Publications by authors named "Mohd Azahadi Omar"

22 Publications

  • Page 1 of 1

Association of Internet Addiction with Adolescents' Lifestyle: A National School-Based Survey.

Int J Environ Res Public Health 2020 12 29;18(1). Epub 2020 Dec 29.

Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia.

Internet addiction (IA) among adolescents is an issue of growing concern with adverse effects on adolescents' health and social functioning. This study aims to determine the prevalence of IA among school-going adolescents in Malaysia and its associated factors-specifically, lifestyle factors. A nationwide cross-sectional school-based health survey was conducted in 2017 among 27,497 students from 212 randomly selected secondary schools. Information regarding sociodemography, lifestyle, and internet use was obtained using a self-administered questionnaire. IA was measured using the Malay Version of Internet Addiction Test (MVIAT). The prevalence of internet addiction was 29.0%. A multivariable logistic analysis revealed that inadequate fruit and vegetable intakes, consumed carbonated soft drinks at least once a day, consumed fast food at least three days/week, sedentary behavior, current E-cigarette users, and ever/current alcohol drinkers were lifestyle factors significantly associated with IA. Adolescents from urban schools, of higher school grade, and those whose parents are married but living apart were also found to have a greater risk for internet addiction. A positive association was found between IA with unhealthy dietary and lifestyle behaviors among adolescents. The modification of lifestyle factors needs to be considered while developing strategies and interventions for awareness-raising and prevention of IA among adolescents.
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http://dx.doi.org/10.3390/ijerph18010168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801949PMC
December 2020

Prevalence and factors associated with physical inactivity among older adults in Malaysia: A cross-sectional study.

Geriatr Gerontol Int 2020 Dec;20 Suppl 2:49-56

Center for Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Aim: Physical inactivity in older adults is linked to increased risk of chronic diseases, disability and various poor health outcomes. As the aging population rises, the prevalence of diseases associated with aging also increases. Regular physical activity in older adults is important to improve overall health and promote healthy aging. This study aimed to determine the prevalence and factors associated with physical inactivity among older adults in Malaysia.

Methods: This study was based on 3969 Malaysian older adults aged ≥60 years who completed the physical activity module in the National Health and Morbidity Survey 2018, a population-based cross-sectional survey. Physical activity was measured using the Global Physical Activity Questionnaire through a face-to-face interview. Participants were classified as physically active or inactive. Associations between physical inactivity, sociodemographic characteristics and a range of selected independent variables were examined using multivariable logistic regression.

Results: Overall, three out of 10 (29.8%) Malaysian older adults were physically inactive. Results of multivariable analysis showed that older age group (≥80 years), of Bumiputera Sarawak ethnicity, unemployed/retirees/homemakers, functional limitation, diabetes mellitus and dementia were significantly associated with a higher risk of physical inactivity. Women, with secondary education level and good social support were less likely to be physically inactive.

Conclusions: The present study reported the status of physical inactivity among older adults in Malaysia. There is the need to design effective public health programs and interventions to promote active living and healthy aging among Malaysian older adults, particularly in those at-risk older population subgroups. Geriatr Gerontol Int 2020; 20: 49-56.
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http://dx.doi.org/10.1111/ggi.13977DOI Listing
December 2020

An overview of the methodology and general findings from the National Health and Morbidity Survey (NHMS) 2018: Older persons' health in Malaysia.

Geriatr Gerontol Int 2020 Dec;20 Suppl 2:7-15

Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia.

Aim: This article describes the methodology of the 2018 Malaysian National Health and Morbidity Survey, and provides an overview of the sociodemographic details of the respondents and key findings on the health of older adults.

Methods: The survey included 3977 community-dwelling respondents, aged ≥60 years across Malaysia. Two-stage stratified random sampling with selection of enumeration blocks from both urban and rural areas ensured the findings were representative of the Malaysian older population.

Results: Complex sampling analyses ensured that findings on various geriatric syndromes, non-communicable diseases, nutritional status, functional status, social well-being and quality of life are representative of the Malaysian older population. Among the limitations are that the composition of older persons varied slightly from the general older population.

Conclusions: This article presents the methodology of the survey, and a baseline of the major health issues for older persons in Malaysia to provide clear guidance to researchers, program managers and policymakers to fully utilize the data from the Malaysian National Health and Morbidity Survey toward achieving healthy aging. The findings might stimulate more research on the health problems faced by older people to provide inputs for policymaking and program implementation. Geriatr Gerontol Int 2020; 20: 7-15.
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http://dx.doi.org/10.1111/ggi.14094DOI Listing
December 2020

Cardiovascular disease risk factors among older people: Data from the National Health and Morbidity Survey 2015.

PLoS One 2020 21;15(10):e0240826. Epub 2020 Oct 21.

Centre for Family Health Research, Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor, Malaysia.

