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.

Epidemiological Factors of Periodontal Disease Among South Indian Adults.

Introduction: Oral conditions exist worldwide, and are related with astounding morbidity. Indian adults' incidence of mild and moderate periodontal conditions was nearly 25%, while about 19% of adults experience severe periodontitis. Objective: The aim of this study was to analyse epidemiological factors of periodontal disease among a south Indian population based on the role of sociodemographic factors, habitual factors and set of oral health knowledge, attitude, and behaviour measures. Methods: A sample of 288 participants above 18 years of age residing in Tamil Nadu, India took part in this cross-sectional study. Based on WHO criteria, periodontal disease was measured in our study. Age, ethnicity, smoking, education, and oral health behavior were found to be the covariates. Ordinal logistic regression analysis using R version 3.6.1 was utilized to study the various factors that influence periodontal disease among south Indian adults. Results: Various demographic factors such as age between 25 and 34 years (AOR = 2.25; 95% CI 1.14-4.55), 35-44 years (AOR = 1.80; 95% CI 0.89-3.64), ≥ 45 years old (AOR = 2.89; 95% CI 1.41-6.01), ethnicity (AOR = 2.71; 95% CI 1.25-5.81), smoking (AOR = 0.38; 95% CI 0.16-0.65), primary level education (AOR = 0.07; 95% CI 0.01-0.50) high school level education (AOR = 0.06; 95% CI 0.01-0.27), university level education (AOR = 0.08; 95% CI 0.01-0.36) and an individual's oral health behavior (AOR = 0.59; 95% CI 0.32-1.08) were found to be related with periodontal disease among the south Indian population. The maximum log likelihood residual deviance value was 645.94 in the final model. Conclusion: Based on our epidemiological findings, sociodemographic, habitual factors and oral health behavior play a vital role in an individual's periodontal status among south Indian adults. An epidemiological model derived from the factors from our study will help to bring better understanding of the disease and to implement various preventive strategies to eliminate the causative factors.

Association between a dietary pattern high in saturated fatty acids, dietary energy density, and sodium with coronary heart disease.

This study aimed to determine the association between dietary pattern (DP) and coronary heart disease (CHD) among high-risk adults as determined by metabolic syndrome (MetS) criteria in Malaysia. This cross-sectional study involved 365 participants with (CHD = 178; non-CHD = 187) who were recruited from selected health clinics. Dietary intake was measured using a 189-item semi-quantitative foods frequency questionnaire (FFQ) whilst anthropometry and clinical data were measured by trained researcher and biochemical data were obtained from medical records. The reduced rank regression (RRR) method was used to derive DPs scores and binary logistic regression was used to assess the associations between identified DPs and CHD. The main DP found in this study was characterised by "high saturated fatty acid (SFA), high dietary energy density (DED), high sodium". This DP, which is attributed to high consumption of coconut-based dishes, fast foods and snacks, rice dishes, fat spread, seasoning sauces, salted and processed foods, and low intake of fruits, green leafy vegetables, white rice and other vegetables were associated with CHD (OR:1.32, 95% CI:1.03, 1.69) p value = 0.026 when, adjusted for age, sex, race, education level, household income, family history of CHD, marital status, smoking status, physical activity, stress level and BMI. This study suggests that individuals with a DP of high SFA, high DED, and high sodium have a significantly increased likelihood of having CHD compared to those who do not practice this DP.

Changes in health-related lifestyles and food insecurity and its association with quality of life during the COVID-19 lockdown in Malaysia.

