Theses (MSc. Public Health)
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- ThesisRestrictedImpact Of Night Shift Work On Dietary Habits Among Nurses(International Medical University, 2013)Jamilah Abd JamilIntroduction: There has been an increasing growth in the population of shift workers particularly among night shift workers. Concerns are for the occupational health and safety of the workers. Increasing evidence indicates that night shift work is associated with many health diseases like obesity and metabolic syndrome. Studies have also shown that night shift work affects the dietary habits of the workers. Objective: The aim of this study is to assess how night shift impacts a person’s diet quality as measured by Healthy Eating Index (HEI) tool. HEI measures overall dietary habits with consideration of balance, moderation and variety aspects. Methods: This is a cross sectional study done among nurses on rotating shift aged between 20 to 60 years. Subjects needed to record their intake over 24 hours for 3 days when their morning shift is on and another 3 days when their night shift is on. Nutrient analysis was done using a software called Nutritionist ProTM Diet Analysis. To translate the mean of the nutrients analysis into the scoring of HEI, excel spreadsheet was used. Data analysis was done using Statistical Package for the Social Sciences (SPSS) software version 17.0. Result: In univariate analysis, total HEI score was significantly different (P<0.05) between the two shifts (Night shift 57.4 ± 10.0 < Day shift 61.8 ± 8.6). From the ten components of HEI, vegetables intake score was significantly different between the two shifts (Night shift = 2.8 ± 0.5 < Day shift = 4.1 ± 0.5). There was also a significant difference between day and night shifts for meat and legumes intake score (Night shift = 3.5± 2.0 < 4.5 ± 2.0). In multivariate analysis, variety score correlates with HEI scores. Variety of foods gave significant result with p-value of 0.047 for night shift and p-value of 0.036 for day shift. Conclusion: Night shift work impacts shift workers’ diet quality. Future research should focus on education approaches on how to improve dietary habits of the night shift workers and environment that can support healthy lifestyle behaviours.
- ThesisRestrictedRelationship Between Fast Food Consumption And Overweight/Obesity Among Secondary School Children In Kepong, Kuala Lumpur(International Medical University, 2013)Ng Ai KahIntroduction: Obesity is a serious type of malnutrition affecting people of all age groups across the world, especially the young. One of the factors that are strongly associated with overweight or obesity is the consumption of fast food. Objective: To study the relationship between fast food intake and overweight/obesity among secondary school children of Kepong, Kuala Lumpur. Methods: The study design was case-control. The sample size comprised of 148 participants. There were 47 cases and 101 controls. All the questionnaires were self-administered. Univriate and Multivariate analysis were conducted for comparison purposes. In this study, a p-value <0.05 was considered as statistically significant. Results: This study revealed that the respondents, on an average, were consuming fast food three to four times a month. Majority of them consumed fast food because they liked the taste and had even developed craving for it. However, the association between fast food consumption and overweight was not found to be statistically significant. The Multiple Logistic regression analysis revealed that father’s education level, family history of hypertension; eating out of home and dieting were significantly associated with fast food consumption. The multivariate analysis also revealed that gender, mother’s occupation, BMI of father, BMI of mother, family history of high blood cholesterol, fruit intake, dieting and level of physical activity were significantly associated with overweight/obesity. Conclusion: The findings from this study suggest that family–based nutritional interventions, promotion of healthy eating habits and increase in physical activity are essential for the well-being of adolescent school children as they are the future leaders of the nation.
- ThesisRestrictedDETERMINANTS OF MALARIA IN PREGNANCY IN A RUBBER PLANTATION COMMUNITY IN NIETE, CAMEROON (WEST AFRICA)(International Medical University, 2015)GEETHANJALI A/P M. RAJASEGARIntroduction: Malaria is a major public health problem in Cameroon (West Africa) where 100% of the population is at risk. Malaria in Cameroon is mainly due to infections by Plasmodium falciparum. Some population groups including pregnant women are at considerably higher risk of contracting malaria, and developing severe disease, than others. In Africa, 30 million women living in malaria-endemic areas become pregnant each year. It is known that malaria infection during pregnancy is a significant public health problem in Cameroon with substantial risks for the pregnant woman, her foetus, and the new-born child. The symptoms and complications of malaria in pregnancy vary according to malaria transmission intensity in the given geographical area and the individual’s level of acquired immunity. Agricultural practices of the population are often associated with malaria. Ecological complexity is both at the heart of agricultural impacts on malaria transmission and also the deepest challenge to successful collaboration between the agricultural and health sectors. Thus, malaria in pregnancy in plantation settings presents an important opportunity for health-related interventions that can simultaneously improve outcomes for both mother and child in Cameroon. Objectives: 1. To identify socio-demographic factors associated with malaria in pregnancy in the plantation community at Niete, Cameroon. 2. To identify the antenatal, housing and environmental factors associated with malaria in pregnancy in this population. 