Study on cardiovascular disease (CVD) risk factors and their prevalence among the older people in Malaysia is limited. We aimed to determine the prevalence and factors associated with CVD risk factors using the non-laboratory Framingham Generalized 10-Year CVD risk score among older people in Malaysia. This was a population-based cross-sectional study using data of 3,375 participants aged ≥60 years from the National Health and Morbidity Survey 2015. Sociodemographic, health factors and clinical assessments (anthropometry and blood pressure) were included. Complex survey analysis was used to obtain prevalence with 95% confidence intervals (CI). We applied ordinal regression to determine the factors associated with CVD risk. The prevalence for the high 10-year CVD risk was 72.1%. Body mass index was higher among those aged 60-69 years in men (25.4kg/m2, 95%CI 25.1-25.8) and women (26.7kg/m2, 95%CI 26.3-27.1) than the other age groups. The factors associated with moderate and high 10-year CVD risk were Malay ethnicity (Odds Ratio(OR) 0.76, 95%CI 0.63-0.92, p = 0.004), unmarried status (OR 1.55, 95%CI 1.22-1.97, p<0.001) and physically inactive (OR 0.72, 95%CI 0.55-0.95, p = 0.020). There is a need for future study to evaluate preventive strategies to improve the health of older people in order to promote healthy ageing.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240826PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577487PMC
December 2020

Sequential intermittent therapeutic plasma exchange: A possible induction and maintenance therapy in the management of adult patients with neuromyelitis optica spectrum disorder.

Ther Apher Dial 2020 Oct 7. Epub 2020 Oct 7.

Department of Neurology, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia.

Evidence on the benefits of intermittent therapeutic plasma exchange (TPE) as maintenance therapy in neuromyelitis optica spectrum disorder (NMOSD) is limited. This study explores the possible effectiveness of sequential intermittent therapeutic plasma exchange (SITPE), a novel TPE protocol in the management of adult NMOSD patients. Through retrospective review of medical records in Kuala Lumpur Hospital, Malaysia, NMOSD patients who underwent SITPE, namely, an induction phase of monthly cycle of TPE (1 cycle = five exchange sessions) for three cycles with or without a subsequent maintenance phase of three-monthly cycle of TPE for three cycles, were included in this controlled historical cohort study. We explored their serial improvements in Expanded Disability Status Scale (EDSS), limb power, visual acuity, and annualized relapse rate following SITPE initiation. Statistical significance was set at P < .05. Fifteen adults (mean age: 35.4 years, mean disease duration: 9.5 years, 73% female, 87% AQP4-IgG positive) with corticosteroid-refractory attacks were included. Upon SITPE initiation, significant improvements in EDSS and limb motor power for up to 12 months, in addition to significant improvements in visual acuity for up to 6 months, were recorded. Significant reduction in annualized relapse rates for up to 2 years was documented. These improvements were not significantly influenced by age groups, gender, or presence of cord atrophy. Notably, adverse events of SITPE were infrequent and manageable. Sequential intermittent therapeutic plasma exchange as induction and maintenance therapy may improve the disease outcomes and prevent relapses in adult NMOSD patients with severe, corticosteroid-refractory attacks.
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http://dx.doi.org/10.1111/1744-9987.13595DOI Listing
October 2020

Trends in population blood pressure and prevalence, awareness, treatment and control of hypertension among older persons: The 2006 & 2015 National Health and Morbidity Survey in Malaysia.

PLoS One 2020 10;15(9):e0238780. Epub 2020 Sep 10.

Sector for Biostatistic & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia.

Background: Hypertension is one of the most important risk factors for cardiovascular diseases. Thus, it is an important public health challenge worldwide. In Malaysia, only a few studies have focused on the trends of hypertension specifically for the aging population. In view of the rapid growth of the elderly population in Malaysia, there is an urgent need to explore the condition of hypertension in this aging population. Hence, the objectives of this study were to determine the trends of population mean systolic and diastolic blood pressure (BP) levels, the prevalence, awareness, treatment and control of hypertension, and its' associated factors among older persons in two cross-sectional national surveys that were conducted in 2006 and 2015 in Malaysia.

Methods: This was a subanalysis of secondary data collected from the two cross-sectional national population-based surveys conducted in Malaysia in 2006 and 2015. Adults aged 60 and older who had participated in these two surveys were included in the study.

Results: A total of 4954 (2295 males and 2659 females) and 3790 (1771 males and 2019 females) respondents completed the hypertension module surveys in 2006 and 2015, respectively. The mean age of the respondents was 68.5±6.9 years in 2006 and 68.6±7.1 years in 2015 and the difference was not significant. The prevalence of hypertension significantly reduced from 73.8% in 2006 to 69.2% in 2015 (p<0.001). Among the respondents with hypertension, the awareness, treatment and control of hypertension significantly increased from 49.7% to 60.2%, 86.7% to 91.5% and 23.3% to 44.8%, respectively, from 2006 to 2015. Logistic regression analysis showed that female sex and unemployed/retiree were significantly associated with higher hypertension prevalence in both 2006 and 2015. Being unemployed/ retiree was significantly associated with higher awareness of hypertension in both 2006 and 2015. In both 2006 and 2015, Chinese ethnicity were significantly associated with higher awareness and control of hypertension.

