Theses (MSc. Public Health)

Dyslipidaemia is a highly prevalent and asymptomatic disorder that warrants blood lipid screenings to identify at-risk individuals and to prevent the development of vascular diseases. Various predisposing, enabling and need factors have been described in literature to elucidate the inclination of an individual to perform medical screenings. The objectives of this study were to determine the level of knowledge about dyslipidaemia, to determine the association between the level of knowledge about dyslipidaemia and the frequency of lipid testing, and to determine the personal and healthcare related factors in relation to predisposing, enabling and need factors that are associated with the frequency of lipid testing among adults aged 30 and above, residing in Taman Selatan, Klang, Selangor, Malaysia. Methods: A cross-sectional survey was carried out amongst 314 residents of Taman Selatan from September 2022 to October 2022. Participants were selected via systematic random sampling and were administered a paper-based 42-item bilingual questionnaire, that assessed the predisposing, enabling and need factors, in terms of the respondent’s sociodemographic characteristics, knowledge about dyslipidaemia, belief and attitude towards screening, and healthcare related factors that may influence lipid testing practice, as measured by the lipid testing frequency of Malaysian adults aged 30 and above, residing in Taman Selatan, in the past year. Results: Out of the 314 residents approached, 271 responded to the questionnaire yielding a response rate of 86.31%. The median and interquartile range for total dyslipidaemia knowledge score was found to be 5 and 1 respectively. A medium positive correlation was identified between total dyslipidaemia knowledge score and frequency of blood lipid testing (r=0.447, p<0.001). Four variables, namely total knowledge score (OR=1.385, 95% CI = 1.112, 1.726), respondent’s belief and attitude, in terms of fatalistic attitudes, fear and perception of good health (OR=0.276, 95% CI = 0.132, 0.575), ethnicity, specifically Chinese (OR=0.458, 95% CI = 0.225, 0.933), and lower income group (OR=3.428, 95% CI = 1.379, 8.525) were found to be statistically significantly associated with the frequency of lipid testing. Conclusion: The sample had below average knowledge level about dyslipidaemia. Higher knowledge score and low monthly income were associated with frequent lipid testing. Higher fatalistic attitudes, fearfulness and perception of good health correlated to a decrease in lipid testing frequency. Respondents of Chinese ethnicity were found to be associated with a lower lipid testing frequency. Key words: Dyslipidaemia, knowledge, lipid testing, practice, frequency.

Objective: The objective of this study was to identify the correlates of diet quality among adults in a suburban area in Johor, Malaysia. Methodology: A cross sectional study among 300 participants was carried out in a suburban area located in Johor during the study period of two weeks in September 2018. A systematic random sampling without replacement method was conducted and the individuals who met the selection criteria were selected for this study. The Healthy Eating Index for Malaysians (M-HEI) was used to determine the diet quality of adults. The survey instruments to determine sociodemographic, socioeconomic, lifestyle, 24-hour dietary recalls and health status were also conducted amongst the participants. Results: The prevalence of participants who scored M-HEI score of 46 and below with an indication of at risk of poor diet quality is 58.3%. The factors such as lower education level (p=0.047) and consumption of alcohol (p=0.010) were statistically significantly associated with M-HEI scores. No association could be seen from other factors with M-HEI scores. Conclusion: The findings of this study showed that the prevalence of at risk of poor diet quality among the participants residing in a suburban area in Johor, Malaysia was 58.3%. Multivariate analysis revealed that adults with an education level below tertiary level were more likely to be at risk of poor diet quality. Those adults who reported alcohol intake were non-Muslims and found to be at low risk of poor diet quality. Key words: Determinants, diet quality, Healthy Eating Index (HEI), adults, Malaysia

Objective: The objective of this study was to determine the relationship between eating behaviours and work-related stress among working-adults residing at Rasah Kemayan, Malaysia. Methodology: A cross sectional study was conducted among 133 working-adults at the residential area of Rasah Kemayan to determine the relationship between eating behaviour and work-related stress and identify the coping strategies used by the respondents when they are stressed. The study was conducted between September to November 2016. Systematic sampling was carried out to select the houses and from each house a working-adults who met the selection criteria was selected for this study. The Eating Behaviour of the subjects was assessed using Three Factor Eating Questionnaire (TFEQ). The Job Content Questionnaire was used to determine the work-related stress among the employees. The Brief Cope Inventory Questionnaire (BCI) survey instruments were used to determine the coping skills of the subjects. Results: The prevalence of work-related stress among the working population in Rasah Kemayan is 25.6%. Factors that were statistically significantly associated with work-related stress are transport mode; shared vehicle (13.5%), self-driven vehicle (12.0%) and emotional eating (21.8%). Other factors had no association with Work-related stress. As for coping, the strategies that were used frequently by the respondents are Behavioural Disengagement, Self-Blame, and Positive Reframing with median of 4. Conclusion: These findings bear potential implications in preventing work-related stress by applying suitable coping strategy to combat of work-related stress which may alter their eating behaviour. There is need for working adults to come up with interventions to manage stress and healthy eating at the work place for better health. Keywords: Work-related stress, eating behaviour, coping skills