3. To identify the outcomes associated with malaria in pregnancy in this population. Methods: The study design was case-control. The sample size comprised of 120 participants. There were 60 cases and 60 controls. Data was collected from hospital records and also by interview technique as well as observation of investigator. Univariate and Multivariate analysis were conducted for comparison purposes. In this study, a p-value <0.05 was considered as statistically significant. Results: In univariate analysis for determinants of malaria in pregnancy it was revealed that there were significant association between these factors listed below and malaria in pregnancy in the Niete Plantation: Socio- Demographic Factors: Younger Maternal Age, Lower Education, Lower Household Income, Women not being employed and Women Rubber Tappers. Antenatal Factors: Lower Frequency of antenatal attendance Housing Factors: Absence of Fan, No Toilet Facility, Wooden Floor Material, Wooden Wall Material, Wooden Floor Holes, Wooden Wall Holes, Zinc Roof Holes, More than six months older Insecticide Treated Net (ITN), Holes on Currently Using ITN’s, Lower Usage of ITN by Pregnant Women, and Lower Usage of ITN by All Age Groups Environmental Factors: Presence of Bush Around the House Compound, Presence of Mosquito Breeding Sites, Absence of Personal Use of Insecticides or Sprays, Less Than One Kilometre distance of water body from house and ownership of livestock especially pig. Then using Multiple Logistic Regression the confounders were removed and this analysis revealed that the best significant predictors of malaria in pregnancy which were ownership of fan (p = 0.001*, OR = 6.349, 95% CI = 2.679 – 15.045), bush around compound (p = 0.016*, OR = 2.378, 95% CI = 1.175 – 4.812), presence of mosquito breeding site (p = 0.009*, OR = 3.882, 95% CI = 1.407 – 10.712), and use of personal insecticides or sprays (p = 0.027*, OR = 2.229, 1.098 – 4.524). Furthermore, it was observed that women whom had malaria in pregnancy were significantly (P < 0.05) more likely to have babies with medical problems such as low birth weight and neonatal asphyxiation as compared to women who did not have malaria in pregnancy. Conclusion: This study identified the maintenance of a clean environment free of mosquito breeding sites and use personal protections in the form of mosquito repellents as most essential measures for reducing mortality and morbidity rates associated with malaria in pregnancy. Keywords: Predictors, Malaria, Pregnancy, Cameroon, Multiple Logistic Regression
- ThesisRestrictedFACTORS ASSOCIATED WITH SELF-MEDICATION WITH ANTIBIOTICS IN THE ADULT POPULATION OF WARD 1 OF CHUADANGA TOWN, BANGLADESH(International Medical University, 2015)MUHAMMED SAMITH ZAMANIntroduction: Self-medication with Antibiotics is the use of antibiotic drugs to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of a prescribed Antibiotic drug for chronic or recurrent disease or symptoms. A major problem with self-medication with antibiotics is the emergence of antibiotic resistance. There is enough evidence of Antibiotic resistance in Bangladesh, due to its misuse like self-medication, but studies aimed to find out the factors associated with self-medication with Antibiotic has not been done before in Bangladesh. Objective: To determine the prevalence of self-medication with antibiotics among the adult population of Ward 1 of Chuadanga Town, Bangladesh; and to identify potential factors that are associated with self-medication with antibiotics. Methodology: This was a cross-sectional study done among 300 residents of Ward 1 of Chuadanga Town. Simple random sampling was used to select unit numbers of Ward 1.A list of the unit numbers was obtained from the municipality office and used as sampling frame. Everyone residing in the unit who fitted the inclusion criteria was included in the study. For the study instrument face validated structured questionnaire was used, which had two parts. The first part was socio-demographic data and the second part of the questionnaire was on self-medication with antibiotics and its related factors. Data collection was done by face to face interview. Univariate and Multivariate analysis were used to determine associations, and P-value <0.05 was considered statistically significant. Results: The prevalence of self-medication with antibiotics among the population of Ward 1 of Chuadanga Town was 32%. In bivariate analysis participants with age of below 34 years, who were unmarried, whose jobs were not related to medical profession, had access to antibiotics and lacked knowledge about antibiotic resistance were more likely to self-medicate with antibiotics (P-value <0.05). Predictors of self-medication with antibiotics include age, access to antibiotics and knowledge about antibiotic resistance. Conclusion: In this study the prevalence of self-medication with antibiotics was 32%. The factors that were significantly associated with self-medication with antibiotics were age, access to antibiotics and knowledge about Antibiotic resistance. To decrease this high prevalence of self-medication with antibiotics policy makers have to take into account these factors that are associated with self-medication with antibiotics. Better enforcement of laws regarding OTC drug sales to minimize access to antibiotics. Public awareness about antibiotic resistance and its potential health hazards should be increased through campaigns. Keywords: Self-medication, Antibiotic, Chuadanga town, Bangladesh