Conclusions: The mean population BP levels and hypertension prevalence among the elderly population in Malaysia have reduced significantly over the past decade. Although the awareness, treatment and control of hypertension among older adults have improved significantly, the awareness and control rates remain suboptimal. As population aging is inevitable, appropriate public health programs and optimal treatment strategies targeting this vulnerable group are urgently needed to improve the overall awareness and control of hypertension and to prevent hypertension-related complications.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238780PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482969PMC
November 2020

Incidence and predictors of mild cognitive impairment (MCI) within a multi-ethnic Asian populace: a community-based longitudinal study.

BMC Public Health 2019 Aug 22;19(1):1159. Epub 2019 Aug 22.

Institute of Public Health, Ministry of Health, Jalan Bangsar, Federal Hill, 59000, Kuala Lumpur, Malaysia.

Background: Limited information is available from longitudinal studies regarding the predictors and incidence of MCI in older Asian adults. Thus, a community-based longitudinal study was conducted to determine the incidence of MCI among multi-ethnic older adults in Malaysia. The role of health and lifestyle as predictors of MCI was also examined.

Methods: Analysis of data obtained from the Towards Useful Aging (TUA) study (2014-2016), wave 1 (baseline) and wave 2 (1½ years of follow-up) was conducted. For the baseline, comprehensive, interview-based questionnaires were administered to 1227 subjects who were 60 years old and above. MCI is a unique transitional state between normal ageing and dementia. MCI characteristics include a decline and disturbance of cognition, minimal impairment of complex activities, ability to perform regular daily functions, and absence of dementia. The incidence of MCI was assessed using comprehensive neuropsychological batteries. The study then performed a logistic regression analysis to examine the effect of each possible predictor of MCI. This analysis began with univariate analyses and a separate review of the effect of every variable. Binary logistic analyses followed hereafter.

Results: During the follow-up after 1½ years, 179 (14.6%) of the participants who did not exhibit MCI at baseline were observed to have developed MCI. Among the participants who did not exhibit MCI at baseline, the incidence rate was 10.5 per 100 person-years. Male sex and lack of engagement in mental activities were predictors of MCI among participants without MCI at baseline.

Conclusion: After the 1½-year follow-up, the incidence rate for MCI was considerably high among the respondents. Being male and being less engaged in mental activities were predictors of the occurrence of MCI. Mental activities need to be promoted for the prevention of MCI incidence among older adults.
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http://dx.doi.org/10.1186/s12889-019-7508-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704715PMC
August 2019

Methodology and Representativeness of the Adolescent Health Survey 2017 in Malaysia.

Asia Pac J Public Health 2019 11 21;31(8_suppl):8S-17S. Epub 2019 Jun 21.

Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia.

Health risk behaviors and mental health problems are associated with morbidity and premature mortality among adolescents. Understanding the magnitude of the problem may improve adolescent health status. The Adolescent Health Survey was conducted to collect data on health risk behaviors among Malaysian school-going adolescents using self-administered questionnaires. A 2-stage stratified cluster sampling design was used and samplings weights were calculated to ensure representativeness to the general population. A total of 27 497 out of 30 823 school-going adolescents completed the questionnaires, yielded an 89.2% overall response rate. The methodology was robust to ensure valid estimation on the prevalence of health problems among Malaysian school-going adolescents.
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http://dx.doi.org/10.1177/1010539519854884DOI Listing
November 2019

Prevalence and correlates of physical inactivity among older adults in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2015.

Arch Gerontol Geriatr 2019 Mar - Apr;81:74-83. Epub 2018 Nov 26.

Centre for Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Electronic address:

Malaysia has an increasingly aging population. Despite the substantial benefits of physical activity for healthy aging, older adults are considered the most physically inactive segment of the Malaysian population. The purpose of this study was to determine the prevalence of physical inactivity among older adults in Malaysia and its correlates. We analysed data on adults aged ≥60 years (n = 3790) from the National Health and Morbidity Survey (NHMS) 2015, a cross-sectional, nationwide population-based survey covering information on socio-demographic characteristics, physical activity and other lifestyle-related variables, health conditions, and functional limitations. Individuals included in this study were classified as physically active or physically inactive. Logistic regression was used to determine factors associated with physical inactivity. The overall prevalence of physical inactivity among older adults aged ≥60 years old was 48.8%. Physical inactivity was significantly more prevalent among females, older age groups, Indians, those being single/widowed/divorced, those with no formal education, those who reported high sedentary time (≥7 h/day), those with diabetes, anaemia, and functional limitations (p < 0.001). In fully adjusted analyses, females, older age, high household income (≥MYR4000), inadequate fruits and vegetables consumption (<5 servings/day), high sedentary time, having diabetes, and having mobility impairment were all associated with physical inactivity. Approximately half of the Malaysian older population are physically inactive. Identifying the correlates of physical inactivity among Malaysian older adults will help to develop public health policies and interventions that encourage active living among older people and promote healthy aging in Malaysia.
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http://dx.doi.org/10.1016/j.archger.2018.11.012DOI Listing
January 2020