BACKGROUND: The pandemic of SARS CoV2 virus has severely impacted the entire world population. The lockdown imposed during the pandemic has created enormous challenges particularly on the health, economic and social life of most individuals. This study aimed to investigate the changes in health-related lifestyle and food security during the lockdown and how they influenced the quality of life (QoL) of Malaysian adults. METHODS: An online survey using a structured questionnaire consisting of sociodemographic, body weight, diet quality, physical activity, sleep quality, food insecurity, and QoL was conducted among adult respondents across Malaysia. Multivariate linear regression analyses were conducted to assess the associations between the changes in each component and QoL based on the total score before and during the lockdown. RESULTS: A total of 759 valid responses were included in the final analysis (75% female and 24.5% male). There was a significant improvement in diet quality during the lockdown while sleep quality and food insecurity worsened significantly. As for physical activity, metabolic equivalents (METs) in moderate activity increased significantly, whilst there was a significant decrease in the METs in walking and total minutes spent on physical activity during the lockdown. Overall, independent of age, gender, ethnicity, and religion, there were significant associations between QoL during lockdown and changes in BMI, METs of moderate activity, sleep quality, and food insecurity. CONCLUSIONS: The unprecedented COVID-19 outbreak and the lockdown measure during the pandemic have caused significant negative changes in health-related lifestyles and affected the QoL of Malaysian adults. Despite the new norms and rules to prevent disease transmission, efforts to maintain a healthy lifestyle and food security among the population must be rolled out to improve the QoL and prevent further adverse mental and physical health outcomes.

Systematic literature review on the neonatal outcome of preeclampsia.

Preeclampsia is a pregnancy-specific multisystem disorder that is a leading cause of maternal and foetal/neonatal morbidity and mortality. Thus this systematic review aims to identify the neonatal outcomes of preeclamptic patients. A systematic literature review of works published between January 2015 and March 2021 written in the English language and freely accessed online were used considering the PRISMA guidelines. The results from the search were managed using the endnote X7 software and extracted data from the full articles were documented in Microsoft Word. The neonatal outcomes of preeclampsia identified are; preterm birth, stillbirth, low birth weight (LBW), low Apgar score, intrauterine growth reduction (IUGR), neonatal intensive care unit (NICU) admission are foetal/neonatal outcomes of preeclampsia and were subsequently classified into six groups according to the similarities of their outcome; group 1: death related neonatal outcomes, group 2: weight-related neonatal outcomes, group 3: prematurity related neonatal outcomes, group 4: respiratory related neonatal outcomes, group 5: injury-related neonatal outcomes, and Group 6: internal organ related outcome. The magnitude of occurrence of the classified neonatal outcomes is; respiratory-related neonatal outcome, death-related neonatal outcome, weight-related neonatal outcome, prematurity related neonatal outcome, internal related neonatal outcome and injury-related outcome in that sequence. All round interventions to improve neonatal morbidity and mortality of preeclamptic mothers should be targeted in addition to adequate provision of health/ medical resources for the tending of preterm neonates.

Development and Validation of Oral Health Knowledge, Attitude and Behavior Questionnaire among Indian Adults.

Background and objectives: The Indian population faces numerous challenges to attain better oral hygiene due to a lack of oral health literacy. For the past 10 years, the prevalence of dental-related conditions in India has become a considerable problem in every state of India. A health-education-based oral health promotion strategy will be an ideal choice for the Indian population instead of endorsing conventional oral health promotion. The use of unsuitable tools to measure may lead to misleading and vague findings that might result in a flawed plan for cessation programs and deceitful effectiveness. Therefore, the research aimed to develop and validate an instrument that can assess the oral health knowledge, attitude and behavior (KAB) of adults in India. Materials and Methods: This study was carried among adults in India, who live in Chennai, Tamil Nadu. A questionnaire was fabricated and then validated using content, face, as well as construct. The knowledge domain was validated using item response theory analysis (IRT), whereas exploratory factor analysis (EFA) was used to validate the behavior domain and attitude. Results: Four principal sections, i.e., knowledge, attitude, demography and behavior, were used to fabricate a questionnaire following validation. Following analysis of item response theory on the knowledge domain, all analyzed items in the domain were within the ideal range of difficulty and discrimination. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.65 for the attitude and 0.66 for the behavior domain. A Bartlett's test of sphericity was conducted and demonstrated that outcomes for both domains were highly significant (p < 0.001). The factor analysis resulted in three factors with a total of eight items in the attitude domain and three factors with a total of seven items in the behavior domain depicting satisfactory factor loading (>0.3). Across the three factors, i.e., knowledge, attitude and behavior, internal consistency reliability was tested using Cronbach's alpha, and the values obtained were 0.67, 0.87, 0.67, and 0.88, respectively. Conclusions: The findings of this study that assessed validity and reliability showed that the developed questionnaire had an acceptable psychometric property for measuring oral health KAB among adults in India.

