Theses (MSc. Public Health)

Introduction: 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

Background : World Health Organization (WHO), has reported that depression is a widespread psychiatric disease that affects more than 264 million people worldwide and postnatal depression (PND) is one of the most common causes of maternal distress, representing a major public health issue affecting the mother, her infant and her family. The purpose ofthis study was to determine the level of awareness on PND and its predisposing factors, and factors associated with the awareness. Methodology: 350 couples attending antenatal follow up had responded to a survey in which the level of awareness on mental Health ( MH) problems during the postpartum period, factors that predispose to and coping mechanism of PND has been determined. Results: PND is the most common type of MH problem identified. Factors that were associated with the level of awareness were gender and age of the respondents. Three hundred and fifty couples responded to the questionnaires. The mean age was 31.2 years ( SD =5.3). The mean level of awareness of the factors predisposing to postnatal depression of husbands 114.43(±9.83) was significantly higher than wives 112.87 (± 10.48 ), (t= -2.03, p = 0.043). Multiple linear regression showed that female gender was positively correlated with awareness b = 1.96 , 95% CI: 0.28, 3.64 , p = 0.022. Increasing age was negatively associated with awareness b = -0.21 95% CI: (-0.36, -0.06 ) , p = 0.007. The model R2 was 0.028. Conclusion: Primary health centre plays an important role in health care promotion. The health education program should involve both pregnant women and their husband as they will facilitate early detection of postnatal depression. Keywords: Postnatal depression, postpartum depression awareness, pregnant women, husband, factors

Objective: The objectives of this study were to determine the perceived barriers to childhood immunization, the association between mother’s age, number of children with SHOTS subscales scores, and also to determine the differences in perception of barriers between religious groups, educational level, employment status and marital status groups among mothers in Damaturu Local Government, Yobe state, Nigeria. Methodology: A community cross-sectional study was conducted among mothers in six selected wards in Damaturu local government, Yobe state, Nigeria. A total number of fifty mothers in each of the six wards were sampled, in which two hundred and ninety-two mothers agreed and participated in the study. Data for the study were collected using a designed instrument for sociodemographic and Searching for Hardship and Obstacles to Shots (SHOTS). Descriptive and inferential statistics were used in the data analysis. Results: Barriers to childhood immunization identified among mothers who consider the SHOTS items as “quite a bit/ a big problem” in Access subscale are: ‘I don’t know when my child need to get his/her shots’ (28.1%), ‘I don’t know where to take my child to get his/her shots’ (27.1%), ‘the shots cost too much’ (20.5%), and ‘I couldn’t get time off work’ (21.6%). Items considered as most problematic in the Concern subscales of the SHOTS is: ‘I don’t believe in getting my children shots’ (20.2%), while items considered as problematic in the Importance subscale of the SHOTS are; ‘I worry my child might get sick from shots’ (20.2%), ‘if something happen to my child after shots, I will feel like it’s was my fault’ (20.2%) and ‘I don’t think children shots are important’ (21.2%). The Spearman Correlation analysis shows no significant association(p>0.05) between the mothers’ age and number of children with the three SHOTS subscales scores of Access, Concern, Importance and the total subscales of the SHOTS. Significant differences were observed in the results of the independent t-test conducted to test for the differences in mother’s perception of barriers in the two religion groups (Muslims and Christians). Differences were observed in the Access subscale with effect size (d=0.66), Concern (d=0.056), Importance (d=0.35) and total (d=0.61) in all the SHOTS subscales with p<0.05. There were significance differences in the perception of barriers between mothers in two educational groups (educated, uneducated) in the Access with effect size (d=0.50), Concern (d=0.52), Importance (d= 0.37) and total (d=0.55) in all SHOTS subscales with p<0.05. No statistical differences were observed in the perception of barriers between mothers who are employed and unemployed in all the SHOTS subscales(p>0.05).However there were statistical differences in the perception of barriers were observed between the marital status groups (Married, Unmarried) in all the SHOTS subscales, Access (d=1.05), Concern(d=0.48), Importance(d=0.49), Total(d=0.90) and all with p<0.05 in the subscales. Conclusion: Perceived barriers to childhood immunization were observed in the SHOTS subscales of Access, Concern and importance. Barriers identified are lack of awareness on time and place of immunization, inadequate knowledge of routine immunization, fear of side effects and religious and cultural beliefs. Findings show the need for educational programmes to sensitize and raise awareness among parents, active engagement of stakeholders at all levels and the need for appropriate and reliable communication channels to provide parents with information regarding immunization. Keywords: Immunization, Vaccine-preventable diseases, coverage, barriers, challenges.