Changes in body pain among overweight and obese housewives living in Klang Valley, Malaysia: findings from the MyBFF@home study.

BMC Womens Health 2018 07 19;18(Suppl 1):101. Epub 2018 Jul 19.

Kuala Lumpur General Hospital, Ministry of Health Malaysia, Jalan Pahang, Kuala Lumpur, Malaysia.

Background: Obesity leads to the increase of pain at different parts of the body and it is a potential marker for complications of chronic diseases. This paper aims to assess changes in the body pain among overweight and obese housewives who participated in the My Body is Fit and Fabulous at home (MyBFF@home) study.

Methods: Housewives aged 18 to 59 years old from the MyBFF@home study were selected and pain was measured using the Visual Analogue Scale (VAS) questionnaire. VAS measured the pain intensity at different parts of the body (score of 0-10). Data were collected at base line, 3 months and 6 months among the housewives in both the control and intervention group. Pain scores and other variables (age, Body Mass Index (BMI) and waist circumference) were analysed using SPSS version 22.

Results: A total of 328 housewives completed the VAS questionnaires at baseline, while 185 (56.4%) of housewives completed the VAS at 3 months and 6 months. A decreasing trend of mean pain score in both groups after 6 months was observed. However, the intervention group showed a consistent decreasing trend of pain score mainly for back pain. In the control group, there was a slight increment of score in back pain from baseline towards the 6 months period. Older housewives in both groups (aged 50 years and above) had a higher mean score of leg pain (2.86, SD: 2.82) compared to the other age group. Higher BMI was significantly associated with pain score in both groups.

Conclusion: There were some changes in the level of body pain among the housewives before and after the intervention. Older obese women had a higher pain score compared to younger obese women. Pain was associated with BMI and change in BMI appears to be beneficial in reducing body pain among overweight and obese individuals.
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http://dx.doi.org/10.1186/s12905-018-0597-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069687PMC
July 2018

The effect of weight loss intervention programme on health-related quality of life among low income overweight and obese housewives in the MyBFF@home study.

BMC Womens Health 2018 07 19;18(Suppl 1):111. Epub 2018 Jul 19.

Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.

Background: Obesity is an emerging global public health concern as it is related to chronic diseases and its impact to health related quality of life. The aim of this study was to assess the effect of weight reduction on health related quality of life (HRQOL) among obese and overweight housewives.

Methods: Data on 123 obese and overweight housewives in the intervention group from the MyBFF@home study were utilised. A validated Malaysian Malay version of Obesity Weight Loss Quality of Life (OWLQOL) questionnaire was administered at baseline and 6 months after intervention. Descriptive analysis, univariate analysis, paired t-test and multiple logistic regression were performed using SPSS Version 22.

Results: Mean body mass index (BMI) was 31.5 kg/m (SD:4.13), with 51 participants classified as overweight (41.5%) while 72 were obese (58.5%). About 72% of the housewives experienced weight reduction (62% reduced weight less than 5% and 11% reduced weight more than 5% of their baseline weight). There was a significant improvement in HRQOL with a pre-intervention total mean score of 59.82 (SD: 26.60) and post-intervention of 66.13 (SD: 22.82), p-value < 0.001. By domain, the highest post intervention mean score was self-image 71.46 (SD: 22.85), followed by social stigma 68.77 (SD: 28.70), physical 61.83 (SD: 24.25) and trying to lose weight 61.24 (SD: 27.32). There was no significant association between weight reduction and HRQOL improvement.

Conclusion: Weight loss intervention programme utilizing behavioural modification has led to a significant improvement in HRQOL among overweight and obese housewives.
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http://dx.doi.org/10.1186/s12905-018-0591-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069293PMC
July 2018

Incidence and predictors of multimorbidity among a multiethnic population in Malaysia: a community-based longitudinal study.

Aging Clin Exp Res 2019 Feb 30;31(2):215-224. Epub 2018 Jul 30.

Institute of Public Health, Ministry of Health, Jalan Bangsar, Federal Hill, 59000, Kuala Lumpur, Malaysia.

Background: Multimorbidity in older adults needs to be assessed as it is a risk factor for disability, cognitive decline, and mortality.

