NPV 91.2%. CONCLUSIONS: It is feasible to use single cut-off point of >38 ratio of the biomarkers sFlt-1/PlGF in combination with other parameters (maternal clinical characteristics) in predicting preeclampsia and adverse pregnancy outcomes among medium to high risk mothers without restricting outcome measurement period to 1 and 4 weeks in a single urban tertiary centre in Kuala Lumpur, Malaysia.

Vaccine hesitancy from parents and healthcare providers perspectives in Hadhramout Governorate, Yemen: a mixed-method study protocol.

INTRODUCTION: Although immunisation prevents the death of millions of infants and children each year, the vaccination coverage of routine childhood vaccination does not reach its target. The reasons for low vaccination uptake can be related to both demand and supply side determinants. The prevalence of vaccine hesitancy is increasing globally. However, data on vaccine hesitancy in low-income Arabic countries are scarce. To investigate this issue in Yemen, an Arabic low-income country, we aim to examine the link between vaccine hesitancy and the immunisation status of children living in Costal Hadhramout, Yemen, from the perspective of their parents and healthcare providers. METHODS AND ANALYSIS: We will use a mixed-method research design. The study will be conducted in Costal Hadhramout in three phases. Phase 1 will involve a situational analysis using secondary data from records of the national expanded immunisation programme in Costal Hadhramout to examine the trend for previous years. Phase 2 will be a quantitative study aimed at assessing the prevalence of vaccination status of children aged <2 years and the determinants of parental vaccine hesitancy perception through a validated questionnaire. Lastly, phase 3 will be a qualitative study that explores vaccine hesitancy in Yemen using in-depth interviews and focus group discussions with parents and healthcare providers, respectively. ETHICS AND DISSEMINATION: The study has been approved by the Research Committee of the Faculty of Medicine, University Kebangsaan Malaysia. The findings will be disseminated via publication in peer-reviewed academic journals, academic conferences and public presentations.

Universal Testing Policy for COVID-19 in Pregnancy: A Systematic Review.

Background: The coronavirus disease (COVID-19) has spread at an accelerated rate. WHO reported that in the general population, the majority are either asymptomatic or mildly infected. In view of the high risk of SARS-CoV-2 transmission from a pregnant woman to her newborn, healthcare workers and other patients, it is a raised concern whether universal testing should be implemented in this targeted population. The current guidelines have not recommended a universal testing policy. In certain European countries, however, the policy was implemented by some hospitals in regions with high prevalence of COVID-19 infection. Aims: To assess the justification for universal screening of pregnant women for COVID-19 prior to admission in labor through systematic review of antenatal prevalence of asymptomatic infection, hence risk of inadvertent spread of infection. Materials and Methods: Three databases confined to PubMed, Ovid and Science Direct were used to search for articles from November 2019 onwards published in the English language. The search was conducted using the keywords "COVID-19" or "coronavirus" or "SARS-CoV-2" and "pregnancy" or "pregnant" or "obstetric" or "labor" and "universal" or "testing" or "prevalence". The review was registered with PROSPERO. Results: The search result retrieved 34 studies, with the majority consisting of retrospective cohort studies, while other studies such as prospective cohort study, research letters and a case series were also identified. A total of 19,958 pregnant women were universally tested until the date of report. Overall, the prevalence of universal testing among pregnant women presenting to labor and delivery units are higher in Western regions. From the total number of pregnant women 5.3% tested positive and among these, the majority (75.5%) did not manifest any symptoms at the time of testing. Conclusion: In areas with high prevalence of COVID-19 infection, the implementation of a universal testing policy among pregnant women presenting to labor and admission units may be cost effective in helping to curb disease transmission. Systematic Trial Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020184248, PROSPERO: CRD42020184248.

Reproductive health practices and use of health services among immigrant Indonesian women working in Malaysia

ABSTRACT OBJECTIVE To describe the reproductive health practices of immigrant Indonesian women working in Malaysia and their accessibility to health services. METHODS A cross-sectional study using a validated self-administered questionnaire was conducted with 593 immigrant Indonesian workers who stayed in Malaysia for at least six months and within the reproductive age group. RESULTS About 13.5% of the respondents have used health facilities for reproductive health-related problems. Less than half of the respondents preferred to use public health facilities. Only 15% used treatment available in health facilities related to irregular menstrual cycles (34.6%), severe dysmenorrhea (58.7%) and nonspecific symptoms related to menstruation (31.7%). Family planning services were the most required health service. However, only 31.5% met the needs for family planning services. One-third of the respondents had sexual reproductive health problems and required treatment, but only 9.9% sought reproductive health services when needed. CONCLUSIONS Strategies to improve the accessibility to sexual reproductive health services requires a collaboration between the Indonesian government representatives in Malaysia and non-governmental organizations to address the reproductive health issues among immigrant Indonesian women in Malaysia. Health policy related to immigrant workers is needed in order to enhance the accessibility to women's health needs for universal health coverage.

Maternal Variables as Determinant of Fetal Growth: Study Protocol on Customized Fetal Growth Charts in Malaysia (GROW-My).