Demographic and Habitual Factors of Periodontal Disease among South Indian Adults.

The aim of this study was to evaluate the performance of a set of sociodemographic and habits measures on estimating periodontal disease among south Indian adults. This cross-sectional study was carried out among 288 individuals above 18 years old in Tamil Nadu, India. The outcome of the study was periodontal disease, measured by WHO criteria. The covariates were age, ethnicity, smoking and alcohol habit. The assessment of factors predicting periodontal disease was carried out by multiple logistic regression analysis using R version 3.6.1. The demographic factors like age group (AOR = 3.56; 95% CI 1.69-7.85), ethnicity (AOR = 6.07; 95% CI 2.27-18.37), non-alcoholic (AOR = 0.31; 95% CI 0.13-0.64) and non-smoking (AOR = 0.33; 95% CI 0.15-0.67) were found to be associated with the outcome. The maximum log likelihood estimate value was -30.5 and AIC was 385 for the final model, respectively. Receiver operating characteristic (ROC) curve for the periodontal disease was 0.737. We can conclude that sociodemographic factors and habits were useful for predicting periodontal diseases.

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.

The Cox model of predicting mortality among melioidosis patients in Northern Malaysia: A retrospective study.

ABSTRACT: Melioidosis is an infectious disease that is initiated by a bacteria recognized as Burkholderia pseudomallei. Despite the high fatality rate from melioidosis, there is a minimal published study about the disease in Malaysia.This study aimed to identify the prognostic factors of mortality among melioidosis patients in northern Malaysia.All inpatient patients who were admitted to Hospital Sultanah Bahiyah, Kedah and Hospital Tuanku Fauziah, Perlis with culture-confirmed melioidosis during the period 2014 to 2017 were included in the study. The study retrospectively collected 510 melioidosis patients from the Melioidosis Registry. Hazard ratio (HR) used in advanced multiple Cox regression was used to obtain the final model of prognostic factors of melioidosis. The analysis was performed using STATA/SE 14.0 for Windows software.From the results, among the admitted patients, 50.1% died at the hospital. The mean age for those who died was 55 years old, and they were mostly male. The most common underlying disease was diabetes mellitus (69.8%), followed by hypertension (32.7%). The majority of cases (86.8%) were bacteremic. The final Cox model identified 5 prognostic factors of mortality among melioidosis patients. The factors were diabetes mellitus, type of melioidosis, platelet count, white blood cell count, and urea value. The results showed that bacteremic melioidosis increased the risk of dying by 3.47 (HR: 3.47, 95% confidence intervals [CI]: 1.67-7.23, P = .001) compared to non-bacteremic melioidosis. Based on the blood investigations, the adjusted HRs from the final model showed that all 3 blood investigations were included as the prognostic factors for the disease (low platelet: HR = 1.76, 95% CI: 1.22-2.54, P = .003; high white blood cell: HR = 1.49, 95% CI 1.06-2.11, P = .023; high urea: HR = 2.92, 95% CI: 1.76-4.85, P < .001; and low level of urea: HR = 2.69, 95% CI: 1.69-4.29, P < .001). By contrast, melioidosis patients with diabetic had 30.0% lower risk of dying from melioidosis compared to those with non-diabetic (HR = 0.70, 95% CI: 0.52-0.94, P = .016).Identifying the prognostic factors of mortality in patients with melioidosis allows a guideline of early management in these patients, which may improve patient's survival.

Confirmatory Factor Analysis of Knowledge, Attitude, and Behaviour Questionnaire towards Oral Health among Indian Adults.