Aims: A community-based longitudinal study was performed to determine the incidence and to identify possible predictors of multimorbidity among multiethnic older adults population in Malaysia.

Methods: Comprehensive interview-based questionnaires were administered among 729 participants aged 60 years and above. Data were analyzed from the baseline data of older adults participating in the Towards Useful Aging (TUA) study (2014-2016) who were not affected by multimorbidity (349 without any chronic diseases and 380 with one disease). Multimorbidity was considered present in an individual reporting two or more chronic diseases.

Results: After 1½ years of follow-up, 18.8% of participants who were initially free of any diseases and 40.9% of those with one disease at baseline, developed multimorbidity. The incidence rates were 13.7 per 100 person-years and 34.2 per 100 person-years, respectively. Female gender, smoking, and irregular preparing of food (lifestyle) were predictors for incidence of multimorbidity, especially in those without any disease, while Body Mass Index (BMI) 22-27 kg/m and inadequate daily intake of iron were identified as predictors of multimorbidity among participants who already have one disease.

Conclusions: The incidence rates of multimorbidity among Malaysian older adults were between the ranges of 14-34 per 100 person-years at a 1½-year follow-up. Gender, smoking, BMI 22-27 kg/m, inadequate daily intake of iron and lack of engagement in leisure or lifestyle physical activities were possible predictors in the development of multimorbidity. There is a need to formulate effective preventive management strategies to decelerate multimorbidity among older adults.
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http://dx.doi.org/10.1007/s40520-018-1007-9DOI Listing
February 2019

Prevalence, Awareness, Treatment and Control of hypertension in the Malaysian population: findings from the National Health and Morbidity Survey 2006-2015.

J Hum Hypertens 2018 09 13;32(8-9):617-624. Epub 2018 Jun 13.

Institute for Public Health, Bangsar, Kuala Lumpur, Malaysia.

Hypertension is strongly associated with chronic diseases such as myocardial infarction, stroke, heart failure, and renal failure. The objective of this study is to determine the trend of prevalence, awareness, treatment, and control of hypertension among Malaysian population since 2006 to 2015. The study used the data from National Health and Morbidity Survey (NHMS) 2006, 2011, and 2015. It was a cross-sectional with two-stage stratified random sampling throughout Malaysia for eligible respondents 18 years old and above. Respondents were interviewed face to face and blood pressure was recorded as the average reading from two electronic pressure monitoring measurements. Data was analyzed using the Complex sample module in SPSS Version 20. The prevalence of hypertension in Malaysia was 34.6% (95% CI: 33.9, 35.3) in 2006, 33.6% (95% CI: 32.6, 34.6) in 2011 and 35.3% (95% CI: 34.5, 36.3) in 2015. Awareness of hypertension in 2006, 2011, and 2015 was 35.6% (95% CI: 34.6, 36.6), 40.7% (95% CI: 39.3, 42.1), and 37.5% (95% CI: 36.1, 38.9) respectively. The trend of receiving treatment from 2006 to 2015 was 78.9% (95% CI: 77.5, 80.2) to 83.2% (95% CI: 81.3, 84.8). The control of hypertension increased significantly from 27.5% (95% CI: 25.9, 29.2) in 2006 to 37.4% (95% CI: 35.3, 39.5) in 2015. Despite higher proportions receiving treatment over time, the control of hypertension remained below 40% since NHMS 2006 until 2015. The strategies to further reduce the prevalence and increase awareness of hypertension should be enhanced particularly among the targeted age group to ensure early detection, treatment, and control thus preventing from long-term complications.
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http://dx.doi.org/10.1038/s41371-018-0082-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150908PMC
September 2018

Timed up and go test combined with self-rated multifactorial questionnaire on falls risk and sociodemographic factors predicts falls among community-dwelling older adults better than the timed up and go test on its own.

J Multidiscip Healthc 2017 26;10:409-416. Epub 2017 Oct 26.

Institute for Public Health, Ministry of Health, Kuala Lumpur, Malaysia.

Background: Early detection of falls risk among older adults using simple tools may assist in fall prevention strategies. The aim of this study was to identify the best parameters associated with previous falls, either the timed up and go (TUG) test combined with sociodemographic factors and a self-rated multifactorial questionnaire (SRMQ) on falls risk or the TUG on its own. Falls risk was determined based on parameters associated with previous falls.

Design: This was a retrospective cohort study.

Setting: The study was conducted in a community setting.

Participants: The participants were 1,086 community-dwelling older adults, with mean age of 69.6±5.6 years. Participants were categorized into fallers and nonfallers based on their history of falls in the past 12 months.

Method: Participants' sociodemographic data was taken, and SRMQ consisting of five falls-related questions was administered. Participants performed the TUG test twice, and the mean was taken as the result.

