Exploring adolescents' practice and perspective on the use and misuse of kratom in northwest Malaysia.

Kratom is a plant homogenous to Southeast Asia with a long history of traditional use as medicinal herbs. However, recent years have witnessed its pervasive infiltration into international audience with growing public health concern. This cross-sectional study was conducted from 1 August 2017 till 31 August 2018 aiming to explore the practice and perspectives of kratom use and misuse among adolescents in northwest Malaysia. The study involved a self-administered questionnaire that was designed for the purpose of the study. The instrument had undergone prior validation process with a good overall internal reliability for the knowledge domain (Cronbach's alpha = 0.728) and attitude domain (Cronbach's alpha = 0.700). The questionnaire was distributed to 135 respondents involving adolescents aged 13 to 19 years old via convenience (non-kratom user) and snowball sampling (kratom users). There were 65 (47.8%) kratom users, while 70 (51.5%) were kratom-naïve. Among the kratom users, peer influence was the most common reason for them to be first involved with kratom, 26 (41.3%) whereas the reasons for kratom use quoted were to improve physical stamina, 10 (16.4%), as painkiller, 9 (14.8%), and to be accepted by peers, 7 (11.5%). Multiple logistic regression found that older age (95% CI: 0.13, 0.58; p = 0.001) and being active smokers (95% CI: 39.33, 980.63; p < 0.001) significantly predict kratom use among adolescents. The emerging trend of kratom abuse and misuse especially among the younger generation in Malaysia is raising concern and warrants social and governmental vigilance.

Implementation pilot study of community self-testing for COVID-19 among employees of manufacturing industries and their household members in 2022 to 2023.

COVID-19 self-testing is essential for enabling individuals to self-care, screen themselves and, if positive, isolate themselves. Since 2021, COVID-19 self-tests have been extensively used in high-income countries, however, their programmatic implementation in low- and middle-income countries has been delayed. An implementation pilot, mixed-methods study, was conducted in four industrial manufacturing companies, in Kedah State between November 2022 and May 2023. Participants were asked to take COVID-19 self-tests home for themselves and their household members and to use the tests according to national guidelines. At enrolment and at the end of the study, participants completed an online sociodemographic, knowledge and satisfaction survey. Data were cleaned and analysed using SPSS Statistics V28.0. Qualitative data were collected through semi-structured interviews and focus group discussions. Thematic analysis was conducted. A total of 1768 employees from four manufacturing industries enrolled in the pilot, representing 60% of the total employees and more than 50% of employees at each site. There were 40 COVID-19-positive cases detected in participants from the manufacturing industries, and 100 positive household members. Participants reported 27 invalid test results. Individuals aged 30 or less [adjusted odds ratio (AOR): 2.65; 95% CI: 1.63 to 4.31; p<0.001] and males (AOR: 1.54; 95% CI: 1.09 to 2.17; p = 0.014) showed a significant higher likelihood of self-testing compared to older and female participants. Additionally, individuals who received three or more doses of a COVID-19 vaccine had higher odds of using self-tests (OR 1.56 (95% CI: 1.03 to 2.36, p = 0.037)). There was a significant increase in participants' knowledge on how to correctly collect a self-sample using a nasal swab from 36,9% at baseline to 43,6% post-implementation (p = 0.004) and correct interpretation of a positive result from 80,5% at baseline to 87,6% post-implementation (p<0.001). Furthermore, there was a notable increase in the correct understanding of actions following a positive result, especially regarding self-isolation, which rose from 59.1% to 71.9% (p<0.001). A total of 44 SSIs, and 4 FGDs with a total of 14 participants, were performed. The five main themes explored were: 1) previous experiences with COVID-19, 2) COVID-19 ST experiences during the pilot study, 3) advantages of COVID-19 ST, 4) feelings related to COVID-19 ST, 5) willingness to use COVID-19 ST again, and 6) ST for other diseases. This research shows the feasibility of a self-testing model in the community through workplaces due to participants' high acceptability to enrol and high self-tests' uptake. Lessons learnt can inform operational aspects of the introduction and scale-up of self-care strategies in low- and middle-income countries, in particular the South-East Asia region.