- ThesisRestrictedCOPING STRATEGIES AND PSYCHOLOGICAL DISTRESS AMONG ROHINGYA REFUGEES IN KLANG, MALAYSIA(International Medical University, 2015)HARNESH KAURIntroduction: Psychological distress is a major problem of present era discussed extensively in many refugee literatures. It is reported that 84% of Rohingya had been emotionally distressed. In spite of that, individuals who cope effectively with such situations can move from having psychological distress to being well. Limited research work has been carried out on the psychological distress of the Rohingya refugees and how they cope with their distress. Objective: To determine the prevalence, determinants of psychological distress and the coping strategies among the Rohingya Refugees in Klang, Malaysia. Methodology: A cross-sectional study was conducted among 227 Rohingya Refugees in Klang, Malaysia in March 2015. Psychological distress was assessed by using Kessler Psychological Distress Scale (K10). Factors associated with psychological distress were assessed using a 24-item questionnaire grouped into three main themes namely the work related factors, personal and family related factors as well as security and protection related factors. The validated Brief COPE inventory was used to assess coping strategies. Data collection was by face to face interview. Univariate and Multivariate analysis were used to determine associations, and p-value <0.05 was considered statistically significant. Results: The prevalence of psychological distress among Rohingya refugees in Klang was 70.9%. Determinants of Psychological distress among Rohingya Refugees revealed using the multiple logistic regression analysis include employment status (OR = 2.828, 95% CI=1.291–6.197, p = 0.009), overcrowded living conditions (OR = 0.164, 95% CI=0.068–0.397, p < 0.001), behavioural disengagement coping strategy (OR = 15.759, 95% CI=2.028–122.4, p = 0.008) and acceptance coping strategy (OR = 8.369, 95% CI=2.209–31.706, p = 0.002). (p-value <0.05).The most commonly used coping strategies by the Rohingya refugees to deal with their psychological distress were religion, positive reinterpretation, acceptance, and active coping. Conclusion: This study confirmed the magnitude of psychological distress experienced by Rohingya refugees in Klang Malaysia. In order, to reduce the levels of psychological distress among the Rohingya refugees the multiple factors that affect it should be taken into account. In addition to that, utilization of effective coping strategies among Rohingya refugees might improve their psychological health. These points should be taken into consideration for improving the training professionals who may encounter Rohingya Refugees. Keywords: Psychological Distress, Coping Strategies, Refugees, Distress, Rohingya
- ThesisRestrictedFACTORS ASSOCIATED WITH CONDOM USE AMONG FEMALE COMMERCIAL SEX WORKERS IN FARIDPUR, BANGLADESH(International Medical University, 2015)MEHADI HASANBackground Female commercial sex workers are important in the transmission of HIV/AIDS. Studies done worldwide have shown that they act as vector to transmit HIV infections to commercial and non-commercial partners. Consistent condom use has been proven to reduce the transmission of HIV/AIDS and other sexually transmitted infections. So condom use every time while having sexual intercourse is important for the success of any HIV/STI control program. This study was therefore aimed to evaluate condom use among female commercial sex workers and to assess the information on factors that influence condom use. Method The study design was a cross-sectional study. Two hundred and ninety six female commercial sex workers were recruited from Faridpur brothel (Bangladesh) using simple random sampling technique. A standard questionnaire was used for data collection. Bivariate and multivariate regression models were used to establish the relationship between independent variables and condom use. Results The overall prevalence of condom use was 72%. Condom use was lower among non-paying clients (29.3%) than paying clients (80.4%). Condom use was significantly associated age, frequency of using condom with paying clients, heard about STI, and self-reported STI. Conclusion Prevalence of condom use was relatively high with 72%. Age, paying clients, and self-reported STI where positively associated with condom use. Keywords: Condom use, HIV/AIDS, Sexually transmitted infection (STI), Female commercial sex workers, Faridpur bothel.
- ThesisRestrictedPREDICTORS OF HYPERTENSION AMONG LOW INCOME HOUSEHOLDS IN KOTA DAMANSARA, MALAYSIA(International Medical University, 2015)SHUAIBU HASSANA OJONUBAIntroduction: Non-communicable diseases have become a major cause of morbidity and mortality in developing and developed countries in recent years. This is as a result of demographic ageing, urbanisation and adoption of unhealthy lifestyles. Hypertension is accountable for about half of the heart disease and stroke cases. It is also one of the most important causes of premature deaths across the world. Knowledge on its predictors could be highly influential on preventive measures. Predictive models would be helpful in identifying high risk groups and developing more efficient health care interventions. With this background, a study was conducted among low income households to determine the predictors of hypertension among the adult population residing in the community housing project at Kota Damansara in Peninsular Malaysia. Methodology: This cross sectional study was conducted among randomly selected 207 adult individuals of PPR Kota Damansara. Study instruments used were Omron sphygmomanometer, weighing scale, measuring tape and modified version of the WHO Stepwise questionnaire. Univariate analysis was conducted by using the chi-square test. Multivariate analysis was conducted by using the binary logistic regression. In this study, p-value <0.05 was considered as significant. Results: Prevalence of hypertension among the study population was 33.8% (27.7 – 40.4). Age, diabetes, level of education, obesity, history of heart attack or stroke, high cholesterol level and family history of hypertension were found to be significantly associated with hypertension in the univariate analysis. However, the predictors of iii hypertension identified in this study from the multivariate analysis were age, level of education, obesity, diabetes and family history of hypertension. The prediction model had ability for discrimination of 0.821 with an overall performance of 73.9%. Conclusion The prevalence of hypertension in this study population was found to be considerably high. Identification of predictors of hypertension provided an insight for the strategic planning of implementation of preventive measures for the target population to reduce the risk of developing hypertension. This study should be replicated in a multi-centric model to confirm the findings. Keywords: Hypertension, Predictors, Multivariate, Model.