Results: A total of 161 participants were categorized as fallers (14.8%). Multivariate logistic regression analysis showed that the model ((6)=61.0, <0.001, Nagelkerke =0.10) consisting of the TUG test, sociodemographic factors (gender, cataract/glaucoma and joint pain), as well as the SRMQ items "previous falls history" (Q1) and "worried of falls" (Q5), was more robust in terms of falls risk association compared to that with TUG on its own ((1)=10.3, <0.001, Nagelkerke =0.02).

Conclusion: Combination of sociodemographic factors and SRMQ with TUG is more favorable as an initial falls risk screening tool among community-dwelling older adults. Subsequently, further comprehensive falls risk assessment may be performed in clinical settings to identify the specific impairments for effective management.
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http://dx.doi.org/10.2147/JMDH.S142520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667639PMC
October 2017

Physical activity and overweight/obesity among Malaysian adults: findings from the 2015 National Health and morbidity survey (NHMS).

BMC Public Health 2017 09 21;17(1):733. Epub 2017 Sep 21.

Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590, Kuala Lumpur, Malaysia.

Background: Overweight and obesity are growing health problems both worldwide and in Malaysia due to such lifestyle changes as decreased physical activity (PA), increased sedentary behavior and unhealthy eating habits. This study examined the levels and patterns of PA among normal-weight and overweight/obese adults and to investigate the association between PA level and overweight/obesity in Malaysian adults.

Methods: This study used data from the 2015 National Health and Morbidity Survey (NHMS), a nationwide cross-sectional survey that implemented a two-stage stratified random sampling design. Respondents aged 18 years and above (n = 17,261) were included in the analysis. The short version of International Physical Activity Questionnaire (IPAQ) was administered to assess the respondents' PA levels. The respondents' height and weight were objectively measured and body mass index (BMI) was calculated. The respondents were categorized according to BMI as either normal-weight (18.5-24.9 kg/m) or overweight/obese (≥ 25 kg/m). Descriptive and complex sample logistic regression analyses were employed as appropriate.

Results: Overall, approximately 1 in 2 respondents (51.2%) were overweight/obese, even though the majority (69.0%) reporting at least a moderate level of PA (total PA ≥ 10 MET-hours/week). In both normal-weight and overweight/obese groups, a significantly higher prevalence of high PA (total PA ≥ 50 MET-hours/week) was observed among men than women (p < 0.001), but women reported a significantly higher prevalence of low and moderate PA than men (p < 0.001). Men reported significantly higher activity levels (in MET-hours/week) than women with regard to walking, vigorous-intensity PA and total PA (p < 0.001). Overweight/obese men reported a significantly lower level of vigorous-intensity PA and total PA than normal-weight men (p < 0.001). A low level of PA was associated with the risk of overweight/obesity (Adjusted OR = 1.14; 95% CI: 1.01-1.30) compared to a high level of PA among men but not among women.

Conclusions: The levels of PA were inversely related to the risk of overweight/obesity in men but not in women. Programs designed to reduce overweight/obesity rates should encourage the practice of moderate- to vigorous-intensity PA. Future research should consider using longitudinal and prospective approaches that simultaneously measure dietary intake, PA and BMI among Malaysian adults to investigate the actual relationship between PA and overweight/obesity.
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http://dx.doi.org/10.1186/s12889-017-4772-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5609047PMC
September 2017

Erratum to: Validation of verbal autopsy: determination of cause of deaths in Malaysia 2013.

BMC Public Health 2017 08 31;17(1):687. Epub 2017 Aug 31.

Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia.

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http://dx.doi.org/10.1186/s12889-017-4687-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580286PMC
August 2017

Validation of verbal autopsy: determination of cause of deaths in Malaysia 2013.

BMC Public Health 2017 08 11;17(1):653. Epub 2017 Aug 11.

Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia.

Background: Mortality statistics by age, sex and cause are the foundation of basic health data required for health status assessment, epidemiological research and formation of health policy. Close to half the deaths in Malaysia occur outside a health facility, are not attended by medical personnel, and are given a lay opinion as to the cause of death, leading to poor quality of data from vital registration. Verbal autopsy (VA) is a very useful tool in diagnosing broad causes of deaths for events that occur outside health facilities. This article reports the development of the VA methods and our principal finding from a validation study.

Methods: A cross sectional study on nationally representative sample deaths that occurred in Malaysia during 2013 was used. A VA questionnaire suitable for local use was developed. Trained field interviewers visited the family members of the deceased at their homes and conducted face to face interviews with the next of kin. Completed questionnaires were reviewed by trained physicians who assigned multiple and underlying causes. Reference diagnoses for validation were obtained from review of medical records (MR) available for a sample of the overall study deaths.