Background: Oral health-related conditions are among the common conditions seen in adults in India. The usage of inappropriate measurement tools that are unvalidated may result in deceptive and imprecise findings that might lead to substandard plans for cessation programs and ineffectiveness. This study was conducted to validate a questionnaire that can assess the factor structure of knowledge, attitude, and behaviour towards oral health among adults in India by confirmatory factor analysis. Methods: Simple random sampling was conducted among adults in India. A total of 260 adults participated in this study. The knowledge, attitude, and behaviour (KAB) questionnaire on oral health was circulated among the adults who were willing to participate in the study after it was explained to them, and the questionnaires were retrieved once they completed. Software R version 3.6 was used to analyse the data of this study. Robust maximum likelihood was utilized for the assessment due to the violation of multivariate normality assumption. For attitude and behaviour domain, a three-factor model was used for measurement model validity and construct validity. Results: The confirmatory factor analysis of the three-factor model for the 26-item KAB questionnaire on oral health gave sufficient goodness-of-fit values and the measurement model exhibited ideal convergent and discriminant validity following model re-specification. The three-factor model was tested to obtain measurement model validity and construct validity for attitude and behaviour domains. The results of this study gave a statistically significant value (p < 0.001), with χ2 (df) values of 39 (7) and 28 (11) for attitude and behaviour domains, respectively. Conclusions: The KAB oral health questionnaire used in this study has a valid measurement model and reliable constructs. It was found to be an ideal tool to measure the KAB towards oral health among adults in India.

The Trend of Direct Medical Cost of Meliodiosis Patients in Kedah: A Retrospective Study from 2014 to 2017.

PURPOSE: This study was conducted to determine the direct medical cost of treating melioidosis patients. The calculation was made according to the variables extracted from medical records. MATERIALS AND METHODS: Data collection was performed retrospectively on a total of 293 cases from Hospital Sultanah Bahiyah, Kedah, Malaysia. The data consisted of personal information, treatment history, and investigation findings, including blood results, USG abdomen results, and CT scan results. The site of culture and sensitivity were also obtained. The total direct medical cost was based on the antibiotics/treatments received by the patients, diagnostic test and investigations performed. The trend analysis used to see the pattern of costs from 2014 to 2017. All the costs were compared based on patients' status and duration of stay at the hospital using the independent t-test. RESULTS: The overall mean of direct medical cost for melioidosis amounted to US $233.61 (RM931.33). Overall, the finding confirms a huge reduction (44.7%) of direct medical cost from 2014 to 2017 (P = 0.001). From 2015 to 2016, there was a 19.1% reduction of direct medical cost (P>0.95), followed by a 38.8% reduction in costs from 2016 to 2017 (P = 0.019). In the case of the duration of stay, the mean of total direct medical cost among patients with ≥14 duration of stay was higher compared to those with <14 duration of stay (p < 0.001). There was no significant mean difference of direct medical cost between patients who were cured and died. CONCLUSION: Despite the higher mortality of melioidosis cases compared to other infectious diseases, there is a limitation in the amount of published data on the management cost of melioidosis. The importance of cost in managing this disease should be underlined to perform a fully prepared management toward the disease.

Assessment on Oral Health Knowledge, Attitude, and Behaviour and its Association with Sociodemographic and Habitual Factors of South Indian Population

ABSTRACT Objective: To assess the oral health knowledge, attitude, behaviour, and its association with sociodemographic and habitual factors among South Indian Population. Material and Methods: A total of 288 adults living in a residential community situated in Chennai were selected by systematic random sampling method participated in this cross-sectional study. Data collection was carried out using a validated questionnaire. Results: About 97.9% of the participants in our study had good knowledge, 33.3% had a positive attitude and 48.2% had adequate oral health behaviour. Sociodemographic and habitual factors like diet (p=0.006), education (p=0.009), and employment (p=0.003) were significantly associated with knowledge. On the other hand, diet (p=0.012) was the only factor significantly associated with attitude. Ownership of house (p= 0.030) was significantly associated with behaviour and no factor was associated with all three KAB profiles. Absence of correlation were identified between Knowledge-Attitude (r=0.11, p=0.23), Knowledge-Behaviour (r= -0.037, p= 0.68) and Attitude-Behaviour (r =0.01, p=0.94). Conclusion: It has been found a massive number of participants possessed a high knowledge level towards oral health. On the other hand, less than half of the participants had a positive attitude and adequate behaviour towards oral health. No positive linear correlation was seen among knowledge, attitude, and behaviour towards oral health.

A confirmatory factor analysis of the knowledge, attitude and practice questionnaire towards prevention of respiratory tract infections during Hajj and Umrah.