- ThesisRestrictedBULLYING VICTIMIZATION AND DEPRESSIVE SYMPTOMS AMONG SECONDARY SCHOOL STUDENTS IN PENANG(International Medical University, 2015)SANGEETHAA R SIVAMIntroduction: Bullying in school is prevalent in many countries around the world. The impact of bullying gives out negative consequences such as depressive symptoms towards psychological health and development of adolescents. More research in bullying victimization and depressive symptoms among adolescents needed in Malaysia. Objective: To determine the relationship between bullying victimization and depressive symptoms among secondary school students. Methodology: This cross-sectional study was conducted among 355 students from two secondary schools in Simpang Ampat, Penang. The study was conducted for two weeks in March 2015. Stratified simple random sampling was used to select the respondents. Self-administered questionnaire that contains socio-demographic variables, perceived academic performance, Adolescent Peer Relation Instrument scale and Center for Epidemiological Studies Depression Scale for children were used to detect the prevalence and variables that were associated. Results: Significant association was found between bullying victimization and depressive symptoms. Physical, verbal and social bullying victimization were significantly associated. Variables that were significantly associated with bullying victimization were age, father’s education level and perceived academic performance. Gender, perceived academic performance and social bullying victimization were statistically significant with depressive symptoms. Conclusion: The prevalence of bullying victimization was 82.8% and out of this proportion, 54.5% of secondary school students were found to have depressive symptoms. Being a female student, those who perceived below average for their academic performance and socially bullied were the statistically significant variables of depressive symptoms among secondary school students under the multivariate analysis. These significant variables are important for the development of intervention programs to prohibit negative effects towards adolescents. Awareness campaign about the nature of bullying and its effects among secondary school students needed. Keywords : Bullying victimization, depressive symptoms, secondary school students
- ThesisRestrictedQUALITY OF LIFE AMONG THE ELDERLY IN NON-GOVERNMENTAL ORGANIZATIONS’ ELDERLY HOMES IN KUALA LUMPUR(International Medical University, 2015)ONUNKWOR OBINNA FRANCISIntroduction: There is an unprecedented increase in the population of the elderly globally, and Malaysia is anticipated to become an ageing nation in 2030. Maintaining health, social participation, reducing institutionalization, and improving quality of life of the elderly are public health challenges of the 21st century. Quality of life among elderly in Elderly Homes in Malaysia is under researched. Objective: To determine the level of quality of life and its associated factors among the Elderly in Elderly Homes in Kuala Lumpur. Methodology: This was a cross-sectional study among 203 residents aged 60 years or more in eight randomly selected Elderly Homes in Kuala Lumpur in September 2014. Stratified simple random sampling was used to select participants. Study instruments included World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF), Geriatric Depression Scale, Multidimensional Scale for Perceived Social Support, and a questionnaire for Socio-demographic variables. Data collection was by face to face interview. Univariate and Multivariate analysis were used to determine associations, and P-value <0.05 was considered statistically significant. Results: The mean score of quality of life was 58.8 (±9.9), and 52.7% of respondents had poor quality of life. Females, those with lower level of education, poor socioeconomic status, less physically active, no outdoor activity, lived in ward accommodations, lived in a home for less than two years, those with hypertension, diabetes, history of stroke, hearing impairment, visual impairment, dental problem, chronic pain, falls, hospitalization, arthritis, depression, co-morbidity, poor self-rated health, those dissatisfied with their health and those with low levels of social support were more likely to have poor quality of life (P-value <0.05). Predictors of poor quality of life included level of education, socio-economic status, hearing impairment, visual impairment, chronic pain, depression, self-rated health, and social support. Conclusion: To attain optimal quality of life among the elderly in elderly homes, such institutions and policy makers have to take into account the multiple factors that affect quality of life in such homes. Better accommodation, health and welfare services, increase in physical activity, social support, public awareness of the challenges and ways to improve quality of life of the elderly, are actions that could yield positive results. Keywords: Elderly, Elderly Homes, Quality of Life, Kuala Lumpur.
- ThesisRestrictedBARRIERS TO CHILDHOOD IMMUNIZATION AMONG THE ROHINGYA REFUGEES IN KLANG, SELANGOR, MALAYSIA(International Medical University, 2015)HAY MAR WINObjective: The objective of this study was to determine the immunization status and the barriers to childhood immunization among the Rohingya refugees in Klang, Selangor, Malaysia. Methodology: A cross-sectional study was conducted among 150 mothers of Rohingya refugee children aged 6 months to 5 years old residing in Taman Sentosa and Kampung Sungai Pinang during the study period of two weeks in March 2015. Stratified random sampling method was carried out and mothers who met the selection criteria were recruited into the study. A face to face interview was done to determine the immunization status of children and to identify the barriers to immunization. Results: The prevalence of ‘no immunization’ and ‘incomplete immunization’ in this study was 3.3% and 37.9% respectively. In the univariate analysis, variables that were significantly associated with incomplete immunization included: child’s place of birth, child’s documentation status, length of stay of the mother in Malaysia, fathers’ level of education, mothers’ first source of information about childhood immunization, whether or not mothers knew the immunization schedule, inconvenient clinic working hours, unfriendliness of healthcare providers and lack of time. After the multivariate analysis, child’s documentation status, child’s age, length of stay of the mother in Malaysia, and whether or not the mothers knew of any diseases which can be prevented through immunization were independently associated with incomplete immunization. Conclusions: The findings in this study suggested that Rohingya refugee children who do not have the UNHCR card and those less than 24 months of age are more likely to have incomplete immunization. Also, Rohingya refugee mothers who have been living in Malaysia for less than 4 years and mothers who do not know of any diseases which can be prevented through immunization are more likely to have children with incomplete immunization. Key words: Barriers, Vaccination, Immunization, Rohingya refugees, Malaysia.