Introduction: Overweight and obesity are pandemic public health concern, where more than a billion people worldwide are estimated to be overweight or obese. Reports have shown that Malaysia is now the fattest nation in the Southeast Asia region, where almost half of its population are either overweight or obese. Many public health interventions have been introduced to modify behaviour associated with weight management, but with low success rate. This has been attributed to failures in identifying the perception about health and obesity from the overweight and obese individuals themselves. Objective: To determine the factors associated with attempts to lose weight among overweight and obese adults. Methodology: This was a cross sectional study conducted in a public health clinic at Klang District from 12 December 2018 to 28 January 2019. A self-administered questionnaire, incorporating Health Belief Model constructs, was used to collect data from 300 randomly selected overweight and obese respondents, aged 18 to 59 years. Data was analysed to generate descriptive statistics and binary logistic regressions were used to determine the factors associated with attempts to lose weight. Results: It was found that 33.7% of the respondents were overweight with BMI between 24.0kg/m2-29.9kg/m2, and 66.3% were obese with BMI 30kg/m2 or more. About one third of them claimed to have attempted to lose their body weight in the last 12 months. The multivariate binary logistic regressions found that females are 2.4 times more likely to attempt to lose weight compared to males (OR=2.4, 95% CI=1.4-4.1), those with absence of associated medical conditions are 3.8 times more likely to attempt to lose weight compared to those with associated medical conditions (OR=3.8, 95% CI=2.1-6.7), those who currently satisfied with weight status are 6.2 times more likely to attempt to lose weight compared to those not satisfied with their weight status (OR=6.2, 95% CI=2.7-14.2), and those who have a higher mean score in the perception of benefits gained from healthy eating and exercise habits are 2.2 times more likely to attempt to lose weight (OR=2.2, 95% CI=1.4-3.3). Conclusion and recommendation: This study identified gender, associated medical condition, weight satisfaction, and perceived benefits as the predictors to attempts to lose weight. The predictors should be optimally used in the design of interventional activities to support overweight and obese adults to manage their weight. Keywords: Adults, Overweight, Obese, Health Belief Model, predictors, attempts to lose weight.

Introduction: 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

Objective: The objective of this study was to estimate the prevalence of both poor and normal sleep quality and to determine variables that may be associated with it among Malaysian adults who actively engage in video games. This study also aims to find the difference in association of sleep quality within hardcore and casual/mid-core gamers. Methodology: A cross-sectional study including 5 sections to inquire various variables including the Pittsburgh Sleep Quality Index (PSQI) was deployed using Google Forms to collect information from 415 members of local online gaming servers. 15 local online gaming servers were identified, and approval was granted to promote the questionnaire among the members. Snowball sampling was used within these servers by interacting with people who left likes and comments on the promoting post. Results: The proportion of Malaysian adult gamers who scored PSQI index above 5 were 57.8% and were classified as having “poor sleep quality” and those who scored 5 and below were 42.2% and were classified as having “good sleep quality.” Variables that were significantly associated were perceived stress, in-game purchasing habits as well as snacking habits 2 hours before bed. Other factors in this study showed no significant association with sleep quality during the multivariate analysis. Hardcore gamers in terms of the frequency of gameplay were also significantly associated with lowered sleep quality when compared to casual/mid-core gamers. Conclusion: This study found the prevalence of poor sleep quality and normal sleep quality was 57.8% and 42.2% respectively. Multivariate analysis disclosed the significant association between perceived stress was significantly associated with sleep quality. Also, in-game purchasing habits and snacking 2 hours prior to bedtime were significantly associated with varying sleep quality. Lastly, hardcore gamers are more likely to experience poor sleep quality when compared to casual/mid-core gamers. Keywords: Sleep Quality, Adult Gamers, Pittsburgh Sleep Quality Index (PSQI), Hardcore Gamers

Background: The relationship between spirituality and stress has been documented in the literature. This study aimed to determine the relationship between spirituality and stress and other associated factors among non-governmental organizations in Malaysia. Method: A cross-sectional study was conducted of 241 personnel from non-governmental organizations registered with the National Coalition for Mental Wellbeing (NCMW). The participants, including NGO employees, completed a self-administered online questionnaire. The survey included questions about sociodemographic and job-related factors. Stress levels were evaluated using the Perceived Stress Scale 10 (PSS-10) Questionnaire. Together, spiritual well-being was evaluated through 10 items from the Existential Well-Being Scale (EWB) incorporated within the Spiritual Well-Being Scale (SWBS). Results: The study found that a majority of NGOs (68.9%) reported moderate stress, with 18.1% experiencing low stress and 13.2% facing high perceived stress. Significant predictors of stress included age (P = 0.007), spirituality (P = 0.000), income satisfaction (P = 0.048), job satisfaction (P = 0.005), marital status (P = 0.026), and living status (P = 0.010). Conclusion: Contributors to stress among NGOs include age, spirituality, income satisfaction, job satisfaction, marital status and living status. Higher spirituality, linked to a connection with a higher power, reduces stress. Further studies are required to explore spirituality's role and manifestation. Keywords: Spirituality, Stress, NGOs, Malaysia, Spiritual Well-Being Scale (SWBS), and Perceived Stress Scale (PSS).