BACKGROUND: Respiratory tract infections are one of the common infection associated with Hajj pilgrimage that is of great public health and global concern. This study is aimed at determining the factor structure of the knowledge, attitude, and practice questionnaire for the prevention of respiratory tract infections during Hajj by confirmatory factor analysis (CFA). METHODS: A multistage cluster sampling method was conducted on Malaysian Umrah pilgrims during the weekly Umrah orientation course. A total of 200 Umrah pilgrims participated in the study. The knowledge, attitude and practice (KAP) questionnaire was distributed to pilgrims at the beginning of the orientation and retrieved immediately at the end of the orientation. Data analysis was done using R version 3.5.0 after data entry into SPSS 24. The robust maximum likelihood was used for the estimation due to the multivariate normality assumption violation. A two-factor model was tested for measurement model validity and construct validity for each of the attitude and practice domains. RESULTS: CFA of a 25-item in total, the two-factor model yielded adequate goodness-of-fit values. The measurement model also showed good convergent and discriminant validity after model re-specification. A two-factor model was tested for measurement model validity and construct validity for each of the attitude and practice domains. The result also showed a statistically significant value (p < 0.001) with χ2 (df) values of 76.8 (43) and 121 (76) for attitude and practice domains, respectively. CONCLUSION: The KAP questionnaire was proven to have a valid measurement model and reliable constructs. It was deemed suitable for use to measure the KAP of Hajj and Umrah pilgrims towards the prevention for all respiratory tract infections.

Health Education Intervention as an Effective Means for Prevention of Respiratory Infections Among Hajj Pilgrims: A Review.

The prevalence of respiratory illness has continued to surge among Hajj pilgrims from different countries despite having some practices of preventive measures. Respiratory illnesses during Hajj could be due to many reasons and many factors that promote disease spread. These factors include overcrowding, cigarette smoking, and direct contact with infectious agents particularly viruses promote the spread of respiratory infections. However, due to the longer duration of the pilgrimage, there are high chances of pilgrims contracting various respiratory illnesses due to exposure to respiratory pathogens. Hajj pilgrims' knowledge, attitudes, and practices toward respiratory tract infections are used as the determinant of the effectiveness of the health education interventions. Knowledge and application of basic hygiene principles, use of face masks, following cough etiquettes, engaging in social distancing, and engaging in other measures are highly important. In this paper, we reviewed the various effective intervention strategies implemented to help prevent respiratory tract infections during Hajj.

Development and validation of knowledge, attitude and practice questionnaire for prevention of respiratory tract infections among Malaysian Hajj pilgrims.

BACKGROUND: Hajj pilgrimage faces numerous challenges including a high prevalence of respiratory tract infection as well as its prevention strategies. The aim of this study was to develop and validate a questionnaire to evaluate knowledge, attitude and practice (KAP) towards respiratory tract infections (RTIs) prevention among Malaysian Hajj pilgrims. METHODS: This study was conducted among Malaysian Umrah pilgrims in Malaysia from Kuala Lumpur and Kelantan. The questionnaire then underwent a series of validation process that included content, face validity and exploratory part. Item response theory (IRT) analysis was utilized for the validation of the knowledge domain. The attitude and practice were validated using the exploratory factor analysis (EFA). RESULTS: The validation process resulted in a questionnaire that comprised of four main sections: demography, knowledge, attitude, and practice. Following IRT analysis of the knowledge domain, all items analyzed were within the acceptable range of difficulty and discrimination. The Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) was 0.72 and 0.84 for attitude and practice domain respectively and Bartlett's test of Sphericity for both domains were highly significant (P < 0.001). The factor analysis resulted in two factors with total of 12 items in attitude domain, and 2 factors with total of 13 items in the practice domain with satisfactory factor loading (> 0.3). The Cronbach's alpha for reliability of the knowledge, attitude and practice domains all showed acceptable values of > 0.6 (0.92, 0.77 and 0.85). CONCLUSION: The findings of this validation and reliability study showed that the developed questionnaire had a satisfactory psychometric property for measuring KAP of Malaysian Hajj pilgrims.

Assessment of Knowledge, Attitude and Practice towards Prevention of Respiratory Tract Infections among Hajj and Umrah Pilgrims from Malaysia in 2018.