- ThesisRestrictedPREVALENCE AND DETERMINANTS OF POOR SLEEP QUALITY AMONG MYANMAR MIGRANT WORKERS(International Medical University, 2015-02)Lwin Mie AyeObjective: The objective of this study was to identify the prevalence of poor sleep quality and to determine the factors associated with it among Myanmar migrant workers in Malaysia. Methodology: A cross-sectional study was conducted amongst 216 Myanmar migrant workers who visited the Cahaya Suria Building in Pudu, Kuala Lumpur, during the study period of two weeks in Septemper 2014. Systemic random sampling with replacement method was carried out and visitors who met the selection criteria were recruited into the study. A face to face interview, to filled up the questionnaire, was used to detect the prevalence of poor sleep quality and it’s associated factors. Results: The proportion of Myanmar migrant workers who scored PSQI index of five and above was 62.5%. Factors that were statistically and significantly associated with poor sleep quality were body mass index, skill level, shift work, days worked per week, working hours per day, and work-related physical tiredness. Other factors had no significant association with poor sleep quality. Conclusions: The findings of this study showed that the prevalence of poor sleep quality among Myanmar migrant workers was 62.5%. Multivariate analysis revealed that workers with lower body mass index were found to be significantly associated with poor sleep. Similarly, higher-level skill workers were more likely to have poor sleep compared to lower-level skill workers. Working shifts, working more than five days per week and prolonged working hours more than eight hours a day were another factors that were associated with poor sleep quality. Lastly, those migrant workers who reported that their work was physically tiring were also found to be associated with poor sleep. Key words: Poor sleep quality, determinants, Myanmar migrant workers, Pittsbury Sleep Quality Index (PSQI), Malaysia.
- ThesisRestrictedPREVALENCE AND DETERMINANTS OF MRSA AMONG THE UNDERGRADUATE MEDICAL STUDENTS(International Medical University, 2015-02)PRIYANKA VICHAREIntroduction: Methicillin resistant Staphylococcus aureus (MRSA) is no longer just a simple healthcare issue as it has insidiously made its way into communities all around the globe. Needless to say, it is important to keep track of the prevalence rate of this hospital-acquired microbe and take measures to curb its growing presence in the community. This study reports the current prevalence of MRSA in undergraduate clinical and preclinical medical students of a tertiary educational institution in tropical, equatorial Malaysia and analyses the determinants that contribute towards the spread of this virulent, drug resistant bacterium. Methodology: A cross-sectional study was conducted in a tertiary educational institution amongst undergraduate medical students enrolled at the time of data collection. An administered questionnaire was used to obtain information regarding determinants of MRSA colonisation. Nasal swabs obtained from students were pre-enriched in Mannitol Salt Broth prior to culture onto Mannitol Salt Agar (MSA) and Mannitol Salt Agar containing the antibiotic Cefoxitin (MSA-Cef). Culture plates were incubated at 37°C for isolation of Methicillin-Sensitive Staphylococcus aureus (MSSA) and at 32°C for isolation of Methicillin Resistant Staphylococcus aureus (MRSA). Presumptive identification of S.aureus was made by examination of colonial morphology on MSA / MSA-Cef plates i.e. characteristically yellow colonies with yellow discolouration of medium. Five randomly selected isolates per culture plate were subcultured for subsequent analyses which included Gram staining and the coagulase tube test for confirmation of S.aureus. Putative MRSA colonies from MSA-Cef plates were confirmed as such using the latex agglutination test. Results: 75% of the study population were pre-clinical students whilst 25% were clinical phase students. The overall prevalence of S.aureus in the study population was 45.8% and MRSA, 5%. The prevalence of MRSA amongst pre-clinical and clinical students was 4.3% and 7.1% respectively. A history of antibiotic use in the 6 months prior to sampling was a significant risk factor for acquiring MRSA carriage. Swimming was significantly associated with MRSA colonisation but did not remain significant in multivariate analysis. All other determinants tested i.e. race, history of flu-like illness, history of hospitalisation, history of soft skin injury / infection, having household members younger than 7 years, having companion animals, smoking, partaking in sports, gymnasium training, swimming and working in a hospital environment, were not significantly associated with MRSA carriage. Conclusion: The overall prevalence of MRSA obtained in this study was found to be higher than that obtained in other similar studies conducted in Malaysia, possibly reflecting the fact that medical students, particularly clinical – phase medical students, fall in the high-risk category for acquiring MRSA carriage. The latter premise is echoed in this study by the fact that the prevalence of MRSA amongst clinical students, who are constantly exposed to the hospital environment, was higher as compared to that of pre-clinical students.