Recommended Interventions to Improve Human Papillomavirus Vaccination Uptake among Adolescents: A Review of Quality Improvement Methodologies.

BACKGROUND: Routine human papillomavirus (HPV) vaccine uptake continues to be suboptimal since its recommendation in 2006 for girls and in 2011 for boys. This paper aims to review published quality improvement (QI) methodologies on interventions to improve HPV vaccine uptake among adolescents. METHODS: Science Direct and Scopus databases were searched for QI initiatives evaluating the effect of multimodal interventions to improve HPV vaccination rates (initiation and/or completion of series) among adolescents. Studies that included an outcome of interest among adolescents aged 10 to 18 years old were included. Two investigators worked independently to screen for potential articles and a designated investigator extracted data on study characteristics and evaluated the outcomes. RESULTS: A preliminary search yielded a total of 523 articles and 13 were included in the final analysis. Common strategies were provider-specific (i.e., webinar, telementoring, train-the-trainer approach) and patient- and/or parent-specific interventions (i.e., reminder emails, phone calls and text messages, social events), with an emphasis on education and knowledge empowerment. System-level interventions such as policy changes and revised protocols were less commonly prescribed despite being associated with a more significant weight on the overall outcome. CONCLUSIONS: Creative, sustainable, and economical multilevel interventions that focus not only on provider training and public education but also incorporate local policies and system enhancements can substantially improve HPV vaccination coverage among adolescents.

Knowledge, attitude and practice towards COVID-19 and perceived challenges of working during the movement control order: a quantitative analysis among healthcare workers in a Malaysian northwestern state.

OBJECTIVE: This study aimed to assess COVID-19 knowledge, attitude and practice (KAP) among healthcare workers (HCWs) in northwest Malaysia and recognize the challenges faced working during the Movement Control Order (MCO). Commonly referred to as "MCO", this order enforcement is a series of national quarantine and cordon sanitaire measures implemented by the federal government of Malaysia in response to the COVID-19 pandemic as of 18th March 2020. It is akin to a national lockdown. METHODS: A multi-centric cross-sectional web-based study was conducted from 29th May to 27th July 2020 among HCWs in Perlis, Malaysia using a 19-item validated questionnaire [Cronbach's alpha: 0.61 (knowledge domain), 0.74 (attitude domain), and 0.72 (practice domain)]. Challenges when working during MCO were identified from a self-rated five-point Likert scale of 14-item. RESULTS: There were a total of 373 respondents (response rate more than 40%); 48.0% were nurses, 14.7% were medical doctors, and 12.9% were administrative and technical support staffs. Majority of HCWs (90.1%, n = 336) had good knowledge, optimistic attitude (54.7%, n = 204) and good COVID-19 preventive measure practices (90.9%, n = 339). Multiple logistic regression demonstrated that profession was the single significant factor for good COVID-19 KAP. Though having lesser odds of good knowledge (aOR 0.07, 95% CI:0.01-0.36, p = .009), nurses showed greater odds of good attitude (aOR 3.14, 95% CI: 1.71-5.76, p = .011) and practice (aOR 10.69, 95% CI:2.25-50.86, p = .022) as compared to doctors and dentists. Main challenges identified when working during MCO were increased workload (44.5%, n = 166), difficulty going out shopping (48.3%, n = 180), to exercise (40.2%, n = 150) and meet with family members (64.3%, n = 240). CONCLUSION: Generally, HCWs in Perlis had good KAP with regards to COVID-19 infection and its preventive measures. Challenges underlined by HCWs while working during the MCO were increased workload, difficulty to shop for daily essentials, exercise and meet with family members. Should good COVID-19 KAP be sustained, they might contribute to success in combating this disease.