Adverse perinatal outcomes such as stillbirth, low birth weight and small for gestational age are still reported to be of high prevalence despite advanced healthcare technology and good quality hospital services in Malaysia. The purpose of this study is to create a model to evaluate individualized birth weight customized for maternal characteristics in a Malaysian population. Three phases are involved in designing the customized fetal growth chart (GROW-My). Baseline data is collected from previous pregnancies in the UKM Medical Centre from year 2010 to 2017. Specific maternal attributes were screened for its completeness and validity, namely maternal height and weight at booking, maternal ethnicity and parity, and the baby's birth weight, for all singleton pregnancies. The design and construction of a Malaysian customized fetal growth chart, Growth Related Optimal Weight (GROW-MY) was based on baseline birth data. The customized chart is used in the implementation phase for testing its feasibility, taking into consideration feedback from caregivers and patients before and after implementation. The current study provides staunch information and data regarding the needs and strategies for using maternal variables for estimating birth weight and the risk of being small for gestational age, in order to facilitate screening and appropriate management. With improved diagnosis of fetal growth restriction, medical care and treatment costs can be reduced.

Growth patterns and nutritional status of small for gestational age infants in Malaysia during the first year of life.

PURPOSE: This study aimed to identify small for gestational age (SGA) infants' growth patterns, nutritional status, and associated factors. METHODS: This prospective cohort study was conducted at primary-care child health clinics in Greater Kuala Lumpur, Malaysia. The sample consisted of infants who fulfilled the criteria and were born in 2019. The anthropometric data of infants were assessed at birth and at 1, 3, 6, 9, and 12 months. RESULTS: A total of 328 infants were analysed. In total, 27.7%(n=91) of the subjects were SGA infants, and 237 of them were not. Significant differences in the median weight-for-age and length-for-age z-scores were observed between SGA and non-SGA infants at birth, 1 month, 6 months, and 12 months. There was a significant difference between the growth patterns of SGA and non-SGA infants. Birth weight and sex significantly predicted the nutritional status(stunting and underweight) of SGA infants during their first year of life. CONCLUSION: SGA infants can catch up to achieve normal growth during their first year of life. Even though the nutritional status of SGA infants trends worse than non-SGA infants, adequate infant birth weight monitoring and an emphasis on nutritional advice are crucial for maintaining well-being.

Effectiveness of "Be SAFE Drowning Prevention and Water Safety Booklet" Intervention for Parents and Guardians.

BACKGROUND: We aimed to assess the effectiveness of the health educational booklet intervention in improving parents/guardian's knowledge on prevention of child drowning and, the perception of drowning risk and water safety practice. METHODS: A quasi-experimental study was conducted in year 2017 in Selangor, Malaysia among 719 parents/guardians of primary school children. The parent/guardians were randomly assigned as the intervention groups and were given a health educational Be-SAFE booklet on drowning prevention and water safety. The pretest was conducted before the intervention and posttest was done one month of intervention. The data collection tool was using a validated questionnaire on knowledge, attitude and practice for drowning prevention and water safety. RESULTS: There were 719 respondents (response rate of 89.9%) participated at baseline and 53.7% at end line (after the intervention). Significant differences found in knowledge, attitudes and practice on drowning prevention and water safety for the intervention and control groups after the intervention (P<0.001). There was a significant difference in mean scores for knowledge and attitude before and after the intervention, whereas no significant findings noted for practices (P<0.001). CONCLUSION: Be SAFE booklet contributed to the increase in parents/guardian's knowledge and attitudes towards drowning prevention and water safety to prevent the risk of child drowning.

Developing and implementing a health educational package for preemie moms in the care of their baby after hospital discharge.

INTRODUCTION: Educating a mother of a premature baby and providing a structured written educational information can enhance better understanding and practice. This article describes the development and implementation of a health educational package for preemie moms in the care of their premature baby after neonatal intensive care unit discharge. SUBJECTS AND METHODS: The package known as "Preemie Mom: A Guide for You" was designed based on Stufflebeam's model and has four phases: (1) content evaluation from available sources of information, (2) input evaluation based on mothers' need related to premature baby care, (3) process evaluation for package designing and content drafting, and (4) product evaluation to determine its feasibility. The contents were extracted and collated for validation by consulting various specialists in related fields. A final draft was drawn based on comments given by experts. Comments from the mothers were taken for formatting, visual appearance, and content flow for easy understanding and usage. RESULTS: All ten existing articles and eight relevant documents were gathered and critically appraised. The package was designed based on 11 main components related to the care of premature baby after discharge. The content validation was accepted at a minimum score of 0.85 for the item-level content validity index analysis. Both experts and mothers were agreed that the package is easy to use and well accepted as a guide after discharge. The agreement rate by the mothers was at 93.33% and greater for the front page, writing style, structure, presentation, and motives of the package. CONCLUSIONS: "Preemie Mom: A Guide for You" is a validated health educational package and ready to be used to meet the needs of the mother for premature baby care at home.