- ThesisRestrictedA COMPARATIVE STUDY ON RESPIRATORY SYMPTOMS BETWEEN A COMMUNITY EXPOSED AND A COMMUNITY UNEXPOSED TO CEMENT DUST.(International Medical University, 2015-03)TIAMIYU FATAI BAMIDELEIntroduction: Air pollution continues to receive a great deal of interest worldwide due to its negative impacts on human health and welfare. Cement industry has been listed as one of the 17 most polluting industries. Many studies have revealed the effects of cement dust on the respiratory system (larynx and lungs), gastro intestinal system (oral cavity and teeth, liver, stomach and colon), urinary system (kidney), cardiovascular system and the lymphatic system (spleen and thymus). Objectives: To determine the health effects on a population living in the proximity a cement factory. Methodology: The study was a cross sectional study with 203 participants. 96 exposed participants living within 5km radius of cement factory were selected and 107 participants living 15km away from the cement factory were selected as control. A modified respiratory symptom questionnaire was used to assess respiratory symptoms experienced by the participants in the two communities and peak expiratory flow rate was also measured for all the selected participants. Results: In this study we found out that the exposed population had higher prevalence of respiratory symptoms with 35.4% shortness of breath, 40% wheeze, 58.3% cough, 36.5% morning phlegm and 2.1% chronic bronchitis compared to unexposed population with 15% shortness of breath, 33.6% wheeze, 27.1% cough, 10.3% morning phlegm and 0.0% chronic bronchitis. These differences were found to be statistically significant except wheeze and chronic bronchitis that were not statistically significant. The exposed population also had higher prevalence of eyes, throat and skin irritation than unexposed population. The differences were statistically significant except for throat irritation. PEFR decreased significantly in exposed population compared to unexposed population. Conclusions: The findings in this study suggested that people living in the proximity of cement factories are more likely to develop respiratory symptoms and other symptoms such as eyes, throat and skin irritations than unexposed population. These may be as a results of dusts produced by the cement plant which is known to cause several health problems in human, vegetation and environment. Key words: Respiratory symptoms, community, industrial pollution, cement dust and peak expiratory flow rate (PEFR).
- ThesisRestrictedDETERMINANTS OF GESTATIONAL DIABETES MELLITUS AMONG PREGNANT WOMEN IN TERTIARY CARE HOSPITAL TUANKU JA’AFAR, SEREMBAN, MALAYSIA(International Medical University, 2015-03)SHAISTHA ZUBAIRGestational Diabetes Mellitus (GDM) is a diabetic disorder that increases risk of development of type 2 diabetes mellitus (T2DM) and it occurs during pregnancy and its incidence has been steadily rising all over the world. GDM prevalence in the United States (U.S.) was 4.6% in 2010. In India it increased from 1% to 16% from 1998-2004. A study done in Malaysia showed that GDM is increasing and the prevalence was 18.3% in 2009. GDM is one of the most common complications with short term and long term effects for the fetus and the mother. The objective of the study was to identify the determinants of Gestational Diabetes Mellitus among pregnant women in one of the hospitals in Malaysia. Methodology The sample consists of 112 cases and 112 case-control from 224 participants who delivered at Tuanku Ja’afar Hospital in Seremban. The data were collected from the record book in the labour room. The data were collected from the patients with strict confidentiality. Results The results of the research undertaken shows the proportion of GDM is 12%. Risk factors include age, high risk race group (Indians), maternal history of DM, family history of DM, obesity pre-pregnancy, BMI during delivery, infertility treatment, menstrual history, parity, gravida, previous history of GDM, previous history of caesarean section were all associated with GDM. iii Conclusion: The determinants of GDM identified in this study from the multivariate analysis were age, family history of diabetes and menstrual history. The predicted probability was 80.5%. The findings from this study suggest the need for preventive measures by policy makers and health promoters. Keywords: Gestational diabetes, Determinants, Multivariate, Diabetes mellitus, Pregnancy.
- ThesisRestrictedBIRTH PREPAREDNESS AND COMPLICATION READINESS AMONG PREGNANT WOMEN ATTENDING TWO ANTENATAL CLINICS IN KANO, NIGERIA(International Medical University, 2016)FAIZA BAKARIObjective: The main aim of the study is to determine Birth Preparedness and Complication Readiness (BPCR) and its associated factors among pregnant women attending two antenatal clinics in rural and urban settings in Kano, Nigeria. Methodology: A cross-sectional study was conducted among 397 antenatal clients, who visited Aminu Kano Teaching Hospital and Maryam Sani Abacha General Hospital, Gezawa during the study period of six weeks, four days from 15th September to 30th October, 2015. A sampling by convenience was carried out on the patients who met the selection criteria and were recruited into the study. A face to face interview was conducted and questionnaires were filled to detect the prevalence of Birth Preparedness and Complication Readiness and its associated factors. Results: This study established the prevalence of Birth Preparedness and Complication Readiness among the pregnant women in rural and urban areas to be 39.4% and 94.7% respectively. The factors that were statistically significantly associated with Birth Preparedness and Complication Readiness were age, education, gestation age and antenatal clinic visitation, but only education and gestation age were found to be good predictors of Birth Preparedness and Complication Readiness. Other factors had no significant association with Birth Preparedness and Complication Readiness. Knowledge of danger signs was found to be very low in both rural (0.8%) and urban (5.7%) settings. Conclusion: This study established the prevalence of Birth Preparedness and Complication Readiness among the pregnant women in rural and urban areas to be 39.4% and 94.7% respectively. The prevalence of knowledge of danger signs of pregnancy was found to be significantly low in both rural (0.8%) and urban (5.7%) women with the most common danger sign known being vaginal bleeding and the least being prolonged labour beyond 12 hours. Multivariate analysis revealed education level and gestation age as the factors that were significantly associated with Birth Preparedness and Complication Readiness. Those with higher education level were found to be more likely prepared than those with lower education status. Finally, those at 27 to 40 weeks’ gestation age were found to be more likely prepared than those with pregnancy at 16 to 26 weeks’ gestation age.