Respiratory tract infection (RTI) is a major public health challenge during the Muslim pilgrimage to Makkah. This study aims to evaluate the knowledge, attitude, and practice of Malaysian Hajj and Umrah pilgrims towards the prevention of RTIs in 2018 and determine correlations among three domains. A cross-sectional study was conducted among 225 Umrah and Hajj pilgrims. Knowledge, attitude, and practice (KAP) towards RTI prevention was assessed by using a validated self-administered questionnaire among pilgrims attending a weekly orientation course organized by private Hajj/Umrah companies. Out of 225 participants, 65.9% of respondents were female with the mean (SD) age of 46.74 (13.38) years. The interquartile range (IQR) score for knowledge is 18.0 (6.0), the mean scores of attitude and practice are 32.65 (4.72) and 25.30 (4.9). respectively. Significant and negative linear correlations between knowledge and practice (r = -0.232, p < 0.001), and attitude and practice (r = 0.134, p = 0.045) were observed. Results from the current study showed good knowledge of RTIs among Malaysian pilgrims. However, a poor attitude was reflected in their preventive practice behaviors. This will further help in the prevention and management of RTIs during Hajj and Umrah. Therefore, an extensive educational health campaign should be provided to pilgrims to create awareness.

Uptake of Recommended Vaccines and Its Associated Factors Among Malaysian Pilgrims During Hajj and Umrah 2018.

This study aimed to assess the uptake of recommended vaccines and to identify the factors associated with the vaccines' uptake among Malaysian Hajj and Umrah pilgrims. A cross-sectional survey among Malaysian Hajj and Umrah pilgrims in 2018. The uptake of the recommended vaccines was surveyed through an anonymous self-administered questionnaire to pilgrims attending a pre-departure Hajj/Umrah orientation course. Descriptive statistics were used for elaborating the demographic characteristics and vaccines uptake of the respondents. Multiple logistic regression was used for predicting the factors associated with the vaccines' uptake. A total of 1,274 pilgrims participated in the study with a mean age (standard deviation) of 42.42 (15.6). A total of 833 (65.4%) participants were females and 232 of the participants (18.2%) had at least more than one chronic disease. The uptake of influenza and pneumococcal vaccines were 28.6% (364/1,274) and 25.4% (324/1,274), respectively. Among the 527 pilgrims who were "at increased risk" of infections, 168 (31.9%) and 184 (34.9%) received influenza and pneumococcal vaccines, respectively. Gender, marital status and occupation were the common predictors associated with vaccines uptake. The vaccination uptake among Malaysian Hajj and Umrah pilgrims is low and declining from previous years. Educating the pilgrims toward vaccine uptake is essential and exploring the barriers for vaccination.

Short-term and long-term survival probabilities among first-ever ischaemic and haemorrhagic stroke patients at a hospital in the suburban east coast of Peninsular Malaysia.

AIM: This study aimed to determine the 28-day, 1-year, and 5-year survival probabilities in first-ever stroke patients in a relatively understudied setting: a suburban hospital that serves a predominantly rural population in the east coast of Peninsular Malaysia. METHODS AND RESULTS: A retrospective record review was conducted among 432 first-ever stroke patients admitted to the Hospital Universiti Sains Malaysia, Kelantan, Malaysia. Data from between January 1, 2005 and December 31, 2011, were extracted from the medical records. The Kaplan-Meier product limit estimator was applied to determine the 28-day, 1-year, and 5-year survival probabilities. Log-rank test was used to test the equality of survival time between different groups. A total of 101 patients died during the study period. The 28-day, 1-year, and 5-year survival probabilities were 78.0% (95% confidence interval [CI]: 73.5-81.9), 74.2% (95% CI: 69.4-78.4), and 70.9% (95% CI: 65.1-75.9), respectively. There were significant differences in the survival time based on the types of stroke, Glasgow Coma Scale, hyperlipidaemia, atrial fibrillation, fasting blood glucose, and diastolic blood pressure. CONCLUSION: This study, though retrospective, highlights several clinical parameters that influenced the survival probabilities among first-ever stroke patients managed in a suburban setting in Malaysia, and compared them to those reported in more urban regions. Our data emphasise the need for wider establishment of specialized stroke units and teams, as well as for prospective multi-centre studies on first-ever stroke patients to better inform the development of stroke care provision in Malaysia.