Results: Corresponding MR diagnosis with matched sample of the VA diagnosis were available in 2172 cases for the validation study. Sensitivity scores were good (>75%) for transport accidents and certain cancers. Moderate sensitivity (50% - 75%) was obtained for ischaemic heart disease (64%) and cerebrovascular disease (72%). The validation sample for deaths due to major causes such as ischaemic heart disease, pneumonia, breast cancer and transport accidents show low cause-specific mortality fraction (CSMF) changes. The scores obtained for the top 10 leading site-specific cancers ranged from average to good.

Conclusion: We can conclude that VA is suitable for implementation for deaths outside the health facilities in Malaysia. This would reduce ill-defined mortality causes in vital registration data, and yield more accurate national mortality statistics.
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http://dx.doi.org/10.1186/s12889-017-4668-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553780PMC
August 2017

The cut-off values of anthropometric variables for predicting mild cognitive impairment in Malaysian older adults: a large population based cross-sectional study.

Clin Interv Aging 2017 7;12:275-282. Epub 2017 Feb 7.

Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia.

Purpose: Older adults are at risk of mild cognitive impairment (MCI), and simple anthropometric measurements can be used to screen for this condition. Thus, the aim of this study was to explore the cut-off values of body mass index (BMI) and waist circumference (WC) for predicting the risk of MCI in older Malaysian adults.

Methods: A total of 2,240 Malaysian older adults aged ≥60 years were recruited using multistage random sampling in a population based cross-sectional study. Receiver operating characteristic (ROC) curve was used to determine the cut-off values of BMI and WC with optimum sensitivity and specificity for the detection of MCI. Age, gender, years of education, smoking habit, alcohol consumption, depression, and medical conditions were used as confounding factors in this analysis.

Results: A BMI cut-off value of 26 kg/m (area under the receiver operating characteristic curve [AUC] 0.725; sensitivity 90.5%; specificity 38.8%) was appropriate in identifying the risk of getting MCI in both men and women. The optimum WC cut-offs for likelihood of MCI were 90 cm (AUC 0.745; sensitivity 78.0%; specificity 59.8%) for men and 82 cm (AUC 0.714; sensitivity 84.3%; specificity 49.7%) for women. The optimum calf circumference (CC) cut-off values for identifying MCI were 29 cm (AUC 0.731; sensitivity 72.6%; specificity 61.1%) for men and 26 cm (AUC 0.598; sensitivity 79.1%; specificity 45.3%) for women.

Conclusion: The cut-off values could be advocated and used as part of the screening of MCI among older Malaysian adults. There is a need to further determine the predictive values of these cut-off points on outcomes through longitudinal study design.
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http://dx.doi.org/10.2147/CIA.S118942DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304972PMC
January 2018

Lifestyle, chronic diseases and self-rated health among Malaysian adults: results from the 2011 National Health and Morbidity Survey (NHMS).

BMC Public Health 2015 Aug 6;15:754. Epub 2015 Aug 6.

Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.

Background: Self-rated health (SRH) has been demonstrated as a valid and appropriate predictor of incident mortality and chronic morbidity. Associations between lifestyle, chronic diseases, and SRH have been reported by various population studies but few have included data from developing countries. The aim of this study was to determine the prevalence of poor SRH in Malaysia and its association with lifestyle factors and chronic diseases among Malaysian adults.

Methods: This study was based on 18,184 adults aged 18 and above who participated in the 2011 National Health and Morbidity Survey (NHMS). The NHMS was a cross-sectional survey (two-stage stratified sample) designed to collect health information on a nationally representative sample of the Malaysian adult population. Data were obtained via face-to-face interviews using validated questionnaires. Two categories were used to measure SRH: "good" (very good and good) and "poor" (moderate, not good and very bad). The association of lifestyle factors and chronic diseases with poor SRH was examined using univariate and multivariate logistic regression.

Results: Approximately one-fifth of the Malaysian adult population (20.1 %) rated their health as poor (men: 18.4 % and women: 21.7 %). Prevalence increases with age from 16.2 % (aged 18-29) to 32.0 % (aged ≥60). In the multivariate logistic regression analysis, lifestyle factors associated with poor SRH included: underweight (OR = 1.29; 95 % CI: 1.05-1.57), physical inactivity (OR = 1.25; 95 % CI: 1.11-1.39), former smoker (OR = 1.38; 95 % CI: 1.12-1.70), former drinker (OR = 1.27; 95 % CI: 1.01-1.62), and current drinker (OR = 1.35; 95 % CI: 1.08-1.68). Chronic diseases associated with poor SRH included: asthma (OR = 1.66; 95 % CI: 1.36-2.03), arthritis (OR = 1.87; 95 % CI: 1.52-2.29), hypertension (OR = 1.39; 95 % CI: 1.18-1.64), hypercholesterolemia (OR = 1.43; 95 % CI: 1.18-1.74), and heart disease (OR = 1.85; 95 % CI: 1.43-2.39).