- ThesisRestrictedDETERMINANTS OF SYMPTOMS OF POST-TRAUMATIC STRESS DISORDER (PTSD) IN TWO COMMUNITIES AFTER FLOOD IN KOTA BHARU, KELANTAN(International Medical University, 2016)LIM LEE TEINGIntroduction: Flood is a common form of natural disaster that Malaysia experiences regularly. Post-traumatic stress disorder (PTSD) is a psychological disorder that some victims may experience after natural disasters like flood. Identifying those victims of floods who are more at risk of developing PTSD is beneficial in preventing PTSD and disability. The purpose of this study was to determine the prevalence and determinants of PTSD in 2 communities that were affected by the 2014 floods in Kota Bharu, Kelantan. Methodology: A cross-sectional study was carried out among 154 individuals who were affected by the December 2014 flood in Kota Bharu, Kelantan. Multi-stage sampling was done to select subjects from flood affected areas. Data was collected through self-report measures. PTSD was screened using a psychological assessment tool PCL-C civilian version. The data collected included socio-demographic variables, effects of floods, help received. The Brief COPE inventory was used to determine the coping strategies adopted by the victims. Univariate and multivariate analysis were done to determine the associations, p<0.05 considered statistically significant. Results: Total of 54 (35.1%) subjects were screened positive for PTSD. Four independent factors (experienced lost contact with a close associate, loss of belonging(s)/property, total value of loss more than RM 2000, trapped and waited for rescue) were significantly predictors of PTSD. Conclusion: Mental health services should be distributed to groups at particular risks after flood, to reduce any possible psychological impact such as PTSD. Keywords: Flood, PTSD, cope, Kelantan
- ThesisRestrictedFACTORS PREDICTING UTILIZATION OF HERBAL MEDICINES DURING PREGNANCY IN TWO PRIVATE HOSPITALS, MUMBAI, INDIA.(International Medical University, 2016)PURVI MAHENDRABHAI BHATTIntroduction: The usage of herbal medicine in pregnancy has increased in recent years despite the advancement observed in conventional treatments. This study aims to determine the factors associated with utilization of herbal medicines in pregnancy. Method: This is a cross-sectional study performed in Mumbai, among women of any gestational age attending antenatal wards in two hospitals selected randomly. A simple random sampling method was used to select the women. Data was collected by face-to-face interviewer-administered questionnaire and analyzed using the Statistical Package for Social Science (SPSS) version 16.0. Result: A total of 202 pregnant women were surveyed. Herbal medicine usage in current pregnancy was 46.0%, with 98.9% utilized herbal medicine to maintain her as well as foetus wellness and 24.7% used for pregnancy-related symptoms. The most common indication for acquiring herbal medicines was to promote foetus mental and physical growth. The most commonly used herbal medicines were dried fruits (91.4%), followed by saffron (24.7%). The herbal medicine use was significantly associated with women in pregnancy weeks ≥ 27 (adjusted OR= 1.912, CI= 1.029-3.554, p= 0.040) and monthly household income ≥ ₹20,000 (adjusted OR= 2.766, CI= 1.505-5.083, p= 0.001). Herbal medicine users commonly obtained their supplies from the supermarket, herbal drug store and pharmacy. The mean monthly expenditure on herbal supplies was approximately ₹800. Among 93 users, 66.7% disclose the use of herbs while 33.3% did not disclose the use of herbal medicines to medical doctors. Among those who did not disclose the use of herbal medicines, lack of knowledge of herbs and belief on the effectiveness of modern medicine prescribed by doctors were identified as most common barriers for non-utilization. The study found a significant association between beliefs in natural treatments and herbal medicine use (p<0.001). Conclusion: There was a high prevalence of herbal medicine usage among the respondents in the study area. Therefore, pregnancy care providers should be aware of the common herbal supplements used in pregnancy. The family members, friends, relatives and traditional birth attendants should be educated so that correct information is shared among other people. Key words: Herbal medicines, pregnancy, hospital, India
- ThesisRestrictedFACTORS ASSOCIATED WITH BIRTH INTERVAL A STUDY AMONG RURAL WOMEN IN CHANDINA, COMILLA, BANGLADESH(International Medical University, 2016)SYEDA RAZELIN KASHEMObjective: The objective of this study was to determine average birth interval and factors influencing birth interval in Chandina, Comilla, Bangladesh. Methodology: A cross-sectional study among 128 rural women was conducted in Chandina, Comilla, Bangladesh during the study period of two weeks in March 2015. A simple random sampling was carried out and those who met the inclusion criteria were selected for this study. The study was carried out as a house to house survey of all households in two selected villages using an interview schedule in Bangla. The interview schedule consisted of three parts. Part one consisted of a questionnaire for collecting information on socio-demographic information of the respondents. Part two consisted of a questions on behavioural factors, and part three on health literacy The data was obtained through interview of married women of all child-bearing age (eligible women) in the surveyed households. Results: The present study found that the mean duration of birth interval 46.5 ± 19.47 months and median birth interval between two successive live births is 48 months. The prevalence of inadequate birth interval of less than 36 months in the sample population iv is 21.9%. The factor which is significantly associated in univariate analysis is respondents’ education. Conclusion:The findings of this study showed that the average length of birth interval was 46.5 months. The prevalence of inadequate birth interval of less than 36 months among rural women in Chandina, Comilla, Bangladesh was 21.9%. Multivariate results revealed that none of the factors are significant with birth interval. Educated women have adequate knowledge on family planning practice. Thus, it reduces the mother and child mortality. Therefore, education plays an important role. Key words: Factors, Birth interval, Rural women, Chandina, Bangladesh.
