Theses (MSc. Public Health)

Gestational 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.

Introduction: 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

Introduction: 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.

Introduction: The high burden of paediatric pneumonia warrants investigation on its occurrence and risk factors, particularly among children aged five years old and below. Objectives: To determine the a) risk factors associated with paediatric pneumonia, b) occurrence of PCR positivity, c) sensitivity and specificity of pneumococcal urinary antigen test (UAT) in detecting pneumococcal pneumonia and d) colonisers among children aged five years and below in east-coast of Peninsular Malaysia. Methods: This case-control study was conducted over two years at the east-coast of Peninsular Malaysia. Cases were hospitalised children ≤5 years old with clinical and radiological diagnosis by sentinel site paediatrician while controls were children without any features suggestive of pneumonia. Nasopharyngeal swab for polymerase chain reaction (PCR) and urine samples for pneumococcal UAT were collected within 24 hours of admission. Results: Six hundred children, with mean age of 20.99 ± 15.35 months for cases and 21.57 ± 16.96 months for controls, were included in the study. Regression analysis revealed factors associated with pneumococcal pneumonia are children living in household of 3-5 occupants (OR, 1.821; 95%, CI 1.191-2.787, p=0.006), unknown history of hospitalisation (OR, 1.672; 95%, CI 1.034-2.703, p=0.036), and underaged children for vaccination up-to-age (UTA) (OR, 1.552; 95%, CI 1.013-2.378, p=0.044) were found to be significant factors among subjects. PCR testing revealed a positivity rate of 13.5% (n=81) among cases and 5.2% (n=31) among controls, accounting 18.7% (n=112) of all subjects. Additionally, UAT testing showed positivity rate of 8.7% (n=52) cases and 6.8% (n=41) controls, comprising 15.5% (n=93) of the subjects. The sensitivity and specificity of UAT were 38.4% and 89.8% respectively with positive predictive value (PPV) of 46.2% and negative predictive value (NPV) of 86.4%. UAT sensitivity and specificity among cases were 37% and 90% respectively while PPV of 57.7% and NPV of 79.4%. UAT sensitivity and specificity among controls were 41.9% and 89.6% respectively while PPV of 31.7% and NPV of 93.1%. Conclusion: Emphasise on risk factor prevention should be the preference over clinical management. Surveillance on local aetiology is essential. UAT was found to be an unsuitable rapid tool in diagnosing pneumococcal pneumonia nor detecting colonisers in paediatrics. Thus, research focus on higher valency vaccines production and invention of simpler, rapid, and non-invasive diagnostic method to reduce disease burden and improve disease prognosis.