Conclusions: This study indicates that several unhealthy lifestyle behaviours and chronic diseases are significantly associated with poor SRH among Malaysian adults. Effective public health strategies are needed to promote healthy lifestyles, and disease prevention interventions should be enhanced at the community level to improve overall health.
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http://dx.doi.org/10.1186/s12889-015-2080-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527234PMC
August 2015

Prevalence and factors associated with physical inactivity among Malaysian adults.

Southeast Asian J Trop Med Public Health 2014 Mar;45(2):467-80

Using data from the Third National Health and Morbidity Survey (NHMS III) in 2006, this study examined the association between socio-demographic factors and physical inactivity in a sample of 33,949 adults aged 18 years and above by gender. Physical activity levels were measured using the Global Physical Activity Questionnaire (GPAQ vers 1). Physical inactivity was defined as having a total physical activity level of less than 600 metabolic equivalents-minutes per week (METs-minutes/week) contributed by all three different life domains.Logistic regression analyses were conducted.The prevalence of overall physical inactivity was 43.7% (95% CI: 42.9-44.5). The mean total physical activity level was 894.2 METs-minutes/ week. The means METs-minutes/week for the domain of work, travelling, and leisure time were 518.4, 288.1, and 134.8, respectively. Multivariable logistic regression analyses indicated that females were more likely to be physically inactive than males were (aOR=1.62; 95% CI: 1.53-1.72). Among women, being a housewife (aOR = 1.78; 95% CI: 1.56-2.03), widow/divorcee (aOR = 1.23; 95% CI: 1.05-1.43), and those with no formal education (aOR = 1.20; 95% CI: 1.01-1.43) were found to be significantly associated with physical inactivity.Urban residents, older adults aged 65 years and above, private employees, nonworking group, and those with a monthly household income level of MYR5,000 and above appeared to be consistently associated with physical inactivity across men, women, and combined group (both). Specific health intervention strategies to promote physical activity should be targeted on population subgroups who are inactive.
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March 2014

Prevalence, awareness, treatment and control of Hypertension among the elderly: the 2006 National Health and Morbidity Survey III in Malaysia.

Med J Malaysia 2013 Aug;68(4):332-7

Pejabat Kesihatan Daerah Klang, KK Bandar Botanik, Blok A, Jalan Langat, Bandar Botanic, Selangor 41200 Klang, Malaysia.

Introduction: The objective of this study was to determine the prevalence and factors associated with the awareness, treatment and control of hypertension among the elderly population in Malaysia.

Methods: Analysis of secondary data from a cross-sectional national population based survey using stratified multistage sampling conducted from April to August 2006 throughout Malaysia National Health and Morbidity Survey III(NHMS III). Adults aged 60 and older who had participated in the survey were included in the study.

Results: A total of 4954 respondents (14.3%) were elderly from the 34,539 respondents aged 18 years and above for hypertension module in NHMS III. A total of 4933 elderly had their blood pressure examined (giving a response rate of 99.6%). The overall prevalence of hypertension among elderly was 74.0%, more in elderly female (77.4%) than men (70.1%). Only 49.3% of them were aware of their hypertensive status, 42.4% were currently treated and 22.6% of those being treated were under control. The results of multiple logistic regression showed factors associated with higher awareness and treatment rates were similar i.e. females, young-old age group (age 60-74), urban residents, Chinese ethnic group and higher education. For those elderly who were on treatment, determinants associated with controlled hypertension were Chinese and Indians ethnic groups and higher educational level.

Conclusions: There was a high prevalence of hypertension among the elderly in Malaysia but with poor awareness, treatment and control rate. Reliable information on these aspects is important for the development of patient education programs, health policies to improve disease management and overall health care resource allocation especially among the elderly in Malaysia.
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August 2013

Prevalence and impact of physical disability on Malaysian school-aged children: a population-based survey.

Disabil Rehabil 2009 ;31(21):1753-61

Paediatric Department, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia.

Purpose: To determine the magnitude and impact of physical disability on Malaysian school-aged children between 7 and less than 18 years old.

Method: Cross-sectional population-based household interview with two-stage stratified sampling design.

Setting: The Malaysian Third National Health of Morbidity Survey, 2006.

Results: Overall prevalence of physical disability was 2.8 per 1000 population among children aged between 7 and less than 18 years old. The commonest cause was congenital, in 61.5% of the affected children. Slightly more than a third of these children with physical disability were partially or totally dependent on their caregivers in the various areas of self care (37.4%) and mobility (34.9%). We also found that the more severe the physical disability, the more adverse impact it had on the functional independence and community participation of these children. Among these children, almost 40% of them had no verbal communication, 31.5% had not attended formal education and 21% were housebound.

Conclusion: This population-based survey on physical disability among school-aged children highlighted the key areas where physical disability can greatly impact on the child's function. It has identified the areas of needs that require multisectoral involvement and commitment from the government, non-government and private agencies.
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http://dx.doi.org/10.1080/09638280902751964DOI Listing
January 2010