- ThesisRestrictedNIGHT EATING SYNDROME AMONG AN INBOUND CALL CENTRE EMPLOYEES IN KUALA LUMPUR MALAYSIA(International Medical University, 2016)ANTHRI NIMALA ANTHONISAMYObjective: The objective of this study was to determine the prevalence of night eating syndrome and the factors associated with it among inbound call centre employees in Kuala Lumpur, Malaysia. Methodology: A cross sectional study among 217 inbound call centre employees was conducted at a call centre that is located in Kuala Lumpur during the study period of three weeks in September 2015. A simple random sampling was carried out and the employees who met the selection criteria were selected for this study. A night eating questionnaire (NEQ) was used to determine the night eating syndrome among the employees. The survey instruments to determine job stress, wellbeing, lifestyle, and eating psychometric were also completed by the subjects. A sub sample of 8 respondents each were selected based on the presence of job stress and those who did not indicate the presence of stress for the salivary cortisol test. The salivary samples were collected in the morning and evening (in duplicates). ELISA test was performed to detect the cortisol levels in saliva. Results: The proportion of inbound call centre employees who scored NEQ score of 25 and above is 12.0 %. Factors that were statistically significantly associated with NES are buffer time (seconds), exercise level, and emotional eating. Other factors had no association with NES. Conclusion: The findings of this study showed that the prevalence of NES among the selected inbound call centre employees in Kuala Lumpur Malaysia was 12.0%. Multivariate analysis revealed that, those employees with higher buffer was significantly associated with NES. Similarly, those with satisfactory levels of exercise are more likely to have NES. Employees with emotional eating had a stronger association with NES. These findings bear potential implications for prevention of obesity and eating disorders. Employees may be benefitted by intervention of healthy eating activities at the work place. Key words: Night eating syndrome (NES), job stress, depression, salivary cortisol level, inbound call centre employees.
- ThesisRestrictedORAL HEALTH RELATED QUALITY OF LIFE AND ORAL TREATMENT NEEDS AMONG TYPE II DIABETIC PATIENTS ON FOLLOW UP WITH DIABETES MALAYSIA IN PETALING JAYA, MALAYSIA(International Medical University, 2016)MEENAKSHI THIAGARAJANIntroduction: Type II Diabetes Mellitus is a major problem of the present era discussed extensively in several studies regarding oral health. Diabetic patients display an increased risk of oral disorders, and oral health related quality of life (OHRQoL) might affect their management and treatment modalities. The aim of the present study was to determine OHRQoL and associated parameters among patients with Type II Diabetes. It has been previously reported, that 22.5% of Type II Diabetics have impaired Oral Health Related Quality of Life and very high dental and periodontal treatment needs. Understanding the problems of Type II Diabetics with regard to oral health maintenance and disability to access the proper oral health care they need will help increase their Oral Health Related Quality of Life as well as their overall well-being. Limited research work has been carried out on the OHRQoL of the Type II Diabetics. Objective: To determine the prevalence, determinants of OHRQoL and the Treatment needs among the Type II Diabetics in Petaling Jaya, Malaysia. Methodology: A cross-sectional study was conducted among 206 Type II diabetics in Petaling Jaya, Malaysia in October 2015. OHRQoL was assessed by using Oral Health Impact Profile (OHIP-14). Factors associated with OHRQoL were assessed using a 21-item questionnaire grouped into five main themes namely the sociodemographic factors, lifestyle factors, medical factors, dental factors, knowledge of oral complications of diabetes. Treatment needs (Periodontal and Dental), were assessed by clinical assessment using the Basic Periodontal Examination (BPE) and Decayed-Missing-Filled Teeth (DMFT) charting. Data collection was by face to face interview. Univariate and Multivariate analysis were used to determine associations, and p-value <0.05 was considered statistically significant. Results: The prevalence of poor OHRQoL among Type II Diabetics in Petaling Jaya is 33%. The determinants of poor OHRQoL among Type II Diabetic patients are revealed using the multiple logistic regression analysis include Monthly household income (OR= 4.372, 95% CI=1.684-11.347, p=0.002), Alcohol consumption frequency (OR=18.961, 95% CI=3.321-108.262, p=0.002), Periodontal treatment needs (OR=2.948, 95% CI= 1.344-6.470, p=0.007), and Dental treatment needs (OR= 8.894 , 95% CI= 2.514-31.466, p=0.001). Conclusion: This study confirmed the magnitude of poor OHRQoL experienced by Type II Diabetics in Petaling Jaya, Malaysia. In order, to reduce the levels of poor OHRQoL among the Type II Diabetics, the multiple factors that affect it should be taken into account. In addition to that, utilization of available dental health care facilities among Type II Diabetics might improve their quality of life with respect to oral health. These points should be taken into consideration for improving the training professionals who treat as well as plan treatment strategies for Type II Diabetic patients. Keywords: Oral Health Related Quality of Life, Treatment Needs, Type II Diabetes, Type II Diabetic patients