Background: The HIV epidemic in Malaysia affects the general population at the prevalence rate of 0.4% as of 2019. There were 87,000 reported cases of HIV among the key populations (individuals who inject drugs, female sex workers, transgender individuals, and men who have sex with men) in Malaysia since the first case of AIDS was detected here in 1986. A newer and more effective prevention method known as Pre-exposure prophylaxis (PrEP) is now available. Objective: The study aims to find out whether there is a significant correlation between socio-demographic characteristics and HIV risk profile with HIV risk perception, awareness, and acceptance of Pre-Exposure prophylaxis (PrEP) among new clients at a private clinic in Kuala Lumpur, Malaysia. Methodology: The study employed a cross-sectional research design that included a structured self-administered physical survey for the data collection. The study population included 384 participants who had recently visited a private clinic for a sexually transmitted infection (STI) check-up. Consecutive sampling was utilised. Results: The study discovered that the respondents had an adequate HIV risk perception. However, the risk perception could not prevent a large group, specifically 156 (48.8%, N=320) of the respondents from engaging in unprotected sex. The engagement of respondents in unprotected sex despite their high HIV risk perception could be attributed to negligence on their part. The study also discovered that the level of education significantly affects one’s level of acceptance of PrEP. Furthermore, the study discovered that the risk perception of the respondents varies based on each respondent’s sexual acts, and the PrEP awareness of the respondents does not vary based on their sexual acts. Also, race, religion, and employment status significantly affect the level of awareness of PrEP. Finally, gender, race, education, employment, and income levels significantly affect HIV risk perception. Conclusion: The risk perception of the respondents was noted to be lesser in students and high income groups. It also varies based on each respondent’s sexual acts, and the PrEP awareness of the respondents does not vary based on their sexual acts. The study's results will be useful at both the individual and organisational levels. Local researchers might utilise the data obtained to create a prediction model on the acceptance and willingness to take PrEP in the fight against HIV. Keywords: Acquired Immunodeficiency Syndrome, Homosexuality, Pre-exposure prophylaxis, Behaviour, Sexually Transmitted Diseases, Sexual Behaviour.

Objective: The objectives of this study were to determine the prevalence, risk factors, adverse effects and steps to overcome internet addiction among adolescents attending tuition centres in Kepong, Kuala Lumpur. Methodology: A cross sectional study was conducted among 253 students aged between 10 and 19 years old in two selected tuition centres that were located in Kepong. Data collection was carried out in September 2016 using a structured questionnaire. The questionnaire consists of four parts including socio-demographic, Chen Internet Addiction Questionnaire (CIAS), adverse effects of internet addiction questionnaire and steps to overcome internet addiction. Adverse effects of internet addiction were studied based on five major aspects: interpersonal, behavioural, physical, psychological and academic. The CIAS questionnaire was used to determine internet addiction among adolescents participated in present study. CIAS was a self-reported instrument which consisted of 26 items and rated based on 4-point Likert scale. The score for CIAS is ranged from 26 to 104 and a cut-off points of 64 was set. The screening cut-off points has high diagnostic accuracy (88%) and specificity (92.6). The internal reliability of the scale and subscales ranged from 0.79 to 0.93. Results The prevalence of internet addiction among adolescents participated in this study was 27.3%. Multivariate analysis revealed that the adolescents who spent longer time online and having high internet speeds were significantly associated with internet addiction. Based on the five major aspects of adverse effect in this study, adolescents were greatly affected on interpersonal and psychological aspects. The perception of adolescents revealed that by gradually reducing online hours, substitute internet usage with healthier activities and family support were the best ways to overcome internet addiction. Conclusion The findings of this study showed about the prevalence of internet addiction among adolescents attending the selected tuition centres in Kepong, Kuala Lumpur while factors associated with internet addiction included daily online hours (OR = 7.49, 95% CI = 3.23 , 17.33, p < 0.001) and internet speeds (OR = 3.57, 95% CI = 1.10 , 11.55, p = 0.014). Key words: Internet addiction, Kuala Lumpur, adolescent, tuition centre

Introduction The chiropractic profession in Malaysia has grown rapidly over the past five years. The utilization, awareness, and trust were unknown in Malaysia, yet it would be useful in the development of the chiropractic. Objective To estimate the utilization of chiropractic, determine the public awareness of chiropractic and associated factors, public awareness of the Traditional and Complementary Medicine Act, as well as patient’s trust in chiropractic and associated factors. Methods This research was a cross-sectional study conducted in four healthcare centres, namely Klinic Mediviron Sri Rampai, Queck Dental Surgery, IMU Healthcare Chiropractic Centre, and Be Pharmacy Bandar Sri Permaisuri, in Klang valley from July to November 2018 with a total of 440 respondents. All patients who visited the healthcare centres within the study period were invited to participate. The data collection was done by the self-administration method using a questionnaire that was enclosed in an envelope. The questionnaires were passed on to the participants by the centre’s staff. There were five sections in the questionnaire, namely the social demographics, utilization of chiropractic, awareness of chiropractic, regulation of chiropractic and patient’s trust in chiropractic. Descriptive and analytical statistics were conducted on the data collected and presented in tables and figures. The independent variables were gender, age, nationality, ethnicity, marital status, education level, employment status and health status whereas dependent variables were utilization, awareness, trust in chiropractic. Results There were 186 (42.3%) male and 254 (57.7%) female respondents. The youngest respondent was 18 years old and the oldest was 81 years old. The median age was 30 years old. The utilization of chiropractic was 35.9% (95% CI: 31.4, 40.5). Among the respondents, the good awareness of chiropractic was 50.2% (95% CI: 45.5, 54.9) whereas the poor awareness of chiropractic was 49.8% (95% CI: 45.1, 54.5). There were only two factors of the social demographic that were statistically significantly associated with the awareness of chiropractic, which were ethnicity and employment status with the p-value<0.001 and 0.006 respectively. Awareness of the Traditional and Complementary Medicine Act, which governs chiropractic, was only 4.8% (95% CI: 2.8, 6.8). The percentage of patients who had good trust in chiropractic was 48.0% (95% CI: 43.2, 52.8) whereas poor trust in chiropractic was 52.0% (95% CI: 47.2, 56.8). Only one social demographic factor was statistically significantly associated with the patient’s trust in chiropractic, which was ethnicity with the p-value of 0.01. Conclusion The utilization of chiropractic was low. The prevalence of good awareness of chiropractic was moderate, with ethnicity and employment status as statistically significant associated factors. The prevalence of good trust in chiropractic was also moderate with ethnicity as the statistically significant factor associated.